Regina P. Lederman

Psychosocial Adaptation in Pregnancy: Assessment of Seven Dimensions of Maternal Development

The impetus for this book originated from research on the relationship between psychosocial conflicts during pregnancy and selected complications that arise during labor. It became apparent during the interviews with expectant mothers that all the women experienced some conflict in relation to pregnancy and childbearing, and that the patterns of response to conflict could be identified as either adaptive or maladaptive. These patterns of adaptive responses were observed to be progressive in nature in that the gravid woman advanced toward an orientation to a maternal parenting role. When responses were maladaptive, the mother-to-be struggled with her ambivalence about pregnancy and motherhood, and little progress was made in role clarification in the current or in future pregnancies (based on our separate research projects with both primigravid and multigravid women).

The Parent-Adolescent Relationship Education (PARE) program: A curriculum for prevention of STDs and pregnancy in middle school youth

Abstract The Parent-Adolescent Relationship Education (PARE) Program, designed for parents and middle school students, focuses on strengthening family communication about sexual issues and behaviors to help prevent teen pregnancy, human immunodeficiency virus (HIV), and other sexually transmitted diseases (STDs). The program includes content about reproduction, STDs and Acquired Immune Deficiency Syndrome (AIDS), contraception, sex risks, and safe-sex behaviors. The course uses social learning and cognitive behavioral concepts to enhance decision-making, refusal, and resistance skills. A randomized treatment or control group design is used to assign parent-child dyads to an experimental education group (social learning) or an attention-control group (traditional didactic teaching). Three post-program maintenance or booster sessions are held at 6-month intervals and at times prior to peak teen conception periods to reinforce the knowledge and skills learned. Pre- and posttests for parents and students assess group differences in parental involvement and communication, contraception, sex attitudes and intentions, sex behaviors (initiation of sexual intercourse, frequency, number of partners, contraceptive practices, refusal skills), and the incidence of pregnancy.

Treatment Strategies for Anxiety, Stress, and Developmental Conflict during Reproduction

In the preceding article, I reviewed the literature and analyzed psychophysiological and psychosocial foundations of reproductive health outcomes. In this article, I focus on treatment strategies and considerations for policy formation pertaining to the care of women, children, and families during reproduction. I discuss (a) cognitive and behavioral strategies for decreasing anxiety and promoting relaxation during gestation and parturition; (b) educational and other activities to prepare women for the childbirth event and alternatives to current practice; (c) methods of providing support and enhancing the mothers capacity for coping with events occurring during labor and delivery; and (d) current national and international programs and pilot projects that have effectively promoted health and adaptation to pregnancy and have reduced the occurrence of reproductive complications.

Methods of Assessment: Psychosocial Adaptation to Pregnancy Questionnaire Scales and Interview Schedules, and Review of Interventions to Enhance Adaptation

Preceding chapters describe seven psychosocial dimensions of maternal prenatal development for both primigravid and multigravid women. This chapter discusses methods of assessment for identifying gravid women who may be experiencing difficulties in one or more of the seven major psychosocial dimensions discussed. A self-report questionnaire (Lederman, 1996) developed for providing parallel measures of the major dimensions assessed in the clinical interviews is described, as well as the psychometric properties and validation results of its use to date. Suggestions are provided for conducting clinical interviews and for summarizing the information obtained in the form of quantitative ratings. Methods for learning and developing proficiency in assessment skills are also provided. Suggestions are made for clinical interventions and research applications of both interview and questionnaire assessment of maternal psychosocial development and adaptation to pregnancy.

Acceptance of Pregnancy

In a broad sense, acceptance of pregnancy refers to a woman’s adaptive responses to the changes inherent in prenatal growth and development. Data presented in Chapter 1 suggest that acceptance of pregnancy is associated with the gravida’s adaptation to and her gratification with being pregnant. The results further indicate that the gravida is less prepared for childbirth and motherhood when acceptance of the pregnancy is low, and she is more likely to have conflicts and fears concerning labor, and to have a longer duration of labor. Anxiety about acceptance of pregnancy also was related to greater Intrapartum Complications and lower Gestational Age at Birth. Recent data from the National Survey of Family Growth show that half (49%) of all US pregnancies are unplanned (Finer & Henshaw, 2006), a factor in acceptance of pregnancy that may substantially contribute to the findings noted above.

