Skip to main content
Original Article

The Role of Maternal Perceived Social Support on the Relation Between Prenatal Depressive Symptoms and Labor Experience

Published Online:https://doi.org/10.1027/2512-8442/a000103

Abstract.Background: Depression during pregnancy is a severe risk factor for negative outcomes in women and children. In particular, prenatal symptoms of depression are linked to a more complicated labor experience, characterized by more painful labor and more frequent recourse to epidural analgesia and/or oxytocin. Although this link is evident, less is known about possible mediators of this relationship. Aims: This study investigated the mediating role of perceived maternal social support on the relationship between prenatal maternal depression and labor experience. Methods: Participants were 152 Italian nulliparous women (Mage = 31.68 years, SD = 4.94). Data were collected at two different times: T1 (at week 30–33 of gestation) women completed the Beck Depression Inventory and the Maternal Social Support Scale; T2 (at childbirth) clinical data regarding labor was registered from hospital records (duration of labor in hours and administration of oxytocin and epidural analgesia in hours). Results: The Structural Equation Modeling showed that prenatal symptoms of depression are linked to a more complicated labor experience (β = .31, p < .001). However, the quality of the maternal social support can mediate this relationship (indirect effect: β = .17, p < .000). Limitations: The complexity of the proposed model, the characteristics of the sample, the variables investigated, and the questionnaires used are discussed. Conclusion: The perception of having a good social network is an important predictor of women’s health in the transition to motherhood, decreasing the negative effect of maternal prenatal depressive symptoms on the quality of women’s labor experience.

References

  • Alhusen, J. L., & Alvarez, C. (2016). Perinatal depression: A clinical update. The Nurse Practitioner, 41(5), 50–55. doi: https://doi.org/10.1097/01.NPR.0000480589.09290.3e First citation in articleCrossrefGoogle Scholar

  • Anim-Somuah, M., Smyth, R. M., & Jones, L. (2011). Epidural versus non-epidural or no analgesia in labor. Cochrane Database of Systematic Reviews, Dec(12). https://doi.org/10.1002/14651858.CD000331.pub3 First citation in articleGoogle Scholar

  • Azimi, M., Fahami, F., & Mohamadirizi, S. (2018). The relationship between perceived social support in the first pregnancy and fear of childbirth. Iranian Journal of Nursing and Midwifery Research, 23(3), 235–239. https://doi.org/10.4103/ijnmr.IJNMR_170_16 First citation in articleCrossrefGoogle Scholar

  • Babiss, L. A., & Gangwisch, J. E. (2009). Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support. Journal of Developmental & Behavioral Pediatrics, 30(5), 376–384. https://doi.org/10.1097/DBP.0b013e3181b33659 First citation in articleCrossrefGoogle Scholar

  • Balaji, A. B., Claussen, A. H., Smith, D. C., Visser, S. N., Morales, M. J., & Perou, R. (2007). Social support networks and maternal mental health and well-being. Journal of Women’s Health, 16(10), 1386–1396. https://doi.org/10.1089/jwh.2007.CDC10 First citation in articleCrossrefGoogle Scholar

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173 First citation in articleCrossrefGoogle Scholar

  • Beck, A., Steer, R., & Brown, G. (1996). BDI-II, Beck Depression Inventory-II. Psychological Corporation. First citation in articleGoogle Scholar

  • Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. https://doi.org/10.1037/0033-2909.107.2.238 First citation in articleCrossrefGoogle Scholar

  • Bentler, P. M. (1995). EQS structural equations program manual. Multivariate Software. First citation in articleGoogle Scholar

  • Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843–857. https://doi.org/10.1016/s0277-9536(00)00065-4 First citation in articleCrossrefGoogle Scholar

  • Bonari, L., Pinto, N., Ahn, E., Einarson, A., Steiner, M., & Koren, G. (2004). Perinatal risks of untreated depression during pregnancy. The Canadian Journal of Psychiatry, 49(11), 726–735. https://doi.org/10.1177/070674370404901103 First citation in articleCrossrefGoogle Scholar

