The Maternal Fetal Attachment Scale: Some Methodological Ponderings

Abstract

ABSTRACT: The development of Cranley's (1981) Maternal Fetal Attachment Scale (MFAS) has stimulated a great deal of research and discussion about theories, methods and moderating factors affecting prenatal attachment. However, there has been considerable questioning of validity of MFAS. For example, it remains unclear whether inconsistencies found in literature using MFAS are related to issue of conceptualization of dimensions measured with this test, items that are included in test, or interaction of MFAS with personality, situational, ecological or demographic factors that influence pregnant women. The present paper is a discussion of five issues that relate to clarifying use of MFAS as a measure of prenatal attachment. The five issues include a discussion of subscales of test, general reliability of test, validity, factors correlated with MFAS and concern about normative data for measure. Each of these issues is developed both with a survey of relevant literature and related theoretical ponderings. Suggestions for future research are included. KEY WORDS: prenatal attachment; maternal fetal attachment; maternal fetal attachment scale. INTRODUCTION Maternal-fetal attachment is affectionate bond that expectant mothers develop toward their unborn children (Deutsch, 1945; Klaus and Kennel, 1970; Leifer, 1977; Rubin, 1967, 1975). The process of attachment, in this view, begins during pregnancy and continues to develop after birth. In early studies, researchers gathered information, of pregnancy and prenatal attachment, largely by means of interviews (e.g., Leifer, 1977). In 1979, 1981a, Cranley developed Maternal Fetal Attachment Scale (MFAS) to provide an objective measure of her conceptualization of maternal-fetal attachment. Cranley defined maternal-fetal attachment as the extent to which women engage in behaviors that represent an affiliation and interaction with their unborn child (Cranley, 1981a, p 282). In 24 item questionnaire, she measured behaviors towards, and attitudes of pregnant women toward their developing fetus, (e.g., I talk to my unborn baby). Items were scored on a five point scale from definitely no, uncertain, yes to definitely yes. Higher scores represented higher levels of prenatal attachment. In addition to global score, Cranley identified five subscales, (i.e., differentiation of self from fetus, interaction with fetus, attributing characteristics and intentions to fetus, giving of self, and role-taking). The MFAS was modified by Weaver and Cranley in 1983 to assess Paternal Fetal Attachment. Cranley's measure has been criticized for focusing too exclusively on behavior rather than considering thoughts or fantasy (Muller, 1989), for emphasizing women's attitude to pregnancy state and motherhood role (Condon, 1993), and for not providing normative data to allow for comparisons between studies (Cox, 2002). There has also been a concern that factors of her scale have not been derived by statistical analysis and, consequently, do not stand up to statistical scrutiny (Zimerman, 1993). In fact, Cranley herself (1992) recommended that, because psychometric properties of subscales were inadequate, scale should be used only as a global score. Other researchers have attempted to address some of methodological concerns of Cranley's measure by developing other measures of prenatal attachment, including LoBiondo-Wood and Vito-O'Rourke's (1990) Prenatal Maternal Attachment Scale, Muller's (1993) Prenatal Attachment Inventory, and Condon's Antenatal Attachment Scale (1993). In spite of continuing discussion about methodological limitations of Cranley's measure, since its inception MFAS has been principal instrument used to measure maternal fetal attachment (Beck, 1999; Muller, 1992). …