Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were:  to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week.  (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion:  In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero.

Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were:  to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week.  (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion:  In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero.

Bakgrund: Hur mödrar knyter an till sitt väntade barn, vad det påverkas av och vad det kan få för konsekvenser samt hur de lär känna sitt barn under graviditeten innefattas av prenatal anknytning. Prenatal anknytning har stor plats inom mödrahälsovården men som begrepp är det relativt odefinierat. Syfte: Syftet var att beskriva begreppet prenatal anknytning genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Begreppet prenatal anknytning resulterar i flera definierade attribut där fosterrörelser har stor del. Andra attribut är interaktion, dela med sig, fantasier och känslor. Referensramen för begreppet bestäms av dess förutsättningar och konsekvenser. Slutsats: Prenatal anknytning kan ses som ett komplext begrepp som anpassas till varje graviditet utifrån de definierade attributen. / Background: Mothers prenatal attachment, what it is influenced by and what the consequences might be and how the mothers experience their child during pregnancy are included in prenatal attachment. The concept is lacking clear definitions. Prenatal attachment has a great part within maternal health care but as a concept it's relatively undefined. Aim: The aim was to describe the concept of prenatal attachment through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed, earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: The concept of prenatal attachment results in defined attributes. Fetal movement was a significant attribute. Other attributes were interaction, sharing, fantasies and emotions. The frame around the concept is set due to its conditions and consequences. Conclusion: Prenatal attachment can be identified as a complex concept adapted to each pregnancy based on the defined attributes.

This study examines the relationship between maternal emotional attachment to the fetus, beliefs about fetal health locus of control, and use of prenatal testing (i.e., amniocentesis and maternal serum screening). To date, no research has directly addressed the link between these psychosocial variables and prenatal testing uptake. Ninety-one pregnant women at risk for fetal abnormalities (i.e., 35 years of age or older) participated in the study, of whom 35 had no testing, 27 had serum screening, and 29 had amniocentesis in their current pregnancy. Results of a hierarchical multiple regression partially supported the hypothesis that internal and powerful others Fetal Health Locus of Control (Labs & Wurtele, 1986) and prenatal testing status would be predictive of attachment (Prenatal Attachment Inventory; Muller, 1993) over and above the effects of gestational age, maternal age and attitude toward abortion. Fetal Health Locus of Control beliefs regarding ones own role (FHLC-I) in determining the health of ones fetus were found to be predictive of prenatal attachment. Results failed to support the hypothesis that the role of health professionals (FHLC-P) would be predictive of prenatal attachment. As predicted, women who had not used prenatal testing or who underwent amniocentesis tended to have stronger prenatal attachment than those who underwent serum screening only. Results supported the hypotheses that stronger attachment to the fetus would be positively correlated with both FHLC-I and FHLC-P scores. Women who had no testing were found to hold less favourable attitudes toward abortion and rate their religious as stronger than those who had amniocentesis. Emotional attachment to the fetus was stronger among women who had previous miscarriages than those who had not, but did not differ between women who had a previous abortion and those who had not.

This study examines the relationship between maternal emotional attachment to the fetus, beliefs about fetal health locus of control, and use of prenatal testing (i.e., amniocentesis and maternal serum screening). To date, no research has directly addressed the link between these psychosocial variables and prenatal testing uptake. Ninety-one pregnant women at risk for fetal abnormalities (i.e., 35 years of age or older) participated in the study, of whom 35 had no testing, 27 had serum screening, and 29 had amniocentesis in their current pregnancy. Results of a hierarchical multiple regression partially supported the hypothesis that internal and powerful others Fetal Health Locus of Control (Labs & Wurtele, 1986) and prenatal testing status would be predictive of attachment (Prenatal Attachment Inventory; Muller, 1993) over and above the effects of gestational age, maternal age and attitude toward abortion. Fetal Health Locus of Control beliefs regarding ones own role (FHLC-I) in determining the health of ones fetus were found to be predictive of prenatal attachment. Results failed to support the hypothesis that the role of health professionals (FHLC-P) would be predictive of prenatal attachment. As predicted, women who had not used prenatal testing or who underwent amniocentesis tended to have stronger prenatal attachment than those who underwent serum screening only. Results supported the hypotheses that stronger attachment to the fetus would be positively correlated with both FHLC-I and FHLC-P scores. Women who had no testing were found to hold less favourable attitudes toward abortion and rate their religious as stronger than those who had amniocentesis. Emotional attachment to the fetus was stronger among women who had previous miscarriages than those who had not, but did not differ between women who had a previous abortion and those who had not.

