Mariana Moura-Ramos

Maternal adjustment to the birth of a child: Primiparity versus multiparity

Introduction: The literature has highlighted the birth of a first child as a crisis moment that implies change and reorganisation. None the less, the specificities of maternal adjustment to the birth of another child are not yet completely known. Goals: To understand differences in adjusting to the birth of a child, in primiparous and multiparous mothers. Specifically: (1) identify and describe differences in adjusting at two different moments: 2–5 days after the birth and 8 months post‐partum; (2) identify and describe differences or continuities among primiparous and multiparous mothers regarding the temporal evolution of adjustment. Method: 179 mothers (98 primiparous; 81 multiparous) were assessed in two different periods: 2–5 days after the birth and 8 months later, concerning adjustment and need for reorganisation. The assessment protocol included a social‐demographic data file, the Emotional Assessment Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and adjectival scales. Results: Primiparous mothers report greater adjustment difficulties right after the birth. Multiparous mothers show a less positive adjustment trajectory, mainly reflected in increasing levels of negative emotional reactivity. Conclusion: Results support the existence of different adjustment trajectories for primiparous and multiparous mothers, suggesting the need for differentiated psychological intervention strategies regarding each group.

Adult attachment style and cortisol responses in women in late pregnancy

BackgroundRecent research has documented the association between attachment and cortisol rhythms. During pregnancy, when attachment patterns are likely to be activated, elevated levels of cortisol are associated with negative effects for the mother and the foetus. The aim of the present study was to examine the association of adult attachment style and cortisol rhythms in pregnant women.MethodsEighty women in the third trimester of pregnancy participated in the study. Adult attachment was assessed using the Adult Attachment Scale – Revised (AAS-R). Participants collected 4 samples of salivary cortisol at two different days; 3 samples were collected in the morning immediately after wakeup and one sample was collected by bedtime.ResultsResults found group significant differences in the cortisol diurnal oscillation (F(1,71) = 26.46, p < .001,), with secure women reporting a steep decrease in cortisol from awakening to bedtime, while women with fearful avoidant attachment reported no changes. No group differences were found regarding the cortisol awakening response.ConclusionsThese results highlight the importance of considering attachment patterns during pregnancy, suggesting fearful avoidant attachment style as a possible risk factor for emotional difficulties and dysregulation of the neuroendocrine rhythms.

Psychosocial adjustment during the transition to parenthood of Portuguese couples who conceived spontaneously or through assisted reproductive technologies.

We examined the psychosocial adjustment of 35 Portuguese couples who conceived through Assisted Reproductive Technologies (ART) and 31 couples with a spontaneous conception during their transition to parenthood (pregnancy and 4 months postpartum). Couples completed self-report questionnaires regarding their perceptions of pregnancy and parenthood, psychological distress, quality of life, marital relationship, and parenting stress. Compared with parents who conceived spontaneously, parents who conceived through ART perceived pregnancy as being more risky and demanding, reported a decrease in their psychological quality of life, and ART fathers only perceived themselves as being more competent than fathers who conceived spontaneously. Healthcare professionals should be aware of need of couples in their efforts to adapt to the individual and relational challenges associated with the transition to parenthood.

The indirect effect of contextual factors on the emotional distress of infertile couples

Few studies were dedicated to study the role of contextual factors, such as the socioeconomic status and urban or rural residence in emotional distress of infertile couples. This study aimed to explore the impact of contextual factors on emotional distress, either directly or by affecting the importance of parenthood in ones life, which in turn affects emotional distress. In this cross-sectional study, 70 couples recruited during hormonal stimulation phase prior to in vitro fertilisation completed clinical and sociodemographic forms and self-report questionnaires assessing representations about the importance of parenthood and emotional distress. Path analysis using structural equation modelling was used to examine direct and indirect effects among variables. Results indicated that socioeconomic status and place of residence had an impact in emotional distress by affecting the representations about the importance of parenthood in ones life. Gender differences were found regarding model paths, suggesting that the social context may have a stronger influence on womens emotional distress than on their partners’ distress. When delineating psychological interventions, health care providers should consider that cultural values about children and parenthood contribute to shape the infertility experience.

Changes in marital congruence and quality of life across the transition to parenthood in couples who conceived spontaneously or with assisted reproductive technologies

OBJECTIVE To investigate the relationship between changes in marital congruence (ie, level of agreement between partners about their relationship) and quality of life across the transition to parenthood in couples who conceived spontaneously and with assisted reproduction technology (ART). DESIGN Prospective longitudinal cohort design using multilevel modeling. SETTING Portuguese large public university-based hospital. PATIENT(S) Pregnant couples who conceived spontaneously and with ART. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) ENRICH Marital Inventory and the World Health Organization Brief Quality of Life Instrument. RESULT(S) For all couples, an increase in satisfaction with the marital relationship was associated with increases in all quality of life domains. For couples who conceived with ART only, a decrease from pregnancy to the postpartum period in congruence about the existence of conflicts in their relationship was associated with a decrease in psychologic quality of life. CONCLUSION(S) Couples who conceive with ART are usually satisfied with their marital relationship, but they may still disagree in their perceptions of this relationship, which may negatively impact their well-being. These results reinforce the role of couple-based interventions to prevent intracouple disagreement across the transition to parenthood, especially when conception is achieved with ART.

