Stress, maternal role competence, and satisfaction among Chinese women in the perinatal period†
We would like to express our sincere thanks to all women participated in the study.
The changes in and relationships among stress, maternal role competence, and satisfaction in the perinatal period were examined using a longitudinal design. A convenience sample of 78 first-time Chinese mothers completed assessments of stress and maternal role competence during pregnancy and at 6 weeks and 6 months postpartum. Maternal stress increased and role competence declined during early motherhood, which highlighted the potential influence of stress on maternal role competence and satisfaction in the perinatal period. Culturally competent health care interventions should be developed to promote maternal competence and satisfaction, in particular during early motherhood, and to equip women with effective coping skills to deal with the stress of maternal role transition. © 2011 Wiley Periodicals, Inc. Res Nurs Health 35:30–39, 2012
A sense of competence and satisfaction in the maternal role during the transition to motherhood can have tremendous impact on the quality of parenting behavior (Trivette, Dunst, & Hamby, 2010). Women with a strong sense of competence and satisfaction in the maternal role had a secure attachment style and sensitive and responsive nurturing behavior, which facilitated the infant's growth and development (Sadeh, Tikotzky, & Scher, 2010). Stress from negative life events, such as marital problems or financial pressure, has had detrimental effects on maternal role competence and satisfaction (Farkas & Valdés, 2010). Thus, understanding the relationships among stress and maternal role competence and satisfaction is imperative for the development of effective interventions to promote positive adaptation during the transition to motherhood. However, most past researchers who studied the relationships among stress, maternal role competence, and satisfaction relied on cross-sectional design (Farkas & Valdés, 2010; Kowk & Wong, 2000). The present study was conducted to provide a better understanding of the changes and impact of perinatal stress on maternal role competence and satisfaction in a population of Chinese women using a longitudinal design.
This study was guided by self-efficacy theory (Bandura, 1997) and the transaction model of stress (Lazarus & Folkman, 1984). Maternal role competence reflects a mother's belief in her ability to perform mothering tasks effectively, and maternal role satisfaction refers to the mother's feelings of comfort and gratification with parenting (Bandura, 1997; Ohan, Leung, & Johnston, 2000). According to Bandura (1997), women who feel more competent in the maternal role will persist in the demanding tasks of parenting, avoid self-blame, and achieve a sense of accomplishment and satisfaction in mothering. Maternal role competence and satisfaction are closely related. It is difficult to achieve competence if a woman is not satisfied with the role, and maternal satisfaction is unlikely if the woman feels incompetent in mastering the maternal role (Ngai, Chan, & Holroyd, 2007).
The process of maternal role development is progressive, beginning in pregnancy and continuing over 4–6 months postpartum, when most mothers achieve competence and satisfaction in the role (Hudson, Elek, & Fleck, 2001; Mercer, 2004). In a longitudinal study of 44 first-time couples' transition to parenthood in the United States, mothers' reported maternal role competence and satisfaction increased gradually over the first 4 months (Hudson et al., 2001). Forster et al. (2008) conducted focus group interviews of 52 pregnant and postpartum women in Australia and found that women generally lacked confidence in their ability to care for their children in the early postnatal period. In a grounded theory study of Chinese women's experience of transition to first-time motherhood, mothers at 6 weeks postpartum, had recovered physically but expressed feelings of frustration and uncertainty in mastering necessary childcare skills. These women gradually acquired the maternal role with increasing experience of childcare and interactions with their infants and felt competent and satisfied by 6 months postpartum (Li & Levy, 2001).
