Document Type : Original Article
Authors
1 Department of Midwifery, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences
2 Department of Midwifery, Maternal-Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
BACKGROUND: Happiness is among the factors that promote mental health in mothers with
unplanned pregnancy. The present study aimed to determine the impact of attachment skills training
on happiness among women with unplanned pregnancy.
MATERIALS AND METHODS: This clinical trial was conducted on 84 women with unplanned
pregnancy referred to three prenatal clinics in Shiraz in 2018. The participants were randomly divided
into an intervention group and a control group using permutation block. At first, the participants were
requested to sign written informed consent form, demographic information form, and mental health
questionnaire. Then, they were asked to complete Oxford Happiness Questionnaire and Cranley’s
Maternal-Fetal Attachment Scale. The intervention group received attachment training through six
90-min sessions, while the control group underwent the hospital’s routine care. The two groups were
required to fill out the study questionnaires once more after 4 weeks after the intervention. After all,
the data were analyzed using Chi-square test, Fisher’s exact test, independent t-test, and ANOVA.
RESULTS: There was a significant difference between the two groups’ pretest and posttest mean
scores of happiness (P = 0.0001). The results showed that in the experimental group, pretraining and
posttraining period mean scores were 89.64 (7.2) and 93.13 (6.09), respectively; while in the control
group, pretraining and posttraining period mean scores were, respectively, 91.69 (9.96) and 91 (8.82).
The difference between the two groups was statistically significant. No significant relationship was
observed between happiness and the couples’ occupations, number of pregnancies, and number
of miscarriages in the two groups (P > 0.05).
CONCLUSION: The mean score of happiness increased after the training, being significantly different
from that in the control group. Therefore, happiness is a changeable feature that can be promoted
among pregnant women via interventional methods.
Keywords
- Blake SM, Kiely M, Gard CC, El-Mohandes AA, El-Khorazaty
MN, NIH-DC Initiative. Pregnancy intentions and happiness
among pregnant black women at high risk for adverse infant
health outcomes. Perspect Sex Reprod Health 2007;39:194-205.
2. Bishwajit G, Tang S, Yaya S, Feng Z. Unmet need for contraception
and its association with unintended pregnancy in Bangladesh.
BMC Pregnancy Childbirth 2017;17:186.
3. Finer LB, Zolna MR. Unintended pregnancy in the United States:
Incidence and disparities, 2006. Contraception 2011;84:478-85.
4. Singh S, Sedgh G, Hussain R. Unintended pregnancy: Worldwide
levels, trends, and outcomes. Stud Fam Plann 2010;41:241-50.
5. Kassa N, Berhane Y, Worku A. Predictors of unintended
pregnancy in Kersa, eastern Ethiopia, 2010. Reprod Health
2012;9:1.
6. Bahk J, Yun SC, Kim YM, Khang YH. Impact of unintended
pregnancy on maternal mental health: A causal analysis using
follow up data of the Panel Study on Korean Children (PSKC).
BMC Pregnancy Childbirth 2015;15:85.
7. Cheng D, Schwarz EB, Douglas E, Horon I. Unintended pregnancy
and associated maternal preconception, prenatal and postpartum
behaviors. Contraception 2009;79:194-8.
8. Sedgh G, Singh S, Hussain R. Intended and unintended
pregnancies worldwide in 2012 and recent trends. Stud Fam Plann
2014;45:301-14.
9. Theme-Filha MM, Baldisserotto ML, Fraga AC, Ayers S, da Gama
SG, Leal MD. Factors associated with unintended pregnancy in
Brazil: Cross-sectional results from the Birth in Brazil National
Survey, 2011 / 2012. Reprod Health 2016;13:118.
10. Aiken AR, Borrero S, Callegari LS, Dehlendorf C. Rethinking
the pregnancy planning paradigm: Unintended conceptions
or unrepresentative concepts? Perspect Sex Reprod Health
2016;48:147-51.
11. Doherty K, Arena K, Wynn A, Offorjebe OA2, Moshashane N,
Sickboy O, et al..Unintended Pregnancy in Gaborone, Botswana:
A Cross-Sectional Study. Afr J Reprod Health. 2018 Jun;22(2):76-
82. doi: 10.29063/ajrh2018/v22i2.8.
