Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2013

Open Access 01-12-2013 | Research article

Pictorial representation of attachment: measuring the parent-fetus relationship in expectant mothers and fathers

Authors: Hedwig JA van Bakel, A Janneke BM Maas, Charlotte MJM Vreeswijk, Ad JJM Vingerhoets

Published in: BMC Pregnancy and Childbirth | Issue 1/2013

Login to get access

Abstract

Background

Over the past decades, attachment research has predominantly focused on the attachment relationship that infants develop with their parents or that adults had with their own parents. Far less is known about the development of feelings of attachment in parents towards their children. The present study examined a) whether a simple non-verbal (i.e., pictorial) measure of attachment (Pictorial Representation of Attachment Measure: PRAM) is a valid instrument to assess parental representations of the antenatal relationship with the fetus in expectant women and men and b) whether factors such as gender of the parent, parity, and age are systematically related to parental bonding during pregnancy.

Methods

At 26 weeks gestational age, 352 primi- or multiparous pregnant women and 268 partners from a community based sample filled in the PRAM and the M/PAAS (Maternal/Paternal Antenatal Attachment Scale, Condon, 1985/1993).

Results

Results show that the PRAM was significantly positively associated to a self-report questionnaire of antenatal attachment in both expectant mothers and fathers. Age and parity were both found significantly related to M/PAAS and PRAM scores.

