ABSTRACT
Becoming a parent is a highly anticipated milestone for many couples, yet previous research suggests that most couples experience a sharp decline in romantic satisfaction. However, there are few virtual, group‐based couples prevention programs for first‐time parents. The present study examined the feasibility and effectiveness of a newly developed prevention program for the journey to parenthood, the Partners Now Parents program. Sixty‐six racially and socioeconomically diverse expecting parents (33 couples) participated in this small, pilot examination. Seventeen couples were assigned to receive five teletherapy prevention program sessions over the course of the perinatal period, and 16 couples were assigned to an active control group receiving psychoeducation via email. We found a less steep decline in romantic satisfaction for those in the prevention program as compared to the active control group. The findings suggest that the prevention program is feasible, effective, and favorably received by participants. Prevention programs for expecting parents offer entry into mental health support with reduced mental health stigma when couples may be most open to change as they prepare for parenthood.
Keywords: coping and/or resiliency, dyadic couple data, journey to parenthood, mental health, stress
1. Introduction
There is strong support in the literature for a sudden and persistent decline in romantic relationship functioning during the journey to parenthood for first‐time parents (Doss et al. 2009; Doss and Rhoades 2017; Mitnick, Heyman, and Smith Slep 2009). Fostering a positive interparental relationship during the perinatal period is an important target of prevention efforts as strong interparental relationship functioning is known to buffer against risk for gestational and non‐gestational partner depressive and anxious symptoms in the perinatal period (Cummings, Keller, and Davies 2005; Figueiredo et al. 2018). Additionally, there is robust literature support for a significant relationship between couple relationship distress and parental mental health concerns throughout parenthood (Nicolaus et al. 2021; Savell et al. 2022). For romantic couples that will also be future co‐parents, declines in romantic satisfaction and its impact on parent mental health highlight the need for prevention efforts specifically designed to foster relationship functioning as both romantic partners and future co‐parents during the journey to parenthood. Of note, couple adjustment prior to birth significantly predicts postnatal adjustment (Alves et al. 2020; Karney and Bradbury 1997), which suggests that the prenatal period may be a critical time for prevention efforts to strengthen the relationship prior to the onset of the stressors in the postnatal period (Bourque‐Morel et al. 2023; Glade, Bean, and Vira 2005; Tomfohr‐Madsen et al. 2020). The present study described the development and implementation of a new prevention program for the journey to parenthood starting in the antenatal period with 66 expecting parents from diverse socioeconomic and cultural backgrounds.
During the journey to parenthood, many expecting parents are particularly open to new information and change in behavior as they prepare for the demands of parenthood (Cowan and Cowan 2020; Doss et al. 2014). As such, the journey to parenthood is likely a well‐suited time for prevention efforts focused on sustaining romantic satisfaction and fostering the growth of an effective future co‐parenting relationship. Prevention efforts targeting couple romantic satisfaction during the journey to parenthood may buffer against declines in relationship quality, which is a known predictor for divorce (Emery 1982; Leonhardt et al. 2022; Shaw 1991). Interestingly, approximately half of all long‐term committed relationships that end do so in the first 7 years, not long after becoming parents for many couples (Gottman and Levenson 2002).
Targeting couple relationship satisfaction during the journey to parenthood may be helpful not only to the individual parent's mental health but may also have positive downstream effects on the entire family system (Ramsdell and Brock 2020). Prevention efforts targeting romantic satisfaction during the journey to parenthood may buffer against the development of postpartum depressive symptoms for gestational and non‐gestational parents, which may support the development of positive parenting practices for expecting parents in romantic relationships (Kumar et al. 2022; Linville et al. 2010; Nicolaus et al. 2021; Schulz, Cowan, and Cowan 2006). However, it should be noted that prevention efforts focused on expecting couples' romantic relationship and mental health are warranted solely for the benefit to individual parental mental health. Potentially having a positive impact on parenting and child development is noteworthy but is not a necessary justification for prevention efforts beyond the potential positive impact on the parents themselves.
Despite the known stressors associated with the journey to parenthood and potential implications for the development of the entire family system, there are a number of limitations to the current literature on prevention efforts tailored to the stressors associated with the journey to parenthood that should be acknowledged. Of the limited existing programs, very few prevention programs span both the antepartum and postpartum period. The existing programs that do follow couples during both the antepartum and postpartum period (e.g., Becoming a Family Project: Cowan and Cowan 1992) tend to have low retention rates, often retaining only about 40% of the couples. Brief, teletherapy options with flexible scheduling tailored to the participating couples are needed to meet the time demands of busy, expecting parents. Additionally, previous research suggests that the group format can be particularly beneficial for individuals experiencing life stressors such as the journey to parenthood (Feinberg et al. 2016). The group format was selected in the present study to capitalize on the potential benefit of support received by fellow group members and the psychological phenomenon of “not feeling alone” and “sense of belonging.” Finally, existing programs tend to focus on either the growth of the co‐parenting relationship or the romantic relationship with few programs that allow for activities that are uniquely tailored to sustaining romantic relationship satisfaction as well as activities that are focused on fostering an effective co‐parenting relationship for romantic couples and individual mental health for each partner during the journey to parenthood (Lachmar et al. 2019; Pinquart and Teubert 2010).
