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Roberta is an example of Not Integrated Mother. A young woman of twenty-nine years old, the idea of having a child has made its way in her amidst many ambivalences and uncertainties, showing all the difficulties that a not integrated mother manifests in fully accepting a maternal identity.
Now I’m completely terrified on how to do things, and the kinder garden, the people he will hang out with cause we know what it’s like, and my mentality is not ‘live by the day’, maybe I worry too much about everything around me.
That’s why I used to say ‘let’s wait’ then one fine day this decision just arrived. ‘What do you think about it?’ ‘And maybe yes, it’s time’, we made a joke about it, ‘Time to take on responsibilities...’ That’s when I started thinking, I started asking around, how many children, how long did it take etc. Someone told me ‘I thought about having the first one for four years and then the second in twenty day’; others go: ‘Immediately, one after the other’. These kind of things. I said ‘O God, I waited so long, and now I’m thirty’, in fact this was my fear, I said ‘You’ll see that now that I want one, it won’t come’.
I looked for a laboratory where they could do my, my urine test and so I did it, and she goes ‘Congratulations’ and I was practically walking trying to avoid holes, absurd, because I had taken two buses to get there, and I was walking as if over boxes of eggs, I was afraid of ruining this thing.
I thought ‘Oh my God maybe I did something in the first days.
In the beginning, after a month and a half, I started having nausea problems, upset stomach, lots of saliva, so that after two months I was thinking ‘Why on earth did I do it?’. Because I was really sick. (…) I was thinking ‘What a terrible pregnancy I’m going to have’ because some would say ‘It’s all going to end soon’ and others ‘I threw up all the way to the ninth month’.
Q – Have there been specific moments of great emotion during the pregnancy?
A – Yes, when I did my ultrasonography in the fourth month, when they said ‘this is the heart beating’ and on the screen monitor there was this confused image, but when we saw the head, I absolutely didn’t imagine that I could see a profile. It really gave me a strange impression, seeing it.
Then there’s this thing which doesn’t excite me but amuses me. I have found out that, in the morning, drinking very hot milk, the baby does some strange movements. And I feel them even when I drink cold water, directly out of the fridge; so sometimes I switch from a hot thing to a cold thing to see what reactions it has.
In the same manner, the two dimensions formulated to define the construct of the mother's mental representations of her unborn infant were confirmed by factor analysis and accounted for 78.95% of the post-rotational variance. Measures of internal consistency (Cronbach’s alpha) were conducted to examine the reliability of the two dimensions ((F1, M=2.89, SD .40, α .93;F2, M=2.63, SD .73, α .45 ).
At the end of the interview the are 5 scales modelled on semantic differentials, each containing 17 pairs of opposite adjectives. The first three scales designate the individual characteristics of the unborn infant, of the woman’s self and of the infant’s father. Comparing the three lists, it is possible to evaluate if the representation of the baby is more influenced by the woman’s self-representation or that of her partner.
The other two scales, deal with the maternal characteristics of the pregnant woman and those of her mother. In this case adjectives will refer to affective orientations, personal lay-out, maternal role, maternal sensitivity and competence.
The interview is used to assess how information and emotions concerning the woman herself and her child are organized, whereas the five scales give us a picture of the contents of the representations. The two instruments can be used together (Ammaniti et al. 1992; Ilicali, Fisek, 2004) and independently (Ammaniti, Tambelli, Perucchini, 1998; Pajulo et al. 2001; 2006).
To explore the configuration of paternal representations and their differences from the mother’s the I.R.PA.G. (Interview for Paternal Representations during Pregnancy-Ammaniti, Tambelli, Odorisio 2006) is used.
As indicated in table 1, fathers’ representations have a different distribution confronted with mothers’ ones.
during Pregnancy (IRMAG/IRPAG)
The results reported in tab 1 show that in our sample the integrated/balanced parental representation is equally distributed among women and men, as opposed to the restricted/disinvested one more common among men and the non integrated/ambivalent one more common among women. These data confirm the differences of psychological orientation of mothers and fathers during pregnancy, even though the mothers’ and fathers’ attitudes draw closer after birth.