Mentors Offering Maternal Support Reduces Prenatal, Pregnancy-Specific Anxiety in a Sample of Military Women

Objective To determine the efficacy of the Mentors Offering Maternal Support (MOMS) program to reduce pregnancy‐specific anxiety and depression and build self‐esteem and resilience in military women. Design Randomized controlled trial with repeated measures. Setting Large military community in Texas. Participants Pregnant women (N = 246) in a military sample defined as active duty or spouse of military personnel. Methods Participants were randomized in the first trimester to the MOMS program or normal prenatal care. Participants attended eight 1‐hour sessions every other week during the first, second, and third trimesters of pregnancy. Pregnancy‐specific anxiety, depression, self‐esteem, and resilience were measured in each trimester. Linear mixed models were used to compare the two‐group difference in slope for prenatal anxiety, depression, self‐esteem, and resilience. Results The Prenatal Self‐Evaluation Questionnaire was used to measure perinatal anxiety. Rates of prenatal anxiety on the Identification With a Motherhood Role (p = .049) scale and the Preparation for Labor (p = .017) scale were significantly reduced for participants in MOMS. Nulliparous participants showed significantly lower anxiety on the Acceptance of Pregnancy scale and significantly greater anxiety on the Preparation for Labor scale. Single participants had significantly greater anxiety on the Well‐Being of Self and Baby in Labor scale, and participants with deployed husbands had significantly greater anxiety on the Identification With a Motherhood Role scale. Conclusion Participation in the MOMS program reduced pregnancy‐specific prenatal anxiety for the dimensions of Identification With a Motherhood Role and Preparation for Labor. Both dimensions of anxiety were previously found to be significantly associated with preterm birth and low birth weight. Military leaders have recognized the urgent need to support military families.

Relationship with Mother

The significance of the pregnant woman’s relationship with her mother has been emphasized in the literature as an important factor in adaptation to pregnancy and motherhood (Ballou, 1978; Deutsch, 1945; Tulman & Fawcett, 2003, Uddenberg, 1974; Wenner et al., 1969). A positive relationship with the mother also predicted successful adaptation to pregnancy (Lewis, 1989). In our initial multidisciplinary research project presented in Chapter 1, the quality of the pregnant woman’s relationship with her mother was related not only to psychosocial conflicts in pregnancy, but also to physiological measures of progress in labor (Lederman, Lederman, Work, & McCann, 1978, 1979). In another project (Lederman, 1989). Relationship with Mother was predictive of postpartum adaptation scales of Confidence in a Motherhood Role and Satisfaction with Motherhood and Infant Care Tasks. These studies also demonstrated that the relationship with the mother appeared to influence the gravida’s identification with and adaptation to a motherhood role. It previously was noted that a woman’s ability to identify her motherhood role depended on the availability of good models and on her early experience of mothering. The research results revealed the importance of the pregnant woman’s past and current relationship with her mother.

Relationship with Husband or Partner

The marital relationship has been reported as the most significant dimension affecting the course of pregnancy (Wenner et al., 1969). This finding is not always borne out (Shereshefsky & Yarrow, 1973), but the results of studies on the importance of the marital/partner relationship to postpartal adjustment are compelling (Lederman, 2008a; Melges, 1968; Russel, 1974; Shereshefsky & Yarrow, 1973; Tomlinson, 1987a, b). Even when partner support and support of others are both present, partner support tends to make the greater contribution to maternal well-being during pregnancy (Brown, 1986), and it has been associated with earlier prenatal care and more prenatal care visits (Lederman, Weis, Brandon, Hills, & Mian, 2002; Zambrana, Dunkel-Shetter, & Scrimshaw, l991).

Prenatal Fear of Loss of Self-Esteem in Labor

The gravida’s concept of self is central to a consideration of preparation for childbirth. In attempting to elucidate each woman’s self-image, the interviewer arrived at an understanding of the woman’s unique character with its particular personality traits and tensions. This understanding helped explain her personal experience of childbirth. In varying degrees, many women fear that they will lose self-esteem in labor. The degree of fear depends on the stability of their sense of self. It is expected that a young mother who is reasonably confident about her new role will know who she is and will have a healthy sense of her own worth. However, the reverse is not necessarily true; that is, a woman with high self-esteem may not wish to have a baby or may not have an opportunity to have a child for one reason or another. A woman’s sense of self-worth is not necessarily determined by her need or ability to “nurture.” However, if she does need to “nurture” and has no child, she may seek satisfaction by working in the service professions, by serving the community on a volunteer basis, or by expressing her creativity through various activities and personal interests.

Identification with a Motherhood Role

The developmental step of the woman-without-child to the woman-with-child is the goal of identification with a motherhood role. Achievement of this identification can be thought of as a process of unfolding characterized by progressive emphasis in the mother’s thinking away from the single self and toward the mother–baby unit, and ultimately toward recognizing the separateness and individuality of the coming child (Lederman, 1984; Trad, 1991). Identification with a motherhood role also refers to the mother’s attachment orientation and reflective functioning or the capacity to understand the nature of her own patterns of thinking or mental states, as well as those of the developing fetus-baby and newborn infant (Condon & Corkindale, 1997; Haedt & Keel, 2007; Slade, Grienenberger, Bernbach, Levy, & Locker, 2005).