The relational ecology of the transition to parenthood in couples that conceived spontaneously or through Assisted Reproductive Technologies

Abstract

Background. Infertility is a reproductive health problem defined by the World Health Organization as the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse (WHO, 1992), that affects 9% of the population worldwide (Boivin, Bunting, Collins, & Nygren, 2007). Due to the strain of assisted reproductive technology (ART) treatments infertile couples have to undergo in order to pursue a much desired parenthood (Klonoff-Cohen, Chu, Natarajan, & Sieber, 2001) and to the increased obstetrical risks and medical complications associated with pregnancy following successful ART (Basso & Baird, 2003), it has been suggested that couples that conceive through ART may experience increased adjustment difficulties during their transition to parenthood (Colpin, 2002; Klock & Greenfeld, 2000). The present dissertation focused on the relational contexts of the transition to parenthood in couples that conceived spontaneously or through ART. At the theoretical level, we addressed the lack of a reference framework capable of integrating empirical findings by proposing a developmental ecological approach to parenting after infertility and assisted reproduction. At the empirical level, we investigated how a different and harder pathway to parenthood, that is, one that implies undergoing assisted reproduction treatments, impacts on the parents’ psychosocial adjustment, on their socioemotional investment in their child and on their social relationships during their transition to parenthood. Method. This was a longitudinal prospective study that followed 39 couples that conceived through ART and 34 couples that conceived spontaneously from their last pregnancy trimester (twenty-fourth pregnancy week), through birth and until their child was four months old. To investigate parents’ psychosocial adjustment, as indicators of individual adjustment we assessed parents’ subjective perception of pregnancy and parenthood (single items developed for this study), psychological distress (Brief Symptom Inventory) and quality of life (WHOQOL - bref) and at the relational level we considered satisfaction with the marital relationship (ENRICH Marital Inventory) and parenting stress (Parenting Stress Index). To investigate parents’ socioemotional investment in their child we used the Parental Investment in the Child scale. Finally, to assess the parents’ social relationships (structural and functional social network characteristics) across their transition to parenthood we used the Convoy Model. Sociodemographic, clinical, obstetrical and perinatal data was collected directly from the parents and from their medical records. Results. Several relevant findings were reported. The transition to parenthood and parenting context of Portuguese men and women that conceived through ART or spontaneously proved to be similar: they showed similar adjustment levels and changes across the transition to parenthood, they presented a similar social context (i.e. similar structural and functional network changes across the transition to parenthood and similar associations between social network support and adjustment to parenthood and parental care) and they did not show differences in the investment they make in their child. However, some differences were also found: (1) parents that conceived through ART (especially women) perceived their pregnancy as being of higher risk and more demanding, but also more rewarding than parents that conceived spontaneously; (2) fathers that conceived through ART considered themselves to be more competent fathers than those that conceived spontaneously; (3) parents that conceived through ART reported a decrease in their psychological well-being from pregnancy to the postpartum period that was not reported by parents that conceived spontaneously; (4) women that conceived through ART perceived higher levels of emotional and instrumental support from their less intimate nuclear family members and less from their friends than mothers that conceived spontaneously; and (5) compared to men that conceived spontaneously, men that conceived through ART perceived more support from less intimate than from more intimate nuclear family members. For both parents that conceived spontaneously or through ART, the transition to parenthood was characterized by (1) stability in (the inexistence of) psychological distress from pregnancy to the postpartum; (2) a decrease in their marital relationship from pregnancy to the postpartum; (3) several gender based differences in the overall levels and changes in their quality of life from pregnancy to the postpartum; (4) low levels of parenting stress four months after the partum; (5) a strong social nesting movement that consisted in drawing towards them their nuclear family members and that proved to be similar for both men and women; (6) significant associations between perceived network support in pregnancy and parental well-being and their socioemotional investment in their child four months after the partum, that varied as a function of the parents’ gender, of the type of relationship involved and of the type of perceived support; and (7) a high resemblance between maternal and paternal investment in the child, four months after the partum, these being influenced by how satisfied parents were with their marital relationship and by the amount of support they perceived from their social network members. Conclusions. Our results add to the field state-of-the-art by providing innovative evidence that all parents, regardless of the method of conception used to achieve pregnancy, seem to exhibit a social nesting movement in which their nuclear family members play a central role; that parents that conceive spontaneously or through ART do not differentiate in the investment they make in their child; and that parental investment is, to a large degree, a couple shared feature. Results also contribute to an already vast empirical literature that describes the transition to parenthood as a demanding period during which both members of the couple experience significant changes (at the individual, dyadic and social levels) and that shows that there are more similarities than differences in the way parents that conceive spontaneously or through ART live this transition period. However, they add to this literature by showing that these similarities do not only exist at the individual and dyadic level, but also at a broader social level. The main clinical implication deriving from the results presented is that healthcare professionals should be available to assist all couples in their efforts to adapt to the changes associated to the transition to parenthood (Cowan & Cowan, 1995), taking into consideration the different ways men and women experience this life transition. However, sensitivity is required in addressing the unique experience of the transition to parenthood of parents that conceive through ART and the subtle ways in which adjustment may differ for these families.