Women and Birth
Volume 21, Issue 4 , Pages 141-148, December 2008

Partner support in the childbearing period—A follow up study

  • Ingegerd Hildingsson

      Affiliations

    • Mid Sweden University, Department of Health Science, SE-85170 Sundsvall, Sweden
    • Karolinska Institutet, Department of Women and Child health, SE-17177 Stockholm, Sweden
    • Corresponding Author InformationCorresponding author at: Department of Health Science, Mid Sweden University, SE-85170 Sundsvall, Sweden. Tel.: +46 60 1485; fax: +46 60 1910.
    • ,
  • Maria Tingvall

      Affiliations

    • Mälardalen University, Department of Caring and Public Health Science, Box 1020, SE-72126 Västerås, Sweden
    • ,
  • Christine Rubertsson

      Affiliations

    • Mälardalen University, Department of Caring and Public Health Science, Box 1020, SE-72126 Västerås, Sweden

Received 5 June 2008; received in revised form 4 July 2008; accepted 7 July 2008.

Article Outline

Summary 

Background

Social support is important during pregnancy and childbirth and the partner is usually the main source of support. Lack of partner support is associated with less emotional well-being and discontinuation of breastfeeding.

Research problem

The purpose of the study was to investigate the proportion of women dissatisfied with partner support in early pregnancy, and to identify risk factors associated with dissatisfaction through a follow up 2 months and 1 year after childbirth.

Participants and methods

A national cohort of 2430 Swedish speaking women recruited in early pregnancy and followed up 2 months and 1 year postpartum. Data were collected by means of three postal questionnaires.

Results

Five percent of women were dissatisfied with partner support in early pregnancy. Women dissatisfied with partner support were more likely to be multiparas, not living with their partner in early pregnancy and to report unfavorable timing of pregnancy. They experienced more physical symptoms, and less emotional well-being in terms of more depressive symptoms, more major worries and a lower sense of coherence. One year after childbirth a higher rate of divorces and disappointment with the partner's participation in childcare and household chores and understanding from partner was found in women being dissatisfied in early pregnancy.

Discussion and conclusions

This study shows that it might be possible to identify women who are lacking partner support already in early pregnancy. Women's social network and their support from partner should be investigated by health care providers and women in need of additional support should be refereed to available community resources.

Keywords: Partner support, Emotional well-being, Pregnancy, Postpartum, Divorce rates

 

Back to Article Outline

Introduction 

Pregnancy and early parenthood are periods where substantial physical, emotional and social changes take place. Pregnancy is usually a healthy process. Nevertheless, women are engaged within the medical system, mainly in the primary health care, with the midwife as the primary caregiver. Almost all pregnant women in Sweden avail of antenatal care which is free of charge. The standard visiting schedule recommends 7–9 visits during an uncomplicated pregnancy. In general, midwives in antenatal care collaborate with nurses working in child health care and with family doctors and obstetricians when needed. There are usually psychologists and social workers connected to the antenatal clinics for women in need of such support.1 During pregnancy, the woman's partner is encouraged by health professionals to take part in the antenatal visits. In Sweden, gender equality has been in focus for the past 30 years and there have been many governmental initiatives in this area.2 Parent education classes are offered during pregnancy to all first-time parents.3 In Sweden, new fathers receive 10 days off from work when their baby is born paid by governmental parent insurance. They are also encouraged by society to participate in caring for the child and to share the parental leave, which in Sweden is 480 days, 2 months of which are exclusively intended for fathers. In 2006, fathers took 21% of the total leave days used by the couples, with regional variations of 13–26% (www.forsakringskassan.se).

Social support has been defined by Cobb4 (1976) as ‘information leading the subject to believe that he is cared for and loved… esteemed and valued…that he belongs to a network of communication and mutual obligation’. Social support is viewed as an important coping factor regarding the individual's ability to handle stressful events and for the recovery after such events, and has a buffering effect against stress.5 There is no standardized definition of social support, however, House 19816 has identified various components of social support. These components include: emotional support, which refers to empathy, caring, love and trust; instrumental support, which includes direct help to individuals; informational support, when significant others provide helpful information for individuals to cope with personal problems and appraisal support – information, which helps individuals to evaluate themselves.

