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Introduction: Pregnant women increasingly expect to be involved in decisions about their care in collaboration with their clinicians. This involves a of sharing information, knowledge, experience and values, by both the woman and the clinician in order to make decisions together. Shared decision making is especially pertinent in the management of pain in labour where there are many options available, with varying degrees of evidence and acceptability. Pregnancy and childbirth is a context in which the appropriateness of shared decision making has been yet to be thoroughly investigated. Objectives: The key objectives of this research are as follows: · To carry out a systematic literature review covering women’s experience of labour and of pain relief in labour; · To ascertain the views and expectations of various groups of women and professionals using qualitative methodology in order to develop appropriate decision support; · To develop the most appropriate decision support for choice of pain relief in labour in order to assist women in the decision making process. Methods A qualitative approach was used to gain an in-depth perspective of the experience of women and professionals. Semi-structured interviews were conducted with women at various stages of their pregnancy and during their post natal period, whilst focus groups were undertaken with obstetricians, anaesthetists, delivery suite and community midwives. Data were transcribed verbatim and analysed using the principles of the constant comparison method. My analysis was informed by my relativist approach to my work, understanding that there are multiple realities which need to be examined to gain a full understanding of shared decision making in this context. The themes that emerged were used to identify the issues that were important to the two groups. Results: The three key result areas identified were:- 1. Discordance between expectations and realities. Discordance was identified between what women expected in areas such as how painful and how long labour would be, as well as in what support would be provided for example. There was also discordance between what the professionals said they told women and the information women wanted; 2. Information. Despite the information provision professionals still felt that women were generally unprepared for labour. This ill preparation pointed to information that did not answer questions women were asking, was presented at times when women were not receptive and in a format that was not appropriate; 3. Values. At no point in pregnancy were women routinely asked what was important to them regarding their labour in relation to pain relief. Understanding a woman’s values would allow a midwife to offer options of pain relief and support that were congruent with these values, thus helping the woman achieve the birth she hoped for. Discussion: The information needs of both women and professional’s needs to be recognised to ensure that woman have access to sufficient detail to enable them to engage in decision making. The information should be delivered in a format and at a time which is acceptable to the women and which translates into knowledge. During the antenatal preparation of women it is important for midwives to support women in clarifying what is important them – their values. Clarification of a woman’s values will enable the healthcare professionals to discuss options that fit with women’s values and ensure they receive the support they desire during labour. I propose that during pregnancy we need to ensure women are fully informed about their options, the risks and benefits and are clear of their values, but do make a decision antenatally – merely express a preference. This model of antenatal preparation would ensure that a woman was making decisions during labour in reaction to the level of pain she was experiencing based on her knowledge and how these choices related to her values. Women also need to be made aware antenatally that during labour there are elements of unpredictability and events may rapidly become of a more urgent clinical nature. At times of an emerging urgent clinical situation midwives and clinical staff are in a better position to recommend a course of action rather than deliberate options with the woman. Conclusion To support women and healthcare professionals in engaging in shared decision making the following recommendations needs to be considered. The maternity service needs to refine its information provision including the risks and benefits of each option. Provision needs to be made for those women who require enough information to allow them to make informed decision as well as those who require a greater depth of information. Support needs to be developed for midwives and women to allow them to develop new skills to allow engagement in shared decision making. Developing skills for shared decision making early in pregnancy will equip women to make the many decisions they face during pregnancy and once their baby is born. A critical examination of antenatal education provision needs to undertaken to ensure information is being provided at a time and in a format that is both appropriate and accessible to a wide range of women. Responsibility for preparation needs to be made explicit and suitable resources of information accessed and shared. Finally there needs to be a review of the current birth plan, to assess it’s suitability as a tool for assessment of knowledge, clarification of values and communication to support shared decision making. In conclusion the most appropriate way of supporting women is to ensure that, at the beginning of pregnancy, midwives start to prepare women to make decisions by giving them the skills necessary to be involved in shared decision making. This preparation needs to be underpinned by appropriate information delivered in an accessible manner and informed by what is important to the woman.

