Women's expectations of childbirth and early motherhood: Their relation to preferred mothering orientation, subsequent experience, satisfaction and postpartum depression.

Reports from women experiencing postpartum depression often reflect concerns about babycare, the motherhood role and the self-concept and yet very little prospective research has examined women's prior expectations of childbirth and motherhood- related events in relation to the subsequent outcome of events and the development of postpartum depression. The present work was designed to explore this. It was also designed to investigate whether women differed in their antenatal preferences and experiential reports concerning labour, childbirth, the new-born baby and early motherhood in line with Raphael-Leff's (1983) facilitator / regulator theory of mothering orientations. A sociodemographically representative sample of 205 primiparous women were interviewed once in the third trimester of pregnancy. Data were collected concerning sociodemography, pregnancy context, recent life events, psychiatric history, perceived quality of intimate bonds with key others, antenatal psychiatric symptomatology and cognitive style. Women's preferences and expectations of labour, childbirth, the new-born baby and early motherhood were also assessed at this time. Objective obstetric outcome information was collected from medical records. Women completed the Edinburgh Postnatal Depression Scale (Cox et al., 1987) at six weeks postpartum and the General Health Questionnaire (GHQ; Goldberg, 1978) at three months postpartum. Women's subjective experiences of labour, birth, their baby and early motherhood and the corresponding level of outcome satisfaction were also assessed. High scorers and a random sample of low scorers on the GHQ measure received a Present State Examination (PSE-10; Wing et al, 1990). Women displayed fundamental differences in their individual expectations of and preferences regarding childbirth, the newborn baby and early motherhood. These preferences and women's subsequent experiences followed predictions derived from the facilitator / regulator theory. Greater disparity between women's antenatal preferences or expectations of events and their subsequent experiences was significantly predictive of multiple indices of reduced postpartum psychological wellbeing over and above variables previously implicated in the postpartum depression literature. Different facets of expectation-outcome disparity were important for different women depending on their mothering philosophy. The nature of the external stressors and internal vulnerability factors found to be significant predictors of poor outcome also differed as a function of mothering orientation.