Conclusions

The present findings provide support that the PRAM is as a valid, quick, and easy-to-administer instrument of parent-infant bonding. However, further research focusing on its capacity as a screening instrument (to identify parents with serious bonding problems) and its sensitivity to change (necessary for the use in evaluation of intervention studies) is needed, in order to prove its clinical value.
Appendix
Available only for authorised users
Literature
1.
Sroufe LA: Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development. 2005, 7 (4): 349-367. 10.1080/14616730500365928.CrossRef
2.
Allen J: The attachment system in adolescence (2008). J. Cassidy & P.R. Shaver Handbook of Attachment. Theory, research and clinical applications. 2008, New York: Guilford Press
3.
Klaus M, Kennell J: Maternal-infant bonding. 1976, St Louis: CV Mosby Company
4.
Condon JT: The assessment of antenatal emotional attachment: Development of a questionnaire instrument. Br J Med Psychol. 1993, 66 (2): 167-183. 10.1111/j.2044-8341.1993.tb01739.x.CrossRefPubMed
5.
Redshaw M: First relationships and the growth of love and commitment. The new Midwifery. Edited by: Page L, McCandlisch R. 2006, Philadelphia: Elsevier, 21-48.
6.
Winnicott D: Primary maternal preoccupation. Through pediatrics to psychoanalysis. 1958, New York: Basic Books, 300-305.
7.
Raphael-Leff J: Psychological processes of childbearing. 2005, London: The Anna Freud Centre
8.
Brandon A, Pitts S, Denton W, Stringer A, Evans H: A history of the theory of prenatal attachment. Journal of Prenatal and Perinatal Psychology and Health. 2009, 23 (4): 201-222.PubMedPubMedCentral
9.
Bowlby J: Attachment and Loss Volume I: Attachment. 1969, New York: Basic Books, Inc
10.
Ainsworth MDS, Blehar MC, Waters E, Wall S: Patterns of attachment: A psychological study of the Strange Situation. 1978, Hillsdale, NJ: Erlbaum, 1978-
11.
Walsh J: Definition matter: if maternal-fetal relationships are not attachment, what are they?. Archives Womens Mental Health. 2011, 13: 449-451.CrossRef
12.
Cranley MS: Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981, 30 (5): 281-284.CrossRefPubMed
13.
Muller ME: Development of the Prenatal Attachment Inventory. West J Nurs Res. 1993, 15 (2): 199-211. 10.1177/019394599301500205.CrossRefPubMed
14.
Fowles ER: Relationships among prenatal maternal attachment, presence of postnatal depressive symptoms, and maternal role attainment. J Spec Pediatr Nurs. 1996, 1 (2): 75-82. 10.1111/j.1744-6155.1996.tb00004.x.CrossRef
15.
Condon JT, Corkindale C: The correlates of antenatal attachment in pregnant women. Br J Med Psychol. 1997, 70 (4): 359-372. 10.1111/j.2044-8341.1997.tb01912.x.CrossRefPubMed
16.
Siddiqui A, Hägglöf B: Does maternal prenatal attachment predict postnatal mother–infant interaction?. Early Hum Dev. 2000, 59 (1): 13-25. 10.1016/S0378-3782(00)00076-1.CrossRefPubMed
17.
Van den Bergh B, Simons A: A review of scales to measure the mother-foetus relationship. Journal of Reproductive and Infant Psychology. 2009, 27 (2): 114-126. 10.1080/02646830802007480.CrossRef
18.
Van Bussel JCH, Spitz B, Demyttenaere K: Reliability and validity of the Dutch version of the Maternal Antenatal Attachment Scale. Archives of Women's Mental Health. 2010, 13 (3): 267-277. 10.1007/s00737-009-0127-9.CrossRefPubMed
19.
Hjelmstedt A, Widström A-M, Collins A: Prenatal attachment in Swedish IVF fathers and controls. Journal of Reproductive and Infant Psychology. 2007, 25 (4): 296-307. 10.1080/02646830701668911.CrossRef
20.
Büchi S, Sensky T, Sharpe L, Timberlake N: Graphic representation of illness: A novel method of measuring patients' perceptions of the impact of illness. Psychother Psychosom. 1998, 67 (4–5): 222-225.CrossRefPubMed
21.
Van Bakel HJA, Vreeswijk CMJM, Maas AJBM: Verbal and pictorial representations of the antenatal mother-fetus relationship [abstract]. Journal of Reproductive and Infant Psychology. 2009, 27 (3): 323-
22.
Aron A, Aron EN, Smollan D: Inclusion of other in the self scale and the structure of interpersonal closeness. J Personal Soc Psychol. 1992, 63: 592-612.CrossRef
