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. Author manuscript; available in PMC: 2024 Jul 1.
Published in final edited form as: Infant Ment Health J. 2023 May 6;44(4):541–553. doi: 10.1002/imhj.22060

Will I Love My Second Baby as Much as My First? Prevalence and Psychosocial Correlates of Maternal-Fetal Relationship Anxiety for Second-Time Mothers

Brenda L Volling 1, Lin Tan 2, Lauren Rosenberg 1, Lauren R Bader 3
PMCID: PMC10524320  NIHMSID: NIHMS1902180  PMID: 37149744

Abstract

Most mothers have more than one child. Second-time mothers may worry about whether they will love the second baby as much as their first child. The current study examined mothers’ maternal-fetal relationship anxiety (MFRA) to their second baby, the prediction of mother-infant bonding and infant-mother attachment security post-partum, and the psychosocial correlates of mothers’ MFRA during pregnancy. Mothers (N = 241, 85.9% White, 5.4% Black, 2.9% Asian/American, 3.7% Latina) and their second-born infants (55% boys) living in the Midwestern United States participated in a longitudinal investigation starting in the last trimester of pregnancy, and 1, 4, 8 and 12 months postpartum. Most women reported little to no anxiety about forming an attachment to their second baby (89.1%). MFRA predicted less maternal warmth toward the baby at 1, 4, and 8 months postpartum, but did not predict security of the infant-mother attachment at 12 months. Prenatal MFRA was also related to maternal depressive symptoms, an insecure attachment with the first child, more marital distress, and more adult attachment avoidance and ambivalence prenatally. Mothers worrying about loving a second baby as much as their first child may be experiencing other psychosocial risks that have repercussions for the developing mother-infant relationship.

Keywords: maternal-fetal attachment, maternal depression, adult attachment, mother-child attachment, marital relationship quality

Introduction

Most women around the world have more than one child (World Bank, 2019). As such, many women not only go through the transition to motherhood with the birth of their first baby, but also another transition with the birth of their second baby. Yet, there are few studies that even address the concerns of second-time mothers. When preparing for the birth of a second baby, early qualitative research indicated that these women expressed concerns about pregnancy, birth, and the health of their unborn baby (Affonso, 1988; Hiser, 1987; Jenkins, 1976; Jordan, 1989; Moss, 1981; Norr et al., 1980; Richardson, 1983), but they also expressed unique concerns that are not on the minds of women expecting their first baby (Beyers-Carlson et al., 2022). These concerns included how to manage the care of two young children, how to prepare the firstborn for their impending role as an older sibling, and whether they would love the second baby as much as they currently loved their first child (Beyers-Carlson et al., 2022; Hiser, 1987; Jenkins, 1976; Jordan, 1989; Moss, 1981; O’Reilly, 2004). The main goal of the current paper was to address mothers’ prenatal anxiety about loving the second baby (i.e., forming an attachment) as much as they currently loved their first child using longitudinal data from a sample of US mothers.

On January 26, 2018, an episode of the popular Good Morning America (GMA) show aired in the U.S.1 This episode focused on a recent Facebook post by their chief meteorologist, Ginger Zee, who was weeks from delivering her second baby. In her post, she asked “How will I ever love the second one as much as I love this little boy?” The post garnered thousands of responses from women claiming they had felt the exact same way before the birth of their second child, leading the healthcare experts on the show to announce to the 4 million viewers that it was a common and nearly universal emotion that most, if not all, second-time mothers have. These health care professionals also claimed that not only were these feelings completely normal, but they would subside the minute she saw and held her newborn infant. However, there is no research that examines whether these worries of loving a second baby as much as the first child are ”completely normal” for second-time mothers given that few studies address the concerns of these women (Beyers-Carlson et al., 2022). Condon and Esuvaranathan (1990) found that second-time Australian mothers reported being less attached to the unborn baby during pregnancy than did women expecting their first baby, but no study has focused only on second-time mothers and the prevalence of maternal-fetal relationship anxiety among these women. Even though the GMA show aired in the United States, we suspect the issue may be more broadly applicable to women in other countries given that most women worldwide have more than one child (World Bank, 2019). We use the term maternal-fetal relationship anxiety (MFRA) because it reflects maternal anxiety or worrying about attachment to the unborn baby during the second pregnancy (Walsh et al., 2013). We also wanted to distinguish MFRA from the prolific literature on maternal-fetal attachment. Even though MFRA may represent one component of maternal-fetal attachment, it does not reflect the full range of affective, behavioral and cognitive patterns that describe maternal-fetal attachment (e.g., interaction with fetus, protection, gratification, and seeking information; see Trombetta et al., 2021). Thus, the primary goal of the current study was to use data from an existing longitudinal investigation of changes in family life after the birth of a second baby conducted in the United States to address second-time mothers’ anxieties about loving (i.e., forming an attachment to) a second baby as much as their first child during their last trimester of pregnancy. In addition, we also examined the consequences for the developing mother-infant relationship across the first postpartum year when mothers worried about their attachment to the second baby and the psychosocial correlates of MFRA during pregnancy.