The association between social support and health is well known7, 8 and has been focused upon in studies of pregnant women's physical and emotional well-being.9, 10, 11, 12 One predictor of well-being during pregnancy is women's degree of sense of coherence.13 Another is support from partner and social network.11, 14 The partner is usually highly valued as a source of support during pregnancy. Previous studies have revealed that support from a partner facilitated women to stop smoking,15 was associated with a positive birth experience,11, 12, 13, 14 was helpful when considering abortion16 as well as leading to less need for pain relief during labor.17 Lack of or disappointment with partner support has been associated with high levels of anxiety during pregnancy18 and depression.19, 20 Previous studies have also shown that women who lack partner support are more likely to renounce breastfeeding compared to those who receive such support.21, 22

Back to Article Outline

Aims 

The aim of the present study was to investigate the proportion of women dissatisfied with partner support in early pregnancy, to identify the characteristics of women dissatisfied with partner support and to follow up these women's situation 2 months and 1 year after childbirth.

Back to Article Outline

Methods 

Design 

Selected data from a longitudinal cohort study of a national sample of Swedish speaking women were used. The women were recruited in early pregnancy and followed up at 2 months and 1 year postpartum. Of the 608 antenatal clinics operating in Sweden at the time of recruitment, 593 chose to participate in the study. The 15 antenatal clinics not participating in the recruitment of women reported heavy workload or similar ongoing studies. Swedish speaking women who registered for antenatal care during 3 weeks spread over a 12-month period in 1999–2000 were informed about the study by their midwives and asked to participate. Their personal identity codes and contact details were sent to the research office after which questionnaires were mailed to them. Two reminders were sent to non-responders. Background characteristics of the sample were compared with data from a 1-year cohort of women who gave birth in Sweden in 1999. This information was gathered from the Swedish Medical Birth Register, records that include information on socio-demographic variables, care procedures, and health outcomes. The study was approved by the Regional Research and Ethics Committee of the Karolinska Institutet, Stockholm, Sweden.

Subjects 

During the three recruitment weeks approximately 5500 women were booked for antenatal care, an estimation based on data from the Medical Birth Register and the antenatal midwives. After exclusion due to miscarriage (275), inability to communicate in Swedish (550), and attending one of the 15 non-participating clinics (75), 4600 eligible women remained, of which 3293 (72%) consented to participate in the study. The inclusion criteria for the present study were women who reported that they had a partner at 2 months postpartum and had answered all three questionnaires. These criteria were met by a subgroup of 2340 women.

Data collection 

Data were collected by means of three postal questionnaires, the first in early pregnancy, the second at 2 months postpartum and the third at 1 year postpartum, with the response rates of 91%, 84% and 88% respectively. The questionnaires covered a wide range of issues related to aspects relevant for the childbearing period, and selected data are included in this study. The majority of the explanatory variables were collected from the questionnaire completed in early pregnancy (mean gestational week 16), which included the women's socio-demographic and obstetric background, as well as physical and emotional well-being.

Support 

In Sweden the majority of women work outside the home and are financially independent. Although not made explicit, the definition embedded in the Swedish word for support usually means emotional support. The central variable for this study, women's satisfaction with partner support, was worded as follows: “What is your opinion of the support received from your partner”?, with four response alternatives “I receive all the support I need” (i), “I receive almost all support I need” (ii), “I only receive a small amount of support” (iii) and “I receive no support at all” (iv). In the analysis, the answers was dichotomized and labeled “Satisfied with partner support” (i+ii) and “Not satisfied with partner support” (iii+iv).

Physical well-being 

Physical well-being was investigated by means of an index of seven items which measured the most common reported symptoms in early pregnancy, the week prior to answering the first questionnaire (headache, neck and shoulder pain, low back pain, stomach ache, dysuria, sleeping problems and fatigue), on a six point rating scale ranging from zero (no problems at all) to five (serious problems). The total sum of scores was calculated for each woman and thereafter divided into five groups.