  • Byatt, N., Xiao, R. S., Dinh, K. H., & Waring, M. E. (2016). Mental health care use in relation to depressive symptoms among pregnant women in the USA. Archives of Women’s Mental Health, 19(1), 187–191. https://doi.org/10.1007/s00737-015-0524-1 First citation in articleCrossrefGoogle Scholar

  • Castro e Couto, T., Cardoso, M. N., Brancaglion, M. Y., Faria, G. C., Garcia, F. D., Nicolato, R., de Miranda, D. M., & Corrêa, H. (2016). Antenatal depression: Prevalence and risk factor patterns across the gestational period. Journal of Affective Disorders, 192, 70–75. https://doi.org/10.101610.1016/j.jad.2015.12.017 First citation in articleCrossrefGoogle Scholar

  • Costa, D. D., Dritsa, M., Larouche, J., & Brender, W. (2000). Psychosocial predictors of labor/delivery complications and infant birth weight: a prospective multivariate study. Journal of Psychosomatic Obstetrics & Gynecology, 21(3), 137–148. https://doi.org/10.3109/01674820009075621 First citation in articleCrossrefGoogle Scholar

  • Costley, P. L., & East, C. E. (2012). Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries. Cochrane Database of Systematic Reviews, May(5), 1–14. https://doi.org/10.1002/14651858.CD009241.pub2 First citation in articleGoogle Scholar

  • Dabrassi, F., Imbasciati, A., & Della Vedova, A. M. (2009). Il Supporto Sociale in Gravidanza: Validazione italiana e valutazione dello strumento [Social Support during pregnancy: The Italian validation and evaluation of the instrument]. Giornale di Psicologia, 3(2), 141–151. First citation in articleGoogle Scholar

  • Field, T. (2017). Prenatal depression risk factors, developmental effects and interventions: a review. Journal of Pregnancy and Child Health, 4(1), 1–25. https://doi.org/10.4172/2376-127X.1000301 First citation in articleCrossrefGoogle Scholar

  • Flink, I. K., Mroczek, M. Z., Sullivan, M. J., & Linton, S. J. (2009). Pain in childbirth and postpartum recovery–The role of catastrophizing. European Journal of Pain, 13(3), 312–316. https://doi.org/10.1016/j.ejpain.2008.04.010 First citation in articleCrossrefGoogle Scholar

  • Ghinassi, S., Elmi, B., Fioretti, C., Smorti, A., & Tani, F. (2021). Thinking for three: Mothers’ and fathers’ narratives on transition to parenthood. The Open Psychology Journal, 14, 53–61. https://doi.org/10.2174/1874350102114010053 First citation in articleCrossrefGoogle Scholar

  • Ghisi, M., Flebus, G. B., Montano, A., Sanavio, E., & Sica, C. (2006). Beck Depression Inventory – Second Edition. Italian adaptation: Manual. Organizzazioni Speciali. First citation in articleGoogle Scholar

  • Ibarra-Rovillard, M. S., & Kuiper, N. A. (2011). Social support and social negativity findings in depression: Perceived responsiveness to basic psychological needs. Clinical psychology review, 31(3), 342–352. https://doi.org/10.1016/j.cpr.2011.01.005 First citation in articleCrossrefGoogle Scholar

  • Jahedi, F., Neisanisamani, L., Moosavisahebalzamani, S., & Haghani, H. (2014). Relationship between perceived social support in first pregnancy with birth satisfaction in primigravid women referred to Shahid Akbar Abadi Hospital. Preventive Care in Nursing & Midwifery Journal, 4, 53–64. First citation in articleGoogle Scholar

  • Ji, S., Long, Q., Newport, D. J., Na, H., Knight, B., Zach, E. B., Morris, N. J., Kutner, M., & Stowe, Z. N. (2011). Validity of depression rating scales during pregnancy and the postpartum period: Impact of trimester and parity. Journal of Psychiatric Research, 45(2), 213–219. https://doi.org/10.1016/j.jpsychires.2010.05.017 First citation in articleCrossrefGoogle Scholar

