Psychological
processes involved
in childbearing
Adjustment to pregnancy,
prenatal attachment,
attitudes to motherhood
and fatherhood
Psychological
processes involved
in childbearing
Adjustment to pregnancy,
prenatal attachment,
attitudes to motherhood
and fatherhood
Reproductive decisions – the
individual factors
Psychological factors
Having children in individual hierarchy of life goals
Feeling ready / not ready for parenthood
„The right time” for a child
Interpersonal factors
The quality of a relationship
„The right partner”
Material factors
Sufficient resources for rising children
Pregnancy – duration
The duration of pregnancy
280 days (40 weeks) – caunting from the
first day of last menstrual cycle
267 days – caunting from the ovulation
The phases of pregnancy
1 trimester (3 months period)
2 trimester
3 trimester
Psychological processes across
pregnancy
Emotions
Changes across pregancy – both positive and
negative emotions
More negative emotions and emotional instability in
the first trimester – not confirmed, eg. Lips (1982),
Elliott (1983), Wijma (1992)
Cognitive processes
Gross & Pattison (1994, 2007) – more memory and
concentration deficits in 4th month then later
(„information overload”)
Psychological processes across
pregnancy
Psychological changes
Mood swings, memory and concentration
problems, fatigue and a need for more sleep
Social changes
Passing information about pregnancy to
others
Study by Kroelinger & Oths (2000) - positive
partner’s reaction to information of
conception – leads to more acceptance of a
pregnancy in women
Phases of pregnancy – female
perspective
(J. Raphael-Leff, 1991, 2005)
The maturational process
Pregnancy as the process
The foetus develops in the womb
The woman develops into a mother
The belief that pregnancy was conceived
the belief that the foetus is present and develops
the belief that a newborn can exist outside the mother’s body
The phases of the maturational process of
pregnancy are related to medically defined
trimesters
Phases of pregnancy – female
perspective
The first phase
From the conception till the experience of fetal
movements
Physical changes
Breast enlargement and tenderness, vaginal
discharge, changes in the skin and hair
condition, change in apetite and food carvings,
Nausea and vomiting
In most women until 12 weeks of gestation
An evolutionary mechanism that prevents intoxication
Phases of pregnancy – female
perspective
The second phase
From fetal movements till development of
a strong anxiety related to delivery
Development of the attachment to a child
Changes in the relationships with a male
partner
A women initiates talks about the child
More sexual contacts than in the first phase
Phases of pregnancy – female
perspective
The third phase
Untill the delivery
Preparation to labour and delivery
The idea that child can live outside a
mother’s body
Looking for the signs of approaching delivery
Fear of labour
Preparation for a maternal role
Phases of pregnancy – male
perspective
Phases of pregnancy by K. May (1986)
Announcement
From the first thoughts about possibility of conception
untill their confirmation
Support to a partner – for continuation of a pregnancy,
healthy behaviours
Moratorium
12 – 25 weeks of gestation, untill visible changes in a
partner’s figure
Expectations related to emotional stability of a female
partner
More interest in pregnancy when better partners’
relationships
Phases of pregnancy – male
perspective
Phases of pregnancy – cont.