A focus on the feelings of love and attachment toward an unborn baby are reminiscent of research on maternal-fetal attachment; the emotional tie that develops naturally between a pregnant woman and her unborn child (Condon & Corkindale, 1997). Because the current study is the first to address MFRA for second-time mothers, we will rely on findings from the maternal-fetal attachment literature when delineating hypotheses about the prevalence, correlates, and consequences for mother-infant relationship outcomes. Maternal-fetal attachment has garnered considerable research attention across many countries because it predicts maternal-infant bonding once the infant is born (Cataudella et al., 2021; de Cock et al., 2016; Le Bas et al., 2021), maternal sensitivity and responsiveness during mother-infant interactions in the first year (Maas et al., 2016; Siddiqui & Hägglöf, 2000), and social and emotional development into late infancy and toddlerhood (Branjerdporn et al., 2017; Le Bas et al., 2021). Maternal-fetal attachment also predicted better health practices (e.g., seeking prenatal care, avoiding substances, exercise) in a sample of predominantly African American women with low income, which, in turn, predicted better neonatal and birth outcomes (Alhusen et al., 2012). Collectively, these studies suggest that for some women, there may be repercussions for the developing mother-infant relationship and subsequent infant development if pregnant women are reporting difficulties loving a second baby.

Because no prior study has examined the issue directly, the first aim of this study was to simply examine the prevalence with which women claimed they were “worried that they may not become emotionally attached to the baby” during their last trimester of pregnancy with their second baby. Because of the exploratory nature of the research, we advanced no specific hypotheses, but if these feelings are indeed “common and normal”, then we would expect far more women to express anxiety about becoming emotionally attached to their second baby than not. From hereafter, we refer to this concern about emotional attachment during the pregnancy with the second baby as maternal-fetal relationship anxiety (MFRA).

A second aim of the current study was to examine whether MFRA predicted maternal-infant bonding difficulties in the first year after the infant’s birth. Taking advantage of the longitudinal research design of the current study and repeated assessments of mothers’ reports at 1, 4, 8, and 12 months postpartum, we examined if MFRA during pregnancy had repercussions for the developing bond between mother and baby by focusing on whether mothers “expected to have closer and warmer feelings for their babies than they did and whether it bothered them.” Based on prior reports of stability in maternal feelings of prenatal and postnatal attachment for women in many countries, including Germany, Japan, Australia, and the United States (Dubber et al., 2015; Honjo et al., 2003; Le Bas et al., 2021; Rossen et al., 2016; also see review by Tichelman et al., 2019), we hypothesized an association between MFRA in pregnancy and maternal-infant bonding in the post-partum. Specifically, we expected MFRA (i.e., worrying about attachment to the fetus) would predict maternal-infant bonding after birth (i.e., feeling less warmth and closeness to the baby). We were particularly interested in whether MFRA had both short-term (in the first months) or long-term (end of the first year) prediction of maternal-infant bonding. If such feelings were “normal” but subsided after the birth of the baby, one might expect stronger relations with maternal reports of bonding in the early months shortly after birth (e.g., 1 and 4 months)--a period of adjustment and adaptation after the birth of a second child (Volling et al., 2017)--but weaker or no relations by 8 and 12 months. On the other hand, significant relations between antenatal MFRA and maternal-infant bonding at 1, 4, 8, and 12 months would suggest that these feelings do not subside, may persist over time, and may disrupt mother-infant bonding. If so, when women are asking their mental health providers if they will love their second baby as much as their first child, this inquiry may be a reflection of the mother’s current state of mind and mental health. From hereafter, we refer to these postpartum feelings of closeness and warmth toward the baby as maternal-infant bonding (MIB) in the remainder of this paper.

Relatedly, the third aim was to determine if there was any relation between MFRA in pregnancy and the security of the infant-mother attachment relationship that developed at the end of the first year as assessed in the Strange Situation Procedure (Ainsworth et al., 1978). Again, our main focus was on whether anxiety about loving a second baby during pregnancy had longer term implications for the developing mother-infant attachment relationship at one year after birth. To our knowledge, there are no prior studies upon which to base firm hypotheses, but we hypothesized that MFRA may predict more insecure infant-mother attachments at the end of the first year.

The final aim was to examine the psychosocial correlates of MFRA during pregnancy with the second baby by focusing on the mothers’ attachment relationships to others in the family, as well as their mental health. Here, we focused on reports of women’s attachment orientations in adult relationships, marital relationship quality, and the firstborn’s attachment security to the mother. If MFRA was a reflection of an internal working model about attachment relationships, we might expect to see a larger circle of attachment insecurity surrounding these women, namely greater avoidance and ambivalence in adult attachments, more conflict and ambivalence in the marital relationship, and less security in the mother-firstborn attachment.

Prior research has reported that adult attachment avoidance and anxiety predicted lower maternal-fetal attachment in Dutch, Italian, Israeli, and African American women in the United States (Alhusen et al., 2013; Cataudella et al., 2021; Hairston et al., 2018; Maas et al., 2014; Mikulincer & Florian, 1999), and several studies found that social support, including partner support, was positively related to maternal-fetal attachment using samples of women from Italy, the Netherlands, Poland, and the United States (Alhusen et al., 2012; Barone et al., 2014; Cataudella et al., 2021; Fijałkowska & Bielawska-Batorowicz, 2020).

