Abstract
Pregnancy and the postpartum period are times of significant transition for women, with changes in maternal physical and mental health. The formation of a relationship between a mother and her infant is vital and has been recognized as laying the foundations for later child development. A relationship between a pregnant woman’s psychological wellbeing and the development of maternal-infant attachment relationship and infant development during pregnancy and in the early postpartum period has been widely recognized by the literature. Finding ways to promote maternal mental health and wellbeing, strengthen mothers’ coping and parenting abilities and their relationship with their babies in the antenatal period is therefore of increasing interest and importance.Mind-body therapeutic approaches during pregnancy, such as mindfulness-based healthcare practices, have previously revealed positive outcomes, primarily in reducing parental stress, anxiety, and depression. However, there remains a need for considering the influence of mindfulness on the mother-infant relationship during pregnancy and the earliest post-partum period. This thesis explored the evidence base for maternal mental health, mindfulness training, and mother-infant relationship during pregnancy and post-birth, in particular emotional availability as an indicator of postnatal favourable mother-infant relationship, to identify what is known and what gaps existed. In particular, the focus was on these maternal variables during pregnancy to introduce intoception (embodied awareness) as another protective factor for mother-infant bonding relationship post-birth. This would then highlight the need for a health-enhancement mind-body model and approach to prenatal and perinatal healthcare. This model may then improve our understanding of the nature of the antenatal mother-infant relationship, which has been previously limited by the theoretical framework surrounding the construct of maternal-foetal attachment.
The first step in this thesis is a literature review which gathered the available data on predictors of mother-infant relationship to identify what is known and what gaps existed. Theoretical links between the maternal psychological constructs are presented, leading to a model for how to conceptualise early in-life protective factors for maternal mental health and mother-infant relationship. The study aimed to add important knowledge of prenatal attachment, based on increasing evidence suggesting foetal consciousness and relational engagement. It also aimed to improve perinatal healthcare practitioners’ way of relating to pregnant mothers and their developing unborn infants.
The second step (Study 1) assessed, through an online longitudinal design, the relationships between maternal mental health (in particular depression, anxiety, and stress), mindfulness, interoception, and mother-infant relationship at two timepoints during pregnancy in a sample of 110 pregnant women at Timepoint 1 (20+ weeks’ gestation) and 72 at Timepoint 2 (approximately 36weeks’ gestation). Postnatal outcomes, including maternal emotional availability, were also assessed at Timepoint 3 (10-12 weeks post-partum) in 69 pregnant women. Changes in the maternal variables were also examined across the time points. These timepoints were selected for the following reasons. Timepoint 1 was at 20+ weeks’ gestation because this is the time when pregnant women usually perceive their baby’s first movements and thus get a sense of the baby developing in their body. Timepoint 2 was at approximately 36 weeks’ gestation as this is the latest time in the third trimester to see changes from the second trimester and not too close to birth to secure participants’ number retention. Timepoint 3 was at 10-12 weeks post-partum because this is not too close to birth for the participants to perceive a survey as a burden and not too far post-birth for the study to look at the first postnatal trimester and the stable effects of the PMRB program over time. The study revealed a significant decrease of maternal depression and anxiety from pregnancy to postpartum and a significant increase of mother-infant relationship during pregnancy, referred to as maternal-foetal attachment by Maternal-Foetal Attachment Scale, from the second to the third trimester. Significant correlations were found between all maternal variables across the three timepoints. Mindfulness and interoception significantly positively correlated with mother-infant relationship during pregnancy and postpartum and these maternal variables significantly negatively correlated with maternal depression, anxiety, and stress.
The third step (Study 2) examined the prenatal pre- and post-intervention, and postpartum results of a Prenatal Mindfulness- Relationship-Based (PMRB) program at the same timepoints as Study 1, with a community sample of 13 pregnant women. The study included a qualitative exploration of the same pregnant women’s experiences of the PMRB program reported during the sessions, including their birth stories. The results of the feasibility trial revealed a significant improvement in mindfulness, depression, interoception and mother-infant relationship from T1(baseline) to T2 (post-treatment). However, although the improvements remained from T1(baseline) to T3 (postpartum), the difference was not significant from T2 to postpartum follow-up. The qualitative analysis led to the identification of 16 themes, which were organized in four categories describing the experience of participants. Findings provide preliminary support for the feasibility of the PMRB program to improve maternal mindfulness, mental wellbeing and mother-infant relationship during pregnancy and post-partum. The qualitative evaluation suggested the PMRB program may help women cope with emotional challenges and be more connected to their bodies and baby.
These studies provide the first evidence that mindfulness, specifically a mindfulness-relationship based program focused on mother-infant sensorimotor interactions, is a feasible way to support mother-infant relationship during pregnancy and postpartum, with potential benefits for maternal wellbeing, the transition to parenting, and infant development and health. Mental distress is prevalent in pregnant women populations, which impacts mothering abilities, birth outcomes and mother-infant relationship. However, mindfulness programs may be part of the solution in this population. Further and larger trials of this kind in academic as well as clinical settings are recommended.
The decrease in depression and anxiety post childbirth in Study 1 may confirm untested speculation in the literature that pregnancy, childbirth, and the transition to motherhood may not necessarily represent a risk factor for mental health but enrichment of identity and mitigation of mild or moderate depression in a non-clinical sample. Furthermore, the not significant decrease in depression and anxiety at post-treatment follow up postpartum compared to the significant decrease from baseline to post program during pregnancy in Study 2, at a time still close to the childbirth experience, may indicate the adverse impact of hospital intervention on maternal mental health.
Examining prenatal predictors of maternal-infant relationship may provide possible avenues for implementation of timely and appropriate strategies, such as mindfulness-based therapeutic approaches in the prenatal period, to prevent perinatal psychological disorders and facilitate favourable maternal-infant relationships. Together, these results indicate that mindfulness is an essential set of abilities required by the transition to parenting and mindfulness training focused on the prenatal relationship and including prenatal psychology education is a feasibility way to improve maternal wellbeing and mother-infant relationship post-partum. Limitations and directions for future research, clinical practice, and policy making are discussed in the study result and discussion chapters and grand discussion.
| Date of Award | 6 Jun 2024 |
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| Original language | English |
| Supervisor | Peta Stapleton (Supervisor) & Alan Patching (Supervisor) |