The Impacts of Self-Compassion Training on Subjective Well-Being and Maternal-Fetal Attachment in Women experiencing Unintended Pregnancy: A Quasi-Experimental Study

Document Type : Original Article

Authors

• Azadeh Salemi ghomshe ¹
• Marzieh Kaboodi ²
• Ali Akbar Foroghi ³
• Bijan Kaboodi ⁴

¹ MA Student in Consultancy in Midwifery, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.

² Assistant Professor in Fertility Health, Department of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran

³ Assistant Professor in Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

⁴ General Practitioner, Center of Cardiovascular Research, Kermanshah University of Medical Sciences, Kermanshah, Iran

10.22067/tpccp.2023.73075.1186

Abstract

Introduction
The maternity process is one of the evolutionary and delightful events in women’s lives. Intended pregnancy is generally viewed as a pleasant issue for families, while unintended pregnancy is usually mentioned as an unpleasant and stressful process for the whole family, especially the mother. Unintended pregnancy refers to a pregnancy occurred without couple’s intention for having a baby. When mothers encounter with an unintended pregnancy, it can disturb her and cause psychological consequences such as depression and anxiety. Some studies have shown that there is a mutual relationship between mother’s anxiety and attachment to the fetus. That is, mothers having unintended pregnancy experience higher levels of depression and anxiety, therefore they cannot make proper bonding with their fetus. Maternal-fetal attachment is defined as a continuous, intimate, and close relationship between the mother and her fetus which is satisfactory for both of them and makes easy the mother-infant relationship after delivery. Mother’s attachment to her fetus improves satisfaction and quality of life in mothers. Studies have showed that there is a positive relationship between the dimensions of attachment and subjective well-being. Subjective well-being explores how people evaluate their lives and it includes life satisfaction, marital life satisfaction, mood, positive emotions, lack of depression and anxiety in two cognitive and affective components. Considering the above-mentioned issues, it is expected that when the subjective well-being of mothers improves, the level of their attachment to their fetus increases as well. One way to increase the mother's attachment to the fetus in such a condition is training, and among the relatively new and effective trainings is self-compassion training. This study tried to examine the impacts of self-compassion training on the subjective well-being and maternal-fetal attachment in women experiencing unintended pregnancy.
Method
This study was conducted using a pre-test, post-test, follow-up design and a semi-experimental control group of 80 pregnant women who had an unintended pregnancy and visited Kermanshah health centers. The inclusion criteria for the study are: being in the first or second trimester of pregnancy, not having severe midwifery problems in the recent pregnancy such as uterine bleeding or abnormal results in fetal health screening, the age between 18 and 45, not taking psychoactive drugs or neuroleptics, and being consent to participate in this research. The exclusion criteria are: Failure to participate in two or more counseling sessions, pregnancy loss during the study, and unwillingness to participate in or continue the process of this study. Participants were selected through cluster and convenient sampling methods. They were divided randomly into control and experimental groups. For collecting data, the demographic characteristics, subjective well-being, and maternal-fetal attachment questionnaires were used. For the experimental group, eight group sessions, each in 90 minutes, once a week were held to train self-compassion. During this time, the control group was placed on the waiting list. The evaluation of the participants was done in the pre-test stage before the start of the intervention, in the post-test stage immediately after the final session of training, and in the follow-up stage, four weeks after the end of the last training session. The data was analyzed using SPSS version 25. Frequency, frequency percentage, and mean were used to check the descriptive indicators, Fisher's exact test, Chi square, and Mann-Whitney test were used to check the homogeneity of demographic variables, and non-parametric Friedman and Mann-Whitney tests were applied to check the findings.
Results
The results of Friedman test showed that the mean score of subjective well-being and maternal-fetal attachment in the experimental group increased after the intervention (post test), and four weeks after the end of training. These changes were statistically significant (p<0.001). However, in the control group, this trend was decreasing. Therefore, we conclude that there was a significant impact during the intervention in the experimental group. Moreover, the results of the Mann-Whitney test showed that there is a significant difference between the experimental and control groups in the second and third rounds of measurement.
Discussion and Conclusion
The results showed seemingly self-compassion training can lead to the improvement of the subjective well-being and improvement of maternal-fetal attachment in women experiencing unintended pregnancy. It is suggested, therefore, that an independent midwifery counseling unit be stablished that provides counselling and self-compassion based training services for women who are experiencing unintended pregnancy. Providing counseling and support services by midwives and health care workers can lead to the women's adaptive behaviors in this period and increase their ability to face the challenges caused by unintended pregnancy. It also can help them deal with this phenomenon better, be able to cope with this, show a more appropriate reaction, and even have more ability to get pregnant again.
 

