Introduction
The previous chapters of this thesis have introduced and discussed the components argued to create a state of postnatal distress. Chapter Two investigated the elements of depression, anxiety, and stress, while Chapter Three examined literature on expectations and loss, as well as highlighting research on the myths of motherhood. What these chapters point to is the complexity of the interactions of the components which can lead to distress following the transition to motherhood. But how does it all fit together? What are the links for instance, between distress and mothering myths?
This chapter introduces a new conceptual model of postnatal distress which draws together the components highlighted and, in doing so, creates opportunities to move forward in the treatment and prevention of postnatal distress. The development of the model was, in a large part, informed by a thorough literature review of the research relating to postnatal distress which was covered in the first three chapters as well as the focus group discussed in Chapter Four.
The Model
Women hold a number of expectations of mothering and mothers prior to giving birth and becoming mothers themselves (Coleman et al., 1999; Hackel & Ruble, 1992; Kach & McGhee, 1982; Knight & Thirkettle, 1987; Pearce & Ayers, 2005). In fact, girls from a very early age engage in games of mummies and daddies and, equipped with an array of pink plastic appliances, quickly begin to acquire an understanding of what it means to be a mother. For example, experimental studies show a preference for gender stereotypical nurturance toys (dolls and the like) is well established by 18 months (Serbin, Poulin-Dubois, Colburne, Sen, & Eichstedt, 2001). So expectations of motherhood begin to emerge and coalesce from a very early age, and arise from exposure to a number of different information sources as shown in Figure 5.1. Research has shown these expectations to be generally optimistic, but also unrealistic.
The question of why some of the expectations maybe unrealistic links in with the literature on mothering myths introduced in Chapter Three. Chapter Three highlighted research suggesting women are exposed to a number of commonly held myth beliefs about mothers and mothering. These myths have been found to generally lack empirical evidence, but impact on the behaviour, cognitions and emotions of mothers as well as others. While some of the myths may be negative, the overarching tone is one of overt positivity and, in general, these beliefs fail to encapsulate realistic negative aspects of mothering such as repetitious tasks, mental ennui, and poor support.
Figure 5.1. Potential Sources of
As a result of these overly optimistic expectations
postnatal experiences do not always align. That is not to say that the experiences and expectations are completely unrelated. There are areas of overlap, and it is argue
area of intersect between an individual’s prenatal expectations and their subsequent postnatal experiences is likely to result in a positive transition to motherhood (
The reason for this is that women experience no cognitive conf
are prepared for the events which occur in this overlap. The overlap represents events which the women have realistically appraised and therefore the postnatal experience is predicted, an important factor in coping.
Figure 5.2: Interaction of Prenatal Expectations and Postnatal Experiences match of expectations and experie
Potential Sources ofInformationfor Women developingPre-natal Expectations
As a result of these overly optimistic expectations women’s prenatal expectations and postnatal experiences do not always align. That is not to say that the experiences and expectations are completely unrelated. There are areas of overlap, and it is argue
area of intersect between an individual’s prenatal expectations and their subsequent postnatal experiences is likely to result in a positive transition to motherhood (Figure 5.2).
The reason for this is that women experience no cognitive conflict in this state. They are prepared for the events which occur in this overlap. The overlap represents events which the women have realistically appraised and therefore the postnatal experience is predicted, an important factor in coping.
: Interaction of Prenatal Expectations and Postnatal Experiences where the overlap represents a atch of expectations and experiences suggesting Positive Adjustment
PRENATAL
EXPECTATIONS EXPERIENCESPOSTNATAL
Positive Adjustment
natal Expectations
women’s prenatal expectations and postnatal experiences do not always align. That is not to say that the experiences and expectations are completely unrelated. There are areas of overlap, and it is argued that this area of intersect between an individual’s prenatal expectations and their subsequent postnatal
Figure 5.2).