The present study explored how emotional cushioning (EC) buffered the relationship between grief intensity of perinatal loss and relationship satisfaction among women who have experienced pregnancy after loss. It was hypothesized that higher levels of grief intensity would be negatively associated with relationship satisfaction among women. Additionally, it was hypothesized that higher levels of EC would lessen the negative relationship between grief intensity of perinatal loss and relationship satisfaction among women. Through the use of a hierarchical linear regression, it was determined that grief intensity was not significantly associated with relationship satisfaction and that EC did not serve as a buffer between grief intensity and relationship satisfaction. However, a significant correlation was found between EC and relationship satisfaction. The results of this study can help contribute to the literature by providing more discussion about utilizing systemic approaches for clients who have experienced perinatal loss and pregnancy-related anxiety.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-04-17T16:40:01Z No. of bitstreams: 1 Bárbara Borges Rubin_ok.pdf: 2368899 bytes, checksum: 497278bc48e1249b965937422adc4f01 (MD5) / Made available in DSpace on 2018-04-17T16:40:01Z (GMT). No. of bitstreams: 1 Bárbara Borges Rubin_ok.pdf: 2368899 bytes, checksum: 497278bc48e1249b965937422adc4f01 (MD5) Previous issue date: 2017-12-14 / Introduction: In general, child neurodevelopment can be determined by genetic, social and environmental factors that interact in complex ways. In addition, the development of the fetus is considered the most vulnerable period in this process. Risk behaviors during pregnancy are often observed in women who are not affectively bonding with the fetus, and there is evidence that the relationship of the pregnant woman with the fetus during pregnancy tends to remain stable after birth. It is known that early mother-infant bonding may influence the child's future social, cognitive and emotional development. Objective: To evaluate the relationship between maternal-fetal attachment and child development in children at three months of age. Method: This is a longitudinal study nested in a cohort of pregnant women in the city of Pelotas, Brazil, with pregnant that were evaluated at up to 24 weeks of pregnancy, 60 days after the first assessment and at 90 days postpartum with the children. A questionnaire that contains sociodemographic variables, questions related to the health of the pregnant, the relationship with the child’s father and data on the pregnancy were used; the Maternal-Fetal Attachment Scale to evaluate the quality of the relationship between the pregnant and the fetus; and the Bayley Scales of Infant Development III to assess child development. Results: The main result indicated that, at each increment of 1 point in the Maternal-Fetal Attachment, there was an increase of 0.03 (95% CI 0.0; 0.5) in the mean of the social-emotional scale and 0.02 (95% CI 0.0; 0.5) in the adaptive behavior scale score. Discussion: Our results suggest the influence of the early bond in the socioemotional and adaptive behavior domains, highlighting the importance of prenatal aspects in child development. / Introdução: Em geral, o neurodesenvolvimento infantil pode ser determinado por fatores genéticos, sociais e ambientais que interagem de forma complexa entre si. Além disso, o desenvolvimento do feto é considerado o período mais vulnerável neste processo. Comportamentos de risco durante a gestação são frequentemente observados em mulheres que não estão vinculadas afetivamente com o feto e, ainda, há evidências de que a relação da gestante com feto durante a gravidez tende a manter-se estável após o nascimento. Sabe-se que a vinculação precoce mãe-bebê pode influenciar o futuro desenvolvimento social, cognitivo e emocional da criança. Objetivo: Avaliar a relação entre Apego Materno-Fetal e Desenvolvimento Infantil em bebês aos três meses de vida. Método: Trata-se de um estudo longitudinal aninhado a uma coorte de gestantes da cidade de Pelotas/RS, no qual as gestantes foram avaliadas com até 24 semanas de gestação, 60 dias após a primeira avaliação e aos 90 dias após o parto junto com os bebês. Foram utilizados um questionário contendo variáveis sociodemográficas, questões relacionadas à saúde da gestante, à relação com o pai do bebê e dados sobre a gestação; a Escala de Apego Materno-Fetal para avaliar a qualidade da relação da gestante com o feto; e as Bayley Scales of Infant Development para avaliar o desenvolvimento infantil. Resultados: O principal resultado indicou que, a cada incremento de 1 ponto na escala de Apego Materno-Fetal, houve um aumento de 0,03 (IC95% 0,0;0,5) pontos na média da escala socioemocional e 0,02 (IC95% 0,0;0,5) na pontuação da escala de comportamento adaptativo. Discussão: Nossos resultados sugerem a influência do vínculo precoce nos domínios socioemocional e comportamento adaptativo, ressaltando a importância dos aspectos pré-natais no desenvolvimento infantil.

