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 ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships

Authors: Judi Walsh, Erica G Hepper, Benjamin J Marshall

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

Background

Maternal-fetal relationships have been associated with psychosocial outcomes for women and children, but there has been a lack of conceptual clarity about the nature of the maternal relationship with the unborn child, and inconsistent findings assessing its predictors. We proposed and tested a model whereby maternal-fetal relationship quality was predicted by factors relating to the quality of the couple relationship and psychological health. We hypothesized that the contribution of individual differences in romantic attachment shown in past research would be mediated by romantic caregiving responsiveness, as maternal-fetal relationships reflect the beginnings of the caregiving system.

Methods

258 women in pregnancy (13, 23, and 33-weeks gestation) completed online measures of attachment to partner, caregiving responsiveness to partner, mental health, and thoughts about their unborn baby. Structural equation modeling was used to test a model of maternal-fetal relationships.

Results

Maternal-fetal relationship quality was higher for women at 23-weeks than 13-weeks gestation. Women in first pregnancies had higher self-reported scores of psychological functioning and quality of maternal-fetal relationships than women in subsequent pregnancies. Structural equation models indicated that the quality of the maternal-fetal relationship was best predicted by romantic caregiving responsiveness to partner and women's own psychological health, and that the association between adult romantic attachment avoidance and maternal-fetal relationships was fully mediated by caregiving responsiveness to partner, even after controlling for other factors. These data support the hypothesis that maternal-fetal relationships better reflect the operation of the caregiving system than the care-seeking (i.e., attachment) system.

