Title: Emotional aspects of the pregnancy experience
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00098650/00001
 Material Information
Title: Emotional aspects of the pregnancy experience anxiety, life changes, and feminine identification
Physical Description: xi, 97 leaves : ; 28 cm.
Language: English
Creator: Peres, Katherine Eleanor, 1950-
Publication Date: 1978
Copyright Date: 1978
Subject: Pregnancy -- Psychological aspects   ( lcsh )
Psychology thesis Ph. D   ( lcsh )
Dissertations, Academic -- Psychology -- UF   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
Thesis: Thesis--University of Florida.
Bibliography: Bibliography: leaves 89-96.
Statement of Responsibility: by Katherine E. Peres.
General Note: Typescript.
General Note: Vita.
 Record Information
Bibliographic ID: UF00098650
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000083030
oclc - 05180619
notis - AAJ8362


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To women-------

mothers and non-mothers,

struggling with the issues of

maturity, nurturance, and growth.


I would most especially like to thank my major professors

for their long-standing support. I am grateful to Jacquelin

Goldman for her confidence in my ability to make decisions

for myself and her calming words during my crises. And I

thank Franz Epting for his gentle guidance and encouragement

and his continued suggestions to "cut it down."

I am also grateful to the rest of my committee: to

Wilson Guertin, for his genuine concern and statistical ex-

pertise; to Mary McCaulley, for her abiding interest in

pregnant women, and her office space; and to Marvin Shaw, for

always being there when I needed him to be.

In addition to these, there are many persons without

whom this project would never has been completed: Cora Braynon,

Joan Buczck, B. J. Price, and Virginia Dick of the Broward

County Health Department, who allowed me access to their

maternity patients; Pam Alexander, Ellen Fischer, and Sandra

Hunter, who interviewed participants, and Dee Dee Read who

telephoned them; Irene and Albert Krieger, who provided emo-

tional support and technical assistance; and Linda Taylor,

whose friendship and typing assistance were invaluable.

Finally, I am most grateful to three people without whom

this work would have been impossible. I thank my parents,

who taught me the ambition and perseverance to complete this

task. And above all, I thank my husband Seth, for under-

standing and tolerating, for prodding and urging, and for

being there through the ordeal.


ACKNOWLEDGMENTS .......... ......... ............ iii

LIST OF TABLES .............................. ........... viii

ABSTRACT ........... ....................... .......... ix

CHAPTER I. INTRODUCTION ............................... 1

Methodological Considerations...................... 2

Substantive Issues in the Study
of Pregnancy and Childbirth.................... 4

Fear of pregnancy, labor and delivery .......... 5

Fear of harming the baby....................... 5

Rejection of the pregnancy..................... 6

Generalized anxiety and neuroticism............ 7

Feminine identification............ ........... 10

Life stress .......................... .......... 12

Somatic symptoms ................................. 15

Hypotheses to Be Tested................. .......... 20

CHAPTER II. METHOD................ ...................... 22

Subjects ................................. ......... 22

Materials .............................. .......... 22

Background Information Questionnaire........... 22

Pregnancy Information Test..................... 23

Somatic Symptoms List.......................... 23

Marlowe-Crowne Social Desirability Scale....... 24

Social Readjustment Rating Scale ............... 24


State-Trait Anxiety Inventory.................. 25

Femininity Measures ............................ 25

Bem Sex Role Inventory...................... 25

Attitudes toward Women Scale ................ 26

Procedure ..................... ........... .. ........ 26

CHAPTER III. RESULTS .................................... 28

Hypothesis 1........................................ 28

Hypothesis 2 ........................................ 28

Hypothesis 3............. ............ ............ 31

Factor Analyses .................................. 31

CHAPTER IV. DISCUSSION ............................... 42

Hypothesized Relationships ........................ 42

Other Correlations .................................. 46

Factor Analyses................ ........... .......... 51

Methodological Considerations in the
Study of Pregnancy................. .............. 55

Volunteer participants.......................... 55

Follow-up ........................................ 57

Future research..................... ............ 58




III. SOMATIC SYMPTOMS LIST....................... 68



VI. BEM SEX ROLE INVENTORY......... ............ 76




IX. LETTER TO PHYSICIANS ........................ 84



REFERENCES ............................................. 89

BIOGRAPHICAL SKETCH .................................... 97



1. Variable Names .................................... 19

2. Variable Ranges, Means, and Standard Deviations... 29

3. Intercorrelation Matrix: Raw Scores ............... 32

4. Intercorrelation Matrix: Corrected Scores......... 34

5. Factor Matrix 1: Raw Scores.......... ............. 36

6. Factor Matrix 2: Corrected Scores ................. 38


Abstract of Dissertation Presented to the Graduate Council
of the University of Florida
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy




August 1978

Chairperson: Jacquelin R. Goldman
Major Department: Psychology

The emotional and somatic experiences of 64 pregnant

women in the first trimester of pregnancy were examined

using objective measures with demonstrated reliability and

validity. Forty-seven participants were patients of Broward

County Health Department maternity clinics; 17 others were

the patients of private physicians. All subjects volunteered

their participation after they were approached by the author.

The relationship between anxiety and somatic symptoms was

explored using A-Trait as the measure of felt anxiety and

A-State as the indicator of anxiety during the pregnancy.

The relationship between stressful life changes and somatic

symptoms was also tested. In addition, sexual identification,

sex role preference, age, race, parity, socioeconomic status,

knowledge of pregnancy, and socially desirable response set

were measured.

The hypothesized relationship between A-Trait and symp-

toms before pregnancy was not substantiated using raw score

data, but was supported when scores were corrected by the

control variables. Similarly, there was a positive relation-

ship between the number of somatic symptoms experienced during

pregnancy and A-State, for both raw and corrected scores. On

the other hand, there was no relationship between life change

units and number of somatic symptoms reported. In addition,

there was no relationship between androgyny score on the Bem

Sex Role Inventory and endorsement of non-traditional femi-

nine roles on the Attitudes toward Women Scale.

Factor analyses of these data produced six meaningful

factors: Factor 1. Anxiety had heavy loadings for A-Trait

and A-State; 2. Sex Role Ambivalence consisted largely of

standard deviation scores on the Bem femininity measure and

the Bem masculinity measure; 3. Sex-typing was defined by

the Bem femininity and masculinity scores; 4. Somatizing and

Ambivalence had heavy loadings for Symptoms Before Pregnancy,

Symptoms During Pregnancy, and the standard deviation scores

for the Attitudes toward Women Scale; 5. Androgyny consisted

of a positive loading for the Bem androgyny score and a

negative loading for the Bem masculinity score; 6. Life

Changes and Traditionalism consisted of loadings from the

life changes score, a traditional role score from the Atti-

tudes toward Women Scale, and standard deviation scores

from that scale.

These factors strongly suggest the need to explore

various aspects of feminine identification in relationship

to the more traditional variables measured during pregnancy.


The role of woman in most societies is centered around

her function as a mother. In all primitive cultures and in

most modern ones, pregnancy and childbirth have been the

focus of folklore and taboos (Chertok, 1972; Mead, 1968).

Modern scientists have attempted to break through the mystery

and customary secrecy surrounding the pregnancy experience1

in an attempt to understand the physiological and psycholog-

ical aspects of this occurrence and how the biology and psy-

chology are interrelated.

Personality theorists such as Helene Deutsch (1945) and

Therese Benedek (1960) have been concerned with pregnancy as

a developmental crisis, an opportunity for the woman to ac-

complish certain developmental tasks (Bibring, 1959; Dyer,

1963; Leifer, 1977; Levy & McGee, 1975; Loesch & Greenberg,

1962). Deutsch considers childbirth to be the expression of

the complete sexual maturity of the adult female. Benedek

believes the pregnancy experience is the culmination of bio-

logical and psychological drives which render the pregnant

woman a mature and fulfilled adult.

1In this paper, the "pregnancy experience" is used to
mean the events surrounding conception, pregnancy, labor
and delivery, and the condition of the newborn.

While many women may be unaware of the purported de-

velopmental importance of pregnancy, most women have been

thoroughly indoctrinated with the social value of child-

bearing by the time they reach puberty. In spite of strong

socialization, many women embark upon the experience of preg-

nancy with a great deal of ambivalence and anxiety (Biskind,

1962; Flapan, 1969; Newton, 1963). The common occurrence of

conflict over the pregnancy has been one of the prime rea-

sons for research into the psychological aspects of the re-

productive experience. This ambivalence has been used to

explain many of the symptoms for which no physiological cause

is evident. Indeed, the emotional as well as the psychoso-

matic aspects of pregnancy and childbirth and their effects

on both the mother and the newborn have become the focus of

much research and a great deal of speculation (Copans, 1974;

Dunbar, 1944; Escalona, 1968; Jones, 1974; McNeil, Wiegerink,

& Dozier, 1970; Mura, 1974; Prechtl, 1967; Werner, Simonian,

Bierman, & French, 1967). As in any widely investigated area,

the hypotheses and results are conflicting and confusing. It

is the purpose of this study to explore the relationships

among some of the variables of concern and to attempt a

parsimonious theoretical explanation of those relationships.

Methodological Considerations

Two general strategies in the study of pregnancy are of

particular concern: (1) prospective vs retrospective de-

sign and (2) objective vs. subjective (interview and pro-

jective) measures.

Most of the studies performed prior to 1960 were retro-

spective in nature. In this design, the new mother is con-

tacted during the period following delivery and is questioned

about her experience during the pregnancy. Generally, a

group of "abnormal" women is compared with a group who ex-

perienced "normal" labors and deliveries. The obvious fault

of this retrospective design is the same as in other areas

of research where the preceding events are not learned until

after the significant experience has occurred; i.e., the

data which are recalled are very likely to have been colored

by the experience. Thus, a woman who has recently delivered

and perhaps undergone a complicated delivery, when asked

about somatic symptoms during her pregnancy, may endorse

suggested sources of difficulty to help her understand the

discomfort she has just experienced, and thus report inac-

curately (Brown, 1964).

Prospective designs have become more abundant in the past

15 years. Some of these studies have gathered a very limited

scope of data, thereby greatly limiting their explanatory

value (e.g., Chertok, Mondzain, & Bonnaud, 1963; Klatskin &

Eron, 1970). Others have included several hundreds of women

without systematic selection thereby making interpretations

of results difficult (Nilsson, Kaij, & Jacobson, 1967).

Others have successfully isolated issues which seem to be of

significance in the study of the pregnancy experience (Davids,

Holden, & Gray, 1963; Grimm & Venet, 1966; McDonald &

Christakos, 1963). It is these often isolated factors upon

which this study will focus.

The method by which data are gathered and interpreted

is crucial in discovering replicable variables and predictions.

The earliest research designs employed psychiatric interviews

to gather most of the data analyzed. As researchers became

more sophisticated, they attempted to use projective techniques

to measure anxiety and sex role identification. The most

recent studies have generally employed scaled questionnaires

and objective tests with empirically demonstrated reliability

and validity. In order to avoid overgeneralization and poor

definition, some care must be taken in interpreting studies

which relied upon projective measures. Additionally, caution

must be exercised in comparing studies which employed ob-

jective test scores with those which used projective tests,

but called the variables by the same names, e.g., anxiety.

Confusion has often occurred because of inconsistent use of

terms, and some of the contradictions in the literature to

be reported may well be the result of this factor.

Substantive Issues in the Study of Pregnancy and Childbirth

If one were to review the pregnancy literature with the

purpose of isolating one factor which seems to be consistently

correlated with difficulties in pregnancy, anxiety would

undoubtedly emerge as the most commonly cited variable. Since

this term can have so many diverse meanings, it seems more

productive to examine each of the areas which has been found

to contribute to anxiety. The variables which will be con-

sidered are fear of pregnancy, labor and delivery; fear of

harming the baby; rejection of the pregnancy; and generalized

anxiety and neuroticism. Other important variables in the

pregnancy experience are feminine identification, conflict

about the feminine role, stressful life events, and tendency

to report somatic symptoms.

Fear of pregnancy, labor and delivery. Many authors have

developed questionnaires aimed at measuring attitudes toward

pregnancy (Grimm & Venet, 1966; Schaefer & Manheimer, 1960).

Fear of the pregnancy experience has habitually been in-

cluded in these questionnaires because of its apparent im-

portance to the outcome of pregnancy. Flanders Dunbar has

noted the relationship between fear and spontaneous abortion

(1962). More recently, Erickson (1965) used a prospective

method to examine the effects of fears of the pregnancy ex-

perience during the prenatal period. Using Schaefer and

Manheimer's questionnaire, she found that fear of harm to

oneself during childbirth was positively correlated with

complications and with length of labor and inversely cor-

related with Apgar Index scores rating the condition of the

infant at birth (Apgar, 1953; 1966). The mechanism by which

fear of the birth experience has its effects on outcome re-

mains unknown at present.

