Influence of Perinatal Depression on Labor-Associated Fear and Emotional Attachment to the Child in High-Risk Pregnancies and the First Days After Delivery

Social and obstetric risk factors of antenatal depression: A cross-sectional study from South-India

PURPOSE

Antenatal depression is as prevalent as postpartum depression and studies on it are very few. It has been relatively neglected leading to adverse effects on the growing child as well as the mother. Hence screening of depression in high risk individuals, planning and adopting important strategies for prevention needs to be undertaken. Our study aimed to assess the modifiable social and obstetric risk factors of antenatal depression.

METHODS

Third trimester pregnant women of 18-40 years attending obstetric out-patient department and admitted in tertiary hospitals who had no past psychiatric illness were screened using Edinburgh postnatal depression scale after obtaining written consent, socio-demographic and obstetric details. Statistical analysis was calculated using IBM version SPSS 23.

RESULTS

Among 222 women recruited, 25.6% had antenatal depression. Significant associations were found between lower level of education (p = 0.02,O.R=1.87), urban population (p = 0.04,O.R=5.139), intimate partner violence (p = 0.01,O.R=15.769), daily alcohol use by husband (p < 0.00,O.R=15.281), poor relationship with in-laws (p < 0.000,O.R=21.733) and parents (p < 0.000,O.R=15.281), number of previous pregnancies (p = 0.026,O.R=5.545), parity (p = 0.04,O.R=4.187), previous abortions (p = 0.007,O.R=2.834), fear of labour (p < 0.000,O.R=5.77) and complications during pregnancy (p < 0.000,O.R=3.017) with antenatal depression. Living in urban area (p = 0.023, A.O.R=3.132), fear of labour (p < 0.000, A.O.R=7.398), intimate partner violence (p = 0.026, A.O.R=36.655), poor relationship with in-laws (p = 0.001, A.O.R=36.855) and parents (p = 0.042, A.O.R=8.377) were found to be predictors of antenatal depression.

CONCLUSION

Antenatal depression is multifactorial in origin and requires a multifactorial approach in prevention and treatment. Routine antenatal screening for depression must be conducted with efforts to build strong family, peer and social support at community level.

The Effect of Midwife-led Psycho-Education on Parental Stress, Postpartum Depression and Parental Competency in High Risk Pregnancy Women: A Randomized Controlled Trial

Introduction: Women with high-risk pregnancy are at increased risk of depression and anxiety during pregnancy, as well as a less favorable parent-infant interaction. This study aimed to investigate the effect of midwife-led psycho-education intervention on parental stress, competency, and postpartum depression in nulliparous women hospitalized with high-risk pregnancy.

Methods: This randomized controlled trial was carried out on 66 nulliparous women admitted to the high-risk pregnancy ward of Kamali Hospital, Karaj, Iran. Using convenient sampling method, the mothers were randomly assigned to control and intervention groups. In addition to routine care, the intervention group received four sessions of midwife-led psycho-education intervention in two group sessions in pregnancy and two individual sessions immediately after delivery. The parental stress, parental competency, and postpartum depression questionnaires were used for data collection before, after, and one month after the intervention. Data were analyzed using SPSS software ver. 13.0. Repeated-measures ANOVA test was used for comparing the mean scores of parenting stress, parental competency, and depression between and within both study groups before, after, and one month after delivery.

Results: While postpartum depression and parental stress decreased in intervention group, parental competency increased.

Conclusion: Our findings indicated that midwife-led psycho-education was effective on parental stress, competency, and postpartum depression in high-risk pregnancy mothers. Accordingly, prenatal distress in high-risk pregnancies should be assessed routinely.

Body Acceptance by Pregnant Women and Their Attitudes toward Pregnancy and Maternity as Predictors of Prenatal Depression

Background: Depressive symptoms during pregnancy may cause unfavorable consequences for both the mother and the infant's physiological and psychological health. Recent evidence indicates that body image plays an important role in prenatal depression. The present study's main purpose was to investigate the level of acceptance of physical appearance in pregnant women, their attitudes toward pregnancy and maternity, and some obstetric characteristics as significant predictors in the development of depression. Methods: A sample of 150 Polish pregnant women completed a set of self-report questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Attitudes toward Maternity and Pregnancy Questionnaire (PRE-MAMA), and the Body-Self Questionnaire (EA-BSQ). All participants also answered a brief sociodemographic and obstetric information questionnaire. Results: A hierarchical binary logistic regression was conducted to predict prenatal depression from selected obstetric variables (unplanned pregnancy, multiparity, and miscarriages) and psychological variables (appearance evaluation and positive or anxious attitudes toward pregnancy and maternity). It was found that higher levels of negative evaluation of appearance increased chances of depression in pregnant women by almost one-and-a-half. The analysis revealed that positive attitudes toward pregnancy and maternity were the most important protective factor for depression. Conclusions: The results confirmed the importance of dissatisfaction with body image during pregnancy as a predictor of the onset of prenatal depression. However, in clinical practice, this risk factor should be considered in combination with positive maternal attitudes, not separately. The implications for future studies and interventions in the field of prenatal depression are discussed in this work.

Women's experiences of fear of childbirth: a metasynthesis of qualitative studies

Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth.

Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.

Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.

Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.

Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.

Attachment Styles, Various Maternal Representations and A Bond to a Baby

(1) Background: The aim of this study was to assess the relationship between: (a) new mothers’ styles of attachment to their own mothers with their representation of self as a mother as well as with their representation of one’s mother as a mother, (b) new mothers’ representation of self as a mother with their representation of one’s own mother as a mother, and (c) their bonds with their children and their styles of attachment to their own mothers. (2) Methods: A total of 86 mothers were interviewed approximately six months postpartum. The Adjective Checklist, a modified version of the Experiences in Close Relationships, and the Postpartum Bonding Questionnaire were used in the study. (3) Results: Analysis revealed a statistically significant relationship between the new mothers’ styles of attachment to their own mothers and both their representation of self as a mother and their representation of one’s mother as a mother. The relationship between representation of self as a mother and representation of one’s mother as a mother was also statistically significant. No statistically significant relationship was observed between the style of attachment to one’s mother and the bond with one’s child six months postpartum. (4) Conclusions: A deeper understanding of the relationship between these variables may improve the help system directed at young mothers.

The Dynamics of Becoming a Mother during Pregnancy and After Childbirth

Background: The aim of this study was to explore the relationship between one’s maternal attachment style and one’s self-image as a mother, image of one’s mother as a mother, and bond with the child over a period of several months. Methods: A total of 86 women took part in the study The Adjective Check List (ACL), Postpartum Bonding Questionnaire (PBQ), Maternal–Fetal Attachment Scale (MFAS), and a modified version of the Experiences in Close Relationships (ECR) were used. Two measurements were used: during pregnancy and about six months after the birth of the child. Results: In terms of their self-image as mothers, the women had higher results the first time they took the questionnaire, regardless of their attachment style. An interaction effect was found between attachment style and the ‘need for changes’ scale. The image of one’s mother as a mother depended on the level of avoidance in attachment, regardless of the measurement. An interaction effect was found between attachment style and the scale of ‘personal adaptation’. There was a correlation between the bond with the child during pregnancy, the bond following birth, and the style of maternal attachment; the main predictor of the bond with the child after birth is the bond with the child during the pregnancy. Conclusion: Those who provide care for pregnant women and new mothers should be aware of the complex psychological processes in the transition to motherhood, have knowledge about perinatal mental health, and when necessary, refer women to specialists such as support groups for new mothers, trained midwives, psychologists, psychotherapists, or psychiatrists.