The Effect of Journaling on Prenatal Attachment in Pregnant Women: A Randomized Controlled Trial
The Effect of Journaling on Prenatal Attachment in Pregnant Women: A Randomized Controlled Trial
Summary Scientific Merit: Pregnancy is one of the periods in which a woman experiences the most intense physical and psychological changes. During this process, the mother's emotional bond with her baby is a key factor determining the postpartum mother-infant relationship and psychological well-being. Strong prenatal attachment is associated with a healthy mother-infant relationship, positive parenting attitudes, and a reduction in postpartum depression. Journaling is a simple yet effective method that helps individuals recognize their emotions, cope with stress, and express themselves. However, evidence-based research evaluating the effect of journaling during pregnancy on prenatal attachment is quite limited in our country. This project aims to make an original contribution to the literature by examining the effect of journaling among second- and third-trimester pregnant women on increasing prenatal attachment. This project aims to fill this gap by examining the effect of journaling on prenatal attachment levels in women in the 2nd and 3rd trimesters of pregnancy. The findings obtained from the study will provide scientific evidence for low-cost psychosocial interventions that can be applied during pregnancy. In this way, a "holistic approach" dimension will be added to midwifery care, contributing to strengthening the mother-infant bond.
Method: The research is experimental in nature and will be conducted using a randomized controlled design. The study will be carried out in collaboration with the İstanbul University-Cerrahpaşa Faculty of Health Sciences, and the sample will consist of volunteer pregnant women between the 13th and 36th weeks of gestation who present to the antenatal outpatient clinic. The experimental group will be given a "Diary" created by the researchers for 4 weeks and asked to keep a journal. Participants will be asked to write at least 4 times over the course of 4 weeks (about emotions, thoughts regarding the baby, worries, hopes, and expressions of gratitude). No intervention other than routine follow-up will be applied to the control group. Data will be collected using the Prenatal Attachment Inventory at the beginning and end of the intervention. The data obtained will be analyzed using appropriate statistical methods in SPSS.
Project Management: The project coordinator will coordinate the research plan, and the advisor faculty member will provide guidance in methodological and ethical matters. The student researchers will be responsible for participant recruitment, data collection, diary follow-up, and data entry. The process will be monitored through regular meetings at every stage, and data will be coded and stored in accordance with confidentiality principles. The study will not begin before ethics committee approval is obtained.
Broader Impact: This study will bring an innovative dimension to psychosocial support approaches during pregnancy, offering a holistic perspective to midwifery care. The findings will constitute a proposal for a low-cost and effective psychological support method that can be applied during the prenatal period. The results will be shared at national student congresses and in scientific journals; they will raise awareness among midwifery students, women's health nurses, psychologists, and researchers interested in the perinatal period, and will bring an innovative dimension to psychosocial support practices during the prenatal period. It will also be made usable in awareness training for expectant mothers.
Hypothesis of the Project In this context, the aim of this project is to examine the effect of journaling during pregnancy on prenatal attachment.
Accordingly, in this experimental study planned as a randomized controlled trial, the hypotheses are as follows; Hypotheses of the Project H0: Journaling during pregnancy has no significant effect on prenatal attachment.
H1: Journaling during pregnancy has a positive effect on prenatal attachment.
Importance of the Topic Pregnancy is the physiological process that begins with the fertilization of a woman's egg by a sperm cell and in which the embryo and fetus develop in the mother's womb. Pregnancy is not only a biological process but also a period in which psychological, emotional, and social changes occur. These transformations taking place in the expectant mother's body and mind are a natural part of preparing for birth and motherhood. Harlow argued that because the mother meets the infant's basic needs such as hunger and thirst during infancy, an attachment forms between mother and child, a notion that also forms the core of Bowlby's research. One of the elements used in the studies Harlow conducted with his students on monkeys in 1958 was maternal deprivation. In the experimental setup established, in order to understand the monkeys' basic drive, they were given two options: either climb to a cloth-covered surface or climb to an uncomfortable wire surface to drink milk. After climbing the wire rod and drinking milk, the monkeys quickly returned to the cloth-covered surface. This shows that not only feeding but also comfort is important (Tüzün and Sayar, 2006).
The expectant mother's emotional contact with her baby during pregnancy - for example, feeling the baby's movements in her womb, talking to the baby, or developing thoughts about the baby - represents the early human form of the "search for comfort and security" observed in Harlow's experiments. Accordingly, this emotional bond established during the prenatal period serves as preparation for the postpartum mother-infant relationship and forms the foundations of the baby's basic sense of security. In this respect, Harlow's findings support the psychobiological and emotional foundations of prenatal attachment studies, emphasizing that the relationship between mother and infant is not only biological but also a psychosocial process. Pregnancy is one of the most special yet fragile periods of a woman's life. During this period, the mother's emotional state, the bond she forms with her baby, and her psychological well-being directly affect both the healthy progression of the pregnancy process and the postpartum mother-infant relationship. Prenatal attachment is defined as the mother's perception of her baby as an individual during pregnancy and the development of feelings of love, protection, and responsibility toward the baby (Müller, 1993). Strong prenatal attachment is associated with a reduced risk of postpartum depression, longer breastfeeding duration, and positive parenting behaviors (Condon and Corkindale, 1997; Alhusen, 2013).