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The aim of the study was to investigate the validity of postnatal bonding measures in routine clinical practice. Identifying mothers who are having difficulty with postnatal bonding provides the best opportunity to identify attachment problems early, so that intervention can be provided. Currently there are no established ways of measuring postnatal bonding routinely in clinical practice. This study aimed to address the validity of postnatal bonding measures by investigating their relationship with key theoretical constructs (adult attachment relationships, antenatal bonding, depression, social support and Health Visitors' assessment of need). Thirty-eight women were recruited antenatally. They completed questionnaires assessing antenatal attachment, depression symptomology, adult attachment relationships and social support. These participants were followed up after the birth of their baby (mean 16 days old) when they completed further questionnaires assessing postnatal bonding (Mother-ta-Infant Bonding Scale, MIBS; Neonatal Perception Inventory, NPI) and depression. Health Visitors also completed a questionnaire about their assessment of need decisions. Results showed that postnatal bonding measures were related to adult attachment relationships with a participants' mother and partner, and antenatal depression. There were no significant relationships between postnatal bonding measures and the other correlates measured.

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Thesis (M.A. (Clinical Psychology)) -- University of Limpopo, 2012 / Recent research has established that teenagers have the means to prevent pregnancy but many do not necessarily use them, because they are open to the idea of becoming pregnant, or have a desire to parent their own child. The aim of this study was to investigate whether there is a relationship between attachment and teenagers’ desire of becoming pregnant and parenting a child. The sample of the study, selected through convenience sampling, comprised 455, 14 and 15 year old registered female learners from selected urban and rural high schools in Mopani District, Limpopo Province. Findings from structural equation modeling indicate that both mother and father attachment do not influence teenagers’ idealization about pregnancy and parenting. Mother trust had a statistically significant relationship with attitudes towards pregnancy. Trust for both mother and father also had a significant relationship with parental readiness. Alienation to mother had a significant association with teenagers preparedness to become parents. Socio-economic status was found to be associated with teenagers’ idealization of pregnancy and their report of being physically and emotionally ready to become parents. This study has found a relationship between the Trust and Alienation dimensions of attachment with attitudes towards pregnancy and parental readiness. Key words: Attachment; socio-economic status; pregnancy; idealization; parental readiness / Medical Research Council (MRC)

L'étude des interactions précoces est complexe mais essentielle à la compréhension de la psychopathologie de la petite enfance. La négligence émotionnelle est une forme courante mais discrète de maltraitance. Elle correspond à une défaillance chronique de la part du parent à offrir à l'enfant, au sein de leur relation, un environnement affectif suffisamment bon pour son développement. Notre recherche explore les interactions précoces mère-enfant de ces situations de négligence émotionnelle par une approche transdisciplinaire à travers deux dimensions : la synchronie et la mentalisation réflexive maternelle. La synchronie est une caractéristique dyadique et temporelle de l'interaction qui traduit la fluidité et la qualité d'un échange par une adaptation dynamique et réciproque des comportements et états émotionnels des partenaires interactifs. Elle constitue un signal social en soi, facteur de qualité de l'interaction. La mentalisation réflexive, traduction du terme Insightfulness (Oppenheim, 2001), évoque la capacité du parent à prendre le point de vue de l'enfant et à comprendre, de façon empathique, les motivations sous-jacentes à ses comportements. Les objectifs de cette recherche sont (1) d'analyser la dynamique comportementale des interactions précoces en élaborant une méthodologie d'analyse computationnelle et (2) d'évaluer l'influence des capacités maternelles de mentalisation réflexive et notamment de leur dynamique intrapsychique, sur la dynamique interactive, dans les situations de négligence émotionnelle. Des mères