Stress is defined as “the relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus & Folkman, 1984, p.19). During the transition to motherhood, women face profound changes in lifestyles, roles, relationships, and responsibilities (Nelson, 2003). Women's appraisal of these changes can trigger a stress response (Lazarus & Folkman, 1984; Leung, Arthur, & Martinson, 2005a). High levels of stress may result in emotional arousal and threaten women's sense of competence and satisfaction in the maternal role (Bandura, 1997; Lazarus & Folkman, 1984). In a study by Holub et al. (2007) of the transition to motherhood experience of 154 pregnant adolescents in the United States, those who experienced high prenatal stress and high parenting stress were more likely to report low parenting competence and satisfaction. Similarly, in a study of 526 Hong Kong Chinese parents, mothers with greater perceived stress reported lower competence in parenting (Kowk & Wong, 2000). Farkas and Valdés (2010) surveyed 121 low-income Chilean mothers and found that stress was directly related to women's sense of competence in the maternal role.
Women's levels of stress change across the perinatal period. In a prospective study of 137 pregnant women in the United States, primiparous women exhibited an increase in stress from pregnancy to 6 weeks postpartum and a decline over the following 2 years (Dipietro, Costigan, & Sipsma, 2008). The sources of stress also vary. Some of the stressors that may affect women in pregnancy derive from marital relationships, family responsibilities, employment conditions, financial problems, and pregnancy-related concerns (Schetter, 2011). In a meta-synthesis of nine studies of women in North America and Australia, changes in daily life, family responsibilities, relationships with family and friends, and financial and working conditions were major adaptation challenges during the transition to motherhood (Nelson, 2003). The Chinese postpartum ritual of “doing the month,” in which a mother is cared for by a senior family member for the month after delivery, was found to lead to in-law conflicts, which were a major source of stress for new mothers (Leung, Arthur, & Martinson, 2005b).
Few researchers have examined changes in and relationships among stress and maternal role competence and satisfaction across the perinatal period using a longitudinal design. Furthermore, limited information is available on the types of stress experienced by Chinese women in the perinatal period. Health care professionals play a key role in identifying and supporting women through the stressful experiences of maternal role transition. Knowledge of women's maternal role competence and satisfaction across the perinatal period will further understanding of their adjustment to parenting and guide interventions to promote effective adaptation to new motherhood. The aims of this study of a sample of Chinese women were therefore to: (a) explore changes in the level of stress and maternal role competence and satisfaction from pregnancy to 6 weeks and 6 months postpartum, (b) examine the relationship between stress and maternal role competence and satisfaction across the perinatal period, and (c) identify the stressors they experienced.
This study used a prospective correlational design. The data were collected as part of an experimental study of the effects of a childbirth psychoeducation program on maternal adaptation (Ngai, Chan, & Ip, 2009). The intervention was developed based on the concept of learned resourcefulness to promote maternal role competence and satisfaction. Participants in the intervention group (n = 92) received a childbirth psychoeducation program, which was incorporated into routine childbirth education. The control group (n = 92) received routine childbirth education alone. Data for the present analysis were collected from participants in the control group who completed assessments during pregnancy, at 6 weeks and 6 months postpartum (n = 78, 84.5%). Participants were pregnant women 18 years of age or above, Hong Kong Chinese residents, nulliparous with a singleton and uneventful pregnancy, able to read Chinese, and without a past or family psychiatric history were enrolled between 12 and 35 weeks gestation (Ngai et al., 2009).
Maternal role competence and satisfaction
The Parenting Sense of Competence Scale (PSOC) consists of two subscales: the efficacy subscale (PSOC-E) assessing women's perceived competence in the mothering role (8 items), and the satisfaction subscale (PSOC-S) measuring women's satisfaction and comfort with parenting (9 items; Gibaud-Wallston & Wandersman, 1978). Each item is rated on a 6-point scale, with higher scores indicating higher competence and satisfaction in parenting. Possible scores on the PSOC-E and PSOC-S range from 8 to 48 and 9 to 54, respectively. The Chinese version of the PSOC has demonstrated good psychometric properties, with internal consistency of .82 and 4-week test–retest reliability of .84. The internal consistency in this study ranged from .72 to .89 for PSOC-E and .84 to .85 for PSOC-S. Construct validity was supported by significant correlations with self-esteem and depression (Ngai et al., 2007). A sample item on the PSOC-E is “I honestly believe I have all the skills necessary to be a good mother to my child.” A sample item on the PSOC-S is “My mother was better prepared to be a good mother than I am.”