Föräldrablivandet är en process som startar redan under graviditeten, då förälderns emotionella band till sitt ofödda barn – den prenatala bindningen – har visat sig ha en betydande inverkan på barnets framtida utveckling och hälsa. Denna prenatala bindning är ett område som har tenderat att förbli ouppmärksammat i den kliniska verksamheten och delvis även inom forskningen, trots att brister i bindning har lyfts fram som bland det allvarligaste inom området. Syftet med föreliggande intervjustudie var därför att undersöka och således erhålla en ökad förståelse för psykologers upplevelse och erfarenhet av arbetet med prenatal bindning. Åtta intervjuer med åtta yrkesverksamma psykologer vid mödra- och barnhälsovårdsenheter genomfördes och analyserades med tematisk analys. Det sammantagna resultatet av analysen påvisade att det finns en samstämmighet i deltagarnas upplevelser och erfarenheter. Deltagarna uppmärksammar en brist på nationella riktlinjer för arbetet med prenatal bindning, vilket skapar en viss osäkerhet i yrkesutövandet. Denna grundas främst på ett svårtillgängligt och otillräckligt kunskapsunderlag samt att det är ett relativt okänt och oanvänt begrepp. Däremot lyfts behovet av att på ett enklare sätt kunna kommunicera kring graviditetens relationella aspekter, där begreppet prenatal bindning blir centralt. Resultaten indikerar ett behov av att på ett tydligare och mer nationellt jämlikt sätt lyfta det psykologiska perspektivet inom mödra- och barnhälsovården, där psykologprofessionen har ett viktigt bidrag utifrån sin expertis. / Becoming a parent is a process that starts during pregnancy, where the parent's emotional bond to their unborn child – the prenatal bond – has been shown to have a significant impact on the child's future development and health. Prenatal bonding is an area that has tended to remain inattentive, in clinical practice and partly also in scientific research, even though insufficient bonding has been highlighted as among the most severe in the field. The purpose of the present interview study was therefore to investigate and thus gain an increased understanding of psychologists' experience of working with prenatal bonding. Eight interviews with eight psychologists at different Maternal Health Care units were conducted and analyzed using thematic analysis. The result showed that there is a consistency in the participants' experiences. They draw attention to a lack of national guidelines for the work with prenatal bonding, which creates an amount of uncertainty in the health practice. This is mainly since it is a relatively unknown and unused concept, with a difficult-to-access and insufficient knowledge base. The need to be able to communicate in a simpler way about the relational aspects of pregnancy is emphasized, where the concept of prenatal bonding becomes central. The results indicate a need to raise the psychological perspective within Maternal Health Care units in a clearer and more nationally equal way, where psychologists as a profession have an important contribution based on their expertise.

