4. Discussion
4.1 Cell cycle-dependent functions of MASTL
Initially data collection and analysis progressed in chorus, with concepts identified through data analysis. Due to the opportunity nature of participant sampling each interview was transcribed, familiarised, “chunked” and open-coded into pertinent concepts as they occurred (Stages in data analyses discussed on p.110). Consequently the raw data from primiparous and
multiparous women were initially not analysed separately but expediently and conveniently as interviews occurred. However during initial coding two
separate index sets were produced as it was originally postulated that these two groups may have very different perceptions and experiences of
attachment and therefore data must remain separate so as not to contaminate or dilute possible inherent differences.
Table 6 shows the concepts that were labelled from the primiparous women’s transcribed interviews, each concept were coded with P (Primigravid) and a number assigned to ease identification and analysis. For example P.21 labelled
Anomaly Screening
contained the thoughts reactions and subsequent decisions about screening tests for fetal abnormality.Table 6: Initial Coding – Concepts identified by Primigravid participants
No. Concept No. Concept No Concept
*P1 Effect of pregnancy on self P22 Early pregnancy feelings P42 Breast feeding P2 Body image P23 Pregnancy an intimate secret P43 Attachment developmental P3 Effects of pregnancy on
self concept
P24 Fetus first perceived as a
“baby”
P44 Feeding
P4 Pregnancy life changing P25 Effects of first USS P45 Explanation of attachment P5 Positive partners reactions P26 Parenting P46 Close = Attachment P6 Positive behavioural signs
of attachment
P27 (a & b) Parental involvement P47 Looking forward to seeing baby
P7 (a & b) Protection P28 Intergenerational attachment P48 Fetus belongs to woman P8 Negative partner reactions P29 Desired children P49 Effect of previous TOP P9 Effects on relationship P30 Pregnancy planned P50 Reactions to possible anomaly P10 Pregnancy not as expected P31 Effects of gender of fetus P51 Feelings re: TOP P11 Fear of miscarriage P32 Discovery of pregnancy P52 Conformity to perceived social
norms P12 Reactions to fetal
movements
P33 Pregnancy not planned P53 Ambivalent feelings first trimester P13 Woman’s expectations of
partner
P34 Nesting instinct P54 Perceived infertility and effects
P14 Apportioning characteristics to fetus
P35 Thoughts on labour P55 Baby
P15 Pregnancy generally enjoyable
P36 Partners lack of joy & effects P56 Positive relationship with partner
P16 Positively interacting with fetus
P37 Baby as a bargaining tool P57 Remains unsure of parenthood
P17 Need to see/hold fetus to fall in love
P38 Concerns re: ability to “bond” P58 Unsure of partners commitment
P18 Fear of congenital abnormality
P39 Woman’s negative feelings &
actions
P59 Practical preparations for parenting P19 Baby described as “ours” P40 Perception of being “in-tune”
with pregnancy
P60 Grieving for loss of freedom
P20 Pregnancy and society P41 Attempts to define feelings towards fetus of the multiparous women. Each concept was coded with M and given a
number to identify it to assist further analysis. For example M60 records
the women’s
Initial Emotional Reactions
on discovering the pregnancy. This includes both the positive joyous reactions and the negative emotionsexperienced by some of the women who were not planning or indeed wanting a
Table 7: Initial coding – Concepts identified by Multiparous participants
M24 Rationale for pregnancy M47 Protection (a & b)
M2 M3 Effects of existing child
with Congenital anomaly
M27 Work outside the home M50 Fetal movements
M5 Attachment –
developmental
M28 Ultra-sound Scan (USS) M51 Maternal-fetal communications M6 When pregnancy becomes a
“baby”
M29 ? Terminate if fetal anomaly detected
M52 Baby described as OURS
M7 Effects of previous childbearing experience
M30 Anomaly screening M53 Birth
M8 Plans for further children M31 Feelings of ACCEPTANCE with this pregnancy
M54 Reactions of other siblings
M9 Effects of existing children on pregnancy
M32 Feelings of being “in-tune”
with fetus
M55 Baby once born
M10 Nesting instinct M33 Positive life-style changes M56 Fetus diagnosed as HAVING anomaly
M11 Attempts to promote partners bonding
M34 This pregnancy SPECIAL M57 Reactions at discovery of pregnancy M12 New relationship – his first
child
M35 Early pregnancy M58 Information seeking
M13 Effects of relationship on Attachment
M15 Artificial feeding M38 Perceptions of pregnancy M61 Pregnancy planned and desired M16 Concerns with attachment
to this baby
M39 Becoming a mother life changing
M62 Positive partner reactions
M17 Natural birth / medicine M40 Changes to emotions M63 Partner providing emotional support
M18 Concerned Postnatal Depression may return
M41 Fear of miscarriage or stillbirth
M20 Pregnancy NOT planned M43 Body image / Self-esteem M66 Relationship with parents M21 Negative relationship with M23 Close = Attachment M46 Words related to feelings
toward fetus
P49 Effects of previous TOP
(* = Multiparous)
Analysis then progressed independently, exploring each index set separately to refine the index system and produce primitive categories.