The original Social Readjustment Rating Scale (SRRS) measures 43 major life events. Responses of yes or no for each event are used to indicate whether that event occurred in the past 12 months. The Chinese version of the SRRS was modified by Shek and Mak (1987) and includes 39 significant life events. The SRRS has been validated in a sample of Hong Kong Chinese women in the perinatal period. It has satisfactory construct validity with the General Health Questionnaire and Edinburgh Postnatal Depression Scale (Lee, Yip, Leung, & Chung, 2004).
The SRRS was scored in three ways for this study. First, the total number of stressful life events was calculated by summing up the number of life events that occurred. Second, using “life-change units” assigned to each event by the tool's developers (Holmes & Rahe, 1967) to reflect the magnitude of adjustment the event required, the total of life change units for the events that occurred was calculated. Higher values indicate greater stress and thus greater degree of readjustment. Third, women were asked to rate the perceived stress intensity of each event on a 5-point scale, with higher scores indicating greater perceived stress. Significant correlations with the General Health Questionnaire and the Somatic Scale demonstrated the construct validity of these calculated stress measures.
Ethical approval was obtained from the Clinical Research Ethics Committees in the study hospital. Women who met the inclusion criteria were approached at the antenatal clinics. They were informed of the purpose and the nature of the study. Women who agreed to participate in the study signed a written consent form. Participants completed the initial assessment of PSOC-E and SRRS at the antenatal clinics. At 6 weeks and 6 months postpartum, the PSOC-E, PSOC-S, and SRRS were mailed to women. Participants were invited to complete the questionnaires at home and mail them back in pre-addressed, stamped envelopes.
Data were analyzed using SPSS for Windows version 16.0. Descriptive statistics, including mean, standard deviation, frequency count, and percentages, were used to summarize demographics, obstetric, and study variables. Pearson product–moment correlations were conducted to assess relationships between study variables and demographic and obstetric characteristics. Univariate repeated measures analyses of variance (ANOVA) was used to assess changes in stress and maternal role competence across the perinatal period. Time contrasts were used to examine differences between the mean scores on stress and maternal role competence from pregnancy to 6 weeks and 6 months postpartum. Paired t-tests were used to examine differences between the mean scores on maternal role satisfaction from 6 weeks to 6 months postpartum.
Two multiple regression analyses were conducted to determine the contribution of stressful life events, stress intensity, demographics and obstetric characteristics to 6-month maternal role competence, and satisfaction. In step 1, prenatal stressful life events, prenatal stress intensity, demographics including age, education, employment status and income, and gestation were entered into the regression model as a block, followed by a second block of 6-week stressful life events, 6-week stress intensity, and mode of delivery, with 6-month maternal role competence as the dependent variable. The same multiple regression analysis was conducted with 6-month maternal role satisfaction as the dependent variable. A p < .05 significance level was used for all statistical tests.
Table 1 presents the demographic and obstetric characteristics of the participants. The mean age of the participants was 30.5 years (SD = 3.7). Over 85% of the women were employed, with a median monthly household income of HK$ 21,720 (US$ 2,785). The study variables during pregnancy and at 6 weeks and 6 months postpartum are described in Table 2.
