The Relationship with Prenatal Attachment of Psychosocial Health Status of Pregnant Women

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1 Intenational Jounal of HealthSciences Mach 2017, Vol. 5, No. 1, ISSN: (Pint), (Online) Coyight The Autho(s). AllRightsReseved. PublishedbyAmeicanReseachInstitutefoPolicy Develoment DOI: /ijhs.v5n1a6 URL: htts://doi.og/ /ijhs.v5n1a6 The Relationshi with Penatal Attachment of Psychosocial Health Status of Pegnant Women Hediye Kaakoça 1 & Hava Ozkanb 2 Abstact Puose: The study examines the elationshi between sychosocial health status of egnant women and enatal attachment and the factos influencing it. Methods: The study was conducted as descitive and coelation. The study was caied out with 305 egnant women in the study and met the inclusion citeia. The data wee collected by using the esonal infomation fom, the Pegnancy Psychosocial Health Assessment Scale and Peatal Attachment Inventoy. The data wee assessed by using descitive statistics, Reliability test, t-test, One- Way Analysis of Vaiance, Kuskall Wallis, Mann Whitney-U and Peason Coelation Analysis. Results: Pegnant woman s and he husband's education status, duation of maiage, numbe of egnancies, numbe of living childen, abotion histoy, status of go to egula contol, status of egnant woman and husband to intent the egnancy, numbe of still bith sand gende of infant affected the level of enatal attachment. It was detemined statistically significant ositive coelation between sychosocial health status sychosocial health status of egnant women and enatal attachment. Conclusion:Psychosocialhealth of egnantwomen, as thelevelinceases, it is foundthatthelevel of enatal attachment is alsoinceased. Keywods:midwives, egnantwomen, enatal attachment, sychosocialhealth,theocess of egnancy. Intoduction A socially comlete well-being, in othe wods not having any oblem in social life is defined as sychosocial health (Kesgin & Touzoğlu, 2006). The souce of sycho-social eactions duing egnancy constitutes the esence of foetus, hysiological changes and diffeences occuing within the family and social life (Da Costa, Laouche, Ditsa, & Bende, 1999; Nelson, 2003; Babacan Gümüş, Çevik, Hataf Hyusni, Biçen, Keskin, & Tuna Malak,2011). It has been eoted that mental and emotional life of the egnant woman may affect the couse of egnancy, and additionally egnancy is effective uon sychological and emotional life as well (Kuğu & Akyüz, 2001; Matthey, 2005; Babacan Gümüş, Çevik, Hataf Hyusni, Biçen, Keskin, & Tuna Malak, 2011). Theefoe, egnancy is elated to imotant hysiological and sychological changes that may affect enatal attachment (Eswi, & Khali, 2012). Backgound The tem of enatal attachment is used to define the emotional bond established between the mothe and he infant duing egnancy which takes lace in emotional, cognitive and behavioual asects (Salisbuy, Law, LaGasse, & Leste,2003;McFaland, Salisbuy, Battle, Hawes, Halloan, & Leste, 2011). Penatal attachment initiates when a ositive eaction is given to egnancy. 1AMsc.,PhDStudent, Lectue,Deatment of Midwifey, College of HealthScience, KTO Kaatay Univesity, Konya, Tukey, e- mail : hediye.bekmezci@kaatay.edu.t 2 b RN, PhD, AssistantPofesso,Deatment of Midwifey, Faculty of HealthScience, AtatukUnivesity, Ezuum, Tukey, havaoan@atauni.edu.t

2 Hediye Kaakoça & Hava Ozkanb 37 A egnant woman with a high enatal attachment level believes to have established a bond with he unbon baby and consides the foetus a seaate individual. She is also awae that the foetus is deendent on he on mattes such as feeding and otection. She thinks about what the baby will look like, how it will move and what kind of a develoment it will show duing thei lifetime. The affections elated to attachment hel the egnant woman show moe affection, comassion, and love to he baby, otect, feed and ay attention to the baby, inteact with the baby and be sensitive to the needs of the foetus (Ryan, 2010;Duyan, Kaısız, & Yakut, 2013). Biological adatation and sycho-social changes duing the hases of egnancy and bith may lead to sychological disodes such as deession (Danaci, Dinç, Deveci, Şen, & İçelli, 2002;Hegüne, Çiçek, Annagu, Hegüne, & Os, 2014). Deessive symtoms such as iitability, soow, and the feeling of unwothiness may inteut the egnant woman s elationshi with the foetus (Lindgen, 2001). In egnancy follow-us, tyically biological and hysiological changes of egnancy ae focused and egnancy s sychological asect is excluded fom the aeas of inteest and following as long as a cetain disode does not develo (Kuğu, &Akyüz, 