Neurotic States of Women and the Features of the Attitude Towards the Newborn in the Situation of “Burdened” Motherhood

Introduction. In the conditions of demographic instability, the falling birth rate and the situation of the transformation of family values, the need to protect the mental health of young children acquires special social significance. The interest towards this problem is due to the growth of mental disorders among children and the search for solutions, including through preventive measures. The relevance of the study is also due to the fact that education, correction and the treatment of children at an early age has a much greater effect.

One of the leading roles in the etiology and pathogenesis of mental disorders is played by the environmental factor, namely, personality-oriented interaction in the newly formed “mother-child” system. According to a number of researchers, “unintended pregnancy poses a high risk for the health of young children, being prenatal deprivation” [3, p.11-12]. When describing neuroses as a psychogenic disease, A.I. Zakharov draws attention to the mutual influence of the nervous state of parents and their children [7].

The purpose of our study is to identify the features of the attitude towards the newborn and the severity of neurotic states in women with a desired pregnancy, but in a situation of giving birth to a child with a disease.

Terminologically, we define “burdened motherhood” as a subjective phenomenon manifested through the attitude towards a newborn with a disease, and having psychological consequences for women in the form of an altered psycho-emotional state (pronounced neurotic), which is reflected in the formation of the “mother-child” system in the early postpartum period.

This phenomenon is observed:

1. At the birth of a child with a disease in women with a preserved and impaired reproductive function;
2. At the birth of a child with a disease as a result of premature labor, including with an extremely low birth weight.

A characteristic sign for women in a situation of “burdened motherhood” is an unstable emotional state. The cause of this state is determined by the frustrating situation of uncertainty about the future for the woman herself and for the newborn. The semantic fixation of the situation redirects the expenditure of the main resources in the situation of the accepting of the role of a mother, to maintain their own optimal functional state. Foreign psychologists state that “Parental stress is associated with the deterioration of health and well-being of parents and infants, as well as with an increase in psychological stress” [18, p. 6].

Methods and Design of the Study 

The study involved women who were transferred together with their child for treatment to the neonatal intensive care unit on the 3rd — 11th day after delivery due to the unstable condition of their children. The main group of 173 respondents (average age — 34.5 years) was divided into 3 subgroups:

—  Subgroup 1 — 78 women whose pregnancy ended with the birth of a child with a disease in the newborn period, including children with extremely low body weight, with a history of perinatal losses;

—   Subgroup 2 — 63 women, without experience of perinatal losses, whose pregnancy ended with the birth of a child with a disease in the newborn period;

—  Subgroup 3 — 32 women with impaired reproductive function whose pregnancy was induced by in vitro fertilization and ended with the birth of a child with a disease in the newborn period.

The control group consisted of 55 women (average age — 30 years), with preserved reproductive function, who gave birth to a healthy child and who represented the “conditional norm”.

Thus, the main criterion for selecting women for inclusion in the main group was the birth of a child with a disease in the newborn period.

At the present stage, there is an acute shortage of valid methods aimed at studying the features of attitudes towards the newborn in women in the early postpartum period. Therefore, a modified version of the Pregnancy Attitude Test (PAT) by I.V. Dobryakov [5], the Clinical Questionnaire for the Identification and Assessment of Neurotic States by K.K. Yakhin and D.M. Mendelevich [13] were used for this study, as well as, the method of the semi-structured interview, the purpose of which was to achieve maximum constructive compliance. The Mann-Whitney U-test and Spearman’s rank correlation coefficient was used for the statistical processing of empirical data.

Results of the Study

1. The study revealed significant differences in women in the main and control groups in their attitudes toward the newborn.

Women in the control group, with preserved reproductive function, predominantly demonstrate an optimal attitude toward the newborn (U = 238.5; p = 0.022610*). Anxious attitudes toward the newborn were more common in women with impaired reproductive function whose pregnancy ended with the birth of a child with a disease in the newborn period without a history of perinatal losses (U = 210; p = 0.004235**) and in women whose pregnancy was uneventful but who had a history of perinatal losses and gave birth to a child with a disease (U = 245.5; p = 0.007393**). For women with impaired reproductive function with a history of perinatal losses, a euphoric attitude toward the child is more characteristic (U = 199.5; p = 0.001285**) [10, p. 225].

A woman’s attitude to the “mother-child” system, which is formed during the nine months of pregnancy, undergoes changes at the birth of a child with a disease. The image of a “healthy child” is destroyed, and the birth of a child with a disease is accepted. Any non-standard situation, including the transfer from a maternity hospital to a neonatal intensive care unit and a prolonged stay in a hospital, does not allow a woman to experience the joy of the “I am a mother” state and affects the formation of the “mother-child” system.