Emotional well-being 

Three validated instruments measuring different aspects of emotional well-being were used. First, the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-report scale widely used in research and screening for postnatal depressive symptoms.23 The scale ranges from 0 to 30 and we have used the cut-off of 14/15, as recommended when using the scale during pregnancy.24

Second, the Swedish version of the Cambridge Worry Scale, which primarily measures women's worries during pregnancy, was used. The scale includes 16 items comprising common worries during pregnancy, such as worries about health, the relationship with partner, the baby, and the forthcoming birth.25 The 5-point scale was added for each woman in order to calculate means and standard deviations. Thereafter the scale was dichotomized into minor (0–3) and major (4–5) worries. The dichotomized items were divided into four groups (no major worry, 1–2 major worries, 3–4 major worries and 5 or more major worries), in the bivariate analysis. In the regression analysis the variable was dichotomized into 0=no major worries/1=one or more major worries.

Third, the short (13 item) version of the Sense of Coherence scale developed by Antonovsky26 was also used. This scale employs a salutogenic perspective and measures coping abilities in terms of comprehensibility, manageability and meaningfulness. The scale ranges from 0 to 91 points. The total sum of the 7-point scale was calculated and thereafter dichotomized and labeled low (15–60) and high (61–91) scores. The dichotomization was based on previous Swedish research.26

Labor and birth data and situation 2 months postpartum 

Two months after childbirth questions about medical diagnosis, timing and mode of delivery was investigated together with feeding pattern and women's feelings of isolation and loneliness.

One year follow up 

One year postpartum questions about the relationship with the partner, women's satisfaction with partner's participation in childcare and housework, his understanding of her situation, and the woman's opinion about herself as a parent were investigated.

Analysis 

Descriptive statistics and epidemiological methods were used. The crude risk ratio was calculated for the different categories of the independent variables as the ratio between the percentage of women who were dissatisfied and satisfied with partner support in early pregnancy. A 95% confidence interval for the relative risk was estimated using a method developed by Mantel and Haentzel.27 In a logistic regression model the risk ratios were adjusted for potential confounders. The analyses were conducted using SPSS for Windows Version 12.0 (SPSS Inc., LEAD Technologies, Haddonfield, NJ, USA).

Ethical approval 

Written informed consent was collected from all women who agreed to participate in the study. The study was approved by the Regional Research and Ethics Committee of the Karolinska Institutet, Stockholm, Sweden

Back to Article Outline

Results 

Background characteristics 

The average age of the women was 29.5 years (range 17–45 years) at time of completion the first questionnaire. The sample included 1027 (44%) primiparas and 1313 (56%) multiparas. The sample characteristics were similar to those of a 1-year cohort of all women who gave birth in Sweden in 1999 (data collected from the Medical Birth Register), with the exception of fewer women who smoked (10% vs 12%) and fewer women born outside Sweden (8% vs 17%), the latter being due to the exclusion of non-Swedish speaking women from our study.

Proportion and characteristics of women dissatisfied with partner support 

At the antenatal registration in early pregnancy 108 women (4.6%) reported dissatisfaction with support from their partner.

Table 1 reveals that multiparous women were dissatisfied to a higher degree compared to primiparous women. Women who were not living with their partner in early pregnancy, women with a low level of education and women who smoked were more likely to be dissatisfied with support received from their partner. Dissatisfaction with partner support was associated with poor physical as well as poor emotional well-being (Table 2). We found a dose-response effect between the number of reported physical symptoms and dissatisfaction with partner support. The same pattern was found regarding major worries and dissatisfaction with partner support. Women who were dissatisfied were more likely to have a lower sense of coherence and to report that the pregnancy was at an unfavorable time or that they had considered abortion. When adjusted for potential background confounders, the majority of the factors identified remained significant.