Fear of harming the baby. Among primigravidas fear of

harming the child by activities during the pregnancy and by

carelessness or overt acts after birth is common. Ferreira

(1960) found that the infants of women who expressed strong

fear of hurting the baby on a questionnaire completed during

the pregnancy were rated by newborn nursery nurses as deviant

from the norm; i.e., the child cried more or less than most

newborns, was more or less irritable, etc. In the same

study cited above, Erickson measured fear of harming the baby

as well as concern for oneself. The two were highly related

in all primigravidas and in multigravidas who had complications.

These data suggest that concerns in some way interact with

the number of prior pregnancies a woman has experienced. Many

women experience fears during their first pregnancy; these

fears are only moderately correlated with complications. How-

ever, multigravidas who are still experiencing fears for the

child and for themselves are much more likely to have com-

plicated deliveries and deviant infants. The possibility

that these women had experienced difficulties in previous

pregnancies and were realistically concerned was not dis-


It must be clarified that an increase in anxiety over

the non-pregnant state is generally considered normal during

pregnancy. Most pregnant women, especially primigravida,

experience some fear of the unknown and anxiety about bodily

changes. These fears are related to both the fetus and one-

self (Leifer, 1977). It is, therefore, extreme levels of

fear which appear to be related to problems in pregnancy.

Rejection of the pregnancy. Several indicators of the

status of pregnancy in the mind of the mother have been used

as measures of rejection of the pregnancy. A woman who

verbally expresses disgust at the fact of her pregnancy has

been considered rejecting (Robertson, 1946). Robertson

found that such disgust was closely associated with severe

nausea and vomiting in pregnancy. Chertok et al. (1963)

used self-reported ambivalence toward the birth as their

indicator of rejection; ambivalence was also highly related to

nausea and vomiting. Alec Coppen (1958), using interviews and

psychologists' ratings, found that women who suffered from
pre-eclamptic toxemia were rejecting of the pregnancy.

Pilowsky (1972), using the H.I.P. Pregnancy Questionnaire

found that women who rejected their pregnancies had more severe

complications, children with lower Apgar ratings, and more

somatic complaints during pregnancy. Finally, Engstrom,

Geijerstam, Holmberg, and Uhrus (1964) found that women who

had negative attitudes toward the pregnancy,based on inter-

views early in pregnancy and shortly after delivery, ex-

perienced more inertia during labor and bore infants suffering

asphyxia more often than a non-rejecting group of women.

Grimm and Venet (1966), however, also using their H.I.P

Pregnancy Questionnaire, have not found fear of pregnancy,

labor, and delivery, fear of harming the baby, or rejection

of the pregnancy to be correlated with complications of the

reproductive course. They consider these to be variables

which relate to the quality of the woman's experience, but

which are not related to outcome of the pregnancy.

Generalized anxiety and neuroticism. Many authors have

been less specific than those discussed above in their

search for relationships among pregnancy variables. It is

this fact which causes "anxiety" to be the most commonly

named variable in studies of prenatal experience. Both

2Pre-eclamptic toxemia consists of two physiochemical
disturbances which have severe effects on both gravida and
fetus: (1) salt and water retention; and (2) arteriolar
spasm (Salerno, 1962).

retrospective and prospective studies have found anxiety

during pregnancy to be related to a variety of outcomes.

Mann and Grimm (1962) found that women who tended to

be habitual spontaneous aborters appeared highly anxious on

prejective test data gathered during pregnancy. The only

successful treatment they were able to discover for this

group was a course of psychotherapy during the pregnancy.

Eighty percent of those women so treated were delivered of

normal full-term infants. Mann and Grinn assumed this to be

the result of reduction of anxiety. Grimm (1961) found that

27% of the women in her extreme tension group had an infant

who died or was deformed, while only 3% of the rest of the

women had such a child. Even those fetuses which do survive

are adversely affected by the mother's anxiety. Lester

Sontag (1962) described what he called hyperactivity and

increased irritability in the infants of such mothers. And

even after delivery, the emotional adjustment and mother-

child interaction of those women highly anxious during preg-

nancy showed evidence of disturbance (Davids et al., 1963).

Besides the dramatic effect manifest anxiety during

pregnancy appears to have on the developing fetus, increased

complications of all sorts are found to be correlated with

this anxiety. Somatic complaints during pregnancy (Zuckerman,

Nurnberger, Gardiner, Vandiveer, Barrett, & den Breeijen,

1963); excessive weight gain and pre-eclampsia (McDonald,

1965); length of labor (Davids & DeVault, 1962; Davids,

DeVault, & Talmadge, 1961; McDonald, Gynther, & Christakos,

1963); obstetric complications during delivery (McDonald,

1965; McDonald & Christakos, 1963; Zuckerman et al., 1963);

and low infant birth weight (McDonald et al., 1963) have

all been related to anxiety during the prenatal period.

Neuroticism, as measured by Minnesota Multiphasic

Personality Inventory, Maudsley Personality Inventory,

Eysenck Personality Inventory, and psychiatrists' ratings,

has proven to be related to several complications of the

pregnancy experience. Nausea and vomiting of early preg-

nancy (Harvey & Sherfey, 1954; Netter-Munkelt, Mau, & Konig,

1972); difficulties in labor (Scott & Thomson, 1956); as

well as more pregnancies, miscarriages, stillbirths, neo-

natal deaths, and psychiatric illness among surviving off-

spring (Mandlebrote & Monro, 1964) have been found among

neurotic women. Recently, however, Jones (1974) using a

predictive design aimed at developing a battery of tests to

predict complications, found no relationship between MMPI

measures of neuroticism and anxiety and complications of


Of the studies discussed thus far, two used projective

tests or subjective ratings as measures of anxiety. Grimm

(1961) used an anxiety score based on the Thematic Apper-

ception Test; Davids et al. (1963) used the ratings of a

group of interviewers. Both found anxiety related to out-

come of the pregnancy, but their results may not be directly

comparable to those of Davids and DeVault (1962), Davids

et al. (1961), McDonald (1965), McDonald and Christakos (1963),

and Zuckerman et al. (1963) who used Taylor's Manifest

Anxiety Scale and McDonald et al. (1963) who used the IPAT

as their measure of anxiety.

Feminine identification. The earliest, most speculative

hypotheses about ambivalence and complications during the

pregnancy experience assumed, based upon the psychoanalytic

literature, that any problem which had no obvious physical

cause must be the result of the immaturity of the pregnant

woman and her inability to accept her feminine destiny as a

mother. This hypothesis has never lost its importance in the

literature, and several researchers have found conflict

about, and rejection of, the feminine role to be highly cor-

related with problems in every stage of the pregnancy ex-


Uddenberg, Nilsson, and Almgren (1971) interpreted

Thematic Apperception Test (TAT) responses and items en-

dorsed on a neuroticism scale to be indicative of conflict

regarding the female role. Conflict was positively related

to severe nausea and vomiting in the early stages of preg-

nancy, as well as to no nausea and vomiting. He described

the women with no nausea and vomiting as repressors of

serious conflict, an explanation supported by other re-

searchers (Rosen, 1955). Problems later in the pregnancy

have also been related to concerns about the feminine role.

Carl Tupper (1962) found two personality types among women

who had habitual spontaneous abortions: (1) the basically

immature woman who cannot accept the major responsibility of

mature femininity, namely, becoming a mother; and (2) the

independent, frustrated woman, who has been conditioned to

and yearns for the rewards of the male world and feels that

maternity, the greatest reward of the female world is much

less satisfying, if not highly unsatisfying.

Such conflict also shows its influence at delivery and

after birth. Abnormal deliveries, consisting of complica-

tions and long labor times, have been correlated with Draw-

a-Person and TAT indications of sex role conflict (Davids &

DeVault, 1960). Rorschach and TAT data have been used to

show that women who were rejecting of the role of mother-

hood during pregnancy were less well adjusted after delivery

than women who welcomed motherhood (Klatskin & Eron, 1970).

Few of these studies used direct measures of attitudes

toward the female role and sex role identification; they

relied upon projective techniques and interpretation of

interview data. Because of the significant discrepancies in

the operational definitions of this variable, these con-

clusions might more realistically be considered hypotheses

still to be examined by more reliable measures and related

to other aspects of pregnancy.

Recent formulations of sex role identification have

begun to regard masculinity and feminity in different ways.

In most measures of sexual identification, femininity is

considered to be the opposite of masculinity, and the two

necessarily exclude one another. If, however, one uses the

formulation which Sandra Bem has developed, one would view

feminity and masculinity as two independent sets of traits

which might represent different ways of being in the world,

but which also might exist in combination in certain in-

dividuals (Bem, 1974). Persons who have approximately the

same proportions of masculine and of feminine traits have

been called androgynous, and these individuals appear to be

better adjusted to the world in general (Bem, 1975).

In most research, it has been considered that a woman

must meet the traditional feminine standards in order to

truly accept her pregnancy and to deal with it effectively.

These new conceptions of sex role identification offer dif-

ferent possibilities. Perhaps women who endorse an androgy-

nous identification have more successful pregnancies. On

the other hand, it may be that women who are conflicted or

ambivalent about their sexual identification are those who

will experience difficulties; e.g. a woman who has a highly

feminine sexual identification but who endorses a non-

traditional feminine role may experience conflict and

anxiety, and thus have many somatic symptoms. Because the

issue of conflict about role endorsement has not been ex-

plored using reliable measures, and because these concepts

might markedly influence the gravida's pregnancy experience,

this study made an initial attempt to explore the relation-

ships between two recent measures of sex role identification,

the Bem Sex Role Inventory (Bem, 1974) and the Attitude

toward Women Scale (Spence & Helmreich, 1972).

Life Stress. The one factor which seems to be almost

as frequently measured as anxiety and neuroticism in studying

outcome of pregnancy is life stress. The notion that psycho-

logical aspects of stressful experiences can affect physical

health has long been part of both common sense beliefs and

medical study (Alexander, 1950). The manner in which one

experiences his life events (Hinkle & Wolff, 1958) and the

degree to which they are seen or felt to be overloads to

his system (Lipowski, 1974) appear to be important factors

in the correlation of life stress with physical illness.

Early attempts to measure life stress (Berle, Pinsky,

Wolf, & Wolff, 1952; Hinkle & Wolff, 1958) developed metho-

dologies for quantifying life experiences and determined

that there are strong correlations between unstable life

experiences, lack of psychosocial assets, and illness onset

(Holmes, Joffe, Ketcham, & Sheehy, 1961). Hinkle deter-

mined that there are "cluster years" of life stress which

can be shown to precede episodes of emotional problems as

well as somatic illness.

Richard Rahe, Thomas Holmes, and their colleagues have

performed extensive research in an attempt to develop an

adequate methodology for predicting susceptibility to disease

based on recent life experiences and the amount of social

readjustment they require. They have consistently found

that life change intensity correlates with illness onset

(Masuda & Holmes, 1967b; Rahe, 1968; 1969; Rahe, McKean, &

Arthur, 1967). Their Social Readjustment Rating Scale

allows the respondent to indicate events which have occurred

within the previous six months; these events include such

changes as death of spouse, major change in living conditions,

change in jobs, and death of a close friend. Life events

have different magnitudes (life change units-LCU) based on

the ratings of large samples of individuals. The clustering

of life changes requiring a large amount of readjustment

within a relatively short time is called a "life crisis."

The severity of life crisis is a strong predictor of health

change, generally in a negative direction (Holmes and Masuda,

1972; Holmes & Rahe, 1967; Masuda & Holmes, 1967a; Rahe,

1969). Even the onset of pregnancy has been shown to follow

life changes. With such a wide realm of effect, it seems

likely that magnitude of life change might be correlated

with other aspects of the pregnancy experience.

The number of personal and/or social difficulties which

a woman undergoes during her pregnancy has been shown to be

related to occurrence of hyperemesis gravidarum (Rosen,

1955; Tylden, 1968), toxemia of pregnancy (Hetzel, Bruer, &

Poidevin, 1961), uterine inertia (Engstrom et al. 1964),

complications of labor and delivery (Gorsuch & Key, 1974),

prematurity (Gunter, 1963), developmental lag in the infant

(Abramson, Singh, & Mbambo, 1961) and central nervous system

birth deformities (Stott, 1971).

The relationship between life stress and complications

is, however, not a simple one. Nuckolls, Cassel, and Kaplan

(1972) found that life changes appear to interact with psy-

chosocial assets, i.e., any psychological or environmental

factors helping the gravida cope with her pregnancy. They

found that, in the presence of significant life events

before and during pregnancy, women with high psychosocial

assets had one-third the rate of complications of women

whose assets were low. However, in the absence of life

changes, psychosocial assets were irrelevant.