Keywords

• Maternal-Fetal Attachment
• Subjective Well-being
• Unintended Pregnancy
• Self-Compassion
• Training

20.1001.1.22516352.1402.13.1.10.2

Main Subjects

• Clinical psychology

---

References

References

Afshani, S. A., Abooei, A., & Abdoli fahadan, A. M. (2019). Self-compassion training and psychological well-being of infertile female [Short Research Reports]. International Journal of Reproductive BioMedicine, 17(10), 757-762. https://doi.org/10.18502/ijrm.v17i10.5300

Altman, D. G., & Bland, J. M. (2005). Standard deviations and standard errors. Bmj, 331(7521). https://doi.org/10.1136/bmj.331.7521.903

Bigdeli, I., Najafy, M., & Rostami, M. (2013). The relation of attachment styles, emotion regulation, and resilience to well-being among students of medical sciences. Iranian journal of medical education, 13(9), 721-729. https://ijme.mui.ac.ir/article-1-2694-en.html (In Persian)

Cranley, M. S. (1981). Development of a tool for the measurement of maternal attachment during pregnancy. Nursing Research, 30(5), 281-284. http://europepmc.org/abstract/MED/6912989

Daroshi, S., & Khayatan, F. (2018). Effects of Self-Compassion on the Quality of Life and Happiness of Mothers of Children with Autism Spectrum Disorder [Research]. Journal of Exceptional Children, 17(4), 77-86. http://joec.ir/article-1-431-en.html

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71-75. https://doi.org/10.1207/s15327752jpa4901_13

Garg, P. K., & Mohanty, D. (2013). Mean (standard deviation) or mean (standard error of mean): time to ponder. World journal of surgery, 37(4), 932-932. https://doi.org/10.1007/s00268-012-1854-z

Hoseini, S., Motaghi, Z., Nazari, A. M., & Goli, S. (2020). Evaluation of Effectiveness Midwifery Counseling with Cognitive-Behavioral Approach to Maternal-Fetal Attachment in Pregnant Women with Unwanted Pregnancy [Original]. Avicenna Journal of Clinical Medicine, 27(2), 85-93. https://doi.org/10.29252/ajcm.27.2.85 (In Persian)

Hosseinian, S., Yazdi, S. M., & Alavinezhad, S. (2016). The Effectiveness of fetal attachment training program on maternal-fetal relationship and mental health of pregnant women. Quarterly Journal of Child Mental Health, 2(4), 75-87. http://childmentalhealth.ir/article-1-84-en.html (In Persian)

Jamshidimanesh, M., Astaraki, L., Moghadam, Z. B., Taghizadeh, Z., & Haghani, H. (2012). Maternal-Fetal Attachment and its Associated Factors. Hayat, 18(5), 33-45. (In Persian)

Kharaghani, R., Yazdan parast, E., & Arasteh, A. (2021). Evaluation of the Quality OF Marital Relationship and its Relationship with Maternal-Fetal Attachment in Wanted and Unwanted Pregnancies [Research]. Nursing And Midwifery Journal, 19(8), 621-632. https://doi.org/10.52547/unmf.19.8.621 (In Persian)

