Poster #69 - Does Autonomy Support During Childbirth Predict Maternal Self-Efficacy and Depressive Symptoms?

• In Event: Poster Session 03

Abstract

The postpartum period can be a time of great joy but also of great vulnerability. Supporting mothers’ well-being during this time benefits both mother and baby (Jacques et al., 2019). Two important indicators of new mothers’ well-being are (low) symptoms of perinatal depression (PD) and (high) maternal self-efficacy (MSE), or feeling capable of the tasks of motherhood (e.g., Ghafoor et al., 2020; Zheng et al., 2018).

Across domains, well-being is predicted by whether one’s basic psychological needs are met vs. frustrated (Vansteenkiste et al., 2020). One basic need is autonomy, or the feeling of making decisions according to one’s own will (Deci & Ryan, 2008). In modern maternity care, many mothers report feeling excluded from – or bullied into – medical decisions during childbirth (e.g., Vedam et al., 2019). Thus, the need for autonomy is frustrated during the transition to motherhood, which is transformational both physiologically and psychologically (Olza et al., 2020). Dissatisfaction with childbirth and lack of autonomy both predict postpartum depression (Bell & Andersson, 2016; Townsend et al., 2020). We argue that when mothers’ autonomy needs are frustrated during childbirth, this negatively impacts their sense of competence as mothers, which in turn fosters depressive symptoms in the postpartum period.

Primaparous women who are between 36 and 42 weeks pregnant will be recruited. A priori power analyses indicates that 70 subjects should provide > 80% power to detect a medium effect size. At approximately 36 weeks pregnant, mothers will be asked to complete an online survey including demographics, history of depression, MSE (the Karitane Parenting Confidence Scale; Crncec et al., 2008) and PD (the Edinburgh Postnatal Depression Scale; Cox et al., 1987).

These measures will be collected again approximately 4 weeks postpartum, in addition to questions about the birth location, providers, and experience. Mothers will complete the Health Care Climate Questionnaire, a measure of autonomy support in healthcare contexts (Williams et al. 2006), with slight modifications specific to childbirth. Items include “I feel that my care provider has provided me choices and options” and are rated on a 1-7 Lickert scale.

In this study, we ask whether PD and MSE are predicted by mothers’ reported autonomy support during childbirth, controlling for PD and MSE measured during late pregnancy. In addition, we ask whether MSE mediates the relationship between autonomy support and PD. We hypothesize:
1. Controlling for pregnancy levels of PD, autonomy support during childbirth will negatively predict postpartum PD.
2. Controlling for pregnancy levels of MSE, autonomy support during childbirth will predict postpartum MSE.
3. MSE will mediate the relationship between autonomy support and PD. That is, with postpartum MSE entered into the equation, the relation between autonomy support and PD will be significantly reduced (Baron & Kenny, 1986). This would be consistent with the causal pathway of: autonomy support impacts MSE which influences depression.

Childbirth is not just another “day in the life” of the mother. This research will help clarify whether and how support for autonomy during childbirth impacts maternal postpartum mental health.

Authors

• Casey A. Gartland, Villanova University

• Grace D. Koo, VILLANOVA UNIVERSITY

• Jordan M. Hicks, VILLANOVA UNIVERSITY

• Madeleine Pekosz

• Rebecca Joan Brand, Villanova University
  Presenting Author