Birth experience of women conceiving with assisted reproduction: a prospective multicenter study.

OBJECTIVE: To determine how infertility and subsequent assisted reproductive treatment (ART) affect a woman's childbirth experience. DESIGN: Prospective multicenter case-control study. SETTING: We recruited women pregnant with a singleton fetus after either ART (n = 324) or spontaneous conception (n = 304) from five infertility clinics and one university maternity clinic in Finland. METHODS: We studied their childbirth experience with the Delivery Satisfaction Scale. We compared how psychosocial and obstetric factors affected satisfaction and dissatisfaction with childbirth between and within the ART and the control group. Logistic regression was then used to analyse the most important contributors to the experienced dissatisfaction. RESULTS: Dissatisfaction with childbirth was as common in the ART group (11%) as in the control (10%) group. In the ART group, the women's education level, cesarean section (CS) and their partner's absence from the delivery were associated with dissatisfaction. In the control group, significant factors for dissatisfaction were nulliparity, severe pregnancy-related anxiety, emergency CS, recalled intense pain and the partner's absence from the delivery. According to adjusted logistic regression analysis of the whole sample, the independent risk factors were elective CS [odds ratio (OR) 5.7; 95% confidence interval (CI) 2.2-14.1] and emergency CS (OR 2.9; 95% CI 1.3-6.5), recalled intense pain (OR 6.8; 95% CI 3.3-16.2) and the partner's absence from the delivery (OR 2.7; 95% CI 1.1-7.3). CONCLUSION: ART is not a risk factor for dissatisfaction with childbirth by itself. However, the contributors to an unsatisfactory childbirth differ partly between women conceiving with ART and those conceiving spontaneously.

What explains violated expectations of parent-child relationship in transition to parenthood?

Parent-child relationship is created already in prenatal fantasies and expectations of the child-to-be. Negative violation of these expectations after the child is born is known to be harmful for the parent-child relationship. Yet, research is scarce about the medical and psychological factors contributing to violated expectations (VE). This study models the role of parent-, delivery- and infant-related underlying mechanisms for VE. It further compares parents with assisted reproductive treatment (ART) and spontaneous conception (SC), and primi- and multiparous couples. The couples (n = 743) separately filled in questionnaires concerning their prenatal expectations (T1) and 2 months postnatal representations (T2) of intimacy and autonomy in the relationship with their child, measured with Subjective Family Picture Test. A negative or positive discrepancy indicated violated expectations. The parent-related (mental health and marital quality), delivery-related (maternal and paternal birth experience, unplanned Caesarean, and amount of analgesia) and infant-related (infant health problems, difficult infant characteristics, and parental worry) factors were assessed at T2. Results show that among mothers, the associations were mostly indirect and mediated via mental health problems. Among fathers, the associations were direct, marital problems most crucially predicting VE. ART fathers were less susceptible to VE resulting from infant-related problems than SC fathers, but more susceptible to VE resulting from delivery problems. Delivery- and infant-related factors also predicted VE differently among primi- and multiparous mothers. Considering factors that contribute to VE is important when working with couples in transition to parenthood.

Prenatal expectations in transition to parenthood: former infertility and family dynamic considerations.

Prenatal expectations are important for the future parent-child relationship. The authors examined how maternal and paternal prenatal expectations of the relationship with the child predicted 1st-year parenting stress and whether these expectations were violated over the transition to parenthood. They further examined how former infertility affected these associations. The participants were 745 Finnish couples, 367 having undergone a successful assisted reproductive treatment and 378 conceiving spontaneously. Couples completed a questionnaire of family representations during pregnancy and when the child was 2 and 12 months old and Abidin's Parenting Stress Index at 2 and 12 months postpartum. The hypothesis of moderately high expectations predicting the lowest level of parenting stress was substantiated only concerning paternal expectations of own autonomy with the child. Generally, however, negative expectations of own and spouse's relationship with the child were linearly associated with higher parenting stress. Postnatal representations were more positive or equal to expectations, except for negative violation occurring in maternal expectation of the father-child relationship, especially among normative mothers. The results are discussed in relation to family dynamic considerations and special features of formerly infertile couples.

Ante- and perinatal factors and child characteristics predicting parenting experience among formerly infertile couples during the child's first year: a controlled study.

In this prospective controlled study, the authors examined (a) parenting experiences among couples with successful assisted reproduction treatment (ART; n = 367) and fertile spontaneously conceiving controls (n = 371) and (b) the impact of ante- and perinatal factors and child characteristics on parenting experiences. The results show that positive mothering experiences increased more during the 1st year of parenting and were generally higher among ART mothers than control mothers. No differences were found between ART fathers and controls in their fathering experience. Unpleasant birth experiences, low birth weight, and difficulty soothing the child were associated with high levels of parental stress in the control group, but this was not so among the ART parents. Psychosocial interventions in maternal care should take into account the various meanings that couples give to the history of infertility and conception and ante- and perinatal experiences.

Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: does former infertility matter?

BACKGROUND: Transition to parenthood involves considerable psychological, social and physiological changes. We examined how prenatal and perinatal mental health and medical conditions predict infant's developmental and health status at 12 months, and whether former infertility and assisted reproduction treatment (ART) affect the predictor model. METHODS: The participants were 520 mothers who filled in questionnaires at the second trimester of pregnancy (T1), and when the child was 2 months (T2) and 12 months old (T3). Depressive and anxiety symptoms indicate reduced levels of mental health, and medical factors involve problems in pregnancy (e.g., high blood pressure and bleeding) and birth complications (pain and loss of blood). Neonatal health refers to, e.g., birth-weight and neurological status. At 12 months mothers reported infants' verbal and motor development and general health status. RESULTS: First, it was shown that generally maternal prenatal anxiety and medical problems in pregnancy together predicted infant's developmental problems at 12 months through poor neonatal health, and medical problems alone also through increased level of birth complications. Second, the predictor models differed according to the history of infertility. In the ART group prenatal depression and anxiety and medical problems together predicted infant's developmental problems through maternal post-partum depression, and medical problems also through birth complications, whereas in the spontaneous conception group psychological and medical paths were separated and did not carry on developmental and health problems into 12 months. CONCLUSIONS: Maternal health care should consider both psychological and medical risk paths across the whole transition to parenthood, and be aware of specific mediating paths in the risk groups.