2001). The Ameican Congess of Obsteticians and Gynecologists (ACOG) defines sychosocial factos as non-biomedical factos that affect mental and hysical wellbeing. ACOG ecommends that sycho-social sceening should be efomed at least once in evey timeste in ode to educe the consequences of unintended egnancies and incease the ossibility of identifying significant oblems (Cunnigham, Leveno, Bloom, Houth, Rouse, & Song, 2010). The egnant woman and the foetus ae affected as a esult of sycho-social oblems affecting the egnant woman s mental health negatively duing egnancy. As a esult, the mothe s and newbon s health in the ostnatal eiod and theefoe family and community health ae affected (Yıldız, 2011). Although thee is a hyothesis that the mental state and enatal attachment duing egnancy ae imotant in tems of the mothe s and infant s health; when the coelation between them is analysed, it is stated that thee ae vey few studies conducted on this matte until ecently and findings ae inconsistent (Hat, &McMahon, 2006;McFaland, Salisbuy, Battle, Hawes, Halloan, & Leste, 2011;Walsh, Hee, Bagge, Wadehul, & Jomeen, 2013). It is imotant to make aoiate inteventions to identify egnant woman who cay the isk of insufficient attachment in egnancy and eae the woman fo mothehood. Howeve, although it has been eoted that some inteventions hel incease mothe-infant attachment duing egnancy, thee ae numeous asects that need to be enlightened in tems of what factos hel incease attachment and what factos event attachment (Yılmaz, 2013). The numbe of studies analysing the coelation between egnant women sycho-social health conditions and enatal attachment is vey limited (Bouchad, 2011;Abasi, Tafazzoli, Esmaily, & Hasanabadi, 2013). Mateials and Methods: Studydesign Thestudywasconducted as descitiveandcoelational. Reseach questions What is the sycho-social health level of egnant women? What is the enatal attachment level of egnant women? Ae socio-demogahic chaacteistics of egnant women elated to thei enatal attachment levels? Is thee any diffeence between the obstetic chaacteistics of egnant women and thei enatal attachment levels? Ae sycho-social health levels of egnant women elated to enatal attachment? Paticiants The oulation of the study consisted of the egnant women who alied to Nene Hatun Matenity Hosital s outatient clinics between Setembe 2014 and Febuay 2015 and met the study s inclusion citeia. The study s samle calculation was conducted by using G* Powe ogamme. In the study whee the scale mean scoe was found to be 61.72±10.72 (Yılmaz, & Beji, 2013), effect size was taken as 0.20, α=0.05, and owe was taken as 95% and theefoe the samle size was calculated as 305 egnant women. Random samling method, which is one of the imobable samling methods, was used fo samling selection.

3 38 Intenational Jounal of HealthSciences, Vol. 5(1), Mach 2017 Pegnant women s inclusion citeia included (Yılmaz, & Beji, 2013) having a egnancy above 20 weeks, having a healthy fetus, being 18 and ove, being sychologically and mentally healthy, having conceived sontaneously, having no chonic diseases and egnancy-elated systematic oblems, having no theatened etem labo and ematue utue of membane and being at least imay school gaduates. Measues Pesonal Infomation Fom eaed by the eseache, Pegnancy Psychosocial Health Assessment Scale, and Penatal Attachment Inventoy wee used fo the collection of study s data. Pesonal Infomation Fom Pesonal Infomation Fom was eaed by eseaches in line with the liteatue. The fom consisted of questions elated to egnant women socio-demogahic (egnant women age, education, lace of esidence, duation of maiage, emloyment status, husband s educational and emloyment statuses, income state ecetion, family tye) and obstetic chaacteistics (numbes of egnancies, suviving childen, stillbiths and abotus, gende of infant, attending medical contols, status of the egnant woman and he husband intending the egnancy). Pegnancy Psychosocial Health Assessment Scale (PPHAS) The scale develoed by Yıldız (2011) sychosocial health duing egnancy is evaluated as a whole. The scale involves 46 items and 6 subscales. Subgou indicate whethe thee ae oblems in tems of conditions affecting sychosocial health. 