The adoption of the “maternal role” takes place in a difficult stressful situation, which significantly reduces the woman’s resources and becomes an additional challenge for her. The woman is in a constant state of unproductive anxiety. “The changing requirements of reality associated with the emergence of a newborn and the individual characteristics of the acceptance of the “mother” role status can lead to the mental and emotional overload of a woman in the postnatal period and catalyze the formation of dysfunctional dyadic relationships in the “mother-child” system, which can affect the mental health of the child in the future” [9, с. 140]. We can consider the features of the attitude towards the newborn among the risk factors for the mental health disorders of children in early childhood and infancy.

2. At the time of the study, the somatic condition of children is described as severe and moderate. The diseases of newborns according to ICD-10 were categorized into 4 large groups: congenital disorders, malformations, deformities and chromosomal disorders (Q00-Q99); respiratory and cardiovascular disorders specific to the perinatal period (P 20-P29); infection specific to the perinatal period (P 35-P39) and other specified brain disorders in the newborn (perinatal CNS damage, oppression syndrome). The study revealed the reaction of response to such different diseases in the early postpartum period as typical, independent of the nosological form and fitting into the clinical manifestations of neurotic conditions, which are unresourceful for the situation of formation of the “mother-child” system. This reflects the results obtained in the study and description of the identified syndromes of neurotic states in women in the situation of “burdened motherhood” on the scales: “anxiety” (U = 157.5; p = 0.000910***), “hysterical type of response” (U = 116; p = 0.000056***), “obsessive-phobic disorders” (U = 367.5; p = 0.002009**) and “vegetative disorders” (U = 320.5; p = 0.000293***) (Table).

The results of the study indicate significant differences in the painful nature of the detected neurotic manifestations (less than -1.28), on the “neurotic depression” scale (U = 133.5; p = 0.000192), and on the “asthenia” scale (U = 79.5; p =0.000003) in women with impaired reproductive function. “A long waiting time for pregnancy due to reproductive difficulties” [8, p. 98], the birth of a sick child and the destruction of hopes for the future, causes and supports the above-mentioned conditions.

3. Also, stable correlations between the psycho-emotional state and the attitude towards the newborn in women of the main group were revealed.

Positive correlations between anxious and depressive attitudes towards the newborn and indicators on the “asthenia” scale in women with reproductive problems and in women with a history of perinatal losses, whose pregnancy ended with the birth of a child with a disease in the newborn period (r = 0.39; <0.05), indicate an altered psycho-emotional state of the mother. “The higher the level of the depletion of the physical and psychological resources of a woman, which is manifested by asthenic state” [10, p. 230], the more anxious, and, in some cases, depressive is the attitude towards the newborn that she shows.

The more often women with experience of perinatal losses with impaired reproductive function and in the situation of giving birth to a child with a disease demonstrate a euphoric attitude towards the newborn, the higher the scores on the “obsessive-phobic disorders” scale is (r = 0.41; <0.05). This may be explained by the dominant ideas of pregnancy, i.e. a woman’s acute desire to have a child formed against the background of a traumatic experience. Obsessive-phobic disorders are obsessive states caused by real or imaginary fears, which most often concern the realization of undesirable events associated with the situation of “burdened” motherhood.

Women with impaired reproductive function are characterized by opposite emotional states — euphoria and anxiety. “The former are accompanied by a feeling of relaxation and occur if the goal is achieved” [6]. Secondary states of anxiety and neurotic depression, arise due to prolonged exposure to stressors. The danger of the development of such neurotic states lies in the potential possibility of their outgrowth into chronic depression or obsessive-compulsive disorder, as well the development of post-traumatic stress disorder. The consequences of these neurotic states are a general asthenization and vegetative disorders. The absence of positive emotions for a long time and the inability to recover resources supports the unproductive emotional state of the woman and is reflected in the attitude towards the newborn. The psychological well-being of the newborn is conditioned by the psycho-emotional state of its mother. This conclusion is reflected in the “Diagnostic classification of mental health and developmental disorders of infancy and early childhood”, which includes in the list of nosologies “a specific disorder of relationships in infancy and early childhood, implying the development and manifestation of symptoms of the disorder in the context of relationships with a particular adult” [1; 12, с. 121; 14].

4. According to the results of the study, women with experience of perinatal losses are more often characterized by a high level of the hysterical type of reaction (U = 245.5; p = 0.0073) to any “non-standard” situation than representatives of the “conventional” norm”. This neurotic state is quite understandable. The woman found happiness in having a child after the negative experience of perinatal loss, but fear and uncertainty for the future of this child, cause a hysterical emotional reaction as a protest, as a disagreement with the real-life situation, which can “weaken primarily those resources that are already relatively scarce” [11, с. 113]. According to the statistics given in foreign publications, approximately, every fifth pregnancy ends in perinatal loss [16; 17]. Negative experience of perinatal loss certainly affects the emotional state of a woman. Changes in emotional state can be one of the unfavorable factors affecting the mental development of children of early childhood and infancy.

Table

Results of the Comparative Analysis of Neurotic States in Women in the Situation of “Burdened” Motherhood and in Women Presenting a Conditional Norm According to the Mann-Whitney U-test 

Note: **— differences at the significance level p <0.01.