Conclusions

Models of maternal-fetal relationships and interventions with couples should consider the role of caregiving styles of mothers to partners and the relationship between expectant parents alongside other known predictors, particularly psychological health.
Appendix
Available only for authorised users
Literature
1.
Lindgren K: Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health. 2001, 24 (3): 203-217. 10.1002/nur.1023.CrossRefPubMed
2.
Siddiqui A, Hagglof 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
3.
White MA, Wilson ME, Elander G, Persson B: The Swedish family: transition to parenthood. Scand J Caring Sci. 1999, 13 (3): 171-176. 10.1111/j.1471-6712.1999.tb00536.x.CrossRefPubMed
4.
Crawford A, Benoit D: Caregivers' disrupted representations of the unborn child predict later infant-caregiver disorganized attachment and disrupted interactions. Infant Ment Health J. 2009, 30 (2): 124-144. 10.1002/imhj.20207.CrossRef
5.
Green J, Goldwyn R: Annotation: attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood. J Child Psychol Psychiatry Allied Discip. 2002, 43 (7): 835-846. 10.1111/1469-7610.00102.CrossRef
6.
7.
Bryan AA: Enhancing parent-child interaction with a prenatal couple intervention. MCN Am J Matern Child Nurs. 2000, 25 (3): 139-144. 10.1097/00005721-200005000-00007.CrossRefPubMed
8.
Carson K, Virden S: Can prenatal teaching promote maternal attachment? Practicing nurses test Carter-Jessop's prenatal attachment intervention. Health Care Women Int. 1984, 5 (5-6): 355-369. 10.1080/07399338409515666.CrossRefPubMed
9.
Carter-Jessop L: Promoting maternal attachment through prenatal intervention. MCN Am J Matern Child Nurs. 1981, 6 (2): 107-112. 10.1097/00005721-198103000-00009.CrossRefPubMed
10.
Davis MS, Akridge KM: The effect of promoting intrauterine attachment in primiparas on postdelivery attachment. J Obstet Gynecol Neonatal Nurs. 1987, 16 (6): 430-437. 10.1111/j.1552-6909.1987.tb01605.x.CrossRefPubMed
11.
Bloom KC: Perceived relationship with the father of the baby and maternal attachment in adolescents. J Obstet Gynecol Neonatal Nurs. 1998, 27 (4): 420-430. 10.1111/j.1552-6909.1998.tb02666.x.CrossRefPubMed
12.
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
13.
Condon JT, Corkindale C: The correlates of antenatal attachment in pregnant women. Br J Med Psychol. 1997, 70: 359-372. 10.1111/j.2044-8341.1997.tb01912.x.CrossRefPubMed
14.
Siddiqui A, Hagglof B, Eisemann M: Own memories of upbringing as a determinant of prenatal attachment in expectant women. J Reprod Infant Psychol. 2000, 18 (1): 67-74. 10.1080/02646830050001690.CrossRef
15.
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
16.
Mikulincer M, Florian V: Maternal-fetal bonding, coping strategies, and mental health during pregnancy - the contribution of attachment style. J Soc Clin Psychol. 1999, 18 (3): 255-276. 10.1521/jscp.1999.18.3.255.CrossRef
17.
Mercer RT, Ferketich S, May K, Dejoseph J, Sollid D: Further exploration of maternal and paternal fetal attachment. Res Nurs Health. 1988, 11 (2): 83-95. 10.1002/nur.4770110204.CrossRefPubMed
18.
Zachariah R: Maternal-fetal attachment- Influence of mother-daughter and husband-wife relationships. Res Nurs Health. 1994, 17 (1): 37-44. 10.1002/nur.4770170106.CrossRefPubMed
19.
Brennan KA, Clark CL, Shaver PR: Self-Report Measurement of Adult Attachment: An Integrative Overview. Attachment Theory and Close Relationships. Edited by: Simpson JA, Rholes WS. 1998, Guilford Press, New York, NY, US, 46-76.
20.
Mikulincer M, Shaver PR: Attachment in Adulthood: Structure, Dynamics, and Change. 2007, Guilford Press, New York, NY, US
21.
Rholes WS, Simpson JA, Blakely BS, Lanigan L, Allen EA: Adult attachment styles, the desire to have children, and working models of parenthood. J Pers. 1997, 65 (2): 357-385. 10.1111/j.1467-6494.1997.tb00958.x.CrossRefPubMed
22.
Rholes WS, Simpson JA, Friedman M: Avoidant attachment and the experience of parenting. Pers Soc Psychol Bull. 2006, 32 (3): 275-285. 10.1177/0146167205280910.CrossRefPubMed
23.
Wilson CL, Rholes WS, Simpson JA, Tran S: Labor, delivery, and early parenthood. Pers Soc Psychol Bull. 2007, 33 (4): 505-518. 10.1177/0146167206296952.CrossRefPubMed
24.
Cranley MS: Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981, 30 (5): 281-284. 10.1097/00006199-198109000-00008.CrossRefPubMed
25.