13 items in the fist subscale of the scale involve Featues egading the elationshi of egnancy and husband, 8 items in the second subscale Featues egading anxiety and stess, 7 items in the thid subscale Featues egading domestic violence, 7 items in the fouth subscale Featues egading the need fo a sychosocial suot, 4 items in the fifth subscale Family featues and 6 items in the sixth subscale involve Featues egading egnancy-elated hysical-sychosocial changes. PPHAS is a 5-oint liket scale. The scale of 29 items 1=vey much, 2=much, 3=modeate, 4=least, 5=neve being shaed scoed, 17 items in the (1, 2, 3, 5, 6, 8, 16, 17, 18, 19, 20, 31, 32, 33, 34, 35, 42) is coded as 5=vey much, 4=much, 3=modeate, 2= least, 1=neve. Mean scoes of items ae detemined by dividing the total scoe obtained fom the assessment of the scale into the numbe of items and the esult is between 1 and 5. When the total scoe diveges fom 5 to 1, it signifies a oblem in the sychosocial health duing egnancy. 1 oint obtained fom the scale signifies that the sychosocial health is vey bad. The same assessment is also made in the subscales. The Conbach Alha eliability coefficient of the PPHAS was detemined as 0.93 (Yıldız, 2011).In this study, Conbach Alha coefficient was found as Penatal Attachment Inventoy (PAI) Penatal Attachment Inventoy was develoed by May Mulle in 1993 (Mulle, 1993). It was adated totukish by Deeli Yılmaz and Beji in 2009 (Yılmaz, 2010; Yılmaz, & Beji, 2013). This inventoy, evaluating enatal attachment subjectively, includes 21 items. It is a 4-liket tyescaledeveloedtodetemineegnantwomen sfeelings, thoughts, andconditionsduingegnancy, andtheilevels of attachment with the fetus in enatal eiod. Whilethelowestscoeto be eceived fom the inventoy is 21, thehighestscoe is 84. Highescoesindicatehighe enatal attachment. Yılmaz and Beji secified the inventoy s Conbach Alha eliability coefficient as 0.84 (Yılmaz, & Beji, 2013). Inthisstudy, Conbach Alha coefficientwasfound as Data collection The data wee collected between 15 Setembe 2014 and 27 Febuay 2015 by using face-to-face inteview method. Peliminay alication was conducted on 10 egnant women befoe initiating the study in ode to evaluate the intelligibility of questions in the questionnaie fom. It was obseved afte this alication that no change was needed on the data collection fom. Peliminay alication data wee not included in the data of the study. Inteviews lasted a total of 30 minutes; 5 minutes of which wee allocated fo the esonal infomation fom and the emaining 25 minutes wee allocated fo the scales fo each egnant woman. Indeendent vaiables of the study Socio-demogahic chaacteistics of egnant women

4 Hediye Kaakoça & Hava Ozkanb 39 Obstetic chaacteistics of egnant women Mean scoe of egnant women sychosocial health condition Deendent vaiables of the study Penatal attachment mean scoe Data analyses Suitability of the study s data to nomal distibution was detemined with Lilliefos Kolmogoov-Sminov test and nomal distibution cuve, Skewness and Kutosis tests and it was found that the data demonstated a nomal distibution. Data wee evaluated in SPSS 20.0 statistical ackage ogamme by using descitive statistics, Reliability test, t-test, One-way Analysis of Vaiance, Kuskall Wallis, Mann Whitney-U, and Peason Coelation Analysis. Pocedue Pemissions wee obtained fom the esidency of the ethics committee and fom the hosital whee the study was lanned to be conducted. Vebal consents wee eceived afte infoming aticiants egading the uose of the study befoe filling in the questionnaies. Results When socio-demogahic chaacteistics of the egnant women wee analysed; it was detemined that 41.6% wee in the age gou of 20-24, 35.7% wee imay school gaduates, 77.0% esided in cities, 32.5% wee maied fo 1 yea o less, and 89.5% wee unemloyed. 37.0% of egnant women s husbands wee found to be high school gaduates and 93.4% wee emloyed. It was found that 59.0% of egnant women had incomes equal to thei exenses and 68.2% had nuclea family stuctues. When obstetic chaacteistics of the egnant women wee examined; 49.2% wee found to have thei fist egnancies, 53.4% did not have suviving childen, 95.7% did not have stillbiths, and 88.5% did not have miscaiage. 