The timing of the life stress was demonstrated to be

significant by Gorsuch and Key (1974). State-Trait Anxiety

during the first trimester of pregnancy was predictive of

complications as was life stress during the second and third

trimester. These authors found no correlation between

anxiety and life stress at any of the times measured; how-

ever, both were related to outcome. Jones (1974), however,

studying women in their ninth month of pregnancy found the

number of life changes to be consistently negatively cor-

related with complications; i.e., the fewer life changes a

woman experienced, the more complications she had. None

of these studies examined life stress as it relates to

somatic symptoms during pregnancy.

Somatic symptoms. The fact that several authors have

been unable to demonstrate statistically significant corre-

lations among anxiety, attitudes toward pregnancy, and com-

plications of pregnancy, labor and delivery or physical

symptoms during the pregnancy (Brown, 1964; Grimm & Venet,

1966; Heinstein, 1967) suggests the possibility that there

are some other important factors at work besides attitudes

and anxiety. Perhaps one of these other factors is the

manner in which the gravida deals with her attitudes or with

her anxiety, and the extent to which she is willing to report

those events. It is obviously the case that individuals

handle anxiety differently (Lazarus, 1966). Some persons

become immobilized and can do nothing; some feel emotionally

agitated; some become accident prone; some convert their

feelings of anxiety into physical symptoms. If a woman's

anxiety affects her bodily processes it may very well affect

the fetus (Davids & DeVault, 1962; Davids et al., 1961;

McDonald, 1965; McDonald, et al., 1963). The way in which

the gravida deals with her physical symptoms may well be

related to her general approach to the world, her personality


Recent attempts to study pregnancy as part of the nor-

mal developmental process have focused less on emotional

upheaval and more on issues such as the developing sex role

identification of the gravida, her attitude toward her body

and the changes she is experiencing, and her ability to con-

sider the fetus as an individual separate from herself

(Arbeit, 1975; Leifer, 1977). These efforts at construing

the pregnancy experience in positive, growth-producing terms

are in stark contrast to those studies which focus solely on

the stressful aspects of pregnancy.

An assessment of the studies reviewed might well lead

to confusion about the types of emotional experiences women

have during pregnancy, as well as the potential effects of

these emotional events. Indeed, the variables which have

been studied to date have been garnered from theories about

the pregnancy experience and from the investigators' per-

sonal preference. Few attempts have been made to measure

and quantify the empirical relationships among the variables

considered important during pregnancy, and to then relate

them to outcome. Grimm and Venet (1966) have done so on a

limited basis, but have found no relationship between their

questionnaire alone and complications. Other studies of

the gravida's experience without regard for outcome have

been exploratory and descriptive using few of the measures

typically employed in personality research (Arbeit, 1975;

Leifer, 1977).

In order to approach accurate and quantified descrip-

tions of the pregnancy experience, it was necessary to choose

measures which have been demonstrated to be significant to

the gravida's experience and which have documented reliability

and validity. Medical data have consistently shown that

age at the time of pregnancy, race, parity or number of

children the woman has, and socioeconomic status are related

to frequency of symptoms and complications a woman may ex-

perience (Eastman & Hellman, 1966). Because of the signifi-

cance of these variables, it is essential that they be

recorded and their influence controlled. Thus, age, race,

parity, and socioeconomic status were all accounted for in

this study.

In addition, the need to control two other areas has

been demonstrated. Barclay (1972) showed that the knowledge

a woman has about the biological aspects of pregnancy is

related to the amount of anxiety she experiences at delivery.

It was a logical extension of this finding that knowledge of

pregnancy might influence anxiety during the pregnancy as

well as at delivery. Consequently, pregnancy information

was also measured as a control variable. Finally, tendency

to respond in a socially desirable manner has consistently

proven to be a source of bias in data sets (Crowne &

Marlowe, 1960). Because such a response set might influence

a woman's willingness to accurately report anxiety, feminine

identification, and somatic symptoms, this variable was

also used as a control measure.

More substantive issues which have frequently been

studied are anxiety, life stress, sex role identification,

and somatic symptoms during pregnancy. As previously re-

ported, these variables have frequently been related to

outcome of pregnancy, but have seldom been related to one

another. Based on the literature, one might expect to find

complex interactions among some of the variables. Examin-

ation of both the simple and complex relationships among

these variables, without regard to outcome, was the purpose

of this study. (The variables are listed in Table 1.)

While correlational techniques allow researchers to

quantify simple relationships between variables, techniques

which relate all the variables to one another were also re-

quired in this study. In order to isolate variables which

accounted for a significant portion of the gravida's ex-

perience, and limit the measures to those which did account

for a considerable amount of the variance in her responses,

it was decided that factor analysis would be used to describe

the factor structure, thus elucidating the relationships of

interest. It was assumed that the description of meaningful

Table 1
Variable Names

1. Age
2. Race
3. Paritya
4. Socioeconomic Status
5. Knowledge about Pregnancy
6. Socially Desirable Responding
7. Life Changes before Pregnancy
8. Somatic Symptoms before Pregnancy
9. Somatic Symptoms during Pregnancy
10. State anxiety
11. Trait anxiety
12. Attitude toward Women
13. Attitude toward Women, Standard Deviations
14. Masculinity
15. Femininity
16. Androgyny
17. Masculinity, Standard Deviations
18. Femininity Standard Deviations

Corrected Score Variable Names

1. Life Changes before Pregnancy
2. Somatic Symptoms before Pregnancy
3. Somatic Symptoms during Pregnancy
4. State anxiety
5. Trait anxiety
6. Attitude toward Women
7. Attitude toward Women, Standard Deviations
8. Masculinity
9. Femininity
10. Androgyny
11. Masculinity, Standard Deviations
12. Femininity, Standard Deviations

aIn this study, Parity was used to mean the number of
children the pregnant woman had prior to this pregnancy.

factors in this population would assist in determining the

importance of measuring particular variables.

While the interactions among all the variables might

indeed be quite complex, several straightforward relation-

ships were expected to exist. Since anxiety has been re-

peatedly shown to correlate with complications of all sorts,

it was expected that a correlation would exist between

anxiety and somatic symptoms in this study as well. While

the relationship between anxiety and life stress is not

clear, life stress has frequently been related to physical

symptoms. Thus, it was also expected that a correlation

would exist between life changes and somatic symptoms.

In addition, in an attempt to begin exploration of the

concept of conflict about the feminine role, two recent

measures of sex role identification were used. It was as-

sumed that women who endorsed a non-traditional sex role

would also have an androgynous identification. If this is

so for pregnant women generally, then a discrepancy between

these two scores might be considered conflict about sex role.

Hypotheses to Be Tested

1. If a woman habitually experienced high anxiety,

then she would report more symptoms before pregnancy than

a woman who experienced low anxiety; i.e., high A-Trait on

the State-Trait Anxiety Inventory (STAI) would be negatively
correlated with Symptoms Before Pregnancy.

3A low score on Symptoms Before Pregnancy and on
Symptoms During Pregnancy indicates many symptoms. Thus,
the predicted negative correlations would indicate the
existence of many symptoms and high anxiety.

Similarly, if a woman reported marked anxiety during

her pregnancy (A-State), she would also experience many

symptoms during pregnancy, producing a negative correlation

between A-State and Symptoms During Pregnancy.

2. If a woman reported many salient life changes (LCU)

prior to pregnancy, then she would experience more physical

symptoms during pregnancy than women with few life changes;

i.e., LCU will be negatively correlated with Symptoms During


3. If a woman endorsed an androgynous identification

on the Bem Sex Role Inventory (low score), she would show a

preference for a non-traditional feminine role on the At-

titude toward Women Scale (high score); i.e., a negative re-

lationship between the two would exist.

4A low score on Symptoms Before Pregnancy and on Symp-
toms During Pregnancy indicates many symptoms. Thus, the
predicted negative correlations would indicate the existence
of many symptoms and high anxiety.

5A low score on Symptoms During Pregnancy indicates
many symptoms. Thus, the predicted correlation would indi-
cate the existence of many symptoms and many life changes.



Participants in this study were 64 pregnant women

who were in their first trimester of pregnancy. These

women were recruited from among the patients of the Broward

County Health Department Maternity Clinics and from several

area obstetricians. Only English-speaking women were used

in the study.

These participants ranged from 14 to 36 years of age,

mean age = 23.6. Thirty-nine were white; the other 25 were

black Americans. Of these, 34 were pregnant for the first

time, 16 were pregnant for their second child, 11 were

expecting their third child, one her fifth, and two their

sixth children. Two of the gravidas were in the highest

socioeconomic class, three in the second, 13 in the middle

class, 22 in the fourth, and 24 in the fifth and lowest

class based on education and occupation.


Background Information Questionnaire. This question-

naire was in large part taken from one used in the doctoral

dissertation of D. J. Venezia (1972). The information re-

quested was that required to determine socioeconomic class

according to A. B. Hollingshead's Two-Factor Index of

Social Position (1957). This is a frequently used indica-

tor of socioeconomic status which determines social class

according to education and occupation. In addition, the

questionnaire included questions about race, age, number

of previous pregnancies, spontaneous abortions, multiple

births, and RH factor. This instrument was used to gather

information about the control variables. (The question-

naire can be found in Appendix I.)

Pregnancy Information Test. This was a measure

developed by Rosalyn Barclay (1972) to determine the amount

of objective knowledge a woman has of pregnancy and of the

physical processes involved in labor and birth. This

measure was included as a control variable in order to

account for another possible source of variation which

might have contributed to anxiety. (This test is found in

Appendix II. Means and reliability data are in Appendix XI.)

Somatic Symptoms List. This list consists of 60

items taken from the Health Insurance Program Pregnancy

Questionnaire developed by Elaine Grimm and Wanda Venet

(1966). The items were rated on frequency of experience


sponses for each item were "Always", "Rarely", "Seldom",

and "Never." In scoring, weights of one, two, three, and

four were applied with "Always" receiving a score of one,

and "Never" receiving a score of four. Thus, on this scale

low scores meant that the gravida experienced many

physical symptoms. (This list appears in Appendix III.)

Marlowe-Crowne Social Desirability Scale (SD). The

Social Desirability Scale was developed by Crowne and

Marlowe (1960) to represent behaviors which are not social-

ly acceptable but which are not psychopathological in the

sense of the Minnesota Multiphasic Personality Inventory

(MMPI) items included in the Edwards Social Desirability

scale. The Marlowe-Crowne SD was used in an attempt to

determine which subjects might be responding to the atti-

tude questions on the basis of a socially desirable set.

Such a set might well influence scores, in that individuals

who refuse to give a response which is not socially ac-

ceptable may appear to endorse traditional roles when in

actuality they do not. High scores indicated a tendency

to respond in a socially desirable manner. (The scale is

presented in Appendix IV.)

Social Readjustment Rating Scale (SRRS). Holmes and

Rahe (1967) have developed this 43 item scale to measure

the quantity of life stress which has occurred in the pre-

vious six months in an individual's life. Each item

endorsed by a participant was assigned a standard weight

based on previous research. The sum of the weights was

the total number of Life Change Units the person had ex-

perienced. Previous research has demarcated scores over

300 as indicative of a "life crisis" (Rahe, 1969).

The scale has been found to have coefficients of re-

liability ranging from .638 to .744. The instrument is

most reliable for the events with highest salience or

magnitude ratings (LCU), those events which seem to be

most significant in predicting health change (Casey,

Masuda, & Holmes, 1967). (The SRRS can be found in

Appendix V.)

State-Trait Anxiety Inventory (STAI). This instru-

ment, developed by Spielberger, Gorsuch, and Lushene

(1970), is a measure of felt anxiety under two different

sets of instructions. The test measures the way a person

typically feels (A-Trait) and the way he feels in a par-

ticular situation (A-State). The inventory was used in

this study in an attempt to separate the anxiety aroused by

the state of pregnancy (A-State) from the anxiety typically

felt by the woman (A-Trait).

Femininity Measures. In order to examine two separate

aspects of feminine identification or acceptance of the

female role, two measures of femininity were employed.

Bem Sex Role Inventory (BSRI). The BSRI was developed

by Sandra Bem (1974) in response to a need for a measure

of sex role identification which does not posit that mascu-

linity and femininity are merely opposites of one another.

The BSRI treats these two dimensions as separate constructs

which interact to form another category of identification

called androgyny. The scale appeared to be useful for this

study because it introduced the concept of androgyny-a

healthy combination of masculine and feminine elements.

