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Midwifery (2010) 26, e1–e9

0266-6138/$ - sdoi:10.1016/j.m

www.elsevier.com/midw

Comparison of maternal–and paternal–fetal attachment inTurkish couples

A. Ustunsoz, RN, PhD (Lecturer)�, G. Guvenc, RN, PhD (Lecturer), A. Akyuz, RN, PhD (AssociateProfessor), F. Oflaz, RN, PhD (Assistant Professor)

Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey�Corresponding author. E-mail address: austunsoz@yahoo.com (A. Ustunsoz).

Received 30 December 2008; received in revised form 6 November 2009; accepted 22 December 2009

AbstractObjective: to compare maternal–fetal attachment (MFA) and paternal–fetal attachment (PFA) in terms of selectedvariables.Design: cross-sectional study.Setting: three training hospitals in Ankara, Turkey. The study was performed between December 2005 and March 2006.Participants: a total of 144 pregnant women and 144 partners participated in the study; the response rate was 98%.Findings: there was a statistically significant difference between MFA and PFA scores (po0.001). A comparison of MFAand PFA scores according to the selected variables (education, employment status, planning of pregnancy, pregnancyrisk status) revealed that the MFA scores for pregnant women were significantly higher than the PFA scores of theirpartners, except for unemployed partners. The MFA (r ¼ �0.24, po0.004) and PFA (r ¼ �0.32, po0.001) scoresdecreased with increasing age of both pregnant women and their partners.Key conclusions and implications for practice: although partners have lower fetal attachment scores than pregnantwomen, it is important to recognise factors influencing the attachment of the mother and father towards their fetus.Prenatal midwives and nurses are in a unique position to assess attachment and to intervene to promote attachmentbehaviours.& 2010 Elsevier Ltd. All rights reserved.

Keywords Attachment; Maternal–fetal attachment; Paternal–fetal attachment

Introduction

Over the past 20 years, there has been increasingrecognition that the relationship between a motherand her child starts to develop before the child isborn. The significance of the relationship between amother and her infant, as conceptualised by theattachment theory, is well documented (Bowlby,1969). Although Bowlby’s later work (1982) focused

ee front matter & 2010 Elsevier Ltd. All rights reservidw.2009.12.006

on the unidirectional infant-to-mother relationship,other researchers have since focused on the mother-to-fetus relationship (Cranley, 1981; Bowlby, 1982).Cranley (1981) defined maternal–fetal attachmant(MFA) theoretically as the extent to which womenengage in behaviours that represent an affiliationand interaction with their unborn child. MFA playsan important role in the health of pregnant womenand their unborn babies. Maternal attachment is

ed.

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also an important component of maternal identityand is essential in promoting positive adaptation tomotherhood (Mercer, 2004). Optimal attachment inearly infancy has been identified as an integralcomponent in the future development of a child(Oppenheim et al., 2007). MFA is an importantrequirement for optimal maternal–infant adapta-tion (Bryan, 2000; Oppenheim et al., 2007).According to Condon, paternal–fetal attachment(PFA) is a subjective feeling of love for the unbornchild, rather than an attitude or belief about thechild, and is at the heart of a man’s experience ofearly parenting (Condon, 1985). Attachment-re-lated studies mainly focus on MFA (Cranley, 1981;Condon, 1985; Lindgren, 2001; Shieh et al., 2001;Ahern and Ruland, 2003; Damato, 2004) and less onPFA (Weaver and Cranley, 1983; Condon, 1985;Buist et al., 2003). However, both the mother andfather are attached to the fetus when expectinga baby.

Mothers and fathers interact differently with thedeveloping fetus, but evidence for these differences iscontradictory. Some studies have shown that mothershave higher attachment to the fetus compared withtheir partners (Mercer et al., 1988; Lorensen et al.,2004), some studies found higher fetal attachment inthe fathers (Schodt, 1989; White et al., 1999), andanother study found similar levels of fetal attachmentin both parents (Wilson et al., 2000).