Focusing
25/30 weeks untill delivery
Preparation to labour/delivery
Ideas of paternal role
Intense emotions, eg. anxiety
Difficulties in adjustment to a new
role/situation
Couvade syndrome
(„a pregnant male”)
Information about changed behaviour and
symptoms in partners of pregnant women
60 BC – Diodorus Siculus (Corsica)
XVII Century – East England
Anthropological findings – couvade as a
symbol of accepting a child
„Pseudo-maternal” couvade
„Diet” couvade
Symptoms associated with the
Couvade syndrome
(Conner & Denson, 1990)
1. Gastrointestinal symptoms
Nausea, heartburn, abdominal pain, bloating
and appetite changes
Upper respiratory disturbances and pains
Colds, breathing difficulties
Toothache, leg cramps, backache, urogenital
irritations
Psychological symptoms
Changes in sleeping patterns, anxiety & worry,
depression, reduced libido, restlessness
Intensity of symptoms associated
with the Couvade syndrome
I trimester
II trimester
III
trimester
Appear in
the first
trimester
and might
be intense
Reappear in
the
last
trimester,
but cease at
birth or
shortly
within the
postpartum
period
Temporarily
disappear
in the
middle
trimester
The prevalence of the Couvade
syndrome (Bennan et al.,
2007)
The detailed data
from:
UK – 11-50%
Sweden – 20%
USA – 94-97%
Thailand – 61%
China – 68%
The incidence in:
South Africa
France
Russia
Serbia
Australia
Consistent findings – higher incidence among black men
Inconsistent findings – age, social class, educational level,
number of previous children, planned/unplanned
pregnancy
Theoretical concepts of the
Couvade syndrome
(Bennan et al., 2007)
Psychoanalythical theories
The effect of man’s envy of the woman’s procreative ability
For the expectant man the partner’s pregnancy acts as a
catalyst of the resurgence of the Oedipal conflicts
Man’s rivalry with his unborn child
Psychosocial theories
A reaction to the marginalisation of men during pregnancy
An effect of men’s transitional crisis to prospective parenthood
Paternal theories
Preparation to paternal role
Anxiety as the cause (but also as the effect) for the syndrome
Hormonal changes
Increase level of prolactine & oestrogen and lower level of
testosterone associated with Couvade symptoms (Storey et al.,
2000; Berg & Wynne-Edwards, 2001)
Description of the Couvade syndrome
(Based on Brennan et al., 2007)
Men’s
experienc
es
Emotional diversity
in response to
pregnancy
Nature, duration &
meaning of
symptoms
Explanation
of
symptoms
The
Couvade
syndrome
Feelings towards
pregnancy/parentho
od/partner/
involvement in
pregnancy
Failure to explain by
professionals/male
partner
Investigatio
n/managem
ent
Attachment - a definition
...a relatively enduring emotional tie
to a specific other person
Maccoby (1980)
the strong emotional tie that a
person feels toward a special other
person in his or her life
Lefton (1997)
The other side of
attachment
(bonding with a child)
A special process of emotional
attachment that may occur
between parents and babies in
the minutes and hours
immediately after birth
Lefton (1997)
Prenatal attachment
first concepts
Forming emotional bonds with a child - one
of the psychological tasks of pregnancy
First mentioned by Deutsch (1945)
Bibring (1959) - one of the psychological
task of pregnancy - to invest libido in the
foetus
Benedek (1959) - the concept of
pregnancy as ‘the gestation of the person’
Prenatal attachment
more recent concepts
Lumley (1972) - women form
‘mental picture’ of the foetus in 2nd
& 3rd trimester of pregnancy
Leifer (1977) - no attachment in
25% of mothers; these women less
attracted to infants 7 months
postpartum
Prenatal attachment
more recent concepts
Raphael-Leff (1991, 2005)
Approaches to pregnancy / foetus in women
Facilitator
Regulator
Intermidiate / Bipolar (proposed later by other
authors)
Approaches to pregnancy / foetus in men
Participator
Renouncer
Can we measure it?
