The relationships between prenatal stress, social support, spiritual well-being, and maternal-fetal attachment for pregnant women

Abstract

The purposes of this study are to test four measurement models and a hypothesized structural model which related to maternal-fetal attachment (MFA). The conceptual model of this study is primarily derived from stress and coping theory (Lazarus & Folkman, 1984) and crisis theory (Burgess & Baldwin, 1981) which includes three major conceptual domains: stress (prenatal stress), moderators of stress (social support and spiritual well-being), and manifestation of stress (MFA). A sample of 349 pregnant women in their third trimester was recruited from obstetrical outpatient and inpatient centers, including high-risk and low-risk pregnant units, and childbirth education classes. The questionnaires consisted of the Visual Analog Scale (VAS) and the Taylor Manifest Anxiety Scale (TMAS) designed to measure prenatal stress, the Personal Resource Questionnaire (PRQ), the Spiritual Well-Being Scale (SWBS), the Prenatal Attachment Inventory (PAI), and selected demographic, obstetrical, and health related questions. Confirmatory factor analysis of the four research instruments yielded results that supported the initial structural definition of PAI, TMAS, and prenatal stress. The constructs of the SWBS, and the PRQ were not supported by the data. The violation of multivariate normality assumption and multicollinearity were the factors that seemed to impact model fit. After using item parceling and deleting items with similar wording, both models fit well. The results of testing the hypothesized structural model yielded results that the interaction terms were deleted from the model because of non-normality and multicollinearity problems. Attachment showed positive correlation with prenatal stress (beta = .36, t = 4.15, p < .05) and social support (gamma = .27, t = 3.36, p < .05). Prenatal stress was negatively related to spiritual well-being (SWB) (gamma = -.45, t = -3.40, p < .05). In addition, pregnancy health status had an interaction effect on the structural model indicating the model fit differently for those with high-risk pregnancy as compared to those with low-risk pregnancy. The research indicated the importance of social support in MFA. The PAI is a valid instrument for measuring prenatal attachment. Although the spiritual components did not show direct effect to prenatal attachment, it has an indirect effect to prenatal attachment through prenatal stress as well as social support. The interaction effect of pregnant health status on the structural model suggested that high-risk pregnant women may have different demands in social support, SWB, prenatal stress, and/or MFA as compared to low-risk pregnant women.