Others have studied development of the capacity for mothering. Lederman (1984) studied the paradigm shift she claims a woman must make from her perception as woman without child to woman with child. Lederman's (Lederman, Lederman, Workk, and McCann, 1978) original study of women in labor prompted her to do further work on women's adaptation during pregnancy. Finding that there were women who demonstrated behavioral and physiological correlates of stress during labor that prolonged stage two of labor, Lederman was eager to study more fully what prenatal psychological factors predicted this difficulty of progressing in labor. She saw the woman as needing to make a paradigm shift from her former lifestyle and behaviors to attain this capacity to give to the child. Lederman proposed that the woman needs to be willing to give up her former self and learn to achieve satisfaction from giving in her relationship with the child.
If the woman has not resolved this paradigm shift during the pregnancy, as labor and delivery approach, she becomes more anxious. Lederman studied the relation between the outcome of labor and the pregnant woman's perceptions regarding this paradigm. The prenatal variables obtained through client interviews were acceptance of the pregnancy, identification of a motherhood role, relationship with own mother, and fears about pregnancy. The variables of acceptance of pregnancy and identification of the motherhood role had the most consistent correlations with progress during labor, including measures of uterine activity, plasma epinephrine, state anxiety, and duration of labor. These findings provide support for Rubin's (1967a, 1967b) assertion that acceptance of the pregnancy and child is an important maternal role attainment task.
Josten (1982) developed a method for prenatal assessment of mothering potential. The method involved review of individual women's prenatal clinic charts for the positive or negative evidence of the following aspects: (1) perception of the complexities of mothering, (2) attachment, (3) acceptance of child by significant others, (4) ensuring physical well-being, and (5) evidence of problem areas such as history of parenting difficulties, lack of knowledge about children, inadequate cognitive function, inadequate support, spousal abuse, mental illness, substance abuse, major stress, rejection of child, or inappropriate use of services.
Prenatal clinic charts were rated with the Parental Assessment Guide. A score of positive, negative, or neutral was assigned to each woman for each type of evidence defined. Josten (1982) studied 52 mothers, all part of a larger study at the University of Minnesota. In the larger study, the quality of care had been rated by independent observers. Excellent care was defined as meeting the physical and the psychological needs of the infant with sensitivity and cooperative handling by the mother, whereas inadequate care was defined as failure to take action to provide the basic physical or psychosocial care that, when absent, caused physical or psychological harm to the infant. Josten compared 27 mothers rated as providing excellent mothering with 25 mothers rated as providing inadequate care. From the prenatal chart reviews, the inadequate mothers had more negative scores on their perception of the complexities of the mothering role, acceptance of the child by significant others, and physical well-being during pregnancy. The majority of the inadequate mothers had therefore not prepared for pregnancy including dealing with the emotional tasks of pregnancy. It is apparent that high-risk women have little opportunity to do the psychological work to prepare for mothering.
In the late 1980s, through a research partnership with an Early Head Start program (Barnard, Spieker, and Huebner, 1996), we instituted a protocol, by utilizing the theories of Rubin and Mercer, to guide program mothers through their pregnancy. We found that the women were receptive to talking about their pregnancy and their role as mother (Solchany, Sligar, and Barnard, in press). It was the case that many mothers had not identified a maternal role model, rejecting their own mother as such a model. In fact, it was difficult for the home visitors who implemented the pregnancy protocol to help mothers find in their circle of friends a good maternal role model. In addition to difficulties and interference in taking on the maternal role, home visitors working with pregnant women were further challenged with issues such as maternal mental illness, difficulties or avoidance in making a connection with the unborn child, a lack of or a problematic social or familial network, and a lack of preparation for the baby. In reaction to these challenges, Solchany (2001) developed a book that addresses mental health theory, practice, and intervention during pregnancy, specifically as they pertain to maternal role attainment, mothering, and developing a healthy relationship with the child.
The capacity for forming relationships and confidence in visualizing self as mother are efficient predictors in anticipating parent-child and child outcomes (Heinicke, in Vol. 3 of this Handbook). A simple self-report measure of the transition to motherhood has been reported: Ruble et al. (1990) constructed a questionnaire and completed preliminary psychometric testing on the Childbearing Attitude Questionnaire. This scale contains 16 factors: maternal worries, maternal self-confidence, relationship with husband, relationship with mother, body image, identification with pregnancy, feelings about children, negative self-image, attitude toward breast-feeding, pain tolerance, interest in sex, denial, negative aspects of caregiving, feelings of dependency, social boredom, and information seeking. The questionnaire was given at three time points—prepregnancy, pregnancy, and postpartum—to 51 women. There was a consistency in perception of self and others across the time points, supporting the assumption that there is a lifelong developmental impact of one's self-confidence, social orientation, identification with motherhood, and attitude toward giving birth that remains stable during this transition.