Beyond the limitations to prior prevention programs, there are several limitations to the existing literature on the journey to parenthood for couples. Prior research focused on couple's romantic relationship satisfaction starting in their first child's infancy; few studies have investigated changes over time in romantic relationship quality beginning during the child's gestation (Kuersten‐Hogan 2017; Schulz, Cowan, and Cowan 2006). Beginning the assessment and prevention program during the antepartum period (during fetal gestation) allows for a more precise measurement of change in romantic satisfaction prior to the onset of a significant stressor (e.g., labor and delivery, sleep challenges in the postpartum period). Examining romantic satisfaction as early as the second trimester is a particularly understudied area of the literature even in cross‐sectional work. Further, many prior studies focused on gestational partners, specifically biological mothers, often leaving out the perspective and experiences of both members of the dyad and the distinctive experiences of non‐gestational partners. Additionally, White, heterosexual, married, biological parents have been the majority of participants in prevention programs tailored to stressors for first‐time parents. Therefore, the context in which a substantial number of children are raised today has not been represented in the current literature (Martin et al. 2018). Less is known about family beginnings and child development longitudinally in modern types of family structure (e.g., intergenerational families, cohabitating parents, same gender parents) and families of color (Amato 2010; Jensen and Sanner 2021; Savell et al. 2022). However, recent work with lesbian and gay couples suggests some congruence with findings from heterosexual couples in regard to psychosocial stress and resilience during the journey to parenthood (D'Amore et al. 2023; Rubio et al. 2020). It is of vital importance to represent participants from low‐income backgrounds and marginalized social identities to diversify the current scholarship as low‐income participants and participants of color have traditionally been left out of research literature. The present study takes a small, yet important step toward addressing these aforementioned limitations with the help of community partnerships that facilitated the recruitment of a relatively racially and ethnically diverse sample of participants from a variety of socioeconomic backgrounds as well as varied family structures and types of romantic partnerships.
1.1. Prevention Program Development
Although the current literature is relatively small and has numerous limitations as described above, a recent meta‐analysis by Pinquart and Teubert (2010) on prevention programs designed to address stressors associated with the journey to parenthood illuminated several findings that informed the research questions and methods of the present study. A number of decision points were made based on the evidence in the current literature in developing the current study that will be outlined below. Specifically, Pinquart and Teubert (2010) found that prevention programs that included at least five sessions and included an antepartum and postpartum component had the largest effect sizes for positive outcomes for couples. Of note, Kermeen (1995) found no differences in marital satisfaction between treatment and control groups when utilizing an ‘add‐on’ prevention program design by integrating a short couple enrichment segment to previously existing childbirth education courses. Thus, the four‐session antepartum (pre‐birth) and one follow‐up session postpartum (post‐birth) format was selected. Given the recent global pandemic, the time constraints present during the journey to parenthood, as well as the established comparable efficacy of teletherapy supports (Gentry et al. 2019; Stubbings et al. 2013), the teletherapy format was selected.
The targets of the prevention program were on partner communication and expectations about parenthood to prepare for their roles as both romantic partners and future co‐parents using elements from the Gottman Model for couples therapy, Cognitive Behavioral Therapy (CBT) intervention principles including (e.g., cognitive restructuring, stress management, and behavioral change) and more third‐wave CBT strategies from Acceptance and Commitment Therapy (e.g., cognitive defusion, values clarification, and values‐consistent committed action) and Dialectical Behavior Therapy (DBT) intervention principles (e.g., distress tolerance, mindfulness, and interpersonal effectiveness strategies) to decrease the risk for conflict over parenting responsibilities and increase supportive practices that foster relationship satisfaction (Beck 2011; Del Rio 2021; Lindenboim, Comtois, and Linehan 2007; Luoma, Hayes, and Walser 2007). Targeting communication and expectation management was expected to prevent sharp declines in romantic satisfaction and foster the growth of the future co‐parenting relationship (Doss et al. 2009; Mihelic and Morawska 2018).
2. The Current Study
The current study represents a small, pilot examination of the newly developed prevention program, the Partners Now Parents Program. The pilot study included 66 expecting parents from diverse socioeconomic and cultural backgrounds during their journey to parenthood in the midst of the COVID‐19 pandemic. The development and the implementation of the Partners Now Parents Program will be described in addition to a quantitative description of the participants' reactions to their experiences in the Partners Now Parents Program. The current study utilized longitudinal data on romantic satisfaction collected from both gestational (pregnant person) partners and non‐gestational partners as well as information from an anonymous survey given to participants in the prevention program following their participation in all five telehealth support sessions. We hypothesized that there would be a less steep decline in romantic satisfaction from antepartum to postpartum for those in the prevention program as compared to those in the active control group. We also expected that the majority of participants would report in the anonymous survey that they found the prevention program helpful and enjoyable and would recommend it to loved ones during their journey to parenthood.