The role of maternal attachment in the experience of labor pain: a prospective study.

Objective To examine the influence of attachment dimensions and sociodemographic and physical predictors in the experience of labor pain. Methods Eighty-one pregnant women were assessed during their third trimester of pregnancy and during labor. The perceived intensity of pain in the early stages of labor (3 cm of cervical dilatation) and before the administration of patient-controlled epidural analgesia was measured using a visual analog scale. Pain was also assessed indirectly based on anesthetic doses. Attachment was assessed using the Adult Attachment Scale–Revised. Results Attachment anxiety and avoidance were positively and significantly correlated with labor pain and anesthetic consumption. In the multivariate models, attachment anxiety was a significant predictor of higher pain at 3 cm of cervical dilatation (&bgr; = 0.36, p = .042) and before the administration of patient-controlled epidural analgesia (&bgr; = 0.51, p = .002). Older age (&bgr; = 0.31, p = .005), a shorter duration of labor (&bgr;= −0.41, p = .001), and attachment avoidance (&bgr; = 0.41, p = .004) were significant predictors of higher anesthetic use. Conclusions The study findings suggest that perceived labor pain and anesthetic use are strongly associated with attachment, rather than demographic and physical factors. These data support the importance of understanding the experience of labor pain within an attachment theoretical framework.

Network support and parenting in mothers and fathers who conceived spontaneously or through assisted reproduction

Background: Little is known about the contribution of other significant relationships beyond the partnership for parental adjustment and care in parents who conceived through Assisted Reproductive Technologies (ART). Objective: This study examined the role of perceived network support on parenting stress and investment in the child in parents who conceived spontaneously or through ART, during their transition to parenthood. Methods: Thirty‐five couples who conceived through ART and 31 couples who conceived spontaneously completed self‐report questionnaires regarding perceived emotional and instrumental support from their social network members (i.e. nuclear and extended family members and friends) during pregnancy (twenty‐fourth week) and regarding parenting stress and investment in the child four months after the partum. Results: Regardless of method‐of‐conception, instrumental support from the nuclear family was positively associated with maternal investment in the child and emotional and instrumental support from the extended family were positively associated with paternal stress while support from friends was negatively associated with it. Conclusion: Results suggest that parents who conceive through ART and spontaneously are alike in that their adjustment to parenthood and the quality of the care they provide to their children depends on perceived support from nuclear and extended family and friends.

Attachment and Mental Help-Seeking in the Perinatal Period: The Role of Stigma

This study aimed at (1) examining how women’s attachment representations influence their intentions to seek formal help for their emotional problems, either directly or by affecting attitudes towards professional help-seeking (stigma and psychological openness), and (2) examining whether these effects are moderated by the presence of clinically significant psychopathological symptoms. A cross-sectional online survey including 226 women during the perinatal period was conducted. Results showed that, when clinically significant psychopathological symptoms were present, women’s more insecure attachment representations were associated with lower intentions to seek professional help, and this influence occurred throughout a decrease in women’s indifference to stigma associated with mental healthcare. These results support both the intra and interpersonal nature of the help-seeking process, and highlight the importance of implementing stigma reduction strategies (e.g., awareness campaigns, health professional’s non-judgmental questioning of emotional difficulties), particularly in women with clinically significant psychopathological symptoms.

The Role of Attachment Anxiety and Attachment Avoidance on the Psychosocial Well-being of Infertile Couples

This study’s objective was to explore the mediating role of attachment orientation in infertile women and their partners as a mediator of the relationship between need for parenthood and psychosocial well-being. Ninety participants (45 couples) undergoing in vitro fertilization completed self-report questionnaires that assessed representations of the importance of parenthood, attachment orientations, and psychosocial well-being. Path analysis was used to examine the direct and indirect effects. The results indicated that women’s attachment anxiety mediated the effect of need for parenthood on the psychological well-being of themselves and their partner. Although causality cannot be assumed, this study highlights the importance of considering attachment orientations and related strategies of emotion regulation in clinical settings and the need to address the meaning of parenthood for promoting couples’ well-being.

Was it worth it? Infertile couples’ experience of assisted reproductive treatment and psychosocial adjustment one year after treatment

Res_por:O recurso a tecnicas de procriacao medicamente assistida (PMA) tem sido descrito como um acontecimento exigente fisica e psicologicamente. No presente estudo, e utilizando um desenho longitudinal., pretendemos descrever as mudancas no ajustamento psicossocial desde o momento do tratamento ate um ano apos o tratamento, em 33 casais inferteis portugueses, bem como avaliar, de forma retrospetiva, a experiencia do tratamento. Os resultados mostraram que, quando comparado o momento tratamento com um ano mais tarde, os casais cujos tratamentos tinham sido bem- sucedidos tiveram um aumento das emocoes positivas e diminuicao das negativas. No entanto, de um modo geral, todos os casais avaliaram de forma positiva o tratamento de PMA, independentemente do seu resultado, apesar de os casais que alcancaram uma gravidez terem avaliado a experiencia de forma mais positiva. Pode concluir-se que a reatividade emocional e a avaliacao da experiencia sao em parte influenciadas pelo resultado do tratamento.