Masculinity and femininity scores were obtained inde-

pendently and ranged from one to seven. Androgyny was a

corrected difference between the masculinity and femininity

scores, a t-score. A score near zero was an indication of

an androgynous identification. Positive scores suggested

feminine sex-typing, and negative ones indicated masculine

sex-typing. Bem has obtained internal consistency esti-

mates on all three scales ranging from .70 to .86; test-

retest reliability is also adequate, ranging from .89 to

.93 (Bem, 1975). (The BSRI can be found in Appendix VI.)

Attitudes toward Women Scale (AWS). Janet Spence and

Robert Helmreich (1972) have developed a scale to measure

the tendency with which a person views feminine roles-

traditional vs. liberal-a low score indicating a conserva-

tive system of values about feminine role, and a high score

indicating a more liberal, feminist set of values. The

scale consistently measures differences between males and

females. (The AWS appears in Appendix VII.)


Subjects in this study were contacted by letter and/or

by telephone about the purpose of the study. A brief de-

scription of the research and their involvement was given.

An appointment was arranged with each woman who agreed to
In this study, the Androgyny score was operation-
ally defined as a t-score using the masculinity and
femininity scores in the following formula:


t = F 2+ M 2
n1 + n2 2


participate; an interview was conducted by the experimenter

or by one of three interviewing assistants. The purpose of

the meeting was to explain in greater detail the nature of

the study, to answer any questions, and to give instruc-

tions on responding to the various questionnaires. (The

Letter to Prospective Subjects is in Appendix VIII; the

Letter to Physicians can be found in Appendix X; and the

Structured Interview Protocol is in Appendix X.)

Since the questionnaires used were all paper-and-

pencil tasks, self-administration was the standard pro-

cedure. Some of the information and ratings requested

were retrospective in nature, but the bulk of the informa-

tion required concerned the present state of the gravida.

The tasks were performed by each woman at approximately the

same time in pregnancy, i.e., prior to the sixteenth week

of the pregnancy. Five randomized orders of presentation

of the questionnaires were employed to avoid a response set

based on sequence of questions. Each gravida completed

the questionnaires in her own home at her convenience.

The completed questionnaires were picked up from the

participant by the investigator.


In order to determine the effects the control variables

had on the other variables measured, two sets of analyses were

performed. First, raw scores on all 18 variables were used to

test the hypotheses. Secondly, corrected scores were calcu-

lated by means of regression analysis, partialling out the

portion of each score which could be predicted by the control

variables alone. Once corrected scores or residuals were

calculated, the analyses were repeated. Finally, factor

analyses were performed on both raw scores and residuals to

obtain an indication of the manner in which the measures

varied in common. (Table 2 contains the ranges, means, and

standard deviations of all 18 variables.)

Hypothesis 1. It was hypothesized that if a woman habi-

tually experienced high anxiety, then she would report more

symptoms before pregnancy than a woman who experienced low

anxiety; i.e., high A-Trait on the State-Trait Anxiety In-

ventory would be negatively correlated with Symptoms Before

Pregnancy. A negative correlation was expected because a low

score on the Symptoms Before Pregnancy measure indicated many

symptoms. Similarly, if a woman reported marked anxiety dur-

ing her pregnancy (A-State), she would also experience many

Symptoms During Pregnancy. Both portions of this hypothesis

were tested by means of the Spearman Rank Order Correlation

Table 2
Variable Ranges, Means, and Standard





14 -

white or
1 or

3. Parity

4. Socioeconomic Status

5. Pregnancy Information

6. Social Desirability

7. Life Changes

8. Symptoms Before

9. Symptoms During

10. A-State

11. A-Trait

12. Attitude toward Women

13. AWS-Standard
Deviations (SD)

14. Bem Sex Role Inven-
tory, Masculinity

15. Bem Sex Role Inven-
tory, Femininity

16. Bem Sex Role Inven-
tory, Androgynya

17. Bem Sex Role Inven-
tory, Masc.-SD

18. Bem Sex Role Inven-
tory, Fem.-SD













0.674 1.501

2.45 5.65

2.40 6.20

-1.34 5.43

0.696 2.720

0.598 2.540

23.6094 4.5676






198. 7699


163. 1563



95. 7031












1.0587 0.1731

4.2578 0.6982

4.9267 0.6813

1.3716 1.3411

1.7091 0.3857

1.5966 0.3918

were used in




aAbsolute values of the Androgyny scores
all computations as per Ben (1974).

Coefficient to determine the direction and degree of the

relationship between the two variables.

Part one of Hypothesis 1 was not confirmed using raw

scores. No significant correlation was found between A-Trait

and Symptoms Before Pregnancy, thus disconfirming the notion

that tendency to report more physical symptoms before pregnancy

was related to typical state of anxiety (r = -.0944). Part

two of this hypothesis did, however, receive moderate support

in the data. A-State was slightly negatively correlated with

Symptoms During Pregnancy (r = -.2192, p .050), thus sug-

gesting that women who experienced higher anxiety during preg-

nancy also reported more symptoms during pregnancy. Since a

stronger correlation was expected, tests of curvilinearity were

performed using regression analysis. For part two of the hy-

pothesis, a slight curvilinear relationship was found using a

squared term (Multiple R = .2614, F = 4.55, df = 1,62, p .05).

Using corrected scores to compute the correlation

coefficients resulted in confirmation of both parts of the

hypothesis. When the effects of Age, Race, Parity, Socio-

economic Status, Pregnancy Information (Knowledge of Preg-

nancy), and Social Desirability were subtracted from the

other variables, A-Trait was negatively correlated with

Symptoms Before Pregnancy (r = -.2543, p .025), thus

suggesting that when controls are employed for Age, Race, and

the other variables, women who were typically anxious

experienced more physical symptoms before pregnancy than

women low in anxiety. Similarly, when the effects of the

control variables were subtracted out, A-State was again

negatively correlated with Symptoms During Pregnancy

(r = -.2194, p < .050). When the control variables were

accounted for, the magnitude of this correlation remained

significant at the same level. (Correlation coefficients

for the raw score data can be found in Table 3, and for the

corrected scores in Table 4).

Hypothesis 2. If a woman reported many salient life

changes (LCU) prior to pregnancy, then she would experience

more physical symptoms during pregnancy than women with few

life changes; i.e., LCU would be negatively correlated with

Symptoms During Pregnancy. This hypothesis was also tested

by means of Spearman Rank Order Correlations. No relation-

ship was found between LCU and Symptoms During Pregnancy using

raw scores (r = -.0633) or using corrected scores (r = -.1130).

Hypothesis 3. If a woman endorsed an androgynous iden-

tification on the Bem Sex Role Inventory (low score), she

would show a preference for a non-traditional feminine role

on the Attitude toward Women Scale; i.e., a negative rela-

tionship between the two would exist. This hypothesis was

also tested by means of the Spearman Rank Order Correlation

Coefficient. The absolute values of the Androgyny scores

were used to retain the meaning of the scale. No relationship

was found between the two variables. When raw scores were

used, r = -.0342; when corrected scores were used, r = -.0326.

Factor Analyses. In order to examine the complex

interrelationships of all the measures in terms of the

manner in which they vary together, factor analyses were

Table 3
Intercorrelation Matrix: Raw Scores

Variables 1 2 3 4 5 6 7 8


2 a-.4653
3 a .5536 -.1761

4 a-.4810 a .6301 -.1602
5 a .4380 a-.6537 d-.2643 a-.5233

6 -.1369 .2042 .0515 .1859 -.1823

7 -.0087 -.0910 -.0262 .0514 -.0845 -.0650

8 -.0305 .0546 e .2431 .0863 .0363 .1804 -.0828

9 -.0320 -.0269 -.0335 -.0641 -.0295 .0861 -.0633 a .4250

10 -.1416 a .3660 .1628 c .2976 -.1709 .0966 .1982 -.0436

11 c-.2994 a .4138 .0227 a .4351 -.1642 .0245 .0484 -.0944

12 .0429 -.3122 -.0613 a-.3731 b .3567 .2615 e-.2437 -.0592

13 -.1257 a .3866 .0671 e .2214 e-.2424 .1962 .1671 -.1583

14 e .2230 c-.3046 .0172 d-.2522 .1411 -.0655 -.2009 -.1676

15 .1955 d-.2673 .0304 -.0919 .1507 .0695 -.0947 -.0462

16 -.1217 .0191 -.1121 .0431 .0635 -.0702 .0635 .0071

17 -.0982 -.0052 .0758 b .3444 -.1312 .0065 .1632 .1192

18 b-.3549 a .4710 -.0462 a .5723 a-.4221 .1639 .1432 .1737

a p < .001 bp .005 cp < .010 p < .025 e p < .050

Table 3 extended

9 10 11 12 13 14 15 16 17 18


c-.3043 a .7623

.0303 d-.2627 -.1631

-.1501 .1622 .2271 a.4159

-.1317 e-.2151 -.1560 e .2348 -.1478

.0880 d-.2592 d-.2716 e .2263 -.1779 a .5323

.0314 -.0916 -.1465 -.0342 .0088 a-.3905 b .3183

-.0536 -.0389 -.0060 -.1655 .0769 .1091 .0699 -.1845

-.0662 e .2131 e .2409 b-.3225 d .2760 -.1150 -.1715 -.1648 a .5556

Table 4
Intercorrelation Matrix: Corrected Scores

Variables 1 2 3 4 5 6 7 8 9 10 11 12


2 -.1365

3 -.1130 a .4341

4 .1627 -.1213 e-.2194

5 .0667 d-. 2543 a.3987 a .6651

6 b-.3221 .0591 .0549 -.1671 -.0003

7 d .2685 b-.3518 -.1520 -.1285 .0908 b-.3436
8 e_-.2216 -.0772 -.1030 -.0575 .0311 e .2193 -.0470

9 -.0870 .0177 .1287 -.1333 e-.2161 e .2218 -.1372 a .4823

10 .0126 -.0231 .0518 -.1373 d-.2533 -.0326 -.0025 a-.4089 b .3600

11 .0733 .0885 -.1066 -.0625 -.1345 -.0504 .0916 e .2212 .1593 e-.2150

12 .1829 .2022 -.1086 -.0350 -.0546 -.1388 .0760 -.0608 -.1330 -.2027 a .5850

a < .001 bp < .005 c p< .010 dp< .025 e p< .050

performed on both the raw data and the corrected scores.

This procedure allowed comparison of the common variance

accounted for by the measures of interest, and thus gave

an indication of their importance in the pregnancy ex-

periences of this group of women. It was assumed that

systematic examination of the factor structure would

facilitate an understanding of the ways in which women

experience their pregnancies.

Guertin and Bailey's program EEL 501 was used to

calculate Principle Axes Factor Matrices for the raw data

and corrected scores, and to rotate those matrices to

Varimax Criterion (Guertin & Bailey, 1970). The principle

axes solution locates the first factor so as to maximize

the sum of squares of its factor loadings. A residual

matrix is calculated for each succeeding extraction, and

each factor is located similarly with respect to the

residual matrix from which it is calculated. The Varimax

solution for factor rotation allows an orthogonal rotation

of the factors. This computer program produced the factor

matrices using squared Multiple R's as the communality

estimates. In addition, this procedure produced three

rotated matrices rotating those factors with latent roots

of at least 0.44, then trying one more and one less factor

in the rotations. Table 5 contains the factor matrix

(Matrix 1) including nine factors rotated to the Varimax

Criterion. This matrix was calculated from the raw scores,

and thus included loadings for all 18 variables. Table 6

Table 5
Factor Matrix 1: Raw Scores

1 2 3 4 5



















Sum of


* .7881


* .5721

*-. 7533










-. 1332














* .7987

* .8695























* 8736





* .7577


* .8233

















greater than 0.40.
















* .8884




*Factor loadings

Table 5 extended

S Comunality
6 7 8 9 Estimate








* .7337

* .5685


















-. 1030



-. 1139





* .7933

* .7530







* .5876

















* .6129































1.55 0.72 0.90


Table 6
Factor Matrix 2: Corrected Scores

1 2 3 4 5 6 ity

1 .1274 .1999 -.0996 -.0669 .0575 .4999 .3642

2 -.0975 .1930 -.0363 .7469 -.0455 -.0440 .6014

3 -.2781 -.1514 -.0004 .5887 .0906 -.0481 .4872

4 .8545 -.0344 -.0228 -.0331 -.0344 .1401 .7339

5 .7684 -.0727 -.0519 -.2941 -.1659 -.0287 .7321

6 -.0339 -.0300 .1076 .0009 .0063 *-.6201 .3950

7 -.1196 .0826 -.0302 *-.4876 .0165 .5161 .5354

8 -.0044 .1360 .7669 -.0673 *-.4443 -.2120 .8311

9 -.0765 .1130 .8173 .0222 .3655 -.1599 .8238

10 -.1607 -.1780 .0388 .0128 .8399 .0411 .7542

11 -.0917 .7647 .1746 -.0383 -.1114 .0453 .6457

12 .0021 .7794 .0080 .0775 -.0868 .2281 .6727

Sum of
Squared 1.48 1.37 1.32 1.25 1.10 1.05

*Factor loadings greater than 0.40.


shows the rotated factor matrix for the corrected scores

(Matrix 2); six rotated factors were included.