3. Method
3.1. Participant Recruitment and Retention
The present study included 66 individuals (33 couples) who were initially recruited between October 2021 and August 2022 from various sources, including in‐person recruitment at Maternal and Fetal Medicine Clinics, OBGYNs, and Family Medicine Clinics at two large academic medical centers in Virginia, social media engagement, and through study flyers with over 30 community partners, such as WIC and new‐parent oriented stores. All participants provided signed consent to participate in this University of Virginia Health Sciences Institutional Review Board approved study.
Inclusion criteria were as follows: being at least 18 years of age, being an expectant parent on the journey to parenthood for the first time, being in a romantic relationship for at least 12 months and currently cohabitating, having access to the internet in the home or in an easily accessible and private space, fluent in English, and living within 60 min driving time from a central Virginia city. Couples with previous miscarriages or terminated pregnancies were included to ensure adequate sample size; although these experiences may influence one's thoughts and feelings during the journey to parenthood, that was not the focus of the present study and, as such, was not examined.
Couples were recruited individually and all couples were offered the opportunity to participate in the prevention program sessions. If interested couples were not able to logistically make the session times that were available at the time of their recruitment (which depended on the availability of other couples given that we were aiming for at least two couples in every session), then the interested couple was offered the opportunity to participate in the active control group and receive summary information from the prevention program sessions via email. At baseline, there were no significant differences (p > 0.05) in the prevention program group and active control group on levels of romantic satisfaction, constructive communication, depressive symptoms, nor levels of psychological well‐being, giving some confidence that selection bias effects were not considerably influencing any differences in the prevention program group and active control group.
Forty‐three couples agreed to participate and signed the consent. However, 33 couples actively participated in the study and 10 couples (23%) did not actively participate. Five of those 10 couples that did not actively participate signed the consent form but then became unresponsive and did not answer any surveys. The other five couples that did not actively participate noted various concerns including moving out of state or experiencing a miscarriage. Only the 33 couples that actively participated were included in the current analyses. Regarding demographic factors (e.g., household income) and baseline psychosocial measures (e.g., romantic satisfaction and depressive symptoms), there were no significant differences (p > 0.05) between participants retained in the sample and those who did not actively participate.
Of the 66 expecting parents, approximately 20% (13 expecting parents) identified as coming from a historically marginalized racial background. Specifically, seven expecting parents (11%) identified as Latinx, two expecting parents (3.5%) identified as Black/African–American, three expecting parents (4.5%) identified as Asian, and one expecting parent (1.5%) identified as Multiracial. Thirty‐three expecting parents identified as male and 33 identified as female. Thirty‐one couples were different‐gendered and two couples were same‐gendered. In regard to sexual orientation, 59 (89%) expecting parents self‐identified as heterosexual/straight, three expecting parents (4.5%) as gay or lesbian, two expecting parents (3%) as bisexual, one expecting parent (1.5%) as queer, and one expecting parent (1.5%) as pansexual. Within the active control group, couples had been together for an average of 6.24 years (SD = 2.84) and were, on average, 31.4 years old (SD = 3.46). Within the prevention program group, couples had been together for an average of 7.12 years (SD = 2.90) and were, on average, 31.9 years old (SD = 4.31).
In regard to socioeconomic status, there was quite a wide range within the sample with doctors, lawyers, teachers, farmers and mechanics all participating. Four couples (12%) had an annual household income (including annual income of both partners) below $60,000. Nine couples (27%) had an annual household income between $65,000 and $100,000. Eight couples (24%) had an annual household income between $110,000 and $150,000. Seven couples (21%) had an annual household income between $170,000 and $285,000. Two couples (6%) had an annual household income between $350,000 and $500,000. Three couples did not report their annual household income. Specifically, within the active control group, the mean annual income for the couple (including both partners) was $182,792 (SD = $123,915) with a range of $56,000 to $500,000 and, on average, expecting parents had 16.41 years (SD = 2.5) of formal education with a range of 12 to 21 years of education. Within the prevention program group, the mean annual income for the couple (including both partners) was $129,519 (SD = $69,419) with a range of $25,000 to $320,000, and, on average, expecting parents had 17.60 years (SD = 3.28) of formal education with a range of 11 to 25 years of education. Most couples were living in a home just by themselves (no roommates or family members), but one couple had friends living with them at the time. Approximately half of participating couples owned their home, while the other half rented their home. 63% of couples lived in a single‐family home, while 37% lived in an apartment, duplex, or townhome. Additionally, most participants had never been pregnant (85%), 5% had experienced a miscarriage, 4% had terminated a prior pregnancy, and 6% preferred not to report their prior experience with pregnancy but considered themselves first‐time expectant parents. 81% of the couples reported having had conversations with their partner about their expectations about the journey to parenthood. Almost all participants (96%) endorsed prior caretaking experience through activities like babysitting, helping with siblings growing up, or helping to take care of friends or other family members' children. 67% of couples shared a pet at the start of the study. Approximately 85% of couples reported having plans for childcare including options like nannies, babysitters, family help, and daycare, whereas 15% reported no plan for childcare at the start of the study.
