Mental Health and Personal Growth among Parents of Pre- and Full-term Babies

The journey through parenthood is a complex psychological experience that entails the need for significant intrapsychic and interpersonal reorganization. These pervasive changes may give rise to both positive and negative psychological reactions. The birth circumstances under which this major life transition occurs may affect the path family members take, especially when they entail a certain amount of stress. One of such circumstances is giving birth prematurely.

The primary goal of the present series of three studies was to broaden understanding of the possible reactions parents may experience when facing the adversity of premature birth, from a multifaceted –longitudinal perspective. Study 1 explored the effects of premature birth on maternal mental health trajectories across four years after childbirth. Study 2 examined personal growth of first-time parents of pre and full term babies, from a dyadic perspective at one and five months post-partum. Finally, Study 3 aimed to examine the long-term contribution of premature birth and the mechanism by which premature birth promotes higher personal growth in comparison to full-term birth, through changes in mental health over the first four years post-partum. The contribution of additional birth circumstances and/or internal and external resources to the dependent variables was also examined in the 3 studies.

Study 1 (n=561) was part of MOST (Mothers of Singletons and Twins), a large-scale research project. It aimed to compare the change of maternal mental health under stressful and normative circumstances i.e. premature and full-term births. The study also examined the contribution of additional birth circumstances (birth of singleton/twins and first or non-first child), internal (attachment styles) and external (marital quality and mother’s support) resources measured one month post-partum, to the trajectories of maternal mental health over the course of four years following childbirth. Furthermore, the mediating effects of the external resources on the associations between birth circumstances and attachment orientations on the one hand, and the trajectories of maternal mental health on the other, were investigated. Findings indicated individual differences in maternal mental health one month after childbirth, and a general increase over four years. We also found that mental health levels stabilized at one year post-partum, and that its trajectory was not the same for all mothers. The findings indicated that premature birth, insecure attachment styles, lower marital quality, younger age, and higher education were risk factors for lower maternal mental health one month after delivery. In addition, premature birth, younger age, higher education, and multiple births predicted improvement in maternal mental health one year after. Women with insecure attachment styles or lower marital quality reported lower initial mental health that did not improve over time, and the mental health of older or less educated mothers deteriorated over time. Marital quality was found to mitigate or exacerbate the effects of birth circumstances and insecure attachment style on mental health shortly after giving birth.

Study 2 implemented a dyadic form of analysis (APIM; Actor-Partner Interdependence Model) in a two-phase longitudinal design in an effort to increase understanding of the underlying processes of personal growth in first-time parents of premature infants (n=121 couples). To this end, the contribution of individual and spousal factors (attachment orientations, parental self-efficacy and perceived infant temperament), measured one month post-partum, to the personal growth of first-time parents one and five months post-partum, were explored. The findings confirmed that becoming a parent, under normative and stressful circumstances can lead to personal growth and parents of premature babies experience higher levels of growth than parents of full-terms. Moreover, one month post-partum, actor effects were found for higher attachment anxiety and higher parental self-efficacy. Furthermore, personal growth at one month post-partum was found to be the strongest predictor of personal growth five months after childbirth. Five months post-partum, a positive partner effect was found for parental self-efficacy. Mothers reported higher growth than fathers only five months after the birth. It seems time plays an important role as to which variables contribute to personal growth. In the early stages of parenthood personal growth is mostly an individual experience. 

Using a longitudinal design, Study 3 aimed to extend previous research by exploring three questions concerning the mechanism underlying the process of mothers’ personal growth in the aftermath of a premature birth: Are the positive changes reported by women who gave birth prematurely long-lasting and salient four years post-partum?; Does the degree of change in maternal mental health over time (as found in Study 1) predict personal growth four years after childbirth?; Does the change in maternal mental health mediate between premature birth and personal growth four years later? Data were collected from 561 Israeli mothers also as part of MOST. The findings revealed that mothers who gave birth prematurely report higher personal growth four years after childbirth than mothers who delivered at full-term. Moreover, higher initial mental health and greater improvement in mental health over time predicted higher personal growth. Finally, the higher personal growth shown by women who gave birth prematurely was explained by their greater improvement in mental health over time than women who delivered at full-term.

This series of studies contributed to the literature by revealing the effects of giving birth prematurely change throughout time. Taken together, results from our studies suggest that even though women who give birth prematurely are vulnerable for lower mental health in the early post-partum period, the adversity may also serve as an opportunity for personal growth and help improve their psychological functioning for years after the event. Furthermore, our findings provided new empirical evidence about the interrelation between mental health and personal growth in the context of motherhood and the mechanism by which mothers of premature infants experienced higher personal growth than mothers after full-term pregnancies.