Using loadings greater than 0.40 as the cut off

criterion, the nine factors in Table 5 appeared to be

psychologically meaningful. They were named as follows

based upon the variables which loaded heavily on the

factor: 1. Control: Race, Socioeconomic Status, Knowledge

of Pregnancy; 2. Anxiety; 3. Sex-typing; 4. Control: Age,

Parity; 5. Androgyny; 6. Somatizing and Ambivalence;

7. Sex Role Ambivalence; 8. Life Changes; and 9. Conven-


Removal of the effects of the control variables re-

sulted in a factor matrix which did not include the two

Control factors (1 and 4) and which eliminated the Conven-

tionality factor, the Social Desirability scale also being

a control variable. The resultant factors were the

following: 1. Anxiety; 2. Sex Role Ambivalence; 3. Sex-

typing; 4. Somatizing and Ambivalence; 5. Androgyny; and

6. Life Changes and Traditionalism.

The variables which loaded heavily on these factors

and therefore defined them were those one might expect

from the names chosen. The Anxiety factor (2 and 1, from

Matrices 1 and 2 respectively) had only two measures which

loaded significantly. In Matrix 1, A-State loaded .7987

on Factor 2, while A-Trait loaded .8695; in Matrix 2,

A-State had a loading of .8545 on Factor 1 with A-Trait

loading .7684. Sex-typing (3 and 3) consisted of the two

scales which directly measured tendency to be masculine or

feminine in sex role identification. The Bem Sex Role

Inventory measure of masculinity loaded .7280 on Factor 3

in Matrix 1; the BSRI measure of femininity loaded .8736 on

that factor. In Matrix 2, BSRI masculinity had a loading

of .7669 while BSRI femininity loaded .8173. The Androgyny

factor (5 and 5) consisted of the Bem androgyny score and

the BSRI masculinity score. BSRI androgyny loaded .8884 in

Matrix 1 and .8173 in Matrix 2 and masculinity loaded

-.5030 in Matrix 1 and -.4443 in Matrix 2.

The factor entitled Somatizing and Ambivalence (6 and

4) had large loadings from three variables. Symptoms

Before Pregnancy loaded .7337 in Matrix 1 and .7469 in

Matrix 2; Symptoms During Pregnancy loaded .5685 and .5887

in Matrices 1 and 2, respectively. The Standard Deviations

of scores on the Attitude toward Women Scale (AWS-SD)

loaded -.5086 in Matrix 1 and -.4876 in Matrix 2. Factors

7 and 2, Sex Role Ambivalence, also consisted largely of

the Standard Deviations of scores, this time of the Bem

masculinity and femininity scales. BSRI masculinity-standard

deviations (BSRI-M-SD) loaded .7933 on Factor 7 while Bem

femininity-standard deviations (BSRI-F-SD) loaded .7530 on

that factor. In the second matrix, BSRI-M-SD loaded

.7647 on Factor 2 with BSRI-F-SD loading .7794. Finally,

the Life Changes factor (8 and 6) consisted solely of LCU

in Matrix 1 (loading .5876). But in Matrix 2, two other

measures also loaded heavily. LCU had a loading of .4999

In addition, the AWS was loaded -.6201, and the AWS standard

deviations loaded .5161. It is for this reason that the

factor was entitled Life Changes and Traditionalism in the

second set of factor titles.

The rotated factors in Matrix 1 accounted for 68.60%

of the total score variance'which was 96.65% of the common

variance. Similarly, those in Matrix 2 accounted for

63.01% of the total score variance which was 97.02% of

all the common variance. These factor matrices thus

accounted for a significant portion of the variance in the

variables measured, and were therefore a reasonable repre-

sentation of the factor structure in this sample of pregnant



Hypothesized Relationships

The strong effect of the control variables measured in

this study was demonstrated by the difference in the tests

of Hypothesis 1 using raw scores and corrected scores. When

no control for the effects of Age, Race, Parity, Socioeconomic

Status, Knowledge of Pregnancy, and Socially Desirable Re-

sponding was employed, there was no relationship between

Symptoms Before Pregnancy and A-Trait. However, when the

effects of these variables were removed, there was a signifi-

cant negative correlation; thus, women who were high in

A-Trait also habitually experienced more physical symptoms.

The mild curvilinear relationship which was found be-

tween Symptoms During Pregnancy and A-State presented an

interesting situation. Women who were high in anxiety had

both low and high numbers of physical symptoms. Women with

an intermediate number of symptoms reported little anxiety.

This relationship suggested either that some women who reported

high anxiety did not somatize that anxiety or that they denied

the physical symptoms that went with high anxiety for the other

group. The latter interpretation was supported by some of the

previous literature (Rosen, 1955; Uddenberg et al., 1971).

Support for Hypothesis 1 was consistent with the

literature. Studies have reliably found that anxiety before

and during pregnancy is correlated with physical symptoms of

all kinds, including complications of labor and delivery

(Davids & DeVault, 1962; Davids et al., 1961; Mann & Grimm,

1962; McDonald, 1965; McDonald & Christakos, 1963; McDonald

et al., 1963; and Zuckerman et al., 1963).

Hypothesis 2, on the other hand, has received mixed

support in previous research. While Holmes and Rahe have

consistently demonstrated that the amount of life stress is

related to physical illness (Masuda & Holmes, 1967b; Rahe,

1968; 1969; Rahe et al., 1967), studies which have dealt

directly with pregnancy have produced varying results.

Williams, Williams, Griswold, and Holmes (1975) have found

that life change correlates with prematurity. This study

used a retrospective design on one group of women who had

delivered prematurely and one group who had not. The pos-

sibility that the women reported more life changes as an

explanation for their premature deliveries does exist,

making interpretation of these results difficult. Jones

(1974), on the ocher hand, found a negative relationship

between life stress and complications. Women with high life

change scores experienced fewer complications.

Gorsuch and Key (1974) found that life change was cor-

related with complications of labor and delivery. They also

found that there was no correlation between anxiety and life

changes; anxiety during the first trimester was related to

complications while life changes in the second and third

trimesters predicted difficulties.

In the present study, there was no correlation between

anxiety and life changes, but anxiety was correlated with

somatic symptoms before and during pregnancy. On the other

hand, there was no correlation between life changes and somatic

symptoms. Since the measures in this study were taken during

the first trimester of pregnancy, a period when Gorsuch and

Key found no relationship of life changes to physical prob-

lems, this study supports their findings. Finally, since

none of these studies examined somatic symptoms before and

during pregnancy, there was no direct comparison study to the

one reported herein.

It is entirely possible that the explanation of Nuckolls,

Cassell,and Kaplan (1972) is pertinent. The fact that some

persons live very unsettled and transient life styles and

therefore experience many life changes, does not in itself

mean that they experience stress. If the individual has an

adequate social support system, then the effects of so many

changes upon their lives and upon physical illnesses may be

negligible. On the other hand, if a person is without such

supports, then life changes may indeed be more stressful.

Since no measure of social support system was used in this

study, it was impossible to separate out those women who

had adequate supports from those who did not.

Finally, Yamamoto and Kinney (1976), using a variation

of the Schedule of Recent Events, have developed a scale

including pregnant women's rank and mean stress ratings of

life events. They have concluded that it is essential to

use the stress ratings given to life events by special

groups, rather than the ratings developed by Holmes and Rahe

for use with all groups. They also believe that a modifi-

cation of the Schedule of Recent Events which clarifies the

events and more clearly defines them for use with pregnant

women (Helper, Cohen, Beitenman, & Louise, 1967) increases

the reliability of a woman's responses. Since this question-

naire was not employed, it was not possible to recalculate

the results using Yamamoto's weights. Without these data,

we must assume that life changes had negligible effect on

the number of somatic symptoms a woman experienced before

and during pregnancy.

Hypothesis 3 also received no support from these data.

This relationship was hypothesized based upon the logical

and theoretical connection of endorsement of non-traditional

feminine role behaviors and psychological androgyny. Con-

siderable discussion has occurred about the method of

scoring androgyny. Strahan (1975) pointed out some of the

difficulties in using a t-score. Spence, Helmreich, and

Stapp (1975) explicated the difficulties in terms of the

spread of ratings by the subject. They demonstrated the

existence of some persons who were low responders and some

who were high responders. Based on this notion, they divided

their groups into high masculine-high feminine, high mas-

culine, low feminine, low masculine-high feminine and low

masculine-low feminine responders. They found distinct

differences among persons in these groups who would have

been rated as androgynous using the t-score. Low masculine-

low feminine and high masculine-high feminine persons might

be considered androgynous with Bem's method. However,

self-esteem and other ego strength scores for the two groups

were extremely different. Bem has agreed with Spence that

only those persons who are high masculine-high feminine

should be considered androgynous having the qualities in-

cluded in the concept (1975).

In order to assign Spence's four groups, it is necessary

to have both men and women in the population measured so

that median scores for men and women can be used as the cut

off points for the four categories. While separating low

masculine-low feminine from high masculine-high feminine

women might have been desirable in this study, there was

no comparable group of male subjects to use in determining

the median points for the low and high categories. In a

study of this sort, it would have been necessary to find a

group of men who were comparable in age, race, and socio-

economic status to the female participants. It is likely

that the husbands or mates of the Subjects would have been

the ideal group. Efforts should be made in future research

to obtain such samples. Based on these results we concluded

that androgyny, as measured by the Bem Sex Role Inventory,

must be considered a completely separate concept from en-

dorsement of a non-traditional feminine role on the Attitude

toward Women Scale. Non-agreement of these scores could not

be considered sex role conflict.

Other Correlations

In addition to the relationships between A-Trait and

Symptoms Before Pregnancy, and between A-State and Symptoms

During Pregnancy, an even stronger relationship existed be-

tween A-Trait and Symptoms During Pregnancy. The magnitude

of these correlations was considerably greater than the

others. When the variance due to the control variables was

not accounted for, r = -.3043 (p < .010); when residual

scores were used, r = -.3987 (p < .001). Theoretically,

A-Trait is considered to be one's potential for felt anxiety

in a stressful situation (Spielberger, Gorsuch, & Lushene,

1970). It is logical that this potential would be related

to the number of somatic symptoms one experienced. It is

not at this time clear why there was a stronger relation-

ship between A-Trait and Symptoms During Pregnancy than

there was between A-Trait and Symptoms Before Pregnancy.

The correlations between A-Trait and A-State in this

study were somewhat higher than the correlations that

Spielberger et al. (1970) reported (r = .7623 for raw data;

r = .6651 for residuals). In the STAI Manual (1970), the

authors suggested that high correlations occur in situations

where both parts of the questionnaire were completed con-

secutively with no time lapse. Since this was the condition

in the present study, the high correlations were not un-


While attitude toward the feminine role as measured by

the Attitude toward Women Scale was not correlated with Bem

androgyny, it was significantly correlated with the Bem

femininity score (r = .2263, p < .05) when raw scores were

used. This suggested that a woman who endorsed a non-

traditional feminine role had a slight tendency to rate

herself as feminine on the Bem scale. This supported the

notion that the two scales are measuring different concepts.

Each participant's score on the Attitude toward Women Scale

was moderately correlated with her own standard deviation

score on that scale (r = -.4159). This negative correlation

reflected the fact that the range of AWS standard deviations

was quite constricted. Each item received a response

ranging from zero to three, for 55 items. Thus, while the

AWS score could potentially range from zero to 165, and did

vary from 64 to 156, the range of the standard deviations

was considerably less. Thus, the standard deviation score

of each subject remained low while AWS scores increased.

This negative correlation was, therefore, an artifact of

the limitations on the AWS standard deviation scores.

Because of this constriction, relationships involving the

AWS-SD score must be interpreted with care. This limitation

did not appear to be present for each participant's standard

deviation score on the Bem scale. There was a near zero

correlation between Bem masculinity score (BSRI-M) and

BSRI-M standard deviation; similarly the correlation between

BSRI femininity and BSRI-F standard deviation was negligible.

As previously mentioned, the control variables were of

considerable importance in this study. A brief review of

some of the relationships which existed among the control

variables will further explicate this importance. Age was

related to race, parity, SES, and knowledge of pregnancy.