3.2. Procedure
3.2.1. Prevention Program Timeline and Prevention Program Session Content
The majority of the prevention program sessions were conducted before birth to maximize participation given the scheduling challenges that tend to occur in the postpartum period. Sessions one through four occurred before birth and were scheduled for one session per week over the course of 1 month in the early third trimester or earlier to try to account for premature births and have adequate time for all participants to participate in all sessions. Session five occurred for participants within 3–6 months postpartum to allow participants to recover from birth and start their new schedules and routines. Each program session lasted approximately 45 minutes with at least two couples in the group session at a time and typically the same couples in each group session to allow for continuity and group cohesion. Sixteen of the 17 couples participated in all five teletherapy prevention program sessions (i.e., 94% retention rate). The one couple that did not participate in all five sessions participated in all four antepartum sessions and then experienced a miscarriage and elected to not participate in session five (the post‐birth session).
Session one focused on providing psychoeducation about the cognitive behavioral framework, identifying symptoms of postpartum psychological disorders (e.g., anxiety and depression), and developing flexible balanced thinking and expectations about the journey to parenthood through cognitive restructuring and cognitive defusion. Session two focused on building partnerships as romantic partners and co‐parents through reflecting on values‐based actions in the “Bulls‐eye” activity in the Acceptance and Commitment Therapy framework in which couples identify a values‐based action plan with concrete, approachable steps for getting closer to the “Bulls‐eye” for their parenting alliance, relationship with friends and family, romantic relationship, and their own personal growth and wellness. Session three focused on maintaining closeness and connection using elements from the Gottman Model for couples therapy and navigating conversations about intimacy and communicating and asserting needs. Interpersonal effectiveness strategies were also introduced (e.g., “I feel statements”). Session four focused on conflict management and developing strategies to set up an environment of success during times of disagreement (e.g., fair fighting rules). Session five (the only postpartum session) provided an opportunity for couples to celebrate their journey to parenthood with fellow group members, take a pause to reflect on each other's strengths and gratitude for one another, and to identify strategies that were reviewed from the first four sessions that they want to start incorporating to increase connection in their relationship, identifying habits they want to stop that are barriers to connection, and identifying strategies they are already doing that they want to continue to build connection. For an outline of session content and study design across sessions, see Figure 1.
FIGURE 1.
Partners now parents study design.
3.2.2. Active Control Group
As an active control group, we also assessed parenting dyads pursuing treatment as usual through their OGBYN or fetal medicine clinic. Active control group participants also received “low dose” psychoeducation through written materials via email on research findings about the journey to parenthood in lay‐person language with coping skill tips and resources. To ensure that all participants received the information from the prevention program group sessions in a similar timeline, the active control group participants received the informational packet via email halfway through the four antepartum prevention program group sessions (i.e., after group session two).
3.2.3. Assessment
All participants were asked to complete approximately 45 minute assessments at three separate time points: baseline, 1 month follow‐up antepartum (in the third trimester for most participants and after session four for participants in the prevention program sessions), and, finally, approximately 3–6 months postpartum. The assessments included demographic and pregnancy‐related information as well as measures of romantic satisfaction. The present study utilized data from the last antepartum time point and the postpartum follow‐up.
3.2.4. Measures
3.2.4.1. Romantic Satisfaction
The romantic satisfaction of the couples was measured from antepartum to postpartum using the Short Marital Adjustment Scale (SMAT; Locke and Wallace 1959; α = 0.58). The SMAT contains 15 items measuring general satisfaction and adjustment and contains a measure of agreement or disagreement on common issues that can cause conflict for couples. Romantic satisfaction among the couples was measured at baseline, 1 month follow‐up, and 3–6 months postpartum. Romantic satisfaction was assessed in both partners separately, and the dyad was accounted for in the analyses. The SMAT was initially used to differentiate between well‐adjusted couples from distressed (dissatisfied) couples. Scores below 100 represent clinically distressed couples. Examples of general satisfaction items include, “Do you and your mate engage in outside interests together?”, “Do you ever wish you had not married?”, “Do you confide in your mate?”, and so forth. Response options vary by question, but higher scores indicate higher romantic satisfaction. Examples of agreement and disagreement on common issues included: handling family finances, friends, sexual relations, dealing with in‐laws, and so forth. The couples responded on a scale ranging from always agree to always disagree and more frequent agreement is scored higher.
3.2.4.2. Anonymous Feedback on Prevention Program Sessions
Additionally, all participants in the prevention program sessions were offered the opportunity to provide anonymous feedback, not tied to their participant ID to encourage honest and transparent responding regarding their experience in the prevention program sessions. Anonymous feedback included items such as how often they enjoyed the sessions on a scale of never to always, how useful they found the sessions, and how useful they think the sessions were for their partner on a scale of not at all useful to extremely useful, whether they would recommend friends and family members to participate in the program (yes/no), and what session they benefited from the most. Further, there was an open‐ended response item that asked participants to: “Please describe your overall experience and any feedback you may have for the Partners Now Parents study sessions.”
