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PRENATAL FETAL ATTACHMENT IN

PRIMIPAROUS ADOLESCENT WOMEN

BY
Judith Lorena Apgar

A DISSERTATION
Submitted to
. Michigan State University
in partial fulfillment of the requirements
for the degree of A

DOCTOR OF PHILOSOPHY

Department of Family and Child Ecology

1991

ABSTRACT

PRENATAL FETAL ATTACHMENT IN
PRIMIPAROUS ADOLESCENT WOMEN

BY
Judith Lorena Apgar

Research which focuses on maternal attachment in the
prenatal period has primarily addressed the adult mother in
her third trimester. Few investigators have studied the
process of attachment to the fetus in the adolescent. Those
who have, reported findings inconsistent with those found in
adult groups.

The purpose of this correlational study of indicators of
prenatal fetal attachment was to determine if the process of
prenatal fetal attachment occurs in primiparous adolescent
women, and if so, in what manner. A second purpose was to
determine whether the indicators of prenatal fetal attachment.
are related to psychosocial factors such as levels of self-
esteem and anxiety, the extent of social support and health
behaviors practiced, and the degree of perceived stress and
890 development. The sample consisted of 40 adolescents; data
were collected at four points during the gestational period.

Results of this study supported previous investigations
which suggested that the degree of prenatal fetal attachment

increases over the gestational period. Statistical analyses
revealed weak to moderate correlations between the dependent
and independent variables. Behaviors which provide a healthy
environment for the fetus were inversely related to the level
of state anxiety. The extent of affection and instrumental
aid received from the father of the baby were associated with
the degree of prenatal fetal attachment.

Some indicators of the degree of prenatal fetal
attachment were associated with cultural orientation. The
group of Caucasian adolescents, who reported a greater degree
of stress, also reported imagining themselves more in
roletaking behaviors. The extent of affection received from
her mother was associated with a greater degree of prenatal
fetal attachment for Caucasian adolescents. The extent of

this support appeared to be less important for the Black and

Hispanic adolescents.

 

DEDICATION

To Peter, Michael, and Rachel

and

my parents, Loren and Marietta Miller

iv

ACKNOWLEDGEMENTS

The successful completion of my dissertation was made
possible by the support and encouragement I received and I
would like to take this opportunity to acknowledge each one of
those involved. First, I would like to thank my major
professor, Dr. Dolores Borland-Hunt, for her assistance with
the evolution of this work. She always seemed to know just
what.itbwas I was struggling with and in a few short words she
captured the essence of that which had been eluding me. She
demonstrated a special ability to guide the dissertation
process while allowing me the latitude to make it wholly mine.
I would also like to thank the members of my committee, Dr.
Dennis Keefe, Dr. Thomas Luster, and Dr. Herbert Rudman. Each
of them lent me his special knowledge and expertise and gave
willingly of his time. I could always count on their words of
encouragement.during those times when I felt that there‘was no
end in sight.

I would like to thank Dr. Howard Gallup for his
continuing interest in my academic progress. He never ceased
to challenge my thinking and he persuaded me to look at the
issues from a different viewpoint. My telephone calls at odd
hours requesting clarification of statistical procedures never

seemed to perturb him. I would like to thank Charles Jadwin

V

for his patience and understanding when I frequently
interrupted the business of the day, and for generously
sharing his claim on Peter's time.

My acknowledgements would not be complete without a
special thanks to the adolescents who agreed to participate in
this study. They were a delightful group and I am.pleased to
have been acquainted with them, if only for such a short time.
I would also like to thank the staff at the prenatal clinic
for making it possible to conduct this study.

Finally, I would like to give a special thank you to my
family for their unfailing support of my academic endeavors
throughout the last few years. I could not have completed .
what I had begun without their belief in me. This often meant
postponing or canceling plans at a moment's notice; they
always understood and willingly accommodated their schedule to

mine.

vi

 

Table of Contents

List of Figures . . . . . . . . . . . . . . . . . . . . . x

List Of Tables 0 O O O O O O O O O O O O O O O O O O O O Xi

Chapter 1

Introduction . . . . . . . . . . . . . . . . . . . . 1
Statement of the Problem . . . . . . . . . . . . . 1
Purpose of the Study . . . . . . . . . . . . . . . 4
Significance of the Study . . . . . . . . . . . . 5

Chapter 2

Review of the Literature . . . . . . . . . . . . . . . 8

Theoretical Framework . . . . . . . . . . . . . . . . . 41

Chapter 3

Methodology . . . . . . . . . . . . . . . . . 48
Conceptual and Operational Definitions . . . . . . 50
Degree Of Prenatal Fetal Attachment . . . . 50

Extent of Health Behaviors Practiced During
Pregnancy . . . . . . . . . . . . . . 52
Degree of Ego Development . . . . . . . . . . 53
Level of Self-Esteem . . . . . . . . . . . . 54
Extent of Social Support . . . . . . . . . . 55
Degree of Perceived Stress . . . . . . . . . 57
Level of Anxiety . . . . . . . . . . . . . . 58
Control Variables . . . . . . . . . . . . . . 60
Demographic Instrument . . . . . . . . . . . 61
Hypotheses . . . . . . . . . . . . . . . . . . . . 61
Sampling Method . . . . . . . . . . . . . . . . 63
Data Collection . . . . . . . . . . . . . . . . . 66
Data Analysis . . . . . . . . . . . . . . . . . . 68

Chapter 4
Data Analysis 0 O O O I O O O O O O O O O O O O O O O O 7 0
Stage I Analysis . . . . . . . . . . . . . . . . . 70

Sample Description . . . . 70
Analysis of Prenatal Fetal Attachment Over
Time . . . . . . . 80

Analysis of Health Behaviors Scale Over Time 97

Stage II Analysis . . . . . . . . . . . . . . . . 103
Null Hypothesis 1 . . . . . . . . . . . . . . 111
Null Hypothesis 2 . . . . . . . . . . . . . . 112
Null Hypothesis 3 . . . . . . . . . . . . . . 113

vii

Hypotheses 4 . . . . . . . . . . . . . . . .
Null Hypothesis 5 . . . . . . . . . . . . . .
Null Hypothesis 6 . . . . . . . . . . . . . .

Chapter 5
Discussion, Limitations, Implications, and
Recommendations . . . .

Discussion . . . . .

Null Hypothesis .

Null Hypothesis .

Null Hypothesis .

Hypotheses 4 . .

Null Hypothesis .

Null Hypothesis .

Limitations . . . . . .
Implications for Health Care Providers

GW' UNH'
e e e o o o e e 0
00000.00
0 o o e o o e o o
e e o o e o e e 0
0000000

Recommendations . . . . . .
Summary . . . . . . . . . .

APPENDIX A
Parametric Properties of Instruments . . . . .
Maternal Fetal Attachment Scale . . . . .
Role Taking . . . . . . . . . .
Differentiation Of Self From Fetus .
Interaction With Fetus . . . . . .
Attributing Characteristics To The Fetus

Giving Of Self . . . . . . . .

Health Behaviors Scale . . . . . .

The New Imaginary Audience Scale .

The New Personal Fable Scale . . .
Omnipotence . . . . . . . . .
Invulnerability . . . . . . .
Uniqueness . . . . . . . . . .

The Coopersmith Self-Esteem Inventory .

Norbeck Social Support Questionnaire .
Total Functional Support . . .
Total Network Properties . .
Total Loss . . . . . . . .
Father of the Baby as Support

Life Events Questionnaire . . . .

State Trait Anxiety Inventory . .

APPENDIX 8

Significant Correlations and the Corresponding Partial
Correlation Coefficients of the Dependent and
Independent Variables . . . . . . . . . . . . . .

APPENDIX C
Verbal Script and Consent Forms . . . . . . . . . . . .

APPENDIX D
INSTRMNT O O O O O O O O O O O I O O O O O O O O O 0

viii

114
121
122

124
124
128
134
138
143
148
152
154
157
159
163

166
166
167
167
167
167
168
168
169
170
171
172
172
173
173
173
174
174
174
174
175

176

182

185

APPENDIX E

Comparison of Maternal Fetal Attachment Scale
for No Studies O O O O O O O O O O O O O O O O O O O O 2 2 3

APPENDIX 1"
Correlational Matrices of Variables and Ethnicity . . . 225

BIBLIWMPHY . O O O O O O O O O O O O O O O O O O O O 228

ix

List of Figures

Figure 1 An Ecological Model of Competence and

Figure 2

Adaptation in Primiparous Adolescent Women .

A Theoretical Model of the Relationship of the
Degree of Prenatal Attachment and the Extent
of Social Support, Levels of Self-Esteem and
Anxiety, Degree of Perceived Stress and Ego
Development, and Extent of Health Behaviors
Practiced in a Study of Prenatal Fetal
Attachment in Primiparous Adolescent Women .

44

49

Table
Table
Table

Table

Table
Table

Table
Table

Table

Table

Table

Table

Table

Table

10

11

12

13

14

List of Tables
Age Distribution of Adolescents . . . . . . .
Frequency Distribution of Demographic Data .

Source of Income for Adolescents and Their
Families 0 O O O O O O O O O O O O I O O O 0

Educational Achievement of Parents of
Adolescents (%) . . . . . . . . . . . . . . .

Educational Status of Adolescents . . . . . .

Plans for Pregnancy and for the Infant After
Delivery 0 O O O O O O 0 O O O O O O O O O O

Gestational Age in Weeks at Time 1 . . . . .

Health Behaviors and Complications in
Pregnancy 0 O O O O O O O O O O O O O O O O O

Adapted Version of The Maternal Fetal
Attachment Scale Percentage of Responses to
Individual Items (N. a 40) Time 1 (10-39
weeks) . . . . . . . . . . . . . . . . . . .

Maternal Fetal Attachment Scale Percentage of
Responses to Individual Items Time 2 (10-24
weeks) 0 O O I O O O O O O O O O O O O O O O

Maternal Fetal Attachment Scale Percentage of
Responses to Individual Items Time 3 (25-31
weeks, 0 O O O O O O O O O O O O O O O O O O

Maternal Fetal Attachment Scale Percentage of
Responses to Individual Items Time 4 (32-39
week8) O O O O 0 O O O O 0 O O O O O O O O O

Maternal Fetal Attachment Scale Percentage of
Positive Responses to Individual Items Times
1' 2’ 3’ and 4 O O O O O O O O O O O O O O .

Maternal Fetal Attachment Scale Classification

of Response (t), Mean, Standard Deviation, and
Estimated Internal Consistency . . . . . . .

xi

71

74

75

76

76

77

79

81

82

83

84

86

88

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

Roletaking Subscale Classification of Response
(%), Mean, Standard Deviation, and Estimated
Internal Consistency . . . . . . . . . . . .

Interaction with Fetus Subscale Classification
of Response (t), Mean, Standard Deviation, and
Estimated Internal Consistency . . . . . . .

Giving of Self Subscale Classification of
Response (8) , Mean, Standard Deviation, and
Estimated Internal Consistency . . . . . . .

Differentiation from Self Subscale
Classification of Response (%), Mean, Standard
Deviation, and Estimated Internal

cons i‘tency O O O O O O O O O O O O O O O O O

Attributing Characteristics to Fetus Subscale
Classification of Response (%), Mean, Standard
Deviation, and Estimated Internal Consistency

Summary of Positive Responses (%) Across Time
PeriOds O O O O O O O O O O O I O O O O O O 0

Summary of Means of Maternal Fetal Attachment
Scale and Subscales Across Time Periods . . .

Repeated Measures Analysis of Variance of the
Maternal Fetal Attachment Scale at Times 1, 2,
3 ' and 4 O O O O O O O O O O O O O O O O O 0

Health Behaviors Scale Response to Adequate
Sleep (%) O O O O O O O I O O O O O O O O O 0

Health Behaviors Scale Response to Adequate
Rest (*) O O O O O O O O O O O O O O O O O 0

Health Behaviors Scale Response to Adequate
ExerCise (%) O O O O O O O O O O O O O O O 0

Health Behaviors Scale Response to Adequate
Diet (%) O I O O O O O O O O O O O O O O O 0

Health Behaviors Scale Response to Smoking

(%) . . . . . . . . . . . . . . . . . . . . .

Health Behaviors Scale Response to Use of Over
the Counter Drugs (%) . . . . . . . . . . . .

Health Behaviors Scale Response to Alcohol
Ingestion (%) . . . . . . . . . . . . . . . .

xii

9O

90

91

91

92

94

95

95

98

98

99

99

100

100

101

 

Table

Table

Table
Table

Table

Table

Table

Table

Table

Table

Table

Table

Table

30

31

32

33

34

35

36

37

38

39

40

B1

32

Health Behaviors Scale Response to Use of
Street Drugs (%) . . . . . . . . . . . . . .

Mean , Standard Deviation , and Estimated
Internal Consistency of Health Behavior Scale
at Times 2 ' 3 ' and 4 O O O O O O O O O O O 0

Repeated. Measures Analysis of Variance of
Health Behaviors Scale at Times 2,3, and 4 .

Estimated Internal Consistency of Independent
variables 0 O O O O O O I O O O O O O O O O 0

Identification of Variables Used in Study . .

Spearman Rho Correlation Matrix of Independent
and Dependent Variables . . . . . . . . . . .

Spearman Rho Correlation Matrix of Independent
and Dependent Variables for Subscales of the
Maternal Fetal Attachment Scale . . . . . .

Pearson Correlation Matrix of Independent and
Dependent Variables . . . . . . . . . . . . .

Pearson Correlation Matrix of Independent and
Dependent Variables for Subscales of the
Maternal Fetal Attachment Scale . . . . . . .

Estimated Internal Consistency of Subscales of
Total Functional Support for all Adolescents,
Adolescents with Mother Support, and
Adolescents with Father of Baby . . . . . . .

Correlational Matrix of Independent and
Dependent Variables with Subscales of Total
Functional Support for All Adolescents,
Adolescents with Mother Support, and
Adolescents with Father of Baby Support (one-
tailed) . . . . . . . . . . . . . . . . . . .

Significant Correlations and the Corresponding
Partial Correlation Coefficients of the
Dependent and Independent Variables . . . .

Significant Spearman Rho Correlations and the
Corresponding Partial Correlation Coefficients
of the Independent Variables and the Subscales
of . Total Functional Support for 40
Adolescents . . . . . . . . . . . . . . . . .

xiii

101

102

103

105

106

107

108

109

110

116

118

176

177

Table

Table

Table

Table

Table

Table

Table

Table

Table

B3

B4

BS

B6

E1

E2

F1

F2

F3

Significant Pearson Correlations and the
Corresponding Partial Correlation Coefficients
of the Dependent Variables and the Subscales
of Total Functional Support for Adolescents
Reporting Support from Mother . . . . . . .

Significant Extraneous Correlations and
Corresponding Partial Correlation Coefficients

Significant Pearson Correlations and the
Corresponding Partial Correlation Coefficients
of the Dependent Variables and the Subscales
of Total Functional Support for Adolescents
Reporting Support from Father of Baby . . . .

Significant Extraneous Correlations and
Corresponding Partial Correlation Coefficients

Comparison of Maternal Fetal Attachment Scale
and Subscales for Two Studies (t) . . . . . .

Comparison of Maternal Fetal Attachment Scale
Individual Items for Two Studies (%) . . . .

Correlational Matrix of Dependent Variables
and EthniCity O O O O O O O O O I O O I O O O

Correlational Matrix of Independent Variables
and Ethnicity . . . . . . . . . . . . . . . .

Correlational Matrix of Social Support
Variables and Ethnicity . . . . . . . . . . .

xiv

178

179

180

181

223

224

225

226

227

Chapter 1

Introduction

Statement_of_the_£rghlsm

Adolescent pregnancy is not a new phenomenon. However,
over the last few years, concern for the continuing high
incidence has escalated. Although the numbers of births to
adolescents have declined since 1977, due to a decrease in the
population of adolescents, the proportion of teens giving
birth has remained almost unchanged particularly for the group
15 and under. In 1985 out of a total of 472,623 births to all
females under the age of 20, 64% of them occurred out of
wedlock. This compares with 30% born out of wedlock to the
same age group in 1970 (Moore, 1989) . Based on previous
statistics it is estimated that four out of ten teens will
become pregnant and two out of ten will have at least one
child by the age of 18. Of the 1.1 million adolescents who
become pregnant each year 600,000 will carry their infants to
term and 96% will keep their babies (Human Ecology Forum,
1981).

Adolescent parenting has been shown to result in a

variety of poor biopsychosocial outcomes for some infants.

1

2

These outcomes appear to be based on the interaction of
multiple, complex variables which include late entrance into
the health care system (Felice, Granados, Ances, Hebel,
Roeder, & Heald, 1981; Mangold, 1983), low socioeconomic
status (Graham, 1981; Miller & Stokes, 1985) interrupted and
uncompleted education (Cohen, Belmont, Dryfoos, Stein, &
Zayac, 1980) ,poor employment prospects (Spivak a Weitzman,
1987), poor health habits (Osofsky, 1985), and insufficient
support systems (Mercer, Hackley, & Bostrom, 1984: Ventura &
Hendershot, 1984).

Elster, MCAnarney, and lamb (1983) suggested that age
related intrapersonal variables interact simultaneously to
create a situation of crisis for the adolescent parent.
Cognitive immaturity inhibits her ability to develop realistic
expectations of infant. behavioru This results in less
adaptive parenting behaviors and a tendency toward intolerance
and insensitive response to infant cues. A lack of knowledge
of child development may lead the adolescent to neglect
appropriate verbal interaction. The normal self-centered
behavior which adolescents exhibit may cause them to place
their own needs before those of their vulnerable infants.

Adolescent and adult mothers have been compared on
parenting behaviors in an attempt to determine a developmental
basis for their differing styles. Correlates of adolescent
parenting behaviors with regard to age are conflicting. Jones,
Green, and Krauss (1980) found that older mothers demonstrated

significantly more responsiveness, maintenance of proximity,

3

and lateral trunk contact during moments of infant stress than
17 and 18 year old mothers. McAnarney, Lawrence, and Aten
(1981) also reported a positive correlation between the
mother’ s age and healthy interaction with her infant. The
younger the mother, the less likely she was to demonstrate
behaviors commonly associated with good parenting, such as,
touching, verbal interaction and the use of high pitched
voice, and synchronous movement. In addition, younger
adolescents have been reported to engage in aggressive
behaviors, such as, picking, poking and pinching their infants
(Lawrence, Mc Anarney, Aten, Iker, Baldwin, & Baldwin, 1981).
McAnarney, Lawrence, Aten, and Iker (1984) , however, found no
correlation between age and parenting behaviors. Gentle touch
and vocalization were found to be related to being non-black
suggesting a cultural rather than age difference in parenting
behaviors.

The past two decades have witnessed a great deal of
interest in the phenomenon of maternal-infant relationships.
Observation of the interaction between mother and infant has
stimulated research which has attempted to determine the point
at which the pregnant woman first experiences an affiliation
with her child as well as to discover the biopsychosocial
mechanisms which enhance or disrupt this phenomenon. A review
of the literature revealed that the complexity of these issues
has been amplified by the lack of consistency in the use of
two terms, attachment and bonding, among the many

investigators. Klaus and Kennell (1976) used the terms

4
attachment and bonding interchangeably, whereas, other
investigators have tended to assign them two distinct
meanings. Bonding is used most often to refer to the
immediate postpartum period during which the mother exhibits
behaviors of fondling, skin-to-skin contact, and suckling, all
of which facilitate a reciprocal response in the infant.
Attachment, according to Bowlby (1969), refers to the
affectional tie which develops between mother and infant
within the first year of life and is viewed as a reciprocal
relationship between the dyad. The issue is further
complicated by those who wish to study the affiliation the
woman develops for her unborn child. It is assumed by these
investigators that the developing mother-child relationship
has its origin in the prenatal period. Because little is
known about the phenomenon of prenatal fetal attachment in
pregnant women, this study of mother-child relationships
focused on the prenatal fetal attachment which they develop
for their unborn children rather than the more frequently
investigated phenomenon of bonding or attachment in the

postpartum period .

W

The purpose of this correlational study of indicators of
prenatal fetal attachment among primiparous adolescent women,
or those carrying their first infant to term, was to determine

if the process of prenatal fetal attachment occurs in

5
adolescent women, and if so, in what manner. A second purpose
was to determine whether the indicators of prenatal fetal
attachment are related to psychosocial factors such as levels
of self-esteem and anxiety, the extent of social support and
health behaviors practiced, and the degree of perceived stress

and ego development.

W

Research which focuses on maternal attachment in the
prenatal period has primarily addressed the adult mother in
her third trimester and results of these studies have been
inconsistent. Little is known about the process of attachment
to the fetus in the pregnant adolescent. Theories of human
development support age-stage differences between adolescent
and adult cognitive and psychosocial development. It would
seem reasonable to expect that the adolescent may not exhibit
attachment indicators in the same manner or to the same degree
as an adult. Once a better understanding of the process by
which adolescents begin to form a relationship with their
babies is achieved, it is possible that for those who exhibit
a lesser degree of attachment, interventions designed to
strengthen this relationship can be developed. With a better
understanding of the process investigators may find an
association between this relationship and psychosocial factors
thought to affect the strength of the relationship. In

addition, the strength of the relationship, which may have its

6

origins in the prenatal period, may be associated with the
extent of health behaviors demonstrated during gestation.
Those adolescents who demonstrate a high degree of attachment
to their unborn babies may be shown to hold a commitment to
provide a healthy prenatal environment for themselves and
their fetus. With a better knowledge of prenatal fetal
attachment, an association with maternal-infant attachment in
the postnatal period may be found. Early recognition of weak
attachment indicators in the mother could result in specific
interventions to assist the development of this process.

In summary, the continued high incidence of adolescent
pregnancy and parenting, and ultimately the psychosocial
vulnerability of the mother-infant dyad, has stimulated
interest in the maternal-infant relationships of this age
group. The study of these relationships has been complicated
by the inconsistency of terms which may refer to maternal-
infant bonding in the early postnatal period, attachment which
is often defined as a reciprocal relationship which forms
between the mother and infant in the first year of life, and
the affiliation the pregnant woman forms with her unborn
child.

This study focused on the manner in which these young
mothers began to form an attachment to their unborn babies, a
process which may provide the basis for the mother-infant
relationship which evolves after birth. In addition,
psychosocial variables thought to have an effect on the

strength of this relationship were examined. It is possible

7
that with a better understanding of this phenomenon,
interventions which are designed to strengthen the

relationship may be developed.

Chapter 2

Review of the Literature

The previous chapter presented a brief review of the
literature which describes the phenomenon of adolescent
pregnancy as well as parenting characteristics found to be
fairly common in this age group. It was suggested that a
better understanding of the phenomenon of prenatal fetal
attachment could result in specific interventions designed to
facilitate the development of this early mother-infant
relationship.

The origins of the concept of prenatal fetal attachment
will be presented in this chapter. This will be followed by
a review of the literature related to prenatal fetal
attachment and variables which may affect the degree of
attachment which a woman develops for her unborn baby. Each
of the related variables will be discussed in relation to
their association with pregnancy and childbearing in general,
as well as research which reports their relationship with
prenatal fetal attachment. The chapter will conclude with

literature specifically related to the pregnant adolescent.

2rsnatal_rstal_Attashment

A few studies, based in grounded theory, have been
conducted in an effort to describe the beginnings of the early
mother-infant relationship. Leifer (1977, 1980) , Lumley
(1980,1982), and.Stainton (1985) identified affective changes
which developed over the course of pregnancy. Women in these
studies were found to develop an emotional bond with their
fetus soon after conception which deepened considerably during
pregnancy. For some women, the first trimester was
characterized by an emotional detachment until viability was
assured. Others, however, described behaviors indicative of
attachment as early as 8 to 12 weeks. These early attachers
were more likely to talk to the fetus, to stroke it, to feel
certain of the sex of the fetus, and to describe themselves as
very involved with extensive preparations for the birth and
postpartum period (Lumley, 1980, 1982) . Until the experience
of fetal movement, which seemed to stimulate a sense of the
fetus as a separate identity, women commonly viewed the fetus
as part of themselves. When Liefer (1977, 1980) asked women
in her sample to describe their babies, initially the fetus
was viewed as diffuse. This image progressed to a textbook
image and was then personified. These findings were
substantiated by Stainton (1985) and by Lumley (1980, 1982)
who reported that 85% of women at 18 to 22 weeks gestation had

no doubts that the fetus was fully formed: by mid-pregnancy

10

63% believed that the fetus was a real person. At 36 weeks
all the women described their fetuses realistically. Leifer
(1977, 1980) found that most women engaged in activities which
served to heighten the reality of the baby; choosing a name
established an identity and a link to other family members.
Fetal movements initiated conversations with the fetus and the
partner was often drawn into the pregnancy through
conversations about the future child and by stimulating the
fetus so that he could observe and feel movement.
Furthermore, women in Stainton's study actually attributed
meaning to movement by the fetus. The authors of these
studies suggested that these behaviors reflected a growing
sense of a developing maternal relationship with her unborn
baby.

Further theoretical support for the concept of prenatal
fetal attachment was provided by investigators who studied the
grief response following the loss of a fetus through
spontaneous abortion, stillbirth, and neonatal death. In
retrospective studies it was concluded that women in all three
groups experienced similar emotions of grief and loss
regardless of gestational age (Leppart r. Pahlka, 1984; Peppers
8 Knapp, 1980) . These findings, however, were in direct
contradiction of observations made by Deutsch ( 1945).

Observation of women who immediately after delivery

have lost their joyfully expected children, or who

have given birth to dead babies, show that the

reactions to such loss do not have the character of

real grief such as one suffers after the death of a
beloved object. They correspond to the effects of

ll
nonfulfillment of a wish fantasy, of mobilized

guilt feelings, of accusation against others etc. (
p. 263)

In the belief that the maternal-infant relationship has
its beginnings in the prenatal period, a few investigators
have attempted to quantify the degree to which pregnant women
develop an affiliation with their unborn babies (Condon, 1985:
Cranley, 1979, 1981a, 1981b, 1984; Reading, Cox, Sledmere, &
Campbell, 1984; Rees, 1979: Vito, 1986). Cranley (1979,
1981a, 1981b) suggested that the mother-infant relationship
actually has its roots in the prenatal period and that it is
the result of dynamic psychological and physiological events.
She defined prenatal maternal attachment as, "The extent to
which the woman engages in behaviors that represent
affiliation and interaction with her unborn fetus" (1981a, p.
282) . Based on this definition Cranley developed the Maternal
Fetal Attachment Scale which was constructed from various
facets of the nature of mothering and the tasks of pregnancy.

Utilizing the Maternal Fetal Attachment Scale, Cranley
(1979) found that 78% of the women in her study engaged in
behaviors or attitudes purported to be indicative of
attachment at least ”sometimes": nearly one-third indicated
they do "most of the time”. The behaviors of the Giving of
Self subscale were most frequently practiced with 93%
reporting the behavior or attitude at least “sometimes“. The
least common behaviors were in the Interaction with Fetus

subscale: only 55.5% of the women engaged in these behaviors

12
at least sometimes. Cranley concluded that women in their
third trimester of pregnancy demonstrate attachment to their
unborn babies. Support for Cranley's conclusions was provided
by Davis and Akridge (1987) who utilized Cranley’s scale.
They reported similar results in. their study of women ages 17
to 32, in their third trimester. A '

The majority of the studies on prenatal fetal attachment
utilized Cranley's Maternal Fetal Attachment Scale and most
selected one point in time in the third trimester in which to
examine the attachment process (Armantrout, .1983; Carey, 1985;
Davis 5 Akridge, 1987; Gaffney, 1986; Kemp r. Page, 1987:
Mercer, Ferketich, May, DeJoseph, & Sollid, 1988; Wawrzynski,
1986;). Three investigators (Condon, 1985: Reading, et al.,
1984; Vito, 1986) , however, examined the development of
prenatal fetal attachment over the course of gestation
utilizing different instruments, one of which was an adapted
version of Cranley's (1979, 1981a) scale.

In an attempt to measure the development of prenatal
fetal attachment over the course of the pregnancy, Vito (1986)
modified Cranley's (1979, 1981a) instrument in a cross-
sectional design. The investigator found that gestational age
was positively associated with the subscales of Interaction
with the Fetus, Attribution of Characteristics and Intentions
to the Fetus, and Differentiation of Self from the Fetus by
the mid-point in pregnancy. Gestational age was positively
associated with the Nesting subscale, reintroduced by this

investigator, by the latter part of pregnancy. The author

13

concluded that prenatal fetal attachment is an orderly
process; from zero to eighteen weeks the woman focuses on her
new role and giving of herself for a healthy pregnancy.
Behaviors continue throughout pregnancy with differentiation
of self, interaction with fetus, and attribution of
characteristics and intentions to the fetus added at
approximately 18 weeks gestation. .At approximately 28 weeks,
nesting and physical preparation are added to the process.
Although studies by Reading, et al., (1984) and Condon (1985)
utilized two entirely different instruments, they also
concluded that pregnant women exhibit an increasing attachment
to their unborn babies over the gestational period.

Several researchers, (Cranley, 1979, 1981a, 1981b;
Reading, et al., 1984) interested in the attachment process,
attempted to determine whether attachment in the prenatal
period can predict attachment in the postnatal period.
Cranley (1979, 1981a), administered an adapted version of the
Broussard Neonatal Perception Scale to her sample early in the
postnatal period. Only the adapted Average Baby subscale
correlated significantly with each of the Maternal Fetal
Attachment subscales and the total score. Mothers who were
more attached to their fetus had significantly more positive
attitudes toward output behaviors of edimination and
regurgitation of the baby in the postpartum period.

The relationship of prenatal fetal attachment to mother-
infant bonding in the postnatal period reported by Cranley

(1979, 1981a) was not entirely confirmed by Reading, et al.

14

(1984) . Utilizing an instrument developed for their study,
psychological reactions toward the pregnancy and fetus were
measured at the time of entry into the study, and again at 16
and 32 weeks, shortly after delivery, and at three months
postpartum. Following delivery, those mothers who reported
positive or negative reactions toward the infant showed no
difference in ratings of prenatal attachment. Multiple
regression analysis revealed that drugs in labor, fetal
attachment scores at 16 and 32 weeks, and the Apgar score, in
combination were the best predictors of attachment to the
neonate. They accounted for almost 50% of the variance. At
three months, attachment scores at delivery were the best
predictor. However, these scores plus mood ratings accounted
for only 10% of the variance.

In an effort to determine whether prenatal
attachment can be enhanced through a process of prenatal
intervention and whether the intervention might have an effect
on mother-infant attachment in the postpartum period, Carter-
Jessup (1981) utilized an experimental design. The attachment
intervention methods consisted of teaching the mothers to feel
for fetal parts and fetal position daily, encouraging
awareness of fetal activity and maternal behaviors which
affect that activity, and massaging and stroking the abdomen
daily. These interventions were administered on a weekly
basis two to three times in late pregnancy. Attachment
behaviors were then measured at two to four days postpartum.