Facello DC: Maternal/Fetal Attachment: Associations Among Family Relationships, Maternal Health Practices, and Antenatal Attachment. PhD Dissertation. 2008, West Virginia University, Morgantown
26.
Seimyr L, Sjogren B, Welles-Nystrom B, Nissen E: Antenatal maternal depressive mood and parental-fetal attachment at the end of pregnancy. Arch Womens Ment Health. 2009, 12 (5): 269-279. 10.1007/s00737-009-0079-0.CrossRefPubMed
27.
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
28.
Condon JT: The assessement of antenatal emotional attachment - Development of a questionnaire instrument. Br J Med Psychol. 1993, 66: 167-183. 10.1111/j.2044-8341.1993.tb01739.x.CrossRefPubMed
29.
Van den Bergh B, Simons A: A review of scales to measure the mother-foetus relationship. J Reprod Infant Psychol. 2009, 27 (2): 114-126. 10.1080/02646830802007480.CrossRef
30.
Walsh J: Definitions matter: If maternal-fetal relationships are not attachment, what are they?. Arch Womens Ment Health. 2010, 13 (5): 449-451. 10.1007/s00737-010-0152-8.CrossRefPubMed
31.
Sandbrook SP, Adamson-Macedo EN: Maternal-fetal attachment: searching for a new definition. Neuroendocrinol Lett. 2004, 25: 169-182.PubMed
32.
Bowlby J: Attachment and Loss: Vol 1. Attachment. 1969, Basic Books, New York
33.
Ainsworth MDS, Blehar MC, Waters E, Wall S: Patterns of Attachment: A Psychological Study of the Strange Situation. 1978, Lawrence Erlbaum, London
34.
Solomon J, George C: Defining the caregiving system: toward a theory of caregiving. Infant Ment Health J. 1996, 17 (3): 183-197. 10.1002/(SICI)1097-0355(199623)17:3<183::AID-IMHJ1>3.0.CO;2-Q.CrossRef
35.
Redshaw M, Martin C: Babies, `bonding' and ideas about parental `attachment'. J Reprod Infant Psychol. 2013, 31 (3): 219-221. 10.1080/02646838.2013.830383.CrossRef
36.
Feeney BC, Collins NL: Predictors of caregiving in adult intimate relationships: an attachment theoretical perspective. J Pers Soc Psychol. 2001, 80 (6): 972-994. 10.1037/0022-3514.80.6.972.CrossRefPubMed
37.
Kunce LJ, Shaver PR: An attachment-theoretical approach to caregiving in romatic relationships. Adv Pers Relationships. 1994, 5: 205-237.
38.
Millings A, Walsh J: A dyadic exploration of attachment and caregiving in long-term couples. Pers Relat. 2009, 16 (3): 437-453. 10.1111/j.1475-6811.2009.01232.x.CrossRef
39.
George C: Couple relationships and the family system: commentary from a behavioral systems perspective. Attach Hum Dev. 2009, 11 (1): 103-110. 10.1080/14616730802564293.CrossRefPubMed
40.
Selcuk E, Günaydin G, Sumer N, Harma M, Salman S, Hazan C, Dogruyol B, Ozturk A: Self-reported romantic attachment style predicts everyday maternal caregiving behavior at home. J Res Pers. 2010, 44 (4): 544-549. 10.1016/j.jrp.2010.05.007.CrossRef
41.
Dunkel-Schetter C: Maternal stress and preterm delivery. Prenat Neonatal Med. 1998, 3: 39-42.
42.
Rini CK, Dunkel-Schetter C, Wadhwa PD, Sandman CA: Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999, 18 (4): 333-345. 10.1037/0278-6133.18.4.333.CrossRefPubMed
43.
van Bussel JCH, Spitz B, Demyttenaere K: Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord. 2009, 114 (1-3): 232-242. 10.1016/j.jad.2008.07.018.CrossRefPubMed
44.
Sjogren B, Edman G, Widstrom AM, Mathiesen AS, Uvnas-Moberg K: Maternal foetal attachment and personality during first pregnancy. J Reprod Infant Psychol. 2004, 22 (2): 57-69. 10.1080/0264683042000205936.CrossRef
45.
Wei M, Russell DW, Mallinckrodt B, Vogel DL: The experiences in close relationship scale (ECR)-short form: reliability, validity, and factor structure. J Pers Assess. 2007, 88 (2): 187-204. 10.1080/00223890701268041.CrossRefPubMed
46.
Feeney JA: Attachment, caregiving, and marital satisfaction. Pers Relat. 1996, 3 (4): 401-416. 10.1111/j.1475-6811.1996.tb00124.x.CrossRef
47.
Stewart AL, Hays RD, Ware JE: The MOS short-form general health survey- reliability and validity in a patient population. Med Care. 1988, 26 (7): 724-732. 10.1097/00005650-198807000-00007.CrossRefPubMed
48.
Brazier JE, Harper R, Jones NMB, Ocathain A, Thomas KJ, Usherwood T, Westlake L: Validating the SF-36 health survey questionnaire- new outcome measure for primary care. Br Med J. 1992, 305 (6846): 160-164. 10.1136/bmj.305.6846.160.CrossRef
49.
Kline RB: Principles and Practice of Structural Equation Modeling. 2005, Guilford Press, New York, NY, US, 2
50.
Hu LT, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999, 6 (1): 1-55. 10.1080/10705519909540118.CrossRef
51.