4. Results
4.1. Change in Romantic Relationship Satisfaction
An independent sample t‐test comparing the difference scores (representing steepness of decline in romantic satisfaction from the last antepartum assessment to the postpartum assessment approximately 3–6 months post‐birth) between the prevention program group and the active control group revealed a less steep decline in romantic relationship satisfaction from the last antepartum assessment (1 month follow‐up from the baseline assessment) to postpartum (approximately 3–6 months post‐birth) for couples in the prevention program (M = 5.75 point decline, SD = 10.43) as compared to the active control group (M = 11.22 point decline, SD = 7.05), t(44) = −1.95, p = 0.029; see Figure 2. The slope of the decline in the active control group is more steep from antepartum to postpartum than the slope of the decline in the prevention program group. In other words, there is a more paced decline in the prevention program group than the active control group.
FIGURE 2.
Change in romantic satisfaction from antepartum to postpartum. Romantic relationship satisfaction was reported on the short marital adjustment test (SMAT) developed by Locke and Wallace (1959). The SMAT is one of the most commonly used measures of romantic relationship satisfaction in research and practice. It contains 15 items that are weighted with resulting scores in the range of 2–158 and scores less than 100 represent clinically‐distressed couples.
4.2. Anonymous Feedback on Prevention Program Sessions
When given the opportunity to report on whether they found the sessions to be useful, 96.88% of participants (31 of 32) indicated that they found the sessions extremely, very, or moderately useful (see Figure 3). Additionally, 93.75% of participants (30 of 32) indicated that they think the prevention program sessions were extremely, very, or moderately useful for their partner. Thus, the vast majority of participants reported that they found the sessions useful for themselves and their partner. Interestingly, the participants were asked to do challenging things like sharing their emotions and proactively thinking about conflict management strategies, so it was possible that participants would find the sessions useful but would not find them enjoyable. However, when given the opportunity to report on how often they found the sessions to be enjoyable, 90.63% of participants (29 of 32) indicated that they always or most of the time enjoyed the sessions (see Figure 4). Further, given how much time these couples invested in the prevention program sessions (approximately 45 min per session with 5 sessions total), the study team also wanted to know if participants would recommend the prevention program sessions to friends and family becoming parents. All participants (100%) indicated that they would recommend the prevention program sessions to loved ones becoming parents.
FIGURE 3.
Participant reported usefulness of the prevention program sessions.
FIGURE 4.
Participant reported enjoyment in the prevention program sessions.
To better understand the active ingredients in the prevention program sessions to potentially reduce the number of sessions and reduce burden on participants, the participants were asked which session they benefited from the most. Although all four antepartum sessions had at least three participants indicating that they benefited from that session the most, session four on conflict management and planning ahead emerged as the session with the most participants (15 of 32 participants), indicating that it was the one they benefited from the most. No participants indicated that they benefited the most from the postpartum check‐in and support session. The postpartum session included a review of session content from the antepartum period, a discussion of the strengths they see in their partner and their gratitude, and strategies they want to start incorporating to build closeness in their relationship as romantic partners and co‐parents, habits or behaviors they want to stop, and strategies they want to celebrate and continue that help them feel connected were identified. We were also interested in whether the group atmosphere, which we expected would facilitate the active ingredient of feeling validated and not alone by hearing from other couples with similar thoughts and feelings, would be apparent on Zoom such that participants felt connected to their fellow group members. The majority of participants (56.25%) reported they felt somewhat or extremely connected to their fellow group members, with the rest of participants indicating they felt neither connected nor disconnected to group members.
In the open‐ended question in which participants could describe their experience and provide any feedback to the Partners Now Parents Program team, the vast majority of participants noted that they had applied the strategies discussed in the sessions and felt more prepared for the journey to parenthood as a result. Specifically, one expecting parent noted: “I felt this program was very helpful for my wife and I. It prompted us to have important conversations before our baby came, and then we were able to utilize skills learned after he came.” Another expecting parent said: “I really enjoyed the sessions prior to birth and post‐birth. Most classes offered are centered around baby. These sessions allowed us to focus on our relationship which directly impacts our baby. I'm so grateful to have been a part of this!” Similarly, another parent said: “It was a huge amount of very useful knowledge and tools for raising our daughter.” Another parent noted: “It was overall positive and I learned good tools for stepping into parenthood.” Relatedly, another parent said: “I think it helped us prepare for the stress of parenthood.”
Many parents recommended the sessions and indicated that they want them to be available to more people (“I think more education and resources like this should exist”) and have more sessions to explore the concepts further (“I thought this was a wonderful experience. I wish we could have had more sessions to explore these ideas further”). In line with what emerged as the session that participants indicated they benefited the most from (i.e., conflict management), one parent said: “Thought the sessions were very helpful! Really enjoyed learning ways to deal with conflict, stay connected as partners and parents.”
