The Effect of Journaling on Prenatal Attachment in Pregnant Women

Importance of the Topic Pregnancy is the physiological process that begins with thefertilization of a woman's egg by a sperm cell and in which the embryo and fetus developin the mother's womb. Pregnancy is not only a biological process but also a period inwhich psychological, emotional, and social changes occur. These transformations takingplace in the expectant mother's body and mind are a natural part of preparing for birthand motherhood. Harlow argued that because the mother meets the infant's basic needs suchas hunger and thirst during infancy, an attachment forms between mother and child, anotion that also forms the core of Bowlby's research. One of the elements used in thestudies Harlow conducted with his students on monkeys in 1958 was maternal deprivation.In the experimental setup established, in order to understand the monkeys' basic drive,they were given two options: either climb to a cloth‐covered surface or climb to anuncomfortable wire surface to drink milk. After climbing the wire rod and drinking milk,the monkeys quickly returned to the cloth‐covered surface. This shows that not onlyfeeding but also comfort is important (Tüzün and Sayar, 2006).The expectant mother's emotional contact with her baby during pregnancy ‐ for example,feeling the baby's movements in her womb, talking to the baby, or developing thoughtsabout the baby ‐ represents the early human form of the "search for comfort and security"observed in Harlow's experiments. Accordingly, this emotional bond established during theprenatal period serves as preparation for the postpartum mother‐infant relationship andforms the foundations of the baby's basic sense of security. In this respect, Harlow'sfindings support the psychobiological and emotional foundations of prenatal attachmentstudies, emphasizing that the relationship between mother and infant is not onlybiological but also a psychosocial process. Pregnancy is one of the most special yetfragile periods of a woman's life. During this period, the mother's emotional state, thebond she forms with her baby, and her psychological well‐being directly affect both thehealthy progression of the pregnancy process and the postpartum mother‐infantrelationship. Prenatal attachment is defined as the mother's perception of her baby as anindividual during pregnancy and the development of feelings of love, protection, andresponsibility toward the baby (Müller, 1993). Strong prenatal attachment is associatedwith a reduced risk of postpartum depression, longer breastfeeding duration, and positiveparenting behaviors (Condon and Corkindale, 1997; Alhusen, 2013).Prenatal attachment is the emotional, cognitive, and behavioral bond that the motherdevelops toward her unborn child. The imaginary communication the expectant motherestablishes with the fetus during pregnancy, and the way she perceives and interprets itsmovements, contribute to the strengthening of this bond. Studies have found that prenatalattachment is influenced by factors such as the mother's mental health, anxiety level,attitude toward pregnancy, and level of social support (Özdemir et al., 2020). Ninebehaviors that may affect prenatal attachment have been described. These are: planningthe pregnancy, the pregnancy being wanted, accepting the pregnancy, feeling fetalmovements, accepting the fetus as a separate individual, giving birth, seeing the baby,touching the baby, and caring for the baby (Peppers and Knapp, 1980). Robin, who foundedthe theoretical framework of prenatal attachment, emphasized that women have fourspecific tasks during the prenatal period. These are: (a) seeking a safe passage forherself and her baby throughout pregnancy, (b) ensuring the baby's acceptance by others,(c) establishing an inner bond with the fetus, and (d) devoting herself to the baby(Robin, 1975).From the beginning of pregnancy until the start of the second trimester, women form animaginary image of the baby in their minds. Wondering who the baby will resemble and howit will move, making preparations for the baby, valuing and caring about the baby, andshowing love, interest, affection, and protectiveness all indicate the pregnant woman'sprenatal attachment (Öztürk, 2021). However, studies have indicated that stress, anxiety,fatigue, lack of social support, and low self‐perception experienced during pregnancy maynegatively affect prenatal attachment (Yarcheski et al., 2009). For this reason, the needfor psychosocial interventions that support attachment during pregnancy is increasing.Journaling (expressive writing) is an effective, cost‐free, and easily applicable methodthat enables individuals to recognize their emotions, cope with negative emotions, andmake sense of life events (Pennebaker, 2018). However, there is no experimental orquasi‐experimental study in Turkey on the effect of journaling during pregnancy onprenatal attachment. This constitutes a significant gap in the literature.The pregnancy period is a process in which intense changes are experienced bothphysically and emotionally. Journaling helps the mother recognize her emotions, expressher fears, and deepen the bond she forms with her baby during this period. Writing canstrengthen prenatal attachment by enabling the mother to make sense of her pregnancyexperience and express herself better (Gao, 2022). Written expression can reduce themother's stress level by providing emotional release (catharsis). A mother who puts heremotions into words rather than suppressing them can cope more healthily with theanxiety, fear, or uncertainties of the pregnancy process. The literature indicates thatexpressing emotions increases oxytocin release, reinforcing feelings of relaxation andpeace, which in turn positively affects mother‐infant interaction. Thus, writtenexpression not only supports psychological well‐being but may also have an indirectpositive effect on biological processes. Journaling facilitates the mother'sinternalization of her maternal role and emotional preparation for the postpartum period.Scientific research has shown that regular writing during pregnancy reduces anxietylevels and improves the mother's self‐awareness and emotion regulation skills (Baikie andWilhelm, 2005). In the study by Özdemir and colleagues (2020), pregnant women with highlevels of prenatal attachment were also reported to have lower stress and anxiety levels.In this context, journaling can be considered an important tool that both supportspsychological balance and strengthens the mother‐infant bond during pregnancy. Inconclusion, journaling is a method that increases an individual's emotional awareness,strengthens the capacity to cope with stress, and supports psychological recovery. Theimportance of this effect increases further during pregnancy. Journaling helps theexpectant mother organize her inner world, recognize her emotions, and form a strongemotional bond with her baby. In the study conducted by Mirmolaei (2020), expressivewriting was applied to pregnant women twice a week for 15‐20 minutes over a 2‐monthperiod. In this study, anxiety and depression decreased significantly by the 4th week ofthe intervention, but the stress level did not decrease by the 4th week; when theintervention was extended to 8 weeks, a significant decrease in stress level was alsoobserved.Diaries kept during pregnancy help the woman make sense of her pregnancy experience,organize her inner processes, and position her baby in her mind as a "real being."Writing down the physical characteristics the mother imagines for her baby, herpredictions about its temperament, her conversations with the baby, or her wishes for thebaby contributes to giving concrete form to this otherwise abstract bond. This allows themother to perceive her baby not merely as "a being growing in her womb" but as "anindividual with whom she has formed an emotional bond." For this reason, journalingduring pregnancy is a simple yet effective method that strengthens prenatal attachment byallowing the mother to express her emotions, thoughts, and expectations. The act ofwriting helps the mother give concrete form to her baby in her mind, gain emotionalawareness, and cope with stress.