This study examines the relationship betweenparental attachment (MFA and PFA) and bothdemographic and perinatal variables among cou-ples in Turkey. It is important to recognise thefactors influencing MFA and PFA because of theeffects on the future health and development ofthe infant. There is evidence, some conflicting,that the demographic variables of maternal age,education and family income may correlate withattachment. Maternal age has not been correlatedwith prenatal attachment scores in most studies(Cranley, 1981; Lerum and LoBiondo-Wood, 1989;Ustunsoz and Inanc, 2001). However, some studiesreported an inverse relationship between maternalage and attachment (Mercer et al., 1988; Zachar-iah, 1994; Lindgren, 2001). Maternal education hasbeen correlated inversely with prenatal attach-ment in some studies (Mercer et al., 1988;Lindgren, 2001) but not in others (Wilson et al.,2000; Ustunsoz and Inanc, 2001). Similarly, incomewas not correlated with prenatal attachment in onestudy (Cranley, 1981), but was negatively corre-lated with attachment in another study (Lerum andLoBiondo-Wood, 1989).

The perinatal variables selected for this study (i.e.parity, pregnancy risk status, planning of pregnancy)were based on past research findings. Cranley (1981)

did not find a relationship between attachment andparity, but Ferketich and Mercer (1994) found thatincreased parity had a negative effect on attach-ment. Risk status has (Feldman et al., 1999) and hasnot (Cranley, 1981; Mercer et al., 1988; Chazotte etal., 1995; Lindgren, 2001; Ustunsoz and Inanc, 2001)been shown to influence maternal attachment.Previous investigators have found planning of preg-nancy to be positively correlated with postnatalattachment (Lerum and LoBiondo-Wood, 1989;Damato, 2004). The only Turkish study on MFA wasby Ustunsoz and Inanc (2001), and the authors areunaware of any Turkish studies on PFA. Furthermore,only a few studies have evaluated both MFA and PFAtogether (Mercer et al., 1988; Schodt, 1989; White etal., 1999; Wilson et al., 2000; Lorensen et al., 2004).However, it is important to consider the mother andfather together as the attachment of both parents tothe fetus is important for the psychosocial develop-ment of the child and to increase the harmony of thecouple.

Prenatal care is a good opportunity to evaluatethe attachment of the mother and father to theunborn child. The candidate mothers and fathersare taught procedures that may increase paren-tal–fetal attachment during prenatal care such asloving the fetus over the mother’s belly and talkingto the fetus (Bryan, 2000). Prenatal nurses are in aunique position to assess attachment and tointervene to promote attachment behaviours(Franklin, 2006). Bellieni et al. (2007) showed thatprenatal education courses have a positive influ-ence on prenatal attachment. However, someimportant factors influencing parental attachment,such as mother–father relationship, age of parents-to-be, parity of mother/previous experience offatherhood, high-risk pregnancy, number of exist-ing children, education levels etc., cannot bechanged. Nurses may assess the factors thatinfluence parental–fetal attachment during prena-tal care. If a pregnant woman and/or her partnerdo not appear to have deep feelings of attachment,nurses can refer her/him for professional counsel-ling. It is hoped that this study may help midwivesand nurses who work in the prenatal field tounderstand the attachment process and to providecomprehensive prenatal care.

The purpose of this study was to compare MFAand PFA in pregnant women and their partners interms of selected factors with the potential toinfluence prenatal attachment.

Specifically, the following questions were exam-ined in this study:

�

What is the relationship between the MFA andPFA scores?

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What is the relationship between selectedvariables (education, employment status, plan-ning of pregnancy, risk status) and MFA and PFAscores?

Methods

Design

The study was approved by the appropriate ethicscommittee. The participants were informed orallyabout the purpose of the study and the length oftime it would take. They were also informed thattheir responses would be kept confidential, andthat they would have the right to withdraw fromthe study at any time.