The use of IRMAG-R in at-risk pregnancies allows to study the contents and structure of maternal representations which give significant indication to evaluate parenting capabilities during pregnancy and the postnatal period.
Tab. 2 Distribution of Maternal Representations during pregnancy in risk and non-risk mothers
In at-risk situations, persistent preoccupations and phobic fears have been found; a specific scale is being created for these. This scale allows us to detect the levels of pervasiveness and intrusiveness of fears in relation to the pregnancy, to delivery and to the rearing of the child. The scale for the evaluation of the risk factors is, like the others, an ordinal scale with a five point range.
The IRMAG-R can be used for research in the clinical field to study the psychological state of women during pregnancy or for at-risk situations, in medically assisted pregnancies or in projects to support motherhood.
2) Self-Report Questionnaires and Scales have been used to assess attachment processes during pregnancy, when emotional ties start rising between mother and child. The construct of prenatal attachment (Cranley, 1981; Condon, 1993; Muller, 1993) takes account of the mother’s affective investment for the foetus, which is “the most precocious and basic form of human intimacy” (Condon & Corkindale, 1997, 1998). Condon (1993) has suggested a hierarchical model of attachment based on five subjective experiences which derive from maternal love experience and mediate this core experience and overt behaviours. These subjective experiences are expressed in maternal disposition "to know" the loved foetus, "to be with" him or her, "to avoid separation or loss" of the loved object, disposition "to protect" the foetus and finally "to gratify" the foetus's needs.
The quality and evolution of the prenatal attachment is influenced by many factors, first of all by the advancing of the pregnancy which entails growing ties between the mother and child, hastened by the appearance of foetal movements. Aside these factors, the personal history of the woman and of the couple have a significant influence on prenatal attachment.
Obviously this attachment is not only present in mothers but in fathers as well, although in 15-20% of the fathers this affective attachment to the foetus seems not to rise (Condon,1993).
The instruments more frequently used to study prenatal attachment are Self-Report Questionaires.
Maternal Fetal Attachment Scale (MFAS) influenced by many factors, first of all by the advancing of the pregnancy which entails growing ties between the mother and child, hastened by the appearance of foetal movements. Aside these factors, the personal history of the woman and of the couple have a significant influence on prenatal attachment.(Cranley, 1981), based on 24 items upon which an agreement score from a range of 5 points is expressed. Higher the score in the items and more definite and consistent is the mother’s attachment to the foetus. The items refer to 5 basic components: differentiation of self from foetus, interaction with foetus, attributing characteristics to the foetus, giving of self, role taking. Measurements of internal consistency (Cronbach’s alpha .85) are good on the total of the items, while the subscales have lower scores (between 52 and 73). Typical of the MFAS is that the items evaluate the mother’s behaviour more than her feelings or thoughts. In the validation sample used by Cranley, this instrument was used between the 35th and 40th week. The scale of maternal attachment was later adapted to a specular version which measures the father’s attachment to the foetus.
Maternal Antenatal Attachment Scale (MAAS) influenced by many factors, first of all by the advancing of the pregnancy which entails growing ties between the mother and child, hastened by the appearance of foetal movements. Aside these factors, the personal history of the woman and of the couple have a significant influence on prenatal attachment.(Condon, 1993), based on 19 items, the response is rated on a 5 response options, enquiring as to the frequency and /or intensity of these experiences over the preceding 2 weeks. The scale was used during the third trimester of pregnancy and has good levels of internal consistency (Cronbach’s alpha >.80).
