Maternal Role Development: The Influence of Maternal Distress Following Childbirth

Little is known about the relationship between maternal role development and maternal distress following childbirth. Initial work on maternal role development (MRD) was undertaken three decades ago, and despite many changes to maternity care delivery and to society more generally, the relevance of MRD to contemporary birthing women has not been assessed. MRD may be influenced by a number of factors. Of particular interest to this thesis is emotional distress. Maternal distress may manifest itself as depression and anxiety, but has not been well described in the literature. Feelings of distress may adversely affect women's adaptation to motherhood. This study therefore, aimed to examine MRD and the influence of maternal distress following childbirth. A longitudinal prospective study with a cohort of 614 women was conducted and data collected at 36 weeks gestation and at six and 12 weeks following childbirth. MRD was measured using a revised standardised tool, the What Being the Parent of a Baby is Like (WPL-R) (Pridham & Chang, 1989). Maternal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden & Sagovsky, 1987) with a score of plus or minus 10. Analysis confirmed significant changes in MRD subscale scores across time. The main difference was in self-perceptions of parenting (F (2, 390) = 25.2, p less than . 001) accounting for 11.4% of variance. Changes as a person, in lifestyle and relationships and the importance and priority of the infant in the mother's life were noted, particularly in women who reported low and moderate expectations of motherhood. Incidence of maternal distress was 42% (n = 252) of women at 36 weeks gestation, which decreased to 19.2% (n = 97) at six weeks following childbirth, and 15.5% (n = 73) at 12 weeks postpartum. This effect across time was significant (F (2, 918) = 174.9, p less than . 001) and accounted for 27.6% of variance when tracking the incidence of maternal distress from pregnancy to the postpartum period. MRD was associated with maternal distress across time. At 36 weeks gestation, overall maternal expectations were correlated with maternal distress (r = .20, p less than .001) whilst at six and 12 weeks postpartum, analysis yielded negative associations between self-perceptions of parenting and maternal distress, and positive associations between changes as a person, in lifestyle, and in relationships and maternal distress. The results of the present study provide a better understanding of the experiences and perceptions of contemporary birthing women that differed from original conceptualisations. MRD, although similar to initial proposed theoretical constructs, takes longer than previously thought. The present study also confirmed previous propositions that motherhood for many women in contemporary society is distressing. Studies on MRD enable us to better understand how women respond to the difficulties of motherhood over time. Health care services need to provide greater support for mothers by recognising the challenges of childbearing and the intensity and demands of motherhood. Midwives need to re-examine their practice and support women from a fresh perspective. This view entails an appreciation of a high proportion of women reporting distress symptoms; assessing for risk, particularly in relation to domestic violence; and fostering social support, which was found to be an important mediator for MRD.