This cross-sectional descriptive study was con-ducted at the prenatal care units of three traininghospitals in Ankara, Turkey, between December2005 and March 2006. These hospitals provideservices to women of varied socio-economic statusin Ankara, and it was planned that the study wouldinclude a sample that reflected Ankara in general.Maternal health-care services in Turkey are mainlyprovided by the government-run referral system,composed of health stations in rural areas, healthposts in urban areas, health centres and hospitals(C- elik, 2000; Erci, 2003).

Participants

All eligible pregnant women and their partners inthe prenatal care waiting rooms of three hospitalsduring the period of investigation were invited toparticipate in the study. The study sample consistedof 144 pregnant women and 144 partners. Parentswith the following features comprised the studysample:

�

married couples (Turkish culture does not ap-prove of having children out of wedlock andunmarried pregnant women therefore preferprivate doctors. As such, the authors did notencounter any unmarried pregnant women in thestate hospitals included in this study); � pregnant women and their partners who were at

least primary school graduates and were willingto participate in the study;

� pregnant women (low and high risk) who were in

the third trimester (24–36 weeks) and theirpartners; and

� pregnant women who had any risk factors

(diabetes, pre-eclampsia, multiple pregnancy,stillbirth, history of abortion, etc.) were

evaluated as high-risk pregnancies, while thosewho did not have any risk factors were evaluatedas low-risk pregnancies.

Measures and data collection

Three tools were used for data collection. The firsttool was the Demographic Information Question-naire, which was developed by the investigatorsbased on the existing literature. This questionnaireincludes general demographic data (age, educa-tion, etc.) and obstetric data (pregnancy week, riskstatus, etc.). The second tool was the MFA scale(Cranley, 1981), which measures the affectionateattachment between mother and fetus; and thethird tool was the PFA scale (Weaver and Cranley,1983), which measures the affectionate attach-ment between father and fetus. Both scales have24 five-point Likert-type items and are self-admi-nistered. The scales are scored on a scale of one tofive, with five being the most positive statement.Note that the scoring is reversed for Item 22, with‘Definitely yes’ scoring one point and ‘Definitely no’scoring five points. The mean score is calculated bydividing the sum of the item scores by the numberof items answered. Cronbach’s alpha for MFA was0.84 in Cranley’s study (1981), and Cronbach’salpha for PFA was 0.86 in Weaver and Cranley’sstudy (1983). Permission was obtained from Cranleyto adapt the scales for Turkish culture. Twobilingual faculty members independently trans-lated the scales to the Turkish language andreached similar results. The faculty then met,reviewed the translations together, and agreed onthe first draft of the translated tools. The trans-lated Turkish versions of the scales were indepen-dently back-translated to English by two bilingualpersons. The two back-translations were almostidentical and matched the original meaning of theEnglish versions. No changes in wording wereneeded as a result of back-translation. The toolswere then given to four bilingual health profes-sional experts to validate the content of thetranslated version of the scales and to determinecultural appropriateness. These professional ex-perts were two medical doctors and two nursingfaculty members. The experts suggested minorchanges in wording and the translated tools wererevised accordingly. The instruments were pilottested with eight couples to assess the clarity ofthe items. Changes in wording recommended by thecouples were incorporated into the final versions ofthe instruments. Cronbach’s alpha was 0.82 for MFAand 0.86 for PFA in this study. These results indicate

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that the MFA and PFA scales are reliable for Turkishcouples.

Verbal informed consent was obtained duringdata collection. Both partners were interviewedseparately, often simultaneously, in prenatal careunits. Data collection forms were completed duringface-to-face interviews. The time taken for parti-cipants to complete the questionnaire was approxi-mately 15–20 minutes. Three couples did not wishto take part in the study for various reasons andwere not included. A clinical psychologist wascontacted before the study to provide counsellingservices if any couples were found to have attach-ment problems. The participants were asked tocontact the investigators if they had any questionsor worries about the survey. However, no couplesrequested or needed counselling as determined bythe investigators.

