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published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Thesis (D.N.S.)--Boston University. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (MA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: Pregnancy has evolved from being predominantly understood as a medical phenomenon to what psychoanalytic theorists would regard as a holistic experience encompassing both physiological and psychological changes. According to psychoanalytic theorists, pregnancy is a transitional phase and a time of susceptibility and flux for most women. This often results in psychic turmoil where boundaries between conscious and unconscious process become more permeable. The pregnant woman's dreams and fantasies create an inner working model of relationships and this in tum provides a template of how her relationship with her baby will be experienced and conducted. This link to the unconscious increases insight into the process occurring between the woman and her evolving relationship with the fetus and provides the health professional with clues for early intervention. However care should be taken by health-care professionals to communicate the psychological processes during pregnancy within the cultural framework of the pregnancy mother for positive outcomes to be achieved. / AFRIKAANSE OPSOMMING: Die wyse waarop swangerskap verstaan word het ontwikkel vanaf grotendeels mediese verskynsel na wat die psigoanalitiese teoretici sal beskou as 'n holistiese ervaring wat beide die fisiologiese en die sielkundige veranderinge insluit. Die psigoanalitiese teoretici beskou swangerskap as 'n oorgangs fase en 'n periode van vatbaarheid en veranderlikheid vir die meeste vroue. Dit gee dikwels aanleiding tot psigiese wanorde waar die grense tussen bewustelike en onbewustelike prosesse meer deurdringbaar word. Die swanger vrou se drome en fantasië skep 'n innerlike werkende model van verhoudings en op sy beurt voorsien dit templet van hoe haar verhouding met haar baba ervaar en hanteer sal word. Hierdie band met die onbewustelike verleen insig in die proses wat tussen die vrou en haar ontwikkelende verhouding met die fetus voorkom en voorsien die gesondheids werker van leidrade vir vroeë intervensie. Die gesondheids werker moet egter versigtig wees om die sielkundige prosesse gedurende swangerskap binne die kulturele raamwerk van die swanger moeder te interpreteer om sodoende positiewe uitkomste verkry.

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This study was conducted to determine whether or not a significant difference exists in pregnant women among those receiving therapeutic touch, mock therapeutic touch, or no touch on measurements of anxiety and well-being. Thirty third trimester primigravida subjects were tested pre- and postintervention using the State-Anxiety Inventory and a Well-Being Visual Analog; heart and respiratory rates were monitored before, during, and after the treatment. No significant differences were found using analysis of covariance with the pre-test scores as the covariate. The findings indicate that therapeutic touch may not be useful in reducing state anxiety or enhancing subjective well-being in pregnancy. Study limitations include a small sample size, use of an instrument without established reliability and validity, and a study environment that may have increased anxiety.

Anxiety is common among pregnant and postpartum women. The research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given the health implications of maternal anxiety on the physical and psychological well being of both mothers and their offspring, there is an urgent need to fill the current research gaps. The objectives of the present study were to determine the prevalence of antenatal and postpartum anxiety symptoms; investigate the nature and development of antenatal and postpartum anxiety; clarify the constructs of antenatal anxiety; identify demographic and psychosocial risk factors; and examine the effects of antenatal anxiety on postpartum anxiety and infant development and temperament. A prospective longitudinal design with quantitative approach was adopted in the present study. Pregnant women from two regional hospitals in Hong Kong were invited to participate in the study. They were assessed using standardized and validated psychological instruments on 5 time points including the first, second and third trimesters of pregnancy, 6-weeks and 6-months postpartum. A total sample of 1470 pregnant women was assessed on antenatal general anxiety and postpartum anxiety and hypothesized risk factors. A subset of 186 pregnant women was assessed on pregnancy-specific anxiety and infant temperament and development. The results showed that an appreciable proportion of pregnant women manifested general anxiety symptoms and pregnancy-specific anxiety symptoms during pregnancy. A mixed-effects model analysis for repeated measures showed that both forms of anxiety followed a U-pattern across pregnancy (p<.05 for both), with both being less prevalent in the second trimester. Findings supported that pregnancy-specific anxiety symptoms and general anxiety symptoms are two distinct but inter-related forms of anxiety. Different demographic risk factors for anxiety symptoms vary across different trimesters. Self esteem and marital satisfaction were consistently associated with both general anxiety symptoms and pregnancy-specific anxiety symptoms over the course of pregnancy. Regarding the impact of antenatal anxiety, general anxiety symptoms in the third trimester had the strongest association with postpartum anxiety at 6-weeks postpartum (p<.05). In general, general anxiety symptoms were more strongly associated with postpartum anxiety than pregnancy-specific anxiety symptoms. After adjusting for the effects of postpartum anxiety and depression and other covariates, pregnancy-specific anxiety symptoms were independent predictors for fewer infant’s falling reactivity response (p<.05), greater infant’s fear response (p<.05) and greater distress to limitations (p<.05), whereas general anxiety symptoms were independent predictors for poorer social (p<.05) and speech (p<.05) development. The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem with changing course and has serious impacts on maternal well-being and infant development. General anxiety symptoms and pregnancy-specific anxiety symptoms reflect different pathologies with potentially different pathogeneses and different pathways to postpartum well-being and infant outcomes which deserved further investigation. The present findings contributed to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical problems. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

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Giving birth to a child can have a major impact on a woman's feelings about herself and her newborn, influencing perceptions and interactions, and having both short and long term implications. In this study the effect of an experience of labour and delivery discrepant or not discrepant with expectations on mood and level of distress postpartum were investigated. / Thirty primaparas were pretested on a Labor and Delivery Expectation scale and posttested on an Experience scale two days postpartum. Two mood measures and a Distress scale were administered at this time. The influences of formal preparation for childbirth and of personality variables on the childbirth experience and postpartum mood were also investigated. / It was found that a positive mood and low distress postpartum were related to an experience of labour and delivery better than had been expected. An experience more negative than expected resulted in low mean scores for mood with high distress levels.