Bollen KA: Structural Equations With Latent Variables. 1989, John Wiley & Sons, Oxford, EnglandCrossRef
52.
Ullman JB: Structural Equation Modeling. Using Multivariate Statistics. Edited by: Tabachnick BG, Fidell LS. 2001, Allyn & Bacon, New York, 653-771. 4
53.
Byrne BM: Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming. 2010, Routledge, New York, NY, 2
54.
Cheung GW, Rensvold RB: Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equation Model. 2002, 9 (2): 233-255. 10.1207/S15328007SEM0902_5.CrossRef
55.
Mikulincer M, Shaver PR: Adult Attachment and Caregiving: Individual Differences in Providing a Safe Haven and Secure Base to Others. Moving Beyond Self-Interest: Perspectives from Evolutionary Biology, Neuroscience, and the Social Sciences. Edited by: Brown SL, Brown M, Penner LA. 2012, Oxford University Press, New York, 39-52.
56.
George C, Solomon J: The Caregiving System: A Behavioral Systems Approach to Parenting. Handbook of Attachment: Theory, Research, and Clinical Applications. Edited by: Cassidy J, Shaver PR. 2008, Guilford Press, New York, NY, US, 833-856. 2
57.
Collins NL, Guichard AC, Ford MB, Feeney BC: Responding to Need in Intimate Relationships: Normative Processes and Individual Differences. Dynamics of Romantic Love: Attachment, Caregiving, and sex. Edited by: Mikulincer M, Goodman G. 2006, Guilford Press, New York, NY, US, 149-189.
58.
Feeney BC, Collins NL: Motivations for caregiving in adult intimate relationships: Influences on caregiving behavior and relationship functioning. Pers Soc Psychol Bull. 2003, 29 (8): 950-968. 10.1177/0146167203252807.CrossRefPubMed
59.
Berant E, Mikulincer M, Shaver PR: Mothers' attachment style, their mental health, and their children's emotional vulnerabilities: A 7-year study of children with congenital heart disease. J Pers. 2008, 76 (1): 31-65. 10.1111/j.1467-6494.2007.00479.x.CrossRefPubMed
60.
Mikulincer M, Shaver PR: Adult Attachment and Affect Regulation. Handbook of Attachment: Theory, Research, and Clinical Applications. Edited by: Cassidy J, Shaver PR. 2008, Guilford Press, New York, NY, US, 503-531. 2
61.
Condon JT, Esuvaranathan V: The influence of parity on the experience of pregnancy- a comparison of 1st-time and 2nd-time expectant couples. Br J Med Psychol. 1990, 63: 369-377. 10.1111/j.2044-8341.1990.tb01632.x.CrossRefPubMed
62.
Cowan CP, Cowan PA: Interventions to ease the transition to parenthood- why they are needed and what they can do. Fam Relat. 1995, 44 (4): 412-423. 10.2307/584997.CrossRef
63.
Shaver PR, Mikulincer M, Shemesh-Iron M: A Behavioral-Systems Perspective on Prosocial Behavior. Prosocial Motives, Emotions, and Behavior: The Better Angels of our Nature. Edited by: Mikulincer M, Shaver PR. 2010, American Psychological Association, Washington, DC, US, 72-91.
64.
Walsh J, Hepper EG, Bagge SR, Wadephul F, Jomeen J: Maternal-fetal relationships and psychological health: emerging research directions. J Reprod Infant Psychol. 2013, 31 (5): 490-499. 10.1080/02646838.2013.834311.CrossRef
65.
Bifulco A, Moran P, Jacobs C, Bunn A: Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attach Hum Dev. 2009, 11 (1): 69-85. 10.1080/14616730802500826.CrossRefPubMed
66.
Cowan PA, Cowan CP: Couple relationships: a missing link between adult attachment and children's outcomes. Attach Hum Dev. 2009, 11 (1): 1-4. 10.1080/14616730802500149.CrossRefPubMed
67.
Halford WK, Petch J: Couple psychoeducation for new parents: observed and potential effects on parenting. Clin Child Fam Psychol Rev. 2010, 13 (2): 164-180. 10.1007/s10567-010-0066-z.CrossRefPubMed
Metadata
Title
Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships
Authors
Judi Walsh
Erica G Hepper
Benjamin J Marshall
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-014-0383-1

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

Efficacy of prenatal ultrasonography in diagnosing urogenital developmental anomalies in newborns

Research article

Improving interprofessional coordination in Dutch midwifery and obstetrics: a qualitative study

Research article

Prevalence and determinants of unintended childbirth in Ethiopia

Research article

Birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia

Research article

Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey

Debate

Routine administration of Anti-D: the ethical case for offering pregnant women fetal RHDgenotyping and a review of policy and practice