Table 1. Demographic and Obstetric Characteristics of the Participants (n = 78)
| ||Tertiary, university or above||27||34.6|
|Monthly household income||<HK$ 20,000||34||43.6|
| ||HK$ 20,000–30,000||29||37.2|
| ||HK$ 30,001–40,000||7||9.0|
| ||>HK $40,000||8||10.3|
|Trimester of Enrollment||Second||17||21.8|
|Mode of delivery||Vaginal||57||73.1|
| ||Cesarean section||21||26.9|
Table 2. Means and Standard Deviations of Study Variables (n = 78)
|Maternal role competence||33.9||5.1||31.7||4.5||33.5||5.5|
|Maternal role satisfaction||—|| ||34.6||7.8||37.2||7.2|
|Stressful life events (total life change units)||246.8||170.3||342.3||189.4||279.3||204.4|
Changes Over Time in Maternal Role Competence and Satisfaction
An ANOVA revealed the main effect of time, indicating significant mean differences in maternal role competence across the perinatal period (F[2,154] = 7.89, p < .001). Repeated contrasts for time showed that maternal role competence scores declined from pregnancy to 6 weeks postpartum (F[1,77] = 12.14, p < .001), followed by improvement at 6 months (F[1,77] = 13.43, p < .001). The change in maternal role competence between pregnancy and 6 months postpartum was not significant (F[1,77] = .47, p = .50). A paired t-test revealed an increase in maternal role satisfaction from 6 weeks to 6 months postpartum (t = −3.47, p < .001).
Change Over Time in Stress
An ANOVA revealed the main effect of time, indicating significant mean differences in stressful life events (F[2,154] = 11.13, p < .0001) and stress intensity (F[2,154] = 20.19, p < .0001) across the perinatal period. Repeated contrasts for time showed that both stressful life events and stress intensity increased from pregnancy to 6 weeks postpartum (F[1,77] = 26.54, p < .001 and F[1,77] = 42.55, p < .001, respectively) and then declined at 6 months postpartum (F[1,77] = 4.42, p < .05 and F[1,77] = 7.44, p < .01, respectively). Both stressful life events and stress intensity increased from pregnancy to 6 months postpartum (F[1,77] = 5.95, p < .05 and F[1,77] = 13.10, p < .001, respectively).
The mean numbers of stressful life events were 5.5 (SD = 4.1), 8.2 (SD = 4.5), and 7.0 (SD = 4.8) during pregnancy, at 6 weeks and 6 months postpartum, respectively. Table 3 presents the most frequently reported life events experienced by women during pregnancy and at 6 weeks and 6 months postpartum.
Table 3. Stressful Life Events During Pregnancy and Postpartum (n = 78)
|Change in sleeping habits||33||42.3||54||69.2||31||39.7|
|Change in eating habits||30||38.5||31||39.7||14||17.9|
|Change in personal habits||19||24.4||38||48.7||30||38.5|
|Change in financial state||19||24.4||21||26.9||20||25.6|
|Change in working hours||18||23.1||18||23.1||22||28.2|
|Change in recreation||18||23.1||37||47.4||38||48.7|
|Change in social activities||17||21.8||37||47.4||37||47.5|
|Change in responsibility at work||14||17.9||32||41.0||27||34.6|
|Trouble with in-laws||6||7.7||20||25.6||20||25.6|
Relationships Between Participants' Characteristics and Study Variables
Age was found to have significant correlations with maternal role competence and satisfaction at 6 weeks (r = .26, p < .05 and r = .23, p < .05, respectively) and 6 months postpartum (r = .28, p < .05 and r = .41, p < .001, respectively). Education, employment status, income, gestation, and mode of delivery were not associated with maternal role competence or satisfaction at 6 months postpartum. Stressful life events and stress intensity were not associated with any of the demographic or obstetric variables. In the final regression model, age was the only demographic predictor of 6-month maternal role satisfaction (β = 0.39, p < .001).