23.
Lehmann V, Oerlemans S, van de Poll-Franse LV, Vingerhoets AJJM, Mols F: Suffering in long-term cancer survivors: An evaluation of the PRISM-R2 in a population-based cohort. Quality of Life Research. 2011, 20: 1645-1654. 10.1007/s11136-011-9911-x.CrossRefPubMedPubMedCentral
24.
Mühleisen B, Büchi S, Schmidhauser S, Jenewein J, French LE, Hofbauer GFL: Pictorial Representation of Illness and Self Measure (PRISM): A novel visual instrument to measure quality of life in dermatological inpatients. Archives Of Dermatology. 2009, 145 (7): 774-780. 10.1001/archdermatol.2009.121.CrossRefPubMed
25.
Kassardjian CD, Gardner-Nix J, Dupak K, Barbati J, Lam-McCullock J: Validating PRISM (Pictorial Representation of Illness and Self Measure) as a measure of suffering in chronic non-cancer pain patients. J Pain. 2008, 9 (12): 1135-1143. 10.1016/j.jpain.2008.06.016.CrossRefPubMed
26.
Wittmann L, Schnyder U, Büchi S: PRISM (Pictorial representation of Illness and Self measure): A new method for the assessment of suffering after trauma. J Trauma Stress. 2012, 25: 94-97. 10.1002/jts.20710.CrossRefPubMed
27.
Büchi S, Morgeli H, Schnyder U, Jenewein J, Glaser A, Fauchere JC: Shared or discordant grief in couples 2–6 years after the death of their premature baby: Effects on suffering and posttraumatic growth. Psychosomatics. 2009, 50 (2): 123-130. 10.1176/appi.psy.50.2.123.CrossRefPubMed
28.
Büchi S, Mörgeli H, Schnyder U, Jenewein J, Hepp U, Jina E, et al: Grief and post-traumatic growth in parents 2–6 years after the death of their extremely premature baby. Psychother Psychosom. 2007, 76 (2): 106-114. 10.1159/000097969.CrossRefPubMed
29.
Schubert TW, Otten S: Overlap of self, ingroup and outgroep, Pictorial measures of self-categorization. Self & Identity. 2002, 1: 353-376. 10.1080/152988602760328012.CrossRef
30.
Row AC, Carnelley KB: Preliminary support for the use of a hierarchical mapping technique to examine attachment networks. Pers Relat. 2005, 12: 499-519. 10.1111/j.1475-6811.2005.00128.x.CrossRef
31.
Armstrong DS: Emotional distress and prenatal attachment in pregnancy after perinatal loss. J Nurs Scholarsh. 2002, 34 (4): 339-345. 10.1111/j.1547-5069.2002.00339.x.CrossRefPubMed
32.
Condon JT: The parental–foetal relationship: A comparison of male and female expectant parents. J Psychosom Obstet Gynecol. 1985, 4 (4): 271-284. 10.3109/01674828509016729.CrossRef
33.
Mercer RT, Ferketich S, May K, DeJoseph J: Further exploration of maternal and paternal fetal attachment. Res Nurs Heal. 1988, 11 (2): 83-95. 10.1002/nur.4770110204.CrossRef
34.
Lorensen M, Wilson ME, White MA: Norwegian families: Transition to parenthood. Health Care Women Int. 2004, 25 (4): 334-348. 10.1080/07399330490278394.CrossRefPubMed
35.
Ustunsoz A, Guvenc G, Akyuz A, Oflaz F: Comparison of maternal-and paternal-fetal attachment in Turkish couples. Midwifery. 2010, 26 (2): e1-e9. 10.1016/j.midw.2009.12.006.CrossRefPubMed
36.
Wilson ME, White MA, Cobb B, Curry R, Greene D, Popovich D: Family dynamics, parental-fetal attachment and infant temperament. J Adv Nurs. 2000, 31 (1): 204-210. 10.1046/j.1365-2648.2000.01245.x.CrossRefPubMed
37.
White MA, Wilson ME, Elander G, Persson B: The Swedish family: Transition to parenthood. Scand J Caring Sci. 1999, 13 (3): 171-176.CrossRefPubMed
38.
Ferketich SL, Mercer RT: Paternal-infant attachment of experienced and inexperienced fathers during infancy. Nurs Res. 1995, 44 (1): 31-37.CrossRefPubMed
39.
Sorensen DS, Schuelke P: Fantasies of the unborn among women. MCN: Am J Matern Child Nurs. 1999, 24: 92-97. 10.1097/00005721-199903000-00009.
40.
41.
Lerum CW, LoBiondo Wood G: The relationship of maternal age, Quickening, and Physical Symptoms of Pregnancy to the Development of Maternal Fetal Attachment. Birth. 1989, 16 (1): 13-17. 10.1111/j.1523-536X.1989.tb00848.x.CrossRefPubMed
42.
Lindgren K: Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Heal. 2001, 24 (3): 203-217. 10.1002/nur.1023.CrossRef
43.