Table 1. Socio-demographic background in relation to partner support in early pregnancy
Satisfied with support from partner (n=2232 n (%))Not satisfied with support from partner (n=108 n (%))RR (95% CI) for those not satisfied with partner supportp-value
Parity (mean, S.D.)1.4 (0.7)1.6 (0.9) 0.074
Primiparas996 (97.0)31 (3.0)1. 0 (Ref.)
Multiparas1236 (94.1)77 (5.9)1.9 (1.3–2.9)<0.01
Age (mean, S.D.)29.5 (4.6)29.9 (5.3) 0.245

Age groups
<25430 (95.6)20 (4.4)1.0 (0.6–1.7)0.933
25–351582 (95.6)72 (4.4)1. 0 (Ref.)
>35220 (93.2)16 (6.8)1.5 (0.9–2.6)0.098

Living with partner2160 (96.1)88 (3.9)1. 0 (Ref.)
Not living with partner72 (78.3)20 (21.7)5.5 (3.6–8.6)<0.001
Born in Sweden2047 (95.7)93 (4.3)1. 0 (Ref.)
Not born in Sweden173 (93.5)12 (6.5)1.5 (0.8–2.7)0.178

Educational level
Elementary School109 (87.9)15 (12.1)2.5 (1.5–4.2)<0.01
High School1214 (95.1)62 (4.9)1. 0 (Ref.)
College or University893 (96.9)29 (3.1)0.6 (0.4–1.0)0.046

Residential area
Large city723 (95.1)37 (4.9)1. 0 (Ref.)
Middle-sized city470 (95.7)21 (4.3)0.9 (0.5–1.5)0.627
Small town408 (95.1)21 (4.9)1.0 (0.6–1.7)0.984
Rural area605 (95.7)27 (4.3)0.9 (0.5–1.4)0.597

Did not smoke in early pregnancy2036 (95.9)93 (4.0)1. 0 (Ref.)
Smoked in early pregnancy183 (90.6)19 (9.4)2.3 (1.4–3.7)<0.001
Table 2. Physical and emotional well-being in relation to partner support in early pregnancy
Satisfied with support from partner (n=2232 n (%))Not satisfied with support from partner (n=108 n (%))Crude RR (95% CI) for those not satisfied with partner supportAdjusted RR (95% CI) for those not satisfied with partner supporta
In early pregnancy
Physical index (mean, S.D.)9.3 (5.1)11.6 (5.6)***

Number of reported symptoms
0–5568 (97.6)14 (2.4)1. 0 (Ref.)1. 0 (Ref.)
6–10831 (95.3)41 (4.7)2.0 (1.1–3.7)*2.1 (1.1–3.9)*
11–15566 (95.4)27 (4.6)1.9 (1.0–3.7)*2.0 (1.0–3.7)
16–20213 (91.8)19 (8.2)3.6 (1.8–7.3)***3.3 (1.5–6.9)**
>2053 (88.3)7 (11.7)5.3 (2.1–13.9)***4.1 (1.5–11.3)**

Edinburgh Depression Scale (EPDS) (mean, S.D.)7.411.8***

Number of depressive symptoms
No depressive symptoms (0–14)2106 (96.6)80 (3.4)1. 0 (Ref.)1. 0 (Ref.)
Depressive symptoms (15–30)126 (80.2)31 (19.8)6.7 (4.3–10.6)***4.9 (2.0–8.0)***

Cambridge Worry Scale (CWS) (mean, S.D.)15.323.4***

Number of major worries
No major worries1051 (97.9)22 (2.1)1. 0 (Ref.)1. 0 (Ref.)
1–2 major worries754 (94.4)44 (5.6)2.8 (1.6–4.7)***2.6 (1.5–4.4)***
3–4 major worries315 (91.6)29 (8.4)4.4 (2.5–7.8)***4.0 (2.2–7.3)***
5 or more major worries112 (89.6)13 (10.4)5.5 (2.7–11.3)***5.0 (2.3–10.5)***

Sense of coherence (mean, S.D.)69.758.1***
Low (15–60)422 (88.8)53 (11.2)4.1 (2.8–6.1)***3.7 (2.5–5.7)***
High (61–91)1808 (97.0)55 (3.0)1. 0 (Ref.)1. 0 (Ref.)

Timing of pregnancy
Pregnancy planned and welcome2148 (96.4)80 (3.6)1. 0 (Ref.)1. 0 (Ref.)
Unfavorable timing/abortion considered83 (74.7)28 (25.3)9.0 (5.6–14.7)***7.3 (4.3–12.3)***

aAdjusted for age, parity, civil status, education, smoking.

*p<0.05.