Statistical analysis

The data were analysed statistically using Statis-tical Package for the Social Sciences Version 15.0(SPSS Inc., Chicago, IL, USA). Descriptive statisticswere computed for the demographic characteris-tics. Reliability was assessed using item-totalsubscale correlations and Cronbach’s alpha coeffi-cients. Normal distribution was evaluated using theone-sample Kolmogorov–Smirnow test and non-parametric tests were chosen. The relationshipsbetween selected variables (education, employ-ment status, planning of pregnancy, risk status) andMFA and PFA scores were evaluated using theMann–Whitney U test. The relationship betweenMFA and PFA scores according to selected variableswas assessed using the Wilcoxon test. The interclasscorrelation coefficient was determined to analysethe association between MFA and PFA scores. Thecorrelation between MFA and PFA scores for somechosen variables (age, gravida, parity, education)was evaluated using Spearman’s correlation andKendall Tau B tests. A p-value less than 0.05 wasaccepted as statistically significant for all analyses.Backward linear regression was performed toevaluate factors that affect attachment scores.

Findings

Out of 147 couples approached, 144 pregnantwomen and 144 partners participated in the study(144/147 ¼ 98.0%). Demographic and obstetricdata are shown in Table 1. The mean age of thepregnant women was 26.68 years [standard devia-tion (SD) 5.34], and the mean age of the partners

was 30.34 years (SD 5.89). The education level washigh school or higher in 50% of the pregnant womenand 18.1% were employed. The respective numberswere 73.6% and 97.9% for the partners. Sixty percent of the pregnant women were low risk and40.3% were high risk (Table 1).

There was a positive and significant correlationbetween MFA and PFA (r ¼ 0.86, po0.001) (Table 2).On the other hand, there was a statisticallysignificant difference between MFA and PFA scores(po0.001) (Table 3). A comparison of MFA and PFAscores according to the selected variables revealedthat the MFS scores of pregnant women weresignificantly higher than the PFA scores of theirpartners, except for unemployed partners (Table 3).

There was a significant and negative correlationbetween the age of the pregnant women and theirpartners and MFA (r ¼ �0.24, po0.004) and PFA(r ¼ �0.32, po0.001) scores (Table 2). The MFAand PFA scores decreased with increasing age ofboth pregnant women and their partners. Asignificant negative correlation was found betweenMFA and the number of pregnancies and parity, andalso between PFA and the number of children of thepartner (Table 2).

In addition, the MFA scores of nulliparous womenwere significantly higher than the MFA scores ofmultiparous women. The PFA scores of the partnersof nulliparous women were significantly higher thanthose of the partners of multiparous women(po0.001) (Table 3).

A significant and positive correlation was foundbetween the educational levels of the pregnantwomen and their partners and the MFA (t ¼ 0.32,po0.001) and PFA (t ¼ 0.26, po0.001) scores(Table 2). The MFA and PFA scores increased withan increasing level of education. In addition,pregnant women and partners educated at highschool or a higher level had significantly higherfetal attachment scores that those who had onlycompleted primary or secondary school (po0.001)(Table 3). The PFA scores of the partners of low-riskpregnant women were significantly higher thanthose of the partners of high-risk pregnant women(p ¼ 0.007). There was no statistically significantdifference between pregnancy risk status whencompared by MFA score (p40.05) (Table 3). Therewas a statistically significant difference betweenplanning of pregnancy and MFA (po0.02) and PFA(po0.001) scores. Both MFA and PFA scores werehigher in planned pregnancies than in unplannedpregnancies (Table 3).

Backward linear regression was performed toevaluate factors which affect MFA and PFA scores.Age, education, employment status, number ofpregnancies, number of children, pregnancy risk

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Table 1 Demographic and obstetric data.

