Effect of learning attachment behaviors on anxiety and maternal fetal attachment in first pregnant women

Document Type : Original Quantitative and Qualitative Research Paper


1 Department of Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Statistic, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Anxiety with different shapes induces some complications in women in their first pregnancy. Reducing anxiety level can promote maternal-fetal health.
Aim: to examine the effect of learning the “attachment behaviors” on the anxiety level and “maternal fetal attachment” in first pregnant women referring to Shiraz obstetric clinics in 2010
Methods: In this randomized control trial 84 pregnant women were allocated in two groups randomly. Experimental group received routine pregnancy care in addition to four 90- minutes’ sessions on the attachment behaviors during one month of intervention period. The control group received usual pregnancy services. Anxiety and maternal fetal attachment were measured before and after intervention in two groups. Data were collected using Spielberger's State Anxiety Inventory and maternal fetal attachment scale Cranley. Data were analyzed with SPSS software (v.11.5), using statistical tests including Chi square, pair T test, and T test. P value less than 0.05 considered statistically significant.
Results: women in the case group experienced significantly less anxiety and more maternal fetal attachment after learning attachment behaviors (p=0.003, p <0.001). No significant changes were found in the control group.
Conclusion: educating the attachment behaviors can increase maternal fetal attachment and reduce women’s anxiety in their first pregnancy. It could be suggested to include teaching this subject in to pregnancy health care services.