52.5% of the egnant women wee found to have male infants, and 85.2% went to egula follow-us. 78.0% of egnant women eoted that they wanted and lanned thei egnancies; wheeas, 83.9% of thei husbands wanted and lanned the egnancy. It was found in the study that egnant women s minimum PAI scoes was 25, maximum PAI scoe was 83 and the total mean scoe was 56.97± In PPHAS scoes of the egnant women, minimum scoe was 2.59, maximum scoe was 4.85 and the total mean scoe was 4.15±0.40. Accoding to the PPHAS subscales in the study; egnancy and elationshi with husband subscale mean scoe was 4.20±0.58, anxiety and stess subscale mean scoe was 3.77±0.75, domestic violence subscale mean scoe was 4.53±0.389, sychosocial suot need subscale mean scoe was 3.85±0.67, familial chaacteistics subscale mean scoe was 4.40±0.58, and egnancy-elated hysical sychosocial changes subscale mean scoe was 4.21±0.63 (Table 1). Table 1.Thelowestandhighestscoesthat can be eceivedandaeeceivedfompai and PPHAS byegnantwomenanddistibution of meanscoes Scale TheLowestandHighestScoesTo Be Received TheLowestandHighestScoesReceived ReceivedMeanScoe X±SS PAI ±11.58 PPHAS ±0.40 Relationshi of ±0.58 egnancyandhusband Anxietyandstess ±0.75 Domesticviolence ±0.39 Needfo a sychosocialsuot ±0.67 Familyfeatues ±0.58 Pegnancy-elatedhysicalsychosocialchanges ±0.63 Penatal attachment mean scoe of egnant women who wee imay school gaduates was 53.86±11.51 and the mean scoe of egnant women who wee univesity gaduates was 61.74±10.05, and the diffeence between

5 40 Intenational Jounal of HealthSciences, Vol. 5(1), Mach 2017 the mean scoes was found to be statistically significant (=0.001, Table 2). The diffeence between maiage duations and enatal attachment mean scoes was statistically significant (=0.000, Table 2). Penatal attachment mean scoe of egnant women s husbands who wee imay school gaduates was 51.38±12.54; wheeas the mean scoe of the husbands who wee univesity gaduates was 58.14±11.06, and the diffeence between the mean scoes was statistically significant and the diffeence was caused by the gou of imay school gaduates (=0.001, Table 2). The diffeence between egnant women s age gou (=0.265), lace of esidence (=0.139), emloyment status (=0.147), husband s emloyment status (=0.188), income state (=0.376), family tye (=0.134) chaacteistics and enatal attachment mean scoes was not statistically significant (Table 2). Table2. Comaingthesocio-demogahicchaacteistics of egnantwomenwithmeanscoes of PAI (N=305). Socio-demogahicchaacteistics n % X±SD Test and value Age gou 19 yeasandbelow yeas yeas 30 yeasandabove Education Pimayschool Secondayschool High school Gaduateschool Place of esidence Village Distict Povince Duation of maiage 1 yeasandbelow 2-4 yeas 5-9 yeas 10 yeasandabove Wokingcondition Emloyed Unemloyed Education of husband Pimayschool Secondayschool High school Gaduateschool Wokingcondition of husband Emloyed Unemloyed Pecetion of incomestatus Lessincomethanexense Equalincomeandexense Moeincomethanexense FamilyTye NucleaFamily ExtendedFamily ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±12.04 KW=3.971 =0.265 F=5.873 =0.001 F=1.987 =0.139 F=7.117 =0.000 t=1.454 =0.147 F=5.284 =0.001 Z= =0.188 F=0.980 =0.376 t=1.502 =0.134 Penatal attachment mean scoe of egnant women who had one egnancy was 60.42±10.42, the mean scoe of egnant women who had fou o moe egnancies was 48.35±9.85, and the diffeence between the mean scoes was statistically significant (=0.000, Table 3). The diffeence between the mean scoes of gous in which women had thee egnancies and fou o moe egnancies was significantly low. The diffeence between the numbe of suviving childen and enatal attachment mean scoe was statistically significant (=0.000, Table 3). The diffeence was found to be aising fom the gou of women who had no suviving childen. The enatal attachment mean scoe of egnant women who did not have

6 Hediye Kaakoça & Hava Ozkanb 41 any stillbiths was 57.32±11.50, the mean scoe of egnant women who had one stillbith was 49.23±10.99 and the diffeence between the mean scoes was statistically significant (=0.013, Table 3). Penatal attachment mean scoe of egnant women who did not have any abotus histoy was 57.86±11.18, enatal attachment mean scoe of women who had abotus histoy was 50.11±12.44 and the diffeence between the mean scoes was statistically significant (=0.000, Table 3). The diffeence was found to be aising fom the gou of women who had abotus histoy. The diffeence between the enatal attachment mean scoes accoding to the infant s gende was statistically significant (=0.002, Table 3). It was found that the diffeence was aisen fom the gou of women who did not know the gende of thei infants and the mean scoe was low. Penatal attachment mean scoe of egnant women who egulaly went to thei medical contols was 58.03±10.87, the mean scoe of those who did not egulaly go to contols was 50.82±13.61 and the diffeence between the mean scoes was statistically significant (=0.000, Table 3). The diffeence between state of the egnant woman and he husband to want the egnancy (=0.000, Table 3) and enatal attachment mean scoes was statistically significant. In the advanced analysis, the diffeence was aisen fom the gou who wanted and lanned