Theoretical concepts of measurement
tools
Cranley (1981) - self-report questionnaire for
maternal-foetal attachment
Condon (1993) – parental prenatal love
Condon (1998) – prenatal love continues
postnatally
Muller (1993) – affectionate relationship between
a mother and her unborn baby from a mother’s
perspective
Used in Sweden by A. Siddiqui
Polish validation has finished and will be presented soon
Studies on prenatal
attachment
Development of attachment during
the course of pregnancy
in mothers and in fathers
Correlates of attachment
Effects of pregnancy complications
Attachment and experience of
pregnancy and the process of care
Studies on prenatal
attachment in Lodz
Changes of attachment in pregnancy
Pregnancy complications and attachment
Gender identity and attachment
Depression, prenatal attachment and
postnatal relationships with a baby
Paternal attachment as perceived by a
baby’s mother
Development of attachment
in mothers (MAAS by
Condon)
Development of attachment
in fathers (PAAS by Condon)
Attachment in complicated and in normal
pregnancy (mothers and fathers)
Mothers
Fathers
Attachment in mothers in
different types of pregnancy
(Maternal Foetal Attachment Scale by Cranley)
Other studies
Previous fetal loss
Armstrong & Hulti, 1998
Less strong attachment in next pregnancy
High risk pregnancy
Chazotte et al. 1995
No differences in attachment between women with
GDM, risk of preterm delivery and normal pregnancy
Wisniewska, 2003
Less strong attachment when complications and
prenatal screening
Fathers’ prenatal
attachment as perceived by
mothers
Women
correctly
predicted their
partners’ FAS
scores in 73%
of cases
Depression and father-infant
attachment (prenatal)
Father-infant attachment
(pregnancy and postnatal
period)
Prenatal attachment – study with
Swedish and Polish expectant
women
(Bielawska-Batorowicz & Siddiqui,
2008)
Prenatal
Attachment
Inventory (PAI)
by
Müller
21 items
4-point Likert scale
Higher score stronger
attachment
Demographic
questionnaire
Analyses
principal component
analysis (Varimax)
t-test for
independent
samples
Pearson correlation
regression analysis
PAI - Factors extracted in both
samples
1 – Fantasy
I plan the things I will do with my baby
I wonder what the baby looks like now
2 – Interaction
I know when the baby is asleep
I can make my baby move
3 – Sharing
I buy/make things for the baby
I tell others what the baby does inside me
4 - Attributing traits
I know things I do make a difference to the baby
I know the baby hears me
5 – Affection
I feel love for the baby
I enjoy feeling the baby moves
Factor scores for both
samples
All differences at p <
0,01
Intensity of attachment in
planned/unplanned pregnancy
PAI total
scores
All n.s.
Intensity of attachment and
pregnancy complications
PAI total
scores
All p < 0,05
Predictors of attachment
intensity
(combined samples)
Variable
B
Beta
t
p
R
R
2
Initial model
(Residual)
Age
Education
Pregnancy complications
Parity
Nationality
73.85
2
-0.189
-0.885
0.867
-2.429
-2.536
-0.110
-0.062
0.043
-0.127
-0.134
19.37
8
-1.747
-0.978
0.716
-1.837
-1.976
0.00
0
0.08
2
0.32
9
0.47
4
0.06
7
0.04
9
0,27
0
0.05
6
Final model
(Residual)
Age
Nationality
71.67
7
-
0.2
54-
-3.308
-0.147
-0.175
22.09
3
-2.481
-2.944
0.00
0
0.01
4
0.00
4
0.24
3
0.05
2
Prenatal attachment and
parental behaviour towards an
infant
Study by A. Siddiqui & B. Haggloff (2000)
Stronger prenatal attachment more intense
postnatal interaction
Maternal behaviour observed and videorecored (!)
Study by H. Pearce & A. Ayers (2005)
Mothers who during pregnancy present negative
attitudes toward a baby:
are more prone to negative behaviour after the delivery
(when asked about their possible reactions)
do express more negative behaviour towards the baby
Attachment and parental
behaviour towards an infant
Study by R.B. Wilkinson & F.B. Schrel (2006)
Comparison of breast-feeding and bottle-feeding
mothers
Measures: e.g. Maternal attachment inventory
(MAI) by Muller (1994), Relationships questionnaire
by Bartholomew &Horowotz, 1991)
Breast-feeding mothers do not express more
positive affect (attachment) towards their infants
If mothers are securely attached to infants, then:
More positive affect towards an infant
More often breast-feeding