Primigravid Women
Core analysis (Figure 3, stage 5) followed initial coding. On further examination using constant comparative strategies concepts were re-defined
or incorporated into existing concepts, e.g. P (Primigravid) 41
“attempts to define feelings towards fetus”
and P43“attachment developmental”
was integrated into P45“explanation of attachment”
. The concepts were explored, definitions given and constantly compared and integrated until clusters of similar codes began to emerge creating primitive categories (Figure 3, stage 6). Once incorporated into a category the individual concept cards were tied together to form a set. During this stage certain concepts appeared flawed, neither causal nor challenging to the emerging themes and were as a consequence discarded (P35, 42 and 44). Eight primitive themes emerged and were defined (Table 8),Three themes appeared pervasive and important within the women’s perceptions and experiences of attachment – protection, the developmental nature of attachment and the influence of the partner. Protection and progressive development appeared to be the essential characteristics that were fundamental within the women’s experience of attachment and were therefore integrated into a theme of definition. The partner’s reactions and support whether positive or negative was described as important, either
pregnancy. This was considered causal within attachment and included as a single category.
Table 8: Primitive themes – Primigravid participants
No. Primitive Themes
1 DEFINITION
Two major themes emerging: PROTECTION & DEVELOPMENT
2 POSITIVE SIGNS OF ATTACHMENT
Includes behavioural and emotional signs Considers when fetus first described as a “baby”
3 FRAGILE PREGNANCY
Explores early pregnancy feelings and fears Includes early feelings of ambivalence Includes perceptions and plans for parenting
8 EFFECT OF FETAL GENDER
Strong desire to give birth to a specific gender
Multiparous Women
Following initial coding 68 concepts were labelled (Table 7). On review a concept identified by a woman that for the purpose of the study was
classified as primiparous (she had previously had a social termination in her first pregnancy at eight weeks gestation, consequently this is her only experience of nurturing a developing pregnancy) was included within the
experiences of multiparous women as she identified
“the effects of previous termination of pregnancy”
on her attitude to her current experience. As core analysis (Figure 3, stage 5) progressed concepts were integrated, e.g. M(Multiparous) 22
“happy to be pregnant”
was merged into M60“initial
emotional reactions to pregnancy”
. In the course of refining, extending and integrating concepts five labelled concepts were abandoned as they detracted from the focus of attachment (M8, 15, 17, 27 and 37). Nine primitive themes materialized and were defined and tied together into sets (Table 9).As identified by primigravid women three themes were again ubiquitous, re-appearing consistently within the discourses – these were protection, attachment as a progressive developmental process and the pervasive effects of the partner’s support. A decision was made to separate the themes of protection and developmental attachment, as on further exploration within the contexts used they appeared essentially different in focus – protection
describing an overwhelming innate emotion and developmental attachment describing an emotional reaction to environmental and physical experiences.
Table 9: Primitive themes – Multiparous participants
No. Primitive themes
Attachment grows throughout pregnancy and is affected by specific events, that demonstrate fetal growth and well-being
3
PARTNERS
Positive and negative reactions of partners Support offered
4
PREGNANCY Positive and negative aspects
3 out of 5 women described this pregnancy as SPECIAL
5
INTERGENERATIONAL ATTACHMENT Quality of attachment to parents
Parental support
6 EFFECT OF FETAL GENDER
Strong desire to give birth to a specific gender
7
PREVIOUS CHILDBEARING EXPERIENCE
How previous experiences affect perception and subsequent choices within the current pregnancy
8
POSITIVE DIAGNOSIS OF FETAL ANOMALY Affect this has on perception and emotional response to pregnancy
9
EFFECT OF EXISTING CHILDREN Pregnancy must now “fit in” with family commitments
Concern re: ability to attach to another child
Integration of primitive themes primigravid and multiparous women to produce nascent themes (Figure 3, step 7)
The themes for primigravid and multiparous women were integrated following further comparison and investigation for cohesion and variety. It was necessary to re-examine all identified categories, to look again at the concepts within each set to identify whether similarly titled categories contained interrelated or incongruent data on attachment. As a result categories were refined, sub-divided and assimilated to produce thirteen nascent themes (Table 10). One multiparous category was abandoned as it
related to specific incidents of complications
“Positive diagnosis of anomaly”
, which could not be generalised to a normal pregnancy experience and was therefore for the intention of this study invalid. This is supported by Grace (1984) whose empirical study found that women at risk of delivering anabnormal child appeared to experience the fetus in a unique and differing way to those women having a normal pregnancy.
Thirteen Key Concepts / Themes, relating to women’s feelings towards the fetus and the pregnancy, were identified following extensive review and constant comparison (Table 10). Nine themes were common to both
primigravid and multiparous women. One theme was specific to primigravid women – the novelty of prospective parenthood led to concerns being
on the couple’s relationship. Two themes were exclusive to multiparous women
– although the wonder of pregnancy remained it was described as
“a normal everyday event”
(Interviewee 3),“…a fact of life”
(Interviewee 7). Previous experiences during childbearing also affected their response to the currentpregnancy