Further, given the negative associations between maternal-fetal attachment and maternal distress (e.g., depression, anxiety) reported in many prior studies in several different countries (Alhusen et al., 2012; Dubber et al., 2015; Göbel et al., 2018; Goecke et al., 2012; Hart & McMahon, 2006; Honjo et al., 2003; Hopkins et al., 2018; Lindgren, 2001; Mason et al., 2011; McNamara et al., 2019; Røhder et al., 2020), we also examined whether MFRA was positively related to more maternal depressive symptoms during pregnancy. Rumination and excessive worrying in early pregnancy were related to both depression and impaired maternal-fetal attachment during late pregnancy for a sample of German women (Schmidt et al., 2016). If women are worrying about loving their second baby as much as their first child, these thoughts may also be symptoms of depressive rumination and indicate a need for mental health interventions.

Based on these earlier findings, we hypothesized that mothers would report more MFRA with their second baby when they reported more attachment avoidance and anxiety, more marital distress, and more depressive symptoms. To our knowledge, no study has examined the links between maternal-fetal attachment with a second baby and firstborn children’s attachment with the mother, so we did not advance specific directional hypotheses.

The Current Study

In summary, there were four aims to the present study which examined (1) the prevalence of MFRA in a sample of women expecting their second baby; (2) whether MFRA predicted maternal-infant bonding difficulties in the first year after the infant’s birth, and (3) the security of the infant-mother attachment relationship at one year; and (4) the psychosocial correlates of MFRA during pregnancy.

Methods

Participants

Participants included 241 pregnant women residing in the midwestern United States and enrolled in a longitudinal investigation of changes in family life after the birth of a second baby (55% boys), starting in the last trimester of their pregnancy (prenatal) and then again at 1, 4, 8 and 12 months after the infant’s birth. Enrollment criteria included (1) the mother was pregnant with her second child; (2) the father was the biological father of the second child (98% were also the biological father of the first); (3) the mother and the father were living together (99% were married); (4) the firstborn child (Mage = 29.92 months, SD = 10.16) was between the ages of 1 and 5 years at the time of the infant’s birth; and (5) neither the firstborn nor newborn infant had chronic and severe physical, mental, or developmental problems. All infants were singleton births and were born full term (> 37 weeks). Women (Mage = 31.6, SD = 4.22) were recruited from obstetric clinics associated with a large midwestern university health system, local pediatric offices, and from community flyers and advertisements in local parenting media. The sample of mothers was 85.9% European American, 5.4% African American, 2.9% Asian/Asian-American, and 2.1% Other; 3.7% of mothers identified as Latina. Most mothers had completed a Bachelor’s degree or higher (83.9%). The modal household income was $60,000 - $99,999 USD (37.8%). At the prenatal time point, 35.7% of the mothers were employed full-time, 29.9% were employed part-time, and 32.8 % were staying home full-time.

As with any longitduinal study there was attrition over time (15.8%). Of the 241 families recruited, 203 families remained in the study at 12 months. The 203 families remaining at 12 months did not differ significantly from the families that discontinued the study on years of marriage, parents’ age and race/ethnicity, the firstborn children’s age and gender at the initial pre-birth assessment (T1). Families who remained had higher annual family incomes, t(239) = −2.76, p = .01; and both mothers, Fisher’s exact test = 10.75, p = .01, and fathers, Fisher’s exact test = 9.37, p = .02, had higher educations than those who dropped. Only 229 mothers had complete data at the prenatal timepoint and were used in analyses.

Women completed several self-report questionnaires to assess maternal-fetal relationship anxiety (MFRA) at the prenatal time point, and their feelings of maternal-infant bonding (MIB) at 1, 4, 8 and 12 months after the birth. In addition, depressive symptoms, marital relationship quality, and adult attachment orientations were also assessed, as was the firstborn child’s attachment security to the mother before the infant sibling’s birth (prenatal) and the infant’s attachment to the mother one year after the birth during a laboratory visit. All women provided written consent upon enrollment. This research was approved by the Institutional Review Board of the Medical School (IRBMED) at the University of Michigan.

Measures

Maternal-fetal relationship anxiety (MFRA: Prenatal).

Mothers were asked to report on pregnancy concerns utilizing the 12-item Prenatal Distress Questionnaire (Yali and Lobel,1977) with responses ranging from 0 (not at all) to 4 (extremely). To assess MFRA, we focused on one item that we believed best reflected mothers’ anxieties about whether they would love their second baby, “I’m worried that I might not become emotionally attached to the baby.”

Depressive symptoms (Prenatal).

Women were asked to complete the 21-item Beck Depression Inventory BDI (Beck et al., 1961) at the prenatal timepoint. The BDI has high internal reliability, well-documented concurrent and discriminate validity, and has been used in many studies of pregnant and postpartum women (Beck et al., 1988). Items were summed to create a measure of depressive symptoms (α = .85).

