Psychological changes over the course of pregnancy: A study of attitudes toward the fetus/neonate.

Abstract

Pregnant women's attitudes towards their fetus over the course of the pregnancy were studied in relation to physiological events of pregnancy, namely seeing the fetus via ultrasound and experiencing fetal movement. A consecutive series of primiparae (n = 129) was randomly assigned, at recruitment between 10 and 14 weeks menstrual age, to conditions of high (n = 67) or low (n = 62) feedback real time ultrasound. Thereafter, women were assessed at 16 and 32 weeks gestation, within 24 hours of delivery and by questionnaire at 3 months postpartum. On each occasion women completed attitude rating scales concerning their pregnancy and their fetus or neonate. These scales were subjected to principal components analysis and two main dimensions were derived for ratings of both attitudes towards the pregnancy and the fetus/neonate. No relationship was found between factor scores and ultrasound feedback condition, although scores on the fetal attachment dimension showed a significant linear increase over the pregnancy. Women reporting fetal movement at 16 weeks displayed significantly higher scores on the fetal-attachment dimension at all three assessment points. Multiple regression analyses were utilized to identify predictors of initial reactions to the neonate and attachment ratings at 3 months postpartum. At delivery, ratings of attachment to the neonate were related to drug requirements in labor and attachment ratings at 32 weeks. Reactions to the neonate at delivery and ratings of postpartum mood emerged as significant predictors of maternal attachment at 3 months postpartum. These results are discussed in the context of research attempting to establish the importance of postpartum bonding.

Antenatal Depression and Maternal-Fetal Attachment

“…Most of our subjects were still in the stage before fetal movement could be felt, and it is possible that the nature of their attachment is different from that perceived by pregnant mothers in the latter stages of pregnancy when fetal movement gives substance to the reality of the baby. This interpretation is supported by Reading et al [29] who state that attachment increases with the course of pregnancy, and that 'the data suggest that women experiencing early fetal movement display more positive attitudes from the outset'. However, as they do not touch upon change in the association between maternal attachment and depression in the course of the pregnancy, clarification of this aspect should allow for closer interpretation of our negative finding.…”

Women's Responses to Ultrasound Examinations During Routine Screens in an Obstetric Clinic

“…25,26 There are several key influences that appear to be relevant in influencing maternal-fetal attachment by using ultrasound, including recognition of the fetal form, 27,28 which can increase maternal understanding of fetal behavior and development, 5,11,29,30,31 and the ability to reduce maternal anxiety during the scan. 29 When looking at specific maternal responses, these influences all seem to play a role in the results of this study.…”

“…9 Prenatal interventions, especially ultrasound examinations, in pregnancies in which there is high psychosocial risk and active substance abuse have the potential to increase maternal-fetal attachment and reduce the risk of behaviors that may harm the fetus and compromise the health status of the pregnancy. 10 Research on the conduct of a scan includes determining how the amount of feedback during the ultrasound examination session contributes to effectiveness 4,11 ; avoiding "slips of the tongue" 4 ; using language that is simple and T Article appropriate; viewing the examination in real time 12 ; being able to view the fetus' face, limbs, and trunk 13 ; confirming maternal recognition of structures and identification of fetal features 14 ; using 2-or 3-/4-dimensional sonography with a clear picture 5 ; providing a session of adequate length 14,15 ; providing interpretation of fetal physical behavior 5,16 ; giving the mother an opportunity to interact 17 ; allowing the mother to self-initiate behavior 17 ; "debriefing" the session; and sharing the scan with family and friends either directly or with photographs or videos/DVDs. 5,8 In previous work, the reliability and validity of the ultrasound consultation method have been established, showing higher maternal-fetal attachment scores 18 and lower state anxiety measures 19 after the consultation.…”

Emotional Rejection of the Infant: Status of the Concept

“…As with many psychiatric disorders, the end state of rejection can be reached by many trajectories (equifinality, isotelesis). There are indications that prenatal attachment is a forerunner; this epigenetic connection has been confirmed many times [95,168,169,170,171], including some recent reports [172,173,174,175,176]. Behind a failure to bond to the foetus lurks unwanted pregnancy, a risk factor for a number of adverse maternal and child outcomes [21,177,178], but modern studies have still not assessed the intermediary of a mother-infant relationship disorder.…”

“…This was covered thoroughly in the 2011 paper under the headings of self-rating questionnaires [91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107], expressed emotion [108,109], interviews [110,111,112], observation [71,113,114,115,116,117,118,119], and neuro-scientific investigations. Almost all publications during the last 5 years have used self-rating questionnaires.…”