PREGNANT WOMEN'S RECOLLECTIONS OF EARLY MATERNAL BONDING: ASSOCIATIONS WITH MATERNAL-FETAL ATTACHMENT AND BIRTH CHOICES.

Recollections of own maternal care measured by parental bonding were found to be important in the pregnant woman's construction of herself as a mother. Although these recollections were studied with regard to various variables, there is a dearth of studies associated with pregnancy and childbirth. In this cross-sectional study, 341 pregnant women were recruited. Measures included a Sociodemographics-Obstetric History Questionnaire; the Childbirth Choices Questionnaire (H. Preis, M. Gozlan, U. Dan, & Y. Benyamini, 2018); the Parental Bonding Instrument (G. Parker, H. Tupling, & L.B. Brown, 1979); a question regarding the planned presence of the woman's mother at delivery; and the Maternal-Fetal Attachment Scale (M.S. Cranley, 1981). Parental recollections of Care were associated with fewer natural birth choices (hence, a more "medicalized" delivery), lower maternal-fetal attachment, and a wish for the mother's mother to be present at the birth. Parental recollections of Encouragement of Behavioral Freedom in childhood were associated with more natural choices regarding childbirth. In addition, women with higher scores on the parental bonding Denial of Autonomy factor reported stronger maternal-fetal attachment. Thus, early recollections of experiences with caregivers as manifested in parental bonding may be a possible influence on the transition to motherhood, and working through possible difficulties associated with these recollections may improve adjustment to motherhood.

A quantitative investigation into women's basic beliefs about birth and planned birth choices.

OBJECTIVE: Perceptions about the nature of the birth process are important in determining women's birth choices regarding labour and delivery but are scarcely the subject of empirical research. The aim of the current study was to assess women's beliefs about birth as a natural and safe or medical and risky process and study the associations of these beliefs with fear of childbirth and planned birth choices. DESIGN: An observational study using self-administered questionnaires during pregnancy. SETTING: 1. Community women's health centres in a metropolitan area in Israel; 2. Purposeful sampling of women who plan to birth naturally, through home midwives and targeted internet forums. PARTICIPANTS: 746 women with a singleton pregnancy in their second and third trimester. MEASUREMENTS: Beliefs about birth as a natural and a medical process, fear of childbirth, and a range of natural birth choices. FINDINGS: The birth beliefs were associated with women's birth intentions. The more women believed birth to be natural and the less they believed it to be medical, the more likely they were to make more natural birth-related choices. In the presence of the birth beliefs, fear of childbirth no longer had an independent association with birth choices. The beliefs interacted with each other, revealing a stronger association of viewing birth as natural with planning more natural choices among women who did not view birth as very medical. KEY CONCLUSION: It is important to recognize women's beliefs about birth and how they may affect their fear of childbirth and birth intentions. Further studies on the origin of such beliefs and their development are needed. IMPLICATIONS FOR PRACTICE: Women should be allowed to choose how they would like to birth in accordance with their beliefs. At the same time, strengthening women's belief in the natural birth process and their body's ability to perform it, could help lower fear of childbirth and medical intervention rates.

Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture.

PURPOSE: Infertility could be highly stressful, particularly in a pronatalist culture. We aimed to develop the concept and a measure of normalization (maintaining normal life routines and feeling "normal") as a strategy that could enable women with infertility maintain their quality of life (QoL) while coping with this condition. We tested its associations with women's well-being, distress and QoL in Israel, where being childless is socially unacceptable and highly stigmatized. METHODS: One-hundred and eighty Israeli women undergoing infertility treatment at a fertility community clinic filled in questionnaires assessing normalization-related coping strategies, QoL, and psychological adjustment (distress, wellbeing). Eight months later, 55 women conceived; 55 women who had not conceived completed a second questionnaire. RESULTS: At baseline, normalization was related to higher QoL and better adjustment. Structural equation modeling showed that QoL was impaired mainly among women who felt different than others, compared, and blamed themselves. Over time, normalization was overall unrelated to conception or to changes in adjustment yet was protective against decrease in well-being among women who already had a child. CONCLUSIONS: Infertility is highly stressful in a pronatalist culture like Israel. It requires treatment yet is not disabling. Patients who manage to maintain normal routines and not feel different than other people their age may experience better QoL and psychological adjustment.