Adult attachment orientations (Prenatal).

Women completed the Adult Attachment Questionnaire (Simpson et al., 1996) to assess adult attachment orientations. The 8-item avoidance subscale reflects an individual’s discomfort with intimacy, negative views of others, and tendency to avoid or withdraw from closeness and intimacy (α = .84, e.g., “I don’t like people getting too close to me”). The 9-item ambivalence subscale reflects an individual’s negative views of self and relationships, and excessive preoccupation with abandonment, loss, and their partner’s commitment to the relationship (α = .80, e.g., “Others are often reluctant to get as close as I would like”). Mothers rated items using a 7-point scale, ranging from 1 (strongly disagree) to 7 (strongly agree).

Marital relationship quality (Prenatal).

We considered the marital relationship in this study as the primary adult romantic attachment for women and asked women to completed two subscales from the Intimate Relations Questionnaire (Braiker, 1979)): (1) conflict - the extent to which couples engaged in marital disputes (5 items; e.g., “How often do you feel angry or resentful toward your partner?”, α = .78 ) and (2) ambivalence - the extent to which spouses were unsure about the future of the relationship (5 items: e.g., “How confused are you about your feelings toward your spouse?”, α = .75). Each item was answered on a 9-point scale from 1 (very little or not at all) to 9 (very much or extremely).

Mother-firstborn attachment security (Prenatal).

Mothers completed the Attachment Q-sort (AQS) (Waters & Deane, 1985) to assess the security of the mother–firstborn attachment relationship. The AQS consists of 90 cards, each of which contains a statement about child behavior (e.g., “when child returns to mother after playing, she/he is sometimes fussy for no clear reason”). During a home visit at the prenatal timepoint, a trained research assistant sat with the mother while she sorted the 90 cards into nine piles (10 cards each), ranging from “least characteristic of your child” to “most characteristic of your child.” Attachment security scores were calculated by correlating mothers’ sorts with a criterion sort representing the hypothetically “most secure” child. Higher scores indicate a closer fit to the criterion sort for a securely attached child.

Mother-infant bonding (MIB: 1, 4, 8 and 12 months).

Mothers also completed the attachment subscale of the parent domain of the Parenting Stress Index, Short-Form, 4th edition (Abidin, 1997) at 1, 4, 8, and 12 months after the infant’s birth. To measure potential problems with maternal-infant bonding (MIB) after the infant was born, we focused on the one item “I expected to have closer and warmer feelings for my baby than I do and this bothers me.”, which was answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree).

Infant-mother attachment security (12 months).

At 12 months, mothers accompanied their infants to the university laboratory to participate in the Strange Situation Procedure (SSP: (Ainsworth et al., 1978)), which consists of seven, 3-minute episodes involving a series of separations and reunions. All SSP were video-recorded and coded by trained independent coders. Infants were assigned an attachment classification of secure (B), insecure-avoidant (A), or insecure-resistant (C), and also coded as disorganized (D) or non-Disorganized. The distribution of infant-mother attachment was as follows: A (n = 12, 6.3%), B (n = 117, 61.3%), C (n = 51, 26.7%), and D (n = 11, 5.8%). Attachment security was assessed by creating an insecure (A, C, D; n = 74) and secure (B; n = 117) group. Inter-rater reliability was calculated on 10.5% of the sample using Cohen’s kappa (Cohen, 1960), which was excellent, α = .82.

Data Analysis Plan

We conducted descriptive statistics examining the frequencies and percentages of women reporting they were or were not worried about becoming emotionally attached to the second baby (MFRA) at the prenatal time point to determine how prevalent these feelings were. Due to the skewed nature of the distribution of women’s responses to the MFRA item, Spearman’s Rho nonparametric correlations were then calculated to examine longitudinal associations between MFRA before the birth and mothers’ reports on the one item of MIB after the birth at 1, 4, 8 and 12 months. We also conducted a chi-square analysis to determine if there was any relation between prenatal MFRA and classifications of infant-mother attachment security at 12 months. A sample size of 88 is required to detect a moderate effect size of .30 for the chi-square test, with a power of 0.8 at an alpha level of .05 Spearman’s Rho nonparametric correlations were also conducted to examine concurrent relations between MFRA and maternal reports of depressive symptoms, adult attachment orientations, marital relationship quality, and the firstborn’s attachment security to mothers using the AQS. Finally, a multinomial logistic regression was performed using all prenatal predictors of MFRA to determine which prenatal indicators predicted greater likelihood of women having prenatal MFRA. A sample size of 177 is needed to detect an odds ratio of 1.72 (moderate effect size) with a power of 0.8 at an alpha level of .05. All analyses were conducted using SPSS v. 27.

Results

Preliminary analyses in the form of one-way ANOVAs and univariate correlations showed that MFRA was not significantly related to infant sex, maternal education, maternal age, or family income so these variables were not considered further.

Do Mothers Worry a Little or A Lot About Attachment to Their Second Baby?

