History of perinatal loss and maternal–fetal attachment behaviors Pegah Mehran a , Masumeh Simbar b, *, Jamal Shams c , Fahimeh Ramezani-Tehrani d , Navideh Nasiri e a Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, International Branch, Tehran, Iran b Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran c Department of Psychology, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran d Reproductive Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran e Department of Bio-Statistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Iran 1. Introduction Prenatal period is usually considered as a pleasant period of life for women; however, it can be regarded as a stressful circumstance for some women such as those with a history of fetal or neonatal loss. 1 Perinatal loss (PL) is a terrible emotional experience that was followed by a feeling of failure, hopelessness, and losing of self- confidence. 2 Psychological disorders related to PL can be sustained till subsequent pregnancy and it may lead to a resistance to motherhood adaptation process and MFA. 3,4 MFA was conceptualized by the attachment theory 5 as an effective emotional relationship between mother and her baby 6 that initiate from the prenatal period while the physical development of the fetus and transformation of a woman into a mother are occurring, simultaneously. Transformation of a woman into a mother means woman’s recognition of her role, the identity of her developing fetus, and the relationship between herself and her fetus. 7 The development of this relationship is critical because of the correlation between prenatal and postnatal attachment 8–10 and because of optimal attachment in early infancy is an integral component in the future development of a child. 11 MFA initiated with fetal movement or first observation in sonography. It increases during pregnancy with increasing of fetal movements, and peaks in the 3rd trimester of pregnancy and Women and Birth xxx (2013) xxx–xxx A R T I C L E I N F O Article history: Received 11 October 2012 Received in revised form 24 April 2013 Accepted 25 April 2013 Keywords: Pregnancy Perinatal loss Perinatal care Maternal Health Maternal–fetal attachment A B S T R A C T Background: Maternal–fetal attachment (MFA) is an important requirement for optimal maternal–infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/ neonatal death) affects maternal attachment in pregnancy. Research question: ‘‘Does a history of perinatal loss affect maternal–fetal attachment behaviors?’’ Methods: One hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly’s Maternal–Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann–Whitney tests. Findings: Finding showed that total score of MFA for women with a history of PL (68.95 Æ 9.20%) is not significantly different from this score for women without such a history (71.22 Æ 11.75%; p < 0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors ‘‘differentiation of self from fetus’’ compared to women without of a history of PL (78.25 vs. 83.21%; p < 0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups. Conclusion: In this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal–fetal attachment behaviors related to ‘‘differentiation of self from fetus’’ in a subsequent pregnancy. ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. * Corresponding author at: Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Science (3rd Floor, Deputy of Research), Vali-Asr Avenue, Cross of Vali-Asr and Neiaiesh Highway, Opposite to Rajaee Heart Hospital, Postal Code: 1996835119, Tehran, Iran. Tel.: +98 21 88202516; fax: +98 21 88202521. E-mail addresses: msimbar@sbmu.ac.ir, msimbar@yahoo.com (M. Simbar), J_shams@yahoo.com (J. Shams). G Model WOMBI-288; No. of Pages 5 Please cite this article in press as: Mehran P, et al. History of perinatal loss and maternal–fetal attachment behaviors. Women Birth (2013), http://dx.doi.org/10.1016/j.wombi.2013.04.005 Contents lists available at SciVerse ScienceDirect Women and Birth jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/wo mb i 1871-5192/$ – see front matter ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. http://dx.doi.org/10.1016/j.wombi.2013.04.005