Kurd, B. (2016). Prediction of Nursing Students’ Subjective Well-being based on Mindfulness and Self-compassion. Iranian journal of medical education, 16(78), 272-282. http://ijme.mui.ac.ir/article-1-4025-en.html (In Persian)

Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of personality and social psychology, 92(5), 887–904. https://doi.org/10.1037/0022-3514.92.5.887

Matthies, L. M., Müller, M., Doster, A., Sohn, C., Wallwiener, M., Reck, C., & Wallwiener, S. (2020). Maternal–fetal attachment protects against postpartum anxiety: The mediating role of postpartum bonding and partnership satisfaction. Archives of gynecology and obstetrics, 301(1), 107-117. https://doi.org/10.1007/s00404-019-05402-7

Mehrabi S, & A, S. (2017). Predictive model of cognitive factors in mental well-being among patients with epilepsy in isfahan city, Iran. Journal of isfahan medical school (I.U.M.S), 35(424), 326-334. https://www.sid.ir/en/journal/ViewPaper.aspx?id=544271 (In Persian)

Moeini, M., Mokhtari, N., & Vafaei, Z. (2018). Unwanted pregnancy after earthquake in bam city, Iran. Pharmacophore, 9(2), 80-84.

Mohamadirizi, S., & Kordi, M. (2016). The relationship between multi-dimensional self-compassion and fetal-maternal attachment in prenatal period in referred women to Mashhad Health Center. Journal of Education and Health Promotion, 5. https://doi.org/10.4103/2277-9531.184550

Molina, R. C., Roca, C. G., Zamorano, J. S., & Araya, E. G. (2010). Family planning and adolescent pregnancy. . Best practice & research. Clinical obstetrics & gynaecology, 2(2), 209–222. https://doi.org/10.1016/j.bpobgyn.2009.09.008

Mortazavi, F., Damghanian, M., Mottaghi, Z., & Shariati, M. (2012). Women’s experiences of unwanted pregnancy. Kermanshah Univ Med Sci, 15(6), 492-503. https://brieflands.com/articles/jkums-78904.html (In Persian)

Nazari, H., Farhadi, A., Jariayani, M., Hosseinabadi, R., Asgari, S., & Majidimehr, M. (2014). Mental health of pregnant women referred to Khorramabad health centers. Yafteh, 16(2), 40-48. http://yafte.lums.ac.ir/article-1-1667-fa.html (In Persian)

Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and identity, 2(3), 223-250. https://doi.org/10.1080/00223891.2020.1729774

Niazi Sadiqah, D. N., Ali, Momeni, Somayeh. (2019). Comparison of fertility behavior and adjustment in desired and unwanted pregnancies of pregnant women in Kanabad National Conference on Midwifery and Women's Health (on the occasion of one hundred years of academic midwifery in Iran),  https://civilica.com/doc/997830

Pakseresht, S., Rasekh, P., & Leili, E. K. (2018). Physical health and maternal-fetal attachment among women: Planned versus unplanned pregnancy. INternational Journal of Womens Health and Reproduction Sciences, 6(3), 335-341.

Parsa, P., Saiedzadeh, N., Roshanaii, G., & Masoumi, S. Z. (2016). The effect of training on maternal-fetal attachment (MFA) in nulliparous women: A randomized clinical trial. Avicenna Journal of Nursing and Midwifery Care, 24(1), 24-30. http://nmj.umsha.ac.ir/article-1-1458-en.html (In Persian)

Pillitteri, A. (2010). Maternal & child health nursing: Care of the childbearing & childrearing family. Lippincott Williams & Wilkins. https://books.google.com/books?