Recall that we were using the item “I am worried that I might not become emotionally attached to the baby” based on maternal reports in the last trimester of the second pregnancy as a measure of MFRA in the current study. The frequencies for mothers who agreed with the statement are shown in Table 1. Only 3 of 229 mothers (1.3%) reported they were extremely worried about the attachment to the baby and 7 mothers (3.1%) reported that they were very much worried about their ability to become emotionally attached to the baby. A majority (n = 160, 69.9%) reported they were not at all worried, with 44 mothers (19.2 %) stating they were a little worried and only 15 (6.6%) claiming they were moderately worried.

Table 1.

Frequency of Mothers’ Responses to the Statement “I am worried that I might not become emotionally attached to the baby”

Maternal-Fetal Relationship Anxiety N %
Not at all 160 69.9
A little 44 19.2
Moderately 15 6.6
Very much 7 3.1
Extremely 3 1.3
Total 229 100.0
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Does MFRA Predict Maternal-Infant Bonding (MIB) After Birth?

Spearman’s Rho nonparametric correlations were conducted to examine whether MFRA was related to MIB (i.e., expecting warmer and closer feelings to the baby than they did) to the baby at 1, 4, 8, and 12 months. Results showed that MFRA during pregnancy was significantly and positively related to less warm MIB at 1, ρ (216) = .234, p < .001, 4, ρ (203) = .158, p = .025, and 8 months, ρ (205) = .166, p = .017, but not at 12 months, ρ (196) = .092, p = .199.

Does MFRA Predict the Security of Infant-Mother Attachment?

A chi-square analysis looking at the association between MFRA and the security of the infant’s attachment to mothers at 12 months was then conducted. We included all three groups of women in these analyses: not at all worried, a little worried, and moderately to extremely worried about the emotional attachment to the fetus. Because of attrition across the year, only 130 of the 160 women remained in the not at all group, 38 of 44 in the a little worried group, and 22 of 25 in the moderately to extremely worried group. Pearson’s chi-square revealed no significant association between the three categories of MFRA during pregnancy and infant-mother attachment security at 12 months, χ2 (2) = 4.691, p = .099.

Correlates of MFRA: Maternal Depression, Adult Attachment, Marital Relationship Quality and Firstborn-Mother Attachment Security

Spearman’s Rho correlations between all variables at the prenatal assessment can be found in Table 2. MFRA during pregnancy was significantly and positively related to more depressive symptoms, higher attachment avoidance and ambivalence, less secure attachment with the firstborn child, and more conflict and ambivalence in the marital relationship.

Table 2.

Spearman’s Nonparametric Correlations of Maternal-Fetal Relationship Anxiety, Maternal Depression, Adult Attachment, Marital Relationship Quality and Firstborn-Mother Attachment Security at the Prenatal Time Point.

Variable 1 2 3 4 5 6 7
1. I am worried that I might not become emotionally attached to the baby (MFRA) 1 −.16* .24** .21** .25** .17** .14*
2.Attachment Q-sort firstborn1 1 −.09 −.14* −.16* −.02 <.01
3. AAQ - avoidance 1 .35** .25** .19** .27**
4, AAQ – ambivalence 1 .39** .34** .35**
5. Prenatal depression 1 .33** .33**
6. Marital conflict 1 .51**
7. Marital ambivalence 1
N 229 229 230 230 230 230 230
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1

Higher scores indicate greater child-mother attachment security for first child. AAQ = Adult Attachment Questionnaire.

*

Correlation is significant at the 0.05 level (2-tailed).

**

Correlation is significant at the 0.01 level (2-tailed).

There are also other significant intercorrelations in Table 2 that are noteworthy. For instance, adult attachment ambivalence and maternal depressive symptoms were significantly and negatively correlated with the security of the firstborn’s attachment to mothers. Both adult attachment avoidance and ambivalence were also positively and significantly correlated with maternal depressive symptoms and both conflict and ambivalence in the marital relationship. Maternal depressive symptoms were also positively correlated with mothers’ reports of marital conflict and ambivalence. In general, there appears to be a circle of attachment insecurity and relationship risk surrounding women with more anxiety about becoming emotionally attached to their second babies during the last trimester of their pregnancies.

Multiple Prediction of MFRA to the Second Baby

The final analysis involved a multinomial logistic regression with a three-category dependent variable (moderately to extremely worried, a little worried, not at all worried) to predict which prenatal variables were the strongest predictors of classifying women who were moderately to extremely worried about forming an attachment with their infants before the birth compared to the women who were not at all worried.. The women who were not at all worried were used as the reference group. Our primary interest was the comparsion between the women who were not at all worried with those women who were moderately to extremely worried and we present those findings here. The estimated multinomial logit coefficients (B) from these analyses can be found in Table 3. The final model with all predictors indicated that at least one of the regression coefficients in the model was not equal to zero and significantly predicted women with moderate to extreme levels of MFRA, −2 Log Likelihood = 327.130, χ2(12) = 34.326, p = .001.

Table 3.