Prenatal attachment is the emotional, cognitive, and behavioral bond that the mother develops toward her unborn child. The imaginary communication the expectant mother establishes with the fetus during pregnancy, and the way she perceives and interprets its movements, contribute to the strengthening of this bond. Studies have found that prenatal attachment is influenced by factors such as the mother's mental health, anxiety level, attitude toward pregnancy, and level of social support (Özdemir et al., 2020). Nine behaviors that may affect prenatal attachment have been described. These are: planning the pregnancy, the pregnancy being wanted, accepting the pregnancy, feeling fetal movements, accepting the fetus as a separate individual, giving birth, seeing the baby, touching the baby, and caring for the baby (Peppers and Knapp, 1980). Robin, who founded the theoretical framework of prenatal attachment, emphasized that women have four specific tasks during the prenatal period. These are: (a) seeking a safe passage for herself and her baby throughout pregnancy, (b) ensuring the baby's acceptance by others, (c) establishing an inner bond with the fetus, and (d) devoting herself to the baby (Robin, 1975).
From the beginning of pregnancy until the start of the second trimester, women form an imaginary image of the baby in their minds. Wondering who the baby will resemble and how it will move, making preparations for the baby, valuing and caring about the baby, and showing love, interest, affection, and protectiveness all indicate the pregnant woman's prenatal attachment (Öztürk, 2021). However, studies have indicated that stress, anxiety, fatigue, lack of social support, and low self-perception experienced during pregnancy may negatively affect prenatal attachment (Yarcheski et al., 2009). For this reason, the need for psychosocial interventions that support attachment during pregnancy is increasing. Journaling (expressive writing) is an effective, cost-free, and easily applicable method that enables individuals to recognize their emotions, cope with negative emotions, and make sense of life events (Pennebaker, 2018). However, there is no experimental or quasi-experimental study in Turkey on the effect of journaling during pregnancy on prenatal attachment. This constitutes a significant gap in the literature.
The pregnancy period is a process in which intense changes are experienced both physically and emotionally. Journaling helps the mother recognize her emotions, express her fears, and deepen the bond she forms with her baby during this period. Writing can strengthen prenatal attachment by enabling the mother to make sense of her pregnancy experience and express herself better (Gao, 2022). Written expression can reduce the mother's stress level by providing emotional release (catharsis). A mother who puts her emotions into words rather than suppressing them can cope more healthily with the anxiety, fear, or uncertainties of the pregnancy process. The literature indicates that expressing emotions increases oxytocin release, reinforcing feelings of relaxation and peace, which in turn positively affects mother-infant interaction. Thus, written expression not only supports psychological well-being but may also have an indirect positive effect on biological processes. Journaling facilitates the mother's internalization of her maternal role and emotional preparation for the postpartum period.
Scientific research has shown that regular writing during pregnancy reduces anxiety levels and improves the mother's self-awareness and emotion regulation skills (Baikie and Wilhelm, 2005). In the study by Özdemir and colleagues (2020), pregnant women with high levels of prenatal attachment were also reported to have lower stress and anxiety levels. In this context, journaling can be considered an important tool that both supports psychological balance and strengthens the mother-infant bond during pregnancy. In conclusion, journaling is a method that increases an individual's emotional awareness, strengthens the capacity to cope with stress, and supports psychological recovery. The importance of this effect increases further during pregnancy. Journaling helps the expectant mother organize her inner world, recognize her emotions, and form a strong emotional bond with her baby. In the study conducted by Mirmolaei (2020), expressive writing was applied to pregnant women twice a week for 15-20 minutes over a 2-month period. In this study, anxiety and depression decreased significantly by the 4th week of the intervention, but the stress level did not decrease by the 4th week; when the intervention was extended to 8 weeks, a significant decrease in stress level was also observed.
Diaries kept during pregnancy help the woman make sense of her pregnancy experience, organize her inner processes, and position her baby in her mind as a "real being." Writing down the physical characteristics the mother imagines for her baby, her predictions about its temperament, her conversations with the baby, or her wishes for the baby contributes to giving concrete form to this otherwise abstract bond. This allows the mother to perceive her baby not merely as "a being growing in her womb" but as "an individual with whom she has formed an emotional bond." For this reason, journaling during pregnancy is a simple yet effective method that strengthens prenatal attachment by allowing the mother to express her emotions, thoughts, and expectations. The act of writing helps the mother give concrete form to her baby in her mind, gain emotional awareness, and cope with stress.
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husniye.dinckaya@iuc.edu.tr+905336841952