Many expecting parents indicated that they enjoyed the group setting. Specifically, one expecting parent said: “Enjoyed the sessions. Liked hearing from other couples in similar situations‐relatable.” Relatedly, another parent said: “Really enjoyed the approach and the ability to hear from other couples.” Some expecting parents even noted that they would have liked more time with fellow group members: “I found participation to be quite helpful during this major life transition! Meeting virtually was very convenient but I do wonder if meeting in person would have created more of a group bond. It would have been great to connect more with other participants. But the content and activities were applicable and useful for my partner and I!” Similarly another expecting parent noted: “I definitely appreciate that the sessions were held in a group format and liked listening to the other couples.”
5. Discussion
Becoming a parent is a highly anticipated milestone for many couples. Yet, counter to expectations, previous research suggests that nearly seven out of 10 couples experience a sharp decline in romantic satisfaction and increase in conflict and distress following the birth of the couple's first child (Shapiro, Gottman, and Carrere 2000), potentially as a result of the strain on the couple's relationship. Prior research has found that feeling more connected in your romantic relationship is associated with numerous positive outcomes. Specifically, romantic satisfaction during the antepartum period is associated with reduced risk for postpartum depression and anxiety for gestational and non‐gestational partners (Moshki, Baloochi Beydokhti, and Cheravi 2014), reduced risk for cardiovascular disease (Tulloch et al. 2020), more effective immune system functioning (Kiecolt‐Glaser 2018), lower levels of a stress hormone, cortisol, (Saxbe and Repetti 2010), and more attenuated neural threat response (Coan, Schaefer, and Davidson 2006).
Taken together, the findings suggest that setting families on a positive trajectory from the start of family formation remains an important area for prevention efforts. Support for expecting couples that helps them prepare for and manage the journey to parenthood is critically needed. Yet, few prevention programs have been developed to strengthen relationships during the journey to parenthood that are brief and offered virtually during both the antepartum and postpartum period. Further, the few prevention programs that have been developed tend to focus solely on married, White, highly educated and high income, heterosexual couples.
To address the limitations in the current literature, the present study examined the initial feasibility and effectiveness of the Partners Now Parents Program for stressors associated with the journey to parenthood for couples expecting their first child. Sixty‐six expecting parents (33 couples) were recruited from diverse racial and ethnic backgrounds and a wide range in regards to socioeconomic status. Additionally, heterosexual, gay, lesbian, and pansexual couples all participated. Sixteen of the 33 couples participated in an active control group and 17 couples participated in the five‐session prevention program virtually in groups of two to five couples at a time. The prevention program sessions focused on preparation for being both romantic partners and co‐parents together by building skills for staying connected as a couple and managing stress and conflict.
Approximately 90% of participants indicated that they found the sessions extremely or very useful and enjoyed the sessions always or most of the time. All participants reported that they would recommend the sessions to other expecting parents. Overall, participants had positive reactions to the prevention program sessions, which highlights the need for larger scale implementation of such programs for first‐time parents. Further, 100% of the active participants that gave birth completed all five prevention program sessions, which represents the feasibility of the program design.
Results revealed a less steep decline in relationship satisfaction from antepartum to postpartum for those in the prevention program group as compared to the active control group. It may be that the prevention program served to prime couples for the decline (with enhanced knowledge about potential stressors and tools to manage those stressors) and prompted the couples to start to prepare and cope with changes in their relationship prior to their child's birth. For those in the prevention program group, a more paced decline in romantic satisfaction from the antepartum follow‐up assessment to the postpartum follow‐up assessment is likely a more balanced transition and may be easier to cope with and manage. To that end, a paced decline may be more feasible to manage and adjust to rather than a sharper decline. The more paced decline may allow couples to respond to those changes in an approachable way and cope more effectively compared to a more sudden, sharp decline. Prior research has focused on gestational partners, specifically biological mothers, often leaving out the perspectives and experiences of non‐gestational partners and the dyad as a whole. Romantic satisfaction was assessed separately for gestational and non‐gestational partners, and the dyad was accounted for in analyses in the present study.
5.1. Limitations and Future Research
Given the small sample size and limited power, findings should be interpreted with caution. Replication of the findings is needed in a larger, more representative sample. Future work would continue to benefit from recruiting inclusive samples so that couples that have been historically excluded from the research literature can be represented and access prevention programs for stressors associated with parenthood. With this small sample size, the present study was not well‐powered to examine possible differences in outcomes across various social identities; however, future research with larger samples is warranted to understand possible differences in the effectiveness of the prevention program for different groups. Interested couples who were not able to logistically make the prevention program session times were given the opportunity to participate in the active control group; however, this lack of random assignment is a limitation of the study. Future research with the Partners Now Parents Program should include a randomized controlled trial. It was beyond the scope of the present study to examine other possible outcomes (i.e., impact of the prevention program on individual parent mental health and well‐being and social support received), but future work is needed to understand possible benefits of the prevention program beyond romantic satisfaction. Although the participant feedback was anonymous, several items on the participant feedback measure were skewed toward positive responses, which may represent social desirability bias in responding.