Carter-Jessup found a significant difference in postpartum

15

behaviors and concluded that maternal attachment is underway
in the third trimester and that differences between the two
groups were likely due to the intervention. Carter-Jessup did
not, however, measure the existence of prenatal attachment.

Davis and Akridge ( 1987) modified the C‘arter-Jessup
(1981) study in an attempt to address the aforementioned
deficit. Subjects in their third trimester completed
Cranley's Maternal-Fetal Attachment Scale (1979, 1981a) and
were then randomly assigned to experimental and control
groups. The experimental group received the interventions
described by Carter-Jessup in a slightly modified form. The
two groups were assessed in the early postpartum period
utilizing .Avant's IMaternal .Attachment Scale (1981). No
significant differences were found between groups on the
extent of maternal attachment exhibited in the. postpartum
period, thus contradicting reports by Cranley (1979, 1981a)
and Carter-Jessup.

- The early research which provided a theoretical basis for
the existence of the construct of prenatal fetal attachment
has resulted in a number of studies which have attempted to
find a correlation between psychosocial factors which may have
an effect on the developing attachment of the mother to her
unborn child. These psychosocial factors include (1) the
extent of social support, (2) the degree of perceived stress,
(3) the level of self-esteem, and (4) the level of anxiety.

Each will be discussed in the following paragraphs and pages.

16

The first psychosocial factor, the extent of social
support which one possesses, appears to be a resource which
affects one’s ability to adapt to alterations in the internal
and external environment (Cobb, 1976; Coll, Vohr, Hoffman 8
Oh, 1986: Colletta 8 Greg, 1981; Crnic, Greenberg 8 Slough,
1986; Crockenberg, 1987; Norbeck 8 Sheiner, 1982; Pascoe 8
Earp, 1984). Early works on social support established that
an association exists among social support, life stress, and
biopsychosocial adaptation. House, Landis, and Umberson
(1988) reviewed studies which found a correlation between
social isolation and the incidence of suicide, tuberculosis,
accidents, myocardial infarction, and psychiatric disorders.
They suggested that until the recent emergence of a
theoretical cause and effect model it has been unclear whether
a lack of social relationships causes illness or whether
unhealthy people are less likely to establish and maintain
social relationships. The application of the causal model in
the more recent studies has resulted in increasing empirical
evidence that social relationships are a predictor .of
morbidity and mortality.

Much of the investigative work on the concept of social
support has been accomplished by Cobb (1976) who delineated
the component parts of the construct. Information that one is
cared for and loved is transmitted through intimate
relationships which involve mutual trust. To be valued and
esteemed leads the individual to esteem himself and reaffirms

his sense of self-worth. .A network that is common and shared

17

provides information on. the characteristics of the
relationship and knowledge that goods and services are
available upon demand. Based on this theoretical framework,
Cobb defined social support as, "Information leading the
subject to believe that he or she is cared for and loved,
esteemed and valued and that he belongs to a network of
communication and mutual obligation" (p. 300).

Kahn (1979) further developed the theoretical constructs
associated with the phenomenon of social support. He adopted
the term "convoy" to imply that each person moves through his
life surrounded by others who have a particular meaning for
him. Over the life course the structure of his convoy changes
as his roles change. Kahn and Antonucci (1980) described the
convoy structure as a set of concentric circles arranged about
the focal person with those of least importance to him the
furthest from him. This circle tends to be the least stable
in terms of composition. The second concentric circle
consists of family, friends, or co-workers forming a more
stable relationship but one which may not be maintained over
time if either member loses his role. The inner most circle
contains those who are very close to the individual, are
independent of role, and whose interpersonal relationships
tend to remain stable over time. These are the relationships
which provide ongoing support in the form of affective
expression, affirmation of worth, and direct assistance in a

variety of situations.

18

The mechanisms by which social support functions within
relationships to protect an individual's health are of two
types. Social resources may have a beneficial effect on
health regardless of whether the individual is experiencing
significant levels of stress. A perception of an adequate
social network will provide positive interpersonal
experiences. For example, supportive network members may
encourage the individual to engage in healthy behaviors and to
seek appropriate health care. Cohen and Wills (1985)
suggested that this network also assures a sense of
predictability and control as. well as a feeling of self worth.

A second mechanism by which social relationships affect
health is through a buffering action which protects
individuals from the pathogenic effects of stressful events.
Support may intervene at the junction of a .stressful event and
the stress reaction by altering the stress response. The
individual may redefine the potential for harm or develop new
coping skills when social resources are available. Support
may also intervene between the experience of a stressful event
and the onset of a maladaptive state by reducing or
eliminating the stress reaction or by. influencing the
maladaptive process. Social support may provide the solution
to the stressful situation or it may alter its perceived
importance for the individual (Cohen 8 Wills, 1985). Cobb
(1979) stated that those who are emotionally supported are
more. able to change themselves to fit into a changing

environment, to have a sense of autonomy and thus more likely

20

individuals under stress. External stimuli will exert
pressure on one or more systems, thus inducing the remaining
systems to respond so that functioning ability in each of the
three systems may be affected. The ability to adapt to
external stressors can be enhanced by individual behavior
which acts to assure the availability of the best resources
possible over the longest period of time.

According to Trumbull and Appley (1986) , "Stress results
from a demand, real or perceived, beyond the real or perceived
carrying capacity of the -individual's physiological,
psychological, and/or social systems" (p. 34) . One's carrying
capacity has some resilience depending upon the predisposition
of the individual as well as characteristics of the
precipitating stressor(s) . Factors which appear to alleviate
stress are 1) having a sense of control over the events in
one's‘life; 2) accurate anticipation of an event; 3) accurate
information about the circumstances surrounding the event, and
4) an awareness of the means for reducing the stress or
escaping from it (Trumbull and Appley, 1986) . It appears that
the provision of social support assists the individual to
acquire the necessary knowledge about the stressor and to
develop mechanisms by which he can successfully cope with
them. .

The effects of social support and life stress during the
perinatal period have been well documented over the last two
decades (Colletta, 1981; Crittenden, 1985; Crnic, et al.,

1986: Crockenberg, 1987; Nuckolls, Cassel, 8 Kaplan, 1972;

21.

Tilden, 1983; Ventura 8 Hendershot, 1984; von Windeguth 8
Urbano, 1989; Zarling, Hirsch, 8 Landry, 1988). Nuckolls,
Cassel, and Kaplan (1972) explored the degree to which
psychosocial assets (feelings and perceptions of self and
pregnancy, overall life satisfaction, and relationship with
husband, extended family, and community) were protective and
the degree to which multiple life changes during pregnancy
were detrimental to health. Those women with high life change
scores both before and during pregnancy and high psychosocial
assets experienced only one-third the pregnancy complications
rate of women whose psychosocial asset scores were low. In
the absence of such life changes, particularly for the period
before pregnancy, the level of psychosocial assets was
irrelevant, there being no significant difference in the
complication rate between those having high and lOw
psychosocial asset scores.

Life stress and social support have been found to have an
important effect on the pregnant woman's psychological well-
being as well. Tilden (1983) hypothesized that high life
stress and low social support were related to high emotional
disequilibrium, defined by anxiety, depression, and self-
esteem scores during pregnancy. Tilden found that life stress
and social support exerted separate and significant main
effects on emotional disequilibrium and that the amount of
variance in emotional disequilibrium explained by life stress
was extremely high. The effect of social support on emotional
disequilibrium, although weaker, was also significant.

22

Several other factors were found to be related to a
mother' 8 health during pregnancy which suggest that the
effects of the mother's social support is mediated through her
to her developing fetus and infant (Colletta, 1981;
Crittenden, 1985; Crockenberg, 1987: Pascoe 8 Earp, 1984;
Ventura 8 Hendershot, 1984; Earling et al. 1988; vonWindeguth
8 Urbano, 1989) . Ventura and Hendershot examined the
relationship between infant biological outcomes of adolescent
and adult mothers and several psychosocial variables. They
found that regardless of marital status at conception, infant
outcomes were not significantly better for legitimate as
opposed to legitimated births when conception was soon
followed by marriage. Teenage mothers began prenatal care
earlier if they were married at conception; those who were
married after conception but before delivery began care
earlier than those who were not married at the time of
delivery. The authors suggested that a reduction of infant
risk was not solely attributable to early prenatal care.
Among those adolescents who sought early prenatal care, those
who gave birth out of wedlock were more likely to have a baby
with low birth weight or low one minute Apgar scores than
those teens who were married at the time of delivery. The
authors suggested that the socioemotional and financial
support from the baby's father and her parents contribute
directly to a healthy pregnancy through the reduction of
stress. This finding was supported by Giblin, Poland, and

Sachs (1987) who investigated the effects of social support on

23

health seeking behaviors of pregnant adolescents. They found
that a positive relationship with the father of the baby was
positively associated with adequate levels of prenatal care.

The mediating effects of social support on life stress
have been extended into the realm of mother-infant
relationships in the postnatal period (Crittenden, 1985:
Crnic, et al., 1986: Crockenberg 1987; Pascoe a Earp, 1984:
vonWindeguth 8 Urbano, 1989; Zarling, et al., 1988). Pascoe
and Earp utilized a group of 69 Neonatal Intensive Care
graduates (30 at risk for parenting failure and 39 not at
risk). They hypothesized that mothers with many life changes
who perceived high levels of social support would provide more
home stimulation than isolated mothers with a similar number
of life changes. Data supported this hypothesis. Mothers
with high and low levels of life changes provided the same
amount of stimulation to their infants, but mothers who
perceived more social support provided more stimulation to
their children, an effect that was unrelated to the amount of
life changes they experienced. The relationship between
social networks, life stress, and maternal behavior was
supported by Crnic et al. (1986) . In this longitudinal study,
greater stress reported at one month postpartum was related to
less positive maternal affect, while intimate friendship and
community support were related to more positive mother-infant
interaction at 8 months.

Further support for the effect of social support on

parenting styles was reported by Crittenden (1985) who

24

identified five distinct parenting styles of women with a
varying extent of social support. The pattern associated with
adequate child rearing was typified by a mixture of long term
and recently acquired friendships, and emotional, concrete,
and dependable support from both friends and relatives. On
the other hand, social support patterns associated with
abusive or neglectful childrearing were infrequent contact
with friends, and conversely, very frequent contact with an
over dependence on relatives, friends, and professionals for
help, as well as a general dissatisfaction with the
dependability of the support system.

Parenting styles of adolescents also appear to be
affected by the characteristics of their support system
(Colletta, 1981; Crockenberg, 1987; vonWindeguth 8 Urbano,
1989). With high levels of support adolescent mothers were
more affectionate toward their children, were more sensitive
to their babies, and responded more readily when they cried.
Those who believed that they should be responsive engaged in
more smiling and eye contact. Furthermore, with high levels
of emotional support, adolescents were less likely to nag,
scold, ridicule, or threaten their children. Those who
received little or no task assistance were more likely to
direct their anger at their child and were less likely to be
spontaneously warm and affectionate (Colletta, 1981;
Crockenberg, 1987). Crockenberg found that for her sample,
the addition of life stress to the variables of social support

and maternal behavior altered the relationship of the two

25

variables. Daily support was associated with smiling, eye
contact, and maternal sensitivity only when stress was low.
Zarling, Hirsch, and Landry ( 1988) reported similar results in
their study of social networks and mother-infant interactions
with full term and very low birth weight infants. A larger
number of ties between the mother's family of origin and her
friends related to higher sensitivity in mothers of full-term
but not very low birth weight infants. They proposed, that
for mothers of very low birth weight infants who experienced
high levels of stress, a high boundary density may increase
distress through interpersonal communication which tends to
reinforce her sense of helplessness and sense of failure.

A third psychosocial factor frequently studied as to its
effect on the developing attachment of the mother to her
unborn child is the level of self-esteem. Based on a
synthesis of psychological theory, Coopersmith's (1967)
conceptual model of this construct proposes that self-esteem
is enhanced if an individual’s personal achievement approaches
the level of aspiration he has set for himself and if
extensions of himself (e.g., body, spouse, and friends)
prosper. During the process of development the individual
internalizes attitudes expressed toward him by significant
others and adopts them as his own. These attitudes and
beliefs about one's self-worth are relatively constant and
resistant to change and they vary across different aspects of
one's life. To protect himself from loss of self-esteem which

results in anxiety, he develops coping mechanisms of

26
repression and.denial, or redefines the circumstances. Based
on this research, Coopersmith defined self-esteem as, "A
personal judgement of worthiness that is expressed in the
enduring attitudes the individual holds for himself" (1967).

The influence of social support, on the development of
adequate levels of self-esteem, particularly that provided by
parents, is of primary importance. Coopersmith found that
unconditional love and approval but with necessary constraints
placed. on. behavior, an. appropriate level of demands on
performance, and a parenting style which allows for discussion
and disagreement without fear of punishment, is most likely to
result in competent, self-confident children with a belief in
their own self-worth.

The association between the extent of social support,
degree of perceived stress, and the level of self-esteem has
been found not only in the general population but also in the
population of pregnant adolescents and teenage mothers (Belle,
1982: Colletta & Gregg, 1981; Pischman, 1975: Giblin, et al.,
19873'Held, 1981). Colletta and Gregg found that 41% of the
variance in the degree of emotional stress was explained by
levels of self-esteem, the extent of total support, and coping
style in black adolescent mothers. Those girls who reported
high ,levels of social support, received high self-esteem
scores, and used direct action as a coping method, reported
lower levels of emotional stress.

Several sources of support were found to have an effect

on the psychosocial development of the adolescent. Of

27 '

particular importance is that support which is provided by her
mother. Giblin, et al. , ( 1987) assessed the influence of
social support on maternal attitudes and behaviors in a sample
of predominantly black adolescents. They found that high
self-esteem scores were positively associated with receiving
help from their mothers and anticipation of assistance with
child care. These findings substantiated those of Held (1981)
who reported that adolescents who scored within the norm on
levels of self-esteem were most likely to name their mothers
as their primary source of support. In addition to mother’s
support, Giblin, et al., also found that for their sample of
adolescents, self-esteem was positively associated with having
a job or being in school, experiences which provide differing
types of support for the adolescent.

The extent of social support, degree of perceived stress,
and level of self-esteem.are related to a fourth psychosocial
factor, level of anxiety, which has been frequently studied as
to its effect on the developing attachment of the mother to
her unborn child. Spielberger, Gorsuch, Lushene, Vagg, and
Jacobs (1983) conceptualized anxiety as being comprised of two
different although related constructs. The subjective
feelings of tension, apprehension, nervousness, and worry at
a particular point in time are referred to as state anxiety,
while the persistent personality trait characterized.by these
feelings is referred to as trait anxiety. These subjective
feelings result from the perception of stressful situations as

dangerous or threatening. The stronger the anxiety trait the

28
more likely it is that the individual will view situations as
threatening. Furthermore, those interpersonal situations in
which one's self-esteem is threatened are more likely to
result in increased feelings of anxiety for those who
demonstrate higher levels of state and trait anxiety.

Studies by Gorsuch and Key (1974) and Avant ( 1981)
examined the effects of high levels of anxiety during the
perinatal period. Gorsuch and Key found that their adult
subjects, which were divided into normal and. abnormal
pregnancy categories, did not differ in levels of trait
anxiety before becoming pregnant. They differed
significantly, however, as pregnancy progressed. Those women
who consequently developed complications of pregnancy were
found to have significantly higher levels of state anxiety at
the third and fourth month. Additional analysis indicated
that the level of state anxiety was independent of life
stress. The authors concluded that anxiety is dysfunctional
when it occurs early in pregnancy whereas, life stress is more
dysfunctional later in pregnancy.

The effects of high levels of anxiety on the mother-
infant relationship in the early postpartum period have been
reported to be associated with the age of the mother. Avant
(1981) found that for a group of women, ages 15 through 29,
low levels of anxiety were inversely related to attachment to
her newborn. Adolescents 15 to 18 had significantly higher

anxiety scores and significantly lower attachment scores than

29
women 27 to 29 years of age. By the third postpartum day,
however, anxiety scores were not significantly different.

In summary, research has demonstrated that the extent of
social support, degree of perceived stress, and levels of
self-esteem and anxiety affect the interaction of mothers and
their infants in the postnatal period. These variables also
appear to affect the extent to which she provides a healthy
internal environment for her developing fetus. It would seem
reasonable to expect that these psychosocial variables would
also affect the behaviors, thoughts, and feelings that a woman
has for her unborn child. An adequate social support system,
minimal degree of perceived stress, low levels of anxiety and
high levels of self-esteem during the gestational period may
stimulate or enhance the initial attachment process which
develops over the perinatal period. In addition, this
developing attachment may result in improved health behaviors
as the pregnant woman commits herself to the provision of'a
healthy internal environment for her fetus.

Several investigators have examined possible
relationships between the process of prenatal fetal attachment
and these four psychosocial variables. Cranley (1979, 1981a)
found that for adult women in their third trimester of
pregnancy, the presence of a social support system was
positively associated with the degree of prenatal attachment,
Whereas, the level of perceived stress was inversely related.
Those women who perceived higher stress levels reported a

lesser degree of prenatal fetal attachment. In a similar

30

study, Wawrzynski (1986) found some support for Cranley's
study. In her sample of 106 matched adult couples in their
third trimester of pregnancy, for women, social support was
significantly associated with prenatal fetal attachment.
Mercer, Ferketich, May, DeJoseph, and Sollid (1988) found that
received support was significantly and positively correlated
with prenatal fetal attachment for only low risk women.
Prenatal fetal attachment in high risk women and their
partners was not related to the extent of their social
support. This finding lends support to the supposition
offered by Zarling. et al., (1988) that the degree of
perceived stress experienced in a high risk pregnancy is not
relieved by the social support system and may even be
aggravated by it due to reinforced feelings of failure."

In addition to social support in general, specific
sources of social support from the woman's spouse and her
mother have also been investigated for a possible relationship
with prenatal fetal attachment in pregnant women. The
findings have been mixed, ‘ however. In a third study by
Cranley (1984) the marital relationship of 326 couples was
assessed as one aspect of social support. Cranley found a
positive association between scores on the Spanier Dyadic
Adjustment Scale and the Maternal Fetal Attachment Scale for
both men and women. Zachariah, (1984) however, reported that
although the extent of husband-wife attachment and mother-
daughter attachment had a strong positive relationship with
her psychological well-being . during pregnancy, . the

31
investigator found no relationship between these variables and
the extent of prenatal fetal attachment. Mercer, Ferketich,
Hay,'DeJoseph, and Sollid (1988) also found no relationship
between a gross measure of the quality of the early mother-
daughter relationship and the degree of prenatal fetal
attachment.

Studies by Cranley (1979, 1981a), Gaffney (1986) and
hercer, Ferketich, Hay, DeJoseph, and Sollid (1988) found
mixed support for a relationship between prenatal fetal
attachment and anxiety, a concept related to self-esteem and
life stress. Gaffney assessed 100 adult women, in their third
trimester, for prenatal fetal attachment and temporary and
long term anxiety. The author found a significant inverse
relationship between temporary anxiety and the Maternal-Fetal
Attachment' Scale. The study failed to demonstrate any
relationship between long term anxiety and attachment.
Mercer, Ferketich, May, DeJoseph, and Sollid ( 1988) on the
other hand, reported a weak negative association «with long
term anxiety but not temporary anxiety. Cranley (1979, 1981a)
found no support for the hypothesis that both temporary and
long term anxiety are associated with prenatal fetal
attachment.

The variables of self-esteem and self-concept have been
found to be unrelated to prenatal fetal attachment in samples
of pregnant adult women (Cranley, 1979, 1981a; Gaffney, 1986:

Hercer, Ferketich, Hay, DeJoseph, and Sollid, 1988;

Wawrzynski, 1986) . Although Wawrzynski. discovered a

32

significant positive relationship between self-concept and
prenatal fetal attachment, when self-concept was included with
social support in regression analysis, it was no longer
significant. The author attributed the effect of self-concept
on prenatal fetal attachment to the extent of social support.

Several variables have been investigated for the
possibility of a confounding effect between the degree of
prenatal fetal attachment and the four psychosocial variables
under discussion and have netted contradictory results. These
include several demographic variables, the degree and severity
of physical symptoms, visualization with ultrasound, planned
versus unplanned pregnancy, number of previous pregnancies and
first fetal movement (Carey, 1985: Kemp 8 Page, 1987; Lerum I:
LoBiondo-Wood, 1989: LoBiondo-Wood, 1985; Mercer, Ferketich,
Hay, DeJoseph, and Sollid, 1988; Reading, et al., 1984: Vito,
1986) . In' general, demographic variables of age, marital
status, length of marriage, socioeconomic status, and physical
symptoms of pregnancy . (degree and severity) revealed no
association with the degree of prenatal fetal attachment.
Garey found a significant and positive relationship between
visualization of the fetus with ultrasound and four of the
subscalesof the Maternal-Fetal Attachment Scale, Attributing
Characteristics to the Fetus, Roletaking, Interaction with the
Fetus, and Giving of Self. Visualization with ultrasound was
also positively associated with the total scale. Vito and
Lerum and LoBiondo-Wood contributed support to this finding
only in that Giving of Self and the total Maternal Fetal

33
Attachment Scale were positively correlated in the two
studies. Reading, et al. (1984), however, found no
association between these two variables in their investigation
of attitudes and feelings of the woman toward the pregnancy
and the neonate.

Whether a pregnancy was planned and the number of
previous pregnancies have also been assessed for their
confounding effects on the degree of prenatal fetal attachment
and the four psychosocial variables under discussion.
Although LoBiondo-Wood (1985) and Kemp and Page (1987) found
no relationship between prenatal fetal attachment and whether
or not the pregnancy was planned, Lerum and LoBiondo-Wood
(1989) found the relationship to be positive and significant.
This was also supported by Vito (1986) who found that the
combination of a planned pregnancy, older age, and previous
pregnancy was associated with higher scores on the subscales
of Roletaking and Giving of Self. Although Vito did not
specify the effect of parity (number of previous pregnancies)
Mercer, Ferketich, May, DeJoseph, and Sollid (1988) reported
an inverse relationship between the number of children and
scores on the Maternal-Fetal Attachment Scale. This finding
supported that of Phipps and zinn (1986) who found a low
negative correlation between the Maternal Fetal Attachment
Scale scores and parity.

Fetal movement has been linked with prenatal fetal
attachment (Lerum 8 LoBiondo-Wood, 1989; Reading, et al. ,

1984: Vito, 1986) . Vito reported that quickening or the first

34

experienced fetal movement, was positively related to the
Nesting subscale which had been adapted from Cranley’s (1979)
early scale. Lerum and LoBiondo-Wood found that the frequency
and degree of fetal movement was positive and significantly
associated with the degree of maternal fetal attachment. In
their longitudinal study, Reading, at al. (1984) suggested
that women experiencing early fetal movement display more
positive attitudes from the outset, rather than attitude
change occurring as a function of fetal movement.

Investigation of the phenomenon of prenatal fetal
attachment during pregnancy has received a great deal of
attention over the last 15 years. The primary emphasis has
been on descriptive studies and psychosocial factors thought
to have an effect on the degree of prenatal fetal attachment
developed by adult women. Research which investigates the
relationship which the adolescent forms with her unborn baby
is sparse. Armantrout (1983) surveyed 35 adolescents between
the ages of 16 and 18 in their third trimester of pregnancy in
an effort to determine whether this group demonstrated
attachment behaviors in a manner similar to their older
counterparts. Almost 75% indicated that they had engaged in
behaviors and attitudes as represented by the total score on
the Maternal Fetal Attachment Scale. The indicators of
roletaking were most frequently practiced; ninety-four percent
of the respondents indicated they engaged in these behaviors
by responding ”definitely yes" or ,"yes" to these items.
Ninety-one percent indicated they displayed differentiation

35
from self, and 83% engaged in behaviors suggesting giving of
self. Attributing characteristics to the fetus and
interaction with the fetus were less commonly practiced.
Scores on the total scale and Giving of Self subscale were
comparable to those reported by Cranley (1979) . Although
roletaking indicators were reported more frequently in the
adolescent group, Cranley found that adults more frequently
demonstrated giving of self. For both groups, interaction
with the fetus was less common.

Although Armantrout's data on adolescents essentially
agreed with Cranley's adult sample, a study of prenatal fetal
attachment by Koniak-Griffin (1988) indicated that adolescent
and adult gravid women may differ in the progression of
prenatal attachment behaviors. In a group of 90 adolescents
with a mean age of 16.8 years and gestational age of 30.7
weeks, Koniak-Griffin discovered that the length of pregnancy
was not a significant predictor of prenatal fetal attachment,
thus contradicting Leifer (1977) , Cranley (1984) , Reading, et
al. (1984), Condon (1985), and Phipps and zinn (1986), all of
whom observed a progressive attachment with the advancement of
pregnancy in adult women.

Investigators may have made the assumption that prenatal
fetal attachment in the adolescent occurs in a manner similar
to that of adults. Theoretically, it can be argued that the
adolescent’s stage of cognitive and social development which
results in a preoccupation with herself could be associated

with the degree of prenatal fetal attachment that she develops

36

for her unborn child. Iapsley and Rice (1988), described
their work on the General Model of Adolescent Ego Development
which has evolved out of an effort to forge a synthesis
between psychoanalytical and Piagetian ego models, two
theoretical perspectives which have significant paradigmatic
differences. They believe that social cognition, which in
itself is a synthesis of several psychological positions,
focuses on the process by which children gain knowledge of
their social world and their reasoning processes in social
matters. Central to this theory is the assumption that both
children and adolescents apply cognitive abilities to
interpersonal relationships and social problem solving tasks
(Muuss, 1982). The psychoanalytic concept of recapitulated
patterns of development, ego ,separation-individuation,
sequences of sel f—understanding, and grandiosity and
narcissism, are basic to this model.

According to the General Model of Adolescent Ego
Development, the two constructs of recapitulation and personal
fable are ideation patterns which advance adolescent ego
development. They restore self-esteem in the face of mourning
reactions which result from. the separation-individuation
process (Lapsley, Fitzgerald, & Rice, 1989). Recapitulation
is defined as the repetition of a structural form or pattern
for a given developmental process. It is the re-emergence of
these earlier developmental patterns which results in typical
adolescent behaviors such as, showing off, self-consciousness,

preoccupation with shame, shyness, and embarrassment. These

37

behaviors seem to reflect the adolescent's tendency to
construct an imaginary audience which is grounded in the
belief that he or she is the object of others’ attention.
Because the adolescent assumes that others in his social
environment are as preoccupied with himself as he is, he
anticipates the reactions of others and therefore, plays to an
imaginary audience. Coincident with this constructis that of
the personal fable, the belief in one' s uniqueness,
invulnerability, and omnipotence. Because he regards himself
as special and unique, he tells himself stories which are not
true. This may account for the risk-taking behaviors such as
alcohol and drug ingestion, and unprotected intercourse.

Research which investigates. the effects of ego
development on adolescent mother-infant interaction is sparse.
In addition, the definition of ego development and
instrumental measurement varies from one investigator to the
next. Levine, Garcia-Coll, and Oh (1985) compared the pattern
of mother-infant interaction between ' adolescent and adult
mothers to examine the contribution of age, level of ego
development, education, and extent of social support.. For
them, the concept of ego development was based on Loevinger's
theory in which each stage of development represents
progressively more complex ways of perceiving oneself in
relation to the world. They found that higher levels of ego
development, associated with older age, and greater child
support were significant predictors of positive maternal

affect and time spent in mutual gaze.

38

Wise and Grossman (1980) also investigated the
relationship that certain aspects of the personality,
including ego strength, have with adaptation to pregnancy and
motherhood. However, for them ego strength was defined as
having the ability to plan realistically and to have a
positive emotional involvement with the pregnancy. These
characteristics were associated with more positive feelings
about babies and a more realistic view of baby behavior during
pregnancy. At six weeks postpartum, the degree. of' ego
strength was positively associated with the degree of
attachment.

The effect of social support on the degree of prenatal
fetal attachment among adolescent women has been examined by
three investigators with unifOrm results. Armantrout (1983),
found that only the subscalesOof Roletaking and Giving of Self
were associated with certain aspects of social support. In
this sample, adolescents who experienced loss of quality
support demonstrated less roletaking behavior. In addition,
those who reported receiving more aid, reported fewer
behaviors indicative of giving of self. When data were
subjected to regression analysis, duration of relationships,
total functional support, number in the network lost, quality
of loss, and fetal activity accounted for 51% of the variance
in the subscale, Interaction With Fetus. Koniak-Griffin
(1988) suggested that among the main factors which influenced
overall maternal fetal attachment and its subscales in her

sample of adolescents were the total functional support

39
available and the total network size. Althoughgeneral social
support was not measured.by Lindner (1984), this investigator
found a positive and significant association between the
adolescent's relationship with her mother, her relationship
with the father of the baby, and Maternal Fetal Attachment
Scale scores.

Koniak-Griffin (1988) and Lindner (1984) assessed the
effect of self-esteem and prenatal fetal attachment in their
adolescent groups with inconsistent findings. In Lindner's
study, those adolescents who reported a greater degree of
self-esteem also reported a higher degree of prenatal fetal
attachment. Koniak-Grif f in, on the other hand, found no
association between these variables.

In addition to the psychosocial variables of extent of
social support and level of self-esteem, both Lindner (1984)
and Koniak-Griffin (1988) found that the intent to keep the
infant was significantly and positively associated. with
prenatal fetal attachment. Twenty-seven percent of the
variance in attachment scores in Lindner’s study was explained
by group membership. Koniak-Griffin found that in addition to
the extent of social support available to the adolescent, the
intent to keep the infant and a planned pregnancy accounted
for 32% of the variance in the dependent variable.

In summary, exploratory studies of the relationship that
the pregnant woman develops for her unborn baby have elicited
interest in the quantification of this phenomenon. Research

has supported the contention that women begin the process of

4O

psychological and emotional attachment to their offspring
during the prenatal period. It appears that the process is
orderly and that the indicators of attachment which develop
continue throughout.pregnancyu Theoretically, prenatal fetal
attachment may be thought of as the precursor of postnatal
maternal infant attachment. However, attempts to correlate
the two have been generally unsuccessful.. Although Cranley
(1979, 1981a) reported a correlation between prenatal fetal
attachment and operationalized concepts used to define
postnatal maternal attachment, the association was weak.

Although research supports the belief that the maternal
infant relationship has its origins in the prenatal period,
psychosocial variables which may affect the degree of prenatal
fetal attachment a pregnant woman forms for her unborn child
were conflicting in both the adolescent and adult groups. For
both groups, however, the extent and/or quality of the support
network appears to have a significant impact on this
relationship. The degree and frequency of fetal movement,
planned pregnancy, intent to keep the infant, and the degree
of prenatal fetal attachment were consistent across the age
groups. The literature has been primarily directed toward an
understanding of this developmental process in the pregnant
adults ‘we know 'very little concerning' the process of

affiliation in the adolescent.