the egnancy. Table3. Comaingtheobsteticalchaacteistics of egnantwomenwithmeanscoesof PAI (N=305). Obsteticalchaacteistics n % X±SS Test and value Numbe of egnancies andabove ± ± ± ±9.85 F= =0.000 Numbe of childenliving Not Numbe of Stillbiths No 1 Numbe of abotions No Yes Gende of Infant Female Male Do not know Status of gotoegulacontol Yes No State of intendingtheegnancy I wasintendingandlanningtheegnancy I wasintendingtheegnancy, but foanothe time in thefutue I wasintendingtheegnancyneithefotheesent time nothefutue I was not intendingtheegnancy; but, when I conceived, I acceted it State of thehusbandtointendtheegnancy He wanted me toconceiveandlannedtheegnancy He wanted me toconceive, but foanothe time in thefutue He wanted me toconceiveneithefotheesent time nothefutue He did not want me toconceive; but when I did, he acceted it ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±10.64 KW= =0.000 Z= =0.013 t=3.805 =0.000 KW= =0.002 t=3.950 =0.000 KW= =0.000 KW= =0.000

7 42 Intenational Jounal of HealthSciences, Vol. 5(1), Mach 2017 A ositive significant coelation was detemined between PPHAS and PAI mean scoes. When the coelation between PPHAS subscale mean scoes and PAI mean scoes was analysed; a ositive significant coelation was found between egnancy and elationshi with the husband (=0.000), anxiety and stess (=0.001), domestic violence (=0.040), sychosocial suot need (=0.015), familial chaacteistics (=0.000) mean scoes and PAI mean scoes (Table 4). The diffeence between the egnancy-elated hysical-sychosocial changes subscale and PAI mean scoe was not statistically significant (=0.939, Table 4). Table4. Theelationshibetweenmeanscoeof PPHAS andmeanscoeof PAI. Scales PPHAS Relationshi of egnancyandhusband Anxietyandstess Domesticviolence Needfo a sychosocialsuot Familyfeatues Discussion and Conclusion Pegnancy-elatedhysical-sychosocialchanges PAI 0.307** ** ** * * ** In esonse to the eseach question, What is the enatal attachment level of egnant women?, egnant women s enatal attachment levels wee found to be modeate. The esults of the studies conducted by Yılmaz and Beji (2010) and Metin (2014) wee comatible with the esult of this study. The fact that the sychosocial health of egnant women in the study was found to be on a good level was found as the eseach question, What is the sychosocial health level of egnant women?. In thei studies, Uça (2014) and Keskin (2014) secified that the sychosocial health of egnant women was at good/vey good levels. Pegnant women s anxiety and stess subscale and sychosocial suot need subscale wee at a medium level. In his study, Uça (2014) eoted that anxiety and stess subscales wee at a medium level. The study esults wee simila. Howeve, in a study conducted by Yıldız (2011), it was stated that distinct oblems ae exeienced aticulaly in tems of anxiety and stess subscales and the sychosocial health of egnant women at total was at a medium level. This diffeence may have aisen fom the locations that the studies wee conducted and aticiants chaacteistics. That is to say; the study of Yıldız (2011) was conducted in health centes and the educational levels of egnant women wee mostly imay schools, wheeas this study was conducted in a matenity hosital and egnant women wee mostly high school and univesity gaduates, which may have cause the diffeence. As the age of egnancy inceased, enatal attachment mean scoe educed; howeve, no statistically significant diffeence was found. In such a way to suot the study s esult, thee ae studies indicating that thee is no significant coelation between enatal attachment duing egnancy and mothe s age (Abasi, Tahmasebi, Zafai, & Nasii Takami, 2012; Metin, 2014). Ustunsoz et al., (2010) stated that mothe-infant attachment educed as the age of egnancy inceased; wheeas, Lindgen (2001) eoted that egnant women in younge age gou had highe enatal attachment levels than egnant women in olde age gou, Rubetsson et al., (2014) eoted that a low level of attachment was obseved among women olde than the age of 25. The diffeence between egnant women s educational levels and enatal attachment mean scoes was found to be statistically significant. Ustunsoz et al., (2010) secified a ositive coelation between education and enatal attachment, and Kwon and Bang (2011) stated that women with lowe educational levels had lowe enatal attachment levels. This esult makes us think that eole with highe educational level ae likely to be in the emloyed gou, detemine thei ioities in tems of lanning thei lives and ae highly eaed fo the decision of being aents.