12. Motaghi Z, Poorolajal J, Keramat A, Shariati M, Yunesian M,
Masoumi SZ. Induced abortion rate in Iran: A meta-analysis.
Arch Iran Med 2013;16:594-8.
13. Ohara M, Okada T, Kubota C, Nakamura Y, Shiino T, Aleksic
B, et al. Validation and factor analysis of mother-infant bonding
questionnaire in pregnant and postpartum women in Japan. BMC
Psychiatry 2016;16:212.
14. Honemeyer U, Kurjak A. Pregnancy and loneliness: The
therapeutic value of 3D/4D ultrasound. Psychology 2014;5:744. - 15. Alhusen JL, Gross D, Hayat MJ, Woods AB, Sharps PW. The
influence of maternal-fetal attachment and health practices on
neonatal outcomes in low-income, urban women. Res Nurs Health
2012;35:112-20.
16. Van Bergh BD, Simons A. A review of scales to measure the
mother–foetus relationship. J Reproductive Infant 2009;27:114-26.
17. Galeshi M, Mirghafourvand M, Alizadeh-Sharajabad F,
Sanaati F. Predictors of mother-child bonding. J Hayat 2016;22:13-
26. Available from: http://dspace.tbzmed.ac.ir:8080/xmlui/
handle/123456789 / 57284. [Last accessed on 2016 Jan].
18. Ustunsoz A, Guvenc G, Akyuz A, Oflaz F. Comparison of
maternal-and paternal-fetal attachment in Turkish couples.
Midwifery 2010;26:e1-9.
19. Prenatal attachment training: Designing the educational package
and its effectiveness on mother’s relationship with fetus and
spouse. J Appli Psychol Res 2015;6:143-59. [doi 10.22059/
japr.2015.61430].
20. Alhusen JL, Hayat MJ, Gross D. A longitudinal study of maternal
attachment and infant developmental outcomes. Arch Womens
Ment Health 2013;16:521-9.
21. Kissgen R, Krischer M, Kummetat V, Spiess R, Schleiffer R,
Sevecke K. Attachment representation in mothers of children
with attention deficit hyperactivity disorder. Psychopathology
2009;42:201-8.
22. Seligman M. Positive Interventions: More Evidence of
Effectiveness. Authentic Happiness Newsletter; September, 2004.
23. Hills P, Argyle M. Emotional stability as a major dimension of
happiness. Pers Individ Differ 2001;31:1357-64.
24. RF Valois, KJ Zullig, ES Huebner… Physical activity behaviors
and perceived life satisfaction among public high school
adolescents. Journal of school health. 2004;74(2):59-65.https://
doi.org/10.1111/j.1746-1561.2004.tb04201
25. Taube-Schiff M, Van Exan J, Tanaka R, Wnuk S, Hawa R,
Sockalingam S. Attachment style and emotional eating in bariatric
surgery candidates: The mediating role of difficulties in emotion
regulation. Eat Behav 2015;18:36-40.
26. Fenwick J, Gamble J, Nathan E, Bayes S, Hauck Y. Pre- and
postpartum levels of childbirth fear and the relationship to
birth outcomes in a cohort of Australian women. J Clin Nurs
2009;18:667-77.
27. Jayasvasti K, Kanchanatawan B. Happiness and related factors
in pregnant women. J Med Assoc Thai 2005;88 Suppl 4:S220-5.
28. Toosi M, Akbarzadeh M, Zare N, Sharif F. Effect of attachment
training on anxiety and attachment behaviors of first-time
mothers. Hayat 2011;17:69-79. Available from: http://hayat.tums.
ac.ir/article-1-56-en.html. [Last accessed on 2020 Mar 25].
29. Alipoor A, Noorbala AA. Preliminary evaluation of the validity
and reliability of the Oxford happiness questionnaire in students
in the universities of Tehran. Iran J Psy Clin Psychol 1999;5:55-66.
Available from: http://ijpcp.iums.ac.ir/article-1-1777-fa.html.
30. Akbarzadeh M, Toosi M, Zare N, Sharif F. Effect of learning
attachment behaviors on anxiety and maternal fetal attachment
in first pregnant women. EBCJ 2011;1:21-34.
