Making It Real: Prenatal, Relationship-Based Interviews with Pregnant Women Exposed to Environmental Risk

Purpose: Research (e.g., Benoit, et. al., 1997) has established the importance of parental perceptions of infants and young children in parenting behaviors, the parent child relationship, and as a potential risk factor for child maltreatment. The purpose of this study was to examine the influence of key psychosocial and bio-behavioral risk and resilience factors on the development of parenting thoughts and behaviors during pregnancy among a sample of urban-dwelling mothers with histories of psychosocial trauma exposure.  Expectant mothers’ perceptions and subjective experiences of their developing infant were assessed prenatally. The central aim was to understand the underlying psychological processes that overburdened mothers experience as they prepare to parent a new infant. 

Methods: This study employed qualitative data from a larger investigation examining the effects of psychosocial risk and resilience factors on the bio-psycho-social functioning of parents expecting a new baby.  The Working Model of the Child Interview was conducted with 50 low-income, urban, expectant mothers in Detroit. The interviews were qualitatively coded using thematic analysis, drawing on principles of grounded theory. Through an iterative process of identifying and reviewing themes in the narratives, final codes were developed for data analysis. Each transcript was subsequently reviewed by the first author and two research assistants independently and the data were analyzed using NVIVO software.

Results: Mothers described positive and negative perceptions of their child in utero, and ways in which these perceptions were influenced by relationships with important others in the mother’s life such as partners and mother’s parents.  Themes emerged regarding the ways in which the environment-including presence or absence of social support and financial stressors affected the development of the mother child relationship and mothers’ changing sense of identity as a result of pregnancy.  Themes reflected turning points- moments when mothers recognized the pregnancy as “real” and the developing child as a “real person”. One mother described the ultrasound as the point when she moved from “not ready” to “getting ready”. Mothers described the ways in which the pregnancy served as a bridge between the mother and other important individuals in her life such as her mother, her partner, or another child. One woman stated, “he felt the baby push and he pushed back for like 30 minutes, the longest interaction we’ve had together with the baby”.

Conclusion: These data contribute to our understanding of prenatal psychological processes among at risk expectant mothers, with implications for improving intervention and support services. Findings highlight the importance of expectant mothers’ relationships, both past and current, in her capacity to develop positive perceptions of her child in utero. Effective interventions with this population might focus on expectant mothers’ relational histories, with the aim of facilitating positive perceptions and attachments to her developing child in utero. This may be especially salient for expectant mothers with histories of trauma and poor attachment histories of their own. Future research might evaluate the effectiveness of specific interventions for at risk expectant mothers.