41
W

This study of prenatal fetal attachment in primiparous
adolescent women, and the psychosocial variables thought to
have an effect on the strength of that attachment, is based
upon. an ecological model. This model assumes that an
interdependent, reciprocal relationship exists between the
system and the environment in which the system is embedded.
In this study, the adolescent's family, which shares a common
identity, resources, goals, and values, is viewed as the
adolescent's environment (Bubolz, Eicher, & Sontag, 1979) .
The adolescent and her developing fetus are viewed as the
Adolescent System which is embedded within the Family
Environment and which interacts within itself and with members
of her environment.

The Family Environment, within which the Adolescent
System functions, is the primary source from which human
energy, in the form of competent individuals (those who have
the capacity to interact effectively with the environment) is
generated. Paolucci (1983) stated, "The family organizes and
uses a complex of resources- a mix of materials, "things”,
time, labor, skills, and space- to achieve its particularistic
set of goals. In most families, some of these resources are
invested in building the human resource of each family member,
i.e., the capabilities of members so they can become
productive and self-fulfilled persons." In addition to the

resources described by Paolucci (1983) , Amato and Ochiltree

42

(1986) included biologically inherited capacities, personal
relationships, and information as necessary for the
development of human competence. Behavior of family members
can facilitate or inhibit this development. When mastery
attempts are encouraged, realistic feedback is given, and the
environment is characterized by relative warmth and support,
the adolescent develops pyschosocial characteristics which
have the potential for enhancing her functional ability as
well as her responsiveness to others within her environment.
In addition, the adolescent's capacity for adapting to
internal and external environmental change is enhanced.

The interdependent nature of systems and their
environments requires a mutual process of adaptation, a second
central concept in this ecological model. Systems are not
static but must continually adjust or adapt to change in one
another»- Melson (1980) defined adaptation as the fit between
system demands and environmental. supply. The process of
adaptation is the system's attempt to establish and maintain
a relatively stable relationship with the internal and
external environment. The process of adaptation may be
gradual and go unnoticed or be very apparent in the instance
of a sudden change in the external environment or within the
system itself. Each system has a level of adaptation, that
is, a neutral state of stimulation at which the system is at
its customary level of functioning. However, the system must
be responsive to change so that it can function according to

the dictates of a multitude of environmental settings. The

43

ability to adapt to varying situations suggests that the level
of adaptation may be a learned response and the outcome will
be dependent on the quantity and quality of system and
environmental resources which are individually and
collectively possessed. The repertory of adaptive responses
may include coping actions which make it possible to
understand and master the environment, defense mechanisms,
e.g. , denial which may provide time to gather necessary
strength to meet a situation, mastery or the development of a
skill or. technique with which to actively deal with the
situation, retreat, and redefinition of the situation. The
response which is selected is done so for the purpose of
maintaining one's sense of self-esteem (Melson, 1980).

The diagram in' Figure 1 (p. 44) illustrates the
application of the concepts of human competence and adaptation
in this study of prenatal fetal attachment in primiparous
adolescent women. This ecological model of interpersonal
competence and adaptation illustrates the significance of
these personality dimensions in the adolescent's developing
relationship with her unborn baby. The major components of
the model, the Family Environment and the Adolescent System
embedded within it, are depicted with broken lines which
indicate the semi-permeable nature of the component
boundaries. Information, matter, and energy can be
selectively admitted from the surrounding environment or
selectively discharged from the system, thus giving the

system a degree of autonomy and control over the flow of

44
energy into and out of the system, The bi-directional arrows

indicate pathways by which information, matter, and energy are

 

 

INPUT
Biopsychosocial
FAMILY ENVIRONMENT Resources of

’F Social Support

L

TRANSFORMATION

 

J/

 

 

 

 

Interpersonal
Competence

 

 

 

\’ Self-Esteem
Stress 8 Anxiety'

 

 

.Adaptation

\l/

OUTPUT

 

 

Adolescent <--> Fetus

Prenatal Fetal
‘< Attachment

ADOLESCENT SYSTEM < r J!
I Health Behaviors I

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1

An Ecological Model of Competence and Adaptation
in Primiparous Adolescent Women

45
reciprocally exchanged between the Family Environment and the
Adolescent System.

Although the model indicates the reciprocal nature of the
relationship between the adolescent and her family, the
emphasis in this study of prenatal fetal attachment is on the
effect of having developed interpersonal competency and
adaptive capacities through interaction with members of her
Family Environment and ultimately their effect on the
adolescent’s interaction with her unborn child. This aspect
of the model is depicted as Input into the Adolescent System
and it consists of biopsychosocial resources of social support
in the form of affectionate expression, affirmation of self-
worth, and direct support and assistance, supplied in
quantities which meet the adolescent's perceived need. These
resources are then utilized by the Adolescent System to attain
a maximum level of self-esteem and minimal levels of stress
and anxiety. Thus, the Adolescent System emerges with
interpersonal competence and adaptive capacities with which to
cope with maturational and situational crises. This is
depicted in the model as the process of Transformation. The
development of these psychosocial characteristics enables the
adolescent to interact effectively with her fetus and to
develop mothering role behaviors. This is depicted as
prenatal fetal attachment or Output. As the degree of
prenatal fetal attachment increases, she is more likely to
provide a healthy environment for herself and her fetus

through appropriate health behaviors. Finally, it is the

46

response by the fetus, that is, progressive growth and
activity which serves to enhance and cement this relationship.

The purpose of this _ correlational 'study of factors
related to prenatal fetal attachment among primiparous
adolescent women was to determine 1) the degree of prenatal
fetal attachment in primiparous adblescent women at various
gestational stages; 2) to determine whether the indicators of
attachment appear in a particular sequence in the gestational
period; 3) to determine if the degree of prenatal fetal
attachment is related to specific factors including:

a) psychosocial factors such as levels of self-esteem
and anxiety

b) the extent of social support and health behaviors
practiced during pregnancy

c) the degree of perceived stress and ego development

In summary, this study of prenatal fetal attachment in
primiparous adolescent women was based upon an ecological
model which assumes an interdependent relationship between the
adolescent system and her family environment. Supportive
relationships provided by significant others will enable the
adolescent to attain and maintain a maximum level of self
esteem while minimizing the degree of perceived stress and
level of anxiety which are associated with her developmental
stage and aggravated by the situational crisis of pregnancy.

These supportive relationships result in the development of an

47
interpersonal competency and adaptation within the adolescent
which stimulates and enhances the beginning of a life long
attachment to her child.

Chapter 3
Methodology

The objectives of this study of prenatal fetal attachment
in primiparous adolescent women were to determine whether this
process actually occurs and in what manner it occurs. A
second objective was to determine whether the strength of the
attachment is related to psychosocial variables such as levels
of self-esteem and anxiety, the extent of social support and
health behaviors practiced, and the degree of perceived stress
and ego development. In this chapter the research design is

presented.

The diagram in Figure 2 (p. 49) illustrates the
relationship of the independent and dependent variables in
this study of prenatal fetal attachment in adolescent women.
It assumes that the degree of prenatal fetal attachment
(dependent variable) which women develop toward their unborn
children is directly related to individual personality
characteristics (independent variables) of level of self-
esteem, and level of anxiety, and the degree of perceived
stress. 'Social support is mediated through these personality

characteristics thus the extent of social support directly

48

49

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

'Degree of
Ego
Development
l \f
Extent of Levels of Degree of Extent of
Social Self-Esteem Prenatal Health
Support a 8 Anxiety Fetal ~§ Behaviors
Degree of .Attachment Practiced
Perceived '
Stress
Figure 2

A Theoretical Model of the Relationship of the Degree of
Prenatal Attachment and the Extent of Social Support, Levels
of Self-Esteem and Anxiety, Degree of Perceived Stress and
Ego Development, and Extent of Health Behaviors Practiced in
a Study of Prenatal Fetal Attachment in Primiparous

. Adolescent Women

affects the levels of self-esteem and anxiety, and the degree
of perceived stress experienced by the adolescent. These in
turn, affect the degree of attachment the adolescent develops
for her unborn child. The degree of ego development, a fourth
independent variable, is also directly related to the degree
of prenatal fetal attachment. This variable is a function of
her age. Personal preoccupation with an imaginary audience

and the construction of a personal fable are characteristics

50
which are typical of the adolescent, and are assumed to
inhibit a developing relationship which requires placing
concern for the fetus before concern for herself. This
theoretical design also assumes that the degree of prenatal
fetal attachment affects the extent of health behaviors
practiced during the gestational period, that is, the greater
the degree of attachment, the more likely she will be to
provide an optimal prenatal environment for herself and her
fetus. Thus, the degree of prenatal fetal attachment then
becomes the independent variable, the extent of health
behaviors practiced during pregnancy becomes the dependent
variable. Finally, the levels of self-esteem and anxiety, the
degree of perceived stress, and the extent of social support
are directly related. to ‘the extent of health. behaviors

practiced during pregnancy.

W

This study of prenatal fetal attachment in adolescent
women conceptually defined. the major variables in the

following manner:

W This was conceptually
defined as the extent to which the mother reports behaviors,

attitudes and feelings that represent affiliation and
interaction with her unborn fetus (Adapted from Cranley,
1981a). Operationally this concept was defined through the

51

use of the Maternal Fetal Attachment Scale developed by
Cranley (1979, 1981a). This is a Likert type scale which
originally contained 24 items, one of which was deleted on the
advice of the author. The remaining 23 items were scored from
one to five, with five (definitely yes) being the most
positive and one (definitely no) being the least positive.
A. total score was obtained by summing over all items. The
scores could range from a high of 115 to a low of 23.

The 23 items are distributed into five subscales which
measure attitudes, beliefs, and behaviors indicative of
prenatal fetal attachment. The subscales are, Roletaking,
Differentiation of Self From Fetus, Interaction With the
Fetus, Attributing Characteristics to the Fetus, and Giving of
Self. Subscale scores were derived in the same manner as the
total score and could range from a high of 30 and a low of 4
depending on the subscale.

Because adolescents tend to delay entry into the health
care system until late in pregnancy, the degree of prenatal
fetal attachment at Time 1 which may have occurred in the
weeks previous to her first prenatal visit were assessed
retrospectively by asking the mother to respond to the
Maternal Fetal Attachment Scale (Cranley, 1981a) which was
adapted for that purpose. Items 3, 9, 16, 17, 20, 21, and 23
were deleted as they pertain to active, observable fetal
movement which does not occur until late in the second
trimester. A total score was obtained by summing over all 16

items and scores could range from a high of 80 to a low of 16.

52
The subscales were reduced accordingly (See Appendix A, p.166
for the psychometric properties and a description of the items
of which the total scale and subscales of this instrument
consist. A copy of the instrument appears in Appendix D, p.

185).

'42: -' ,2. viz—9: 9.. :2 u- ,. --.,._, This
was conceptually defined as the extent to which a series of
health behaviors were practiced by the pregnant woman. This
concept was operationally defined by requesting the subject to
respond to a health behaviors scale which was developed by the
investigator specifically for this study of prenatal fetal
attachment in adolescent women. The items for this scale were
selected based upon prenatal health education which was
provided by the selected health care clinic. It elicits the
extent to which, over the previous six weeks, she has avoided
substances which are known to be harmful to the fetus, (non-
prescription drugs, alcohol, tobacco, and street drugs), the
maintenance of adequate nutritional intake, adequate sleep,
rest, and exercise. This is a Likert type scale which
consists of five responses ranging from never to every day.
A response of never received a score of one for items one
through four and indicates that the health behavior was not
practiced. A score of five indicates that health behavior was
always practiced. Scoring for items five, six, seven, and
eight were inverted. The total score. ranged from a high of 40

to a low of 8, with the higher scores indicating a greater

53
extent of health behaviors practiced (See Appendix A, p. 166
for the psychometric properties of this instrument and a
description of items of which this scale consists. A copy of

the instrument appears in Appendix D, p. 185).

W This was conceptually defined

through two related constructs, the imaginary audience and the
personal fable. The imaginary audience was defined as, "The
tendency to see the self as the object of other's attention,
to anticipate the reactions of others to the self in real or
imagined situations". The personal fable was defined as,
"The belief in one's personal uniqueness, omnipotence, and
invulnerability" (Lapsley, et al., 1989, p. 3). Uniqueness
was defined as, "A difference from everyone else", omnipotence
was defined as, "Having virtually unlimited authority or
power,“ and invulnerability was defined as, ”Incapability of
being ‘wounded' (Lapsley, et al., 1989, p.12-13). This
variable was operationally defined through the use of the New
Imaginary Audience Scale (NIAS) and the New Personal Fable
Scale (NPFS), developed by Lapsley, et al. (1989). One item
in the NPFS (#40) and one item in the NIAS (#12) was adapted
to conform to the characteristics of those who participated in
this study.

. The New Imaginary Audience Scale is a 38-item Likert
scale which has four response choices ranging from "Never" to
"Often" with a value of one assigned to a "Never" response,

and a value of four assigned to a response of "Often." A

54
total score was obtained by summing over all responses and
scores could range from 152 to 38. .Higher scores indicate an
increased tendency to react to an imaginary audience.

The New Personal Fable Scale is a 46-item Likert scale
with five responses ranging from "Strongly Disagree" with an
assigned value of one, to "Strongly Agree" with an assigned
value of five. Scoring for 15 of the items was inverted. A
total score was obtained by summing over all responses.
Scores could range from a high of 230 to a low of 46. The New
Personal Fable Scale contains three subscales, Omnipotence,
Invulnerability, and Uniqueness. The scoring for the
subscales was done in the same manner as for the total score.
Higher scores indicate a greater tendency to construct a
personal fable (See Appendix A, p. 166 for the psychometric
properties and a description of items of which the total
scales and subscales consist. A copy of the instrument

appears in Appendix D, p. 185).

Leygl_gfi_§glf:£gtg§m This was conceptually defined as, ”The

evaluation which the individual makes and customarily
maintains with regard to himself. It expresses an attitude of
approval or disapproval, and indicates the extent to which the
individual believes himself to be capable, significant, and
worthy.” ' (Coopersmith, 1967). This variable was
operationally defined through the use of the Coopersmith Self-
Esteem Inventory (CSEI). Two forms, the Short Form designed

for students ages eight through fifteen.and the Adult Form for

55
those sixteen and older, were utilized. These are essentially
the same forms but wording is geared toward the particular age
group. Each consists of 25 items and requires the respondent
to indicate whether the item is "Like me" or "Unlike me”. .A
score was obtained by scoring negative items correct if they
were answered ”unlike me.” Positive items were scored correct
if they were answered "like me. A total score was obtained by
summing the number of items answered correctly and multiplying
the total raw score by four. This resulted in a maximum
possible score of 100 (See Appendix A, p. 166 for the
psychometric properties of this instrument and a description

of items which are scored positively and negatively).

W This was conceptually defined as

"Interpersonal transactions that include one or more of the
following: The expression of positive affect of one person
toward another: the affirmation or endorsement of another
person's behaviors, perceptions, or expressed views; the
giving of symbolic or material aid to another" (Kahn, 1979, p.
85) . The functional aspects of social support, affect,
affirmation, and aid, as well as the dynamic properties of the
construct, were operationally defined through the use of the
Norbeck Social Support Questionnaire (NSSQ).

The NSSQ requires the respondent to list those
individuals in her social network who are important to her,
and to indicate their relationship to her. The adolescent was

then requested to respond to a series of six items which

56

elicit the functional aspects of social support. These items
are arranged on a five point Likert scale with responses which
range from "Not at all" to "A great deal". The size,
stability, and availability of the network are obtained
through totaling the number of individuals listed, duration of
the relationship, where responses indicate that the individual
has been known for less than six months to more than five
years, and frequency of contact, where responses range from
once a year or less to daily. Network loss and the extent of
support lost can also be obtained. Because the instrument
does not have the mechanism for determining whether or not one
of the listed members is the father of her baby, a tenth item
was included to elicit this information.

Scoring of the instrument was done in the following
manner. Questions one through six, which measure total
functional support, received a score of zero to four since one
indicates no support and will artificially inflate the total
score if it is included. For these items, a Total Functional
Support score was obtained by adding the: ratings for each
question and summing over all items. Scores could range from
a high of 24 to a low of zero. A single score for each
subscale was obtained by totaling items one and two
(Affection), three and four (Affirmation), and five and six
(Aid). Scores for each of these subscales could range from a
high of 8 to a low of zero. A Total Network Properties score
was obtained by totaling the number of members listed, the

duration of the relationship, and frequency of contact. These

57
items were scored one to five with higher scores indicating
more durable relationships (See Appendix A, p. 166 for the
psychometric properties of this instrument and a description
of items of which the scale and subscales consist. A copy of

the instrument appears in Appendix D, p. 185).

W The degree of perceived stress was
conceptually defined as, "Any ‘unfavorable experience or

situation whiCh is perceived by the individual as being of
such magnitude that the individual is not able to cope with
his or her usual pattern of behavior". This variable was
operationally defined through the use of The Life Events
Questionnaire (LEQ) (Norbeck, 1984).

This instrument was adapted from the Life Events Survey,
developed by Sarason, Johnson, and Siegle (1978) , in an effort
to render it more appropriate for adult women. Although it
has not been utilized in the study of the. adolescent
population, it was believed to be appropriate for this sample
due to the similarity of circumstances of the adolescent group
to adult women. 'The instrument consists of 82 items which.are
categorized into Health, work, School, Residence, Love and
Marriage, Family and Close Friends, Parenting, Personal and
Social, Financial, Crime and Legal, and Other (an open-ended
response to allow the respondent additional latitude). The
respondent is requested to indicate whether the event, which
occurred in the last year, had a good or bad effect and then

to rate that effect on a four’point scale with a value of zero

58
given for "no effect" and a value of three given for ”great
effect”. Three scores can be obtained from the questionnaire,
the sum of the negative or bad events, the sum of the positive
or good events, and a total events score, the sum of both
negative and positive events. Only those scores which were
obtained by summing the weighted bad events were utilized in
this study; higher scores indicated a greater degree of
perceived stress. Rationale for the utilization of only the
negative events score was provided by the literature. Early
work by Holmes and Rahe (1967) was based on the assumption
that any life change, positive or negative, is stressful to
the individual involved. Other investigators, however,
(Mueller, Edwards 8 Yarvis, 1977: Sarason, Johnson and Siegel,
1978: Vinokur 8 Selzer, 1975) based their work on the belief
that undesirable life events have a greater effect on
perceived stress than do desirable life events. In general,
these investigators found higher correlations, of greater
significance, between undesirable life changes and several
personality variables indicative of maladjustment (See
Appendix A, p. 166 for the psychometric properties of this
instrument.. A copy of the instrument appears in Appendix D,

p. 185).

Leye1_gf_5nxigty; This variable was conceptually defined as'a
state which is characterized by subjective feelings of
tension, apprehension, nervousness, and worry. Anxiety may be

transitory (State) and can occur when evoked by appropriate

59

stimuli. Trait anxiety is a relatively enduring condition in
which the individual has a tendency to perceive stressful
situations as dangerous or threatening. The stronger the
anxiety trait, the more probable that the individual will
experience a greater state anxiety in threatening situations
(Spielberger, et al., 1983). This concept was operationally
defined through the use of the State-Trait Anxiety Inventory
(Spielberger, et al., 1983).

This instrument is a two part scale which measures the
level of anxiety the respondent is experiencing at the moment
(State Anxiety), as well as the level of anxiety which is
generally' experienced (Trait; Anxiety). Both scales are
arranged on a Likert scale which utilizes four responses. The
S-Anxiety scale responses range from ”Not at all” to "Very
much so", while the T-Anxiety scale ranges from ”Almost never"
to “Almost always”. Item scores range from one to four
depending on the particular item. Because 10 of the State
Anxiety items and eight of the Trait Anxiety items are
presented as indicating the absence of anxiety, scores for
these items are reversed. Total scores for both scales can
range from a high of 80 to a low of 20 where higher scores
indicate a greater level of anxiety (See Appendix A, p. 166

for psychometric properties of this instrument).

so
Wrinkles

The following variables were selected to be treated as
control variables for this study of prenatal fetal attachment

in adolescent women.

Age of Adolescent
Ethnicity of Adolescent
Socioeconomic Status ‘
Marital Status of Adolescent ‘
Planned/Unplanned Pregnancy ‘
Attendance at Prenatal Classes 1
Gestational Age in Weeks
Complications in Pregnancy
Visualization of Fetus During Ultrasound ‘
Intent to Keep the Infant ‘

Date of Month Fetal Movement First Felt 2

With the exception of socioeconomic status, the control
variables are self-explanatory and were operationally defined
either by requesting that information from the subject or by
collecting the data from the prenatal record (See Appendix D,

p. 185).

 

1 There was little or no variability in these variables,
therefore they were excluded from the analysis.

2 The adolescents generally did not know when quickening had
occurred, therefore, this was excluded from the analysis.

61
figgigeggngn19_§tatns This was operationally defined through
obtaining the amount of personal and household income as well
as the educational levels obtained by the adolescent’s

parents.

WW An instrument. for the purpose of
measuring demographic data, was specifically designed by the

investigator. It consists of two parts. The data sheet was
utilized at each period of data collection and information
concerning the progress of the pregnancy was elicited either
from the adolescent or her medical chart . The second part
consists of personal information, for example, birth date,
religious preference, living arrangements, income, and

education (See Appendix D, p. 185).

W

Six null hypotheses were developed to meet the objectives
of this study of prenatal fetal attachment in primiparous
adolescent women. ‘Working hypotheses were developed for each
of the variables only to illustrate the direction of the
relationship suggested.by the theoretical framework, Because
the 'majority of the ;variables either have demonstrated
conflicting results or have not.been previously investigated,
two-tailed tests were utilized except for the variable of the

extent of social support. The working hypotheses, with the

62
exception of hypothesis H14, do not appear in the analysis of
the data.

H01: Among pregnant adolescents, there is no relationship
between the level of self-esteem and the degree of
prenatal fetal attachment.

H11: Among pregnant adolescents, there is a positive
relationship between the level of self-esteem and the
degree of prenatal fetal attachment.

H02: Among pregnant adolescents, there is no
relationship between the level of anxiety and the degree
of prenatal fetal attachment.

H12: Among pregnant adolescents, there is a negative
relationship between the level of anxiety and the degree
of prenatal fetal attachment.

H03: Among pregnant adolescents, there is 'no
relationship between the degree of perceived stress and
the degree of prenatal fetal attachment.

H13: Among pregnant adolescents, there is a negative
relationship between the degree of perceived stress and
the degree of prenatal fetal attachment.

H04: Among pregnant adolescents, there is no
relationship between the extent of social support and the
degree of prenatal fetal attachment.

H14: Among pregnant adolescents, there is a positive
relationship between the extent of social support and the
degree of prenatal fetal attachment.

H05: Among pregnant adolescents, there is no
relationship between the degree of ego development and
the degree of prenatal fetal attachment.

H15: Among pregnant adolescents, there is a negative
relationship between the degree of ego development and
the degree of prenatal fetal attachment.

63
H06: Among pregnant adolescents, there is no
relationship between the extent of health behaviors
practiced and the degree of prenatal fetal attachment.
H16: Among pregnant adolescents, there is a positive
relationship between the extent of health behaviors
practiced and the degree of prenatal fetal attachment.
The level of significance at which the null hypothesis
was rejected was set at p < .05: all statistical analyses were

based on two-tailed tests except for the analysis of the

extent of social support.

W

'The clinic which was selected for the sample is located
in a medium sized city in a midwestern state. It serves only
the high-risk obstetrical client, of which the adolescent is
by virtue of her age. This clinic was specifically selected
as the site in which to investigate the phenomenon of prenatal
fetal attachment in adolescent women because of the large
number of adolescents served.

The administrators of the clinic were personally
contacted by the investigator. Rationale for the proposal was
presented, stressing the current lack of knowledge about the
process by which adolescent mothers form an attachment to
their unborn children. It was suggested that appropriate
interventions could be developed which may promote a high
degree of attachment early in the gestational period, thus

affecting the mother's commitment to provide an optimal

64
environment for herself and her developing fetus. The
administrators reviewed the entire proposal with the
knowledge that the investigator would retain all rights to the
entire study, as well as the right to publish results. Agency
and University approval regarding the protection of human
subjects was obtained.

A sample of 40 primiparous adolescent women was drawn in
a non-random manner. Any adolescent who presented herself at
the clinic and who met the criteria of age (12 through 19
years), was primiparous, i.e. , who was carrying her first
fetus to term, and who agreed to participate was included in
the study.

A total of 46 adolescents was approached as possible
subjects. Of these 46, one declined to participate at the
request of her mother who claimed insufficient time. One
adolescent transferred to another prenatal clinic and one was
lost to the study for failure to keep her prenatal
appointments: she could not be located. Three adolescents
spontaneously aborted. The partial data sets which had been
collected for these subjects were not included in the
analysis. The final sample consisted of 40 adolescents
ranging from 12 to 19 years of age.

A clinic employee collaborated with the investigator in
the recruitment of potential subjects. Those adolescents who
were attending the clinic for their initial biopsychosocial
evaluation and health teaching, and who met the criteria,

i.e., primiparous and low risk, except for her young age,

65

received a verbal explanation of the study and a formal letter
of consent (See Appendix C, p. 182) . The adolescent‘was asked
to consider participation, and if she agreed, to- bring the
signed consent with her to her next scheduled visit two or
three days hence. The dependent adolescent who was under the
age of 18, was required to include the signature of one parent
or guardian. Adolescents '18 years and older or who were
emancipated minors gave self-consent for participation. Upon
her return visit to the physician, providing she. had the
signed consent, she was met by the investigator for the first
period of data collection. Adolescents who wished to
participate in the study and who had obtained parental
signatures, but had forgotten to bring the signed consent to
the clinic, were asked by the investigator if it would be
permissible to telephone the consenting parent or guardian if
she 'or he had not accompanied the adolescent. If she agreed,
a signed consent was obtained from her which indicated who
should be contacted and at what telephone number (See Appendix
C, p. 182). None of the adolescents failed to mail the
required signed consent before the next scheduled period of
data collection. A self-addressed stamped envelope was
provided for this purpose.

All participants were offered a summary at the conclusion
of the study. In addition, in order to encourage
participation in the study, and to compensate for her time,
the participant was reimbursed $10.00 for each set of data for

a total of $30.00 which was paid at the completion of the

66
fourth data set. Data were collected weekly over a period of
five months until the required 40 were obtained. Longitudinal
data were collected at the appropriate time intervals: the

entire process occurred over seven months.

Wigs

Each subject was met by the investigator or a research
assistant at the time of her first visit to the physician and
she was requested to respond to the first and second data sets
which were dictated to her. Rationale for dictation as a
method of data collection was based on the belief that more
complete data would be obtained due to the varied reading
abilities of this group, and conservation of time as these
adolescents spent several hours at the clinic during each
visit. The date and time for subsequent clinic visits during
which data were collected was obtained by requesting her to
return a stamped, self-addressed postcard which was to be
mailed when she had reached the designated gestational age.
Follow up telephone calls and letters confirming future
appointments were initiated as necessary.

The approximate time required on the first visit was 30
minutes and 45 minutes on each of the two later visits. The
following data collection schedule was developed to allow
maximum utilization of time so that the already lengthy

prenatal visits would not be unduly extended.

67

WNW
TIME 1: Maternal Fetal Attachment Scale-
Retrospective Assessment
TIME 2: (10-24 weeks)
Maternal Fetal Attachment Scale
Health Behaviors Scale
Coopersmith Self-Esteem Inventory

State-Trait Anxiety Inventory
Data Sheet Completed by Investigator

WW

Time 3: Maternal Fetal Attachment Scale
Health Behaviors Scale '
New Personal Fable Scale
New Imaginary Audience Scale
Norbeck's Social Support Questionnaire
Data Sheet Completed by Investigator

WM

Time 4: Maternal Fetal Attachment Scale

Health Behaviors Scale

Demographic Data

Life Events Questionnaire

Data Sheet Completed by Investigator

Gestational age ranged from 10 to 39 weeks at the time of

the first interview, thus at Time 2 the adolescent, according
to her gestational age, might be more appropriately‘placed in
Time 3 or Time 4. For those adolescents who were late
registrants (who were 25 weeks or beyond), three or four data
sets were collected at the initial visit. For example, if an
adolescent made her first prenatal visit at 37 weeks,

retrospective and current data for the -Maternal Fetal

Attachment Scale and all. remaining. measures were obtained.

68.
Therefore, for this adolescent, only two attachment measures,
Time 1 and Time 4, and one health measure (Time 4) were
obtained. Gestational age at ‘Time 3 and 4 was less variable.
Participants ranged from 25 to 31 weeks at Time 3 (Mean 26.6
weeks). Gestational age ranged from 32 to 39 weeks at Time 4

(Mean 33.4 weeks).

Minis

Analysis of the data for this study of prenatal fetal
attachment in primiparous adolescent women was accomplished in
two stages. Stage I consisted of descriptive statistics which
were utilized to describe sample characteristics and the
response to the dependent variable. In addition, the data
were subjected to Repeated Measures Analysis of Variance in
order to determine whether the sample. demonstrated a change in
thoughts, feelings, and behaviors indicative of prenatal fetal
attachment, as well as the extent of health behaviors
practiced over the course of the gestational period. Stage II
consisted of correlational analyses to determine the existence
of a relationship between the independent and dependent
variables. Partial correlational analyses were then conducted
to determine the extent to which the variability in the major
variables could be explained by the control variables. The
Statistical Package for Social Sciences x (1983) was used for

the purpose of data analysis.

69

In summary, instruments which were utilized to measure
the independent variables 'in this study of prenatal fetal
attachment in primiparous adolescent women have, in general,
been adequately subjected to measurements of reliability and
validity. The Maternal Fetal Attachment Scale, although
reliable, has yet to be subjected to measures of validity
other than content validity.- Forty adolescents participated
in this study and data were collected at intervals over the

gestational period.

Chapter 4‘
Data Analysis

The results of the data analysis are presented in this
chapter. The sample description will be followed by findings
which were generated by each of the research questions and the
results of correlational analyses which were utilized to test

the hypotheses.

Minis

Sampaneseriptiqn

Tables 1 through 8 (pp. 71-79) describe the demographic
data for the subjects who participated in this study of
prenatal fetal attachment in primiparous adolescent women.
Subjects ranged in age from 12 to 20 years of age, at Time 4,
with a mean age of 16.70 and SD 1.57 years. The age group
most frequently represented was 15 through 17 years which
contained slightly more than three-fourths of the sample. The
younger and older age groups were almost equally represented

with 1.1% and 13% of the adolescents respectively. Five

70

71
percent of the adolescents attained their 20th birthday during

the course of the study (Table 1, p.71).