Introduction: Close emotional bands develop between mother and child and begin already during pregnancy, several factors affect how this band develops. Fetal life and the first few hours after childbirth are important for the infant's emotional development. Purpose: The purpose of this study is to investigate how midwives in post-natal care pay attention to emotional reactions in the mother, which these reactions are and how the midwives consider themselves to promote the relationship between mother and child. Issues: How do midwives describe that they pay attention to emotional reactions in the mother after childbirth, and what reactions are described? And how do midwives describe that they are working to promote the relationship between mother and child during the aftercare? Method: Five midwives working in the aftercare were interviewed based on a qualitative approach. The data collection method that has been used for this study is a semi-structured interview. The study material has been processed using an inductive thematic analysis. Result: What appears in the study is that midwives find it central to identify the woman's way of thinking about the child's needs and her ability to interpret the child's signals. The participants pay particular attention to those women where the emotional stress has been great after giving birth and can be assumed to need support. Discussion: Most studies and literature support what emerged from this study on the midwives' knowledge and experience about emotional reactions and its influence on the relationship between mother children. The mother's care for the child's needs and the midwife's work in promoting the relationship between these two can be interpreted as the concept of mentalization. / Inledning: Nära känslomässiga band utvecklas mellan mor och barn och påbörjas redan under graviditeten, flertalet faktorer påverkar hur detta band utvecklas. Fosterlivet och de första timmarna efter förlossningen är av betydelse för spädbarnets känslomässiga utveckling. Syfte: Syftet med denna studie är att undersöka hur barnmorskor inom eftervården uppmärksammar känslomässiga reaktioner hos modern, vilka dessa reaktioner är och hur barnmorskorna anser sig främja relationen mellan mor och barn. Frågeställningar: Hur beskriver barnmorskorna att de uppmärksammar känslomässiga reaktioner hos modern efter förlossningen, och vilka reaktioner beskrivs? Samt hur beskriver barnmorskorna att de arbetar för att främja relationen mellan mor och barn under eftervården? Metod: Fem barnmorskor verksamma inom eftervården intervjuades utifrån en kvalitativ ansats. Datainsamlingsmetod som har används för denna studie är en semistrukturerad intervju. Studiens material har bearbetas med hjälp av en induktiv tematisk analys. Resultat: Det som framkommer i studien är att barnmorskorna finner centralt att identifiera är kvinnans sätt att tänka om barnets behov och hennes förmåga att tolka barnets signaler. Deltagarna uppmärksammar särskilt de kvinnor där den känslomässiga påfrestningen har varit stor efter förlossningen och kan antas behöva stöd. Diskussion: Flertalet studier samt litteratur stödjer det som framkom i denna studie om barnmorskornas kunskap och erfarenhet om känslomässiga reaktioner och dess påverkan på relationen mellan mor barn. Moderns omsorg om barnets behov samt barnmorskans arbete i att främja relationen mellan dessa två kan tolkas till begreppet mentalisering.

