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