Pregnant women Pregnant women’s partners

n % n %

Educational statusPrimary to secondary school 72 50.0 38 26.4High school to university 72 50.0 106 73.6

Employment statusEmployed 26 18.1 141 97.9Unemployed 118 81.9 3 2.1

Pregnancy risk statusLow risk 86 59.7High risk 58 40.3

Planning of pregnancyPlanned 28 19.4Unplanned 116 80.6

Mean SD Mean SDAge (years) 26.68 5.34 30.34 5.89Number of pregnancies 1.88 1.20Parity 0.81 1.04

Table 2 Correlations between maternal–fetal attachment (MFA) and paternal–fetal attachment (PFA) andselected variables.

MFA and PFA Correlation coefficientc p

0.86 o0.001

MFA (n ¼ 144) PFA (n ¼ 144)

ra p ra p

Pregnant woman’s age �0.24 0.004 �0.26 o0.001Partner’s age �0.20 0.01 �0.32 o0.001Number of pregnancies �0.42 o0.001Parityb �0.45 o0.001 �0.45 o0.001Pregnancy week 0.11 0.18 0.10 0.23Pregnant woman’s educationd t ¼ 0.32 o0.001 t ¼ 0.26 o0.001Partner’s educationd t ¼ 0.25 o0.001 t ¼ 0.25 o0.001

aSpearman’s Rho test.bNumber of children for partners.cInterclass correlation coefficient.dKendall Tau B test.

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status and planning of pregnancy were assessed inthis analysis. Variables influencing the MFA and PFAscores are presented in Table 4. The MFA score wasfound to be negatively influenced by the mother’sage, although the PFA score was negativelyaffected by the pregnancy risk status, the father’sage and the number of children of the father. TheMFA score was most positively correlated with the

PFA score, and the reverse was also true (po0.001)(Table 4).

Discussion

Parental–fetal attachment is a naturally occurringevent that begins during the prenatal period. The

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Table 3 Comparison of maternal–fetal attachment (MFA) and paternal–fetal attachment (PFA) scores byselected variables.

MFA (n ¼ 144) PFA (n ¼ 144)

Median (min–max) Median (min–max) Zb df p

MFA and PFA 3.75 (2.29–4.63) 3.54 (2.00–4.42) 9.53 143 o0.001

ParityNulliparous 3.94 (3.08–4.63) 3.71 (2.88–4.42) �5.16 74 o0.001Multiparous 3.64 (2.29–4.42) 3.33 (2.00–4.38) �5.89 70 o0.001

Za ¼ �4.52, po0.001 Z ¼ �4.46, po0.001

Pregnant woman’s educational statusPrimary to secondary school 3.66 (2.29–4.58) 3.31 (2.00–4.38) �6.23 72 o0.001High school to university 4.00 (3.08–4.63) 3.70 (2.88–4.42) �4.87 72 o0.001

Z ¼ �4.94, po0.001 Z ¼ �5.11, po0.001

Pregnant woman’s employment statusEmployed 4.02 (2.38–4.50) 3.72 (2.00–4.33) �2.80 26 0.005Unemployed 3.75 (2.29–4.63) 3.50 (2.00–4.42) �7.41 118 o0.001

Z ¼ �1.39, p ¼ 0.16 Z ¼o2.12, p ¼ 0.03

Partner’s educational statusPrimary to secondary school 3.58 (2.29–4.38) 3.25 (2.00–4.29) �4.72 38 o0.001High school to university 3.83 (2.38–4.63) 3.62 (2.00–4.42) �6.30 106 o0.001

Z ¼ �3.70, po0.001 Z ¼ �3.71, po0.001

Partner’s employment statusEmployed 3.75 (2.29–4.63) 3.54 (2.00–4.42) �7.80 141 o0.001Unemployed 3.79 (3.67–4.08) 3.62 (2.88–3.75) �1.06 3 0.28