  • Junge, C., von Soest, T., Weidner, K., Seidler, A., Eberhard-Gran, M., & Garthus-Niegel, S. (2018). Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal study. Birth, 45(4), 469–477. https://doi.org/10.1111/birt.12349 First citation in articleCrossrefGoogle Scholar

  • Kim, Y., Bird, A., Peterson, E., Underwood, L., Morton, S. M., & Grant, C. C. (2020). Maternal antenatal depression and early childhood sleep: Potential pathways through infant temperament. Journal of Pediatric Psychology, 45(2), 203–217. https://doi.org/10.1093/jpepsy/jsaa001 First citation in articleCrossrefGoogle Scholar

  • Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford Publications. First citation in articleGoogle Scholar

  • Lai, C. C., & Ma, C. M. (2016). The mediating role of social support in the relationship between psychological well-being and health-risk behaviors among Chinese university students. Health Psychology Open, 3(2), 1–11. https://doi.org/10.1177/2055102916678106 First citation in articleCrossrefGoogle Scholar

  • Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry, 8(1), Article 24. https://doi.org/10.1186/1471-244X-8-24 First citation in articleCrossrefGoogle Scholar

  • Lin, N., Dean, A., & Ensel, W. M. (2013). Social support, life events, and depression. Academic Press. First citation in articleGoogle Scholar

  • Maimburg, R. D., Væth, M., & Dahlen, H. (2016). Women’s experience of childbirth – a five year follow-up of the randomised controlled trial “ready for child trial”. Women and Birth, 29(5), 450–454. https://doi.org/10.1016/j.wombi.2016.02.003 First citation in articleCrossrefGoogle Scholar

  • Mori, R., Tokumasu, H., Pledge, D., & Kenyon, S. (2011). High dose versus low dose oxytocin for augmentation of delayed labour. Cochrane Database of Systematic Reviews, (10). https://doi.org/10.1002/14651858.CD007201.pub2 First citation in articleCrossrefGoogle Scholar

  • Muthén, L. K., & Muthén, B. O. (1998–2007). Mplus user’s guide (7th ed.). Muthén & Muthén. First citation in articleGoogle Scholar

  • Myers, D. G. (2000). The funds, friends, and faith of happy people. American Psychologist, 55(1), 56–67. https://doi.org/10.1037/0003-066X.55.1.56 First citation in articleCrossrefGoogle Scholar

  • NICE Guideline. (2008). Induction of labour. National Collaborating Centre for Women’s and Children’s Health. National Institute for Health and Clinical Excellence. RCOG Press. First citation in articleGoogle Scholar

  • Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. McGraw Hill. First citation in articleGoogle Scholar

  • Pampaka, D., Papatheodorou, S. I., Al Seaidan, M., Al Wotayan, R., Wright, R. J., Buring, J. E., Dockery, D. W., & Christophi, C. A. (2019). Postnatal depressive symptoms in women with and without antenatal depressive symptoms: Results from a prospective cohort study. Archives of Women’s Mental Health, 22(1), 93–103. https://doi.org/10.1007/s00737-018-0880-8 First citation in articleCrossrefGoogle Scholar

  • Pereira, P. K., Lovisi, G. M., Pilowsky, D. L., Lima, L. A., & Legay, L. F. (2009). Depression during pregnancy: Prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil. Cadernos de Saude Publica, 25(12), 2725–2736. https://doi.org/10.1590/s0102-311x2009001200019 First citation in articleCrossrefGoogle Scholar

  • Piko, B. F., & Kovács, E. (2010). Do parents and school matter? Protective factors for adolescent substance use. Addictive Behaviors, 35(1), 53–56. https://doi.org/10.1016/j.addbeh.2009.08.004 First citation in articleCrossrefGoogle Scholar

  • Plant, D. T., Pawlby, S., Sharp, D., Zunszain, P. A., & Pariante, C. M. (2016). Prenatal maternal depression is associated with offspring inflammation at 25 years: A prospective longitudinal cohort study. Translational Psychiatry, 6, Article 936. https://doi.org/10.1038/tp.2015.155 First citation in articleCrossrefGoogle Scholar