Table 1

Age Distribution of Adolescents *

 

 

 

 

 

 

 

 

 

 

 

 

* Mean 8 16.70
8.0. = 1.57

Most adolescents were in dependent living arrangements,
many of which were unstable, as 38% moved at least once during
the course of the study. All but 8% of the adolescents were
single and 70% were living with their mothers: only 20%
reported living with both parents, 5% of whom were
stepfathers. The remaining caretakers were other family

members, primarily grandmothers and aunts. Of the 8% who were

72
Table 2

Frequency Distribution of Demographic Data

 

Marital Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Married I 3 I 8
Single [ 37 I 93
Living Arrangements
With both parents 8 20
With mother only 20 50
With spouse 2 5
With guardian/friend 5 13
With boyfriend 3 I
l Alone 2 5 J
Ethnicity
Afro-American 21 53
Caucasian 12 30
Hispanic 7 18
Religious Affiliation
Catholic 12 30
Protestant 20 50
None 8 20
Extent of Religious Practice
None 5 l3
Inactive 5 13
Infrequent (2-3 times yearly 10 25
Monthly 14 35
Weekly 5 13
Daily 1 1 3

 

 

 

-73
married, 5% were living with.their'husbands and.3% were in the
process of divorce. Eight percent of the adolescents were
living with the father of their baby and 5% were living alone
(Table 2, p. 72).

In this sample of pregnant adolescent women, three ethnic
groups were represented. Just over half were Black, almost
one-third were Caucasian, and almost one-fifth were Hispanic.
Although 80% reported a religious affiliation, only 15%
participated in religious activities on a regular basis (Table
2, p. 72).

The dependent adolescents generally did not know the
extent of family income and either indicated this or attempted
an estimate. Clinic records inconsistently recorded financial
status by monthly income or with only the notation of public
assistance. Although these data are not totally accurate, it
is ievident that income was generally inadequate for a
reasonable lifestyle. Medicaid funds provided the sole income
for 55% of parents or guardians: eight per cent of the care
providers held part-time employment in addition to medicaid.
Although 25% of the adolescents had their own income, except
for 3% who held part-time employment, it was exclusively
medicaid income and was less than $5,000 per year. Thus,
fully 88% of the group received at least partial support
through governmental assistance (Table 3, p. 74).

Adolescents who were cognizant of their parents'education
revealed that their parents were generally poorly educated.

Similarity in educational achievement between parents was

74
Table 3

Source of Income for Adolescents and Their Families

 

Own Medicaid

 

Parent/Guardian Medicaid Only

 

Parent/Guardian Medicaid and Part Time Work

 

Parent/Guardian/Spouse Full Time Work

 

 

 

evident. While nearly one-third of their fathers had not
graduated from high school, 40% of their mothers had not.
Approximately 40% of both parents had either graduated from
high school or had earned a GED. Fewer than one-fourth of
their mothers had obtained schooling, either technical or
collegiate, beyond high school while 25% of their fathers had
done so (Table 4, p. 75).

Achieving their own education while experiencing a
pregnancy proved to be a difficult task for these adolescents.
Ninety-five percent of the group had not graduated from high
school although nearly 75% were attempting to maintain their
educational status either in their original educational
setting or in the local alternative school. Slightly more
than two-thirds were within three years of graduation, 29%
were in middle school and 3% were in grade six of elementary
school. Only 3% of the adolescents had graduated from high

school and had accumulated some college credits (Table 5, p.

76).

75
Table 4

Educational Achievement of Parents of Adolescents (%)

 

 

 

 

 

 

 

 

 

 

‘-
< HS HS GED 1-2 > HS College Grad
Mother * 40 26 13 18 3
I Father ** 31 38 6 16 9 I
a n - 33'
** n I 32

For most of these adolescents this pregnancy was not
anticipated. While only 15% had planned the pregnancy, the
entire group had determined to keep the infant rather than to
seek adoption (Table 6, p. 76).

The point in pregnancy at which the participants sought
prenatal care was variable. The mean gestational age was
20.45 weeks with a SD of 7.09, and a range of 10 to 39 weeks.
The data exhibited a polymodal distribution with 8% of the
adolescents registering'at.gestational ages of 13, 14, 18, 20,
and 24 weeks. Sixty percent did not register until their
second trimester with the majority being in the latter half of
the trimester. Slightly more than one-fourth did not receive
care until their third trimester and almost half of them

registered at 30 weeks or later (Table 7, p. 77).

76
Table 5

Educational Status of Adolescents

 

 

 

 

 

 

 

 

 

 

 

I | g I g
In School I 29 I 73

I Grade
6 l 3
I 7 l 3
8 l 3
l 9 9 23
10 11 28
I 11 11 28
} 12 5 13
College 1 3

 

 

 

 

Table 6

Plans for Pregnancy and for the Infant
After Delivery

 

 

 

g I %
Pregnancy

 

Planned 6 15

 

 

 

 

 

Unplanned 34 85
Plan to keep baby 40 100

 

 

FIT

Gestational Age in Weeks at Time 1*

77

Table 7

 

stational Age

 

10

 

11

 

12

 

13

 

14

 

15

 

16

 

17

 

18

 

19

 

!
!
L

20

 

21

 

22

 

24

 

25

 

27

 

28

 

29

 

 

30

 

31

 

32

 

L__2,9__

* Mean - 20.45 weeks

SD 3

7.09 weeks

 

ha M id be a: H ta a: a: N 0a c» a: u to ya h‘ u t» a; a: H F:

 

 

UUIUHUIUUUIQUIUOUIQUIUUGQUIUIUOP

 

78

The majority of adolescents recognized the need for
continuing prenatal care. Although most of them did not enter
the health care system until the second half of pregnancy, 80%
of the group kept their scheduled appointments. The clinic
routinely mails a second appointment to those who fail to keep
their appointments. Therefore, all adolescents demonstrated
an adequate prenatal care schedule. The majority of
adolescents also recognized.the need for parenting education.
Eighty five percent had registered for prenatal classes .by the
fourth period of data collection. Of the 15% who did not, 8%
were late entrants into the health care system and.were within
six weeks of delivery (Table 8, p. 79).

Slightly more than two-thirds of this group of
adolescents experienced a variety of potentially serious
complications related to their pregnancies. Bleeding,
polyhydramnios, or incompetent cervix occurred in nine percent
of the adolescents. Three percent were inadvertently exposed
to radiation at five weeks gestation. Eight percent of the
adolescents experienced preterm labor, 5% developed
gestational diabetes, and 45% developed infections, almost
half of which were sexually transmitted diseases (Table 8, p.
79).

Visualization of the fetus via ultrasound was included as
a control variable in this studyu Ninety-eight.percent.of the

adolescents received ultrasound at least once during the

79
Table 8

Health Behaviors and Complications in Pregnancy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g %
Kept Scheduled Appointment 32 - 80
Registered for Prenatal Class 32 85
Complications in Pregnancy
Bleeding 1 3
Polyhydramnios 1 3
Incompetent Cervix 1 3
X-rayExposure 1 3
Pre-Term Labor 3 8
I Diabetes 2 5
Infection 18 45
Venereal Disease 8 20
Urinary Tract Infection 9 23
Beta Hemolytic Strep l 3
Utrasound f 39 98

 

 

pregnancy. Eighty percent of them were given an ultrasound
photograph of the baby. Data for the remaining 20% were
inadvertantly omitted. However, it is believed that all of
those adolescents who received ultrasound also received
photographs of their babies, as this is common practice in
this clinic (Table 8, p. 79).

80

 

Research questions one and two were posed as follows:

1. Does prenatal fetal attachment occur during the
gestational period in adolescents, and when during the
gestational period do the various indicators of prenatal

attachment occur?

2. Is there a sequential order among the indicators of

prenatal fetal attachment in adolescents?

These questions were . answered through frequency
distributions of individual items and the five subscales for
each of the four periods of data collection. Tables 9 through
12 (pp. 81-84) show the frequency of response to individual
items. The number of adolescents answering items varied at
Time 2 depending on the gestational age at the first
interview. In Table 10, (p. 82) the number in parentheses
following the particular items reflect the numbers of
adolescents who had not yet experienced fetal movement at Time
2 .

Table 9 (p. 81) shows the adapted version of the Maternal
Fetal Attachment Scale which measured the degree of attachment
developed in early pregnancy. Comparison of this scale with

the other three scales excludes those items which address

81
fetal movement since this event does not occur until almost

midway through the pregnancy.

Table 9

Adapted Version of The Maternal Fetal Attachment Scale
Percentage of Responses to Individual Items (H = 40)
Time 1 (10-39 weeks) -

3. ...picturing myself feeding the baby.

4. ...forward to seeing that baby looked

certain

 

Data from Time 2 are presented in Table 10 (p. 82).
Because gestational age was highly variable (range 10 to 24
weeks) for this measurement, comparison with the other three
time periods must be made with some caution. Data from Times

3 and 4 appear in Tables 11 and 12 (pp. 83 and 84)._

82

Table

10

Maternal Fetal Attachment Scale

Percentage of Responses to Individual Items*

Time 2 (10-24 weeks)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fen.',33uexcept~where»noted

 

 

 

 

DEF N no WCERTAII YES 1
1. ...talh to 5 atom baby. 10 28 3- 34 25
2. ...tretble of ba1na mt was 10 13 13 44 22
gth 1t.
3. ...watcthU 10 14 S 43 29
4. ...pictuflng myself feed1m the baby. 3 16 3 47 31
3. ...forward to seeing first baby looked --- --- --- 31 69
like.
6. ...baby felt crqad 1n there. 3 25 9 38 25
7. ...callad baby by nickn-a. 22 50 --- 16 13
. ...tak1 - care of the - _-, . --- L --- 47 47
9. ..Sparaelmlity would be like... 9 46 18 18 9

.

10. ...picked out fll's name... 3 19 6 34 38
11. ...da th1 - to at healthy... --- 3 --- 56 41
12. ...could hear... --- 13 L §3__ 22
1 . ...1cked out a u.’ .,__ .... 6 L 3 L}; 38
14. ...tlmt mad feel 11-~ _. --- 13 L6 50 22
13. diet. --- 9 13 50 28
16. ...Idcka and moves... (9124) ~-- 23 14 36 27
17. ...poka the M23) 5 33 --- 43 19
18. ...hold the baby. _ A --- --- --- 47 53
19. ...p1ctura int no hwy wouldglook -.-- --- -~- 50 50
llka. ’
20. ...gflat the hwy... (1)-22) S 41 3 46 S
21. ... ~ haah1ccw t. I 5 64 14 ~-- 18
22. - do1 - certa1n thlt‘a... --- --- --- 44 56
:3. ). save the baby's foot... 14 64 18 --- 5

Maternal Fetal Attachment Scale
Percentage of Responses to Individual Items*

83

Table 11

Time 3 (25-31 weeks)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEF 110 NO WCEITAII YES DEF YES

1. ...talk to my whom baby. --- 26 3 47 24
2. ...trolble of being premant --- 21 21 39 18
was worth it.
3. ...wetching my tl—y --- 3 8 50 40
""l.eaa
4. ...picturing myself feeding --- 26 3 47 24
the baby.
5. ...forwerd to seeing what --- --- 3 32 66

looked like.
6. ...baby felt era-pad in --- 16 11 55 18
flhflu
7. ...callad . . - nickname. 3 66 --- 21 11
8. ...takigg care of the baby. --- --- 3 68 29
9. ...personality would be 3 40 26 18 13
like...
10. ...picked out girl's --- 11 3 55 '32
run".
11. ...db things to stay --- 5 --- 61 34
healthy... _
12. ...could hear... --- 13 3 66 18
13. ...picked out a boy's --- 18 5 45 32
'in".
14. ...think and feel inside --- 8 16‘ 61 16
mm
15. diet. --- --- 3 63 34
16. ...kicks and moves... --- 18 11 45 26
17. ...poke the baby... 3' 13 --- 58 26
18. ...hold the baby. --- --- 3 42 55
”a ...P‘Ctlfl‘. Wt t". W ... ." 3 so ‘7
would look like.
20. ...cpiet the baby... 20 37 8 37 16
21. - has hi '3 s... 3 68 5 18 5
22. ...gave In doing certain --- 8 --- 58 34
”If 'eee fi
23. ... love the baby's foot... 3 76 8 8 3

*n338

 

 

 

 

 

Maternal Fetal Attachment Scale
Percentage of Responses to Individual Items*

84

Table 12

Time 4 (32-39 weeks)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEF IO N WCERTAII YES DEF YES
1. ...talk to my uborn baby. 5 15 8 38 35
2. ...trotble of beirm premant 3 8 13 48 30
was worth it.
3. ...watching my tiny jiggle... --- --- --- 43 58
4. ...picturing myself feeding --- 5 10 50 .35
the baby. I
5. ...forwerd to seeing that baby --- --- --- 33 68
looked like.
6. ...baby felt ched in there. --- 15 13 53 20
7. ...callad baby by nickname. 10 50 8 20 13
8. ...tflMera of the baby. --- --- --- 58 43
9. ...personelity would be 5 30 25 28 13
like...
10. ..iicked ouflirl's nae... --- 13 8 45 35
11. ...do things to stay --- 5 --- 48 48
healthy...
12. ...could hear... --- 8 5 60 28
13. ...picked out a boy's name. --- 13 3 38 48
14. ...think and feel inside me. --- 5 10 63 23
15. diet. --- 3 5 53 40
1. ...kicks and moves... --- L 8 43 i
17. e the bay... --- 15' 3 53 3D
18. ...hold the - - . --- --- ~-- 33 68
19. ...picture that the baby --- 3 --- 43 55
would look like.
20. ...cpiet the baby... --- 33 10 33 25
21. ...baby has hing»... 10 48 5 28 10
22. ...gave up doing certain --- --- --- 53 48
thi _
23. move the baby's foot... 3 68 5 15 10

*ua40

 

 

 

 

 

85

For ease of comparison with cautions noted above Table 13
(p. 86) shows only the percentage of positive responses to
individual items across Times 1, 2, 3, and.4. In general, the
percentage of single item attachment behaviors increased over
the gestational period. At Time 4 all items showed positive
increments over Time 1. One item, talking to her unborn baby,
indicated the greatest change over time with the percentage of
positive responses increasing by almost 50% from 26% to 73%.
The adolescents expressed an increasing pleasure in the
observation of fetal movement with almost 75% responding
positively at Time 2 and 100% at Time 4. The availability of
space for her growing fetus also captivated the interest of
these adolescents. Almost half wondered whether the baby was
cramped at.Time:1. By Time 4 this percentage had increased to
almost 75%. Other items which showed an increase of more than
20% from Time 1 to Time 4 were looking torward to holding the
baby (24%), feeling that all of the trouble of pregnancy is
worth it (25%) , and eating well for a healthy baby (23%).
From Time 2 to Time 4, items with a 20% increase or more were
grasping the baby's foot to move him around (20%), and poking
the baby to get him to poke back (21%).

Although other items showed positive increases over time,
they were less dramatic. Fewer than 25% of the adolescents
called their baby by a nickname at Time 1. By Time 4, just
one-third were doing so. .Approximately two-thirds had picked
out both girls and boys names early in pregnancy. However, by

late pregnancy, 20% had not yet chosen a girl's name and 15%

86
Table 13
Maternal Fetal Attachment Scale

Percentage of Positive Responses to Individual Items*
Times 1, 2, 3, and 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“me 1 Time 2

1. ...talk to my u'born baby. 26 59
2. ...trolble of being pregnant 53 66
was worth it.
3. ...wetching my tinny jiggle... NM 72
4. ...picturing myself feeding 58 78 71 85
the baby.
5. ...forwerd to seeing mist baby 93 100 98 100
looked like.
6. ...baby felt cramped in there. 46 63 73 73
7. ...called baby by nickname. 23 29 32 33
8. ...teking care of the baby. 80 94 97 100
9. ...personelity would be NM 27 31 41 I
like...
10. ...picked out girl's nae... 68 72 87
11. ...do things to stay 83 97 95 96
healthy...
12. ...could hear... 68 85 84 88
13. ...picked out a boy's nae. 63 69 77 86
14. ...think and feel inside me. 65 72 77 86
15. diet. 70 78 97 93
16. ...kicks and moves... 41A 63 71 71
17. ...poke the baby... WA 62 84 83
18. ...hold the Loan: 76 100 97 100
19. ...picture that the baby 88 100 97 98

- ld look like.

_., ...- let the . - ... 44.!(8 51 ‘ 53 so
21. - has hicc .- s... IA 18 23 38
223 ...geve w doing certain 85 100 92 100
23. move the baby's foot... MIA 5 11 25

* See the previous four tables For the values of u.

87

had not yet chosen a boy's name. Moreover, almost 10% of the
adolescents who had named a girl child by Time 3 responded
negatively at Time 4 resulting in a decrease in positive
responses to this item. Only 50% reported stroking their
abdomen to quiet a kicking fetus at Time 2 and by Time 4, that
percentage had increased by just 8%. Few could detect when
their babies had the hiccoughs (38% at Time 4) and those who
detected increased fetal activity at eating time rose by just
8% from 63% at Time 2 to 71% at Time 4 (Table 13 p. 86).

A few items other than selecting'a name for a girl showed
a slight decrease in positive responses from Time 2 to 3 and
3 to 4. Slightly more than 50% felt that all of the trouble
of pregnancy was worth it at Time 1. i This increased by
another 13% to 66% by Time 2. At Time 3, only 57% believed
this to be so. .However, by Time 4 more than 75% of the sample
did so. Other decremental responses were negligible (Table
13, p. 86) .

Although the single items show, in general, a positive
increment across the gestational period, when the total
percentage of positive, negative, and uncertain responses are
compared, Time 2 shows a decrease in positive responses from
63% to 59%. Even though the adolescents reported fewer
negative responses in Time 2 from Time 1, they expressed more
uncertainty of their thoughts, feelings, and behaviors. These

data are summarized in Table 14 (p. 88).

88
Table 14
Maternal Fetal Attachment Scale

Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitely No/No
Uncertain

 

 

Yes/Definitely Yes

 

Mean Response
Standard Deviation
Cronbach alpha

 

 

 

 

 

 

 

* Mean Total Score 90.55
SD 9.95

Mean responses, standard deviation, and the estimated
internal consistency for each of the Maternal Fetal Attachment
Scales at Times 1 ,2, 3, and 4 appear in Table 14 (p. 88).
Only mean response scores are reported for Times 1, 2, and 3
due to the variation in numbers of adolescents responding to
the scales and the number of items which were not appropriate
unless she had experienced fetal movement. Mean response
scores as well as a total mean score are reported for Time 4.
The reliability coefficients for the Times 2, 3, and 4 total
scales in this study equal or exceed.those reported by Cranley
(1981a). The relatively low reliability of the Time 1 total
scale, I - .73 is thought to be due to the elimination of
seven items which pertain to fetal movement. The Spearman

Brown formula yielded a coefficient of I -.77 indicating an

89

improvement in reliability if the scale were to be lengthened.
The coefficient alphas of the remaining total scales were
sufficiently high to claim internal consistency (Nunnally,
1978).

‘ Mean responses, standard deviation, and the estimated
internal consistency for each of the subscales at Times
1,2,3, and 4 appear in Tables 15 through 19, (pp. 90-92)
Reliability coefficients, except for the subscales of
Interaction with the Fetus and.Attributing Characteristics to
the Fetus in'Time 4, exceed.those reported.by Cranley (1981a).
Coefficients for the subscales at Time 1 range from .29 to
.61, Again, the low coefficients are thought to be due to the
elimination of specific items from the scales.

The percentage of positive responses by subscales of the
Maternal Fetal Attachment Scale for Times 1, 2, 3, and 4 are
depicted in Tables 15 through 19 (p. 90-92). .All of the
subscales demonstrated an increase in positive responses from
early to late pregnancy. - Because some of the subscales
(particularly at Time 1 with its diminished number of items)
did not achieve alpha coefficients sufficiently high to
indicate reliability, however, interpretation must be made
with some caution.

Although positive responses to the role taking indicators
decreased from Time 2 to Time 3, they revealed the greatest
increase in indicators from Time 1 to Time 2. Over the
gestational period, these indicators showed an increase of

21%. It appears that by the time the group as a whole had

90
Table 15
Roletaking Subscale

Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitely No[No
Uncertain
Yes[Definitely Yes

 

 

 

 

Standard Deviation
Cronbach alpha

 

 

 

 

 

 

Table 16

Interaction with Fetus Subscale
Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitely No/No
Uncertain

 

 

Yes/Definitely Yes

Mean

 

 

Standard Deviation
Cronbach alpha

 

 

 

 

 

 

91
Table 17
Giving of Self Subscale

Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitly Mo/No
Uncertain
Yes/Definitely Yes
Mean

Standard Deviation
Cronbach alpha

 

 

 

 

 

 

 

 

 

 

Table 18

Differentiation from Self Subscale
Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitely No/No
Uncertain

 

 

Yes/Definitely Yes

 

 

Standard Deviation
Cronbach alpha

 

 

 

 

 

 

92

Table 19

Attributing Characteristics to Fetus Subscale
Classification of Response (%),
Mean, Standard Deviation, and Estimated Internal Consistency

 

Definitely No/No
Uncertain

 

 

Yes/DefinitelyYes

 

 

Standard Deviation
Cronbach alpha

 

 

 

 

 

 

made the decision to seek health .care, 75% had begun to
imagine themselves in the role of caretaker of the baby (Table
15, p. 90).

Behaviors which are indicative of interaction with the
fetus showed the second largest gain from Time 1 to Time 2
with an increase of 17%. In addition, these behaviors showed
the greatest increase in positive responses over the course of
pregnancy. At Time 1, slightly fewer than one-fourth reported
these behaviors. By Time 4, slightly more than one-half were
doing so, a 30% increase over time (Table 16, p. 90).

Although thoughts, feelings, and behaviors indicative of
giving of herself increased over the course of the pregnancy
by 18%, the greatest increase in these indicators occurred
between the time she first knew she was pregnant and the time
she first sought health care. The majority of these

93

indicators are concerned with healthy behaviors and almost 75%
were practicing them in the early phase of their pregnancies
(Table 17, p. 91).

Differentiation of the fetus from herself increased by
17% over the gestational period while attributing
characteristics to the fetus increased less dramatically with
a change of just 11% (Table 18, p. 91 and Table 19 p. 92). A
summary of the percentages of positive responses to the total
Maternal Fetal Attachment Scale and its five subscales is
presented in Table 20 (p. 94). A summary of the means of
positive responses to the Maternal Fetal Attachment Scale and
each of its subscales appears in Table 21 (p. 95).

Examination of Table 21 (p. 95) reveals a progression of
total scale means over time thus indicating an increase in the
positive responses with advancing pregnancy. Analysis of
Variance with Repeated Measures, the results of which appear
in Table 22 (p. 95), was.performed on the data to determine if
there were significant differences in the means among Times 1,
2, 3, and 4. The analysis indicated a mean difference,
significant at 135.0453) p-.ooz4. An etaz of 10% indicates
that the variation among groups at Times 1, 2, 3, and 4 were
not large. However, post hoc analysis utilizing the Scheffe
procedure revealed the means at- Time 1 and Time 4 to be
significantly different at p <.05. Adolescents at Time 4
reported a greater degree of prenatal. fetal attachment than at

Time 1. Because the entire group is represented in data at

94
Time 4, these data were utilized in the remaining

correlational analyses.

Table 20

Summary of Positive Responses (%) Across Time Periods

 

 

 

 

 

 

 

 

 

 

Maternal Fetal

Attachment Scale
Roletaking 75 93 91 96
Interaction 24 41 50 54
with Fetus
Giving of Self 73 85 86 91 I
Differentiation 74 79 88 91
from Self
Attributing 54 58 60 65
Characteristics
to Fetus

   

 

In summary, the data indicated that prenatal fetal
attachment, as measured by the Maternal Fetal Attachment
Scale, does occur in adolescent women and it appears that the
degree of attachment increases over the gestational period.
Examination. of‘ Table 14 (p. 88) reveals that in early
pregnancy, 63% of the adolescents in this group reported that
they engaged in thoughts, feelings, and behaviors indicative
of a developing relationship with their unborn babies.

Twenty-nine percent responded negatively to these indicators

95

Table 21

Summary of Means of Maternal Fetal Attachment Scale
and Subscales Across Time Periods

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T1 T2 T3 T4

Maternal Fetal 3.54 3.72 3.77 3.94
Attachment Scale

Roletaking 3.86 4.31 4.23 4.44

Interaction 2.50 2.94 4.22 4.37

with Fetus

Giving of Self 3.85 4.11 4.07 4.28

Differentiation 3.74 3.94 4.22 4.37

from Self

Attributing 3.27 3.46 3.47 3.59

Characteristics

to Fetus

_
Table 22
Repeated Measures Analysis of Variance
of the Maternal Fetal Attachment Scale
at Times 1, 2, 3, and 4

5911129.: 11.11.. as as 1: mi
Between 3 3.0139 1.0046 5.0453* .0939
Groups
Within 146 29.0716 0.1991
Groups
Total 149 32.0855
*p= .0024

and 8% were uncertain. At Time 2, however, the percentage of

adolescents who responded positively had fallen to 59% and

96

almost 20% were uncertain of their thoughts, feelings, and
behaviors. Data from Time 2 were collected at the time of the
adolescents’ first visit to the physician when the diagnosis
of pregnancy was definitively made. The increased uncertainty
which is revealed in these data may reflect the irrevocable
fact of pregnancy and her attempt to come to terms with it.
By Time 3,‘ (Mean gestational age 26.6 weeks) 72% responded
positively.- Although 20% continued to maintain their negative
orientation, more of those who had originally reported
themselves to be uncertain, responded positively. At Time_4
(Mean gestational age 33 .4 weeks) more than three-fourths,
77%, of the sample reported positive responses while, again,
those who maintained a negative response remained fairly
stable at just under 20%. A similar pattern was found for
each of the subscales as well.

As for when, in the gestational period, the indicators of
prenatal fetal attachinent occur, and the sequence in which
they occur, it appears to be a matter of degree rather than
time since each of the indicators was present, at least to
some extent, from early pregnancy. Examination of the
subscales (Table 20, p. 94) indicates that fully three-fourths
of the adolescents reported the indicators of Roletaking,
Giving of Self, and Differentiation From Self, early in
pregnancy. Almost one-fourth interacted in some manner with
the fetus, and slightly more that one-half attributed the
fetus with characteristics. By Time 4, more than 90% of the

sample engaged in the indicators of Roletaking, Giving of

97
Self, and Differentiation From Self. More than one-half
interacted with their fetus while two-thirds of the group were

attributing characteristics to the fetus.

MW

The Health Behaviors Scale was administered at Times 2,
3, and 4 to determine whether the adolescents engaged, more
progressively, in healthy behaviors with their advancing
pregnancies. Tables 23-30 (pp. 98-101) show the percentage of
responses to individual items. Adolescents generally reported
an increase in healthy behaviors over time with the exception
of getting enough sleep and rest. This plagued approximately
half of the group and was fairly constant over time. Fifty-
six percent reported that they exercised every day or almost
every day by Time 4, up from slightly more than one-third at
Time 2. The health behavior of eating a balanced diet
demonstrated the most dramatic increase over time. This was
practiced by two—thirds of the group in late pregnancy, an
increase of almost 40% over early pregnancy. Although 75%
never or rarely smoked at Time 2, by Time 4 an additional 8%
had either ceased or cut cigarette use to rarely. The great
majority used very little over the counter medication;
eighty-eight percent reported positive behaviors at Time 2,
and 96% at Time 4. Surprisingly, none of the adolescents

reported alcohol or drug use at Time 3 or Time 4.

98

Table 23

Health Behaviors Scale
Response to Adequate Sleep (%)

 

 

Never

 

Rarely

 

Occasionally

Almost Every_23y
Every Day

 

 

 

 

 

 

 

* n a 32
** n a 38
*** n a 40

Table 24

Health Behaviors Scale
Response to Adequate Rest (%)

 

 

Never

 

Rarely

 

Occasionally

 

Almost Every Day

 

 

 

 

 

Every Day
* n a 32
** n a 38

ass I - 40

99

Table 25

Health Behaviors Scale
Response to Adequate Exercise (%)

 

Exercise

 

Never

 

Rarely

 

Occasionally

 

Almost Every Day

 

 

 

 

Every Day

 

* n m: 32
** n a 38
*** H a 40

Table 26

Health Behaviors Scale
Response to Adequate Diet (%)

 

 

Never

 

Rarely

 

Occasionally

 

Almost Every Dayy

 

 

 

 

 

Every Day
* n a 32
** n a 38

see u 8 4o

100
Table 27

Health Behaviors Scale
Response to Smoking (%)

 

Smoking

 

Never
Rarely

 

 

Occasionally

 

Almost Every Day

 

 

 

 

 

Every Day
* n - 32
** n a 38
*** n a 40

Table 28

Health Behaviors Scale
Response to Use of Over the,
Counter Drugs (%)

 

Over The Counter Drugs

 

Never

 

Rarely

 

Occasionally

 

Almost Every Day
Every Day

 

 

 

 

 

* n-32
** n a 38
*** n a 40

101
Table 29

Health Behaviors Scale
Response to Alcohol Ingestion (%)

 

 

 

 

 

 

 

 

 

T2 * T3 ** T4 ***
Alcohol
Never . 97 ' 100 100
Rarely 3 _-- ---
Occasionally —-- --- ---
Almost Every Day --- --- ---
Every Day --- --- ---
* n = 32
H 11:38
see u a 40
Table 30’

Health Behaviors Scale
Response to Use of Street Drugs (%)

 

Street Drugs

 

Never

 

Rarely

 

Occasionally

 

Almost Every Day

 

 

 

 

 

Every Day
* n a 32
** n a 38

eee u a 40

102
The Health Behavior Scale means, standard deviations, and
estimated internal consistency scores appear in Table 31 (p.
102). Coefficient alphas for Times 2 and 3 were sufficiently
high to claim internal consistency. The coefficient for Time
4 was low. This is thought to be due to the lack of
variability on two of the items, alcohol and drug ingestion,

as 100% of the adolescents denied use at this time.

Table 31

Mean, Standard Deviation, and Estimated Internal Consistency
of Health Behavior Scale at Times 2, 3, and 4

 

 

Standard Deviation
Cronbach alpha

 

 

 

 

 

a n - 32
** n a 38
*** u a 40

Table 32 (p. 103) shows the results of the Health
Behaviors data which were subjected to Analysis of Variance
with Repeated. Measures to determine if the adolescents
reported improved health behaviors with advancing pregnancy.
The analysis indicates a mean difference, significant at
{(6.5856) n 2.002. An eta2 of 11% indicates that the
variation among groups for Health Behavior Scores at Times 2,
3, and. 4 were not large. However, a post hoc analysis

utilizing the Scheffe procedure revealed the mean of Time 2 to

103
be significantly different from Times 3 and 4 at p <.05.
Health Score means at Times 3 and 4 did .not differ
significantly from each other. Data from Time 3 were utilized
in the remaining analyses since Time 3 and Time 4 data were

not significantly different and since Time 3 had higher
reliability scores. '

Table 32

Repeated Measures Analysis of Variance
of Health Behaviors Scale
at Times 2,3, and 4

 

 

 

552nm: 1211:. as us 1: eta:
'Between 2 136.3106 68.1553 6.5856* 0.1096
Groups -

Within 107 1107.3622 10.3492

Groups

Total 109 1243 . 6727

* p = .002

W

The estimated internal consistency scores of the
independent variables appear in Table 33 (p. 105) .
Coefficient alphas approached those reported in the literature
or exceeded them in most instances. Except .for the Uniqueness
subscale, they were sufficiently high to claim internal
consistency. .