Zachariah R: Maternal-fetal attachment: influence of mother-daughter and husband-wife relationships. Res Nurs Heal. 1994, 17 (1): 37-44. 10.1002/nur.4770170106.CrossRef
44.
McMahon CA, Boivin J, Gibson FL, Hammarberg K, Wynter K, Saunders D, Fisher J: Age at first birth, mode of conception and psychological wellbeing in pregnancy: findings from the parental age and transition to parenthood. Hum Reprod. 2011, 26: 1389-1398. 10.1093/humrep/der076.CrossRefPubMed
45.
Maas AJBM, Vreeswijk CMJM, De Cock ESA, Rijk CHAM, Van Bakel HJA: “Expectant Parents”: Study protocol of a longitudinal study concerning prenatal (risk) factors and postnatal infant development, parenting, and parent-infant relationships. BMC Pregnancy Childbirth. 2012, 12: 46-10.1186/1471-2393-12-46. 10.1186/1471-2393-12-46CrossRefPubMedPubMedCentral
46.
Cannella BL: Maternal-fetal attachment: an integrative review. J Adv Nurs. 2005, 50 (1): 60-68. 10.1111/j.1365-2648.2004.03349.x.CrossRefPubMed
47.
Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL: A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Stud. 2009, 46 (5): 708-715. 10.1016/j.ijnurstu.2008.10.013.CrossRefPubMed
48.
Colpin H, De Munter A, Nys K, Vandemeulebroecke L: Prenatal attachment in future parents of twins. Early Development and Parenting. 1998, 7 (4): 223-227. 10.1002/(SICI)1099-0917(199812)7:4<223::AID-EDP184>3.0.CO;2-7.CrossRef
49.
Slade A, Cohen LJ, Sadler LS, Miller M: The psychology and psychopathology of pregnancy: Reorganization and transformation. Handbook of infant mental health. Edited by: Zeanah CHJr. 2009, New York, NY US: Guilford Press, 22-39. 3
50.
Harpel TS, Hertzog J: “I thought my heart would burst”: The role of ultrasound technology on expectant grandmotherhood. J Fam Issues. 2010, 31 (2): 257-274.CrossRef
51.
Draper J: Men's passage to fatherhood: An analysis of the contemporary relevance of transition theory. Nurs Inq. 2003, 10 (1): 66-78. 10.1046/j.1440-1800.2003.00157.x.CrossRefPubMed
52.
Mitchell LM: Baby's first picture: Ultrasound and the politics of fetal subjects. 2001, Toronto, Canada: University of Toronto Press
53.
Alhusen JL: A literature update on maternal-fetal attachment. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2008, 37: 315-328. 10.1111/j.1552-6909.2008.00241.x.CrossRef
54.
Weingarten CT, Baker K, Manning W, Kutzner SK: Married mothers' perceptions of their premature or term infants and the quality of their relationships with their husbands. J Obstet Gynecol Neonatal Nurs. 1990, 19 (1): 64-73. 10.1111/j.1552-6909.1990.tb02526.x.CrossRefPubMed
55.
Hoffenkamp HN, Tooten A, Hall RAS, Croon M, Braeken J, Winkel FW, Vingerhoets AJJM, Van Bakel HJA: The Impact of Premature Childbirth on Parental Bonding. Evol Psychol. 2012, 10 (3): 542-561.CrossRefPubMed
56.
Russell JA, Weiss A, Mendelsohn GA: Affect-grid: A single-item scale of pleasure and arousal. J Personal Soc Psychol. 1989, 57: 493-502.CrossRef
Metadata
Title
Pictorial representation of attachment: measuring the parent-fetus relationship in expectant mothers and fathers
Authors
Hedwig JA van Bakel
A Janneke BM Maas
Charlotte MJM Vreeswijk
Ad JJM Vingerhoets
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2013
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-13-138

Other articles of this Issue 1/2013

BMC Pregnancy and Childbirth 1/2013 Go to the issue

Research article

Vitamin D intake in mid-pregnancy and child allergic disease – a prospective study in 44,825 Danish mother-child pairs

Research article

Comparison of placental growth factor and fetal flow Doppler ultrasonography to identify fetal adverse outcomes in women with hypertensive disorders of pregnancy: an observational study

Debate

A strategy for reducing maternal and newborn deaths by 2015 and beyond

Research article

Epidemiology of hepatitis B and hepatitis C virus infections in pregnant women in Sana’a, Yemen

Research article

Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study

Research article

A structured review and exploration of the healthcare costs associated with stillbirth and a subsequent pregnancy in England and Wales