  • Ponti, L., & Smorti, M. (2019). Mediating role of labor on the relationship between prenatal psychopathologic symptoms and symptoms of postpartum depression in women who give birth vaginally. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(6), 627–634. https://doi.org/10.1016/j.jogn.2019.09.003 First citation in articleCrossrefGoogle Scholar

  • Ponti, L., Smorti, M., Ghinassi, S., & Tani, F. (2020). The relationship between romantic and prenatal maternal attachment: The moderating role of social support. International Journal of Psychology, 56(1), 1–8. https://doi.org/1-8.10.1002/ijop.12676 First citation in articleGoogle Scholar

  • Reck, C., Zimmer, K., Dubber, S., Zipser, B., Schlehe, B., & Gawlik, S. (2013). The influence of general anxiety and childbirth-specific anxiety on birth outcome. Archives of Women’s Mental Health, 16(5), 363–369. https://doi.org/10.1007/s00737-013-0344-0 First citation in articleCrossrefGoogle Scholar

  • Sigurdardottir, V. L., Gamble, J., Gudmundsdottir, B., Kristjansdottir, H., Sveinsdottir, H., & Gottfredsdottir, H. (2017). The predictive role of support in the birth experience: A longitudinal cohort study. Women and Birth, 30(6), 450–459. https://doi.org/10.1016/j.wombi.2017.04.003 First citation in articleCrossrefGoogle Scholar

  • Smorti, M., Ponti, L., & Pancetti, F. (2019). A comprehensive analysis of post-partum depression risk factors: The role of socio-demographic, individual, relational, and delivery characteristics. Frontiers in Public Health, 7, Article 295. https://doi.org/10.3389/fpubh.2019.00295 First citation in articleCrossrefGoogle Scholar

  • Smorti, M., Ponti, L., & Tani, F. (2019a). Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn’s health: a longitudinal study. Journal of Reproductive and Infant Psychology, 37(4), 444–452. https://doi.org/10.1080/02646838.2019.1581919 First citation in articleCrossrefGoogle Scholar

  • Smorti, M., Ponti, L., & Tani, F. (2019b). The effect of maternal depression and anxiety on labour and the well-being of the newborn. Journal of Obstetrics and Gynaecology, 39(4), 492–497. https://doi.org/10.1080/01443615.2018.1536697 First citation in articleCrossrefGoogle Scholar

  • Smorti, M., Ponti, L., Ghinassi, S., & Rapisardi, G. (2020). The mother-child attachment bond before and after birth: The role of maternal perception of traumatic childbirth. Early Human Development, 142, 1–5. https://doi.org/10.1016/j.earlhumdev.2020.104956 First citation in articleCrossrefGoogle Scholar

  • Steiger, J. H., & Lind, J. C. (1980, May). Statistically-based tests for the number of common factors. Paper presented at the Annual Meeting of the Psychometric Society, Iowa City, IA. First citation in articleGoogle Scholar

  • Tani, F., & Castagna, V. (2017). Maternal social support, quality of birth experience, and post-partum depression in primiparous women. The Journal of Maternal-Fetal & Neonatal Medicine, 30(6), 689–692. https://doi.org/10.1080/14767058.2016.1182980 First citation in articleCrossrefGoogle Scholar

  • Tani, F., Castagna, V., & Ponti, L. (2017). Mothers’ social perceived support, anxiety and prenatal attachment to child: Which direct and indirect influences on delivery clinical indices. International Journal of Health Sciences and Research, 7, 346–352. First citation in articleGoogle Scholar

  • Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10. https://doi.org/10.1007/BF02291170 First citation in articleCrossrefGoogle Scholar

  • Webster, J., Linnane, J. W., Dibley, L. M., Hinson, J. K., Starrenburg, S. E., & Roberts, J. A. (2000). Measuring social support in pregnancy: can it be simple and meaningful? Birth, 27(2), 97–101. https://doi.org/10.1046/j.1523-536x.2000.00097.x First citation in articleCrossrefGoogle Scholar