1. Davis M. In translation: reduce pressure and peace learning muscle, khaje mongahi. 2nd ed. Tehran: Tabib publication; 2005. p. 23-5.
2. Oates MR. Adverse effects of maternal antenatal anxiety on children: causal effect or developmental continuum? Br J Psychiatry 200; 180 (4) : 478-9.
3. Rahman A, Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord. 2007; 100 (1-3) : 115-21.
4. Mulder EJ, Robles de Medina PG, Huizink AC, Van den Bergh BR, Buitelaar JK, Visser GH. Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Hum Dev 2002; 70 (1. 2) : 3-14.
5 . Jannati Y, Khaki N. [Psychiatric in midwifery]. Tehran: Jame Negar Publications; 2005. P. 122-124. (Persian)
6 . Punamaki RL, Repokari L, Vilska S, Poikkeus P, Tiitinen A, Sinkkonen J, Tulppala M. Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: does former infertility matter? Infant Behavior and Development. 2006; 29 (2) : 230-42.
7. Gennaro S, Hennessy MD. Psychological and physiological stress: impact on preterm birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2003; 32 (5) : 668-75.
8. Louise B, Narcoma C,Gomes A. depression during pregnancy. obstetric Gynecology Journal 2003;68 (4) :372-86.
9-Robbins E. depression during pregnanc. birmingha psychology journal 2003; 63 (1) :1-3.
10. Pillitteri A. Maternal and child health nursing. 4th ed. Philadelphia: Lippincott Williams & Wilkins;2003. P. 201-26.
11. Lee AM, Lam SK, Sze Mun Lau SM, Chong CS, Chui HW, Fong DY. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007; 110 (5) : 1102-12.
12. Forouzandeh N, Delaram M, Deris F. The quality of mental health status in pregnancy and it’s contributing factors on women visiting the health care centers of Shahrekord. Journal of Reproductive Infertility. 2003; 4 (2) :146-55.
13. Da-Costa-D, Larouche J, Dritsa M, Brender W. Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders 2000; 9 (1) :31-40.
14. Watterson A, Thomson P, Malcolm C, Shepherd A, McIntosh C. Integrating environmental health into nursing and midwifery practice. Journal of Advanced Nursing. 2005; 49 (6) : 665-74.
15. Rostai M. Physiotherapy and exercise therapy in OB-Gyn. 1th ed. Tehran :Sana Publishers ;2000.
16-Postpartum Mental Health. 2008. Available at:URL:http://www. arhp. org/guide. Accessed Dec 11, 2008.
17. Yarcheski A, Mahon N. E, Yarcheski T. J, Hanks M. M, Cannella B. L. A meta-analytic study of predictors of maternal-fetal attachment. International Journal of Nursing Studies 2009; 46 (4) :708-15.
18. Ustunsoz A, Guvenc G, Akyuz A, Oflaz F. Comparison of maternal and paternal-fetal attachment in Turkish couples. Midwifery Journal 2010; 26 (2) : l-9.
19. Saastad E, Ahlborg T, Froen J. F. Low maternal awareness of fetal movement is associated with small for gestational age infants. Journal of Midwifery Women Health 2008; 53 (4) : 345-352.
20. Pillite A. Maternal and child health nursing. 4th ed. Uk:lippincott Publishers;2003. p. 201-26.
21-Kelly L. Relationships Among Maternal Fetal Attachment,Prenatal Depression, and Health Practices in Pregnancy. Research in Nursing & Health journal 2001; 24 (3) : 203-17.
22. Bellieni CV, Ceccarelli D, Rossi F, Buonocore G, Maffei M, Perrone S, et al. Is prenatal bonding enhanced by prenatal education courses? Minerva Ginecoly journal 2007; 59 (2) :125-9.
23. Debra C. F. Mternal-fetal attachment: Associations among family relationships, maternal health practices, and antenatal attachment. Southern Online Journal of Nursing Reseaech 2008; 8 (2) :131. 2.
24. Salisbury A, Law K, Ladasse L, Lester B. maternal-fetal attachment. JAMA 2003; 289 (13) : 1707.
25. Yarcheski A, Mahon N. E, Yarcheski T. J, Hanks M. M, Cannella B. L. A meta-analytic study of predictors of maternal-fetal attachment. International Journal of Nursing Studies 2009; 46 (4) : 708-15.
26 -Kim JS, Cho KJ. The effect of mother-fetus interaction promotion program of talking and
tactile stimulation on maternal-fetal attachment. Korean Journal Child Health Nursing 2004; 10 (2) : 153-64.
27 . Gedney JJ, Glover TL, Fillingim RB. Sensory and affective pain discrimination after inhalation of essential oils. Psychosom Med. 2004; 66 (4) : 599-606.
28 . Hur MH, Cheong N, Yun H, Lee M, Song Y. Effects of delivery nursing care using essential oils on delivery stress response, anxiety during labor, and postpartum status anxiety. Taehan Kanho Hakhoe Chi. 2005 Dec; 35 (7) : 1277-84.
29 . Hoseini M. [The effect of Benson relaxation education on anxiety status and digestive sign in IBS patients of Faghihi and Motahari hospitals in Shiraz university medical science], 2003. (Persian)
30-Cranley, M. S. Development of a tool for the measurement of maternal attachment during pregnancy. Nursing Research l981; 30 (5) :281-4.
31. khoramrody R. The effect of mothers touch on Maternal Foetal Attachment. Theses for M. S. c Degree of Iran University, 2000.
32. Abasi1 E, Tafazoli M, Esmaeili H. The Effect of Foetal Movement Counting on Primipara Maternal Foetal Attachment. jornal Mazandaran university of Medical Science 2010; 20 (77) :53-60.
33. TeixeiraJ,MartinO. The effects of acute relaxation on indices of anxiety during pregnancy. Journal of Psychosomatic Obstetrics & Gynecology 2005; 26 (4) : 271-6.
34. Davis E. Heart and Hands; A midwifes guide to pregnancy and birth. 4th ed. Toronto :Celestial Arts press ; 2007. p. 105-38.
35. Chang MX, Wang SX. Chen CH. Effect of message on pain and anxiety during labour : a Randomized Controlled trial in Taiwan. Journal of Advanced Nursing 2002; 38 (1) : 68-73.
36. Mirzaee f,Kaviany m,jafary p. The effect of foot reflexology on anxiety in Primipara women. «Hayat» Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences. 2010; 16 (1) : 65-71. (Persian)
37. Bastani F, Haidarnia A, Vafaei M, Kazemnegad A, Kashanian M. Effect of Relaxation Training Based on the Synthesizing of the PRECEDE Model with the Health Belief Model and the Self-efficacy Theory on Anxiety and Pregnancy Outcomes Among Pregnant Women. (Theses) 2004.
38. Malekpour Afshar F, Salari P, Azar Pejouh H, Ismaeili H. The effect of education childbirth preparation on anxiety during pregnancy and delivery in primiparous women. Journal of Shahid Sadoughi University of Medical Sciences and Health Services 2005; 3 (13) : 39-44.
39-Bazrafshan m,ghorbany z. The Effects of Slow-Stroke Back Massage on Anxiety in Primipara women. «Hayat» Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences. 2010; 16 (1) : 34-40. (Persian)
40-Scotf JR, Gibbs RS, Karlan BY, Haney AF. Danforth,s obstetrics and gynecology. 9th ed. Philadelphia:Lippincott Williams and Wilkins; 2003.
41. Griffith JM, Sorenson JR, Bowling JM, Jennings-Grant T Assessment of an interactive computer-based patient prenatal genetic screening and testing education tool. Health Education Behavior 2005; 32 (5) : 613-26.