Relationships Among Study Variables
The relationships among study variables are presented in Table 4. Prenatal stress intensity correlated negatively with prenatal maternal role competence. Postnatal stressful life events and stress intensity at 6 weeks postpartum correlated negatively with maternal role satisfaction, but not with competence at the same point. Stressful life events and stress intensity at 6 months postpartum were not related to maternal role competence or satisfaction. Competence correlated positively with satisfaction at 6 weeks. Competence at 6 months postpartum also correlated positively with satisfaction. In the final regression model, both 6-week stressful life events (β = −0.52, p < .05) and stress intensity (β = −0.53, p < .05) predicted 6-month maternal role competence, and 6-week stress intensity predicted 6-month maternal role satisfaction (β = −2.45, p < .05).
Table 4. Pearson's Correlations Between Study Variables (n = 78)
|Prenatal maternal role competence||—|| || || || || || || || || || |
|Prenatal stressful life events||−.17||—|| || || || || || || || || |
|Prenatal stress intensity||−.24*||.85**||—|| || || || || || || || |
|Maternal role competence at 6 weeks postpartum||.33**||−.12||−.23*||—|| || || || || || || |
|Maternal role satisfaction at 6 weeks postpartum||.12||−.18||−.30**||.48**||—|| || || || || || |
|Stressful life events at 6 weeks postpartum||−.15||.59**||.58**||−.05||−.29*||—|| || || || || |
|Stress intensity at 6 weeks postpartum||−.20||.55**||.64**||−.22||−.38**||.83**||—|| || || || |
|Maternal role competence at 6 months postpartum||.44**||−.11||−.13||.65**||.35**||−.02||−.18||—|| || || |
|Maternal role satisfaction at 6 months postpartum||.31**||−.17||−.23*||.48**||.62**||−.19||−.33**||.65**||—|| || |
|Stressful life events at 6 months postpartum||−.09||.54**||.70**||−.27*||−.21||.54**||.57**||−.15||−.21||—|| |
|Stress intensity at 6 months postpartum||−.06||.47**||.65**||−.25*||−.23*||.51**||.61**||−.14||−.19||.91**||—|
Chinese mothers in this study experienced a substantial decline in maternal role competence and an increase in stress during early motherhood. The mean numbers of stressful life events experienced by Chinese women in the perinatal period (range = 5.5–8.2) were comparatively higher than those reported in a national survey of 1,524 pregnant women and 994 postpartum women in the United States (range = 2.0–2.1; Vesga-Lopez et al., 2008). The most frequent life events during pregnancy could be categorized into three main areas, namely disruption in daily life (changes in sleeping, eating, and personal habit, and recreation and social activities), financial, and work issues. Similar life events were also reported in the postpartum period, with the addition of conflict with in-laws. These Chinese women experienced profound changes in lifestyles, such as eating and sleeping habits, starting in pregnancy and persisting throughout the postnatal period. These changes may be related to the traditional Chinese culture stipulating that pregnant women should follow an array of dietary and behavioral proscriptions, such as no raw or iced foods, lifting of heavy objects, or wearing of high-heeled shoes, in order to maintain the health and safety of the fetus (Lee et al., 2009). The traditional postpartum rituals of “doing the month” also involve an array of dietary and behavioral proscriptions, such as not bathing or washing the hair, avoiding raw, or cold foods but not hot foods, abstaining from sexual intercourse, and remaining confined at home for the first postpartum month (Wong & Fisher, 2009). These traditional practices are still commonly adhered to by contemporary Hong Kong Chinese women (Lee et al., 2009; Leung et al., 2005b). It is possible that Chinese women in this study were obliged to conform to the traditional rituals and make substantial changes in their personal lives, which may have led to greater stress during the perinatal period compared with mothers in Western societies.
The Chinese mothers in this study were also concerned about financial and work issues. With an increase in living standards, the expense of rearing a child, and an emphasis on money and materialism, financial issues are one of the major sources of life stress in contemporary Hong Kong Chinese families. Furthermore, the majority of women in this study were employed, which may have posed additional stress on the women, given that Hong Kong is a city known for its efficient but stressful work environments (So, 2011). Concern about financial and work pressure has been identified as the cause of major postpartum stress in previous studies (Leung et al., 2005b; Nelson, 2003).
