Psychology aspects of pregnancy, childbirth, and the new baby (Human Behaviour))

Question 1

How babies form attachments

Answer 1

4 Stage of Attachment

1. Asocial Stage - 6 weeks after birth, no discrimination between humans, no preference for parents but already show preference for humans over non-humans
2. Indiscriminate Stage - 6 weeks to 6 months, more sociable, can tell people apart, form stronger attachments with familiar adults; don’t show a fear of strangers
3. Specific Stage - 7 months, Separation anxiety (crying when primary attachment leaves) and fear of strangers
4. Multiple Attachments - ~ 10 months, attachment with primary carer grows, increased interest in developing bonds with others

Schaffer & Emerson (1964) - showed the same patterns of attachments in all babies and has since been replicated worldwide

Question 2

Outline different perspectives and psychological influences on pregnancy and birth

Answer 2

Behavioural influences

• physical, sexual or emotional abuse
• alcohol and other drugs
• nutrient deficiencies (folic acid)
• maternal weight change - excessive or insufficient

Stress

Direct:
- physiological response (hormonal changes, BP)
- Effect on mother (placental blood supply)
- effect on foetus

Indirect:
-psychological response
- mother’s behaviour
- effect onfoetus

First trimester

• fluctuations between positive feelings (excitement, happiness, and joy) and rather negative ones (disbelief, anticipation, worry and tearfulness)
• Depends on a variety of factors, such as pregnancy ailments (nausea/ vomiting, reflux diseases, insomnia), planned/ unplanned pregnancy, financial situations, family support, a perception of lifestyle restriction, and a sense of loss of independence

Second trimester

• mood fluctuations continue even during the second trimester, the negative feelings could sometimes lessen.
• This is due to reduced nausea/ vomiting, more adaptation to changes, some idea about the pregnancy care (from healthcare professionals)
• Mental health problems (such as anxiety and depression) occur less commonly in the second trimester (in comparison to the first and third trimesters). (Lee 2007)

Third trimester

• Negative emotional feelings could come back more again during this time. This could be due to increasing discomfort (such as due to pelvic girdle pain/ a backache), insomnia, tiredness/ exhaustion.

Psychological disorders - antenatal period

• Pregnancy is not protective against mental illness (McAllister-Williams et al 2017)
• Poor mental health in pregnancy- strong predictor of mental illness postnatally
• Women with mental illnesses- more likely to misuse alcohol, nicotine, etc.

Untreated depression- associated with low birth weight, increased risk of pre-term delivery

• Adverse outcomes for the child: emotional problems, ADHD, conduct disorder

Psychological disorder - postnatal period

• Depression- poor engagement with infants- poor infant learning and cognitive development
• Experience of childbirth- emotionally intense- PTSD symptoms in _ of women after vaginal deliveries (Olde et al, 2006)

Baby blues

• About _ of women experience mood changes within first week (usually from day 3 or 4) after child-birth (Henshaw 2003)
• They feel mildly depressed at a time when they expect they should feel happy after having a baby
• Usually stops by day 10 post partum, no treatment necessary. (If low mood > 2 weeks, screening for depression warranted)

Question 3

Outline how cultural context affects birth patterns

Answer 3

Infant morbidity & mortality (de Graff et al., 2013)

Black and Asian women have a higher risk of dying in pregnancy

Question 4

Outline the benefits of social support in pregnancy and childbirth

Answer 4

antenatal classes

support in pregnancy and birth is important (Hodnett et al., 2013):

• greater perceived control
  less stress
• greater satisfaction with birth
• lower likelihood of traumatic birth
• lower likelihood of postnatal depression

continuous support in labour:

• shorter labour
• less medical / surgical intervention
• better Apgar scores

Question 5

Describe emotional and psychological responses to childbirth and becoming a parent

Answer 5

Postnatal depression (PND)

