Elsevier

Midwifery

Volume 26, Issue 3, June 2010, Pages 357-366
Midwifery

Psychological factors that impact on women's experiences of first-time motherhood: a qualitative study of the transition

https://doi.org/10.1016/j.midw.2008.07.006Get rights and content

Abstract

Objective

childbearing is a significant transition, especially for first-time mothers. The objectives of this study were to explore the maternal transition from womens’ perspectives and to identify any unmet needs for support.

Design

grounded theory was chosen as the most appropriate method of analysis due to its ability to identify social processes in an inductive way. Semi-structured interviews were used to collect data from the participants, and the interview transcripts were analysed using the constant comparative method.

Setting

communities within one region of the UK.

Participants

13 women (aged ⩾16 years) who had delivered their first child six to 15 weeks prior to the interview were recruited to the study.

Findings

three main themes (control, support and forming a family) all contributed to the core category: ‘changes in the woman's self-concept’. Women felt that they had lost some control over their lives in the early stages of pregnancy and after the birth. The early changes in their self-image and the shift in focus from themselves to the needs of the fetus indicate that the transition may begin at a very early stage in the first trimester. The unfamiliar territory of pregnancy and early motherhood created a need for a mentor or mentors to help guide them through the transition, and to ‘normalise’ their feelings and experiences. Finally, the women recognised that the act of childbearing fundamentally transformed them and their partners from individuals or a couple into founding members of a new family.

Key conclusions

first-time mothers start to undergo a transition at an early stage in their pregnancy. They face difficult periods both early in the pregnancy and after the birth, and have unmet needs for support in those periods, particularly the support of other new mothers.

Implications for practice

providing more information about early pregnancy before conception may enable women to form more accurate expectations of this period. Facilitating contact between pregnant mothers would help them to establish a more appropriate support network prior to the birth.

Introduction

Childbearing, the period of time from conception until after the birth, of a woman's first child has been identified in the literature as a major life event that can bring about many challenges for the woman and her family (Barclay et al., 1997; Weaver and Usher, 1997; Nicolson, 1998; Nelson, 2003). Despite much research on specific aspects of childbearing (such as labour) and the maternal transition, the extent of the overall transition, in terms of temporality and the psychological impact on the mother, is still not clear.

As with other life events, childbearing is a period of psychological transition for the mother that must be viewed in a social context (Wrede et al., 2006). There have been many changes in women's social lives over the past 30 years, such as the age at which a woman has her first child and the number of mothers who work outside the home (Equal Opportunities Commission, 2006). The changing social context has implications for the way in which women view and negotiate the transition from a childless woman to a mother. This paper reports a study of the maternal transition from the perspective of first-time mothers in the current social environment.

Previous work on the maternal transition has included some work on the childbearing process as a whole. Rubin, 1961, Rubin, 1967, Rubin, 1984 saw attainment of an identity as a mother as part of the maturational process of developing a female identity. Building on Rubin's work, Mercer (1986) considered childbearing to be a major life transition and concluded that attainment of the motherhood role was, in fact, not complete for many months after the birth (Mercer, 2004). The transition to parenthood has been described in some psycho-analytical literature as a means of providing an opportunity for growth (Parens, 1975); indeed, Rogan et al. (1997) saw it as a developmental task. The findings of Pancer et al. (2000) suggested that an increase in complexity of thinking before and after birth indicated that parental transition was a time of maturational growth for both men and women.

In terms of this study of the maternal transition, it is important to consider the many inter-related psychological factors that might contribute to a successful transition. Belsky et al. (1985), for example, claimed that unmet expectations of the childbearing process may be associated with more difficult adaptation to parenthood. It has been shown that expectations have an influence on the perceived outcomes of the birth process (Green et al., 1998; Tulman and Fawcett, 2003), and while multiparous women are able to base expectations on their own past experiences (Green et al., 1998), primagravid women have to rely on other sources of information. In a large prospective study by Green et al. (1998), first-time mothers were generally less satisfied with outcomes and more negative about their infants than multiparous women. Hodnett (2002) found that women with expectations of having control over the childbirth experience did, broadly speaking, have these expectations met, whereas Harwood et al. (2007) found that mothers’ experiences were generally consistent with their expectations.