It measures, beside a global attachment value, two underlying dimensions: qualityof involvement and intensity of preoccupation. From the characteristics of these two factors, four styles of attachment can be identified: positive-preoccupied, positive-disinterested, negative-preoccupied, negative-disinterested. The fathers’ version is based on 16 items, 14 of which are in common with the mother’s, as Condon sustains that prenatal attachment, even though it has a common basis for mothers and fathers, has specific aspects as well.
Prenatal Attachment Inventory (PAI) influenced by many factors, first of all by the advancing of the pregnancy which entails growing ties between the mother and child, hastened by the appearance of foetal movements. Aside these factors, the personal history of the woman and of the couple have a significant influence on prenatal attachment. (Muller, 1993). The inventory is based on 21 items. The response to each item is rated on a 4-point Likert scale. The higher score indicates greater attachment. In structure it is similar to Cranley’s scale but the aspects explored are different. It refers to attachment theory, describing women’s thoughts, feelings and relationship towards the foetus. Two constructs, in particular, are extremely relevant in the theoretic model at the basis of the PAI: attachment relation to the partner and adaptation to pregnancy, because according to Muller (1993) these are both positively related to prenatal attachment. The statistical analyses have shown good validity and internal consistency (Cronbach’s alpha varies from 81 to 91 in all researches that used it). Muller’s instrument does not allow an evaluation of father’s prenatal attachment.
The measurements from the self-evaluation scales described above concern the quality and quantity of the emotional investment of the parents towards the foetus without, however, going into more complex elements (mental representations of the parents, parents’ attachment models). Therefore these scales can be used together with other research instruments.
3) Inventories have been used to study the psychic state during pregnancy, such as the primary maternal preoccupation, a mental state Winnicott (1956) described as “almost an illness” that a mother must experience and recover in order to create and sustain an environment that can meet the physical and psychobiological needs of her infant. He hypothesised that this special state begins towards the end of the pregnancy and continues through the first months of the infant’s life.
If Winnicott’s concept had a clinical sense, it was later explored by means of a semi-structured interview, Yale Inventory of Parental Thoughts and Action,YIPTA (Leckman et al., 1999) within which an Inventory systematically explores the mother’s and father’s preoccupations and thoughts.
The specific content of the YIPTA covered the thoughts and actions associated with three domains of caregiving (Care), relationship building (Relationship) and anxious intrusive thoughts and harm avoidant behaviours experienced/performed by parents (AITHAB).
The YIPTA is designed for the use of experienced clinicians and has been used at the eighth months of gestation, at two weeks after delivery and three months after birth.
The measurements of the Early Parental Preoccupations and Behaviours, besides outlining the psychic states typical of mothers, highlight depression and anxiety symptoms that can appear during pregnancy, while the AITHAB measurements highlight intrusive thoughts and harm avoidant behaviours which are conceptually related to obsessive-compulsive disorders (OCD). It can be hypothesised that some forms of OCD that appear in this period are the dysregulative result of this specific psychic state that appears during pregnancy.
Both parents present the highest levels of “preoccupation” towards their child around birth time (between the eighth month of pregnancy and the second week after delivery). Thoughts about the baby during the period of Winnicott’s primary maternal preoccupation occupy the minds of the mothers and fathers for respectively 14 and 7 hours a day.
At the eighth month of pregnancy (Leckman et al., 1999) the following has been found: preoccupations on the baby’s health in 95% of the mothers and 80% of the fathers (health, growth, aspect), thoughts of damaging the baby in 37% of the parents (making it cry, shaking or hitting it, dropping it). These thoughts are a reason of personal distress in 20% of the cases.
The progress of thoughts and preoccupations shows that these tend to appear around the eighth month of pregnancy and reach their climax around the second month after birth to then slowly disappear. (fig.1).
The YIPTA permits an evaluation of the level of parental preoccupation which is an important psychic state during pregnancy and the postnatal period because it focuses the parents’ attention on the baby’s health and stimulates better caregiving capabilities. In the mother’s depression and in obsessive-compulsive states the level of preoccupations can occupy the mother’s mind completely and interfere with her maternal capabilities.