Psychosocial Adaptation to Pregnancy (eBook)

Regina Lederman, MNEd, MA, PhD, is a behavioral scientist, as well as a nurse and a practicing marital and family therapist, who also has 30 years of research experience in the field of maternal psychosocial development. She has published extensively, both original research and reviews, on intervention approaches to decrease maternal anxiety and promote adaptation to pregnancy. Dr. Lederman is a Professor in the School of Nursing and in the Department of Preventive Medicine and Community Health at the University of Texas Medical   Branch in Galveston. She has an extensive writing background of scientific journal articles, books and questionnaires pertaining to pregnancy, childbirth, and early adaptation to motherhood. She has been editor of International Journal for Psychosomatic Obstetrics and Gynaecology, and most recently served as a consultant on a pregnancy and postpartum adaptation assessment project conducted with four branches of the military. An earlier edition of the proposed book, published by Prentice-Hall in 1985, received the American Journal of Nursing Book of the Year Award. She is a member of the Society of Behavioral Medicine, the Nurses Association of the American College of Obstetrics and Gynecology, the American Nurses Association, the Society for Research in Child Development, the American Association for the Advancement of Science, and the American Society for Psychosomatic Obstetrics and Gynecology.

Preface 1
Lederman_CH01.pdf 14
Chapter 1 14
Psychosocial Adaptation in Pregnancy: Assessment of Seven Dimensions of Maternal Development 14
1.1 Introduction 14
1.2 Foundation Research Projects for Theory Development of the Seven Dimensions of Maternal Prenatal Adaptation 16
1.2.1 Maternal Psychological and Physiological Correlates of Progress in Labor and Fetal/Newborn Health 16
1.2.1.1 Theory and Design 16
Psychophysiological Relationships Regarding Biochemical Stress-Related Substances and Reproductive Outcomes 17
1.2.1.2 Methods 18
1.2.1.3 Results 19
Data in Labor 19
Interrelationships Among the Variables During Pregnancy 20
Interrelationships Between Pregnancy and Labor 21
1.2.2 Relationship of Maternal Prenatal Psychosocial Adaptation and Family Functioning to Pregnancy Outcomes 26
1.2.2.1 Background and Theory 26
1.2.2.2 Design and Methods 29
Complications During Antepartum, Intrapartum, and Delivery 30
1.2.2.3 Results 31
Correlations Among the Demographic, Psychosocial, and Pregnancy Outcome Variables 31
Regression Analyses of Significant Demographic and Psychosocial Variables with Pregnancy Outcomes 32
1.2.3 Maternal Prenatal Psychosocial Adaptation Predictors of Infant Birth Weight and Gestational Age 36
1.2.3.1 Theory and Background 36
1.2.3.2 Design and Methods 36
1.2.3.3 Results 37
Prenatal Psychosocial Adaptation and Gestational Age 37
Prenatal Psychosocial Adaptation and Birth Weight 38
1.2.3.4 Discussion 39
Summary 41
1.3 Theoretical Foundations of the Seven Dimensions of Adaptation to Pregnancy 41
References 45
Lederman_CH02.pdf 52
Chapter 2 52
Acceptance of Pregnancy 52
2.1 Planning and Wanting the Pregnancy 53
2.2 Happiness Versus Depression During Pregnancy 54
2.3 Discomfort During Pregnancy 59
2.4 Body Change During Pregnancy 61
2.5 Ambivalence Toward Pregnancy 63
2.6 Summary 66
References 67
Lederman_CH03.pdf 70
Chapter 3 70
Identification with a Motherhood Role 70
3.1 Motivation for Motherhood 71
3.2 Preparation for Motherhood 73
3.2.1 Fantasizing 74
3.2.1.1 Envisioning Oneself as a Mother 74
3.2.1.2 Characteristics Desired as a Mother 75
3.2.1.3 Anticipating Future Life Changes as a Mother 78
3.2.2 Dreams About Pregnancy and Motherhood 80
3.2.2.1 Reliving Childhood 81
3.2.2.2 School Dreams 81
3.2.2.3 Motherhood-Career Conflict 83
3.2.2.4 Confidence in Maternal Skills 84
3.2.2.5 Food Dreams and Infant Intactness 86
3.2.2.6 Life Experience 88
3.3 Conflict Resolution 89
3.4 Maternal–Fetal Attachment Representation and Maternal Role Evolution 92
3.5 Summary 94
References 96
Lederman_CH04.pdf 100