Z ¼ �0.26, p ¼ 0.79 Z ¼ �0.34, p ¼ 0.73

Pregnancy risk statusLow risk 3.79 (2.92–4.58) 3.58 (2.63–4.38) �5.36 86 o0.001High risk 3.75 (2.29–4.63) 3.35 (2.00–4.42) �5.82 58 o0.001

Z ¼ �1.64, p ¼ 0.10 Z ¼ �2.67, p ¼ 0.007

Planning of pregnancyPlanned 3.79 (2.29–4.63) 3.58 (2.08–4.42) �4.25 28 o0.001Unplanned 3.41 (2.38–4.58) 2.87 (2.00–4.08) �1.06 116 o0.001

Z ¼ �3.10, p ¼ 0.02 Z ¼ �3.88, po0.001

aMann–Whitney U test.bWilcoxon test.

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feelings of attachment strengthen when fetalmovement is felt, and grow stronger with paren-t–infant interaction after birth (Franklin, 2006;Oppenheim et al., 2007). Prenatal nurses shouldconsider this topic because parental–fetal attach-ment has important implications for adaptation toroles of motherhood and fatherhood, and for thechild’s growth and development. During the pre-natal period, nurses can assess parental attach-ment, perform procedures to develop attachmentpositively, and direct pregnant women and/or theirpartners with low attachment scores to receiveprofessional counselling. In addition, this assess-ment can help to develop disciplinary knowledge

and provide nurses with the information they needto advance theory and practice in the area ofprenatal care.

MFA and PFA were examined in relation todemographic and perinatal variables in this study.Several reports have demonstrated that mostpregnant mothers and fathers develop strongaffective responses to their unborn child (Cranley,1981; Weaver and Cranley, 1983; Condon, 1985;Mercer et al., 1988). A positive relationship wasfound between the MFA and PFA scores in thecurrent study. However, when comparing thepregnant women and their partners, the MFA scoreswere higher than the PFA scores. This may have

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Table 4 Regression analyses between maternal–fetal attachment (MFA) and paternal–fetal attachment (PFA)and selected variables.

B t p

MFA(Constant) 1511 5.575 o0.001Pregnant woman’s age �0.02 �2.75 0.007Partner’s age 0.01 2.46 0.01Woman’s education 0.05 2.17 0.03PFA 0.61 11.31 o0.001

PFA(Constant) 1.15 3.59 o0.001Pregnancy risk status �0.12 �2.16 0.03Pregnant woman’s age 0.02 3.08 0.003Partner’s age �0.02 �3.55 0.001Number of children �0.11 �3.11 0.002MFA 0.72 10.61 o0.001

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been a result of women feeling the physical signs ofpregnancy directly in their bodies. In addition,quickening develops when a pregnant woman firstfeels her baby moving within her uterus. The abilityto view the fetus as an independent being at anearlier point in pregnancy likely contributes todevelopment of the maternal–fetal relationship(Alhusen, 2008). Stormer (2003) reported thatquickening enhances feelings of attachment to-wards the fetus. Mercer et al. (1988) and Lorensenet al. (2004) reported that mothers had higher fetalattachment than their partners, similar to thepresent findings.

Some studies have reported a negative correla-tion between MFA score and mother’s age, and thatyounger women have higher MFA scores (Mercer etal., 1988; Zachariah, 1994; Lindgren, 2001). Simi-larly, MFA and PFA scores decreased with increasingage of the pregnant women and their partners inthis study. A negative relationship was foundbetween MFA score and the number of pregnanciesand parity, and between PFA score and previousexperience of fatherhood. The multigravid mothersand their partners had significantly lower MFA andPFA scores than the primigravid mothers and theirpartners in this study. Other studies support thesefindings (Ferketich and Mercer, 1995; Condon andCortindale, 1997; Haedt and Keel, 2007; Nichols etal., 2007), although others found no such relation-ship (Zachariah, 1994; Lindgren, 2001). In thecurrent study, this difference with primigravidmothers and their partners may indicate thepossibility of less focus on the current pregnancyand on their fetus, perhaps due to giving attentionto their other child/children. Furthermore, intraditional Turkish society, women usually take

care of responsibilities such as child care, house-work, cooking, cleaning and child education(Turmen, 2003). The women therefore have moreresponsibilities at home than at work, which mayhave produced the study result.

