The Effect of Maternal-Fetal Attachment and its Relationship with Postpartum Depression and Maternal Self-Efficacy in Pregnant Women referring to Tabriz Healthcare Centers, 2016

Abstract

Abstract: Objectives: Maternal-fetal attachment is a special relationship between mother and infant that initiates in the pregnancy. Since maternal self-efficacy has important role in the mother and child relationship and child's mental development and maternal-fetal attachment improves the mother’s health during pregnancy and facilitates maternal role attainment and likely has a protective role against postpartum depression, the aim of this study was to determine the relationship between maternal-fetal attachment, postpartum depression and maternal self-efficacy. Methods: This longitudinal study was done on 242 primipara women –wanted or unwanted pregnancy- in 32-37 weeks of pregnancy, referring to health centers of Tabriz–Iran in 2016. The data collection tools used included a demographic and obstetric information questionnaire, Cranley’s Maternal-Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Maternal Self-Efficacy Questionnaire. A multivariate linear regression was used to estimate the extent to which maternal-fetal attachment affected postpartum depression and maternal self-efficacy. Results: The mean maternal-fetal attachment score was 0.90 (SD: 10.3) from the possible range of 23 to 115. The mean maternal self-efficacy score was 33.4 (SD: 3.7) from the possible range of 10 to 40 and the mean postpartum depression score was 8 (SD: 3.8) from the possible range of 0 to 30. Pearsons correlation test showed a moderate significant positive correlation between maternal-fetal attachment and self-efficacy (r=0.48, p<0.001). The highest correlation with self-efficacy was observed in the domain of ‘differentiation of self from fetus’ (r=0.34) and the lowest in the domain of ‘interaction with the fetus’ (r=0.25). Based on the multivariate linear regression, only two of the maternal-fetal attachment dimensions, namely ‘Interaction with Fetus’ (p= 0.001) and ‘Differentiation of Self from Fetus’ (p<0.001), were found to have a significant relationship with maternal self-efficacy. In addition, Pearson’s correlation test showed a significant inverse relationship between maternal-fetal attachment and postpartum depression (r= -0.196, p<0.001). Postpartum depression had a significant and inverse correlation with all of maternal-fetal attachment dimensions, with the exception of the ‘giving of self’ dimension. The multivariate linear regression model showed that the variable of sex of infant had significant relationship with maternal self-efficacy and the variables of mother's job, income sufficiency and head circumference had significant relationship with postpartum depression. Concussion: According to the findings, maternal-fetal attachment is one of the factors contributing to maternal self-efficacy and postpartum depression. Thus, identifying women who are faced with challenges in establishing a good maternal-fetal attachment and providing further training to mothers on how to improve the relationship with their child are necessary steps in increasing maternal-fetal attachment and thereby increasing maternal self-efficacy and reducing postpartum depression. In addition, considering that pregnancy care measures are mostly concerned with physical care for the mother and since psychological care is often overlooked, greater emphasis should be placed on the preparation of pregnant women for accepting their maternal role, so that the maternal-neonatal relationship can be enhanced.