Future research on the Partners Now Parents Program would also benefit from including additional reporters (e.g., clinicians or partners reporting on each other) and using dyadic latent class growth analyses (Leonhardt et al. 2022), as the current study relies heavily on self‐report data and, as such, is subject to self‐report bias. Although participants noted that the virtual sessions allowed them to attend more easily and facilitated retention, future researchers should consider additional options for in‐person activities as many couples noted they would appreciate that. The journey to parenthood for individuals not in a romantic relationship and for individuals that end their romantic relationship were not represented in the study, but future work is needed in this area.
6. Implications and Conclusion
Given the well‐established psychological stressors associated with the journey to parenthood that were only heightened by the COVID‐19 pandemic (McMillan, Armstrong, and Langhinrichsen‐Rohling 2021), more mental health support for expecting parents is gravely needed. The journey to parenthood may be the “prime time” for relational support programs to set couples on a positive trajectory (Doss et al. 2014; Glade, Bean, and Vira 2005; Shapiro, Gottman, and Carrere 2000). The present study provides important data on a potential scalable method to help ease the stress associated with the journey to parenthood. Participants' responses on the anonymous survey suggest that the Partners Now Parents Program was well‐received by couples and helped to buffer the typical steep decline in relationship satisfaction for first‐time parents.
Couples and family therapists may consider utilizing the techniques presented in this prevention program (e.g., building balanced expectations, increasing flexible thinking, enhancing intentional communication of feelings and expectations, and increasing activities that build romantic connection and gratitude) when working with expecting couples to prevent the typical decline in romantic satisfaction. The findings highlight the importance of considering the lens of the family system in assessment and intervention when physicians, midwives, nurses and couples and family therapists are working with expectant parents.
The Partners Now Parents Program could be delivered on a larger scale through collaborating with OBGYN, midwifery, and family medicine clinics, in a similar manner to the recruitment methods for the present study. For couples expecting their first child, this program could be delivered at relatively little cost beyond the salary of one master's level clinician facilitating the virtual group sessions. Prevention programs for expecting parents offer an important avenue of entry into mental health support with reduced mental health stigma at a critical time when openness to services is high. Offering the Partners Now Parents Program to all expecting couples may be one means to increase access to prevention efforts in an approachable manner at a time in which couples are more open to receiving support as they prepare for a new chapter in their relationship. Fostering growth in the romantic relationship and future co‐parenting relationship during the journey to parenthood may potentially reduce the mental health burden for new families.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
Support for this research was provided by internal funding at the University of Virginia. We also wish to extend our appreciation to the research participants and research assistants of the Partners Now Parents Study.
Funding: This work was supported by University of Virginia.
References
- Alves, S. , Fonseca A., Canavarro M. C., and Pereira M.. 2020. “Does Dyadic Coping Predict Couples' Postpartum Psychosocial Adjustment? A Dyadic Longitudinal Study.” Frontiers in Psychology 11: 561091. 10.3389/fpsyg.2020.561091. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Amato, P. R. 2010. “Research on Divorce: Continuing Trends and New Developments.” Journal of Marriage and Family 72, no. 3: 650–666. 10.1111/j.1741-3737.2010.00723.x. [DOI] [Google Scholar]
- Beck, J. 2011. Cognitive Behavior Therapy: Basics and Beyond. 2nd ed. New York: Guilford Press. [Google Scholar]
- Bourque‐Morel, G. , Grenier L., Arseneault L., et al. 2023. “Romantic Attachment and Sexual Satisfaction Trajectories Among Couples Transitioning to Parenthood.” Journal of Sex Research 62, no. 1: 83–94. 10.1080/00224499.2023.2275271. [DOI] [PubMed] [Google Scholar]
- Coan, J. A. , Schaefer H. S., and Davidson R. J.. 2006. “Lending a Hand: Social Regulation of the Neural Response to Threat.” Psychological Science 17, no. 12: 1032–1039. 10.1111/j.1467-9280.2006.01832.x. [DOI] [PubMed] [Google Scholar]
- Cowan, C. P. , and Cowan P. A.. 1992. When Partners Become Parents: The Big Life Change for Couples. Basic Books. [Google Scholar]
- Cowan, C. P. , and Cowan P. A.. 2020. “Supporting Parents as Partners: The Couple Context of Parenting, a Personal and Academic Journey.” In Couple Relationships in a Global Context. European Family Therapy Association Series, edited by Abela A., Vella S., and Piscopo S., 359–374. Cham: Springer. 10.1007/978-3-030-37712-0_22. [DOI] [Google Scholar]
- Cummings, E. , Keller P. S., and Davies P. T.. 2005. “Towards a Family Process Model of Maternal and Paternal Depressive Symptoms: Exploring Multiple Relations With Child and Family Functioning.” Journal of Child Psychology and Psychiatry 46, no. 5: 479–489. 10.1111/j.1469-7610.2004.00368.x. [DOI] [PubMed] [Google Scholar]
- D'Amore, S. , Maurisse A., Gubello A., and Carone N.. 2023. “Stress and Resilience Experiences During the Transition to Parenthood Among Belgian Lesbian Mothers Through Donor Insemination.” International Journal of Environmental Research and Public Health 20, no. 4: 2800. 10.3390/ijerph20042800. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Del Rio, D. L. 2021. “Partner Psychoeducational Intervention With Dialectical Behavior Therapy: A Pilot Study.” (Publication No. 28713072) [Doctoral Dissertation, University of Louisiana at Monroe]. ProQuest Dissertation & Theses.
