INTRODUCTION:

Maternal fetal attachment is a term used to describe the bond that exists between a pregnant mother and her fetus. In humans and other primates, it is a biological construct that works to defend the species through caring and protective actions. The mother-fetal attachment is the first important relationship formed with the unborn child during pregnancy. This bonding influences the mother-child relationship and has a significant impact on the future physical, emotional, and cognitive development of the child.

Humans are born with a natural need to form a close emotional bond with a caregiver. Attachment is an emotional bond with another person. The attachment theory was first introduced by John Bowlby in 1960s about the mother child bond¹.

He defined attachment as “a set of internal behaviors that would cause the infant to become closely related to his/ her main care giver, who is usually the mother². Although this idea was initially intended for postpartum women, it is thought that attachment begins much earlier than birth, during pregnancy. Bonding during pregnancy is the process by which a pregnant woman develops feelings and emotions for her unborn child. It functions as an invisible relation and helps the mother and fetus stay in close relation. Health professionals frequently conceptualise the bond between the pregnant woman and her fetus in terms of maternal fetal attachment.

Cranley defined maternal fetal attachment as “the extent to which women engage in behaviours that represent an affiliation and interaction with their unborn child. It is evident that the mother and fetus attachment does not begin at delivery; rather, it begins early in pregnancy and intensifies over the course of gestation, peaking in the last trimester. In the first and third trimesters of pregnancy, there is a weaker relationship with the fetus and poorer mental health, whereas in the second trimester, there is a greater bond and higher mental health.

Studies related to woman’s psychological changes and adjustment during pregnancy began in the 1970s. The declining mortality rate and technological development even in developing countries over 30 to 40 years have changed conceptions about pregnancy and fetus. Women's lives are significantly impacted emotionally and socially by pregnancy and childbirth. Although childbirth is a crucial aspect of women's lives, experiences, and identities all over the world. Most women find childbearing a joy, at least some of the time. Being a mother is one of the biggest physical and psychological changes a woman will ever experience, and it also changes her identity. Pregnant women may experience significant psychological changes as a result of hormonal changes during pregnancy. While some of these emotions and experiences are normal, others are uncomfortable and frightening.

Studying attachment when pregnant would provide us the chance to learn more about this process, and researching this topic would aid us in understanding and coping with the psychological issues that arise during and after pregnancy. Some studies suggest that there are three critical attributes related to the maternal fetal attachment they are cognitive, affective and altruistic attachment. Cognitive attachment describes the fascination to know the unborn baby. Affective attachment is the happiness associated with thinking about or speaking to the unborn baby. Altruistic attachment is the desire to protect the fetus. The attachment during pregnancy, which is essential for a good adaptation of the mother to pregnancy, develops gradually from the beginning of pregnancy and reaches its peak in the third trimester and continuing after delivery³.

Researchers have found that a mother's relationship to the developing fetus during pregnancy will aid in her transition to motherhood. The attachment behaviours include continuation of pregnancy care, intake of proper nutrition, adequate sleep and exercise, withdrawal from alcohol and drugs, participation in birth preparation class and the desire to get to interact with unborn baby during antenatal period, which ultimately result in a satisfactory pregnancy outcome and desirable maternal and newborn health status. The attachment between mother and fetus in the womb considered an important factor that affect future relationship between the neonate and mother, and the child’s growth and development. Muller believed that it is more than just a behavior and has defined as a unique relationship between the mother and her fetus⁴.

Maternal fetal attachment has several benefits for both mother and fetus. Maternal fetal attachment is a sign of both the pregnant mother's and the fetus's health throughout pregnancy. For mothers, it plays an important role in their current as well as postnatal well being, is a key element of maternal identity, and is necessary for adaptation to motherhood. For the fetus, maternal fetal attachment is both a physical bond and an emotional connection with the mother. High maternal fetal attachment affects the development of the fetal brain and autonomic nervous system. It also influences the child’s social development across the life span, beyond infancty.⁵

Inappropriate development of attachment would have an adverse effect on the regulating part of a child’s right brain; different related studies have reported lower emotional and mental development, fewer social interactions, school refusal, and more aggressive and hostile behaviors during childhood, behavioral disorders during adolescence and more tendencies toward drug abuse during adulthood.

The maternal fetal attachment can be affected by different factors:

1. Understanding of pregnancy:

Neonatal outcomes may be impacted by the mother's health behaviours during pregnancy. With this knowledge, mothers adopt healthy habits and alter their behaviour, expressing whatever positive actions they are taking for the benefit of their unborn baby.

