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.

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.

Over the past two decades, India has become an international hub of cross-border surrogacy. The extreme economic and cultural differences between international couples seeking surrogacy and the surrogates themselves, clinics compromising health of surrogates for profit, the stigmatisation of surrogacy in India, and the constant surveillance of these women living in a ‘surrogate house’, have raised concerns regarding the potentially negative psychological impact of surrogacy on Indian surrogates. The primary aims of the thesis were (i) to conduct a longitudinal assessment of surrogates’ psychological problems (anxiety, depression and stress) from pregnancy until several months after relinquishing the baby to the intended parents, (ii) to examine the nature of the bond formed between surrogates and the unborn baby and establish whether this prenatal bond contributes to their psychological problems, and (iii) to explore the experiences of surrogates during and post-surrogacy. Fifty surrogates were compared with a matched group of 69 expectant mothers during pregnancy. Of these, 45 surrogates and 49 compairson group of mothers were followed up 4-6 months after the birth. All surrogates were hosting pregnancies for international intended parents and had at least one child of their own. Data were obtained using standardised questionnaires and in-depth interviews and were analysed using quantitative and qualitative methods. Indian surrogates were found to be more depressed than the comparison group of mothers, both during pregnancy and after the birth. However, giving up the newborn did not appear to add to surrogates’ levels of depression. There were no differences between the surrogates and the expectant mothers in anxiety or stress during either phase of the study. The examination of risk factors for psychological problems among the surrogates showed that anticipation of stigma, experiences of social humiliation and receiving insufficient support during pregnancy were associated with higher levels of depression following the birth. With respect to bonding with the unborn child, surrogates experienced lower levels of emotional bonding (e.g. they interacted less, and wondered less about, the foetus), but exhibited higher levels of instrumental bonding (e.g. they adopted better eating habits and avoided unhealthy practices during pregnancy), than women who were carrying their own babies. Contrary to concerns, greater bonding with the unborn child was not associated with increased psychological problems post-relinquishment. All surrogates were able to give up the child. Meeting the intended parents after the birth positively contributed towards surrogates’ satisfaction with relinquishment whereas meeting the baby did not. The qualitative findings on surrogates’ experiences showed that the majority lacked basic medical information regarding surrogacy pregnancy; hid surrogacy from most people; felt positive and supported at the surrogate house; lived in uncertainty regarding whether or not they would be allowed to meet the intended parents and the baby; and did not actually get to meet them. These findings have important implications for policy and practice on surrogacy in the Global South.