L'objet de ce travail est d'analyser l'évolution du processus de deuil lors d'une grossesse suivant une interruption médicale de grossesse (IMG). 8461 enfants sont nés sans vie en France en 2012 et 59 à 86% des femmes démarre,t une nouvelle grossesse dans les 6 mois suivant la perte; le deuil périnatal constitue un problème de santé publique puisque 25% évoluent vers un deuil pathologique. Le statut de l'objet perdu et la représentation que s'en font les mères participent du destin de ce foetus perdu; l'évolution des pratiques favorisant l'humanisation du foetus et l'objectalisation de ce dernier est critiquée par certains auteurs. Nous relevons un maque de consensus dans la littérature sur l'impact de cette nouvelle grossesse sur le processus de deuil; selon certains, elle pourrait interrompre le travail de deuil, pour d'autres au contraire favoriser une reprise élaborative. Ces grossesses suivantes, teintées du deuil, semblent représenter un facteur de risque dans l'attachement prénatal avec des conséquences sur le lien à l'enfant puîné. Nous interrogeons donc la relation entre le processus de deuil périnatal et le processus d'investissement de l'enfant à venir lors d'une grossesse suivante. Méthodologie utilisée: suivi longitudinal de 7 femmes enceintes lors d'une grossesse suivant une IMG après 15 SA, aux 3 trimestres de la grossesse et aux 3 mois de l'enfant suivant, selon une analyse qualitative au moyen d'entretiens de recherche clinique et une analyse quantitative de la dépression (EPDS), anxiété (STAI), deuil périnatal (PGS) et attachement prénatal (PAI) au moyen d'autoquestionnaires. Les résultats qualitatifs, traités de façon singulière selon une analyse psychodynamique, sont regroupés ensuite en fonction de nos hypothèses. Les résultats quantitatifs sont intégrés dans un corpus plus large pour permettre une analyse statistique des données. Résultats: entre le normal et le pathologique, les affects, les émotions, les représentations oscillent sur ce continuum, au fil de la grossesse, des termes et dates anniversaires, des manifestations sensorielles éprouvées. La grossesse suivante permet de revisiter la grossesse précédente; elle donne l'opportunité aux mères endeuillées de mettre en mots les affects brutes consécutifs à la perte, de mettre du sens pour inscrire cet événement traumatique dans l'histoire individuelle, conjugale et familiale. Certaines patientes, pour qui le travail de deuil pouvait sembler figé, ont pu mettre la transparence psychique de cette nouvelle grossesse à profit pour ré-élaborer la perte précédente et donner une juste place à chacun des deux bébés. L'actualisation du processus de deuil lors de la grossesse suivante sera fonction de la structure psychique des patientes; la dépression et l'angoisse sont également des marqueurs de l'élaboration de la perte et de la place faite à l'enfant puîné. L'analyse quantitative des données statistiques montre la présence d'anxiété particulièrement au début de la grossesse suivante. / The objet of this work is to analyze the evolution of the process of mourning during a pregnancy following a termination of pregnancy (TOP). 8461 children were born dead in France in 2012 and 59 to 86% of women start a new pregnancy in the six months following the loss; the perinatal mourning constitutes a problem of public health because 25% lead to a pathological mourning. The status of the lost object and maternal representations participate in the fate this lost foetus. The evolution of the practices favoring the humanization of the foetus and the objectalisation of the latter is criticized by some authors. We find a lack of consensus in the literature on the impact of this new pregnancy on the process of mourning. According to certain authors, she could interrupt the work of mourning, for others on the contrary, favor a elaborative resumption. These following pregnancies, tinged with the mourning, seem to represent a risk factor in the prenatal attachment with consequences on the link to the puisne child. We thus question the relation between the process of perinatal mourning and the process of investment of the child coming during a following pregnancy. Used methodology: longitudinal follow-up of seven pregnant women during pregnancy following a TOP after 15 weeks, three times during the pregnancy and at three months after the birth of the subsequent child according to a qualitative analysis (interview of clinical research) and a quantitative analysis of depression (EPDS), anxiety (STAI), perinatal mourning (PGS) and prenatal attachment (PAI) by means of auto-questionnaires. The qualitative results, treated in a singular way according to a psychodynamic analysis, are then included according to our hypotheses. The quantitative results are integrated into a wier corpus to allow statistical analysis of the data. Results: between the normal and the pathological, affects, feelings and representations oscillate on this continuum, in the course of the pregnancy, the terms and anniversaries, the proven sensory demonstrations. The following pregnancy allows to revisit the previous pregnancy; she gives the opportunity to the mothers saddened to put into words the gross affects consecutive to the loss, to put of the sens to register this traumatic event in the individual, conjugal, and family history. Somme women,for whom the work of mourning could seem motionless, were able to put the psychic transparency of this new pregnancy in profit to redevelop the previous loss and to give a just place to each of both babies. The updating of the process of mourning during the following pregnancy will be function of the psychic structure of the woman. The depression and the anxiety are also markers of the elaboration of the loss and the place made for the puisne child. The quantitaive analysis of the statistical data shows the presence of anxiety, particularly at the begining of the following pregnancy.