2. Planned/desired pregnancy:

Pregnant women who planned their pregnancies tend to have stronger attachment and adjustment from the moment they realised they were pregnant or from the early period of their pregnancies than those who didn't, even though their attachment eventually grows as the pregnancy progresses. as they express their feelings of eagerness to become mothers or wait for the moment.

3. Family type:

The type of family is another element that influences the degree of maternal-fetal attachment. The husband and wife's relationship in a nuclear family becomes more stronger because they support one another and have more space to spend time together. Women when they are alone, they usually communicate with fetus even share what is going on in the world.⁶

4. Perception of fetal movement:

Women say that at the early stages of a baby’s development, they don’t understand much about the growth of the fetus, but once the fetus begins to move, their feelings towards their baby change. They become more attached to their baby, by touching them with their hands on their abdomen and even talking to them.

5. societal customs and beliefs:

Societal customs and beliefs play a significant role in shaping maternal-fetal attachment. Different cultures have different beliefs about pregnancy and the bond between mother and fetus. These beliefs influence how women perceive and interact with their unborn baby, impacting their level of attachment. In some cultures, there may be specific traditions or rituals like baby shower, seventh month ceremony that are believed to strengthen the bond between mother and baby during pregnancy.

6. social support:

The pregnancy will be more successful with social support, which is crucial. Women, whether they stay with in laws or do not, also get psychological support, which means a lot to them. When their family members assist them in terms of what they should eat, the activities they shouldn't be engaging in, and other matters, they may take better care of themselves and their fetus. etc. Positive environments enhance the bond between the pregnant mother and the unborn baby, which in turn affects their attachment level.

7. Progress of pregnancy:

The feeling of the baby’s presence in the lives of mothers grows stronger and more meaningful as it grows. They described the sound of the baby's heart as a fantastic feeling for the first time when they heard it. And when the baby grows in size and begins to expand their tummy, they become prouder to be mothers. Fetal activity is one that they cherish as they spend their time rubbing their bellies and talking with their unborn babies.⁷

8. Emotional well being of the mother:

Mothers' mental states have an influence on maternal fetal attachment. The emotional state of the mother plays a significant role in her attachment to the fetus. Positive emotions, such as happiness and excitement, can strengthen the bond, while negative emotions, like stress or depression, may hinder it. Women during pregnancy undergo unavoidable, significant psychological distress, such as hormone system readjustment. Support from the family, relationships with the partner, and social support play a very important role in maintaining the mental health of women. This is shown by the change in the women’s behavior, like adopting healthy practices, performing regular yoga, eating a healthy diet, avoiding traveling, and others that will be harmful to their baby, which they described as being done for the welfare of their baby.

9. Educational status:

Women’s literacy level is one of the aspects that are associated with levels of attachment. Women with a higher education level have better knowledge about the concept of maternal fetal attachment as compared to women with a lower education level, which ultimately influences the degree of maternal fetal attachment.

10. Occupation:

Occupation may be influenced by their different roles and responsibilities. Working women may experience additional stress and time constraints, which could impact their ability to form a strong attachment with their unborn baby compared to homemakers who may have more time and flexibility to focus on their pregnancy. However, it is important to note that individual factors and personal experiences can also play a significant role in maternal-fetal attachment, regardless of a woman's occupation.

11. Partner’s involvement and support:

During pregnancy, mothers enjoy their partner’s use of various techniques, such as massaging the belly, interact to the fetus, choosing names, enjoying their husband’s company during all of the hospital visits, etc. Encouraging male involvement during the pregnancy process is essential to promoting maternal and fetal attachment. Partner support includes mainly four categories: (1) empathic response, (2) emotional support, (3) ongoing support, and (4) fetus focused attention.⁸

12. Parity of the women:

Multiparous women have been found having weeker maternal fetal attachment level compared to nulliparous.⁹First time mothers have more psychological space to consider their unborn child than mothers who have already cared for a younger infant.

13. Previous pregnancy experiences:

Past experiences with pregnancy and childbirth can influence maternal-fetal attachment. A positive experience may enhance attachment, while a traumatic or difficult experience could have the lower levels of maternal-fetal attachment and also women who had experienced traumatic events during pregnancy were more likely to experience anxiety and depression during subsequent pregnancies.

14. Health status of the mother during pregnancy:

Women having high risk pregnancies might find it difficult to enjoy their pregnancy because of their worry about their health status and the outcome of the pregnancy. Prenatally anxious women have been found to interact less skilfully and communicate less with their newborns. Research identified a marked difference in maternal fetal attachment between high risk and low risk pregnant mothers.¹⁰

15. Monitoring and imaging the unborn baby:

It can provide visual confirmation of the developing fetus, which can enhance maternal-fetal attachment. Additionally, advancements in technology have allowed for non-invasive procedures such as ultrasound scans, allowing mothers to see and hear their baby's heartbeat and further strengthening the bond between mother and fetus.