In this group, the black women tended to be younger than the

white women; the older the participant, the greater the

number of children she had; the younger she was, the lower

her socioeconomic status and the less she knew about preg-

nancy. Since the black women were those who were younger,

they were also the women who were poor and lacking in in-

formation about pregnancy. (See Table 3 for correlations).

The control variables were also significantly related

to some of the other measures. There was a slight relation-

ship between age and A-Trait; younger women tended to be

habitually more anxious (r = -.2994, p < .010) than the

older women. The older a woman was the more she tended to

rate herself high on masculine adjectives (Bem masculinity

score) r = .2230, p < .05). Consistently with this, the

younger women tended to be more ambivalent about their

feminine identification (Bem femininity standard deviations)

(r = -.3549, p < .005). Race was also related significantly

to anxiety and to several of the sex role measures. The

black women in the study tended to report higher A-State

(r = .3660, p < .001) and higher A-Trait (r = .4138, p < .001)

than the white participants. In addition, they endorsed

more traditional feminine roles than did the white women

(r = -.3122, p < .010), were more ambivalent about their en-

dorsements on the Attitude toward Women Scale (r = .3866,

p < .001), tended to rate themselves low on both Bem mas-

culinity and feminity (r = -.3046, p < .010; and r = -.2673,

p ( .001, respectively), and were more ambivalent about their

feminine ratings than were their white counterparts (r =.4710,

p < .001).

As might be expected by the high correlation between

race and SES in this population, socioeconomic status is

significantly related to many of the same factors as race

and in the same directions. SES is correlated with the fol-

lowing variables: A-State (r = .2976, p < .010); A-Trait

(r = .4351, p < .001); Attitude toward Women (r = -.3731,

p < .001); Attitude toward Women standard deviations (r =

.2214, p < .05); Bem masculinity score (r = -.2522, p < .025);

BSRI-M standard deviations (r = .3444, p < .005); and Bem

femininity standard deviations (r = .5723, p < .001).

All of these correlations supported the notion that

women who were young, poor and black were more anxious than

their white counterparts, tended to endorse traditional roles

more than white women did, but were more confused and ambiva-

lent in those endorsements, and tended to have less infor-

mation about the biological aspects of the pregnancy ex-


The tendency to respond in a socially desirable manner

was significantly correlated with only two variables in this

study. Women who reported few Symptoms Before Pregnancy also

had a slight tendency to respond in a socially desirable

manner. Apparently it was important to these women to be

viewed as having few somatic symptoms on a regular basis.

In addition, there was a significant negative correlation

between Marlowe-Crowne Social Desirability scores and the

Attitude toward Women Scale (r = -.2615, p < .025). This

could be interpreted in either of two ways: (1) women who

endorsed a traditional feminine role also tended to respond

in a socially approved manner on other items; or (2) the

endorsements of traditional feminine role on the Attitude

toward Women Scale were not entirely trustworthy because of

the socially desirable response set of the individuals re-

sponding. Neither interpretation would have significant ef-

fects on the other relationships examined herein.

Factor Analyses

Since the two sets of factors presented in Chapter III

were very similar, Matrix 2, the set of factors with the ef-

fects of the control variables removed, was examined in

depth. These six factors represented different and separate

aspects of the pregnancy experience of the women who par-

ticipated in this study. The factors clearly indicated the

importance of the variables measured, the way in which they

related to one another, and the amount of variance in the

scores of the respondents accounted for by each group of


Factor 1 was clearly an anxiety factor. The only

variables which loaded heavily on this factor were A-State

and A-Trait. Thus, anxiety was a separate and clearly de-

fined aspect of the gravida's experience, and the relation-

ship between her potential for anxiety under stress and her

actual experience of such stress was high. Symptoms During

Pregnancy had the next highest loading on Factor 1, -.2781.

This was expected based upon the correlations of this

variable with A-Trait; however, the factor structure sug-

gested that this relationship between Symptoms During

Pregnancy and A-Trait was not an important one in viewing

the overall common variance of the scores.

The second factor was named Sex Role Ambivalence based

upon the loadings of the Bem Sex Role Inventory masculinity

and feminity standard deviation scores. The presence of

this factor suggested that a woman's conflict about her

sexual identification, defined operationally by her tendency

to rate herself both low and high on masculine and feminine

adjectives, was indeed an important part of her pregnancy

experience and was separate from her identification as femi-

nine, masculine, or androgynous. The fact that Attitude

toward Women standard deviation loaded negligibly on this

factor suggested that ambivalence about the social role the

gravida adopted was distinct from her sexual identification

as defined by Bem (1974).

Factor 3, on the other hand, suggested that the gravida's

tendency to rate herself highly on either or both masculine

and feminine adjectives, was a distinct tendency in this

group of women. The moderate positive correlation between

Bem masculinity and femininity listed in Table 4 (r = .4823,

p < .001) suggested that those who rated themselves as

highly feminine also tended to rate themselves as highly mas-

culine. However, it seemed unlikely that this correlation

alone accounted for this factor. Instead, it appeared likely

that the tendency to rate oneself highly, whether masculine,

feminine, or both, was a unique characteristic. If it had

been possible to categorize this group of women based on

Spence's scoring method, it is likely that the women who con-

tribute to this factor would have fallen into three separate

categories: (1) high feminine-low masculine; (2) high

feminine-high masculine; and (3) low feminine-high masculine.

Factor 4, named Somatizing and Ambivalence, had loadings

over .40 for three variables, Symptoms Before Pregnancy,

Symptoms During Pregnancy, and Attitude toward Women standard

deviations. The direction of the loadings indicated a strong

relationship between tendency to report somatic symptoms and

high deviation scores on the Attitude toward Women Scale.

Thus, women who reported many symptoms also were conflicted

about the social role they felt women should take. A low

loading of A-Trait on Factor 4 suggested that women who ex-

perienced many symptoms were ambivalent about their sexual

roles and were moderately anxious. While it was impossible

to hypothesize causal relationships based on these factor

loadings, the potential value of exploring in greater depth

the relationships among sex role conflict and somatic symptoms

was obvious.

The fifth factor was entitled Androgyny. The heaviest

loading on this factor was that of Bem androgyny, .8399.

The next highest loading was -.4443 for Bem masculinity.

The correlation between these two variables in Table 4 is

-.4089. Since low scores were indicative of an androgynous

identification, then we must assume that women who rated

themselves as highly masculine were also androgynous. The

smaller correlation of femininity with androgyny in Table 4

(r = .3600) confirmed the relationship; women who tended to

rate themselves as highly masculine were more likely to

be androgynous than women who rated themselves as highly

feminine. This factor might then be interpreted to be

an Androgyny and Lack of Rigid Femininity factor.

The sixth factor, Life Changes and Traditionalism, had

heavy loadings for three variables and somewhat interesting

weaker loadings for two others. Life Change Units, Attitude

toward Women, and Attitude toward Women standard deviations

defined the factor. Women who experienced many life changes

had traditional attitudes toward women's roles, and were

ambivalent about those roles. Masculine identification had

a small negative loading on this factor, -.2120; and Bem

femininity standard deviation score was loaded .2281. This

pattern of loadings suggested that women who experienced

many life changes were traditional in their role endorsements,

tended not to identify themselves as masculine, but were

somewhat ambivalent about their feminine sexual identification

and traditional social role endorsements. This constellation

of variables suggested an interpretation implying lack of

control over one's life. The occurrence of many external

events which were stressful indicated that a person had little

control over those events. Similarly, the traditional femi-

nine social role did not allow women to determine their own

position in life or to decide about their own behaviors.

Thirdly, the clustering of the ambivalence measures suggested

a characterization of a woman who had not taken charge of

life even to the point of making clear decisions about her

own preferences.

The appearance of such a clear factor structure among

these data suggested the need to further explore the factors

identified in future research. While anxiety has already

been heavily investigated, sexual identification (including

both sex-typing and androgyny), ambivalence about sexual

identification, somatizing, ambivalence about social roles,

and lack of control over life were identified as significant

areas for future research. In this particular group of

women, these factors were independent of one another. How-

ever, the sample used in this study was small. Attempts to

replicate this factor structure, and to explore possible re-

lationships among the factors should involve larger groups

of women at different times during pregnancy.

Methodological Considerations in the Study of Pregnancy

In attempting a large scale study of the pregnancy ex-

perience it became apparent that certain difficulties existed

which must be dealt with in order to gather reliable data

and to produce replicable results.

Volunteer participants. In order to obtain access to

women who were willing to volunteer their time to participate

in a study of this nature, it was necessary to approach

private physicians as well as to contact local maternity

clinics for indigent patients. It was the experience of this

investigator that private obstetricians were not willing to

allow access to their patients for the purpose of requesting

participation in this study. Of approximately forty ob-

stetricians contacted, only one was willing to cooperate.

After referring three patients for potential participation,

he stopped making referrals and was not available to discuss

any difficulties which may have arisen. Thus, the private

patients who participated in this study were persons the

experiementer met through acquaintances in the community.

They were approached independently of their physicians and

agreed to participate. In all, 17 private patients partici-


On the other hand, county officials were quite willing

to allow the investigator access to indigent maternity clinic

patients. Of 757 referrals from three Broward County Health

Department maternity clinics, 127 eventually participated in

the study. Two hundred six were already beyond the first

trimester when the referral was received; the investigator

was unable to contact 147 prospective participants; another

14 had moved; 123 had no telephones; 29 had given an

incorrect telephone number; 5 were screened out because they

did not read English; 6 had previous complications; 14

were not pregnant; 9 had miscarried; and 12 had abortions.

Only 64 were not interested or too busy to participate in

the study.

This large rate of non-participation was carried over

into the study itself. As the research was originally de-

signed, the pregnant woman was asked to complete question-

naires during her entire pregnancy. One hundred forty-five

women in the first trimester of pregnancy agreed to do so.

Of those, 19 stopped doing the questionnaires for various

reasons, 14 women lost the questionnaires before the investi-

gator was able to pick them up, 3 miscarried, and 45 moved.

Repeated efforts by letter and telephone were unsuccessful in

contacting those who moved. Sixty-four of these women com-

pleted the study and are the participants reported herein.

Follow-up. This research was initially intended to re-

late emotional aspects of the pregnancy experience to com-

plications during the pregnancy, labor and delivery. In

order to be sure that the women who did not complete the

study were not different from the group who did finish, an

informal comparison was made of ten women from each group.

The basis of comparison was the number of complications ex-

perienced by the women.

Of ten women who did complete the questionnaires, five

experienced no complications; four experienced one and one

had three. Of the follow-up group, home visits were accom-

plished with five women. Two of those women had no problems

during their pregnancies, two had two complications, and one

had one complication. Family members reported that three

women who had moved had no difficulties during the pregnancy

and delivery. In attempting to visit these women the in-

vestigator learned that one was in jail and two had no

permanent residences and no telephones. The final two

chosen at random were no longer living at their original

addresses, their telephones had been disconnected, and there

was no family to contact. To summarize this information,

four of the women experienced no difficulties, one had one

complication, and two reported two complications; two were

unknown. This was not different from the comparison group

of ten women who completed the study.

Based on this follow-up information, it was assumed

that the major difference in the two groups of women was the

transient life styles of the group who did not complete the

questionnaires. From the small random sample, it appeared

that these groups did not differ in their experiences of

complications; however, it might be assumed that a transient

life style would lead to a different emotional experience

during the pregnancy. Because of this possible difference,

future research should attempt to study this transient

indigent population as well as more stable women.

Future research. The factors which emerged in this

study suggest that there is fertile ground for new research

in the area of pregnancy. While most studies to date have

focused on outcome of the pregnancy experience, the actual

experience has not been adequately examined. In order to

determine if there are predictable relationships between

emotional factors and complications of pregnancy, more re-

search describing and quantifying the experience of preg-

nancy at different stages and looking for types of pregnancy

experiences, is needed.



We would like you to give us some objective information
about your background. This information will be strictly
confidential. Please do not put your name anywhere on the
questionnaire. This data will help us to interpret the re-
sults of this research project. Please complete every item.
If there are any questions you are unclear about, please ask
me and I will discuss it with you.

1. Date of birth: Year____ Month Day

2. Race: (circle one) White Negro Other (specify)_

3. Marital Status: (circle one) Single Married
Other (specify)

4. Number of children:

5. What month of pregnancy are you in? (circle one)

1 2 3 4 5 6 7 8 9

6. Religion:
Do you consider yourself an active member of your
religion? Yes_ No

7. Extent of your education

Indicate the highest level of your education by placing
an "x" in the box next to the appropriate statement. Example:
If you graduated from an accredited high school, check high
school graduate. Check only one box.

( ) Less than seven years of school I had less than seven
years of school.