**p<0.01.

***p<0.001.

Women's situation 2 months postpartum 

Having a medical condition, length of pregnancy or mode of delivery was not associated with dissatisfaction with partner support (Table 3). Women who were dissatisfied with partner support felt more isolated and lonely 2 months after childbirth compared to women who were satisfied with partner support in early pregnancy and they were more likely to have given up breastfeeding at 2 months postpartum compared to women who were satisfied. However, when adjusting for socio-demographic background the difference in breastfeeding vanished.

Table 3. Labor outcome, breastfeeding and women's situation 2 months after childbirth
Satisfied with support from partner in early pregnancy (n=2232 n (%))Not satisfied with support from partner in early pregnancy (n=108 n (%))Crude RR (95% CI) for those not satisfied with partner supportAdjusted RR (95% CI) for those not satisfied with partner supporta
Length of pregnancy
Premature117 (93.6)8 (6.4)0.7 (0.3–1.5)0.6 (0.2–1.0)
Full-term2113 (95.5)100 (4.5)1.0 (Ref.)1.0 (Ref.)

Medical conditions during pregnancy
No1936 (95.1)100 (4.9)1.0 (Ref.)1.0 (Ref.)
Yes296 (97.4)8 (2.6)0.5 (0.2–1.1)0.5 (0.2–1.1)

Mode of delivery
Normal vaginal1756 (95.1)90 (4.9)1.0 (Ref.)1.0 (Ref.)
Instrumental vaginal169 (97.1)5 (2.9)0.6 (0.2–1.4)0.8 (0.3–2.0)
Elective caesarean section132 (96.4)5 (3.6)0.7 (0.3–12.8)0.7 (0.3–1.7)
Emergency caesarean section172 (95.6)8 (4.4)0.9 (0.4–1.9)1.0 (0.5–2.2)

Breastfeeding
Full1763 (95.8)77 (4.2)1.0 (Ref.)1.0 (Ref.)
Partly236 (94.0)15 (6.0)1.4 (0.8–2.6)1.2 (0.6–2.2)
No200 (92.6)16 (7.4)1.8 (1.1–3.2)*1.1 (0.6–2.2)

Feelings of isolation and loneliness
Much/very much2060 (95.7)92 (4.3)1.0 (Ref.)1.0 (Ref.)
Just a little/not at all171 (91.4)16 (8.6)2.1 (1.2–3.6)**2.3 (1.3–4.1)**

*p<0.05, **p<0.01.

aAdjusted for age, parity, civil status, education, smoking.

Women's situation 1 year postpartum 

Table 4 presents the result of the women's assessments 1 year postpartum. The marital relationship of women who were dissatisfied with support received from their partner tended to deteriorate, and it was more common for these women to have separated or divorced during the first postpartum year. Women who were not satisfied with partner support in early pregnancy were more likely to be dissatisfied with their partner's involvement in everyday activities related to housework and childcare 1 year after childbirth. They felt that their partner did not understand their situation and they were more likely to describe themselves as not being a good parent or having parental difficulties. These findings remained statistically significant when adjusting for potential confounders.

Table 4. Women's experiences of relationship and parenting skills 1 year after childbirth
Satisfied with support from partner in early pregnancy (n=2232 n (%))Not satisfied with support from partner in early pregnancy (n=108 n (%))Crude RR (95% CI) for those not satisfied with partner supportAdjusted RR (95% CI) for those not satisfied with partner supporta
The relationship after childbirth
Improved680 (97.6)17 (2.4)0.6 (0.3–1.1)0.7 (0.4–1.2)
Neither better nor worse1275 (96.0)53 (4.0)1.0 (Ref.)1.0 (Ref.)
Worse226 (91.1)22 (8.9)2.3 (1.4–3.9)***2.5 (1.5–4.)***

Divorce or separation
During the first postpartum year31 (72.1)12 (27.9)8.9 (4.4–17.7)***7.4 (3.4–15.8)***
Never or earlier in life2196 (95.8)96 (4.2)1.0 (Ref.)1.0 (Ref.)