8 Hediye Kaakoça & Hava Ozkanb 43 The diffeence between egnant women s duations of maiage and thei enatal attachment mean scoes was found to be statistically significant. In his study, Metin (2014) secified a significant coelation between the duation of maiage and enatal attachment. Accoding to the esult of this study; as age and duation of maiage inceased, enatal attachment deceased. Although thee was no significant diffeence, enatal attachment mean scoe of emloyed egnant women was highe than the enatal attachment mean scoes of unemloyed egnant women. In addition, enatal attachment mean scoes of women whose husbands wee unemloyed wee found to be low. This esult indicates that individuals emloyment statuses may affect the cae eceived by egnant women and einfoce enatal attachment. The diffeence between husbands education and enatal attachment mean scoes was also statistically significant. Penatal attachment levels of egnant women and husbands with high educational levels wee high. Highe educational levels ensue that both the egnant woman and he husband ae moe knowledgeable about egnancy. Theefoe, the husband may suot the egnant woman eceive bette cae and consequently make contibution to develoment of enatal attachment. Pegnant women s income statuses wee not found to be affecting enatal attachment and be statistically significant. Simila studies have eoted no coelation between mothe-infant attachment and income status duing egnancy (Lindgen, 2001; Yılmaz,& Beji, 2010;Abasi, Tahmasebi, Zafai, & Nasii Takami, 2012). The diffeence between family stuctue and egnant women s enatal attachment mean scoes was not statistically significant. Similaly, Yılmaz and Beji (2010) and Metin (2014) eoted that family stuctue was not an effective facto on mothe-infant attachment. These esults make us think that the numbe of individuals living inside the house is not an effective facto in mothe-infant attachment. In esonse to the question, Ae socio-demogahic chaacteistics of egnant women elated to thei enatal attachment levels? ; educational status, duation of maiage, and husband s educational status wee found to be affecting enatal attachment levels. Howeve; chaacteistics of age, lace of esidence, emloyment statuses of the egnant woman and he husband, income state ecetion and family tye did not affect enatal attachment levels. The diffeence between the numbe of egnancies, numbe of suviving childen and enatal attachment mean scoes was found to be statistically significant. As suoting the study s esult, Rubetsson et al., (2014) eoted that low attachment levels ae obseved in multiaa egnant women, Ustunsoz et al., (2010) stated a negative coelation between the numbe of biths and enatal attachment, Abasi et al., (2012) eoted that multiaa women who gave bith fo moe than thee times had low enatal attachment levels. This makes us think that enatal attachment is closely elated to the fact if the egnant woman is eady fo mothehood and wants to have childen. It was detemined that thee was a statistically significant coelation between egnant women s enatal attachment mean scoes, and the numbe of stillbiths and abotus, and the egnant women who had stillbith and abotus histoy have lowe enatal attachment mean scoes. Alhusen (2008) eoted that as the loss of foetus in evious egnancies is a soowful exeience, it may lead to fea of losing in subsequent egnancies and may educe enatal attachment level. A statistically significant was found between the egnant women s enatal attachment mean scoes and the infant s gende. This esult indicated that knowing the gende of the infant had an inceasing effect on enatal attachment fo the egnant woman. State of the egnant women to go to thei egula medical contols was also eoted to affect enatal attachment mean scoe. Alhusen (2008) eoted that health actices such as eceiving enatal cae, eating a healthy diet and execising egulaly wee elated to high levels of enatal attachment. Results wee in aallel. The diffeence between state of the egnant woman and he husband to want the egnancy and enatal attachment mean scoes was found to be statistically significant. Pegnant women who had lanned egnancies had highe enatal attachment levels accoding to unlanned egnancies (Laxton-Kane, &Slade, 2002; Ustunsoz, Guvenc, Akyuz, & Oflaz, 2010; Yılmaz, &Beji, 2010;Abasi, Tahmasebi, Zafai, & Nasii Takami, 2012). Planned and wanted egnancies inceased coules enatal attachment levels. Coelations of the numbe of egnancies, numbe of suviving childen, numbe of stillbiths, numbe of abotus, infant s gende, going to egula medical contols and association of state of the egnant woman and he husband to want the egnancy with enatal attachment levels elied to the question Ae thee any diffeence between the obstetic chaacteistics of egnant women and thei enatal attachment levels?. A ositive significant