lict in this state. They are prepared for the events which occur in this overlap. The overlap represents events which the women have realistically appraised and therefore the postnatal experience is predicted, an
However, there are large areas where the expectations and
each other. The new model proposes within these areas there is potential for postnatal distress (Figure 5.3). That is, if there is a disparity between prenatal expectations and postnatal
experiences the disparity is experienced
Figure 5.3: Figure showing the Areas Experiences which were hypothesised to
Thus the initial equation for postnatal distress was:
IF PNE ≠ PNE¹ THEN PNE
Yet one cannot accurately predict the outcome of an event one has never experienced and thus logically it would suggest there is always going t
and experience to some degree. How then do we explain why not all women transitioning to motherhood experience distress? The model argues there is a moderating factor to be considered and the moderating factor propos
model distress will arise when the disparity is experienced as a los
Thus the new model states postnatal distress results from the disparity between prenatal expectations and postnatal experiences when that disparity is subjectively experienced as a loss. Therefore the equation had to be adjusted
IF PNE ≠ PNE¹ + LOSS THEN DISTRESS
The new model of postnatal distress proposed is shown in Figure 5.4. The model consists of three main components. The first component is prenatal expectations; these are informed and developed by a number of factors including exposure to mythical mothering. Because of the artificially positive portrayal of motherhood women are exposed to during childhood,
adolescence and early adulthood, these expectations are themselves overly optimistic. The
PRENATAL EXPECTATIONS
Where PNE = prenatal expectations & PNE¹ =
POSTNATAL DISTRESS
However, there are large areas where the expectations and experiences do not overlie each other. The new model proposes within these areas there is potential for postnatal distress (Figure 5.3). That is, if there is a disparity between prenatal expectations and postnatal
experiences the disparity is experienced as postnatal distress.
Figure showing the Areas of Disparity between Prenatal Expectations and Postnatal which were hypothesised to lead to Distress
Thus the initial equation for postnatal distress was:
THEN PNE ± PNE¹ = DISTRESS
Yet one cannot accurately predict the outcome of an event one has never experienced and thus logically it would suggest there is always going to be a disparity between expectations and experience to some degree. How then do we explain why not all women transitioning to motherhood experience distress? The model argues there is a moderating factor to be
considered and the moderating factor proposed by the model is loss. That is, according to the model distress will arise when the disparity is experienced as a loss by the individual women. Thus the new model states postnatal distress results from the disparity between prenatal expectations and postnatal experiences when that disparity is subjectively experienced as a loss. Therefore the equation had to be adjusted to the following:
+ LOSS THEN DISTRESS
The new model of postnatal distress proposed is shown in Figure 5.4. The model consists of three main components. The first component is prenatal expectations; these are informed and
number of factors including exposure to mythical mothering. Because of the artificially positive portrayal of motherhood women are exposed to during childhood,
adolescence and early adulthood, these expectations are themselves overly optimistic. The
PRENATAL EXPECTATIONS POSTNATAL EXPERIENCES ¹ =postnatal experiences POSTNATAL DISTRESS
experiences do not overlie each other. The new model proposes within these areas there is potential for postnatal distress (Figure 5.3). That is, if there is a disparity between prenatal expectations and postnatal
of Disparity between Prenatal Expectations and Postnatal
Yet one cannot accurately predict the outcome of an event one has never experienced o be a disparity between expectations and experience to some degree. How then do we explain why not all women transitioning to motherhood experience distress? The model argues there is a moderating factor to be
ed by the model is loss. That is, according to the by the individual women. Thus the new model states postnatal distress results from the disparity between prenatal expectations and postnatal experiences when that disparity is subjectively experienced as a
The new model of postnatal distress proposed is shown in Figure 5.4. The model consists of three main components. The first component is prenatal expectations; these are informed and
number of factors including exposure to mythical mothering. Because of the artificially positive portrayal of motherhood women are exposed to during childhood,
second component is disparity which arises from the mismatch between expectations and experiences. The final component is distress resulting from the subjective experiences of loss following the disparity.
Figure 5.4. A Model of Postnatal Distress.
The question then becomes what would make some women experience the disparity as a loss while others do not? It is argued women who hold rigidly ascribed expectations of mothering and motherhood, and who are highly invested in the images and expectations which they hold, are more likely to experience a violation of that expectancy as a loss than women who are not as invested in the images they hold. Consistent with the principles of cognitive fusion and cognitive flexibility from Acceptance and Commitment Therapy (Ciarrochi et al., 2005; Fletcher & Hayes, 2005; Hayes, 2004, 2005; Hayes et al., 2006), according to this model, women who believe that because they have thoughts of motherhood those thoughts must be true experience distress when they try to then process their experiences through the filter of their thoughts.
So how does it work? Women are exposed to images of mothering and motherhood, almost from birth, with which they use to begin building schematic models of mothers and motherhood. Furthermore with little information to contradict these images (remembering the sanitising and whitewashing of motherhood discussed in Chapter Three) women become fused with the concepts that have developed. Thus despite having no direct experience with
mothering, women can develop detailed and rigid expectations and ideals about life as a mother of a child.
New mothers rapidly encounter experiences which contradict some of their
expectations. It is argued women who have psychological flexibility, and who are able to hold as true more than one image of mothering and motherhood, are less likely to experience distress than women who ascribe rigidly to one image. This is because once women become mothers, those who have cognitive flexibility can experience motherhood as it is, not as it says it is. These women can based their cognitions regarding mothering on their experience of motherhood rather than on preconceived intellectual understandings of others mothering.