Women's attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth.

PROBLEM: Rates of medical interventions in childbirth have greatly increased in the Western world. BACKGROUND: Women's attitudes affect their birth choices. AIM: To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. METHODS: This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at <28 weeks gestation when filling in the questionnaire were asked to fill in a second one at ∼34 weeks. Phone follow-up was conducted ∼6 weeks postpartum to assess actual mode of birth. FINDINGS: Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. DISCUSSION: Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. CONCLUSION: Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth.

Women's and men's perceptions of infertility and their associations with psychological adjustment: a dyadic approach.

OBJECTIVES: Research on illness perceptions and their associations with psychological adjustment to medical conditions has mostly focused on individuals coping with chronic diseases. The objective of the current study was to expand this research to the study of couples by examining the perceptions of infertility among couples undergoing treatment and their associations with each partner's psychological adjustment. DESIGN: The study was cross-sectional and included two samples that differed in the stage of treatment: Sample 1 included 72 couples at their first visit to an infertility clinic and Sample 2 included 49 couples at various stages of treatment. METHODS: Participants filled in the Illness Perception Questionnaire regarding the timeline, consequences and controllability of their fertility problem and Infertility-Specific Distress and Well-being Scales. Dyadic analyses were conducted on the basis of the Actor-Partner Interdependence Model (APIM). RESULTS: The partners differed in their perceptions of infertility and their distress. Partners' psychological adjustment was related to their perceptions of the fertility problem. Among couples at their first visit, perceptions of consequences of both partners were additively related to their distress whereas controllability perceptions interacted in their association with women's distress: Highest distress was reported by women who perceived low controllability whereas their partner perceived high controllability, compared with couples who reported similar (high or low) levels of controllability. CONCLUSIONS: A dyadic approach to studying illness perceptions can uncover patterns of couples at risk for poor adjustment. This is especially needed in contexts such as infertility, where both partners are involved and affected by the health threat.

Coping specificity: the case of women coping with infertility treatments.

Customizing the measurement of coping to a specific situation can answer some of the concerns regarding its measurement by checklist. A context-specific measure of coping with infertility was developed on the basis of theoretical principles of coping, interviews with women and providers, and existing findings. Data on the resulting Coping with Infertility questionnaire was collected from 652 Israeli women undergoing treatment and meta-strategies of coping were identified on the basis of a hierarchical structure of the coping subscales. About half of the women also filled in adjustment measures and findings showed differential associations of coping strategies to negative and positive indicators of psychological adjustment. Taking into account coping specificity can highlight strategies that function in ways that are unique to the context. This approach could be useful as a step in the assessment and understanding of coping with a specific health threat, which can guide further research and interventions designed to improve coping effectiveness.

Variability in the difficulties experienced by women undergoing infertility treatments.

OBJECTIVE: To identify the variety and extent of difficulties experienced by infertile women. DESIGN: A cross-sectional survey study. SETTING: A regional infertility clinic. PATIENT(S): Two hundred forty-two women undergoing evaluation and treatment of fertility problems, mostly at the initial stages of treatment. INTERVENTION(S): List of difficulties administered along with infertility distress and well-being scales. MAIN OUTCOME MEASURES: Infertility distress and well-being measures. RESULT(S): Twenty-two difficulties resulting from infertility and its treatment were identified. Findings show great variability among women in the extent to which they experience these difficulties. Greater experience of difficulties was related to more distress and lower well-being. Some difficulties were lower for mothers of two or more children, yet even mothers of one child experienced difficulties that were mostly at similar levels to those reported by childless women. CONCLUSION(S): It is important to be aware of the great variability among women in their experience of infertility. The list of difficulties identified here, or similar lists identified using this procedure, could assist health care providers and psychosocial counselors in identifying misperceptions of difficulties that result in communication gaps between patients and providers and between patients and spouses.