As the first step in testing the six correlational

hypotheses, the data for each of the independent variables

. 104
(displayed in Table 34, p. 106 with their corresponding
abbreviations) and the Maternal Fetal Attachment data for Time
4 were displayed on a scatter plot to determine whether
assumptions for correlational analyses were met. All scatter
plots revealed a non-linear relationship between the X and Y
variables thus indicating that knowledge of scores obtained on
the independent variables have little value for the prediction
of the degree of prenatal fetal attachment in this group of
primiparous adolescent women. For variables with at least a
5 point scale, Spearman Rho correlations (See Tables 35 and
36, pp. 107-108) as well as the more robust Pearson-Product
Moment correlations were computed (See Tables 37 and 38, pp.
107-108). A. comparison. of ‘values revealed. very little
difference, therefore, Pearson correlations were utilized in
the following discussion and analyses. Spearman Rho
correlations are reported for variables with fewer than 5
scale points and are designated with a superscript a in Tables
37 and 38 (pp. 109 and 110).

The hypotheses which were generated in an attempt to meet
the objectives of this study of prenatal fetal attachment in
primiparous adolescent women, and the results of the
correlational analyses follow. Throughout the rest of the
chapter, the Maternal Fetal Attachment total scale will be
correlated with the independent variables in question. Then
correlations of the subscales of the MFAS with the independent

variables and any of their subscales will be presented.

105

Table 33

Estimated Internal Consistency of Independent Variables
(HF40)

Variable Cronbach
Alpha

 

New Personal Fable Scale (Total Score) .73
Omnipotence .75
Invulnerability - .75
Uniqueness .42

 

 

 

New Imaginary Audience Scale .91
Life Events Questionnaire (Bad Events) ----

 

 

State Anxiety Inventory .91

 

Trait Anxiety Inventory .76

 

Coo3:rsmith Self-esteem Inventory .81

Total Functional Support .99
Affection
Affirmation
Aid

Total Network Properties

 

 

 

 

 

 

 

106

Table 34

Identification of Variables Used in Study

MFAS
ROLETAK
DIFFSELF
INTERACT
ATTRIB
GIVING

LEBAD

HEALTH

NIAS

NPFS '
OMNIPOT
INVULN
UNIQUE

TOT FUNCT

TOT NET

CSEI
SANX

TANK

Maternal Fetal Attachment Scale

Roletaking

Differentiation from Self

Interaction with Fetus

Attributing Characteristics to Fetus

Giving of Self

Norbeck Life Events Questionnaire (Bad Events)
Health Behaviors Scale (Time 3)

New Imaginary Audience Scale

New Personal Fable Scale

Omnipotent (subscale of NPFS)

Invulnerability (subscale of NPFS)

Uniqueness (subscale of NPFS) ,
Total Functional Support (subscale of Norbeck
Social Support Questionnaire, NSSQ)

Total Network Properties (subscale of Norbeck
Social Support Questionnaire, NSSQ)
Coopersmith Self-Esteem Self Inventory

State Anxiety (subscale of State-Trait.Anxiety
Inventory)

Trait Anxiety (subscale of State-Trait Anxiety
Inventory)

3 3o. v m 2:. So. v a .... amo. v a a 3033 use +

 

 

 

 

 

 

 

 

 

107

 

 

 

 

 

 

 

 

 

 

 

 

 

1.8.. o..- .24..- S. n.- thm: .4»..- an. 2. :3. 2.- xx:
11.-fl 2- millllnm mm: 2.8.. 2: ~I~. 8.- m. mm.- %
NF. ee. mm. mm. ...mmqul.ulummnii- eo.- mm. e~.. mm. awmmu
...oo. oo. mmuxi 31. em. up. oo. o_ o.- + has top
ale.- t. 3. 2. 2. na- olo. m. + a
:3. a. 22.2. a. T. nlo: n... 32.5
2. law. :- ofi _fi- . :. ads:
.13. Ma. 2. 9: 3. ...lzlinl
e.- e.- e—.. .iimm. eta:
.mm. o. ~F \Mflfll
a? &. Emflfl
on 933
a.
4 .omfla
_umo co: to» com u:o_== xoa>z_ a_zxo nae: m<_. xeoeuz seams m<az

 

 

 

 

 

 

 

 

 

 

 

 

 

moaned-”.5 useesumun use unoccumuocH no ash—us: coHusHouuoo 05m sea-nounm

mm manna

108
Table 36
Spearman Rho Correlation Matrix of Independent and Dependent

Variables for Subscales of the
Maternal Fetal Attachment Scale

 

* p < .05 ** p < .01 *** p < .001

‘ one-tailed

109

Hoo. v m sea

“Ho.

v d as

“mo.

VQ¥

“oedema use
mucwom mason m can» umoH mufla moanswus> Ho>oa Hocfimuo now 0cm unencumm .

Q

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

seems. seemof 0‘- sow: mo. m~.- ase~n.. lees»...- CNM. or. .53. 2..- m 5.5.
...mm.. o_.- m~.. mm” mm.. ..~e-- 68.. MM. oo.- mN. -.- o xzem
oo. we. mm. o.. ...em. ..Mm. eo.- mm. o~.. mm.- .uoo
...oo. oo.- o.. ~_. 6o. k_. oo- oe. no. 4 cm: hoe
o... me. o.. mm. o.. oo- ao. or. 4 eozoa co»
..ne. 4mm. 44.oe. F~. -. no.- a..- m=o_z=
I III
or. ...~o. or. N.- .F.. me. zoo>z_
I [ll
...oe. ~o. ~.. o... me. a_zxo
ke- FN. a, - so. was:
'1
..oe. or. NF. . m<_z
mm. Mm. =eo<ux
4,. . a<awo
II;
”(as
+ +hfl?
o xz<a _moo cw: hoe hoe w=o_zo zoo>z_ a_zxo maaz . o<_x =eo<w= o o<owo m<ax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.moansfluo> unaccommo one pneumonoosH no xauuoz :ofiuoaouuoo somumum

hm THAMB

110

Table 38

Pearson Correlation Matrix of Independent and Dependent
Variables for Subscales of the
Maternal Fetal Attachment Scale '

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

  

 

  
   

 

  

 

 

  

DIF§§§LF 1u1§51g1, 111111
urns .77*** .71*** .a1*** .79*** .64***
11015111: 1.00 .nm .47“ .49" .44“ I
01mm .7311“ 1.00 .47" .359 .359 I
llTERACI .47** .47** 1.00 .54-** .33- I
111110 .49** .35* .54*** 1.00 .43**
.44** .35* 3.333 .43** 1.00
.30* .15 .19 .07 .00
Vygg .16 -.15 .10 -.05
no mo -m7 22 mo
[Terra .08 .16 -.03 .11 .01
[fawn J7 23 31 .n
IWHJ no m2 mo 20
-.09. .93, -.17 . -.11
101 ruucr * -.02 .11 .19 .13
101 not + .10 -.01 .12 .09
-J5

 

 

 

 

 

 

 

 

 

' Spearman Rho for ordinal level variables with less than 5
scale points

’ One-tailed

* p < .05 M p < .01 mu 2 < .001

111

Finally, correlations found to be significant were submitted
to Partial Correlational analysis using the control variables
in this study to ascertain their impact. These control
variables include age of the adolescent, ethnicity of the
adolescent, gestational age in weeks, and complications in
pregnancy. The results of these partial correlational
analyses are reported in.Appendiow (p. 176), for'the reader's

examination.

W
H01: Among pregnant adolescents, there is no

relationship between the level of self-esteem and

the degree of prenatal fetal attachment.

Correlational analysis (Table 37, p. 109) revealed a non-
significant relationship (r - -.03) between the Maternal Fetal
Attachment total scale (MFAS) and the level of self-esteem
(CSEI) . Investigation of the MFAS subscales (ROLETAK,
DIFFSELF, INTERACT, ATTRIBUT, and GIVING) and their
relationship with the level of self-esteem (CSEI) (Table 38,
p. 110) resulted in correlations ranging from very weak to
negligible and none were significant. These correlations were
.11, .01, -.15, -.07, and .15 respectively. The H01 null
hypothesis could not be rejected. It appears that for this
group of adolescents the relationship between the degree of

prenatal fetal attachment and the level of self-esteem was

negligible.

112
Wei-L2

H02: Among pregnant adolescents, there is no
relationship between the level of anxiety and the
degree of prenatal fetal attachment.

Correlational analysis revealed a nonsignificant
relationship between the Maternal Fetal Attachment total scale
(MFAS) and State Anxiety (SANX) and Trait Anxiety (TANX) . As
Table 37 (p. 109) indicates, these correlations were -.22 and
-.18 respectively.

The five subscales of the Maternal Fetal Attachment Scale
(ROLETAK, DIFFSELF, INTERACT, ATTRIB, and GIVING) were
correlated with State Anxiety (SANX) and Trait Anxiety (TANX) .
These correlations were -.20, -.05, -.14, and -.14
respectively for state anxiety and -.13, -.20, -.08, .11, and
-.24 respectively for trait anxiety. Only the subscale,
Giving of Self, (GIVING) was significantly correlated with the
level of perceived state anxiety (1: -- -.32, p =- .05, R2 .- .10,
see Table 38, p. 110).

Partial correlations for each of the control variables
were calculated to determine whether these variables
contributed any variance to the relationship between the
Giving of Self subscale and the level of state (SANX) anxiety
(Appendix B, p. 176). The original correlation remained
essentially unchanged, thus indicating that the control
variables selected for this study had little effect on the
relationship between the degree of giving of self and the

level of state anxiety. Therefore, based on a significant

113
relationship between the degree of prenatal fetal attachment
in the form of giving of self behaviors and the level of state
anxiety, the H02 null hypothesis was rejected. Among
primiparous adolescent women, there is a significant, inverse
relationship between the degree of prenatal fetal attachment
and the level of perceived state anxiety. As the levels of
currently perceived anxiety increase, the adolescent is less
likely to report giving of self behaviors which provide a

healthy environment for her growing fetus.

Hull.fl122§hefiifi_l

H03: Among pregnant adolescents, there is no
relationship between the degree of perceived stress
and the degree of prenatal fetal attachment.

Correlational analysis failed to establish a significant
relationship between the Maternal Fetal Attachment Scale
(MFAS) and the degree of perceived stress (LEBAD). As Table
37 (p. 109) indicates, this correlation was I = .14.

The five subscales of the Maternal Fetal Attachment Scale
(ROLETAK, DIFFSELF, INTERACT, ATTRIB, and GIVING) were
correlated with the independent variable, degree of perceived
stress (LEBAD) . Only the subscale of roletaking (ROLTAK)
revealed a significant relationship ‘with the degree of
perceived stress (I - .30, p <.05, 32 s .09). The remaining
correlations were .15, .19, .07, and .00 respectively and did

not reach significance (See Table 38, p. 110).

114

Partial correlations for each of the control variables
were calculated to determine whether these variables
contributed any variance to the relationship between the
subscale of ROLTAK and the degree of perceived stress (LEBAD) .
These values remained virtually unchanged, although when the
effects of being non-Caucasian were removed, the correlation
was just short of significance at the p a .05 level (See
Appendix B, p. 176). Therefore, the H03 null hypothesis can
be rejected but only for Caucasian adolescents. As this group
of Caucasian adolescents perceived.a greater degree of stress
in their lives, the more likely they were to imagine

themselves in the role of mothering their infants.

H!DQ§D§§§E.1

H04: Among pregnant adolescents, there is no

relationship between the extent of social support

and the degree of prenatal fetal attachment.

H14: Among pregnant adolescents, there is a

positive relationship between the extent of social

support and the degree of prenatal fetal
attachment.

Correlational analyses revealed non-significant
relationships between the Maternal Fetal Attachment total
scale (MFAS) and the extent of social support as measured with
the Total Functional Support (TOT FUNCT) and Total Network
Properties (TOT NET) subscales of the Norbeck Social Support
Questionnaire. Table 37 (p. 109) indicates that these

correlations were .18 and .08 respectively.

115

The five subscales of the Maternal Fetal Attachment Scale
(ROI-ETAK,‘ DIFFSELF, INTERACT, ATTRIB, and GIVING) .were
correlated with the extent of social support (TOT FUNCT and
TOT NET). Table 38 (p. 110) reveals correlations for the MFAS
subscales and Total Functional Support ranging from -.02 to
.21, while correlations for the MFAS subscales and Total
Network Properties ranged from -.01 to .12.

The six items which make up the subscale of Total
Functional Support were then separated into Affection,
Affirmation, and Aid subscales for 1) all 40 adolescents, 2)
adolescents reporting support from mother, and.3) adolescents
reporting support from the father of the baby. Table 39 (p.
116) reports the estimated internal consistencies for these
new subscales.

For all adolescents, Table 40 (p. 118) indicates that.the
correlations between the MaternalFetal Attachment total scale
and its subscales and these new subscales remained weak to
negligible. Correlations for MFAS and Affection, Affirmation,
and Aid for all adolescents were .18, .17, and .18
respectively. Correlations of each of the subscales of the
MFAS with.Affection, Affirmation, and Aid ranged from -.04 to
.23.

When social support in the form of affection,
affirmation, and aid was supplied by the adolescent's mother
several significant relationships with the Maternal Fetal
Attachment total scale-and.its subscaleswwere found (Table 40,

p. 118). For the 32 adolescents who listed their mothers as

116

a source of support, maternal behaviors which indicated love,
respect, and admiration (Affection) for her daughter were
positively correlated (I s .41, p <.01 32 = .17) with the
Maternal Fetal Attachment Scale (MFAS). Correlations for the
MFAS total scale and Affirmation and Aid were non-significant
at .14 and .20 respectively.

For the 32 adolescents who listed their mothers as a

source of support, the five subscales of the Maternal Fetal

Table 39

Estimated Internal Consistency of Subscales of Total

' Functional Support

for all Adolescents, Adolescents with Mother Support,
and Adolescents with Father of Baby Support

Cronbach
All Adolescents
Affection
Affirmation
Aid

from Mother *

Affection

Affirmation
Aid

from Father of
Affection
Affirmation
Aid

 

* n=32
as n a 25

117

Attachment Scale (ROLETAK, DIFFSELF, INTERACT, ATTRIBUT, and
GIVING) were correlated with the new subscales of AFFECTION,
AFFIRMATION, and.AID. Three of the MFAS subscales were found
to have a significant positive relationship with affection
received from the adolescents' mothers. These were Roletaking
(I - .34, p <.05, 32 - .12), Differentiation From Self (x:
-.44, p <.01, 32 - .19) and Interaction With the Fetus (1; =-
.40, p <.01, 32 =- .16). In addition, when the adolescent
perceived that her mother was giving her adequate support in
the form of material aid, (AID) she reported a greater degree
of giving of self behaviors (GIVING) in the form of providing
a healthy environment for her growing fetus (I s .30, p <.05,
32 - .09) . Other relationships remained non-significant.

When partial correlation coefficients (See Appendix B, p.
176) were calculated to determine the effect of the control
variables, two of the original relationships remained
virtually unchanged (Differentiation From Self and Affection
from Mom (I? .44, p < .01), and Giving of Self and Aid from
Mom (r- .30, p < .05). The remaining correlations, however,
appeared to be influenced by ethnicity. When the effects of
being Hispanic were removed, the correlation of the Maternal
Fetal Attachment total scale and affection received from her
mother, decreased from .41 to .35, although it retained
significance at the .05 level. Interaction with the fetus
(INTERACT) and roletaking' behaviors (ROLETAK) were also

influenced by being non-Caucasian. Once the influence of

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being Black or Hispanic was removed, the relationship between
roletaking (ROLETAK) and affection from her mother was no
longer significant. When the effect of being Hispanic was

removed, the relationship between interaction with the fetus
(INTERACT) and Affection from Mom was no'longer significant.
It appears that the degree of prenatal fetal attachment the
Hispanic adolescent, and to a lesser extent the Black
adolescent, develops for her unborn child is not as dependent
on affection from her mother as it is with the Caucasian
adolescent. For these Caucasian adolescents, the degree of
prenatal fetal attachment is positively associated with the
extent of support, in the form of affection, she receives from
her mother.

For the 25 adolescents who reported support from the
father of their babies, additional significant correlations
were found. The Maternal Fetal Attachment total scale (MFAS)
was positively correlated with the extent of social support in
the form of material aid (AID) received from the father of her
baby (I = .34, p < .05, 32 =- .12). Correlations for MFAS and
AFFECTION, and AFFIRMATION were now-significant (r -= .29, z =
.16, respectively).

For the 25 adoloscents who reported support from the
father of the baby, the five subscales of the Maternal Fetal
Attachment Scale (ROLETAK, DIFFSELF, INTERACT, ATTRIBUT, and
GIVING) were correlated with AFFECTION, AFFIRMATION, and AID.
The subscales of INTERACT and ATTRIBUT were significantly

correlated with AFFECTION (; .- .40, p < .05, 32 - .16; r =

120
.35, p < .05, 82 - .12 respectively). In addition, the
subscale of GIVING was significantly correlated with.material
aid (AID) received from the father of her baby (;,= .38, p <
.05, 32 -= .14). The remaining correlations were non-
significant. These values appear in Table 40, (p. 118).‘

Partial correlations (See .Appendix B, jp. 176) ‘were
calculated for each of the control variables to determine
whether these variables contributed any variance to the
relationship between the extent of social support, the total
scale and the three subscales of INTERACT, ATTRIB, and GIVING.
Although the original correlations decreased somewhat with
respect to the adolescent’s age, each of them retained
statistical significance. Thus,' adolescents who reported
receiving affection and instrumental aid from the father of
their babies developed a greater degree of prenatal fetal
attachment, particularly in the form of providing a healthy
environment, interacting with the fetus, and thinking about
the characteristics of her unborn baby.

Although the construct of social support was more broadly
defined in the theoretical framework, based upon the
importance of the mother-daughter relationship, and to a
lesser extent that with the father of her unborn child, the
H04 null hypothesis was rejected and the alternative
hypothesis accepted. Thus, as the extent of affection and aid
received from her mother and to a lesser degree the father of
her baby increased, the Maternal Fetal Attachment 'Scale scores

increased, particularly for Caucasian adolescents.

121
W'
H05: Among pregnant adolescents, there is no

relationship between the degree of ego development
and the degree of prenatal fetal attachment.

Correlational analysis revealed a non-significant
relationship between the Maternal Fetal Attachment total scale
(MFAS) , the New Imaginary Audience Scale, and theNew Personal
Fable Scale. These correlations were 1: -= .12 and I - .07,
respectively. The MFAS total scale was also correlated with
the subscales of the New Personal Fable Scale. Again, the
correlations were non-significant with Omnipotence (OMNIP) I
:- .13, Invulnerability (INVULN) ; - .15, and Uniqueness
(UNIQUE) r - - .17.

The subscales of the Maternal Fetal Attachment Scale
(ROLETAK, DIFFSELF, INTERACT, ATTRIBUT, and GIVING) were
correlated with the New Imaginary Audience Scale (NIAS) total
score, the New Personal Fable Scale (NPFS) total score and
each of its subscales, Omnipotence (OMNIP) , Invulnerability
(INVULN)} and Uniqueness (UNIQUE). Only the subscale GIVING
(behaviors that provide a healthy environment for the fetus)
and UNIQUE revealed a significant and negative relationship (;
=- -.32, n <.05, 32 .. .10). As Table 38 (p. 110) indicates the
remaining non-significant correlations range from -.17 to .26.

Partial correlations (See Appendix B, p. 176) for each of
the control variables were calculated to determine whether
these variables contributed any variance to the relationship

of giving of self behaviors and the subscale UNIQUE. The

122
original correlation appeared .to be affected by age,
ethnicity, and length of gestation. When the effect of each
was removed the correlation was no longer significant. The
H05 null hypothesis could not be rejected. For this group of
adolescents, there was no relationship between the degree of

ego development and the degree of prenatal fetal attachment.

W
H06: Among pregnant adolescents, there is no

relationship between the extent of health.behaviors

practiced and the degree of prenatal fetal

attachment.

Correlational analysis revealed a non-significant
relationship between the Maternal Fetal Attachment total score
and the Health Behaviors total score. Table 37 (p. 109)
indicates this to be I - .02.

The subscales of the Maternal Fetal Attachment Scale
(ROLETAK, DIFFSELF, INTERACT, ATTRIBUT, and GIVING) were
correlated with the Health Behaviors total scale. Table 38
(p. 109) indicates that these non-significant correlations
ranged from -.15, to .16. The H06 null hypothesis could not
be rejected. For this group of adolescents there was no
relationship between the degree of prenatal fetal attachment
and the extent of health behaviors practiced.

In summary, a general increase in the degree of prenatal
fetal attachment occurred in this group of adolescents over
the gestational period and the degree was significantly
different at Time 1 and Time 4. Thoughts, feelings, and

123
behaviors which indicate interaction with the fetus showed the
greatest increase in positive responses, while attributing
characteristics to the fetus showed the least amount of
increase over time. These adolescents reported a general
improvement in health behaviors with a significant difference
between Times 2 and 3 and Time 4.

Statistical analyses revealed weak to moderate
correlations between the degree of prenatal fetal attachment
and several of the independent variables. Giving of self
behaviors were inversley related to the level of anxiety the
adolescents were currently experiencing. In addition, the
group of Caucasian adolescents, who reported a greater degree
of stress, also reported imagining themselves more in
roletaking behaviors. The extent of social support in the
form of affection received from her mother was positively
associated with a greater degree of prenatal fetal attachment
for the group of Caucasian adolescents. The extent of this
support appeared to be less important for the Black and
Hispanic adolescents. The extent of affection and
instrumental aid received from the father of the baby were
also positively associated with the degree of prenatal fetal
attachment which adolescents developed for their unborn baby.

Chapter 5
Discussion, Limitations, Implications, and Recommendations

The previous chapter reported the results of the
statistical analyses 'which ‘were applied to each of the
research questions and the six hypotheses. This chapter will
present a discussion of the findings as they relate to the
theoretical framework of this study of prenatal fetal
attachment in adolescent women, as well as a comparison of
these findings with other similar studies. Limitations of the
study will be presented: these will be followed by

implications and recommendations for future study.

1213911511520

The first and second research questions raised by this
study of prenatal fetal attachment addressed whether or not
this phenomenon occurs in pregnant adolescents, when during
the gestational period do the various indicators of prenatal
attachment occur, and whether there is a sequential order
among these indicators.

When examining a phenomenon for change over time it is

essential that measurement includes several points, one of

124

125

which assesses thoughts, feelings, and behaviors from the
onset. Because many pregnant women tend to postpone entry
into the health care system, and early measurements are not
always possible, adolescents in this study were requested to
recall their thoughts, feelings, and behaviors when they first
realized they were pregnant. Although recall or retrospective
data must be interpreted with caution, it does give some
indication that the phenomenon under scrutiny exists even in
the early weeks of pregnancy. The results of this study
indicate that prenatal fetal attachment, as measured by the
Maternal Fetal Attachment Scale, does occur in primiparous
adolescent women and it appears that the degree of attachment
increases over the gestational period. These findings lend
further support to this conclusion drawn by others in studies
of adult women (Condon, 1985; Cranley, 1984: Leifer, 1977,
1980; Lumley, 1980, 1982: Phipps a Zinn, 1986; Reading, at
al., 1984; Stainton, 1985). In her study of adolescents,
however, Koniak-Griffin (1988) found that the length of
pregnancy was not a significant predictor of prenatal
attachment.

When the data from this study are compared with those of
Armantrout's (1983) , several similarities are evident.
Armantrout reported a mean response score of 3.70 (SD .41) for
the total scale for a group of adolescents in their third
trimester of pregnancy. This compares to a mean response
score, at Time 4, of 3.94 (SD .43) for the group in this

study. The percentage of positive response rates for the

126

overall indicators and for two of the five subscales were very
similar (See Appendix E, p. 223). Armantrout found positive
attachment indicators for the total scale to be 74%,
Roletaking 94%, and Differentiation from Self 91%. These
compare with 77% and 96% for the total scale and Roletaking
subscale respectively in this study. For Differentiation from
Self the positive response rates were identical for the two
studies at 91%. Armantrout found the percentages for the
three remaining subscales, Interaction with Fetus, Attributing
Characteristics to the Fetus, and Giving of Self to be 17%,
40%, and 83% respectively. These compare with 54%, 65% and
91% for this study. As in Armantrout’s study, Interaction
With the Fetus was the behavior practiced by the fewest
adolescents. Although this was the least practiced behavior,
it revealed the greatest increase over time, from 24% at Time
1 to 54% at Time 4. It is possible that the differences in
positive response rates between the two groups studied reflect
the differing research designs. Armantrout's study
investigated a point of time in the third trimester while the
present study measured four points in time during the entire
period of gestation. The adolescents’ interest in initiating
interaction with their babies may have been piqued at the
earlier interviews in this study, and as the babies became
more noticeably active, more of them responded by talking to
the baby or by stroking their abdomen to quiet the baby.

Individual items on the Maternal Fetal Attachment Scale

which revealed comparable response rates between this study

127

and the Armantrout study were several (See Appendix E, p.
223). Roletaking behaviors of picturing herself feeding the
baby and picturing what the baby looks like were responded to
positively by 89% and 94% of Armantrout's sample. Eighty-five
percent and 98% of this group responded positively to these
items. Eighty percent of both groups had decided on a girl’s
name, while 86% of Armantrout’s group and 85% of this group
had decided on a boy's name. Giving of Self in the form of
eating well to assure that her baby gets a good diet was
practiced by 91% of Armantrout’s group and 93% of this group.
Only one-third of this group referred to their baby by a
nickname, and even fewer (29%) of Armantrout's group did so.

Overall, the percentage of adolescents who reported
behaviors, thoughts, and feelings which are indicative of a
beginning relationship with their unborn babies was quite
similar for this study and the Armantrout study. Although
data collection in this study had been scheduled.at intervals
designed to decrease the possibility of contamination while
measuring change over time, it is a distinct possibility that
previous interviews stimulated adolescent interest in fetal
behavior. This group portrayed an eagerness to learn about
themselves and their babies and the clinic personnel placed an
emphasis on teaching about developmental issues for both the
fetus and the adolescent. It is also possible that the
adolescent responded to the individual items in the present
study in a manner which she interpreted as socially desirable.

Even though she had been assured that the gratuity was not

128
contingent on her positive response, she may have felt some
trepidation and therefore, responded in a manner which she

thought would be desirable to the investigator.

W

H01: Among pregnant adolescents, there is no
relationship between the level of self-esteem and
the degree of prenatal fetal attachment.

The theoretical framework for this study of prenatal
fetal attachment in adolescents assumes that the development
of an undetermined level of self-esteem is necessary before
the adolescent can begin to form an interpersonal relationship
with her unborn baby. This supposition evolved from the
literature which reports that individuals with higher levels
of self-esteem generally exhibit a greater degree of
interpersonal competence. For example, levels of self-esteem
have been found to be associated with the initiation of sexual
activity and with the use of contraceptives. Adolescents
with higher levels of self-esteem are less likely to be
passive and compliant in sexual encounters. In addition, they
are more likely to discuss contraceptive issues with their
partners thus being more effective contraceptors (Adler, 1981;
Patton, 1981).

The supposition that there is a relationship between
levels of self-esteem and the degree of attachment which
develops in the prenatal period was also based on reports of

maternal-infant interaction which occurs in the postnatal

129

period, a relationship which has abundant support in the
literature. Mothers who feel more positive about themselves
are more likely to express warmth for their children, to be
sensitive to their needs, to accept their role as mother and
to carry out that role in a realistic manner. Furthermore,
children of these mothers appear to be more securely attached
to them (Coopersmith, 1967; Egeland 8 Farber, 1984; Medinnus
& Curtis, 1963; Sears, Maccoby, & Levin, 1957). Despite the
theoretical prediction that the level of self-esteem will be
related to the degree of prenatal fetal attachment, results of
this study as well as those of similar studies, indicate that
the role of self-esteem in the prenatal period remains
unclear.

There is some evidence that the capacity for procreation
is associated with the feelings of identity some women have
about themselves, a supposition which was confirmed by Leifer
(1977) who found that more than half of her sample regarded
motherhood as the event which marked entry into adulthood.
Lederman (1990) believes that pregnancy can enhance the status
of women in a society which has often devalued them.
"Pregnancy can give the woman a new sense of weight and
materiality, of power, solidarity, and validity; the pregnant
woman can gain a new sense of self-respect" (p. 279). This
would suggest that levels of self-esteem may be higher once a
pregnancy has been confirmed and.bigher still once motherhood
has been established. Leifer ( 1977) provided support for this

position when she found that the majority of her sample

130

anticipated motherhood as the primary source of their self-
esteem. This was reflected through a sense of feeling closer
to an ideal self as a result of conception. At the time of
the postpartum interview, two-thirds of Leifer’s sample
reported levels of self-esteem which were higher than those
experienced during the pregnancy, a finding which was
supported by Curry (1982).

Because measurement of the level of self-esteem in the
adolescents who participated in this study was made at one
point in time, it is not known how the fact of pregnancy
related to levels of self-esteem, if at all. It is possible
that the group possessed lower levels of self-esteem.previous
to conception which then increased with pregnancy and
motherhood. .It is also possible that levels of self-esteem
were not appreciably altered with the confirmation of
pregnancy nor were levels of self-esteem associated with the
degree of prenatal attachment these adolescents developed for
their unborn babies. The data which were gathered for this
study and extrapolation from previous studies indicate support
for the latter supposition.

Some indication of the levels of self-esteem prior to
conception and during the prenatal period can be inferred by
comparing this sample of adolescents with others described in
the literature. Streetman ( 1987) found no significant
difference (as measured by the Coopersmith Self-Esteem
Inventory) in sel f-esteem scores between a group of unwed

teenage mothers and their non-mother cohorts. Taken

131

collectively, Streetman found the mean score to be 63.65 (SD
= 14.08). For her group of adolescents in their third
trimester, Koniak-Griffin (1988) found self-esteem scores to
range from 12 to 94, with a mean of 66.67, and a standard
deviation of 15.03. Mean scores for adolescents in the
present study were only slightly higher but showed more
variation. These values were 64.20 with a standard deviation
of 19.13 while the range was 20 to 96.

The studies by Streetman (1987) and Koniak-Griffin,
(1988) as well as the present study suggest that levels of
self-esteem in pregnant adolescents may not differ greatly
from non-pregnant adolescents. In addition, levels of self-
esteem in this group did not appear to increase with advancing
pregnancy as there was no significant correlation between this
psychosocial variable and gestational age. This finding is
opposite to that which was suggested by Leifer (1977), Curry
(1982), and Lederman (1990).

