Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships

BMC Pregnancy and Childbirth

Benjamin J Marshall¹  Erica G Hepper²  Judi Walsh¹ 

[1] School of Psychology, University of East Anglia, Lawrence Stenhouse Building, Norwich Research Park, Norwich, UK;School of Psychology, University of Surrey, Guilford, UK

关键词: Relationships;    Pregnancy;    Mental health;    Caregiving;    Antenatal attachment;   

Others  :  1091738
DOI  :  10.1186/s12884-014-0383-1

 received in 2014-03-19, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

Maternal-fetal relationships have been associated with psychosocial outcomes for women and children, but there has been a lack of conceptual clarity about the nature of the maternal relationship with the unborn child, and inconsistent findings assessing its predictors. We proposed and tested a model whereby maternal-fetal relationship quality was predicted by factors relating to the quality of the couple relationship and psychological health. We hypothesized that the contribution of individual differences in romantic attachment shown in past research would be mediated by romantic caregiving responsiveness, as maternal-fetal relationships reflect the beginnings of the caregiving system.

Methods

258 women in pregnancy (13, 23, and 33-weeks gestation) completed online measures of attachment to partner, caregiving responsiveness to partner, mental health, and thoughts about their unborn baby. Structural equation modeling was used to test a model of maternal-fetal relationships.

Results

Maternal-fetal relationship quality was higher for women at 23-weeks than 13-weeks gestation. Women in first pregnancies had higher self-reported scores of psychological functioning and quality of maternal-fetal relationships than women in subsequent pregnancies. Structural equation models indicated that the quality of the maternal-fetal relationship was best predicted by romantic caregiving responsiveness to partner and women’s own psychological health, and that the association between adult romantic attachment avoidance and maternal-fetal relationships was fully mediated by caregiving responsiveness to partner, even after controlling for other factors. These data support the hypothesis that maternal-fetal relationships better reflect the operation of the caregiving system than the care-seeking (i.e., attachment) system.

Conclusions

Models of maternal-fetal relationships and interventions with couples should consider the role of caregiving styles of mothers to partners and the relationship between expectant parents alongside other known predictors, particularly psychological health.

