Love or protection? Defining and measuring maternal-fetal attachment from the woman’s perspective

Abstract

Existing commonly used maternal-fetal attachment instruments have not been thoroughly tested for reliability and validity; criticism can be levelled for a variety of problems ranging from lack of reliability due to an inadequate underpinning framework to facilitate objective interpretation to limited generalizability due to the sample. The aim of this study is to acknowledge the centrality of the mother, to use the experiences of pregnant women to generate a definition of maternalfetal attachment and ultimately create a tool that will act as a reliable, valid and simple measurement. A mixed method framework utilising a sequential exploratory strategy has allowed qualitative exploration of the phenomenon under investigation followed by quantitative testing of the emerging theory on a much larger and different sample. Phase 1 involved face to face open structured interviews on an opportunity sample of 10 (5 primigravid; 5 multiparous) women in the final trimester of pregnancy followed by 3 focus groups targeting specific groups – primigravid women (6 participants); multiparous women (7 participants) and teenagers (4 participants). Data analysis was through constant comparative methodology. A multidimensional, psycho-biological definition of attachment was generated from the women’s own perception of their attachment to their fetus. This was used as a framework to design a questionnaire for the measurement of maternal-fetal attachment. Phase 2 involved the validation of the questionnaire and further testing of the definition. Cohort 1 tested for reliability with 200 participants within their second or third trimester of pregnancy. Following modification of the questionnaire, Cohort 2 a sample of 150 women within the final trimester of pregnancy tested the tool for internal reliability and validity. The generated Maternal-Fetal Attachment Tool (MFAT) following rigorous testing proved both reliable and valid. Maternal fetal attachment is founded in psycho-biological theory and is a complex multi-dimensional construct. Central to the definition is the woman’s need to protect her fetus, attachment develops as the fetus becomes more tangible, it is facilitated through the woman’s intergenerational experience of attachment and through appropriate social support. Maternal-fetal attachment facilitates behavioural change to ensure a favourable intra-uterine environment.