• occurs in 10-15% of mothers (Woody 2017)
• onset usually within 1 or 2 months of birth, 1/3 of women with PND have symptoms which started in pregnancy and continue after birth (Wisner 2013)
• increased risk of later depression
• not only (biological) mothers

Risk factors for PND

• Previous mental health problems, including depression
• Depression or anxiety during pregnancy
• Poor support from partner, family or friends – or marital difficulties
• A recent stressful event - e.g. death of someone close to mother, relationship ending, losing a job.
• Experienced domestic violence or previous abuse
• Arrived in a developed country as a refugee or to seek asylum (Howard 2014)

PND and child development

• important pathway via mother-baby interaction (Murray et al. 2014)
• depressed mothers are less sensitive to child’s emotions
• infants with depressed mothers are less responsive to faces and voices
• problems with (psychological) attachment are more likely

Anxiety

• 13% experience anxiety in pregnancy; many women will experience both (anxiety and depression) NICE 2014
• Depression and anxiety also affect 15_20% of women in the first year after childbirth.
• During pregnancy and the postnatal period, anxiety disorders, can occur on their own or can coexist with depression :
• panic disorder,
• generalised anxiety disorder (GAD),
• obsessive_compulsive disorder (OCD),
• post-traumatic stress disorder (PTSD) and
• tokophobia (an extreme fear of childbirth), can occur on their own or can coexist with depression.

Question 6

Describe the concept of attachment and explain how attachment develops

Answer 6

Pre-attachment (0-6wk)

• non-specific attachment behaviour

Attachement in the making (6wk - 7mo)

• developing preference for the attention/comfort of certain people

Clear-cut attachment (7mo-2yr)

• attachment behaviours are directed to specific people
• separation anxiety
• better ability to maintain contact with preferred people

Reciprocal relationship (2yr-)

• separation anxiety diminishes

Importance

Secure attachment leads to feelings that:

• others will be available to us in times of need
• we are competent and worthy of love and care

Quality of attachment affects neurological development:

• limbic system (emotional brain)
• Temporal loves (language)

Question 7

Outline the different processes of early parent-infant bonding

Answer 7

Parent infant bonding

Physical contact:

• mothers encouraged to keep babies in close contact
• slings can be useful - touch, warmth, sound, smell

Smell:

• babies quickly learn to associate their mother’s smell (pheromones) with comfort, pleasure, food

Sight:

• 3 days olds can visually distinguish mother from others
• Mothers who make more early eye contact are more sympathetic, and more likely to be ‘authoritative’ parents

sound:

• predisposition and preference for mother’s voice

All is not lost if there is less contact in this period
- children in incubators (advantages of kangaroo care Kambarmi, 1998)
- adopted children

children have some resilience (Rutter, 2008):
- outcomes are better with earlier intervention

Bonding and attachment with the father is important too

Question 8

Outline the association between breastfeeding and intellectual development

Answer 8

WHO advocates exclusive breastfeeding for first 6 months (WHO, 2003)

majority intend to breastfeed, but minority meet WHO guidance:

• in UK ~20% no BF
• < 20% exclusive BF for ≥6mo
• lower SES ≈ less BF

Benefits - baby

Health benefits:

• lower mortality due to infectious diseases
• lower rates of asthma
• immunomodulatory - qualities of breast milk (Victora et al., 2016)

Cognitive benefits:

• BF babies perform better on “intelligence” tests in childhood and adulthood (Horta et al., 2015, 2018)
• effect is stronger in disadvantaged children

Explanations:

1. Nutrients in breast milk
2. physical and psychological contact during BF contributes to cognitive development
3. other factos linked to both BF and cognitive development: BF mothers higher education
   higher SES
   more likely to have partner
   less likely to smoke (Mangrio et al., 2018)

Benefits - mother

• prevents breast cancer
• improve birth spacing (lactational amenorrhoea)
• might reduce a woman’s risk of diabetes and ovarian cancer (Victora et al., 2016)