Role of Health Professionals in Improving Mother Fetal Attachment:

Maternal-fetal attachment is continually being evaluated. It is the responsibility of the health care professional to encourage people who are unaware of or worried about their attachment to their fetuses as well as to reassure those who have formed such a bond. Collecting data from different attributes of attachment helps nurses determine each woman’s attachment style and areas that need attention.

Health professionals are in the best position to pave the way for the woman to express her feelings and anxieties during pregnancy, use positive coping mechanisms, organise family interaction, and effectively utilise social support systems in the neighbourhood efficiently. Most of the Obstetricians suggests pregnant women undergo a psychosocial assessment at least once during each trimester.

Health care professionals can assist the couples in having a happy pregnancy and labour experience and establishing a good, strong family bond over time. Also, it is important for health professionals to be familiar with the normal maternal fetal interaction process in order to accurately assess mothers’ attitudes towards their babies properly. Health professionals help expectant mothers overcome their preconceived notions about the fetus and develop a positive perception of both themselves and the fetus by listening to their anxieties, replying to their questions about themselves and their babies, and supporting maternal behaviours. It is crucial to identify pregnant women—especially those who are at risk—who may have had insufficient attachment during their pregnancies and to take the necessary steps to get them ready for motherhood. As a result, it will be possible to stop any potential child abuse and neglect in the future. Plans for audio, visual, and practical instruction should be made in order to create a strong physical and emotional bond between the mother and fetus. In this regard, the women may be advised to touch the fetus on the tummy, communicate with it, and count fetal movements throughout the pregnancy. It might be beneficial to make pregnant women sing or listen to music because it promotes prenatal attachment.

Wanted pregnancy is very important for maternal fetal attachment; it’s important to inform the pregnant women about the importance of planned pregnancy and offer them effective family planning counselling in order to prevent unwanted pregnancy. Considering that psychiatric conditions like depression and anxiety have an impact on attachment, women planning to get pregnant should be evaluated in terms of depressive symptoms and other psychiatric conditions. Social support from family, friends and the community is of great importance for parents in creating a safe attachment. Health workers, with their conscious prenatal professional approach, are the key to beginning the building of affection and keeping it during the attachment process.

CONCLUSION:

The general health of the mother and child both before and after birth is impacted by maternal fetal attachment, which is a unique process in and of itself. Therefore, it is important to focus more on the elements that affect maternal fetal attachment. Pregnant women who have a poor attachment to their unborn child should be directed to receive professional counselling.

REFERENCES:

1. Ossa X, Bustos L, Fernandez L. Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile. Midwifery 2012; 28: 689–696.

2. Bawl J. Attachment and Loss. London: The Hogarth Press and Institute of Psycho-Analysis, 1969. Epub ahead of print 1969. DOI: 10.1192/bjp.116.530.102.

3. Brandon AR, Pitts S, Denton WH, et al. A History of The Theory Of Prenatal Attachment. J Prenat Perinat Psychol Health 2009; 23: 201–222.

4. Muller ME, Mercer RT. Development of the Prenatal Attachment Inventory. West J Nurs Res 1993; 15: 199–215.

5. Hassan NMM, Hassan FMAE. Predictors of Maternal Fetal Attachment among Pregnant Women. IOSR Journal of Nursing and Health Science 2017; 6: 95–106.

6. Memchoubi Keithellakpam, Ray Suresh. Factors affecting the maternal-fetal Attachment during pregnancy. European Journal of Molecular and Clinical Medicine 2020; 7: 01–07.

7. Keithellakpam M, Ray S. Exploring the experiences of maternal-fetal attachment among primigravida women. Journal of Datta Meghe Institute of Medical Sciences University 2022; 17: 73–77.

8. Abasi E, Borghei NS, Farjamfar M, et al. Mothers’ Experiences of Husband’s Involvement in Maternal Fetal Attachment: A Qualitative Study. Iran J Psychiatry Behav Sci 2022; 16: 01–06.

9. Foley S, Hughes C, Murray AL, et al. Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries. Arch Womens Ment Health 2021; 24: 619–625.

10. Eswi A, Khalil A. Prenatal Attachment and Fetal Health Locus of Control among Low Risk and High Risk Pregnant Women. World Appl Sci J 2012; 18: 462–471.

Received on 10.09.2023 Modified on 19.09.2023

A and V Pub Int. J. of Nursing and Medical Res. 2023; 2(4):155-158.

DOI: 10.52711/ijnmr.2023.36