Psychosocial Adaptation to Pregnancy Regina Lederman • Karen Weis Psychosocial Adaptation to Pregnancy Seven Dimensions of Maternal Role Development Third Edition Regina Lederman Karen Weis University of Texas United States Air Force Galveston, TX School of Aerospace USA Medicine, Brooks-City Base [email protected] TX, USA [email protected] [email protected] [email protected] 1st Ed., Prentice Hall - November 1984 2nd Ed., Churchill Livingstone (Springer Publishing) - 1 Mar 1996 ISBN 978-1-4419-0287-0 e-ISBN 978-1-4419-0288-7 DOI 10.1007/978-1-4419-0288-7 Springer Dordrecht Heidelberg London New York Library of Congress Control Number: 2009933092 © Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface The subject of this book is the psychosocial development of gravid women, both primigravid and multigravid women. Seven personality dimensions, or develop- mental challenges, are discussed and intended to serve as a guide for understanding and assessing the gravidas’ adaptation to pregnancy and expectant parenthood. The book is an outgrowth of research projects 1 that investigated the relationship of maternal psychosocial adaptation in pregnancy to maternal anxiety and labor prog- ress during childbirth, to prenatal and parturition obstetric complications, to newborn birthweight, and to maternal and infant postpartum adaptation. Verbatim statements made by the women who participated in the study are used throughout the text to provide examples of good and poor adaptation for each dimension. The excerpts from prenatal interviews illustrate specific conflicts and fears, as well as methods used to cope with them, which are also indicative of levels of adaptation. The chapters have been expanded to incorporate recent literature and research results in the analysis and interpretation of interview statements, with examples of good, moderate, and low maternal adaptation for each dimension. The items on interview schedules and on a subsequently developed question- naire were specifically designed to assess the universal aspects of each personality dimension. Questionnaire scales to assess the prenatal dimensions have consis- tently produced reliable and valid results over time in different cultures, socioeco- nomic classes, and family constellations. Furthermore, there has been limited advancement in the development of theory or alternative theories to explicate maternal psychosocial development or adapta- tion during pregnancy. For these reasons, the original theoretical model and the results obtained with interview and questionnaire assessment remain current and significant to date, and are utilized in this third edition. Research results over the past 30 years support the validity and significance of the personality dimensions. These results and an overview of each dimension are 1 The research projects were supported by grant awards from: (1) the Division of Nursing, Bureau of Health Professions, Health Resources and Service Administration, U.S. Public Health Service, (2) the American Nurses’ Foundation, (3) the Committee on Research, The University of Texas Medical Branch, (4) the Research Advisory Council of the UTMB School of Nursing, and (5) the Triservice Nursing Research Program. v vi Preface presented in the Introduction (Chapter 1). The focus of Chapter 1 is twofold: (1) to present the research foundations for the psychophysiological correlates of prenatal psychosocial adaptation and the seven prenatal personality dimensions with progress in labor and birth outcomes, and particularly (2) to present the theory underlying the seven dimensions of prenatal psychosocial adaptation, which are further analyzed in the following seven chapters. Chapters 2–8 present a content analysis of the interview responses to the seven significant prenatal personality dimensions that are predictive of pregnancy adapta- tion, progress in labor, birth outcomes, and postpartum maternal psychosocial adaptation, and they include: (1) Acceptance of Pregnancy, (2) Identification with a Motherhood Role, (3) Relationship with Mother, (4) Relationship with Husband, (5) Preparation for Labor, (6) (Prenatal) Fear of Pain, Helplessness, and Loss of Control in Labor, and (7) (Prenatal) Fear of Loss of Self-Esteem in Labor. There is no other comparable comprehensive, in-depth, prenatal personality research or empirical and content analysis of pregnancy-specific dimensions of maternal psychosocial adaptation to pregnancy. Chapter 9 provides the findings and discussion of a longitudinal military research project that followed 421 wives of military service members and active duty women through each trimester of pregnancy and delivery. The chapter presents the impact of family flexibility and emotional-esteem building support from a com- munity network on prenatal maternal psychosocial adaptation. The impact of mili- tary deployment on maternal adaptation is briefly discussed. Lastly, 113 women from the original 421 were followed through 6 months postpartum. The capability of the Prenatal Self-Evaluation Questionnaire to predict 6-month maternal postpar- tum satisfaction and confidence with being a mother is presented. Chapter 10 provides a discussion of the particular developmental and adaptive characteristics of multigravid women pregnant with their second or subsequent child, in contrast to the developmental and adaptive characteristics of primigravi- das, women pregnant for the first time. This chapter is a summary of findings from a longitudinal prenatal research project with multigravid women that replicated and extended the initial research project with primigravidas presented in Chapter 1, and of a subsequent large, longitudinal research project with both primigravidas and multigravidas focusing on the quantitative questionnaire assessment of psychoso- cial adaptation in all the three trimesters of pregnancy. Both quantitative and quali- tative results are presented. The presentation of the qualitative content analysis in Chapter 10 was written with the assistance of Fran Holmes. Chapter 11 presents methods that can be used by professional health care per- sonnel to assess the status of gravid women on each of the personality dimensions. A questionnaire developed to serve as a parallel measure of the interview measures of the seven personality dimensions, the Prenatal Self-Evaluation Questionnaire, also is discussed in Chapter 11, and reliability and validity data of results obtained in research projects are presented. Chapter 1 focuses on early and continued research findings supporting the theory and significance of maternal adaptation to pregnancy, while Chapter 11 focuses on a presentation of psychometric data sup- porting the questionnaire assessment of maternal prenatal psychosocial adaptation Preface vii with the Prenatal Self-Evaluation Questionnaire; the difference in the foci of Chapter 1 and Chapter 11 is not entirely precise and may be considered as a fine line rather than a sharp distinction. A section in Chapter 11 also provides recom- mendations for the clinical and academic researcher. The method utilized in the original research study of psychophysiological cor- relates of progress in labor (in primigravidas) was a descriptive analysis based on interview responses recounted to the researcher during meetings with the women who participated in the project. The instruments used in the research project, the interview schedules, and the detailed rating scales for the assessment of personality dimensions are in Appendices A and B. The authors suggest that the readers first peruse the interview questions and the rating scales to become acquainted with the scope of inquiry and the method of assessment that underlies the content analysis of the personality dimensions presented in Chapters 2–8. The analysis of each personality dimension and the identification of subfactors provide a theoretical framework for each developmental construct. Within this framework, it is possible to distinguish adaptive and maladaptive behavior, the manifestations of behavior, and progress in development. Thus, the text provides a model for continued study and guidance in assessment and evaluation, which can be incorporated into clinical practice and research investigations. The book also provides more than a descriptive narrative of pregnancy adaptation. It includes results and discussion of stress and anxiety in labor, progress in labor, and postpartum maternal and newborn health status. The results of the correlational analysis of the pregnancy, labor, and postpartal data in Chapters 1 and 11 support the significance of each personality dimension, and demonstrate a measure of validity for the interview schedules and the rating scale instrument,