Results from Multinomial Logistic Regression Predicting Maternal-Fetal Relationship Anxiety in Pregnancy

Parameter Estimates B St. Error Wald (1 df) Sig. Exp(B) 95% CI
Lower Upper
A Little Worried Intercept −2.296 .953 5.810 .016
Attachment Ambivalence −.057 .214 .070 .791 .945 .622 1.437
Attachment Avoidance .323 .183 3.123 .077 1.381 .965 1.975
Maternal Depression .046 .036 1.627 .202 1.047 .975 1.125
Attachment Security 1st Child −1.165 1.089 1.146 .284 .312 .037 2.634
Marital Conflict .086 .165 .274 .601 1.090 .789 1.507
Marital Ambivalence −.075 .197 .144 .704 .928 .631 1.365
Moderately to Extremely Worried Intercept −5.367 1.344 15.955 .000
Attachment Ambivalence .582 .269 4.688 .030 1.790 1.057 3.032
Attachment Avoidance .528 .258 4.202 .040 1.696 1.023 2.811
Maternal Depression .087 .046 3.596 .058 1.091 .997 1.194
Attachment Security 1st Child −2.149 1.328 2.618 .106 .117 .009 1.575
Marital Conflict .082 .218 .141 .707 1.085 .708 1.663
Marital Ambivalence −.175 .238 .542 .462 .840 .527 1.337
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Note: Mothers reporting they were “not at all worried” were used as the reference group. The multinomial logit (B) is the estimate for a one unit increase in the predictor for mothers reporting to be a little worried/moderately to extremely worried relative to mothers reporting to be not at all worried when other variables in the model are held constant. Exp (B) is the odds ratio for a predictor. An odds ratio > 1 indicates a greater likelihood of being in the a little worried/moderately to extremely worried group relative to the not at all worried group as the predictor increases. An odds ratio < 1 indicates the likelihood of being in the a little worried/moderately to extremely worried group decreases as the predictor increases compared to mothers who were not at all worried. The 95% Confidence Interval (CI) for Exp (B) is equivalent to a z test so that if the CI includes 1, we fail to reject the null hypothesis that B is 0 given the other predictors in the model.

These results indicate that adult attachment avoidance and ambivalence were the most significant predictors of whether mothers were moderately to extremely worried that they might not be emotionally attached to the baby compared to mothers who were not at all worried, when all other variables in the model were held constant. Specifically, if there was a one unit increase in adult attachment ambivalence, the odds of being in the moderately to extremely worried group increased by 79% relative to the not at all worried group of mothers. Similarly, for a one unit increase in adult attachment avoidance, the odds of being in the moderately to extremely worried group increased by 69.6% compared to the not at all worried group. All other predictors were not significant. Results from the analysis comparing the a little worried group with the not at all worried group are also presented in Table 3 and all results are nonsignifcant.

Discussion

The current study was an exploratory investigation designed to answer the question of whether it is a normative experience for second-time mothers to worry about loving a second baby as much as they love their first child. Even though most women around the world will have at least two children, there is relatively little research addressing the needs of pregnant women expecting their second child, including the questions they have as they become a mother of two children. Rather than assuming that it is normal for women to question their abilities to love two children equally when the birth of their second child is approaching, our findings suggest it is rare for women to question their ability to emotionally attach to their second baby while pregnant. Most mothers (69.9%) claimed they were not at all worried about becoming attached to their second baby. Indeed, only 10 of the 229 women (4.4%) reported that they were very much or extremely worried. Thus, it is not the case, at least in the current sample of predominantly European American, middle-class, married women living in the Midwestern United States to voice these concerns.

Continuity in the Mother-Infant Relationship

Not only was it rare for women to have anxiety about the attachment to the second baby, but for those women who did, there were also repercussions for the developing bond between mothers and their second babies in the postpartum. To address this issue, we relied on the extant literature on maternal-fetal attachment and mother-infant bonding. Similar to prior studies in several different countries, we found continuity across time such that women reporting greater worries about MFRA before the birth were also those women more likely to report that they were having difficulties feeling warmth and closeness to their infants after the birth.

One of the benefits of a longitudinal study with multiple time points is that we could also consider how long MFRA predicted mothers’ sentiments about bonding with their infants in the months following the birth. We know from prior reports emanating from this research program that the first month after the birth of a second child sees increases in maternal stress, more externalizing behavior problems for firstborns, and a decrease in mothers’ efficacy at disciplining their first child (Volling et al., 2017; 2019; 2021). But, by 4 months, most parents and children have adapted to the transition and have settled into new routines as a family of four. We wondered if MFRA would predict feelings of MIB in the early months (1 and 4 months), when mothers were adjusting to their new role as the mother of two children, and whether these feelings would subside by the latter half of the first year once mothers have adapted to the transition. The findings suggested that such feelings were stable over time with MFRA predicting MIB at 1, 4, and 8 months after the birth. MFRA no longer predicted MIB at 12 months, nor did it appear to have any consequences for the developing infant-mother attachment relationship at the end of the first year. It appears, then, that even though few women reported being extremely worried about MFRA, these feelings do appear to predict how close women feel toward their second baby for the first 8 months of the infant’s life. In prior work, Dutch mothers with higher maternal-fetal attachments during pregnancy were more sensitive to their 6-month-old infants during caregiving and free play interactions (Maas et al., 2016). Maternal sensitivity, intrusiveness, and scaffolding of infant behavior may be the mediating processes linking MFRA before birth and MIB after birth in the current study. We recommend future research investigate these links further.