31. Heydari N, Dehghani M, Emamghoreishi M, Akbarzadeh M.
Effect of Melissa officinalis capsule on the mental health of female
adolescents with premenstrual syndrome: A clinical trial study.
Int J Adolesc Med Health 2018;31. pii:/j/ijamh.2019.31.issue-3/
ijamh-2017-0015/ijamh-2017-0015.xml.
32. Akbarzadeh M, Moshfeghy Z, Dehghani M, Emamghoreishi M,
Tavakoli P, Zare N. Comparison of the effect of Melissa officinalis
capsule and care educational programs on the intensity of physical
mental and social symptoms of premenstrual syndrome in high
school female students. Int J Womens Health Reproduction Sci
2018;6:18-26.
33. Akbarzadeh M, Dehghani M, Moshfeghy Z, Emamghoreishi M,
Tavakoli P, Zare N. Effect of Melissa officinalis capsule on the
intensity of premenstrual syndrome symptoms in high school
girl students. Nurs Midwifery Stud 2015;4:e27001.
34. Jazayeri SH, Delavar A, Dortaj F. Developing a model of happiness
based on personality traits, emotional intelligence, attachment
style, voluntary activities and demographic characteristics.
Quarterly Counseling Psychother Culture 2018;9:27-56. [doi:
10.22054/qccpc.2018.32077.1826].
35. Blake SM, Kiely M, Gard CC, El-Mohandes AA, El-Khorazaty MN,
Initiative ND. Pregnancy intentions and happiness among
pregnant black women at high risk for adverse infant health
outcomes. Perspectives on sexual and reproductive health.
2007;39:194-205.
36. Nelson JA, O’Brien M. Does an unplanned pregnancy have longterm implications for mother-child relationships? J Fam Issues
2012;33:506-26.
37. Fink NS, Urech C, Cavelti M, Alder J. Relaxation during
pregnancy: What are the benefits for mother, fetus, and the
newborn? A systematic review of the literature. J Perinat Neonatal
Nurs 2012;26:296-306.
38. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors
during pregnancy: Does intention status matter? Fam Plann
Perspect 1998;30:79-88.
39. Sabatini F. The relationship between happiness and health:
Evidence from Italy. Soc Sci Med 2014;114:178-87.
40. Veiskarami H, Amirian L, Khodaei S. The Effectiveness of Critical
Thinking Training on the Happiness and Tolerance of Ambiguity
in Medical Students. Res Med Educ 2018;10:58-66. Available from:
http://rme.gums.ac.ir/article-1-641-fa.html.
41. Diener E, Ryan K. Subjective well-being: A general overview. S Afr
J Psychol 2009;39:11-58. [doi.org/10.1177 / 008124630903900402].
42. Marzouk T, Nabil H. Effect of a training program about
maternal fetal attachment skills on prenatal attachment among
primigravida women. IOSR J Nurs Health Sci 2015;4:70-5.
Available from: http://www.iosrjournals.org. [Last accessed on
2020 Mar 25].
43. Negrini LS. Theory, research, and clinical applications. In: Cassidy
J, Shaver PR, editors, Handbook of Attachment. 3rd ed. New York:
Guilford Press; 2016. p. 1068.
44. Robinson FP. Measurement of quality of life in HIV disease.
J Assoc Nurses AIDS Care 2004;15:14S-9S.
45. Kanari NF, Vafa AM. The prediction of pregnancy anxiety on the
basis of subjective well-being and happiness of pregnant women in
Tabriz. Depiction of Health 2017;8:34-43. Available from: Available
from: https://dohweb.tbzmed.ac.ir/en/pub/20 / 5/258/T
he-Prediction-of-Pregnancy 20 / 06/2017.
46. Salisbury A, Law K, LaGasse L, Lester B. MSJAMA. Maternal-fetal
attachment. JAMA 2003;289:1701.
47. Borghei NS, Taghipour A, Latifnejad Roudsari R. Pregnant
mothers’ strategies for the management of pregnancy concerns.
Hayat 2017;23:106-2. Available from: http://hayat.tums.ac.ir/
article-1-1784-en.html. [Last accessed on 2020 Mar 25].
)