Psychosocial Adaptation to Pregnancy: Seven Dimensions of Maternal Role Development

The proposed book presents an original analysis of seven dimensions of maternal psychosocial development during pregnancy that serve as the foundation for assessment of maternal prenatal adaptation and for psychoeducational and counseling intervention to enhance maternal adaptation. The seven dimensions of maternal adaptation pertain to motivation for and acceptance of the pregnancy, processes involved in evolving a maternal role prenatally, changes in significant kin relationships (with husband/partner and mother), and preparatory emotional, physical, and adaptive processes for labor and delivery. The dimensions were predictive of maternal anxiety in labor and progress in labor (or length of labor and prolonged labor), as well as postpartum maternal adaptation to a motherhood role and selected aspects of early infant development. Assessment is based primarily on analysis of maternal responses to in-depth interviews. The approach is a scientific analysis of maternal adaptive and maladaptive responses within each psychosocial dimension with excerpts of maternal responses to illustrate differences in adaptation. The scientific basis of assessment and analysis distinguishes this approach from other general and subjective approaches. This is relevant because prenatal counseling intervention often is not scientifically based. For example, it is commonly stated that ambivalence during pregnancy is normal. However, we have determined that this is not always the case. High ambivalence late in pregnancy is considered tantamount to rejection; it is not normal. In addition to prenatal interview schedules and rating scales, the author has developed psychometric instruments with items that parallel the responses made by expectant women in interviews. These instruments can be used as a stand-alone assessment or to supplement and validate interview responses. The Interview Schedules, Interview Rating Scales, and a description of two psychometric assessment scales (The Prenatal Self-Evaluation Questionnaire and The Postnatal Self-Evaluation Questionnaire) are proposed for inclusion in the book. There are no other comparable instruments with good psychometric properties available.The book is proposed to address a void in human psychosocial assessment. While almost every age and phase of human life has been studied, analyzed and documented, there is a great paucity of similar work regarding maternal prenatal development and adaptation to pregnancy. Studies are emerging that indicate that maternal adaptation (or anxiety) during pregnancy has substantial and significant short- and long-term effects on the physical and emotional health of the mother and the fetus/newborn infant. Research indicates that maternal anxiety is associated with preterm birth and low birth weight, outcomes that are also associated with infant/child behavioral development and performance in school. Intervention strategies to enhance maternal prenatal adaptation are needed. Intervention strategies will be included in each chapter of the book as appropriate to the seven dimensions of adaptation. In addition, a chapter of the book will be devoted to numerous intervention approaches. An additional chapter is proposed for discussion of the Prenatal Self-Evaluation Questionnaire (PSEQ) and research results that predict to health outcomes of pregnancy, as well as results obtained with different cultural groups. Content will be included on methods of assessment.

Regina Lederman, MNEd, MA, PhD, is a behavioral scientist, as well as a nurse and a practicing marital and family therapist, who also has 30 years of research experience in the field of maternal psychosocial development. She has published extensively, both original research and reviews, on intervention approaches to decrease maternal anxiety and promote adaptation to pregnancy. Dr. Lederman is a Professor in the School of Nursing and in the Department of Preventive Medicine and Community Health at the University of Texas Medical Branch in Galveston. She has an extensive writing background of scientific journal articles, books and questionnaires pertaining to pregnancy, childbirth, and early adaptation to motherhood. She has been editor of International Journal for Psychosomatic Obstetrics and Gynaecology, and most recently served as a consultant on a pregnancy and postpartum adaptation assessment project conducted with four branches of the military. An earlier edition of the proposed book, published by Prentice-Hall in 1985, received the American Journal of Nursing Book of the Year Award. She is a member of the Society of Behavioral Medicine, the Nurses Association of the American College of Obstetrics and Gynecology, the American Nurses Association, the Society for Research in Child Development, the American Association for the Advancement of Science, and the American Society for Psychosomatic Obstetrics and Gynecology.