( ) Junior high school I had seven to nine years of school.

( ) Partial high school I completed the tenth or eleventh
grades but did not graduate from high school.

( ) High school graduate I am a secondary school graduate
from a private, public, or trade school.

( ) Partial college training I completed at least one
year but not more than three years of college.
Training in business schools also comes under
this category.

( ) Four year college graduate I completed a four year
college or university course leading to a recognized
college degree (i.e., AB, BS, BM, BA).

( ) Professional I completed a recognized professional
course leading to a graduate degree (i.e., MA, MS,
MD, Ph.D., LLB).

8. Your occupation

Please state in detail (a) exactly the kind of work you
have done during most of your life, and (b) the kind of or-
ganization, if any, that you worked) for. For example,
distinguish between a sales-clerk in a retail store, a
manager of a retail store, and the owner of such a store; and
between a very small local business, a large local business,
and a store within a chain of retail stores. Please answer
these questions to the best of your knowledge. Be as clear
and specific as possible. Describe your job, the organiza-
tion, and where you are in it.

(a) Kind of work:

(b) Kind of organization:

9. Extent of husband's education

Indicate the highest level of your husband's education
by placing an "x" in the box next to the appropriate statement.
Example: If your husband graduated from an accredited trade
school, check high school graduate. Check only one box.

( ) Less than seven years of school My husband had less
than seven years of school.

( ) Junior high school My husband had seven to nine years
of school.

( ) Partial high school My husband completed the tenth or
eleventh grades but did not graduate from high school.

( ) High school graduate My husband is a secondary school
graduate from a private, public, or trade school.

( ) Partial college training My husband completed at least
one year but not more than three years of college.
Training in business schools also comes under this

( ) Four year college graduate My husband completed a four
year college or university course leading to a
recognized college degree (i.e., AB, BS, BM, BA).

( ) Professional My husband completed a recognized pro-
fessional course leading to a graduate degree
(i.e., MA, MS, MD, Ph.D., LLB).

10. Your husband's occupation

Please state in detail (a) exactly the kind of work your
husband has done or did during most of his life, and (b) the
kind of organization, if any, that he worked for. For
example, distinguish between a sales-clerk in a retail
store, a manager of a retail store, and the owner of such a
store; and between a very small local business, a large local
business, and a store within a chain of retail stores. Please
answer these questions to the best of your knowledge. Be as
clear and specific as possible. Describe his job, the or-
ganization, and where he is in it.

(a) Kind of work:

(b) Kind of organization:

The following are about your experience with pregnancy.
Please answer them as accurately as you can.

11. How many times have you become pregnant in the past?

12. Have you ever had a spontaneous abortion (a miscarriage)?

Yes No

13. Have you ever had a multiple birth (twins, triplets)?

Yes No

14. Is your blood type RH positive_ or RH negative_?
(check one)

15. What do you expect your pregnancy and childbirth ex-
perience to be like? Do you plan to take classes of
any sort or use natural childbirth? (Please answer in
your own words.)

16. Do you have any plans for the care of your baby once he
or she is born? Have you considered breast or bottle
feeding? Will you continue to or begin to work?

17. What do you imagine will be some things that you will
need help with during your pregnancy and after the baby
is born?


Please answer the questions below according to your know-
ledge about the pregnancy experience. If the statement is TRUE
or MOSTLY TRUE, circle T, if it is FALSE or MOSTLY FALSE, circle

T F 1. Conception occurs in the uterus (womb).

T F 2. Bleeding in early pregnancy is one certain sign of

T F 3. Intercourse during pregnancy does not harm the baby.

T F 4. In labor, the pelvic bones separate to allow the
baby to pass through the birth canal.

T F 5. The cervix is the same as the vagina.

T F 6. Extreme or rapid weight gain may be a sign of a
problem during pregnancy.

T F 7. Anesthesia which puts the mother to sleep also puts
the baby to sleep.

T F 8. Falls during pregnancy are extremely dangerous be-
cause the baby is somewhat unprotected in the uterus.

T F 9. The baby gets nourished through the placenta.

T F 10. Breast feeding a child is often related to weight
gain after pregnancy.

T F 11. Long labors (24-48 hours) occur in about 1 of 10
normal pregnancies.

T F 12. The discomfort of labor is due to the opening of the

T F 13. Tight clothing, especially around the uterus, impedes
the baby's air supply and should be avoided.

T F 14. Labor which is medically induced is more uncomfortable
than natural labor.

T F 15. The contractions which women have during the last
months of pregnancy (Braxton-Hicks contractions) are
effective in preparing the uterus for delivery.

T F 16. All anesthesia which affects the mother also affects
the baby.

T F 17. Labor is the baby pushing itself out of the womb
or uterus.

T F 18. Even in a first pregnancy, if the mother has RH
negative blood and her husband is positive, it is
dangerous to the baby.

T F 19. True labor contractions may occur at regular in-
tervals (for example, 3 contractions which are 12
minutes apart) or at irregular intervals (for
example, 2 contractions which are 12 minutes apart
and the next one occurring after 15 minutes).

T F 20. Before real labor begins, the bag of waters has to

T F 21. If the bag of waters breaks well before the baby
is delivered, the birth is a somewhat more uncom-
fortable dry birth.

T F 22. Deliveries are often so uncomplicated that the
doctor is really there to "catch" the baby.

T F 23. The usual or average duration of a First labor is
(circle one answer)
1. 2 12 hours
2. 6 18 hours
3. 10 24 hours
4. 14 30 hours

T F 24. When the baby is in the breech position, it is
coming head first.

T F 25. Women with small breasts may not have enough milk
to breast feed their baby.


Will you please read the following list of health problems, and circle the one which best
describes how often you have had the complaint before you became pregnant, and the one
indicating how often it has occurred since you became pregnant. Remember that the com-
plaint applies to your present pregnancy only.

Please answer every
better than others.
want to say, circle

statement. There are no right or wrong answers and none that are
If you are not sure, or if no answer seems to fit exactly what you
the one that comes closest to what you have in mind.

Often or






1. Upset stomach............................

0 2. Indigestion or heartburn ................

3. Stomach cramps ...........................

4. Nausea (feeling sick to the stomach)....

5. Vomiting.................................

6. A bloated feeling after eating..........

7. Tight or knotted feelings in the pit
of the stomach...........................

8. Loose bowel movements or diarrhea.......

9. Constipation.............................










10. Loss of appetite............... ......... A S R N











11. Excessive hunger.........................

12. Cravings for special foods...............

13. Tendency to gain weight easily...........

14. Tendency to lose weight easily...........

15. Nosebleeds ............... ..............

16. Colds ......................... ..........

17. Stuffiness in the nose...................

18. "Plugged or full feeling in my ears".....

19. Feeling of pressure or fullness in
the head ...............................

20. Headache .................................

21. Spells of feeling faint..................

22 Fainting.................................

23. Dizziness or light-headedness............

24. Sleepiness during the day ................

25. Shortness of breath when doing
housework ..............................

26. Shortness of breath when lying down......

27. Pounding or thumping of the heart........





































28. Sudden spells of fatigue ................

29. Hand trembling ..........................

30. Numbness or tingling of the hands
and feet ..............................

31. Cold hands or feet......................

32. Throbbing feelings in the stomach
or abdomen ............................

33. Hemmorrhoids (piles) ....................

34. Varicose veins (large veins in the
le g s) .. . .. .. .. .. .. .. . . .. . .. .. .

35. Swelling of feet or legs................

36. Swelling of hands or face...............

37. Leg cramps ..............................

38. Weakness or tiredness in legs ...........

39 Backache ................................

40. Achiness or tightness through
neck and shoulders ....................

41. A pulling feeling or "stitch" in
one side ..............................

42. Heavy, aching feelings low down in
the abdomen or in the upper thighs....




















43. Soreness under the ribs (on one or
both sides) .............................

44. Pains down the back of one hip
an d leg ................................

45. Considerable tenderness of the breasts...

46. Vaginal pain.............................

47. Throbbing feelings in the vagina.........

48. Vaginal discharge........................

49. Itching or burning of the vagina.........

50. Pain during sexual relations .............

51. Almost uncontrollable urge to
urinate ................................

52. Loss of urine when coughing or
sneezing ...............................

53. Urge to urinate during the night.........

54. Itching of the skin......................

55. Skin rashes ..............................

56. Blushing or flushing of the face.........

57. Hot or cold spells........................






Blurred vision............................. A S R N

Spots before the eyes.......... .......... A S R N





Listed below are a number of statements concerning personal
attitudes and traits. Read each item and decide whether the
statement is true or false as it pertains to you personally.

1. Before voting I thoroughly investigate the qualifications
of all the candidates.

2. I never hesitate to go out of my way to help someone in

3. It is sometimes hard for me to go on with my work if I
am not encouraged.

4. I have never intensely disliked anyone.

5. On occasion I have had doubts about my ability to suc-
ceed in life.

6. I sometimes feel resentful when I don't get my way.

7. I am always careful about my manner of dress.

8. My table manners at home are as good as when I eat out in
a restaurant.

9. If I could get into a movie without paying and be sure I
was not seen, I would probably do it.

10. On a few occasions, I have given up doing something be-
cause I thought too little of my ability.

11. I like to gossip at times.

12. There have been times when I felt like rebelling against
people in authority even though I knew they were right.

13. No matter who I'm talking to, I'm always a good listener.

14. I can remember "playing sick" to get out of something.

15. There have been occasions when I took advantage of some-

16. I'm always willing to admit it when I make a mistake.

17. I always try to practice what I preach.

18. I don't find it particularly difficult to get along with
loud mouthed, obnoxious people.

19. I sometimes try to get even rather than forgive and forget.

20. When I don't know something, I don't at all mind admit-
ting it.

21. I am always courteous, even to people who are disagree-

22. At times I have really insisted on having things my own

23. There have been occasions when I felt like smashing

24. I would never think of letting someone else be punished
for my wrongdoings.

25. I never resent being asked to return a favor.

26. I have never been irked when people expressed ideas
very different from my own.

27. I never make a long trip without checking the safety of
my car.

28. There have been times when I was quite jealous of the
good fortune of others.

29. I have almost never felt the urge to tell someone off.

30. I am sometimes irritated by people who ask favors of me.

31. I have never felt that I was punished without cause.

32. I sometimes think when people have a misfortune they only
got what they deserved.

33. I have never deliberately said something that hurt some-
one's feelings.


Rank Life Event Mean Value

1 Death of spouse 100
2 Divorce 73
3 Marital separation 65
4 Jail term 63
5 Death of close family member 63
6 Personal injury of illness 53
7 Marriage 50
8 Fired at work 47
9 Marital reconciliation 45
10 Retirement 45
11 Change in health of family member 44
12 Pregnancy 40
13 Sex difficulties 39
14 Gain of new family member 39
15 Business readjustment 39
16 Change in financial state 38
17 Death of close friend 37
18 Change to different line of work 36
19 Change in number of arguments with spouse 35
20 Mortgage over $10,000 31
21 Foreclosure of mortgage or loan 30
22 Change in responsibilities at work 29
23 Son or daughter leaving home 29
24 Trouble with in-laws 29
25 Outstanding personal achievement 28
26 Wife begins or stops work 26
27 Begin or end school 26
28 Change in living conditions 25
29 Revision of personal habits 24
30 Trouble with boss 23
31 Change in work hours or conditions 20
32 Change in residence 20
33 Change in schools 20
34 Change in recreation 19
35 Change in church activities 19
36 Change in social activities 18
37 Mortgage or loan less than $10,000 17
38 Change in sleeping habits 16
39 Change in number of family get-togethers 15
40 Change in eating habits 15
41 Vacation 13
42 Christmas 12
43 Minor violations of the law 11


(Please print)

Sex:____ Age:_


Married Single

On the following pages you will be shown a large number of
adjectives that can describe your personality. We would like
you to use them to describe yourself. That is, we would like
you to mark, on a scale from 1 to 7, how well they fit you.
Please do not leave any unmarked.

Example: sly

Mark a I if you are NEVER OR ALMOST NEVER sly.

Mark a 2 if you are USUALLY NOT sly.

Mark a 3 if you are SOMETIMES BUT INFREQUENTLY sly.

Mark a 4 if you are OCCASIONALLY sly.

Mark a 5 if you are OFTEN sly.

Mark a 6 if you are USUALLY sly.

Mark a 7 if you are ALWAYS OR ALMOST ALWAYS sly.