9 44 Intenational Jounal of HealthSciences, Vol. 5(1), Mach 2017 coelation was found between egnant women s sychosocial health mean scoes and thei enatal attachment mean scoes. As long as sychosocial health condition is high in egnancy, enatal attachment level may incease, as well. Flykt et al., (2010) eoted that enatal deession had a negative effect on the attachment between the mothe and the infant, Walsh et al., (2014) eoted that the most imotant deteminant of enatal attachment is mental health, Lindgen (2001) eoted that attachment educed in enatal eiod when deession levels went highe, Belin et al., (2013) eoted that thee was a significant coelation between the hostile behavious exhibited by egnant women against thei infants and thei mental health oblems and social isolation, Abasi et al., (2012) eoted that mothes with high anxiety and deession levels had lowe mothe-infant attachment levels, and McFaland et al., (2011) eoted that clinical diagnosis of majo deessive disodes in second and thid timestes and low levels of motheinfant attachment wee consideably elated. A ositive coelation was found between egnant women s egnancy and elationshi with husband subscale and enatal attachment. Abasi et al., (2012) indicated that thee was a ositive coelation between the maital elation and enatal attachment. Maital adjustment was seen to have a ositive effect on enatal attachment. A ositive significant coelation was found between anxiety and stess subscale and enatal attachment mean scoes. Foetal loss exeienced in evious egnancies is consideed a soowful incident fo the woman and it may lead to fea of loss in subsequent egnancies (Alhusen, 2008). Abasi et al., (2013) indicated that high levels of enatal attachment wee elated to less anxiety, stess and deession, theefoe bette female mental health. Paticulaly the fea of loss exeienced in abotus and abotion incidents may be thought to educe the enatal attachment level fo subsequent egnancies. A significant coelation was found between domestic violence subscale and enatal attachment mean scoes. Studies have eoted that egnant women wee exosed to violence duing thei egnancies and they mostly exeienced emotional/vebal violence (Göğüş, & Yıldız, 2013; Bolu et al., 2015). Accoding to the esults of the study, being exosed to violence duing egnancy may be thought to affect enatal attachment levels negatively. A ositive significant coelation was found between sychosocial suot need subscale, familial chaacteistics subscale and enatal attachment mean scoe. Hegüne et al., (2014) eoted a ositive coelation between the eceived social suot and enatal attachment. This showed that egnancies acceted and suoted by husbands and family membes may affect enatal attachment levels ositively. No significant coelation was found between egnancy-elated hysical and sychosocial changes and enatal attachment mean scoe. This esult makes us think that the changes occuing duing egnancy wee taken nomally by egnant women. In esonse to the question, Ae sycho-social health levels of egnant women elated to enatal attachment?, a ositive significant coelation was found between egnant women s sychosocial health mean scoe and enatal attachment mean scoe.a ositive significant coelation was found between egnant women s sychosocial health condition and enatal attachment levels. In addition to egnant women s hysical examinations, thei sychosocial health conditions should also be included in outine examinations. Pegnant women should be examined by the use of assessment instuments within the scoe of enatal cae sevices and those caying isks should be identified. Pegnant women with bad sychosocial health should eceive ofessional suot and thei enatal attachment levels should be evaluated duing thei egnancies. Exeimental studies analysing the attachment levels of egnant women with sychosocial health isks in thei late egnancy eiods could be ecommended. Limitations of this study The use of imobable samling method in collecting the study s data is the limitation of this study. Theefoe, the study s esults could be genealized to the egnant women within the scoe of the study. Imlications fo actice Although thee is a hyothesis that the sycho-social health and enatal attachment duing egnancy ae imotant in tems of the mothe s and infant s health, thee ae vey few studies conducted on this matte and findings ae inconsistent. Thee ae many asects that need to be enlightened in tems of detemining which conditions incease enatal attachment and which conditions event enatal attachment. It was detemined statistically significant ositive coelation between sychosocial health status of egnant women and enatal attachment.