【 授权许可】

   
2014 Walsh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Lindgren K: Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 2001, 24(3):203-217.
• [2]Siddiqui A, Hagglof B: Does maternal prenatal attachment predict postnatal mother-infant interaction? Early Hum Dev 2000, 59(1):13-25.
• [3]White MA, Wilson ME, Elander G, Persson B: The Swedish family: transition to parenthood. Scand J Caring Sci 1999, 13(3):171-176.
• [4]Crawford A, Benoit D: Caregivers’ disrupted representations of the unborn child predict later infant–caregiver disorganized attachment and disrupted interactions. Infant Ment Health J 2009, 30(2):124-144.
• [5]Green J, Goldwyn R: Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood. J Child Psychol Psychiatry Allied Discip 2002, 43(7):835-846.
• [6]Alhusen JL: A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs 2008, 37(3):315-328.
• [7]Bryan AA: Enhancing parent–child interaction with a prenatal couple intervention. MCN Am J Matern Child Nurs 2000, 25(3):139-144.
• [8]Carson K, Virden S: Can prenatal teaching promote maternal attachment? Practicing nurses test Carter-Jessop’s prenatal attachment intervention. Health Care Women Int 1984, 5(5–6):355-369.
• [9]Carter-Jessop L: Promoting maternal attachment through prenatal intervention. MCN Am J Matern Child Nurs 1981, 6(2):107-112.
• [10]Davis MS, Akridge KM: The effect of promoting intrauterine attachment in primiparas on postdelivery attachment. J Obstet Gynecol Neonatal Nurs 1987, 16(6):430-437.
• [11]Bloom KC: Perceived relationship with the father of the baby and maternal attachment in adolescents. J Obstet Gynecol Neonatal Nurs 1998, 27(4):420-430.
• [12]Cannella BL: Maternal-fetal attachment: an integrative review. J Adv Nurs 2005, 50(1):60-68.
• [13]Condon JT, Corkindale C: The correlates of antenatal attachment in pregnant women. Br J Med Psychol 1997, 70:359-372.
• [14]Siddiqui A, Hagglof B, Eisemann M: Own memories of upbringing as a determinant of prenatal attachment in expectant women. J Reprod Infant Psychol 2000, 18(1):67-74.
• [15]Wilson ME, White MA, Cobb B, Curry R, Greene D, Popovich D: Family dynamics, parental-fetal attachment and infant temperament. J Adv Nurs 2000, 31(1):204-210.
• [16]Mikulincer M, Florian V: Maternal-fetal bonding, coping strategies, and mental health during pregnancy - the contribution of attachment style. J Soc Clin Psychol 1999, 18(3):255-276.
• [17]Mercer RT, Ferketich S, May K, Dejoseph J, Sollid D: Further exploration of maternal and paternal fetal attachment. Res Nurs Health 1988, 11(2):83-95.
• [18]Zachariah R: Maternal-fetal attachment- Influence of mother-daughter and husband-wife relationships. Res Nurs Health 1994, 17(1):37-44.
• [19]Brennan KA, Clark CL, Shaver PR: Self-Report Measurement of Adult Attachment: An Integrative Overview. In Attachment Theory and Close Relationships. Edited by Simpson JA, Rholes WS. Guilford Press, New York, NY, US; 1998:46-76.
• [20]Mikulincer M, Shaver PR: Attachment in Adulthood: Structure, Dynamics, and Change. Guilford Press, New York, NY, US; 2007.
• [21]Rholes WS, Simpson JA, Blakely BS, Lanigan L, Allen EA: Adult attachment styles, the desire to have children, and working models of parenthood. J Pers 1997, 65(2):357-385.
• [22]Rholes WS, Simpson JA, Friedman M: Avoidant attachment and the experience of parenting. Pers Soc Psychol Bull 2006, 32(3):275-285.
• [23]Wilson CL, Rholes WS, Simpson JA, Tran S: Labor, delivery, and early parenthood. Pers Soc Psychol Bull 2007, 33(4):505-518.
• [24]Cranley MS: Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 1981, 30(5):281-284.
• [25]Facello DC: Maternal/Fetal Attachment: Associations Among Family Relationships, Maternal Health Practices, and Antenatal Attachment. PhD Dissertation. West Virginia University, Morgantown; 2008.
• [26]Seimyr L, Sjogren B, Welles-Nystrom B, Nissen E: Antenatal maternal depressive mood and parental-fetal attachment at the end of pregnancy. Arch Womens Ment Health 2009, 12(5):269-279.
• [27]Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL: A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud 2009, 46(5):708-715.
• [28]Condon JT: The assessement of antenatal emotional attachment - Development of a questionnaire instrument. Br J Med Psychol 1993, 66:167-183.
• [29]Van den Bergh B, Simons A: A review of scales to measure the mother-foetus relationship. J Reprod Infant Psychol 2009, 27(2):114-126.
• [30]Walsh J: Definitions matter: If maternal-fetal relationships are not attachment, what are they? Arch Womens Ment Health 2010, 13(5):449-451.
• [31]Sandbrook SP, Adamson-Macedo EN: Maternal-fetal attachment: searching for a new definition. Neuroendocrinol Lett 2004, 25:169-182.
• [32]Bowlby J: Attachment and Loss: Vol 1. Attachment. Basic Books, New York; 1969.
• [33]Ainsworth MDS, Blehar MC, Waters E, Wall S: Patterns of Attachment: A Psychological Study of the Strange Situation. Lawrence Erlbaum, London; 1978.
• [34]Solomon J, George C: Defining the caregiving system: toward a theory of caregiving. Infant Ment Health J 1996, 17(3):183-197.
• [35]Redshaw M, Martin C: Babies, ‘bonding’ and ideas about parental ‘attachment’. J Reprod Infant Psychol 2013, 31(3):219-221.
• [36]Feeney BC, Collins NL: Predictors of caregiving in adult intimate relationships: an attachment theoretical perspective. J Pers Soc Psychol 2001, 80(6):972-994.