Relationships with in-laws were another source of stress throughout the postnatal period. Traditionally the mother-in-law exercises significant power in Chinese households and has a major influence on the postpartum care of new mothers (Wong & Fisher, 2009). If in-laws hold traditional beliefs about postpartum care, including diet, environment, and activity restrictions, that differ from those of the new mother, conflicts often arise and cause tension as new mothers struggle to balance traditional rituals with contemporary values (Wong & Fisher, 2009; Leung et al., 2005a).
Although the Chinese women in this study faced similar types of stressors across the perinatal period, the frequency and intensity of stress were highest in the early postpartum weeks. Women may begin to feel disruptions in daily life in their pregnancies, but most changes occur after the infant is born, when the new mothers are faced with the reality of infant care. These findings are in accordance with those of a previous study in which primiparous mothers experienced an increase in stress from pregnancy to early postpartum and a decline in late postpartum (Dipietro et al., 2008).
Although their stress levels were higher than previously reported, these Chinese women's mean scores on maternal role competence (range = 31.7–33.9) also were comparatively higher than those reported in previous studies for Caucasian mothers (range = 21.6–31.6; Gibaud-Wallston & Wandersman, 1978; Johnston & Mash, 1989; Ohan et al., 2000). This suggests that the Chinese mothers in this study had a stronger sense of maternal role competence than mothers in Western societies. Perhaps due to the enduring influence of Confucian ideas, Chinese child rearing traditions emphasize the importance of parental responsibility in childcare and development (Park & Chesla, 2007). Chinese mothers are expected to be nurturing and protective with their children to keep them from harm. Starting in pregnancy, a woman is expected to ensure the safety and health of the fetus by adhering to cultural rituals (Lee et al., 2009). As children grow, parents are expected to cultivate their behavior and provide them with appropriate education and discipline to ensure proper development of character. The traditional emphasis on bringing up a healthy and moral child may oblige Chinese mothers to strive for competence in the maternal role in order to fulfill their family and cultural obligations (Park & Chesla, 2007).
The decline in maternal role competence from pregnancy to 6 weeks postpartum is not surprising, given the significant changes that women encounter after the child's birth, particularly in the early postnatal weeks when they are still familiarizing themselves with their infants and their new role. The findings are congruent with previous studies in which women lost confidence in their ability to manage parenting tasks and experienced a negative perception of themselves as mothers during early motherhood (Forster et al., 2008; Li & Levy, 2001; Nelson, 2003). With the passage of time, the influence of the demands of early motherhood on maternal role competence seems to diminish, and women show an improvement in maternal role competence at 6 months postpartum. By this point most mothers have recovered from childbirth, become more sensitive and attached to their infant, and started to master childcare skills, which may contribute to a stronger sense of maternal role competence. Consistent with Bandura's (1997) self-efficacy theory, with increasing experience in childcare, women may have more opportunities to receive positive reinforcement and thus report greater sense of role competence. The result is consistent with previous findings that primiparous mothers perceived themselves to be more competent in the maternal role at 4 months following the birth than at an earlier postpartum stage (Hudson et al., 2001).
Not surprisingly, the Chinese women's satisfaction in the maternal role also increased from 6 weeks to 6 months postpartum. Over time, mothers had increased opportunities to become acquainted and interact with their infants. The findings are consistent with previous studies in which maternal role satisfaction increased over time (Hudson et al., 2001; Mercer, 2004). Given the positive relationship between maternal role competence and satisfaction in this study, the increased sense of satisfaction in the maternal role among these first-time mothers may be related to their positive feelings of maternal role competence. Greater satisfaction with parenting was predicted by higher parenting competence (Coleman & Karraker, 2003; Ngai et al., 2007). Mothers who feel more competent in the maternal role tend to appraise the demands of parenting as challenges instead of stressors, and eventually achieve a sense of satisfaction in parenting (Bandura, 1997). Furthermore, the child's developmental changes may influence a mother's interactions with her infant. A 6-month time may bring extraordinary changes in the child's behavior, for example, they may require fewer feeds, develop more predictable behavior, and become more socially responsive, which are likely to provide mothers with positive reinforcement during interaction and enhance their sense of competence and satisfaction in the maternal role (Hudson et al., 2001; Porter & Hsu, 2003; Tarkka, 2003). The findings support Mercer's (2004) view that both time and experience are needed to enhance maternal role competence and satisfaction.