In attempting to interpret the role of self-esteem during
the perinatal period, cultural orientation must be considered.
Research indicates that most female children are self-
confident and hold a positive self-image of themselves. As
they emerge from adolescence, however, distinct differences
are noted from one cultural group to another. Black
adolescent girls exhibit higher levels of self-confidence
compared to Caucasians and Hispanics; Caucasian girls lose
their self-confidence more quickly than their Hispanic peers

("Girls are put down," 1991). In addition, mores regarding

132

childbearing differ according to cultural groups. Motherhood,
within the marital bond, is held in high regard, is perceived
as essential in the achievement of adult status, and as a
fulfillment of a woman's function in society by both the
Hispanic and Black cultures. This is true to a lesser extent
in the Caucasian culture (Speraw, 1987) . Although none of the
three cultural groups represented in this study encourage
premarital pregnancy, the manner in which the pregnancy is
perceived by the adolescent differs (Held, 1981; Speraw,
1987). Speraw (1987) found that Black and Hispanic
adolescents expressed few feelings of guilt and they expected
a positive pregnancy and motherhood experience. White
adolescents, on the other hand, accepted the pregnancy very
reluctantly and they frequently reported feelings of guilt and
regret.

The feelings of guilt and regret by Caucasian adolescents
may reflect cultural differences in the levels of self-esteem
reported by adolescents who are experiencing a pregnancy.
Held ( 1981) reported that 60% of the Black adolescents in her
study achieved self-esteem scores of 70 or greater as measured
by the Coopersmith Self-Esteem Inventory, whereas less than
30% of the non-Black group did so. Findings by Speraw (1987)
and Held (1981) received some support in the present study.
When the group was separated according to ethnicity, it was
found that the Hispanic and Black adolescents tended toward
higher levels of self-esteem than the Caucasian adolescents

although mean group differences did not reach the .05 level of

133
significance. The mean and standard deviation for the
Hispanic group were 68.57 (SD =- 19.79) , 66.10 (SD - 17.92) for
the Black group, and 58.33 (SD - 21.06) for the Caucasian
group (See Appendix F, p. 225, for tables which illustrate the
relationship between ethnicity and the independent and
dependent variables). .

The higher levels of ' self-esteem in the non-Caucasian
adolescents may be related to the extent of support offered by
the individual's social network. Although differences by
cultural group in the extent of perceived support did not
reach statistical significance in this study, there is some
indication in other studies that the adolescents' mothers
receive the pregnancy differently and therefore, the extent of
support offered may differ. Held (1981) reported that mothers
of Hispanic adolescents were likely to rate the pregnancy more
favorably than mothers of the other two groups. In addition,
the Hispanic adolescent was more likely to plan a second
pregnancy within two years, a situation which may be
associated with more positive feelings about herself. Giblin,
et al. (1987) found that higher self-esteem scores, in a group
of Black adolescents, were associated with receiving help from
her mother and the expectation of receiving assistance with
child care.

If an increase in levels of self-esteem occurs with
conception, increases with pregnancy, and is associated with
the quality of the mother-infant bond in the postpartal

period, all of which are suggested in the literature, then it

134

should be reasonable to expect to see a positive association
in the prenatal period, especially in the non-Caucasian groups
which.place high regard on pregnancy and motherhood. Support
for a relationship 'between levels of self-esteem and the
degree of attachment in the prenatal period for both the adult
and the adolescent populations has been somewhat mixed,
however. Research indicates little support as neither Cranley
(1984), Koniak-Griffin (1988), nor* Lee (1982) found. any
correlation between these variables. Lindner (1984), on the
other hand, found a low positive correlation in her group of
adolescents.

In light of the results of this study and of 'the
inconsistent findings reported in the literature it is
possible that the phenomenon of prenatal fetal attachment may
not be dependent upon the level of self-esteem which has been
achieved by the adolescent. Contrary to reports by Speraw
(1987), Held (1981) found that although the Caucasian
adolescents in her study rated their pregnancy more highly
than either the Hispanic or Black groups, they received lower
self-esteem scores, thus suggesting that levels of self-esteem

were not related to pregnancy.

W

H02: Among pregnant adolescents, there is no
relationship between the level of anxiety and the
degree of prenatal fetal attachment.

Only the Giving of Self subscale was associated.with the

135

level of anxiety reported by this adolescent group. This
subscale was inversely and significantly correlated (r, = -.32,
p <.05) with the level of state or situational anxiety the
adolescent experienced at the time of her first physician
visit, that is, the higher the level of state anxiety the less
likely she was to report behaviors which provide a healthy
environment for her growing fetus. There was no significant
correlation between the degree of prenatal fetal attachment
and the level of long-term or trait anxiety. On the basis of
finding a significant relationship between the level of state
anxiety and the degree of prenatal fetal attachment in the
form of giving of self behaviors, the null hypothesis was
rejected. It is evident, however, that the analysis of this
finding is somewhat more complex than what was initially
expected.

It might be assumed that adolescents who are experiencing
a pregnancy and.visiting the health care clinic for the first
prenatal assessment, would exhibit high levels of anxiety.
Furthermore, characteristics which contribute to heightened
levels of anxiety were prevalent within this group. It has
been reported that unmarried women, those in relationships of
shorter duration, those with low educational achievement,
income, and occupational prestige, non-Caucasian, and at each
extreme of the reproductive age range are at risk for
developing higher levels of anxiety (Glazer, 1980; Mercer &
Ferketich, 1988: Reading, 1983). In addition, primiparous

women are more likely to experience higher levels of anxiety

136

than women who have given birth previously (Areskog,
Uddenberg, & Kjessler, 1981; Light & Fenster, 1974).
Comparison of anxiety scores of this sample with the scores
for high school students in general, however, reveals very
similar values (Spielberger, et al., 1983).1 The mean state
anxiety score for this group was almost identical with the
normed group with a mean of 40.50 (SD = 12.90) , and 40.54 (SD
= 12.86) respectively, thus indicating that there was very
little difference in levels of situational anxiety between
groups. The mean trait anxiety score for this study was 42.70
(SD 8.50) , somewhat higher, and less variable, than the normed
group with a mean of 40.97 and standard deviation of 10.63.
It would seem that this group of adolescents experienced
similar levels of state and trait anxiety as their non-
pregnant peers. In addition, the group experienced lower
levels of anxiety at this point in their pregnancy than they
normally experience on a long term basis.

The discovery of lower levels of state anxiety over
levels of trait anxiety is in direct opposition to that which
is expected on the basis of theoretical support, i.e., that
pregnancy is a situational crisis to which women respond with
heightened anxiety related to fear that labor and delivery
will be harmful to herself and her child, loss of control, and

child care responsibilities (Highley a Mercer, 1978: Lederman,

 

' Although values are derived from ordinal level of
measurement, mean scores. are reported here for the purpose of
comparing this study with previous studies.

137

1984: Rubin, 1975). Furthermore, research findings suggest
that heightened short term anxiety may be an adaptive
response. Leifer (1977) reported that women who were
emotionally invested in the fetus tended to focus their
anxiety on the fetus, those who were moderately invested
expressed anxiety for both the fetus and herself. Finally,
those who were minimally attached tended to focus anxiety on
themselves or manifested little or no anxiety at‘ all.
Lederman (1984) found some support for this supposition in her
study of levels of anxiety and.stress in pregnancy; She found
a significant and.positive relationship between state anxiety
in labor and acceptance of the pregnancy. Those women who
reported a planned or wanted pregnancy which was predominately
happy, an acceptance of discomfort and bodily changes, and
resolved ambivalence near term reported higher levels of state
anxiety. Long-term.anxiety, on the other hand, may reflect a
personality characteristic which might ultimately interfere
with the development of'a healthy mother-child relationship
over time. Sameroff and Chandler (1975) found that increased
levels of trait anxiety were related to decreased interaction
with the infant at six months of age. Mean state anxiety
scores which are lower than expected and mean trait anxiety
scores which are higher than expected may not bode well for
this group of adolescents and their newborn infants.

Although the mean anxiety scores for adolescents in
general as well as for this group of pregnant adolescents in

particular, were higher than those reported for either adult

138
females of childbearing age (Spielberger, et al. , 1983) or for
pregnant adult women (Cranley, 1979; Gaffney, 1986), higher
levels of anxiety were not significantly associated with the
degree of prenatal fetal attachment that these adolescents
developed for their unborn babies except for the subscale
Giving of Self. Although this correlation was in the negative
direction, the data did not strongly support that reported by
other investigators (Cranley, 1979; Gaffney, 1986). .Again, it
is possible that the point in time at which the instrument was
administered may have affected the results. The group
represented gestational ages ranging from 10 weeks to 39 weeks
and adaptive state anxiety may not as yet have been operative
for many of the adolescents. A second explanation for higher
levels of trait over state anxiety may be that these
adolescents had made the decision to seek confirmation of
their pregnancy and had been interviewed by the nursing and
social services staff before collection of the data. The
knowledge that they would receive prenatal care and that some
of their more pressing social needs were to be addressed may
have been the impetus to decrease the levels of anxiety they

may have been experiencing prior to entering the health care

system..
Wheels;
H03: Among pregnant adolescents, there is no

relationship between the degree of perceived stress
and the degree of prenatal fetal attachment.

139

As the data indicate, the degree of perceived stress was
associated with the degree of prenatal fetal attachment for
only the group of Caucasian adolescents; that is, the greater
the degree of stress experienced by these adolescents, the
greater the degree of roletaking. behaviors they imagined
themselves performing. This relationship did not persist in
the Black or Hispanic groups, being just short of
significance.

Comparison of this study and other studies which utilized
the variables of the degree of prenatal fetal attachment and
the degree of perceived stress yielded conflicting results.
While Cranley (1979) found an inverse relationship between the
two 'variables when she applied an instrument specifically
designed to measure the degree of perceived stress in her
adult subjects, Mercer, Ferketich, May, DeJoseph, and Sollid
(1988) failed to discover any relationship between negative
life events in the lives of their adult subjects, and the
degree of prenatal fetal attachment. In contrast to these
findings, the present study found a positive relationship but
only in Caucasian adolescents. Although an examination of the
characteristics of this group does not reveal the basis for
these differences, it is evident that there may have been some
inconsistencies in measurement of the construct of perceived
stress.

Examination of the data which were collected with the

Norbeck Life Events Questionnaire reveals that these

140

adolescents received a mean total life events score of 12.6. 2
Desirable events were more frequently experienced than
undesirable life events by a ratio of three to two with means
of 7.65 and 4.95 respectively. Although an accurate
comparison cannot be made due to differences in scales,
college students in the Sarasen, et al. ( 1978) study received
a mean total score of 16.61, a desirable events mean of 9.57
and an undesirable events mean of 7.04. These means do not
reflect the weighted values which would indicate the magnitude
of the events. Intuitively these values are surprising in
that it would seem that adolescents who are, in general,
economically disadvantaged with all of the attendant stresses,
and who are experiencing an unintended pregnancy, or one‘ which
is not in synchrony with the developmental stage, would report
a greater number of undesirable life events than middle class
college students. There is some reason to believe that the
data reported here do not reflect all of the changes in these
adolescents' lives.

Evidence of a greater degree of perceived stress than was
actually reported by these adolescents was provided by the
assessment of the clinical social worker at the health care
facility. Almost 85%'of‘this group was felt to be exhibiting
symptoms of emotional stress and illness, 25% had experienced

either physical abuse, rape or incest, -5% had attempted

 

2 Although values are derived from ordinal levels of
measurement, mean scores are reported here for the purpose of
comparing this study with previous studies.

141

suicide in the past and 20% had been involved in long term
counseling. In addition; one-third of the group admitted that
they experienced a poor relationship with their parent(s) and
5% were homeless at the time of the intake interview.
Although.all 40 adolescents planned to keep their babies, for
only a third of the group was there no ambivalence. For them,
even thoUgh the pregnancy was unplanned, they welcomed their
babies. For the remaining adolescents whose pregnancies were
unplanned, 35% did not welcome their babies and almost 20%
were fearful about the outcome of the pregnancy. Thirteen
percent requested termination of pregnancy at a gestational
age which had advanced too far for the procedure. These data
were collected by agency personnel at the time of the first
clinic visit. Data on the degree of perceived stress for'this
study were not collected until the fourth interview late in
the third trimester. It is not known how much of the clinic
data is reflected in the variation of life events scores nor
how many of the events occurred within the intervening time
period.

An explanation for the discrepancies in reported events
may be several. The first may lie in the relationship of the
adolescent to the health care provider who makes the decision
as to whether the adolescent will receive government
assistance and whether or not she will receive support which
is independent of her family. Her relationship with the
investigator, on the other hand, is one in which she may have

felt that remuneration was dependent on giving a socially

142
desirable response. In addition, she had no reason to trust
the investigator and.may have been unwilling to share certain
aspects of her life.

Secondly, during the interview process it was evident
that some participants did not perceive an event in the same
manner as the investigator. For instance, adolescents were
asked whether they had experienced a violent act within the
preceding 12 months. One adolescent replied in the negative.
However, on prompting she told the investigator that she had
been asleep on the couch when her brother stabbed her after
mistaking her for her mother. She had hot recognized this as
a violent act and would not have included it in her report of
negative life events.

A third explanation lies in the use of a tool which, in
light of information elicited by social services, was
inappropriate for this adolescent population even though.many
aspects of a pregnant adolescent's life may be comparable to
that of an adult in similar circumstances. Although the item
content covered the myriad of events these adolescents had
experienced, they were obviously not worded in a manner which
would prompt the adolescent to recall the events or that she
would even recognize her life events as being appropriately
included in a particular category.

The positive relationship between the degree of prenatal
fetal attachment and the degree of perceived stress only for
Caucasian adolescents is not easily interpreted. In addition

to the possible explanations which were offered previously,

143
the perception of themselves in the mothering role may be the
impetus for greater degrees of perceived stress.. The greater
degree of perceived stress may also reflect the Caucasian
adolescent's existence in an uncertain and turbulent world.
Research.has indicated that an adolescent pregnancy may occur
because she is searching for someone to love or for someone to
love her (Bobak, Jensen, & Zalar, 1989). Her unborn baby may
represent something real to hang onto and something that is
entirely her own and may represent something or someone over
whom she has some control. Black and Hispanic adolescents may
not exhibit this same relationship due to higher levels of
self-esteem and the greater acceptance of their pregnancy both
by themselves and their support systems. These differences
may protect them from their stressful existence and they,
therefore, do not exhibit the relationship between the degree
of perceived stress and the degree of prenatal fetal

attachment which was found in the Caucasian group.

HXDQLh§§§§_1

H04: Among pregnant adolescents, there is no
relationship between the extent of social support
and the degree of prenatal fetal attachment.

H14: Among pregnant adolescents, there is a

positive relationship between the extent of social

support and the degree of prenatal fetal

attachment. .

Other investigators, utilizing a ‘variety of social
support instruments, have found some support for a

relationship between the variables of extent of social support

144

and the degree of prenatal fetal attachment in adult women
(Cranley, 1979: Mercer, Ferketich, May, DeJoseph, & Sollid,
1988: Wawrzynski, 1986). Because of differences in tools,
comparison of results with this study is difficult. Two
studies of adolescent pregnancy utilized the Norbeck Social
Support Questionnaire: the direction of the correlations was
mixed, however. Koniak-Griffih (1988) reported a positive
relationship between the extent of social support and the
degree of prenatal fetal attachment for her group of
adolescents but only between selected subscales of each of the
constructs. For her group, those who reported receiving more
aid reported more thoughts, feelings, and behaviors associated
with attributing characteristics to the fetus. Armantrout
(1983) , on the other hand, reported ,inverse correlations
between the subscale of Roletaking and Quality of Support Lost
and Giving of Self and the amount of aid received. When
adolescents in the present study received support from their
general network, no- relationship with the measures of
attachment were discovered.

The conceptual framework for this study suggests that the
extent of the adolescent's social support will ultimately
provide the basis for a developing relatidnship with her
unborn baby. More specifically, the framework assumes that it
is within a family environment which is warm and supportive
that the adolescent develops interpersonal competence and
adaptive skills which allow her to interact effectively with

her growing fetus. These characteristics provide the impetus

145

for her desire to interact with her fetus, assist in the
development of maternal role behaviors, and they result in a
commitment to provide a healthy internal environment for her
unborn baby. i

The literature supports the assumption that optimal
pyschosocial development.occurs within the environment of her
support network (Belsky, 1984). More specifically, it
suggests that the adolescent's mother has a strong effect on
her developing interpersonal competencies as well as on her
developing adaptive capacities (Crowell 8 Feldman, 1988:
Rubin, 1975: Shereshefsky & Yarrow, 1973). Support from the
father of her baby, although important, has generally been
found to have a lesser effect on these personality
characteristics (Wise & Grossman, 1980). When these
pyschosocial competencies and adaptation to the mothering role
as measured by the Maternal Fetal Attachment Scale were
correlated, the findings were mixed depending on whether the
samples were adults or adolescents. Studies of adult women
yielded no association between the degree of prenatal fetal
attachment and the extent of social support (Zachariah, 1984) .
Lindner (1984), however, reported a positive and significant
association between the adolescent’s relationship with her
mother, her relationship with the father of her baby and the
degree of prenatal fetal attachment. Each of these studies
utilized gross measures of the pregnant woman's relationship
with her mother and her partner. The results of this study of

adolescents, which utilized a specific social network

146
instrument to separate the sources and types of support
provided substance to the theoretical framework upon which
this study was based.

When both her mother and the father of her baby
supplied the adolescent. with instrumental assistance in
amounts deemed necessary, she demonstrated behaviors which are
adaptive .to the developing maternal role. She no longer
thought only of her own welfare but took positive action
through changes in her lifestyle which were more likely to
assure an optimal outcome for her fetus.

Affection received from the father of her baby had a
positive effect on the development of greater degrees of
prenatal fetal attachment. Adolescents who reported a greater
extent of support from their partners interacted.more readily
with and attributed characteristics to their babies.

The extent to which the adolescent received affection
from her mother was associated with the degree to which she
was able to view the fetus as a separate being, a task which
is necessary to the attainment of the mothering role (Rubin,
1984). She had decided on a name for both a girl baby and a
boy baby, yet recognized that the baby's sex had already been
determined. In addition, she looked forward to seeing what
the baby would look like, that is, she understood that the
baby may look differently from what she had imagined. She
also enjoyed watching the baby move.

Other indicators of attachment, however, were associated

with the adolescent' s ethnicity. Only for the Caucasian

147

adolescent was there a relationship between the extent of
affection from her mother and the degree to which she
developed interaction and roletaking behaviors, that is, only
when these adolescents perceived themselves as receiving
adequate affection from their mothers did they develop a
greater degree of prenatal fetal attachment. This group
demonstrated an interpersonal competence by interacting more
readily with their unborn babies. These adolescents talked to
their babies more frequently, had a favorite nickname,
physically exchanged touch to encourage them to poke back at
their mothers, to quiet them, or to move them around. When
the Caucasian adolescent’s perceived her mother as providing
adequate amounts of affection she also began to picture
herself in the mothering role of taking physical care of her
baby. It appears that affection from her mother was less
important in the development of these behaviors in the
Hispanic, and to a lesser extent, the Black adolescent. These
adolescents appeared to develop an adaption to the mothering
role regardless of the relationship they had with their
mothers. .

In attempting to explain the conflicting results among
the various studies several demographic differences among the
samples were noted. Armantrout (1983) drew her sample from
rural, inner-city, and suburban settings. Slightly less than
40% were Black, 60% were Caucasian, and the remainder were of
Latin-American descent. No indication of socioeconomic status

was reported. Although Koniak-Griffin (1988) did not indicate

148
ethnicity or socioeconomic status in her sample, a primarily
Caucasian extraction was inferred as the sample was drawn from
adolescents who resided in a maternity home. The present
sample was drawn primarily from urban and inner-city
residents. Slightly more than half were Black, one-third were
Caucasian, and 20% were Hispanic: the sample was primarily
from the lower socioeconomic group. Based on the association
of ethnicity and those psychosocial variables which were
previously discussed, it is possible that these and
socioeconomic differences account for the inconsistency among
studies (Jones, Green, 8 Krauss, 1980: Roosa, Fitzgerald, 8
Carlson, 1982). In addition, studies by Zachariah (1984) and
Mercer, Ferketich, May, DeJoseph, 8 Sollid (1988) utilized
adult subjects, whereas, the present study and those by
Armantrout, Lindner, and Koniak-Griffin focused on the
adolescent. It is possible that the adult, by virtue of her
age and developmental status, is no longer dependent on those
who are close to her to assist her in the development of
competencies and adaptive processes which form the basis for

her relationship with her unborn baby.

WM

H05: Among pregnant adolescents, there is no
relationship between the degree of ego development
and the degree of prenatal fetal attachment.

The degree of ego development in this study was

conceptualized as an independent variable which was thought to

149

be associated with the degree of prenatal fetal attachment in
the pregnant adolescent. As defined in this study, the
construct was conceptualized as part of an age-dependent
developmental process and not a variable which contributes to
interpersonal competency and adaptive skills which the
adolescent develops within the context of her family.
Although the data which were generated by this study do not
lend itself to this supposition, evidence does exist that the
degree of ego development may well be associated with the
extent and type of support the adolescent receives from her
family. However, studies in which these relationships were
investigated have conceptualized the variable very
differently.

The relationship between family interaction and the
psychological functioning of their adolescent members was
investigated by Powers, Hauser, Schwartz, Noam, and Jacobson
(1983). They utilized Loevinger’s definition of ego
development, ”The process of integrating and making sense of
experience, a hierarchically ordered, invariant sequence of
stages in which the individual's perception of self, others,
and interpersonal relations become increasingly more
differentiated and complex" (p.7). The authors found
significant group differences in the 'degree of ego development
between a group of healthy adolescents and a group of
adolescents diagnosed with psychiatric impairment .
Furthermore, in the total sample, the extent of mother and

father support was positively and significantly correlated

150
with the degree of adolescent ego development and this was
independent of the degree of ego development in the parents.
Adolescent ego<development.was most advanced in families with
non-competitive sharing of perspectives or challenging
behavior within a context of high support or low affective
conflict and cognitively inhibiting behavior.

Several studies have investigated the relationship
between the degree of ego development in pregnant women and
the extent of adaptation to the maternal role. Heinicke,
Diskin, Ramsey-Klee, and Given (1983) found a significant
positive association between the ability to adapt to changing
circumstances and the degree of ego strength defined as the
ability to maintain a sense of reality and stability, to share
emotional experiences, and to confront life situations without
fear. For their study, Shereshefsky, et al., (1973) defined
ego strength as a group of personality characteristics such as
dependency patterns, general anxiety, sense of humor,
flexibility, acceptance of identity, and extent to which she
had achieved the adult role. The degree of ego strength,
measured at six months gestation, was positively and
significantly correlated with acceptance of the maternal role
at one, three, and six months postpartum as well as with
responsiveness to her six month old infant.

Intuitively it would seem that the degree of ego
development, defined here as the tendency to see the self as
the object of other's attention, to anticipate the reactions

of others to the self in real or imagined situations, and the

151

belief in one’s uniqueness, omnipotence, and invulnerability
(Lapsley, et al., 1989), would be associated with the degree
of prenatal fetal attachment which the adolescent forms for
her unborn baby. That is, the more she is preoccupied with
herself, the less she can invest of herself in her fetus.

Correlations between the New Personal Fable Scale and its
subscales, the New Imaginary Audience Scale, and the Maternal
Fetal Attachment Scale and its subscales failed to uncover any
association between these variables. It is possible that the
instrument utilized does not measure the construct of ego
development as defined in this study. Previously gathered
data, however, suggests that it does. It is also possible
that the development of a relationship between the mother and
her unborn baby has no association with the degree of ego
development which she has attained. She may exhibit the
indices of attachment even though she entertains a degree of
preoccupation with herself. It is evident that the
measurement of the degree of ego development poses difficulty
for the investigator as well as for those who wish to evaluate
and compare studies which have included this variable. It
appears that definitions abound and that a suitable one can be
found to meet almost any requirement. An alternate definition
for this study may have resulted in the discovery of the

relationship which was suggested by the theoretical framework.

152

Wheel-1.9

H06: Among pregnant adolescents, there is no
relationship between the extent of health behaviors
practiced and the degree of prenatal fetal
attachment.

The literature suggested that the infants of adolescent
mothers, who perceive themselves as having an adequate support
system, experience more optimal biopsychosocial outcomes than
infants of adolescent mothers who do not. (Giblin, et al.,
1987: Ventura 8 Hendershot, 1984) . The framework for this
study was predicated on the assumption that an adequately
supported adolescent would form a greater degree of attachment
for her unborn baby and, therefore, would hold a greater
commitment to provide a healthy internal environment for the
growing fetus. Analysis of the data did not reveal an
association between these two variables. There does appear to
be somewhat of a discrepancy in the data, however, which may
reinforce the likelihood that. responses by this group of
adolescents were inconsistent.

The Health Behaviors Scale was specifically designed for
this study of prenatal fetal attachment in pregnant
adolescents. Items which make up the scale were based on
informational materials which are provided to pregnant women
in any health care setting. These items were intended to
measure the extent to which the adolescent received adequate

rest, exercise, and nutrition, as well as whether or not she

153

refrained from. exposing' herself and. her fetus to ‘toxic
substances. Again, there was no correlation between scores
on this scale and scores on the Maternal Fetal Attachment
Scale or any of its subscales. Items on the Maternal Fetal
Attachment subscale, Giving of Self, measure very similar
behaviors although they are not stated quite as specifically.
Doing things to try to stay healthy and giving up certain
things so as to help her baby imply the behaviors which were
explicit in the Health Behaviors Scale. Examination of a
correlation matrix, however, revealed that the Health
Behaviors Scale and the Giving of Self subscale were not
associated as would be expected: in fact the data showed a
negative though non-significant trend. Adolescents .who
reported more giving of self behaviors and thus ensuring a
healthy environment for her fetus tended to report fewer
positive health behaviors on the Health Behaviors Scale.

Further evidence of inconsistency was found on
examination of the relationship between the extent of social
support, the Health Behaviors Scale, and the Giving of Self
subscale. . The extent of social support in the form of
instrumental aid received from the adolescent's mother and
the father of her baby were correlated positively and
significantly with the extent to which she provided a healthy
environment for herself and her fetus as measured by the
subscale of Giving of Self. The extent of health behaviors
practiced as measured by the Health Behaviors Scale, were not

related to this social support variable, however.

154

Two explanations for the discrepancy in responses are
offered. It is possible that the Health Behaviors Scale and
the Giving of Self subscale do not measure the same construct,
although this is unlikely. The second possibility, and one
which has more merit is that adolescents did not interpret the
implied items on the Giving of Self subscale as being health
related.

In addition to the above discrepancies, it should be
noted that.this group>of adolescents did.not report the use of
street drugs and only three percent reported alcohol use at
Time 2. Although these self-reports can neither be supported
nor refuted, clinic data indicate that eight percent reported
a past history of drug abuse. However, at the time of the

intake interview, urine drug screens were negative.

Limitations

Factors which were not under the control of the
investigator created several limitations in. this study. The
usual practice of adolescents is to apply to the health care
system for prenatal care in the . middle or late second
trimester. Data on early prenatal fetal attachment cannot be
obtained easily. Subjects were requested to reply to
retrospective questions to supply information on the degree of
prenatal fetal attachment they may have developed before the
experience of fetal movement. Data based on recall must be

interpreted with some caution. Furthermore, the adolescents

155

presented themselves to the prenatal clinic at varying
gestational ages, thus the intervening time differed from one
adolescent to another. The greatest discrepancy in
gestational age occurred at Time 1 with a range from 10 to 39
weeks. It is recognized that those adolescents who were in
advanced stages of their pregnancies were required to recall
thoughts, feelings, and behaviors which occurred in a more
distant past than those who presented to the clinic early in
their pregnancies. The limitations associated with the recall
data could not be minimized. The variation in gestational age
at Time 2 ranged from 10 to 24 weeks. This range reflects
several adolescents who sought health care earlier than usual
in the typical adolescent group. Again, the limitations
associated with varying gestational ages could not be
minimized. Gestational ages at Time 3 and Time 4, however,
were much less variable. These were 25 to 31 weeks and 32 to
39 weeks respectively. The majority of the adolescents were
interviewed at the lesser of the gestational ages for these
two periods of data collection. Data from Times 1, 2, and 3
were utilized only for frequency distributions, whereas, data
from Time 4 which included the total sample were utilized for
correlational analyses.

Studies which measure change over time run the risk of
test-retest bias. It was assumed that collection of data at
approximately six ‘week intervals permitted adequate
measurement of the degree of prenatal fetal attachment with a

minimum of bias. The time intervals were arbitrary, however,

_ 156
and may not have been appropriately spaced in order to tap the
dimension of prenatal fetal attachment.

Data collection utilizing a close-ended dictated
technique resulted in complete data sets. However, face-to-
face interviews may have resulted in a subject' s socially
desirable responses. The incentive for participation was
considerable and it is possible that the adolescent believed
that her replies might influence whether or not she would
receive the incentive although she had been assured at the
beginning of the study that this was not the case. In
addition, the entire set of instruments was dependent on self-
report of the thoughts, feelings, and behaviors associated
with the dependent and independent variables. Thus, the data
were not verifiable. Finally, in view of the non-random
selection of subjects, the results of this study cannot be
generalized beyond the sample.

In an effort to conserve time and thereby not lengthen
the prenatal visit unduly, measurements were collected at
various stages of the pregnancy. For instance, the State-
Trait Anxiety Inventory was administered at Time 2, while data
on the extent of social support and degree of perceived stress
were collected at Time 3 and Time 4 respectively. The
correlational analyses were based on the degree of prenatal
fetal attachment which had developed by Time 4 . It is
recognized that the emotional status of the adolescent may
have changed during the intervening period and may have been

unique to the time of the interview.’

157

W

This study of prenatal fetal attachment in primiparous
adolescent women revealed several implications for health care
providers. Most importantly, the adolescent's support system
must be adequately assessed. Many adolescents, who are
experiencing a pregnancy, are estranged from family members,
often their mothers. Even though adolescents report having
poor relationships, it should not be assumed that these
relationships are not important to her. Held (1981) reported
that, of her entire support system', the prospective
grandmother was most disapproving of the pregnancy. Even so,
adolescents depend the most on her for support. Although the
pregnant adolescent can legally apply for prenatal care in
this state without parental consent, where possible, the plan
of care should provide for the active participation of her
mother. Interventions which serve to strengthen the mother-
daughter relationship, so that the adolescent perceives her
mother as more affectionate towards her, may ultimately affect
the relationship which develops between the adolescent and her
unborn baby. The assessment of parental-adolescent
estrangement requires further investigation. Family
interaction and interpersonal support may be strengthened
through the process of family therapy.

A second area of concern, regarding the adolescent's
support system, is that of accessibility. It is frequently
determined that the adolescent should be maintained in a

158

living arrangement which is separate from her family of
origin. This decision is made in her best interest. However,
given the available housing choices, the adolescent often
‘ finds herself in a location which does not give her ready
access to her support network. Where it is possible and
desirable, the adolescent should be housed within a reasonable
distance from those on whom she depends for support.