• [37]Kunce LJ, Shaver PR: An attachment-theoretical approach to caregiving in romatic relationships. Adv Pers Relationships 1994, 5:205-237.
• [38]Millings A, Walsh J: A dyadic exploration of attachment and caregiving in long-term couples. Pers Relat 2009, 16(3):437-453.
• [39]George C: Couple relationships and the family system: commentary from a behavioral systems perspective. Attach Hum Dev 2009, 11(1):103-110.
• [40]Selcuk E, Günaydin G, Sumer N, Harma M, Salman S, Hazan C, Dogruyol B, Ozturk A: Self-reported romantic attachment style predicts everyday maternal caregiving behavior at home. J Res Pers 2010, 44(4):544-549.
• [41]Dunkel-Schetter C: Maternal stress and preterm delivery. Prenat Neonatal Med 1998, 3:39-42.
• [42]Rini CK, Dunkel-Schetter C, Wadhwa PD, Sandman CA: Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol 1999, 18(4):333-345.
• [43]van Bussel JCH, Spitz B, Demyttenaere K: Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord 2009, 114(1–3):232-242.
• [44]Sjogren B, Edman G, Widstrom AM, Mathiesen AS, Uvnas-Moberg K: Maternal foetal attachment and personality during first pregnancy. J Reprod Infant Psychol 2004, 22(2):57-69.
• [45]Wei M, Russell DW, Mallinckrodt B, Vogel DL: The experiences in close relationship scale (ECR)-short form: reliability, validity, and factor structure. J Pers Assess 2007, 88(2):187-204.
• [46]Feeney JA: Attachment, caregiving, and marital satisfaction. Pers Relat 1996, 3(4):401-416.
• [47]Stewart AL, Hays RD, Ware JE: The MOS short-form general health survey- reliability and validity in a patient population. Med Care 1988, 26(7):724-732.
• [48]Brazier JE, Harper R, Jones NMB, Ocathain A, Thomas KJ, Usherwood T, Westlake L: Validating the SF-36 health survey questionnaire- new outcome measure for primary care. Br Med J 1992, 305(6846):160-164.
• [49]Kline RB: Principles and Practice of Structural Equation Modeling. 2nd edition. Guilford Press, New York, NY, US; 2005.
• [50]Hu LT, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling 1999, 6(1):1-55.
• [51]Bollen KA: Structural Equations With Latent Variables. John Wiley & Sons, Oxford, England; 1989.
• [52]Ullman JB: Structural Equation Modeling. In Using Multivariate Statistics. 4th edition. Edited by Tabachnick BG, Fidell LS. Allyn & Bacon, New York; 2001:653-771.
• [53]Byrne BM: Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming. 2nd edition. Routledge, New York, NY; 2010.
• [54]Cheung GW, Rensvold RB: Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equation Model 2002, 9(2):233-255.
• [55]Mikulincer M, Shaver PR: Adult Attachment and Caregiving: Individual Differences in Providing a Safe Haven and Secure Base to Others. In Moving Beyond Self-Interest: Perspectives from Evolutionary Biology, Neuroscience, and the Social Sciences. Edited by Brown SL, Brown M, Penner LA. Oxford University Press, New York; 2012:39-52.
• [56]George C, Solomon J: The Caregiving System: A Behavioral Systems Approach to Parenting. In Handbook of Attachment: Theory, Research, and Clinical Applications. 2nd edition. Edited by Cassidy J, Shaver PR. Guilford Press, New York, NY, US; 2008:833-856.
• [57]Collins NL, Guichard AC, Ford MB, Feeney BC: Responding to Need in Intimate Relationships: Normative Processes and Individual Differences. In Dynamics of Romantic Love: Attachment, Caregiving, and sex. Edited by Mikulincer M, Goodman G. Guilford Press, New York, NY, US; 2006:149-189.
• [58]Feeney BC, Collins NL: Motivations for caregiving in adult intimate relationships: Influences on caregiving behavior and relationship functioning. Pers Soc Psychol Bull 2003, 29(8):950-968.
• [59]Berant E, Mikulincer M, Shaver PR: Mothers’ attachment style, their mental health, and their children’s emotional vulnerabilities: A 7-year study of children with congenital heart disease. J Pers 2008, 76(1):31-65.
• [60]Mikulincer M, Shaver PR: Adult Attachment and Affect Regulation. In Handbook of Attachment: Theory, Research, and Clinical Applications. 2nd edition. Edited by Cassidy J, Shaver PR. Guilford Press, New York, NY, US; 2008:503-531.
• [61]Condon JT, Esuvaranathan V: The influence of parity on the experience of pregnancy- a comparison of 1st-time and 2nd-time expectant couples. Br J Med Psychol 1990, 63:369-377.
• [62]Cowan CP, Cowan PA: Interventions to ease the transition to parenthood- why they are needed and what they can do. Fam Relat 1995, 44(4):412-423.
• [63]Shaver PR, Mikulincer M, Shemesh-Iron M: A Behavioral-Systems Perspective on Prosocial Behavior. In Prosocial Motives, Emotions, and Behavior: The Better Angels of our Nature. Edited by Mikulincer M, Shaver PR. American Psychological Association, Washington, DC, US; 2010:72-91.
• [64]Walsh J, Hepper EG, Bagge SR, Wadephul F, Jomeen J: Maternal–fetal relationships and psychological health: emerging research directions. J Reprod Infant Psychol 2013, 31(5):490-499.
• [65]Bifulco A, Moran P, Jacobs C, Bunn A: Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attach Hum Dev 2009, 11(1):69-85.
• [66]Cowan PA, Cowan CP: Couple relationships: a missing link between adult attachment and children’s outcomes. Attach Hum Dev 2009, 11(1):1-4.
• [67]Halford WK, Petch J: Couple psychoeducation for new parents: observed and potential effects on parenting. Clin Child Fam Psychol Rev 2010, 13(2):164-180.