Psychosocial Correlates of MFRA to Second Baby During Pregnancy

We also asked whether these worrisome feelings might also pervade other close relationships and attachments in the family, namely the relationships with the spouse and the current attachment between the first child and mother. Further, we examined whether mothers might also have a characteristic attachment orientation that might reflect their child-rearing histories and their internal working models of attachment. Indeed, we found a pattern of troubling relations between MFRA and other psychosocial risk factors that included more insecurity in the firstborn-mother attachment, and more marital conflict and ambivalence. Further, MFRA was also positively related to adult attachment ambivalence and avoidance. Finally, MFRA difficulties were also positively correlated with greater depressive symptoms in the last trimester of pregnancy, which is consistent with many prior reports linking maternal distress and lower maternal-fetal attachment in the United States and many European and Asian countries (Dau et al., 2019; Dubber et al., 2015; Göbel et al., 2018; Goecke et al., 2012; Honjo et al., 2003; Hopkins et al., 2018). The current findings indicate clearly that these mothers’ anxiety about loving their second baby is part of a larger pattern of attachment insecurity and psychosocial risks that surround these women. Infant mental health specialists should take notice when women voice these concerns and perhaps even follow-up with appropriate screenings and interventions to address the mental health needs of these women.

When we included all the psychosocial variables into a multinominal logistic regression to determine which predictors appeared to have the strongest influence on MFRA, we found it was the adult attachment orientations of avoidance and ambivalence that were significant. Avoidant individuals have negative working models that reflect a tendency to avoid or withdraw from intimate encounters or from forming close relationships, whereas individuals with ambivalent orientations have conflictual emotions and beliefs about the commitment of others and whether they can be counted on in relationships (Mikulincer & Florian, 1999). These different orientations are derived from the different child-rearing histories of these women and have repercussions for their relationships with both their partners and their infants. In a US sample, women with ambivalent orientations tended to have rocky romantic relationships that involved both approach and avoidance, and they displayed more anxiety, and greater hostility and anger toward partners during problem-solving discussions (Simpson et al., 1996). In the current study, women high on both avoidance and ambivalence reported more marital conflict and more depressive symptoms. It is possible that marital and mental health difficulties associated with patterns of insecure adult attachment played some role here in MFRA because maternal-fetal attachment was related to lack of partner support and more depressive symptoms in several prior studies (Alhusen et al., 2012; Barone et al., 2014; Cataudella et al., 2021; Dubber et al., 2015; Hopkins et al., 2018; Røhder et al., 2020).

Mothers with avoidant and ambivalent attachments may also interact differently with infants and these differences may also account for the relations between MFRA and postpartum MIB. For instance, Hairston and colleagues (Hairston et al., 2018) reported that Israeli mothers with an avoidant attachment style had higher scores on anger and rejection of the infant, and mothers with ambivalent attachments had higher scores on anxiety focused on the infant. These differences could translate into different ways of interacting with their infants. In sum, the current findings on MFRA are consistent with a host of studies focused on maternal-fetal attachment; lower MFRA is part of a constellation of factors (e.g., insecure attachments, maternal depression, lack of partner support) that form a network of risk (Alhusen et al., 2012; Hairston et al., 2018; Hopkins et al., 2018; Røhder et al., 2020).

Although future research is needed to replicate these findings, this preliminary investigation suggests that when women are expressing anxieties about loving a second baby as much as they currently love their first child during their pregnancies, they may be having difficulties with establishing a maternal-fetal attachment relationship, in addition to close relationships with their partners and other children in the family. Infant mental health specialists and other health care practitioners are advised to take these concerns seriously and not to dismiss them as common and universal feelings that women expecting their second baby naturally have. These mothers deserve to have their concerns acknowledged and to receive additional mental health screenings if necessary to determine if they would benefit from intervention and support services to facilitate the development of a loving mother-infant relationship with both their first and second babies.

Limitations and Future Directions

Although we are the first to address mothers’ anxieties about loving a second baby as much as their first child empirically with data from a longitudinal investigation of over 220 women undergoing the transition from one child to two children in the United States, there are several limitations that must be acknowledged. First, we did not include a standard measure of maternal-fetal attachment, but instead, had to rely on a single item asking if mothers had any worries about their emotional attachment to the second baby before the birth. Given the complexity of the maternal-fetal attachment relationship, one item cannot capture this complexity, which is why we referred to our measure as maternal-fetal relationship anxiety or MFRA. Further, maternal-fetal attachment may change across different trimesters of pregnancy, so future work may also want to consider repeated measures of MFRA across the months of pregnancy. This longitudinal study was originally designed and initiated in 2004, long before the episode of Good Morning America aired in 2018 with claims that it was normal for women to experience anxieties about loving a second baby as much as their first child. Because health professionals on this episode claimed it was common and perfectly normal to have such feelings without any empirical evidence to back this claim, we wanted to use the best available data we had to attempt to answer the question. We strongly advise that other researchers replicate these results with measures designed specifically to assess maternal-fetal attachment or create measures focused on loving one child more or less than another.