Chapter 4 100
Relationship with Mother 100
4.1 Availability of the Mother 101
4.1.1 Infancy and Childhood 101
4.1.2 Availability During Pregnancy 102
4.2 Reactions to Pregnancy 107
4.3 Respect for Autonomy 108
4.4 Willingness to Reminisce 109
4.5 Empathy with the Mother 111
4.6 Summary 113
References 113
Lederman_CH05.pdf 115
Chapter 5 115
Relationship with Husband or Partner 115
5.1 The Husband’s Concern for His Expectant Wife’s Needs 117
5.1.1 Empathy 117
5.1.1.1 Empathic Partners 117
5.1.1.2 Unempathic Partners 119
5.1.2 Increased Cooperativeness and Flexibility 123
5.1.3 Availability 124
5.1.4 Trustworthiness and Reliability 127
5.2 The Wife’s Concern for Her Husband’s Needs as an Expectant Father 130
5.3 Effects of the Pregnancy on the Marital Bond 133
5.3.1 Closeness and Intimacy 133
5.3.2 Increased or Decreased Conflict in the Marital Bond 136
5.4 Identification of a Fatherhood Role 138
5.5 The Transition to Fatherhood1 141
5.5.1 Readiness for Fatherhood 141
5.5.2 Stress Associated with Fatherhood 142
5.5.3 Paternal–Infant Attachment 142
5.5.4 Paternal Involvement in Child Care 143
5.6 Summary 144
References 146
Lederman_CH06.pdf 151
Chapter 6 151
Preparation for Labor 151
6.1 Planning for Labor: Practical Steps to Gather Information 151
6.1.1 Prenatal Classes 152
6.1.2 Conversing with Other Women 154
6.1.3 Books and Films 155
6.1.4 Other Practical Steps 158
6.2 Planning for Labor: Maternal Thought Processes 158
6.2.1 Thinking Versus Avoidance of Thinking About Labor 158
6.3 Congruence Between Fantasy and Reality 164
6.3.1 Labor Contractions 164
6.3.2 Work and Pain 165
6.3.3 Risks and the Unknown 167
6.3.4 Doubts and Fears About Labor 168
6.4 Level of Confidence Regarding Labor 168
6.5 Envisioning the Challenges of Labor for Oneself and the Fetus 170
6.5.1 Dreams About Labor 172
6.6 Summary 175
References 176
Lederman_CH07.pdf 178
Chapter 7 178
Prenatal Fear of Pain, Helplessness, and Loss of Control in Labor 178
7.1 Loss of Control Over the Body 180
7.2 Loss of Control Over the Emotions 184
7.3 Ability to Trust the Medical/Nursing Staff 187
7.4 Attitudes Toward Being “Awake and Aware” and the Use of Medication 193
7.5 Summary 197
References 199
Lederman_CH08.pdf 202
Chapter 8 202
Prenatal Fear of Loss of Self-Esteem in Labor 202
8.1 Overview 202
8.2 Measures of Self-Image 203
8.3 Evaluation of Self-Worth 204
8.4 Behaviors that Reflect Self-Esteem 206
8.4.1 Tolerance of Self 206
8.4.2 Value of Self 209
8.4.3 Body Image and Appearance 211
8.5 Summary 212
References 212
Lederman_CH09.pdf 214
Chapter 9 214
Prenatal and Postnatal Psychosocial Adaptation in Military Women 214
9.1 Part 1. Prenatal Adaptation 214
9.2 Part 1. Research Questions: The Relationship of Community Support and Family Adaptability to Prenatal Maternal Adaptatio 215
9.2.1 Method 215
9.2.2 Data Analysis 217
9.2.3 Results 217
9.2.3.1 Community Support and Prenatal Self-Evaluation Questionnaire (PSEQ) Scale Scores 217
9.2.3.2 Family Adaptability and Prenatal Self-Evaluation Questionnaire (PSEQ) Scale Scores 220
9.2.4 Discussion of Part 1. Prenatal Results 222
9.3 Part 2. Postnatal Adaptation 226
9.4 Part 2. Research Questions: The Relationship of Community Support, Family Adaptability, and Spousal Deployment to Postna 227
9.4.1 Methods 227
9.4.2 Results 229
9.4.3 Discussion of Part 2. Postpartum Results 233
References 235
Lederman_CH10.pdf 239
Chapter 10 239
Prenatal Adaptation Among Multigravidas 239
10.1 Quantitative Results: Statistical Analysis of Psychosocial Adaptation to Pregnancy Based on Parity 239
10.2 Qualitative Analysis of Psychosocial Adaptation to Pregnancy Based on Parity 240
10.2.1 Acceptance of Pregnancy 241
10.2.1.1 Body Image and Career Transitions during Pregnancy 242
10.2.1.2 The Impact of Experience and Family Planning on Acceptance of Pregnancy 243
10.2.1.3 Other Factors Bearing on Acceptance of Pregnancy 244
10.2.1.4 Financial Considerations of a Larger Family 245
10.2.1.5 Summary: Acceptance of Pregnancy 246
10.2.2 Identification with a Motherhood Role 246
10.2.2.1 Anxiety About Anticipated Life Changes and the Unknown Child 246