There is no sure set of predictive variables; however, the strongest variables include a personal history of a poor childhood, history of psychopathology, current psychopathology, ambivalence about the pregnancy, lack of evidence of forming a positive relationship with the newborn, and lack of capacity for self-care (Gabinet, 1986). In one study of families of children with conduct disorders, mother's report of having been abused as a child and low family income were the most potent variables that differentiated abusive and nonabusive families (Webster-Stratton, 1985).
In our Early Head Start research we found that mothers with unresolved loss or trauma as identified from the baseline Adult Attachment Interview (Main and Goldwyn, 1994) were strongly associated with women who could not be emotionally available for their infants (Spieker, Solchany, McKenna, DeKlyen, and Barnard, 1999). A qualitative analysis of these most difficult mothers showed that they described having mothers present in their lives physically; however, these mothers were rarely emotionally or psychologically available to them. These women shared stories of their childhoods that were filled with incidents of rejection, abandonment, disregard for safety, inability to protect their child from sexually or physically abusive perpetrators, maternal mental illness and unpredictability, and an extreme lack of support for normal childhood experiences such as play and interaction with peers. These women not only experienced traumas such as abuse, they were further traumatized by unavailable mothers who showed little regard for them. Frequently, a case study integrates the circumstances better than the empirical evidence from groups or theories. The story of Amy, one of the traumatized mothers who was interviewed, is recounted to illustrate the obstacles and course of maternal role attainment:
Amy was a 21-year-old, unmarried woman pregnant with her third pregnancy. Amy first became pregnant at the age of 16 years. She was, at the time, living with her mother, who refused to let Amy live with her if she chose to have the baby. Amy decided to abort that pregnancy. Amy soon became pregnant again when she was 17. This time she chose to leave her mother's home. Amy had the child and ended up homeless. When that child was 3 months old, she decided to relinquish him for adoption. At 21 years of age, Amy was now pregnant again, living with the baby's father who also happened to be her exhusband's brother.
Amy had a long history of relationship trauma, as well as physical and sexual abuse. Sexual abuse began at the age of 4 years by her mother's drug dealers. By 5 years of age, she was removed from her mother's care and placed with her biological father, who began to molest her at the age of 6 years. She endured sexual as well as physical and emotional abuse for the following six years. Amy returned to her mother's care at the age of 14 years. By this time her mother had been diagnosed with bipolar disorder, was untreated, still abusing drugs, and prostituting.
Amy's past created many problems in her life. She experienced symptoms consistent with posttraumatic stress disorder, including vivid, violent nightmares, fear of others, paranoid thinking, isolation, fear of her own impulses (especially toward the baby), and a flat, unanimated affect. She had no support system and did not have the skills or the motivation to develop or even accept assistance in developing one.
Amy's past experiences created many obstacles for her in assuming the maternal role and in her ability to mother her child. She did not know what a mother should do; her mother models were inadequate or nonexistent. She was unable to discuss the changes in her body as her pregnancy progressed; these changes seemed to overwhelm her, and she responded to this by denying what was happening to her body. When the baby was born, she could not cuddle him or hold him close to her body. In fact, she could not hold her son when she fed him; instead she laid the baby in a babyseat and held the bottle to his mouth. Her inability to touch her baby seemed to come from her own discomfort with touch and intimate contact with her own body. These feelings generalized; she rarely touched the baby, she would not allow the baby to be completely naked during a bath, and she would stop others from touching and playing with her baby. Any intensity of emotion would be shut down; she did not have the capacity to tolerate extremes of emotion so she would shut them down. She did not play with her baby for she had never developed appropriate play skills herself as a child.
Her baby suffered from her stunted development and poor capacity to mother. He was essentially sensory deprived. He was not touched, he was not nurtured, he was not played with, he was not comforted, he was not cuddled, he was not held, and he was rarely talked to. At 14 months of age this baby did not speak, did not laugh, rarely smiled, had little range of affect, had a depressed response to pain, was clumsy, was disorganized in his interactions with his environment, had multiple environmentally induced developmental delays (fine motor, gross motor, speech, social ability), and had developed an insecure-avoidant attachment with his mother.
At the age of 19 months, this child was removed from his mother's care and placed with his father and his new wife. This woman assumed the mothering role for this child and nurtured and doted on him. Within a year of this placement, this child no longer qualified for disability services, was able to demonstrate a range of emotions, seemed happy, and played well by himself and with other children. His Baley Developmental score jumped 12 points in a 10-month period, and he demonstrated a newfound confidence in his interactions within his environment.
Amy seemed to have no ability to relate on an emotional level with this child. She was unable to become excited for or about him, and it was just as difficult for her to show frustration. Emotionally she responded by giving up, sighing loudly, walking away, retreating to her seat—in essence she was rejecting this baby repeatedly. The significance of maternal emotional availability is very apparent in this case. This child was left in a flat, empty, emotionless void when he was with her, which in turn stunted his own emotionality and ability to relate to others.
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