The educational status of the pregnant womenand their partners was associated positively withMFA and PFA in this study. Inverse correlations(Mercer et al., 1988; Lindgren, 2001) and noappreciable correlation have been reported be-tween these two variables in different studies(Wilson et al., 2000). This study revealed that theemployment status of the woman or her partner didnot influence MFA or PFA. Similar to the presentstudy, some studies have reported no correlationbetween MFA and the pregnant women’s employ-ment status and income (Lindgren, 2001; Ustunsozand Inanc, 2001).

If the pregnancy is high risk, it may be difficultfor the pregnant woman to cope, and her attach-ment towards the baby may be adversely affected(Weingarten et al., 1990). However, no significantdifferences in prenatal attachment were reportedbetween low-risk and high-risk pregnant women inthe present study and others (Cranley, 1981; Merceret al., 1988; Chazotte et al., 1995; Lindgren, 2001;Ustunsoz and Inanc, 2001). The partner of a high-risk pregnant woman may experience a situationalcrisis due to the high-risk pregnancy in addition tothe normal developmental crisis of pregnancy. Thisstress is additional to the normal emotional reac-tion in the partner, and may affect prenatal andpostpartum attachment (Ferketich and Mercer,1994; Ustunsoz and Inanc, 2001; Buist et al.,2003). The current study showed that PFA scoresof the partners of low-risk pregnant women were

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higher than those of the partners of high-riskpregnant women. Unlike the present study, Merceret al. (1988) found no significant differences in thePFA scores of the partners of low-risk and high-riskpregnant women.

Studies have reported that the quality of theemotional attachment of pregnant women towardstheir fetus may be higher if the pregnancy has beenplanned, social support is available, the woman hasa comforting relationship with her partner andprenatal care has been provided (Condon andCortindale, 1997; Bellieni et al., 2007). The findingsof the present study showed that MFA and PFAscores were higher in planned pregnancies thanunplanned pregnancies. Contrary to the results ofthis study, Damato (2004) found that planning ofpregnancy did not predict the level of fetalattachment.

This study found that MFA and PFA had the mostpositive effect on each other among variablesinfluencing the fetal attachment of pregnant womenand their partners. This result emphasises theimportance of evaluating the pregnant woman andher partner together when assessing attachment.

It is hoped that these results will be beneficial forfuture investigations and for midwives and nursesworking in the prenatal field. However, the studydid have some limitations. This study was con-ducted in three hospitals in a large urban area, andcannot be said to represent the whole of theTurkish population. In addition, the relationshipbetween the gender of the unborn baby andattachment was not investigated. A male childincreases a woman’s status in rural areas of Turkey,and further studies in rural areas are recom-mended.

Conclusion

This study has three main findings. First, Cranley’sMFA and PFA scales were found to be validinstruments for Turkish pregnant women and theirpartners. Second, some demographic and perinatalcharacteristics were found to influence prenatalattachment, with MFA and PFA having the mostpositive effect on each other. Finally, pregnantwomen had higher levels of fetal attachment thantheir partners.

Promotion of prenatal attachment may serve as thecrucial link to improving maternal health practices,perinatal health and neonatal outcomes. It isimportant to recognise the factors influencing attach-ment of the mother and father towards their fetus,and to strengthen nursing interventions regarding

these factors both for the physical and emotionaldevelopment of the infant and to provide family-centred prenatal care. Consequently, more studiesare required to gain a better understanding of thefactors that influence MFA and PFA.

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