Second, all measurement was based on maternal reports of MFRA and MIB. We did not have observational measures of mother-infant interaction available during the early postpartum months that might reveal the relationship processes that were responsible for the prediction of MIB in the first year. Third, the findings cannot be generalized outside the characteristics of the current sample which consisted of predominantly European American, middle-class, married women residing with their husbands in the Midwestern United States. It is quite possible that the findings would differ for second-time mothers from different countries, from different racial/ethnic backgrounds, with different socioeconomic resources, and in same-sex relationships. Although many studies report consistent links between maternal-fetal attachment and maternal depression/anxiety, partner support, and infant social-emotional outcomes across many different countries, including the United States, Australia, Italy, Sweden, Israel, Japan, and Poland, parental leave policies and services for mothers after the birth of a baby can and often do differ across these countries. These differences in policies and services could certainly influence feelings of maternal-fetal attachment for first- and second-time mothers.

Fourth, fathers may also have similar or different anxieties about the birth of a second baby that have not been addressed here. The MFRA item was taken from a prenatal pregnancy questionnaire, so fathers were not asked to complete this measure. Therefore, we were unable to assess paternal-fetal relationship anxiety. The determinants of maternal-fetal and paternal-fetal attachment do differ (Fijałkowska & Bielawska-Batorowicz, 2020), and this possibility should be explored in future research. Fifth, we did not collect a measure of MFRA during the mothers’ first pregnancy to know if they had similar anxieties about forming an arrachment to the first baby. Adult attachment orientations are quite stable over time (Paetzoid et al., 2021). In the current study, mothers’avoidant and ambivalent attachment orientations were the strongest predictors of MFRA and maternal attachment avoidance was negatively associated with the security of the firstborn-mother attachment. Thus, the network of attachment insecurity may have already been established during the pregnancy with the first baby. Future research should investigate this association further.

Finally, many women around the globe have more than two children. Yet, most research focuses on the transition to parenthood with first-time parents and often ignores the support that mothers (and fathers) need with each additional birth as they attempt to incorporate one more member into the family system (Ketner et al., 2018). When researchers and infant mental health providers assume that once men and women have experienced parenthood for the first time, they are equipped to handle every subsequent transition after the birth of an infant, we are missing opportunities to understand parenting dynamics and how best to intercede when difficulties arise.

Implications for Practice and the Field of Infant Mental Health

Although many women have at least two children and experience an additional transition with the birth of their second baby, few studies address the concerns of these women. The current study focused on one such concern that has been noted in prior qualitative research and on popular media, the ability to love a second baby as much as the first child. Results from the current research suggest that most second-time mothers do not express anxieties about forming an emotional attachment to the second baby. Although it was rare for these second-time mothers to report MFRA, when they were moderately or extremely worried during pregnancy, they were also more likely to feel less warmth and closeness toward their babies at 1, 4, and 8 months postpartum. Finally, MFRA was associated with a host of other psychosocial risk factors during pregnancy including more depressive symptoms, more marital conflict and ambivalence, more adult attachment avoidance and ambivalence, and a more insecure attachment between firstborn children and their mothers. Thus, it appears that pregnant women concerned about loving their second baby as much as their first child may be surrounded by a network of attachment insecurity in relations with partner, firstborn, and infant, as well as mental health challenges. Thus, we recommend that infant mental health providers and practitioners working with women in the perinatal period take note when second-time mothers express anxiety about loving their second baby as much as their first child, and screen for maternal depression and anxiety symptoms during pregnancy that may give rise to subsequent disruptions in mother-infant relationships once the infant is born. Because adult attachment ambivalence and avoidance were the strongest predictors of MFRA and were also related to marital distress and an insecure mother-firstborn attachment, interventions targeting these internal representations of attachment relationships may benefit second-time mothers, their partners, and their children.

Key Findings.

  1. Mothers rarely worried about forming an attachment to their second babies during pregnancy.

  2. More prenatal worries about forming an attachment predicted mothers’ reports of less warmth and closeness to their babies at 1, 4, and 8 months after the birth, but did not predict the security of the infant-mother attachment at 12 months.

  3. Women who worried about forming an attachment with the second baby had other psychosocial risks, including more depressive symptoms, more marital distress, more attachment avoidance and ambivalence, and more insecure mother-firstborn attachments.

Acknowledgments

The research reported was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (BLV, R01HD042607, K02HD047423). We are grateful to the parents and children of the Family Transitions Study and the many research staff who helped with data collection and coding.

Footnotes

We have no known conflict of interest to disclose.

The data that support the findings from this study are available on request by contacting the corresponding author and filing a data use agreement with the Office of Research and Sponsored Projects at the University of Michigan. The data are not publicly available due to privacy or ethical restrictions.

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