Although there is a large body of literature related to specific aspects of childbirth, such as labour and the birth itself, there is less work relating to the transition to motherhood from the woman's perspective (Barlow and Cairns, 1997), which is the focus of the current study. In 2003, Nelson carried out a synthesis of nine qualitative studies that were related to different aspects of the maternal transition (Nelson, 2003). Nelson suggested that the primary social process to emerge from the synthesis was ‘engagement’, which was described by one author as being actively involved and experiencing the presence of the infant (Noblit and Hare, 1988). A secondary process of ‘growth and transformation’ was also identified, connected with engagement with mothering and involving an expansion of the self. Another finding from this metasynthesis was that women were largely unprepared to deal with motherhood. The early postpartum months are described as physically and mentally exhausting; a time of uncertainty and emotional lability for the mother (Nelson, 2003). Another study that identified ‘unpreparedness’ as a theme was reported in a grounded theory study (Barclay et al., 1997). The core theme was ‘becoming a mother’, and the theme labelled ‘realising’ was related to the women's overwhelming feelings of awe over what was expected of them, both physically and emotionally, in the early weeks and months of motherhood. Another qualitative study (Sethi, 1995) suggested that the process of becoming a mother includes constant change and transformation. The authors’ analysis led to the formation of four major categories: giving of self, redefining of self, redefining relationships and redefining professional goals. Sethi (1995) found differences in the narrative of the first-time mothers and the multiparous women, and reported that most of the mothers in the study felt isolated and confined with their infants.

A further study considering aspects of childbearing focused on the postnatal period. Weaver and Usher (1997) used discourse analysis to identify changes brought to women's lives by the experience of motherhood. This study involved 13 women with one or more children between 16 months and three years of age. The women in this study found the reality of motherhood very different from their expectations. They were often overwhelmed by the drudgery of caring for infants, and felt that they had lost some of their identity. However, these women felt that the overwhelming love they felt for their children counterbalanced the negative elements of being a mother.

Many studies that have explored the maternal transition have focused on the birth and/or postnatal period, with little exploration of the prebirth period. However, the reasons for this focus on the postbirth period do not appear to be evidence based, and the parameters of the maternal transition are not clear. Due to gaps in our knowledge of the temporal and experiential aspects of the childbearing transition and the strategies used by modern women throughout the transition, the aim of this study was to explore the maternal transition from womens’ perspectives. A secondary aim was to enable any unmet needs for support, if they existed, to be identified.

Section snippets

Methods

Qualitative analysis is a way of developing rich explanation from an individual's reported experiences (Willig, 2001). Grounded theory was chosen as the most appropriate method due to its ability to identify social processes in an inductive way (Marcellus, 2005). Semi-structured interviews were used to collect data from the participants.

Demographic characteristics of the participants

Thirteen women, aged 17–39 years, were interviewed between February 2004 and July 2004. All the participants were of White European origin and lived in the south-west of England at the time of the interview. All but one of the participants was in a current relationship with the infant's father. Other general demographic details are provided in Table 1.

Main themes

The core category emerging from the analysis was called the ‘altering self-concept’. Within this category, there were several themes: control,

Discussion

The findings of this study suggest that the maternal transition begins at an early stage in pregnancy, and is not completed until after the mother feels she has regained some control over her internal and external environment, possibly some considerable time after the birth. The findings are consistent with Mercer's view (2004) that the transition may not be complete until many months after the birth, whereas ‘engagement’ with the fetus began very soon after confirmation of the pregnancy and

Conclusion

This study indicates that women start to undergo transition at an early stage of their pregnancy. As they may not have any contact with a midwife or doctor until late in the first trimester, it may be helpful to provide more information about early pregnancy preconceptually in order to enable women to form more accurate expectations of this period. Targeting provision of information relevant to the stage of pregnancy would also be helpful.

Additionally, contact with other pregnant women and new

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