Rajabi, G., & Maghami, E. (2015). Self-compassion as mediator between attachment dimensions with mental well-being: a path analysis model. Health Psychol, 4(16), 79-96. https://hpj.journals.pnu.ac.ir/?_action=articleInfo&article=3113&lang=fa&lang=en&lang=fa&lang=en

Rasouli, P., Shobeiri, F., Cheraghi, F., Rasouli, R., & Ghanbari, V. (2016). Study of the relationship of anxiety and depression in third trimester pregnancy on growth index of neonates and preterm delivery. Iran J Pediatr, 2(4), 1-9. (In Persian)

Saastad, E., Israel, P., Ahlborg, T., Gunnes, N., & Frøen, J. F. (2011). Fetal movement counting—effects on maternal‐fetal attachment: A multicenter randomized controlled trial. Birth, 38(4), 282-293. https://doi.org/10.1111/j.1523-536X.2011.00489.x

Saeedi Z, G. N., Sarafraz MR, Sharifian MH. (2013). The effect of inducing self-compassion and self-esteem on the level of the experience of shame and guilt. Contemporary Psychology, 8(1). https://www.sid.ir/en/journal/ViewPaper.aspx?id=323927 (In Persian)

Salisbury, A., Law, K., LaGasse, L., & Lester, B. (2003). Maternal-fetal attachment. Jama, 289(13), 1701-1701. https://doi.org/10.1001/jama.289.13.1701

Sarani, A., Azhari, S., Mazlom, S., & Aghamohammadian, S. H. (2016). The relationship between coping strategies during pregnancy with perceived stress level in pregnant mothers. 18(7), 7-13. https://profdoc.um.ac.ir/paper-abstract-1063103.html#tabs-2 (In Persian)

Shabani R, M. G., Ghobari bonab B, Emamipour S ,Sepah Mansour M. (2015). Prediction of psychological well-being based on the attachment styles and selfcompassion in mothers of elementary school students in Urmia. woman & study of family, 7(27). https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=530228 (In Persian)

Shobeiri, F., Ahang Poor, P., Parsa, P., & Yazdi-Ravandi, S. (2019). Comparing health condition between wanted and unwanted pregnancy of women in Hamadan city. Avicenna Journal of Nursing and Midwifery Care, 27(2), 82-88. https://doi.org/10.30699/sjhnmf.27.2.82 (In Persian)

Toosi, M., Akbarzadeh, M., Zare, N., & Sharif, F. (2011). Effect of attachment training on anxiety and attachment behaviors of first-time mothers. Journal of hayat, 17(3), 69-79. https://pesquisa.bvsalud.org/portal/resource/pt/emr-138780 (In Persian)

Tork Zahrani, S., Haji Rafiei, E., Mohamad Khani Shahri, L., & Alavi Majd, H. (2019). Investigation of maternal-fetal attachment behaviors and its related factors in pregnant women, Qazvin in 2015. Journal of Inflammatory Diseases, 23(1), 26-37. https://doi.org/http://dx.doi.org/%2010.32598/JQUMS.23.1.26 (In Persian)

Torshizi, M. (2013). Different dimensions of maternal-fetal attachment behaviors and associated factors in pregnant women referred to health centers of Birjand, Iran, 2012. The Iranian Journal of Obstetrics, Gynecology and Infertility, 16(72), 13-21. https://doi.org/https://doi.org/10.22038/ijogi.2013.1946 (In Persian)

Voukelatou, V., Gabrielli, L., Miliou, I., Cresci, S., Sharma, R., Tesconi, M., & Pappalardo, L. (2021). Measuring objective and subjective well-being: dimensions and data sources. International Journal of Data Science and Analytics, 11(4), 279-309. https://doi.org/10.1007/s41060-020-00224-2

Yarcheski, A., Mahon, N. E., Yarcheski, T. J., Hanks, M. M., & Cannella, B. L. (2009). A meta-analytic study of predictors of maternal-fetal attachment. International journal of nursing studies, 46(5), 708-715. https://doi.org/10.1016/j.ijnurstu.2008.10.013

Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self‐compassion and well‐being: A meta‐analysis. Applied Psychology: Health and Well‐Being, 7(3), 340-364. https://doi.org/10.1111/aphw.12051