Thus, if you feel it is sometimes but infrequently true that
you are "sly," never or almost never true that you are "mali-
cious," always or almost always true that you are "irrespon-
sible," and often true that you are "carefree," then you
would rate these characteristics as follows:





Self reliant



Defends own beliefs












Strong personality









Has leadership

Sensitive to the needs
of others


Willing to take risks



Makes decisions




Eager to soothe
hurt feelings








Willing to take
a stand






Acts as a leader




Does not use
harsh language



Loves children






The statements listed below describe attitudes toward the
role of women in society which different people have. There
are no right or wrong answers, only opinions. You are asked
to express your feelings about each statement by indicating
whether you (A) Agree strongly, (B) Agree mildly, (C) Dis-
agree mildly, or (D) Disagree strongly. Please indicate your
opinion by marking the column on the answer sheet which cor-
responds to the alternative which best describes your per-
sonal attitude. Please respond to every item.

(A) (B) (C) (D)
Agree Strongly Agree Mildly Disagree Mildly Disagree Strongly

1. Women have an obligation to be faithful to their hus-

2. Swearing and obscenity is more repulsive in the speech
of a woman than a man.

3. The satisfaction of her husband's sexual desires is a
fundamental obligation of every wife.

4. Divorced men should help support their children but
should not be required to pay alimony if their wives are
capable of working.

5. Under ordinary circumstances, men should be expected to
pay all the expenses while they're out on a date.

6. Women should take increasing responsibility for leader-
ship in solving the intellectual and social problems of
the day.

7. It is all right for wives to have an occasional, casual,
extramarital affair.

8. Special attentions like standing up for a woman who comes
into a room or giving her a seat on a crowded bus are
outmoded and should be discontinued.

9. Vocational and professional schools should admit the
best qualified students, independent of sex.

10. Both husband and wife should be allowed the same grounds
for divorce.

11. Telling dirty jokes should be mostly a masculine prerog-

12. Husbands and wives should be equal partners in planning
the family budget.

13. Men should continue to show courtesies to women such as
holding open the door or helping them on with their coats.

14. Women should claim alimony not as persons incapable of
self-support but only when there are children to provide
for or when the burden of starting life anew after the
divorce is obviously heavier for the wife.

15. Intoxication among women is worse than intoxication among

16. The initiative in dating should come from the man.

17. Under modern economic conditions with women being active
outside the home, men should share in household tasks
such as washing dishes and doing the laundry.

18. It is insulting to women to have the "obey" clause remain
in the marriage service.

19. There should be a strict merit system in job appointment
and promotion without regard to sex.

20. A woman should be as free as a man to propose marriage.

21. Parental authority and responsibility for discipline of
the children should be equally divided between husband
and wife.

22. Women should worry less about their rights and more
about becoming good wives and mothers.

23. Women earning as much as their dates should bear equally
the expense when they go out together.

24. Women should assume their rightful place in business and
all the professions along with men.

25. A woman should not expect to go to exactly the same
places or to have quite the same freedom of action as a

26. Sons in a family should be given more encouragement to go
to college than daughters.

27. It is ridiculous for a woman to run a locomotive and for
a man to darn socks.

28. It is childish for a woman to assert herself by re-
taining her maiden name after marriage.

29. Society should regard the services rendered by the women
workers as valuable as those of men.

30. It is only fair that male workers should receive more
pay than women even for identical work.

31. In general, the father should have greater authority
than the mother in the bringing up of children.

32. Women should be encouraged not to become sexually inti-
mate with anyone before marriage, even their fiances.

33. Women should demand money for household and personal
expenses as a right rather than as a gift.

34. The husband should not be favored by law over the wife
in the disposal of family property or income.

35. Wifely submission is an outworn virtue.

36. There are some professions and types of businesses that
are more suitable for men than women.

37. Women should be concerned with their duties of child-
rearing and housetending, rather than with desires for
professional and business careers.

38. The intellectual leadership of a community should be
largely in the hands of men.

39. A wife should make every effort to minimize irritation
and inconvenience to the male head of the family.

40. There should be no greater barrier to an unmarried woman
having sex with a casual acquaintance than having dinner
with him.

41. Economic and social freedom is worth far more to women
than acceptance of the ideal of femininity which has been
set by men.

42. Women should take the passive role in courtship.

43. On the average, women should be regarded as less capable
of contribution to economic production than are men.

44. The intellectual equality of woman with man is perfectly

45. Women should have full control of their persons and give
or withhold sex intimacy as they choose.

46. The husband has in general no obligation to inform his
wife of his financial plans.

47. There are many jobs in which men should be given pre-
ference over women in being hired or promoted,

48. Women with children should not work outside the home if
they don't have to financially.

49. Women should be given equal opportunity with men for ap-
prenticeship in the various trades.

50. The relative amounts of time and energy to be devoted to
household duties on the one hand and to a career on the
other should be determined by personal desires and inter-
ests rather than by sex.

51. As head of the household, the husband should have more
responsibility for the family's financial plans than his

52. If both husband and wife agree that sexual fidelity isn't
important, there's no reason why both shouldn't have
extramarital affairs if they want to.

53. The husband should be regarded as the legal representative
of the family group in all matters of law.

54. The modern girl is entitled to the same freedom from
regulation and control that is given to the modern boy.

55. Most women need and want the kind of protection and sup-
port that men have traditionally given them.


Dear Prospective Mother:

You are reading this letter in the office of your
obstetrician because he is interested in the research I am
doing and thought you might be willing to participate. I
am a graduate student in Psychology at the University of
Florida and an Intern at the Henderson Clinic in Fort
Lauderdale, and I am doing research on pregnancy.

The purpose of this study is to look at some of your
feelings and attitudes about being a woman and about being
pregnant. We are interested in the kinds of things you have
experienced and the way you feel about them.

The questionnaires we would like you to answer can be
filled out at your own rate of speed in your own home. They
will take a few hours of your time spread throughout your
entire pregnancy. All the information you give us will be
completely confidential, so we hope you will be as honest
about your feelings as possible.

Since we are also interested in the medical aspects of
your pregnancy and delivery, we would like to have your
doctor fill in a form after your child's birth which will
tell us the length of your labor and any difficulties you
might have experienced.

If you have no objections to the conditions of the study
which are stated above, and if you agree to participate,
please sign the attached sheet and obtain a Background In-
formation Questionnaire from the receptionist. I will call
you to set up an appointment to explain more about the study
and to give you instructions for each questionnaire.

I sincerely hope that you will be able to take part in
this study. I believe that research of this sort can eventually
be of great help to women who are pregnant. I hope you will
consider these other persons, as well as yourself, when you
decide whether or not to participate.

Thank you for your time.


Katherine E.Peres


330 S.W. 27th Avenue
Fort Lauderdale, FL 33312
October 14, 1975

Dear Doctor

I am presently a doctoral candidate in Clinical Psychology
at the University of Florida, and have just begun my intern-
ship at the Henderson Clinic of Broward County. During my
internship year, I would like to collect my dissertation data
so that I might receive my degree sometime in the next two

My dissertation proposal is a study designed to examine some
of the emotional and psychological precursors of complications
of pregnancy, labor and delivery. I will be measuring demo-
graphic variables such as age, race, and parity, as well as
the psychological factors of feminine identification, life
stress, attitude toward the pregnancy, and anxiety. My
supervisors and I believe that a careful study of this wide
range of variables will allow us to examine the complex re-
lationship to pregnancy outcome. I believe that my proposal
goes somewhat farther than previous efforts in the elucidation
of the many variables at hand, but to be successful I will
need the cooperation of a number of local obstetricians
(though without excessive time demands) and permission to
approach their patients with my proposal.

I would very much like to have the opportunity to discuss my
research with you, either in person or on the telephone, and
to send you a more detailed description of the proposal. If
you believe that you might be interested in participating in
what my supervisors and I believe to be a significant research
project, please contact me by letter or telephone at:

Henderson Clinic 251-174th Street, Apt. 2103
330 S.W. 27th Avenue Miami Beach, Florida 33160
Fort Lauderdale 931-7738
from 8 a.m. to 5 p.m. after 6 p.m.

I hope to hear from you soon.


Katherine E. Peres


I. Brief introduction of self.

II. Introduction to study. Complete explanation.

"The purpose of this study is to record the way you experience
your pregnancy. The questionnaires pertain to your feelings--
physical and emotional--your attitudes, and your ways of
dealing with the world. Some are related directly to your
pregnancy, some are about your experience of life in general.
All taken together will give us some idea of the way you per-
sonally have experienced your pregnancy. The questionnaires
may take about five hours spread over the next few months.
They can be filled out at your own rate of speed in your home.
All the information you give us will be completely confidential,
so we hope you will be as honest about your feelings as pos-
sible. Your name will not be written on anything but this
card and the release forms. Everything will be coded by
number. After all your data are in, this card will be des-
troyed to make sure that you remain anonymous."

"Since we are also interested in some of the medical aspects
of your pregnancy and delivery, we will need your permission
to obtain your hospital.record after delivery. From this
record we will complete a checklist about such things as the
length of your labor, the condition of the baby at birth, any
medications you received, and other medical aspects of your

"If you are sure that you would like to participate, please
sign these release forms. This one states that I have told
you what the study is about and that you are free to discon-
tinue at any time. It is just an agreement between you and
the Experimenter. This other form is what we will use to
obtain your medical data. It will be presented at the hospital
records room (or to your doctor) in order to complete the
checklist I talked about."

"Now we need to set up a calendar of your pregnancy and de-
termine when each questionnaire should be done. When was your
last period?."....."We'll calculate an approximate due date
by adding seven days to the date and substracting three
months. That puts you due on..... Now I'll count backward
from that date to spread the questionnaires out. If you find
that your due date as computed by the doctor when you go to
the clinic is much different from the one we figured out,
please call Kathy and let her know so she can compute when
the questionnaires can be done."

"The dates for each of these questionnaires are approximate.
As long as you can do them within a week of the date written
on them, that will be fine."

"All the questionnaires are aimed at discovering your feelings
and beliefs. There are no right or wrong answers, only
opinions. Please give as honest an answer as you can based
on your experience."

"The instructions for filling out each questionnaire are at
the top of each one. Most are printed on both the front and
back of the page. Don't forget to do the backs. If you have
any trouble reading the print or understanding the questions,
feel free to call Kathy. Her phone number is on the back of
this calendar. Please answer as many of the questions as
possible. (IF THE GIRL IS SINGLE: Are you single? "Yes"
There are some questions here about your husband. Are you
still seeing the father of the baby? Try to answer the
questions if you possibly can.)"

"I'll be calling you to remind you when it is time to do the
next set of questionnaires. When you finish a group of
questionnaires, you can turn them in at the clinic, or Kathy
can pick them up from you after you deliver."

"If you have no further questions, we can stop now. If you
think of anything else you would like to know, don't hesitate
to call Kathy or me. We'll be glad to answer your questions
if we can."


Test Mean Standard Test-Retest Internal
Test Mean Deviation Reliability Consistency

1. Pregnancy Information Questionnaire(5)a 13.89 .63 --- ---

2. Marlowe-Crowne Social Desirability
Scale (6) 13.72 5.78 .89 .88

3. Social Readjustment Rating
Scale (7) --- --- .74 .95

4. Somatic Symptoms List from
H.I.P. Pregnancy --- --- .67 .93
Questionnaire (8,9)

5. State-Trait Anxiety Inventory
A-State (10) 37.57 11.76 .27 .92
A-Trait (11) 41.61 11.29 .76 .92

6. Attitudes toward Women Scale (12) 98.21 23.16 ---

7. Bem Sex Role Inventory
Masculinity (14) 4.55 .75 .90 .86
Femininity (15) 5.08 .58 .90 .80
Androgyny difference score (F-M) .53 .97 .93 .85
Androgyny t-ratio 1.23 2.42 --- ---

aThe number in parentheses refers to the variable number and names listed in Table 1.


Abramson, J. H,, Singh, A., & Mbambo, V. Antenatal stress
and the baby's development. Archives of Disease in Child-
hood, 1961, 36, 42-49.

Alexander, F. Psychosomatic medicine: Its principles and
applications. New York: Norton, 1950.

Apgar, V. A proposal for a new method of evaluation of the
newborn infant. Current Researches in Anesthesia and
Analgesia, 1953, 32, 260-267.

Apgar, V. The newborn (Apgar) scoring system: Reflections
and advice. Pediatric Clinics in North America, 1966,
13, 645-650.

Arbeit, S. A study of women during their first pregnancy.
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Barclay, R. L. Modifications of pregnancy anxieties: Some
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Bem, S. L. The measurement of psychological androgyny.
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Psychology, 1975, 3_1, 634-643.

Benedek, T. The organization of the reproductive drive.
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Berle, B. B., Pinsky, R. H., Wolf, M. A. S., & Wolff, H. G.
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Bibring, G. L. Some considerations of the psychological
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1959, 14, 113-121.

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