Partners participation in childcare and housework
Satisfied1210 (98.1)24 (1.9)1.0 (Ref.)1.0 (Ref.)
Not satisfied986 (90.2)74 (7.0)3.8 (2.4–6.0)***3.3 (2.0–5.3)***

Partners understanding of the woman's situation
Complete/nearly complete1719 (97.3)47 (2.7)1.0 (Ref.)1.0 (Ref.)
Partial/none whatsoever476 (90.2)52 (9.8)4.0 (2.6–6.0)***3.6 (2.4–5.6)***

The mother's opinion of herself as a parent
I am a very good/good parent1943 (96.0)82 (4.0)1.0 (Ref.)1.0 (Ref.)
I am an average/not a good parent/problems with being a parent277 (91.4)26 (8.6)2.2 (1.4–3.5)***2.2 (1.3–3.5)***

***p<0.001.

aAdjusted for age, parity, civil status, education, smoking.

Back to Article Outline

Discussion 

One finding in this study was that the proportion of women dissatisfied with partner support was 5%. When translated to all women giving birth in Sweden every year, this figure correspond to at least 5000 women who will experience lack of partner support in early pregnancy. Another finding was that dissatisfaction with partner support in early pregnancy was associated with the women's emotional well-being, depressive symptoms, major worries and consideration of abortion. In addition, women who were dissatisfied with partner support were more likely to go through a divorce or separation during the first postpartum year. Similar findings have been reported from Australia28 where 200 new mothers were followed during 6 months after childbirth and a significant decrease in satisfaction with partner support occurred over time.

The finding that multiparous women more often experienced lack of support may be explained by the heavy workload of household tasks and their previous experience of being a new mother. The findings can also imply that Swedish men do not take as much responsibility as women would like. Earlier research suggests that co-parenting interventions might be of great value especially around the birth of the first child.29

Women who were not living with their partner in early pregnancy were more likely to be dissatisfied with partner support, as were women whose pregnancy was unplanned or who had considered abortion. One can assume that these aspects are related. A relationship that starts with a pregnancy could be more challenging than if a couple has been living together for several years and planned the pregnancy. It is also known that women and men have ambivalent feelings about pregnancy and could be unsure when they are ready to become a parent.30 A woman's ambivalence could also be affected by hormonal changes and the physical discomfort in early pregnancy as well as the partner's attitude to the pregnancy. A negative attitude is likely to result in less support which in turn prompts the woman to consider abortion, which is in line with previous findings.16

Dissatisfaction with partner support was associated with the women's emotional well-being to a high degree. The association between lack of partner support and lack of emotional well-being can be understood in several ways. One explanation is that there is a real association between for example depressive symptoms and lack of support, another is that women with depressive symptoms need more support than the partner is able to provide or that the woman is unable to recognize the support given. Irrespectively of depressive symptoms and worries in early pregnancy, relationship problems and low self-esteem are predictors of postpartum depression,31 implying that these women are even more at risk. Lack of emotional well-being will not only affect the woman, but also the child.32 Depressive mood and anxiety during pregnancy have been associated with fetal development, such as low birthweight,33 less breastfeeding and difficulties in mothering34 as well as dysregulation in behavior, physiology, sleeping patterns and elevated levels of cortisol in the child.35 It is therefore very important to identify these women to be able to refer them for treatment as there is evidence of association between successful treatment of parents’ depression and improvement in children's symptoms and functioning.36

Contrary to previous research,32, 33, 34, 35, 36, 37 none of the variables of labor outcome in this study were significantly associated with dissatisfaction with partner support. Previous research has mainly focused on the importance of social support, especially from the partner, in relation to the use of pain relief methods,17 complications during labor11 and overall birth experience.33, 34, 35, 36, 37, 38

Women who were dissatisfied with partner support were more likely to undertake a separation or divorce from their partner. It is likely to assume that these women's lives and parenthood become complicated in some ways, in terms of shared custody, which usually is recommended in Sweden after separation.

Despite the fact that extensive resources have been allocated to promote gender equality among new parents in Sweden, our findings demonstrate that nearly half of the women were dissatisfied with their partner's participation in childcare and household chores at 1 year postpartum, which is in line with previous studies. Gjerdingen et al.34, 35, 36, 37, 38, 39 reported a decline in the amount of housework performed by partners after childbirth, and the Swedish government's investigation of 1300 couples2 revealed that men appreciate being fathers and to be involved in caring for their children, but are less interested in sharing housework and household chores.