Although the extent of support she received from the
father of her baby was not as closely associated with the
degree of prenatal fetal attachment the adolescent developed
for her unborn baby, it was evident that this support was
operative to some extent. It is imperative that health care
providers capitalize on this knowledge. Barret and Robinson
(1982) suggested that when it is assumed that the adolescent's
partner wants to actively participate in the pregnancy, and
when health care providers actively incorporate him into the
plan of care, the adolescent father will demonstrate a greater
degree of responsibility in decision making and will be more
likely to involve himself with his offspring. This process
may be initiated or enhanced through a program of family
therapy which incorporates the prospective father.

The health care provider must assess the adolescent’s
level of anxiety. As was suggested by Leifer ( 1977) and
Lederman (1984) , lower levels of temporary anxiety may portend
a lesser degree of attachment to the fetus. Sameroff and
Chandler (1975) suggested that higher levels of long term

anxiety are related to decreased interaction with the infant.

.159
Interventions designed to stimulate the attachment process as
well as those designed to reduce the level of long term
anxiety may be appropriate.

Finally, the role of education in the repertoire of
interventions must not be overlooked. Data from this study
indicate that the adolescent's interest in her developing
fetus increased over the length of gestation. Based on the
theoretical framework, it was assumed that this was a natural
evolution. It is possible that this increasing interest was
related to the adolescent's participation in a research study
which emphasized thoughts, feelings, and behaviors toward her
unborn baby. With the knowledge that the degree of prenatal
fetal attachment does increase over the pregnancy, it is
essential that health care providers capitalize on this by
providing information about the capabilities of her unborn
baby and by talking with the adolescent about thoughts and

feelings she may be having.

W

The question remains as to why the relationship between
these psychosocial variables and the degree of prenatal fetal
attachment continues to provide inconsistent results.
Although it is possible that the phenomenon of prenatal fetal
attachment does not exist, in view of the supporting
literature this is not an explanation to be given merit. It
is possible that it is the measurement of the degree of

160
prenatal fetal attachment which remains elusive. The
thoughts, feelings, and behaviors which have consistently been
reported by pregnant women may not easily be transposed into
quantifiable data. This would suggest that the dimensions of
prenatal fetal attachment may not, as yet, have been
adequately operationalized.

The dimensions of prenatal fetal attachment may not only
be inadequately measured but may also be inappropriate for
populations of different cultures as well as for adolescents.
The Maternal Fetal Attachment Scale was initially applied to
adult women who were primarily Caucasian, well educated, in a
marital or stable non-marital relationship, at 35 or more
weeks gestation, and with low pregnancy risk (Cranley, 1979) .
The majority of investigators who have utilized the Maternal
Fetal Attachment Scale applied it to populations with
characteristics very similar to Cranley’s. The literature has
suggested that the characteristics of her interaction with her
infant may be more culturally dependent than age dependent
(McAnarney, et al., 1984: Greathouse & Miller, 1981).
Therefore, it is necessary to examine the appropriateness of
the Maternal Fetal Attachment Scale, not only for low risk
Caucasian adults but also for adolescents and those of
differing cultural and socioeconomic extraction.

The results of this study as well as results of previous
studies, indicate that the instruments utilized to measure
these psychosocial variables may not be adequate for the

purpose. Although the State-Trait Anxiety Inventory

161

(Spielberger, et al. , 1983) has tapped two aspects of the
phenomenon, both of which appear to be pertinent indicators
during the perinatal period, it appears that an instrument
which can differentiateanxiety focused on the self as opposed
to anxiety focused on the fetus is needed. The Norbeck Life
Events Questionnaire (Norbeck, 1984) , although appropriate for
adult populations, may not be appropriate for the adolescent
population.

It is evident that the concept of ego development, as it
was defined in this study of pregnant adolescents, requires
re-examination. Whether the conceptualization of the
construct is at fault or the assumption that the adolescent's
preoccupation with herself interferes with her ability to form
a relationship with her unborn baby is erroneous remains to be
discovered.

A longitudinal study provides valuable information when
the variable to be examined is change over time.
Unfortunately, in terms of cost and time, it can be
prohibitively expensive. Where possible larger samples should
be employed. This would guarantee a greater representation of
earlier gestational ages so that comparison can be made with
more accuracy. In addition, it would be valuable to collect
the psychosocial measurements, not only at predetermined
gestational ages, but at two or three points in the pregnancy.
It is important to investigate changes in levels of anxiety
and self-esteem and in degrees of perceived stress as the

pregnancy progresses.

162

In view of the cultural implications which were suggested
by this study, a larger sample, which is ethnically and
socioeconomically diverse should be examined for its social
support systems, particularly for relationships with the
adolescent’s mother and the father of her baby. Future
investigations which explore the prospective grandmother's
reception of her daughter's pregnancy may result in additional
insight regarding the relationship of this reception to the
extent of maternal support perceived by the adolescent and the
effect of this support on the developing attachment for her
unborn baby. -

The theoretical framework from which this study evolved
and to which the results of this study lend some support,
suggests recommendations for future research design. It is
apparent that the attachment process in the adolescent cannot
be fully understood without an in-depth investigation of the
contextual variables which may influence the relationship she
forms with her unborn baby. An ethnographic research design
which considers the impact of .the ,adolescent’s environment and
the effect which that environment has upon her developing
interpersonal competency and adaptive capacities may help to
explicate these phenomena. A design which includes an
assessment of interaction between and among her identified
family members as viewed byeach of the members, would enhance
the knowledge gained in this study which utilized only the
perspective of the adolescent. With this knowledge it may be

found that the family environment might assume one of any

163
number of forms and, thus, would be more appropriately viewed
as a variable rather than. a constant as in this study. In
addition, an in-depth assessment of peer support may reveal
the extent of influence this system has upon the adlolescent's
developing relationship with her unborn baby. Finally, future
investigations of the relationship of several variables to the
degree of prenatal fetal attachment should employ statistical
methods which determine the extent to which each variable

contributes to the overall variance.

53mm

The theoretical framework for this study of prenatal
fetal attachment in adolescents assumed that through
interaction in a warm and supportive environment, a positive
feeling about one's self develops over time. It is this
positive feeling which enables the adolescent to begin the
attachment process through interaction with her unborn baby.

The concept of prenatal fetal attachment has captured the
interest of investigators over the last decade, however, the
mechanism by which to measure it has been elusive. The
Maternal Fetal Attachment Scale, as developed by Cranley
(1979, 1981a) , has provided inconsistent results in past
studies when investigated in relation to variables which have
been found to be associated with the more frequently studied
phenomenon of maternal-infant interaction in the postnatal

period.

164

Results of this study of pregnant adolescents supported
previousinvestigations which suggested that the degree of
prenatal fetal attachment increases over the gestational
period. This study was also found to partially support the
relationship between the phenomenon of prenatal fetal
attachment and selected psychosocial variables which were
suggested by the conceptual framework. Adolescents with
higher levels of currently perceived anxiety were less likely
to report behaviors which would provide a healthy environment
for the fetus. When adolescents reported a greater extent of
affection from their mothers, they were more likely to view
the fetus as distinct from themselves. When a greater extent
of aid was provided by the mother as well as the father of the
baby, they were more likely to provide a healthy environment
for the fetus.

Some indicators of the degree of prenatal fetal
attachment were associated with cultural orientation. For the
group of Caucasian adolescents, a greater degree of perceived
stress was positively associated with the adolescents'
imagining themselves in the mothering role. The degree of
prenatal fetal attachment in Caucasian adolescents was also
positively related to the extent of affection she received
from her'mother as well as the extent of aid she received from
both her mother and the father of her baby. Hispanic and to
a lesser extent Black adolescents were less dependent on this
support and developed a 'greater degree of prenatal fetal
attachment for their unborn babies regardless of the

165
relationship they had with their mothers and their partners.
The level of self-esteem did not reveal a significant
relationship with the degree of prenatal fetal attachment as

was true of the level of ego development and the extent of

health behaviors practiced.‘

APPENDICES

APPENDIX A

Parametric Properties of Instruments

APPENDIX A

Parametric Properties of Instruments

WW1; Through item analysis. 24 of
the original 37 items were distributed into five subscales (a

sixth subscale was eliminated due to low item-scale
correlations), each purported to measure differing aspects of
the construct, prenatal fetal attachment. The instrument was
administered to 71 primiparous and multiparous adult women
between 35 and 40 weeks gestation. They represented the full
range of socioeconomic status and were both married and
single. Subsequently, one item has been eliminated on the
advise of the author and is currently a 23 item Likert type
scale.

Cranley (1981) reported a Chronbach's alpha coefficient
of reliability of .85 for the total scale and .52 to .73 for
the subscales. The scale was determined to have content
validity by a group of five perinatal nurse experts (Cranley,
1979). Validity, that the subscales measure the dimensions of
maternal fetal attachment, was established through
intercorrelations of .61 to .83 among the subscales and the

total scale. Correlations among subscales ranged from .29 to

166

167
.60. thus indicating that the subscales were measuring
different dimensions of the construct. Construct validity has
not been established due to the exploratory nature of this
phenomenon, and the lack of other instruments with which to
correlate Cranley's tool. The following items are presented

according to their respective subscales.

Ming

4. I picture myself feeding the baby

8. I imagine myself taking care of the baby

18. I can hardly wait to hold the baby

19. I try to picture what the baby will look like

WM

3. I enjoy watching my tummy jiggle as the baby kicks
inside

5. I’m really looking forward to seeing what the baby
looks like

10. I have decided on a name for a girl baby

13. I have decided on a name for a boy baby

W

1. I talk to my unbbrn baby
7. I refer to my baby by a nickname
17. I poke the baby to get him/her to poke back
20. I stroke my tummy to quiet the baby when there is
too much kicking
23. I grasp my baby's foot through my tummy to move it
around ‘

MW
6. I wonder if the baby feels cramped in there
9. I can almost guess what my baby's personality will
be from the way she/he moves around
12. I wonder if the baby can hear me inside
14. I wonder if the baby thinks and feels inside of me
16. It seems my baby kicks and moves to tell me itfs

eating time
21. I can tell that the baby has hiccoughs

168

W11

2. I feel all the trouble of being pregnant is worth
it ,

11. I do things to try to stay healthy that I would not
do if I were not pregnant

15. I eat meat and vegetables to be sure my baby gets a
good diet

22. I give up doing certain things because I want to
help my baby

The Maternal Fetal Attachment Scale was adapted for
this study for the purpose of measuring the degree of prenatal
fetal attachment in the early stages of pregnancy. Items 3,
9, 16, 17, 20, 21, and 23 were deleted as they pertain to

active, observable fetal movement which does not occur until

late in the second trimester.

W The Health Behaviors Scale is a Likert

scale which consists of five responses ranging from never to
every day. This scale was specifically designed by the
investigator for the purposes of this study and is based on
information provided to women concerning healthy behaviors
during pregnancy. It has face validity. No other measures of
validity and reliability are available. The following items

are those which were included in the scale.

1. Over the last six weeks I have slept so well that I
feel rested in the morning

2. Over the last six weeks I have been able to rest
for short periods during the day

3. Over the last six weeks I have gotten exercise such
as, taking walks, swimming, bicycling, dancing, and
aerobics

4. Over the last six weeks a typical daily diet
consists of at least 4 servings of milk and cheese,

169
4 servings of breads and cereals, 4 servings of
fruits and vegetables, and 2 servings of meat
5. Over the last six weeks I have smoked cigarettes
6. Over the last six weeks I have drunk alcoholic
beverages .
7. Over the last six weeks I have taken non-
prescription medicines such as aspirin, tylenol

antacids, and cold medicines
8. Over the last six weeks I have taken street drugs

WWI: This scale was designed to

assess the extent to which subjects engage in object
relational ideation and interpersonal fantasies. This was
originally a 42-item Likert scale which has been revised by
the authors to contain 38 items with four responses ranging
from "Never" to "Often"(Lapsley, et al., 1989).

Psychometric evidence of reliability and validity of the
New Imaginary Audience Scale is currently being collected.
Lapsley, FitzGerald, Rice, and Jackson, (1988), reported a
coefficient alpha for the NIAS of .92. Initial attempts to
establish validity have been encouraging. The New Imaginary
Audience Scale was positively correlated with scales of
narcissism and to object relational concerns for example,
engulfment, symbiosis, enmeshment and separation anxiety.
Items of which the New Imaginary Audience Scale consist are as

follows (Items 12, 34, and 35 were adapted for this study):

WW1:

1. Winning a lot of money

2. Being a rock star

3. Being a movie or t.v. star

4. Winning an important game for your team
5. Being popular with friends

6. Being admired for the way you look

170

7. Being a good athlete

8. Being admired because of the way you dress

9. Being an important leader

10. Performing in front of your school in a play

11. Being admired because of how smart you are

12. Having a popular boyfriend or girl friend or
husband

13. Performing in front of your school in a band

14. Rescuing a friend from danger

15. Saving someone's life

16. Standing up to a bully

17. Winning an important award

18. Showing others that you are strong

19. Imagining how others would feel if you were gone

20. Showing others that you are kind and friendly

21. Having a lot of friends

22. 'Getting your feelings hurt in public

23. Making people sorry for hurting you

24. Getting back at an enemy

25. Developing a friendship with someone who doesn' t
like you

26. Imagining how others would feel if you lost your
mother or father

27. Imagining how others would feel if you were in the
hospital

28. Giving an important speech

29. Being rejected by a boyfriend or girlfriend

30. Being admired because you are funny

31. Being admired because of the car you have or want
to have

32. Being admired because of your records or stereo
system

33. Imagining what others are thinking about the way
you look

34. Asking a popular boy for a date

35. What it's like to be married (or single)

36. Making a good impression on your teachers

37. Imagining what everyone will think if you become
famous

38. Other people seem to enjoy it when I am the center
of attention

WWI:

The New Personal Fable Scale, in its original form, was

a 46 item forced choice true/false format. It has been

converted to a 46-item Likert scale with five choices ranging

171

from ”Strongly Disagree" to "Strongly Agree". Lapsley, et
al., (1988) reported a reliability (KR-20) of .65 for the
total scale and .64, .63, and .14 for the omnipotence,
invulnerability, and uniqueness subscales respectively. A
second study, however, reported a coefficient of .37 for the
uniqueness subscale as well as reliability estimates similar
to those obtained by Lapsley et al. (1988) for the omnipotence
and invulnerability subscales. Other studies reported NPFS
reliability coefficients for the total scale to be .78.
Subscale coefficients ranged from .64 (uniqueness) to .80
(omnipotence).

Evidence of scale validity is currently being collected.
Lapsley, et al., (1988) reported it to be positively
correlated with scales of narcissism, as well as to scales of
dependency, denial and self-centeredness. It was negatively
correlated to separation-anxiety and engulfment.

The following items of the New Personal Fable Scale are

distributed into their appropriate subscales.

mm

1. I believe I can do anything I set my mind to.

4. I think that I am more persuasive than my friends.

5. I believe that no one can stop me if I really want
to do something.

7. It often seems like everything I do turns out
great.

8. I don't think anything will stand in the way of my
goals

10. I believe that other people control my life.

13. I think I can be anything I want to be.

16. I believe that everything I do is important.

19. I think I’m a powerful person.

172

22. I think that I am better than my friends are at
-just about anything.

23. I tend to doubt myself a lot.

26. Other people don’t influence me.

28. I often think that people don't listen to what I
have to say.

30. I honestly think I can do things that no one else
can.

32. Everyone knows that I am a leader.

36. People always do what I tell them to do.

37. People usually wait to hear my opinion before
making a decision.

38. I usually let my friends decide what we are goin
to do. -

44. I am always in control.

Iminerabilitx

2. Nothing seems to really bother me.

11. I don’t believe in taking chances.

14. I'm a fragile person.

17. I believe in knowing how something will turn out
before I try it.

20. I believe in taking risks.

29. There are times when I think that I am
indestructible. _

31. I can get away with things that other people can't.

35. It is impossible for people to hurt my feelings.

39. My feelings are easily hurt.

40. Special problems, like using drugs could never
happen to me.

41. I enjoy taking risks.‘

42. It is easy for me to take risks because I never get
hurt. ' .

43. I don' t take chances because I usually get in
trouble.

45. I am not afraid to do dangerous things.

W

3. No one has the same thoughts and feelings that I
have.

6. I'm somehow different from everyone else.

9. I'm the only one that can understand me.

12. I believe that I am unique.

15. I think that deep down everybody is the same.

18. I'm just like everyone else.

21. Everybody goes through the same things that I am
going through.

24. It's hard for me to tell if I am different from my
friends.

25. I often feel that I am insignificant and that I

don't really matter.

173
27. There isn't anything special about me.
33. Nobody will ever really know what I am like.
34. No one sees the world the way that I do.

46. Sometimes I think that no one really understands
me. -

WWW—Imam Radar-Richardson
reliability estimates for the Coopersmith Self-Esteem

Inventory are reported to range from .71 to .74. Construct,
concurrent, and predictive validity have been well

established.

WW Test-retest reliability
has been established for the functional and network property

items with Pearson correlations ranging from .85 to .92.
Analysis of correlations among items and subscales revealed a
high level of internal consistency. Content, concurrent,
construct, and predictive validity have been established. The
following items are distributed into the subscales.

MW

Affect 1. How much does this person make you feel liked
. or loved?
2. How' much does this person make you feel
respected or admired?

Affirm 3. How much can you confide in this person?
4. How' much does this person agree with or
support your actions or thoughts?

174

Aid 5. If you needed to borrow $10, a ride to the
doctor, or some other immediate help, how'much
could this person usually help?

6. If you were confined to bed for several weeks,
how much could this person help you?

Wills:
Number listed in network

7. How long have you known this person?

8. How frequently do you usually have contact
with this person? (Phone calls, visits, or
letters)

W

9. During the last year have you lost any
important relationships due to moving, a job
change, divorce or separation, death, or some
other reason?

9a. Please indicate the number of persons from
each category.who are no longer available to
you.

9b. Overall, how much of your support was provided
by these people who are no longer available to
you?

W

10. Is one of the persons you listed in your
network the father of your baby?

Wigwam: This instrument has a reported
test-retest reliability' of .78 to .83 for the entire

instrument. Items which make up the questionnaire were
derived from a series of open-ended questions and then coded
for congruence with three existing instruments. Thirty-nine
unique responses were converted to an additional nine items.
This procedure provided content validity. Concurrent validity
was established through correlations with the State-Trait

Anxiety Scale, the Profile of Mood States, and the Brief

175

Symptom Inventory.

W This instrument has been

extensively used and has a reported reliability of an alpha
coefficient of .87 to .90. Concurrent, convergent, divergent,

and construct validity have been well established.

APPENDIX B

Significant Correlations and the Corresponding Partial
Correlation Coefficients of the Dependent and Independent

Variables

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APPENDIX C

Verbal Script and Consent Forms

APPENDIX C

Verbal Script and Consent Forms

VERBAL SCRIPT

Judy Apgar is a nurse and student at Michigan State
University. She is studying about pregnant women and their
unborn babies. She would like to know if you would be willing
to answer some questions about yourself, your unborn baby,
your health, and your family and friends.

She would meet you here at the clinic during your first visit
with the doctor for about 20 minutes and then again two more
times at the clinic for about 45 minutes each time. She will
pay you $10.00 for each meeting with her, for a total of
$30.00, to be paid after the third meeting.

The answers you give to her will be strictly private. She
will not share them with us at the clinic nor with anyone
else. Your decision to join in this study is voluntary, and
the care we give you in the clinic will not be affected
whether you participate or not. If there are any questions
which she asks that.make you uncomfortable, you do not.have to
answer them and you may drop out of the study at any time.

If you would like to participate, please bring this letter
when you come for your first visit with the doctor; Sign your
name at the bottom; if you are under the age of 18 you must
have your parent or guardian sign it too.

Type of questions and information:

1. Age, education, religion

2. When I think.about my baby I feel happy (often, sometimes,
rarely)

3. I confide in my best friend ( a lot, a little. not at all)

4. I find myself daydreaming ( never, sometimes, a lot, all
of the time)

182

183

Date
Dear ,

I am a doctoral student at Michigan State University and
am doing a study to help us gain a better understanding of
pregnant women and their unborn babies. I believe that this
knowledge is very important in the planning of health care for
pregnant women and I hope that you will agree to join my
study.

If you do agree to join my study, I will meet you at the
clinic for your first doctor's visit. I will ask you some
questions about you and your unborn baby, about your health,
and about your family and friends. I‘will need to spend about
20 minutes with you at this visit and about 45 minutes at two
other visits to the clinic. Because you are willing to take
the time to answer these questions, I will pay you $10.00 for
each time you meet with me, for a total of $30.00, to be paid
after the third meeting. ‘

I assure you of complete confidentiality. No identifying
information on you will be given to the health care staff, nor
will it be in the report of this study. The sheet on which I
write your answers to my questions will have no identifying
information on it other than a code number which is for record
keeping only. This will allow me to keep all of your answers
to my questions together. My assistant and myself will be the
only people who will have access to these code sheets.
Participation in this study is voluntary and your decision to
participate or not will in no*way affect the health care which
the clinic provides. You need not answer any question with
which you are uncomfortable and you are free to drop out of
the study at any time.

The results of this study will help us to gain a better
understanding of pregnant women and their unborn babies, as
well as to help us plan for better total health care of
pregnant women. If you would like a summary of the results,
I would be happy to mail it to you when the study is
completed.

Please bring this letter with your signature and that of
one parent or guardian, with you to the clinic when you come
for your first doctor’s visit. This will tell me that you
would like to join my study. If you or your parents have any
questions about this study, please feel free to call me at
(313) 695-1559. I would be happy to talk with you. I am
looking forward to meeting you at the Clinic.

Sincerely, Teen:

 

Judith L. Apgar, RN Parent/Guardian

184

Permission for Telephone Contact

 

 

I give permission for Judy Apgar to call ,
(relationship) at the telephone
number for the purpose of confirming that I

 

have been given permission by my parent or guardian to take
part in her study of women and their unborn babies. I
understand that if I do_not want my parent/guardian contacted,

no further effort will be made by her.

Signature

 

Date

 

APPENDIX D

INSTRUMENT

APPENDIX D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUMENT
DATA SHEET
Code i . Date lst appointment
Name Age
Address LMR
Telephone # EDD
Parent's name Telephone #
Address '
1. Clinic Attended
( ) 1. MIC
( ) 2. SCHI
2. Gestational age at lst appointment (weeks)
3. Quickening (weeks)
4. Ultrasound done
( ) 1. Yes (
j 4a. If yes, date
( ) 2. No
Weeks
Visualization? ( ) 1. Yes
( ) 2. No
5. Ethnicity

l. Caucasian

2. Afro-American

3. Mexican-American
4. Oriental

5. Native American
6. Other:

AAAAAA
vvvvvv

 

185

6.

10.

11.

12.

186

Complications in pregnancy

 

( ) 1. Yes 3 6a.

 

( ) 2. No

AAAAAAA

1.
2.
3.
4.

6.
7.

Bleeding
PIH
Diabetes
Infection
Hyperemis s
Drug'abuse
Other

 

 

 

Date for data set #1 4 2

 

Date for data set #3

 

Registered for Prenatal Class

( ) 1. Yes
( ) 2. No

Date for data set #4

 

Registered for Prenatal Class

( ) 1. Yes
( ) 2. No

Clinic visits missed

%

 

( ) 1. Yes 7

12a. If yes, were visits

( ) 2. NO rescheduled?
( ) 1. Yes
( ) 2- H0

 

 

 

187

Data Set #1 a 2 Code #

 

 

This booklet was specifically designed for the study of
the process by which women form relationships with
their unborn babies. It is divided into sections and
you will be asked to answer questions about yourself,
your feelings, and your attitudes.

 

 

 

 

This section of the questionnaire will ask you about
yourself and your baby during the first 3 to 4 months
of your pregnancy. Try to think back to some of the
thoughts and feelings that you had at that time. There
are no right or wrong answers. Your first impression
is usually the best reflection of how you felt at that
time.

 

 

 

l thilt er a the fellwim Definitely Yes Win Io Definitely
V. In

1. As soon as I knew I was ( y ( ) ( ) ( ) ( )
pregnant, I began to talk
to my unborn baby.

2. Even in the early weeks ( ) ( ) ( ) ( ) ( )
of pregnancy, I felt that
all the trouble of being
pregnant was worth it.

3. I started picturing ( ) ( ) ( ) ( ) ( )
myself feeding the baby .
as soon as I knew I was
pregnant.

4. Even early in pregnancy I (-) ( ) ( ) ( ) ( )
looked forward to seeing
what the baby looks like.

5. I wondered if the baby ( ) ( ) ( ) ( ) ( )
felt cramped in there.

6. When I found out I was ( ) ( ) ( ) ( ) ( )
pregnant I began to call
my baby by a nickname.

188

I chili er a the followim Definitely Yes Min lo Definitely
7. I started to imagine ,( ) ( ) ( ) ( ) ( )

myself taking care of the
baby as soon as I knew I
was pregnant.

8. I picked out a girl's ( ) ( ) ( ) ( ) ( )
name shortly after I knew
I was pregnant.

9. As soon as I knew I was ( ) ( ) ( ) ( ) ( )
pregnant, I began to do
things to stay healthy
that I would not have
done if I were not
pregnant.

10. I wondered if the baby ( ) ( ) ( ) ( ) ( )
could hear inside of me.

11. I picked out a boy's name ( ) ( ) ( ) ( ) ( )
shortly after I knew I
was pregnant.

12. I wondered if the baby ( ) ( ) ( ) ( ) ( )
could think and feel
inside me.

13. As soon as I knew I was ( ) ( ) ( ) ( ) ( )
pregnant I made sure that
I ate meats and
vegetables so that my
baby would get a good
diet.

14. As soon as I knew I was ( ) ( ) ( ) ( ) ( )
pregnant I could hardly
wait until I could hold
the baby.

15. Since I became pregnant I ( ) ( ) ( ) ( ) ( )
have tried to picture
what the baby would look
like.

16. As soon as I knew I was ( ) ( ) ( ) ( ) ( )
pregnant I gave up doing
certain things because I
wanted to help my baby.

189

 

 

In this section we would like to know how healthy you
have been over the last six weeks. Please put a
checkmark in front of the number which describes your
usual practice on a typical day.

 

Over the last six weeks I have slept so well that I
feel rested in the morning

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

vvvvv

(

(

(

(

(
Over the last six weeks I have been able to rest for
short periods during the day

1. never

2. rarely

3. occasionally

3. almost every day
5. every day

“AAA“
vvvvv

Over the last six weeks I have gotten exercise such
as, taking walks, swimming, bicycling, dancing, and
aerobics

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

AAAAA
vvvvv

Over the last six weeks a typical daily diet consists
of at least 4 servings of milk and cheese, 4 servings
of breads and cereals, 4 servings of fruits and
vegetables, and 2 servings of meats

) 1. never

) 2. rarely

) 3. occasionally

) 4. almost every day
) 5. every day

AAAAA

 

190

Over the last six weeks I have smoked cigarettes

( ) 1. never

( ) 2. rarely

( ) 3. occasionally

( ) 4. almost every day
( ) 5. every day

Over the last six weeks I have drunk alcoholic
beverages

( ) 1. never

( ) 2. rarely

( ) 3. occasionally

( ) 4. almost every day
( ) 5. every day

Over the last six weeks I have taken non-prescription
medicines such as aspirin, tylenol, antacids, and cold

medicines

( ) 1. never

( ) 2. rarely

( ) 3. occasionally

( ) 4. almost every day
( ) 5. every day

Over the last six weeks I have taken street drugs

1.
2.
3.
4.
5.

AAAAA
vvvvv

never
rarely
occasionally
almost every day
every day

191

The next section will consist of statements about your
feelings. If a statement describes how you usually feel,
say "like me". If the statement does not describe how you
usually feel, say "unlike me".

Coopersmith Self-Esteem Inventory (Coopersmith, 8., 1987),
Consulting Psychologists Press. Copyrighted Instrument.

The following section will ask you to describe how you feel
right now at this moment. Your answer will indicate that
you feel this way either very much so, moderately so,
somewhat, or not at all.

State-Trait Anxiety Inventory (Spielberger, C., 1983),
Consulting Psychologists Press. Copyrighted Instrument.

Next, I will ask you to describe how you usually feel. This
time you will rate your description as either almost always,
often, sometimes, or almost never.

State-Trait Anxiety Inventory (Spielberger, C., 1983),
Consulting Psychologists Press. Copyrighted Instrument.

192

 

Now, try to tell us about the thoughts and feelings
that you are having about your pregnancy at this time.

 

l thitt at h the fellaim Definitely Yes Min Io DefinSsly
Yu

1. I talk to my unborn baby ( ) ( ) ( ) ( ) ( )
2. I feel all the trouble of
2:1n9 Pregnant is worth ( ) ( ) ( ) ( ) ( )

3. I enjoy watching my tummy
jiggle as the baby kicks ( ) ( ) ( ) ( ) ( )

inside
4. I picture myself feeding

tnebaby () () () () (i
5. I’m really looking

forward to seeing what ( ) ( ) ( ) ( ) ( )

the baby looks like

6. I wonder if the baby
feels cramped in there ( ) ( ) ( ) ( ) ( )

7. I refer to my baby by a
nickname () () () () (i

8. I imagine myself taking
care of the baby ( ) ( ) ( ) ( ) ( )

9. I can almost guess what
my baby’s personality
will be from he way s/he ( ) ( ) ( ) ( ) ( )
moves around

10. I have decided on a name
forababygirl () (i (i () ()

11. I do things to try to
stay healthy that I would
not do if I were not ( ) ( ) ( ) ( ) ( )

pregnant

193

I amt or b the followim Definitely Yes Min Is Definitely
Yes lo

12. I wonder if the baby can

hear me inside (.) ( ) ( ) ( ) ( )
13. I have decided on a name

for a baby bOY ( ) ( ) ( ) ( ) ( )
14. I wonder if the baby ( ) ( ) ( ) ( ) ( )

thinks and feels inside

of me

15. I eat meat and vegetables
to be sure my baby gets a ( ) ( ) ( ) ( ) ( )
good diet

16. It seems my baby kicks
and moves to tell me it’s

eating tine ( ) ( ) ( ) ( ) ( )
17. I poke the baby to get

him/her to poke back ( ) ( ) ( ) ( ) ( )
18. I can hardly wait to hold

the baby ( ) ( ) ( ) ( ) ( )
19. I try to picture what the

baby will look like ( ) ( ) ( ) ( ) ( )

20. I stroke my tummy to
quiet the baby when there
is too much kicking ( ) ( ) ( ) ( ) ( )

21. I can tell that the baby
ha! hiccougha ( ) ( ) ( ) ( ) ( )

22. I give up doing certain
things because I want to

help my baby ( ) ( ) ( ) ( ) ( )

23. I grasp my baby’s foot
through my tummy to move ( ) ( ) ( ) ( ) ( )
it around

 

This completes the questionnaire for this visit. I
will plan to meet with you again when you are further
along in your pregnancy. That meeting will take about
45 minutes and we will schedule it for just before or
just after your prenatal checkup.