10 Hediye Kaakoça & Hava Ozkanb 45 Psycho social health of egnant women, as the level inceases, it is found that the level of enatal attachment is also inceased. Study esults show that both hysical and sychosocial examinations of egnant women coming to medical centes fo enatal cae ae imotant. Accoding to these esults, it should ensued duing the actice that; o Psychosocial medical sceenings ae efomed in egnancy eiod, o Pegnant women ae closely followed by the use of assessment instuments within the scoe of enatal cae sevices and those caying isks should be detemined, o Pegnant women with bad sychosocial health eceive ofessional suot in ode to incease mothe-infant inteaction. Skills intended to incease qualifications of oviding cae could be gained by including the concets of sychosocial health and enatal attachment in the subjects of egnancy and women s health in undegaduate and gaduate educations. Conflict of inteest Refeences No otential conflict of inteest was eoted by the authos. Abasi, E., Tafazzoli, M., Esmaily, H., & Hasanabadi, H. (2013). The effect of matenal fetal attachment education on matenal mental health. Tukish Jounal of Medical Sciences,43, Abasi, E., Tahmasebi, H., Zafai, M., & Nasii Takami, G. (2012). Assesment on effective factos of matenal-fetal attachment in egnant women. Life Science Jounal,9(1), Alhusen, J. L. (2008). A liteatue udate on matenal fetal attachment. Jounal of Obstetic Gynecologic Neonatal Nusing,37(3), Babacan Gümüş, A., Çevik, N., Hataf Hyusni, S., Biçen, Ş., Keskin, G., & Tuna Malak, A. (2011). Chaacteistics associated with self-esteem and body image in egnancy. Anatolian Jounal of Clinical Investigation,5(1), Belin, L. J., Dodge, K.A. & Reznick, J. S. (2013). Examining egnant women's hostile attibutions about infants as a edicto of offsing malteatment. The Jounal Of The Ameican Medical Association Pediatics,167(6), Bolu, F., Mayda, A. S., & Yılmaz, M. (2015). Fequency and the factos affecting violence towads egnant woman admitted to a univesity hosital egnancy outatient clinic. Nobel Medıcus,33, Bouchad, G. (2011). The ole of sychosocial vaiables in enatal attachment: an examination of modeational effects. Jounal of Reoductive and Infant Psychology29(3), Cunnigham, F., Leveno, K., Bloom, S., Houth, J., Rouse, D., & Song, C. (2010). Williams Obstetik. Nobel Medical Bookstoes, Istanbul, Tukey Da Costa, D., Laouche, J., Ditsa M., & Bende W. (1999). Vaiations in stess levels ove the couse of egnancy: factos associated with elevated hassles, state anxiety and egnancy-secific stess. Jounal of Psychosomatic Reseach,47(6), Danaci, A.E., Dinç, G., Deveci, A., Şen, F.S., & İçelli, İ. (2002). Postnatal deession in Tukey: eidemiological and cultual asects. Social Psychiaty and Psychiatic Eidemiology,37(3), Duyan, V., Kaısız, S.G., & Yakut, H. İ. (2013). The adatation of fetal attachment inventoy to tukish with a gou of egnant women. The Jounal of Gynecology-Obstetics and Neonatology, 10(39), Eswi, A., & Khali, A. (2012). Penatal attachment and fetal health locus of contol among low isk and high isk egnant women. Wold Alied Sciences Jounal,18(4), Flykt, M., Kanninen, K., Sinkkonen, J., & Punamäki, R. L. (2010). Matenal deession and dyadic inteaction: The ole of matenal attachment style. Infant and Child Develoment,19(5), Göğüş, T., & Yıldız, H. (2013). Status of violence in egnancy accoding to the timestes, effecting factos and einatal esults. TAF Peventive Medicine Bulletin,12, Hat, R., & McMahon, C. (2006). Mood state and sychological adjustment to egnancy. Achives of Women's Mental Health,9(6), Hegüne, S., Çiçek, E., Annagu, A., Hegüne, A., & Os, R. (2014). Association of delivey tye with ostatum deession, eceived social suot and matenal attachment. The Jounal of Psychiaty and Neuological Sciences,27(1),

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