Explanatory model for “becoming a mother” among first-time mothers who experienced high-risk pregnancies

BACKGROUND: High-risk pregnancies can disrupt the transition to motherhood by limiting maternal-infant interaction, increasing psychological distress, and undermining confidence in assuming the maternal role; however, few studies have modeled how relational, social, and health-related factors jointly influence this process. Guided by Mercer's theory of maternal role attainment, this cross-sectional study developed and tested an explanatory structural equation model that described the process of becoming a mother among first-time mothers with a history of high-risk pregnancies. METHODS: In this cross-sectional study, we tested a hypothesized structural equation model for the process of becoming a mother among first-time mothers with high-risk pregnancies. A total of 320 women within 6 months postpartum who had a physician-confirmed high-risk singleton pregnancy and lived with a spouse completed an online survey. Assessed variables included the mother-infant relationship, spousal support, social support, maternal health, maternal role confidence, and the process of becoming a mother. RESULTS: A total of 320 mothers were included in the final analysis. First-time mothers who had experienced high-risk pregnancies demonstrated a stronger sense of becoming a mother when they reported a more positive mother-infant relationship (β = 0.64, p = .001), a more supportive spousal relationship (β = 0.10, p = .003), higher levels of social support (β = 0.36, p = .008), better maternal health (lower scores indicating poorer health; β = -0.52, p = .002), and higher maternal role confidence (β = 0.42, p = .003). CONCLUSIONS: Women who had experienced high-risk pregnancies were both directly and indirectly influenced by their mother-infant and spousal relationships, social support, maternal health, and maternal role confidence. These findings suggest that perinatal care for primiparas with a history of high-risk pregnancy should include brief, structured interventions that strengthen mother-infant bonding and spousal support, proactively address physical and emotional symptoms, and provide targeted opportunities to build confidence in assuming the maternal role.