The complex effects of maternal expectations on postpartum depressive symptoms: when does a protective factor become a risk factor?

Purpose: The present study assessed the effects of several prenatal maternal expectations on postpartum depression (PPD), while considering two relevant factors–incongruence between planned and actual birth and the rigidity of the birth plan–that can affect whether maternal expectations act as protective factors or risk factors for PPD. Methods: Primiparous women (N = 527) were recruited to a longitudinal study about women’s birth choices and experiences. At time 1, during pregnancy, women completed a questionnaire assessing prenatal depression, preferred birth plan, birth plan flexibility–rigidity and maternal expectations (i.e. Natural-Fulfillment, Infant-Reflects-Mothering, Sacrifice). At time 2, two-months post-partum, they reported their actual birth mode and answered a questionnaire assessing their PPD symptoms. Results: Natural-fulfillment maternal expectations were negatively related to PPD symptoms. Yet, the interaction of high natural-fulfillment expectations with an unfulfilled birth plan and the rigidity of the birth plan, served as a risk factor for PPD symptomatology. Conclusions: Understanding the conditions under which specific prenatal maternal expectations serve as a risk factor for PPD, can help healthcare providers identify women who are at high risk for developing PPD symptoms and plan preemptive interventions.