10.2.2.2 Preparing Children for a Sibling 247
10.2.2.3 The Impact of Past Experience with Motherhood 248
10.2.2.4 Anticipation of Life Changes 249
10.2.2.5 Summary: Identification with a Motherhood Role 250
10.2.3 Relationship with Mother 251
10.2.3.1 Motherhood as a Maturational and Developmental Milestone 251
10.2.3.2 The Impact of a Current Negative or Nonexistent Relationship with the Mother 252
10.2.3.3 Summary: Relationship with Mother 253
10.2.4 Relationship with Husband or Partner 254
10.2.4.1 Changes in the Sexual Relationship During Pregnancy 256
10.2.4.2 Family and Social Support 257
10.2.4.3 Summary: Relationship with Husband or Partner 259
10.2.5 Preparation for Labor 259
10.2.5.1 Childbirth Preparation Classes and Books 260
10.2.5.2 Summary: Preparation for Labor 262
10.2.6 Fear of Pain, Helplessness, and Loss of Control in Labor 262
10.2.6.1 Summary: Fear of Pain, Helplessness, and Loss of Control in Labor 264
10.2.7 Concerns for Well-Being of Self and Baby 265
10.2.8 Fear of Loss of Self-Esteem in Labor 265
10.2.8.1 Summary: Fear of Loss of Self-Esteem 268
10.3 Summary 268
References 269
Lederman_CH11.pdf 272
Chapter 11 272
Methods of Assessment: Psychosocial Adaptation to Pregnancy Questionnaire Scales and Interview Schedules, and Review of Inter 272
11.1 Prenatal Self-Evaluation Questionnaire and Psychometric Data1 272
11.1.1 Description of the Seven Scales of the Prenatal Self-Evaluation Questionnaire and Sample Items 272
11.1.1.1 Acceptance of Pregnancy 273
11.1.1.2 Identification of a Motherhood Role 273
11.1.1.3 Relationship with Mother 274
11.1.1.4 Relationship with Husband/Partner 274
11.1.1.5 Preparation for Labor 274
11.1.1.6 Fear of Pain, Helplessness, and Loss of Control in Labor 275
11.1.1.7 Concern for Well-being of Self and Baby in Labor 275
11.1.2 Psychometric Data 275
11.1.2.1 Descriptive Data and Reliability Coefficients 275
11.1.2.2 Intercorrelations Among the Scales 275
Scales with Moderate Intercorrelations 278
Comparison of Scale Mean Levels Based on Parity 278
Congruence Between the Interview and Self-Report Questionnaire Responses 279
Prediction of Anxiety and Stress in Active Labor Using the Prenatal Self-Evaluation Questionnaire 280
Prediction of Maternal Postpartum Adaptation Using the Prenatal Self-Evaluation Questionnaire 282
Comparisons of Reliability Coefficients in Three Trimesters of Pregnancy and in Three Ethnic Groups: Mean Level Differences in 284
Comparisons of Reliability Coefficients Obtained by Different Investigators in Administration to U.S. and non-U.S. Populations 286
11.2 Prenatal Clinical Interview Schedules and Rating Scales 290
11.2.1 Clinical Practice Recommendations for Conducting Interviews 290
11.2.2 Summary Ratings 292
11.3 Recommendations for Clinical Care and Research 294
11.3.1 Clinical Assessment: Continuity of Care and Assessment of Maternal Developmental Adaptation 294
11.3.2 Suggestions for Clinical Research Studies 294
11.3.2.1 Assessment of Prenatal Adaptation and Determination of Labor and Delivery Outcomes 294
Prenatal Assessment for Screening, Identification, and Planned Intervention 295
11.4 Research Intervention Trials for General and Pregnancy-Specific Anxiety Reduction 296
11.4.1 Assessment of the Seven PSEQ Dimensions as a Basis for Intervention 296
11.4.1.1 Characteristics of Effective Interventions 297
11.5 The Panoply of Therapeutic Prenatal Interventions to Promote Maternal Psychosocial Adaptation to Pregnancy 297
11.5.1 Intervention Research Demonstrating Effectiveness in High-Risk Prenatal Populations 298
11.5.2 Intervention Research Demonstrating Effectiveness in Low-Risk Prenatal Populations 299
11.5.3 Marital/Partner Relationships as Factors Influencing Maternal Stress/Anxiety Responses, with Implications for Therapeu 300
11.5.4 Maternal and Paternal Coping Strategies and Birth Outcomes 301
11.5.5 Complementary and Alternative Medical (CAM) Therapies 301
References 303
Lederman_BM1.pdf 308
Lederman_Appendix_A.pdf 308
Anchor 1 308
Lederman_Appendix_B.pdf 312