et leur enfant de 13 à 38 mois, appartenant au groupe en situation de négligence émotionnelle (N=10) et au groupe contrôle sans trouble des interactions (N=9), sont filmés au cours d'un jeu interactif libre. Les vidéos font l'objet d'une double évaluation clinique et computationnelle. La première permet d'obtenir une évaluation clinique globale de la qualité de l'interaction par le Coding Interactive Behavior (Feldman et Keren 1998; Viaux 2014). La seconde, par les techniques de traitement du signal social, offre l'accès à une micro-analyse computationnelle des mouvements des partenaires et de leurs échanges dyadiques. Dans un second temps, 14 mères (n=7 mères en situation de négligence et n=7 mères sans trouble des interactions) ont visionné des extraits de la vidéo de leurs interactions, au cours d'un entretien semi-structuré, l'Insightfulness Assessment (Oppenheim et Koren-Karie, 2001) afin d'évaluer leurs capacités de mentalisation réflexive. Une analyse additionnelle des verbatim a permis d'accéder à des éléments de la dynamique intrapsychique. Les résultats mettent en évidence de nombreuses corrélations significatives les dimensions du CIB (notamment la sensibilité, l'intrusivité maternelle et la réciprocité dyadique) et la micro-analyse automatique (à travers l'activité du corps de la mère). Par ailleurs, les situations de négligence émotionnelle présentent des difficultés de mentalisation empathique. Les entretiens sont caractérisés par des représentations appauvries de leur enfant et des difficultés d'élaboration autour des affects et de la relation mère enfant. La dynamique intrapsychique, influencée par les problématiques inconscientes, s'associe en partie à la dynamique interactive comportementale. Il apparaît que la compréhension de la qualité de l'interaction peut passer par une observation sur une échelle de temps réduite de la dynamique interactive. Par ailleurs, un entretien avec support vidéo étaye l'élaboration de la mère et favorise une mise en mouvement intrapsychique, pouvant constituer ainsi un levier thérapeutique. / Studying early interaction is complex but essential for understanding psychopathology during infancy. Emotional Neglect is a common but insidious form of child maltreatment. It refers to parental failure to give children an emotional environment that allows adequate psychological, cognitive and physical development. We explore mother-infant interaction in these situations following a transdisciplinary approach which consider Synchrony and Insightfulness. Synchrony is a dynamic and reciprocal adaptation of the temporal structure of behaviour and shared affect between interactive partners. It is regarded as a social signal per se. Insightfulness involves the parents' ability to see things from the child point of view and to empathically think about and consider the motives underlying their childrens' behaviour. The aims of this research are (A) to report a novel method to assess features of interactive behavioral dynamics and (B) to assess/underline the impact of Insighfulness, in particular its dynamics, on interactive behavioral dynamics in case/situations of severe emotional neglect. Mothers and children aged from 13 to 38 months (10 in situation of severe emotional neglect and 10 controls) are video recorded during free play. Features of social signal extract by our automatic computational method are compared to qualitative interaction assessment by using the Coding Interactive Behaviour in its French version (Feldman et Keren 1998; Viaux 2014). Secondly, 14 mothers (7 in situation of emotional neglect and 7 without interaction problem) are interviewed during a video-feedback session by using the Insightfulness Assessment (Oppenheim, Koren-Karie, 2001) to assess Insightfulness. An additional qualitative verbatim analysis was performed to explore intrapsychic dynamics. Self-administered questionnaires (BITSEA and Care Support) are proposed to mothers. Results show that individual and synchrony motion features perfectly correlates CIB composite scores trough maternal sensitivity, intrusivity and dyadic reciprocity. Furthermore, pathological mothers are mostly categorised as non-Insighful. Interviews are characterized by poor representations and a lack of elaboration. Intrapsychic dynamics is partly associated with interactive behavioral dynamics. We conclude that computational method might be promising for future studies. It opens an observation window to understand early interactions by changing the time scale. Moreover, interview with a video support seems to underpin maternal elaboration and enhance an intrapsychic movement.