Back to Article Outline

Strength and limitations 

A strength of this study is that we could identify a large unselected national cohort from a free antenatal care system that encompasses almost all Swedish women. Another strength is the fairly high participation rate and the fact that the longitudinal design made it possible to follow up women's experiences over a period of time. An additional strength is the similarity with all women who gave birth in Sweden in 1999, which makes it possible to generalize our findings to Swedish speaking childbearing women.

One limitation is that the study design makes it impossible to draw definite conclusions about the consequences of lacking partner support. The study focuses on women's experiences of support; we have no information about the actual support received.

Back to Article Outline

Conclusions 

This study shows that it might be possible to identify women who are lacking partner support in early pregnancy. Increased awareness of pregnant women's emotional status might increase midwives motivation to identify women who are symptomatic or at risk. The risk factors identified will not only affect the woman's health but also the child's. It is therefore vital to regularly investigate women's marital and social network, and, if necessary, find alternative sources of support to strengthen the network or refer women at risk to available community resources. Public health care providers such as midwives in antenatal care and nurses in child health care, who meet prospective and new mothers and families on a regular basis, are in a unique position to target the importance of social support during the childbearing and postpartum period and may play a critical role in mobilizing support systems for new mothers and fathers. Antenatal classes or groups with single mothers or mothers who lack partner support could be organized within the health care sector and by working closely with other health professionals such as psychologists and social workers future problems might be solved. Successfully identification and extra support when needed is one potential strategy for improving the health of pregnant women and their children.

More research should be encouraged to develop valid screening tools for clinical use and new psychosocial care models for implementation into clinical practice.

Back to Article Outline

Acknowledgment 

The study was funded by Mid Sweden University, Mälardalen University, the Karolinska Institutet and the Vårdal foundation.