 

 

 

194

Data Set #3 Code #

 

Try to tell me about the thoughts and feelings that you
are having about your baby at this time.

 

l thilt or b the felleuim Definitely Yes uncertain Io Definitely
I. Is

1. I talk to my unborn baby ( ) ( ) ( ) ( ) ( )
2. I feel all the trouble of
being' pregnant is worth ( ) ( ) ( ) ( ) ( )
t

3. I enjoy watching my tummy
jiggle as the baby kicks ( ) ( ) ( ) ( ) ( )

inside
4. I picture myself feeding

the baby ( ) ( ) ( ) ( ) ( )
5. I’m really looking

forward to seeing what ( ) ( ) ( ) ( ) ( )

the baby looks like

6. I wonder if the baby
feels cramped in there ( ) ( ) ( ) ( ) ( )

7. I refer to my baby by a
nickname ( ) ( ) ( ) ( ) ( )

8. I imagine myself taking
care of the baby ( ) ( ) ( ) ( ) ( )

9. I can almost guess what
my baby's personality
will be from he way s/he ( ) ( ) ( ) ( ) ( )
moves around

10. I have decided on a name
for a baby girl ( ) ( ) ( ) ( ) ( )

11. I do things to try to
stay healthy that I would
not do if I were not ( ) ( ) ( ) ( ) ( )
pregnant

195

1 thick er & the fellewim Definitely Yes “certain Io Definitely
Y. lo

12. I wonder if the baby can

hear me inside ( ) ( ) ( ) ( ) ( )
13. I have decided on a name

for a baby boy ( ) ( ) ( ) ( ) ( )
14. I wonder if the baby ( ) ( ) ( ) ( ) ( )

thinks and feels inside

of me

15. I eat meat and vegetables
to be sure my baby gets a ( ) ( ) ( ) ( ) ( )
good diet

16. It seems my baby kicks.
and moves to tell me it's

eating time ( ) ( ) ( ) ( ) ( )
17. I poke the baby to get

him/her to poke back ( ) ( ) ( ) ( ) ( )
18. I can hardly wait to hold

the baby ( ) ( ) ( ) ( ) ( )
19. I try to picture what the

baby will look like ( ) ( ) ( ) ( ) ( )

20; I stroke my tummy to
quiet the baby when there
is too much kicking ( ) ( ) ( ) ( ) ( )

21. I can tell that the baby
has hiccoughs ( ) ( ) ( ) ( ) ( )

22. I give up doing certain
things because I want to

help my baby . ( ) ( ) ( ) ( ) ( )

23. I grasp my baby's foot
through my tummy to move ( ) ( ) ( ) ( ) ( )
it around

196

 

 

How often do you daydream about, or imagine yourself to
be in the following situations? In order to tell us
how often you think about these situations, just place
a mark on the appropriate line under either "Never",
"Hardly Ever", "Sometimes", or "Often".

 

 

9.

10.

11.

12.

13.

14.

IuU' Infly than.» one:
ear

Winning a lot of money ( ) ( ) ( ) ( )
Being a rock star ( ) ( ) ( ) ( )
Being a movie or t.v. ( ) ( ) ( ) ( )
star
Winning an important game ( ) ( ) ( ) ( )
for your team - ‘
Being popular with ( ) ( ) ( ) ( )
friends
Being admired for the way ( ) ( ) ( ) ( )
you look .~
Being a good athlete ( ) ( ) ( ) ( )
Being admired because of ( ) ( ) ( ) ( )
the way you dress -
Being an important leader ( ) ( ) ( ) ( )
Performing in front of ( ) ( ) ( )' ( )
your school in a play
Being admired because of ( ) ( ) ( ) ( )
how smart you are
Having a papular ( ) ( ) ( ) ( )
boyfriend or girlfriend
or husband
Performing in front of - ( ) ( ) ( ) ( )
your school in a band
Rescuing a friend in ( ) ( ) ( ) ‘( )

danger

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

197

Saving someone’s life
Standing up to a bully

Winning an important
award

Showing others that you
are strong

Imagining how others
would feel if you were
gone

Showing others that you
are kind and friendly

Having a lot of friends

Getting your feeling hurt
in public

Waking people sorry for
hurting you

Getting back at an enemy

Developing a friendship
with someone who doesn't
like you

Imagining how others
would feel if you lost
your mother or father

Imagining how others
would feel if you were in
the hospital

Giving an important
speech

Being rejected by a
boyfriend or girlfriend

Being admired because you
are funny

Indy
an:

MMn

31.

32.

33.

34.

35.

36.

37.

38.

198

Being admired because of
the car you have or want
to have

Being admired because of
your records or stereo
system

Imagining what others are
thinking about the way
you look

Asking a popular boy for
a date

What it's like to be
married (or single)

Making a good impression
on your teachers

Imagining what everyone
will think if you become
famous .

Other people seem to
enjoy it when I am the
center of attention

”may
Eur

(

)

( )

“Mm

( )

199

 

In this section we would like to know how healthy you
have been over the last six weeks. Please put a
checkmark in front of the number which describes your
usual practice on a typical day.

 

 

 

1. Over the last six weeks I have slept so well that I
feel rested in the morning

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

AAAAA
vvvvv

2. Over the last six weeks I have been able to rest for
short periods during the day

1. never

2. rarely

3. occasionally

3. almost every day
5. every day

AAAAA
vvvvv

3. Over the last six weeks I have gotten exercise such as,
taking walks, swimming, bicycling, dancing, and aerobics

1. never

2. rarely

3. occasionally

4. almost every day
5. every day -

AAAAA
vvvvv

4. Over the last six weeks a typical daily diet consists of
at least 4 servings of milk and cheese, 4 servings of breads
and cereals, 4 servings of fruits and vegetables, and 2
servings of meats

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

“AAA“
vvvvv

5. Over the

1.
2.
3.
4.
5.

AAAAA
UVVVU

6. Over the

1.
2.
3.
4.
5.

vvvvv

7. Over the

200
last six weeks I have smoked cigarettes

never
rarely
occasionally
almost every day
every day

last six weeks I have drunk alcoholic beverages

never
rarely
occasionally
almost every day
every day

last six weeks I have taken non-prescription

medicines such as aspirin, tylenol, antacids, and cold

medicines

1.
2.
3.
4.
5.

“AAA“
vvvvv

8. Over the

1.
2.
3.
4.
5.

“AAA“
vvvvv

never
rarely
occasionally
almost every day
every day

last six weeks I have taken street drugs

never
rarely
occasionally
almost every day
every day

201

 

 

People believe different things about themselves. I
would like you to answer the questions below and rate
them according to how you feel about each of the
questions.

 

 

Statement Strongly Kind of Don't really Kind of Strongly
disagree disagree agree or disagree agree agree

1. I believe I can do ( ) ( ) ( ) ( ) ( )
anything I set my mind
to.

2. Nothing seems to really ( ) ( ) ( ) ( ) ( )
bother me.

3. No one has the same ( ) ( ) ( ) ( ) ( )
thoughts and feelings
that I have.

4. I think that I am more ( ) ( ) ( ) ( ) ( )
persuasive than my
friends.

5. I believe that no one ( ) ( ) ( ) ( ) ( )
can stop me if I really
want to do something.

6. I'm somehow different ( ) ( ) ( ) ( ) ( )
from everyone else.

7. It often seems like ( ) ( ) ( ) ( ) ( )
everything I do turns
out great.

8. I don't think anything ( ) ( ) ( ) ( ) ( )
will stand in the way
of my goals.

9. I'm the only one that ( ) ( ) ( ) ( ) ( )
can understand me.

10. I believe that other ( ) ( ) ( ) ( ) ( )
people control my life.

11. I don’t believe in ( ) ( ) ( ) ( ) ( )

taking chances.

Statement

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

I believe that I am
unique.

I think I can be
anything I want to be.

I'm a fragile person.

I think that deep down
everybody is the same.

I believe that
everything I do is
important.

I believe in knowing

how something will turn

out before I try it.

I’m just like everyone
else.

I think I'm a powerful
person.

I believe in taking
risks.

Everybody goes through
the same things that I
am going through.

I think that I am
better than my friends
are at just about
anything.

I tend to doubt myself
a lot.

It's hard for me to
tell if I am different
from my friends.

I often feel that I an
insignificant and that
I don't really matter.

Other people don’t
influence me.

202

Strongly Kind of

Don't really Kind of Strongly

disagree disagree agree or disagree agree agree

( )

( )

(

)

(

)

( )

203

Statenent Strongly Kind of Don't really Kind of Strongly
disagree disagree agree or disagree agree agree
27. There isn’t anything ( ) ( ) ( ) ( ) ( )

special about me.

28. I often think that ( ) ( ) ( ) ( ) ( )
people don't listen to
what I have to say.

29. There are times when I ( ) ( ) ( ) ( ) ( )
think that I am
indestructible.

30. I honestly think I can ( ) ( ) ( ) ( ) ( )
do things that no one
else can.

31. I can get away with ( ) ( ) ( ) ( ) ( )
things that other
people can't.

32. Everyone knows that I ( ) ( ) ( ) ( ) ( )
am a leader.

33. Nobody will ever really ( ) ( ) ( ) ( ) ( )
know what I am like.

34. No one sees the world ( ) ( ) ( ) ( ) ( )
the way that I do.

35. It is impossible for ( ) ( ) ( ) ( ) ( )
people to hurt my
feelings.

36. People always do what I ( ) ( ) ( ) ( ) ( )

tell them to do.

37. People usually wait to ( ) ( ) ( ) ( ) ( )
hear my opinion before
making a decision.

38. I usually let my ( ) ( ) ( ) ( ) ( )
friends decide what we
are going to do.

39. My feelings are easily ( ) ( ) ( ) ( ) ( )
hurt.
40. Special problems, like ( ) ( ) ( ) ( ) ( )

using drugs could never
happen to me.

204

Statement Strongly Kind of Don't really Kind of Strongly
disagree disagree agree or disagree agree agree

41. I enjoy taking risks. ( ) ( ) ( ) ( ) ( )

42. It is easy for me to ( ) ( ) ( ) ( ) ( )

take risks because I
never get hurt.

43. I don’t take chances ( ) ( ) ( ) ( ) ( )
because I usually get
in trouble.

44. I am always in control. ( ) ( ) ( ) ( ) ( )

45. I am not afraid to do ( ) ( ) ( ) ( ) ( )
dangerous things.

46. Sometimes I think that ( ) ( ) ( ) ( ) ( )

no one really
understands me.

.. .. 5‘“?

f‘f‘fi-fi".

205

“...-0. Buzz!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Data Set # 4 Code #

 

 

Try to tell me about the thoughts and feelings that you
are having about your baby at this time.

 

 

 

I thick or ch the follow". Definitely Yee min Io Definitely
V. I0

1. Italktomyunbornbaby () () () () ()
2. I feel all the trouble of
tieing pregnant is worth ( ) ( ) ( ) ( ) ( )
t

3. I enjoy watching my tummy
jiggle as the baby kicks ( ) ( ) ( ) ( ) ( )

inside
4. I picture myself feeding

thebaby () () () () ()
5. I'm really looking

forward to seeing what ( ) ( ) ( ) ( ) ( )

the baby looks like

6. I wonder if the baby
feels cramped in there ( ) ( ) ( ) ( ) ( )

7. I refer to my baby by a
nickname () () () () ()

8. I imagine myself taking
care of the baby ( ) ( ) ( ) ( ) ( )

9. I can almost guess what
my baby’s personality .
will be from the way ( ) ( ) ( ) ( ) ( )
s/he moves around

10. I have decided on a name
for! baby girl () () () () ()

11. I do things to try to
stay healthy that I would
not do if I were not

Pregnant ( ) ( ) ( ) ( ) ( )

210

I flint or b the follouim Definitely fee uncertain Io Definitely
V. I0

12. I wonder if the baby can
hear me inside

( ) ( ) ( ) ( ) ( )

13. I have decided on a name

for a baby bOY ( ) ( ) ( ) ( ) ( )
14. I wonder if the baby ( ) ( ) ( ) ( ) ( )

thinks and feels inside

of me

15. I eat meat and vegetables
to be sure my baby gets a ( ) ( ) ( ) ( ) ( )
good diet

16. It seems my baby kicks
and moves to tell me it's

eating time ( ) ( ) ( ) ( ) ( )
17. I poke the baby to get

him/her to poke back ( ) ( ) ( ) ( ) ( )
18. I can hardly wait to hold

the baby ( ) ( ) ( ) ( ) ( )
19. I try to picture what the

baby will look like ( ) ( ) ( ) ( ) ( )

20. I stroke my tummy to
quiet the baby when there ‘
is too much kicking ( ) ( ) ( ) ( ) ( )

21. I can tell that the baby
has hiccoughs ( ) ( ) ( ) ( ) ( )

22. I give up doing certain
things because I want to

help my baby ( ) ( ) ( ) ( ) ( )

23. I grasp my baby's foot
through my tummy to move ( ) ( ) ( ) ( ) ( )
it around

211

 

 

In this section we would like to know how healthy you
have been over the last six weeks. Please put a
checkmark in front of the number which describes your
usual practice on a typical day.

 

Over the last six weeks I have slept so well that I
feel rested in the morning

) 1. never

) 2. rarely

) 3. occasionally

) 4. almost every day
) 5. every day

or the last six weeks I have been able to rest for
short periods during the day

) 1. never

) 2. rarely

) 3. occasionally

) 3. almost every day
) 5. every day

Over the last six weeks I have gotten exercise such
as, taking walks, swimming, bicycling, dancing, and
aerobics

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

“AAA“
vvvvv

Over the last six weeks a typical daily diet consists
of at least 4 servings of milk and cheese, 4 servings
of breads and cereals, 4 servings of fruits and
vegetables, and 2 servings of meats

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

AAAAA
vvvvv

 

212
Over the last six weeks I have smoked cigarettes

) 1. never

) 2. rarely

) 3. occasionally

) 4. almost every day
) 5. every day

er the last'six weeks I have drunk alcoholic
beverages

1. never

2. rarely

3. occasionally

4. almost every day g
5. every day 2

vvvvv

Over the last six weeks I have taken non-prescription ;
medicines such as aspirin, tylenol, antacids, and cold
medicines

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

AAAAA
vvvvv

Over the last six weeks I have taken street drugs

1. never

2. rarely

3. occasionally

4. almost every day
5. every day

“AAA“
VVVVV

213

 

The following group of questions asks you to provide
some general background information about yourself.

 

1. What is your birthdate?

 

Religious beliefs play an important role in the lives of
many people. The following two questions ask you to provide
this information.

2. What is your religious preference?

( ) 1. Catholic

( ) 2. Protestant

( ) 3. Jewish

( ) 4. Other: Please Specify
( ) 5. None -

3. What is the extent of your participation in religious
activities?

( ) 1. Inactive

( ) 2. Infrequent participation (1-2 times a year)
( ) 3. Occasional participation (about monthly)

( ) 4. Regular participation (weekly)

( ) 5. Daily

4. What is your marital status?

1. Harried

2. Separated

3. Never married
4. Widowed

5. Divorced

6. Remarried

u z AAAAAA

5. i h whom are you currently living? (Check all that
P 1Y)
1. Mother
2. Father

3. Stepmother

4. Stepfather

5. Boyfriend

6. Husband

7. Friend

8. Guardian

9. Other: Please specify the
relationship

No one. I live alone

A AAAAAAAAA

' H
o
O

6. What is

214

your highest level of education? (Check all

that apply)

( ) 1. Have not graduated from high school

( ) 2. Obtained G.E.D.

( ) 3. Graduated from high school

( ) 4. Completed 1-2 years of technical education
. beyond high school

( ) 5. Completed 1-2 years of college

( ) 6. Completed 4 years of college

( ) 7. Graduate work

( ) 8. Obtained masters degree or higher

7. Are you
( ) 1.

( ) 2.

presently in school?

 

Yes \

' 7a. If yes, in what
grade or year are
you?

 

 

NO

\/

7b. If no, what was
the highest grade
completed?

 

 

 

8. What was your mother's highest level of education?
(Check all that apply)

1.
2.
3.
4.

5.
6.
7.
8.

vvvv vvvv

§ AAAA AAAA

9.

1.
2.
3.
4.

5.
6.
7.
8.

AAAA AAAA A
vvvv VVVV

Did not graduate from high school

Obtained a G.E.D.

Graduated from high school

Completed 1-2 years of technical education
beyond high school

Completed 1r2 years of college

Completed 4 years of college

Graduate work

Obtained masters degree or higher

at was your father's highest level of education?
Check all that apply)

Did not graduate from high school

Obtained a G.E.D.

Graduated from high school

Completed 1-2 years of technical education
beyond high school

Completed 1-2 years of college

Completed 4 years of college

Graduate work

Obtained masters degree or higher

215

 

The following questions ask for information about your
type of employment and yearly income.

 

10. What is

1.
2.

( )
( )
( ) 3.
( ) 4-
( ) 5-

10a. What is

your employment status?

Employed full time (35+ hours per week)
Employed part time (less than 35 hours per
week) .

Unemployed, looking for work
Unemployed, not looking for work
Housewife full time

 

 

N

[Please go on to question number 11

 

your main occupation?

 

10b. What are your main responsibilities?

 

10c. What type of product or service does your company

provide?

 

11. What was the range of your personal income in 1988
before taxes?

1.
2.
3.
4.

g AAAA
vvvv

12.

1.
2.
3.
4.

AAAA U‘
vvvv

Less than $5,000 ( ) 5. $25,000 - $34,999
$5,000 - $9,999 ( ) 6. $35,000 - $44,999
$10,000 -$14,999 ( ) 7. $45,000 - $59,000
$15,000 - $24,999 ( ) 8. more than $60,000

at was the range of total household income in 1988
efore taxes?

Less than $10,000
$10,000 - $14,999
$15,000 - $24,999
$25,000 - $34,999

5. $35,000 - $44,999
6. $45,000 - $59,999
7. $60,000 - $74,999
8. more than $75,000

AAA“
vvvv

216

 

The following two questions will ask you for some
information about this pregnancy.

 

13. Was this a planned pregnancy?

()1. Yes
()2. No

14. What are your plans for this baby?

( ) 1. Keep the baby
( ) 2. Place the baby for adoption
( ) 3. Give to friend/relative to raise

15. Would you like a summary of the results of this
research project when it is completed?

()1. Yes
()2. No

 

Now I will read a list of events which you may have
experienced over the last year. Those events which
have happened to you will be rated as good or bad and
the effect of those events will be rated as having no
effect, some effect, moderate effect, or great effect.

 

 

 

217

LIFE EVENTS QUESTIONNAIRE

111221191221

Number

 

Date

 

.Listed below are a number of events which may bring about changes in the lives of those
who experience them.

Circle the events that have occurred in your life during thegpast year and circle whether
these were Good or 219-

Show how much the event affected your life by circling the appropriate number which

corresponds with the statement (0 - no effect. 1 - some effect. 2 -

3 - great effect).

moderate effect.

If you have not experienced a particular event in the pastgygar, leave it blank.

Please go through the entire list before you begin to get an idea of the type of event
you will be asked to rate.

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
° effect effect effect effect
A. HEALTH
1. major personal illness or injury Good Bad 0 l 2 3
"' 2. major change in eating habits Good Bad 0 l 2 3
3. major change in sleeping habits Good Bad 0 l 2 3
4. major change in usual type and/or Good Bad 0 l 2 3
amount of recreation
5. major dental work Good Bad 0 1 2 3
6. (female): pregnancy Good Bad 0 l 2 3
7. (female): miscarriage or abortion Good Bad 0 l 2 3
8. (female): started menopause Good Bad 0 l 2 3
9. major difficulties with birth Good Bad 0 l 2 3
control pills or devices
3. WORK
[0. difficulty finding a job Good Bad 0 L 2 3
ll. beginning work outside the home Good Bad 0 l 2 3

 

 

stir

-‘ “I'M

‘

218

Page 2

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
effect effect effect effect
12. changing to a new type of work Good Bad 0 l 2 3
13. changing your work hours or Good Bad 0 l 2 3
conditions
14. change in your responsibilities Good Bad 0 l 2 3
at work ‘
l5. troubles at work with your Good Bad 0 l , 2 3
employer or co-workers
16. major business readjustment Good Bad 0 l 2 3
17. being fired or laid off from work Good Bad 0 l 2 3
18. retirement from work Good Bad 0 l 2 3
19. taking courses by mail or studying Good Bad 0 l 2 3
at home to help you in your work
C . SCHOOL .
20. beginning or ceasing school. Good Bad 0 l 2 3
college. or training program ‘
21. change of school. college. or Good Bad 0 l 2 3
- training program
22. change in career goal or academic Good Bad 0 l 2 3
major
23. problems in school. college. or Good Bad 0 l 2 3
training program
0. RESIDENCE
26. difficulty finding housing Good Bad 0 l 2 3
25. changing residence within the Good Bad 0 l 2 3
same town or city
26. moving to a different town. city. Good Bad 0 l 2 3
state. or country
27. major change in your living Good Bad 0 1 2 3

conditions (home improvements or
a decline in your home or
neighborhood)

 

 

219

Page 3

 

 

partner's work outside the home
(beginning work. ceasing work.
changing jobs. retirement. etc.)

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
effect effect effect effect
E. LOVE AND MARRIAGE

28. began a new. close. personal Good Bad 0 l 2 3
relationship

29. became engaged Good Bad 0 l 2 3

30. girlfriend or boyfriend problems Good Bad 0 l 2 3

31. breaking up with a girlfriend or Good Bad 0 l 2 3
boyfriend or breaking an
engagement

32. (male): wife or girlfriend's Good Bad 0 l 2 3
pregnancy

33. (male): wife or girlfriend Good bad 0 l 2 3
having a miscarriage or abortion .‘

3‘. getting married (or beginning to Good Bad 0 l 2 3
live with someone) .

33. a change in closeness with your Good Bad 0 l 2 3
partner

‘_; 36. infidelity Good Bad 0 l 2 3

37. trouble with in-laws Good Bad 0 l 2 3

38. separation from spouse or Good Bad 0 l 2 3
partner due to conflict

39. separation from spouse or Good Bad 0 l 2 3
partner due to work. travel. etc.

60. reconciliation with spouse or Good Bad 0 l 2 3
partner

5i. divorce Good Bad 0 l 2 3

52. change in your spouse or Good Bad 0 l 2 3

2130

Page 6

 

 

SPOUSC Ol‘ partner

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
effect effect effect effect
P. FAMILY AND CLOSE FRIENDS
‘3. gain of a new family member Good Bad 0 l 2 3
(through birth. adoption.
relative moving in. etc.)
is. child or family member leaving Good Bad 0 l 2 3
home (due to marriage. to attend
college. or for some other reason) ,
‘5. major change in the health or Good Bad 0 l 2 3
behavior of a family member or
close friend (illness. accidents.
drug or disciplinary problems.
etc.)
‘6. death of spouse or partner Good Bad 0 l 2 3
‘7. death of a child Good lad 0 l 2 3
‘8. death of family member or close Good Dad 0 l 2 3
friend '
£9. birth of a grandchild Good Bad 0 l 2 3
50. change in marital status of Good Bad 0 l 2 3
“' your parents
c. PARENTING
51. change in child care arrangements Good Bad 0 l 2 3
52. conflicts with spouse or partner Good Bad 0 l 2 3
about parenting
33. conflicts with child's grand- Good Bad 0 l 2 3
parents (or other important
person) about parenting
56. taking on full responsibility for Good Bad 0 l 2 3
parenting as a single parent
SS. custody battles with former Good Bad 0 l 2 3

221

Page 5

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
effect effect effect effect
R. PERSONAL 0R SOCIAL
36. major personal achievement Good Bad 0 l 2 3
57. major decision regarding your Good Bad 0 l 2 3
immediate future
58. change in your personal habits Good Bad 0 l 2 3
(your dress. life-style. hobbies.
etc.
59. change in your religious b.11.t. Good Bad 0 1 2 3
60. change in your political beliefs Good Bad 0 l 2 3
61. loss or damage of personal Good Bad 0 l 2 3
property
62. took a vacation Good Bad 0 I‘ l 2 3 '
63. took a trip other than a vacation Good Bad 0 l 2 3
66. change in family get-togethers Good Bad 0 l 2 3
65. change in your social activities Good Bad 0 l 2 3
‘_‘ (clubs. movies. visiting)
66. made new friends Good Bad 0 l 2 3
67. broke up with a friend Good Bad 0 l 2 3
68. acquired or lost a pet Good Bad 0 l 2 3
I. FINANCIAL
69. major change in finances Good Bad 0 l 2 3
(increased or decreased income)
70. took on a moderate purchase. such Good Bad 0 l 2 3
a T.V.. care. freezer. etc.
71. took on a major purchase or a Good Bad 0 l 2 3
mortgage loan. such as a home.
business. property, etc.
72. experienced a foreclosure on a Good Bad 0 l 2 3

mortgage or loan

 

 

._ a '.U

run-

222

Page 6

 

 

Type of
Event Effect Effect of Event on Your Life
no some moderate great
effect effect effect effect
73. credit rating difficulties Good Bad 0 l 2 3
J. CRIME AND LEGAL HATTERS
76. being robbed Good Bad 0 l 2 3
73. being a victim of a violent act Good Bad 0 l 2 3
(rape. assault. etc.)
76. involved in an accident Good Bad 0 l ' 2 3
77. involved in a law suit Good Dad 0 l 2 3
78. involved in a minor violation Good Bad 0 l 2 3
of the law (traffic tickets.
disturbing the peace. etc.)
79. legal troubles resulting in your Good Bad 0 l 2 3

being arrested or held in jail
OTHER

 

 

Other recent experiences which have had an impact on your life._LLdstqand.§ate..

80.

 

Bl.

 

82.

 

 

Good Dad
Good Bad
Good Bad

 

o ..'1‘.’...:z-'3‘.z 3
f ' '1 ”1’. * '
. ' 1f: ” ‘ ' I
o 1 11...,2 . 3

APPENDIX E

Comparison of Maternal Fetal Attachment Scale for Two
Studies

 

APPENDIX E

Comparison of Maternal Fetal Attachment Scale
for Two Studies

Table E1

Comparison of Maternal Fetal Attachment Scale
and Subscales for Two Studies (%)

 

 

 

 

 

 

 

 

 

Armantrout Study' Present Study (T4)
N = 35 N = 40
MFAS 74 77 I
ROLETAK 94 96
DIFFSELF 91 91 I
INTERACT 17 54 I
ATTRIB 4O 65
GIVING 83 91 I

 

223

224
Table 22

Comparison of Maternal Fetal Attachment Scale
Individual Items for Two Studies (%)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amtrout Present Study
I m 35 . I 60
1. ...talk tomyu'born baby. 69 73
2. ...trolble of being pregnant was worth it. 63 78
3. ...watchiWe... 85 100
6. ...picturing myself feedig the baby. 89 85
5. ...forward to seeing that baby looked like. 91 100
6. ...baby felt erupted in there. 60 73
7. ...called baby by nickname. 29 33
8. ...takino care of the baby. 96 100
9. ...personality would be like... 20 60
10. ...picked out girl's name... 80 80
11. ...do things to stay healthy... 73 95
12. ...could hear... 63 88
13. ...picked out a boy's name... 86 85
16. ...think and feel inside me. 69 85
15. diet. 91 93
16. ...kicks and moves... 62 70
17. ...poke the baby... 69 83
18. ...hold the baby. 96 100
19. ...picture that the baby would look like. 96 98
20. ...qaiet the baby. 69 58
21. ...baby has hiccoups... 17 38
22. v q) doimcertain things... 83 100
23. move the baby's foot... 9 25

 

 

APPENDIX F

Correlational Matrices of Variables and Ethnicity

APPENDIX F

Correlational Matrices of Variables and Ethnicity

Table F1

Correlational Matrix of Dependent Variables and Ethnicity

 

 

 

 

 

 

 

 

 

 

 

 

Black Caucasian Hispanic
MFAS .12 .06 -.24
ROLETAK .17 .00 -.22
DIFFSELF .15 -.12 -.O4
INTERACT .12 .18 -.37*
ATTRIB .13 .04 -.22
l GIVING -.12 .05 .10

 

* p < .05

n.b. Dummy coding was used to separate the ethnic groups from
one another. A negative correlation indicates that the group
demonstrated a lesser degree of prenatal fetal attachment than
the remaining sample.

225

226

Table F2

Correlational Matrix of Independent Variables and Ethnicity

Caucasian

Hispanic

 

-.20

-.17

 

-.08

-.45**

 

-.O9

 

-001

 

-.O7

 

-.15

 

.11

 

.48***

 

-.38**

 

-.11

 

 

 

Spearman Rho

p < .001

 

-021

 

227

Table F3

Correlational Matrix of Social Support Variables and
Ethnicity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Caucasian Hispanic

TOT FUNCT . 1O - . 20

TOT NET . O7 - . 26*

AFFECT .13 .09 -.27*
I AFFIRM . O7 . 08 - . 19

AID -. 01 . 12 - . 12 %
[AFFECTMOM .36* -.04 -.44**
|:FFIRMMOM . 00 - . 04 . 05 l

AIDMOM . 17 - . 29 . 14
IAFFECTFOB . 11 - . 18 . 08 l

AFFIRMFOB -.3O . 15 .22

AIDFOB -.O9 -.16 .32 J
One-Tailed p < .05 ** p < .01

 

 

 

 

BIBLIOGRAPHY

BIBLIOGRAPHY

(1981). Q: Where does less money spent mean more

money Spent? W. 12(2). 21-22-

 

Adler, N. (1981). Sex roles and unwanted pregnancy in
adolescent and adult women. MW,
12(1), 56- 66.

Amato, P. R., 8 Ochiltree. G. (February. 1986). Family
resources and the development of child competence.

WM 5.8. 47- -56-

Areskog, 8., Uddenberg, N., 8 Kjessler, B. (1981). Fear of
childbirth in late pregnancy- W. 1.2..
262-266.

Armantrout. 8- C- (1983). Win

e -e!. .ee ;:. ‘1 .i ee1 :e :_eee

‘_ f! ‘ '
assessment—tests. Unpublished master's thesis,
University of Wisconsin-Madison.

Avant, K. C. ( November/December, 1981) . Anxiety as a
potential factor affecting maternal attachment“ Qggrngl
MW. 416-419-

Barret, R. L., 8 Robinson, B. E. (November, 1982). Teenage
fathers: Neglected too long. Sggigl_flgrx, 484-488.

Belle, D. (1982). Social ties and social support. In D.
Belle (Ed)- Winn.
Beverly Hills, California: Sage Publications.

Belsky, J. (1984). The determinants of parenting: A process
model. Women. 5.5. 83-96-

228

229

Bobak, I. M., Jensen, M. D., & Zalar, M. K. (1989). W
1uuL_9xnes9l9sis_JauaL_the_lnuaua_and_13ua_£amilx- St.
Louis, Missouri: C. V. Mosby Co.

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