The negative relationship between prenatal stress intensity and maternal role competence suggests that pregnant women who perceive a higher level of stress tend to feel less competent in the maternal role. However, stressful life events during pregnancy were not related to prenatal maternal role competence, suggesting that women's overall appraisal of life events might have influenced maternal role competence more than the events themselves. The results support the transactional model of stress, which emphasizes the cognitive aspects of the process, in which an event must be appraised as stressful before it can influence emotional and behavioral responses (Lazarus & Folkman, 1984).
Both stressful life events and perceived stress intensity had negative relationships with maternal role satisfaction at 6 weeks postpartum and continued to have an impact on maternal role competence and satisfaction at 6 months postpartum. The findings suggest that mothers who experienced fewer stressors were more likely to feel competent and satisfied in the maternal role during the postpartum period. Similar to the results of previous studies, stress affected women's sense of competence and satisfaction in taking up the maternal role (Farkas & Valdés, 2010; Holub et al., 2007; Kowk & Wong, 2000). Although it is possible that stress could result from low maternal competence, and that a moderate degree of stress may serve as an impetus for learning maternal skills, the use of longitudinal design and regression analysis help establish the direction of relationship between stress and maternal role competence and satisfaction.
At 6 months postpartum, neither stressful life events nor stress intensity was correlated with maternal role competence and satisfaction, suggesting that stress no longer had an impact on competence and satisfaction in the late postpartum period. This may be a result of the decline in stress level at 6 months, which was too low to elicit a significant effect on competence and satisfaction. Nevertheless, given that the correlations between stressful life events, stress intensity, competence, and satisfaction were modest, the small sample size in this study might have resulted in a lack of sufficient power to detect a relationship that was in fact present. Replication with a larger sample may provide adequate power to more precisely depict the associations between stress, maternal role competence, and satisfaction in the perinatal period.
One strength of this study is the longitudinal nature of the data, which allows a clearer understanding of the changes and relationships between stress, maternal role competence, and satisfaction in the perinatal period. However, generalizability is limited by the small sample size and homogeneity of the sample, composed solely of well-educated Chinese primiparas with uncomplicated singleton pregnancies.
The present study has direct clinical implications for the care of Chinese mothers. Assessing stress and maternal role competence should begin during pregnancy and continue across the perinatal period. The dramatic increase in the stress level and decline in maternal role competence at 6 weeks postpartum indicate that Chinese mothers might not be adequately prepared for the demands of early motherhood. Given that women with unrealistically high expectations of their own parenting capability may be particularly unsettled if their early experience proves more challenging than they had thought (Harwood, McLean, & Durkin, 2007), it is of paramount importance to provide women with a realistic picture of early motherhood to facilitate positive adjustment. Health promotion activities should be initiated early in pregnancy and extend through the sixth postpartum week, in the light of virtually unanimous reports of inadequacy in the maternal role during this period. Effective coping strategies, such as problem solving and decision making skills, should be taught to women to assist them in negotiating the stress of new motherhood, which has a direct impact on maternal role competence and satisfaction. Additional support should be provided to those in conflict with in-laws and facing financial and work pressures. Given that “doing the month” continues to be an important ritual in the lives of Chinese families, healthcare professionals should build on traditional beliefs in the planning and development of interventions to promote maternal role competence and satisfaction in Chinese women.