Back to Article Outline

References 

  1. Aberg A, Lindmark G. Competence and compliance in antenatal care Experience from Sweden. Int J Technol Assess Health Care. 1992;8(Suppl. 1):20–24
  2. SOU. Swedish Official Report. “Ty makten är din....Myten om det rationella arbetslivet och det jämställda Sverige”. Ett betänkande från Kvinnomaktutredningen [“For thine is the power…The myth of the rational working life and equal Sweden”]. Stockholm: Statens Offentliga Utredningar [Swedish Official Report Series]; 1998:6, p. 1–256.
  3. Fabian H, Radestad I, Waldenström U. Childbirth and parenthood education classes in Sweden. Women's opinion and possible outcomes. Acta Obstet Gynecol Scand. 2005;84(5):436–443
  4. Cobb S. Social support as a moderator of life stress. Psychosom Med. 1976;38:300–312
  5. Cooke BD, Rossman MM, McCubbin HI, Pattersson JM. Examining the definition and assessments of social support: a resource for individuals and families. Fam Relat. 1998;37:211–216
  6. House JS. Work stress and social support. Reading: Addison-Wesley; 1981;p. 1–156
  7. Bloom JR. The relationship of social support and health. Soc Sci Med. 1990;30(5):635–637
  8. Nuckolls KB, Kaplan HB, Cassel J. Psychosocial assets, life crisis and the prognosis of pregnancy. Am J Epidemiol. 1972;95(5):431–441
  9. Rodriguez A, Bohlin G, Lindmark G. Symptoms across pregnancy in relation to psychosocial and biomedical factors. Acta Obstet Gynecol Scand. 2001;80(3):213–223
  10. Saurel-Cubizolles MJ, Romito P, Ancel PY, Lelong N. Unemployment and psychological distress one year after childbirth in France. J Epidemiol Community Health. 2000;54(3):185–191
  11. Gjerdingen DK, Froberg DG, Fontaine P. The effects of social support on women's health during pregnancy, labor and delivery, and the postpartum period. Fam Med. 1991;23(5):370–375
  12. Webster J, Linnane JW, Dibley LM, Pritchard M. Improving antenatal recognition of women at risk for postnatal depression. Aust N Z J Obstet Gynaecol. 2000;40(4):409–412
  13. Sjostrom H, Langius-Eklof A, Hjertberg R. Well-being and sense of coherence during pregnancy. Acta Obstet Gynecol Scand. 2004;83(12):1112–1118
  14. Tarkka MT, Paunonen M. Social support and its impact on mothers’ experiences of childbirth. J Adv Nurs. 1996;23(1):70–75
  15. Dejin-Karlsson E, Hanson BS, Ostergren PO. Psychosocial resources and persistent smoking in early pregnancy—a population study of women in their first pregnancy in Sweden. J Epidemiol Community Health. 1996;50(1):33–39
  16. Kroelinger CD, Oths KS. Partner support and pregnancy wantedness. Birth. 2000;27(2):112–119
  17. Ip WY. Relationships between partner's support during labour and maternal outcomes. J Clin Nurs. 2000;9(2):265–272
  18. Norbeck JS, Anderson NJ. Life stress, social support, and anxiety in mid- and late-pregnancy among low income women. Res Nurs Health. 1989;12(5):281–287
  19. O’Hara M, Swain A. Rates and risk of postpartum depression-a meta-analysis. Int Rev Psychiatry. 1996;8(4):37–54
  20. Rubertsson C, Wickberg B, Gustavsson P, Rådestad I. Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Women Ment Health. 2005;8(2):97–104
  21. Ekstrom A, Widstrom AM, Nissen E. Breastfeeding support from partners and grandmothers: perceptions of Swedish women. Birth. 2003;30(4):261–266
  22. Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery. 2002;18(2):87–101
  23. Wickberg B, Hwang CP. The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample. Acta Psychiatr Scand. 1996;94(3):181–184
  24. Murray D, Cox J. Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). J Reprod Infant Psychol. 1990;8(2):99–107
  25. Ohman SG, Grunewald C, Waldenstrom U. Women's worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women. Scand J Caring Sci. 2003;17(2):148–152
  26. Langius A, Bjorvell H, Antonovsky A. The sense of coherence concept and its relation to personality traits in Swedish samples. Scand J Caring Sci. 1992;6(3):165–171
  27. Rothman K. Epidemiology an introduction. New York: Oxford University Press; 2002;p. 1–223
  28. McVeigh C. Investigating the relationship between satisfaction with social support and functional status after childbirth. MCN Am J Matern child Nurs. 2000;25(1):25–30
  29. Feinberg ME. Coparenting and the transition to parenthood: a framework for prevention. Clin Child Fam Psychol Rev. 2002;5(3):173–195
  30. Wikman M, Jacobsson L, Joelsson I, Bo von Schoultz . Ambivalence towards parenthood among pregnant women and their men. Acta Obstet Gynecol Scand. 1993;72(8):619–626
  31. Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–285
  32. Louma I, Tamminen T, Kaukonen P, Laippala P, Puura K, Samelin R, et al. Longitudianal study of maternal depressive symptoms and child well-being. J Am Acad child Adolesc Psychiatry. 2001;40:1367–1374
  33. Teixeira JM, Fisk N, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ. 1999;318:153–157
  34. Green J, Murray D. The use of Edinburgh postnatal depression scale in research to explore the relationship between antenatal and postnatal dysphoria. In:  Cox JL,  Holden JM editor. Perinatal psychiatry: use and misuse of Edinburgh Postnatal Depression Scale. London: Gaskell; 1994;p. 180–196
  35. Field T. Maternal depression effects on infants and early interventions. Prev Med. 1998;27:200–203
  36. Gunlicks ML, Weissman MM. Change in child psychopathology with improvement in parental depression: a systematic review. J Am Acad Child Adolesc Psychiatry. 2008;47(Apr (4)):379–389
  37. Orr ST. Social support and pregnancy outcome: a review of the literature. Clin Obstet Gynecol. 2004;47(4):842–855
  38. Waldenstrom U, Hildingsson I, Rubertsson C, Rådestad I. A negative birth experience: prevalence and risk factors in a national sample. Birth. 2004;31(1):17–27
  39. Gjerdingen DK, Center BA. The relationship of postpartum partner satisfaction to parents’ work, health, and social characteristics. Women Health. 2004;40(4):25–39

PII: S1871-5192(08)00055-3

doi:10.1016/j.wombi.2008.07.003

Women and Birth
Volume 21, Issue 4 , Pages 141-148, December 2008

Article Tools