1

Psychosocial Adaptation in Pregnancy: Assessment of Seven Dimensions of Maternal Development

1

1.1

Introduction

1

1.2

Foundation Research Projects for Theory Development of the Seven Dimensions of Maternal Prenatal Adaptation

3

1.2.1

Maternal Psychological and Physiological Correlates of Progress in Labor and Fetal/Newborn Health

3

1.2.2

Relationship of Maternal Prenatal Psychosocial Adaptation and Family Functioning to Pregnancy Outcomes

13

1.2.3

Maternal Prenatal Psychosocial Adaptation Predictors of Infant Birth Weight and Gestational Age

23

1.3

Theoretical Foundations of the Seven Dimensions of Adaptation to Pregnancy

28

References

32

2

Acceptance of Pregnancy

39

2.1

Planning and Wanting the Pregnancy

40

2.2

Happiness versus Depression during Pregnancy

41

2.3

Discomfort during Pregnancy

46

2.4

Body Change during Pregnancy

48

2.5

Ambivalence Toward Pregnancy

50

2.6

Summary

53

References

54

3

Identification with a Motherhood Role

57

3.1

Motivation for Motherhood

58

3.2

Preparation for Motherhood

60

3.2.1

Fantasizing

61

3.2.2

Dreams About Pregnancy and Motherhood

67

3.3

Conflict Resolution

76

3.4

Maternal-Fetal Attachment Representation and Maternal Role Evolution

79

3.5

Summary

81

References

83

4

Relationship with Mother

87

4.1

Availability of the Mother

88

4.1.1

Infancy and Childhood

88

4.1.2

Availability during Pregnancy

89

4.2

Reactions to Pregnancy

94

4.3

Respect for Autonomy

95

4.4

Willingness to Reminisce

96

4.5

Empathy with the Mother

98

4.6

Summary

100

References

100

5

Relationship with Husband or Partner

103

5.1

The Husband’s Concern for His Expectant Wife’s Needs

105

5.1.1

Empathy

105

5.1.2

Increased Cooperativeness and Flexibility

111

5.1.3

Availability

112

5.1.4

Trustworthiness and Reliability

115

5.2

The Wife’s Concern for Her Husband’s Needs as an Expectant Father

118

5.3

Effects of the Pregnancy on the Marital Bond

121

5.3.1

Closeness and Intimacy

121

5.3.2

Increased or Decreased Conflict in the Marital Bond

124

5.4

Identification of a Fatherhood Role

126

5.5

The Transition to Fatherhood

129

5.5.1

Readiness for Fatherhood

129

5.5.2

Stress Associated with Fatherhood

130

5.5.3

Paternal-Infant Attachment

130

5.5.4

Paternal Involvement in Child Care

131

5.6

Summary

132

References

134

6

Preparation for Labor

139

6.1

Planning for Labor: Practical Steps to Gather Information

139

6.1.1

Prenatal Classes

140

6.1.2

Conversing with Other Women

142

6.1.3

Books and Films

143

6.1.4

Other Practical Steps

146

6.2

Planning for Labor: Maternal Thought Processes

146

6.2.1

Thinking versus Avoidance of Thinking About Labor

146

6.3

Congruence Between Fantasy and Reality

152

6.3.1

Labor Contractions

152

6.3.2

Work and Pain

153

6.3.3

Risks and the Unknown

155

6.3.4

Doubts and Fears About Labor

156

6.4

Level of Confidence Regarding Labor

156

6.5

Envisioning the Challenges of Labor for Oneself and the Fetus

158

6.5.1

Dreams About Labor

160

6.6

Summary

163

References

164

7

Prenatal Fear of Pain, Helplessness, and Loss of Control in Labor

167

7.1

Loss of Control Over the Body

169

7.2

Loss of Control Over the Emotions

173

7.3

Ability to Trust the Medical/Nursing Staff

176

7.4

Attitudes Toward Being “Awake and Aware” and the Use of Medication

182

7.5

Summary

186

References

188

8

Prenatal Fear of Loss of Self-Esteem in Labor

191

8.1

Overview

191

8.2

Measures of Self-image

192

8.3

Evaluation of Self-Worth

193

8.4

Behaviors that Reflect Self-Esteem

195

8.4.1

Tolerance of Self

195

8.4.2

Value of Self

198

8.4.3

Body Image and Appearance

200

8.5

Summary

201

References

201

9

Prenatal and Postnatal Psychosocial Adaptation in Military Women

203

9.1

Part I. Prenatal Adaptation

203

9.2

Part 1. Research Questions: The Relationship of Community Support, and Family Adaptability to Prenatal Maternal Adaptation

204

9.2.1

Method

204

9.2.2

Data Analysis

206

9.2.3

Results

206

9.2.4

Discussion of Part I. Prenatal Results

211

9.3

Part 2. Postnatal Adaptation

215

9.4

Part 2. Research Questions: The Relationship of Community Support, Family Adaptability, and Spousal Deployment to Postnatal Maternal Adaptation

216

9.4.1

Methods

216

9.4.2

Results

218

9.4.3

Discussion of Part 2. Postpartum Results

222

References

224

10

Prenatal Adaptation Among Multigravidas

229

10.1

Quantitative Results: Statistical Analysis of Psychosocial Adaptation to Pregnancy Based on Parity

229

10.2

Qualitative Analysis of Psychosocial Adaptation to Pregnancy Based on Parity

230

10.2.1

Acceptance of Pregnancy

231

10.2.2

Identification with a Motherhood Role

236

10.2.3

Relationship to Mother

241

10.2.4

Relationship to Husband or Partner

244

10.2.5

Preparation for Labor

249

10.2.6

Fear of Pain, Helplessness, and Loss of Control in Labor

252

10.2.7

Concerns for Well-Being of Self and Baby

255

10.2.8

Fear of Loss of Self-Esteem in Labor

255

10.3

Summary

258

References

259

11

Methods of Assessment: Psychosocial Adaptation to Pregnancy Questionnaire Scales and Interview Schedules, and Review of Interventions to Enhance Adaptation

263

11.1

Prenatal Self-Evaluation Questionnaire and Psychometric Data

263

11.1.1

Description of the Seven Scales of the Prenatal Self-Evaluation Questionnaire and Sample Items

263

11.1.2

Psychometric Data

266

11.2

Prenatal Clinical Interview Schedules and Rating Scales

281

11.2.1

Clinical Practice Recommendations for Conducting Interviews

281

11.2.2

Summary Ratings

283

11.3

Recommendations for Clinical Care and Research

285

11.3.1

Clinical Assessment: Continuity of Care and Assessment of Maternal Developmental Adaptation

285

11.3.2

Suggestions for Clinical Research Studies

285

11.4

Research Intervention Trials for General and Pregnancy-Specific Anxiety Reduction

287

11.4.1

Assessment of the Seven PSEQ Dimensions as a Basis for Intervention

287

11.5

The Panoply of Therapeutic Prenatal Interventions to Promote Maternal Psychosocial Adaptation to Pregnancy

288

11.5.1

Intervention Research Demonstrating Effectiveness in High-Risk Prenatal Populations

289

11.5.2

Intervention Research Demonstrating Effectiveness in Low-Risk Prenatal Populations

290

11.5.3

Marital/Partner Relationships as Factors Influencing Maternal Stress/Anxiety Responses, with Implications for Therapeutic Intervention

291

11.5.4

Maternal and Paternal Coping Strategies and Birth Outcomes

292

11.5.5

Complementary and Alternative Medical (CAM) Therapies

292

References

294

Appendix A

299

Appendix B

303

Index

305