- Doss, B. D. , Cicila L. N., Hsueh A. C., Morrison K. R., and Carhart K.. 2014. “A Randomized Controlled Trial of Brief Coparenting and Relationship Interventions During the Transition to Parenthood.” Journal of Family Psychology 28, no. 4: 483–494. 10.1037/a0037311. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Doss, B. D. , and Rhoades G. K.. 2017. “The Transition to Parenthood: Impact on Couples' Romantic Relationships.” Current Opinion in Psychology 13: 25–28. 10.1016/j.copsyc.2016.04.003. [DOI] [PubMed] [Google Scholar]
- Doss, B. D. , Rhoades G. K., Stanley S. M., and Markman H. J.. 2009. “The Effect of the Transition to Parenthood on Relationship Quality: An 8‐Year Prospective Study.” Journal of Personality and Social Psychology 96, no. 3: 601–619. 10.1037/a0013969. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Emery, R. E. 1982. “Interparental Conflict and the Children of Discord and Divorce.” Psychological Bulletin 92, no. 2: 310–330. 10.1037/0033-2909.92.2.310. [DOI] [PubMed] [Google Scholar]
- Feinberg, M. E. , Jones D. E., Hostetler M. L., Roettger M. E., Paul I. M., and Ehrenthal D. B.. 2016. “Couple‐Focused Prevention at the Transition to Parenthood, a Randomized Trial: Effects on Coparenting, Parenting, Family Violence, and Parent and Child Adjustment.” Prevention Science 17: 751–764. 10.1007/s11121-016-0674-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Figueiredo, B. , Canário C., Tendais I., Pinto T. M., Kenny D. A., and Field T.. 2018. “Couples' Relationship Affects Mothers' and Fathers' Anxiety and Depression Trajectories Over the Transition to Parenthood.” Journal of Affective Disorders 238: 204–212. 10.1016/j.jad.2018.05.064. [DOI] [PubMed] [Google Scholar]
- Gentry, M. T. , Lapid M. I., Clark M. M., and Rummans T. A.. 2019. “Evidence for Telehealth Group‐Based Treatment: A Systematic Review.” Journal of Telemedicine and Telecare 25, no. 6: 327–342. 10.1177/1357633X18775855. [DOI] [PubMed] [Google Scholar]
- Gottman, J. M. , and Levenson R. W.. 2002. “A Two‐Factor Model for Predicting When a Couple Will Divorce: Exploratory Analyses Using 14‐Year Longitudinal Data.” Family Process 41, no. 1: 83–96. [DOI] [PubMed] [Google Scholar]
- Glade, A. C. , Bean R. A., and Vira R.. 2005. “A Prime Time for Marital/Relational Intervention: A Review of the Transition to Parenthood Literature With Treatment Recommendations.” American Journal of Family Therapy 33, no. 4: 319–336. 10.1080/01926180590962138. [DOI] [Google Scholar]
- Jensen, T. M. , and Sanner C.. 2021. “A Scoping Review of Research on Well‐Being Across Diverse Family Structures: Rethinking Approaches for Understanding Contemporary Families.” Journal of Family Theory & Review 13, no. 4: 463–495. 10.1111/jftr.12437. [DOI] [Google Scholar]
- Karney, B. R. , and Bradbury T. N.. 1997. “Neuroticism, Marital Interaction, and the Trajectory of Marital Satisfaction.” Journal of Personality and Social Psychology 72, no. 5: 1075–1092. 10.1037/0022-3514.72.5.1075. [DOI] [PubMed] [Google Scholar]
- Kermeen, P. 1995. “Improving Postpartum Marital Relationships.” Psychological Reports 76, no. 3: 831–834. 10.2466/pr0.1995.76.3.831. [DOI] [PubMed] [Google Scholar]
- Kiecolt‐Glaser, J. K. 2018. “Marriage, Divorce, and the Immune System.” American Psychologist 73, no. 9: 1098–1108. 10.1037/amp0000388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kuersten‐Hogan, R. 2017. “Bridging the Gap Across the Transition to Coparenthood: Triadic Interactions and Coparenting Representations From Pregnancy Through 12 Months Postpartum.” Frontiers in Psychology 8: 475. 10.3389/fpsyg.2017.00475. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kumar, S. A. , Franz M. R., DiLillo D., and Brock R. L.. 2022. “Promoting Resilience to Depression Among Couples During Pregnancy: The Protective Functions of Intimate Relationship Satisfaction and Self‐Compassion.” Family Process 62, no. 1: 387–405. 10.1111/famp.12788. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lachmar, E. M. , Farero A., Rouleau‐Mitchell E., Welch T., and Wittenborn A.. 2019. “A Brief Multimedia Intervention for the Transition to Parenthood: A Stage I Pilot Trial.” Contemporary Family Therapy 41: 357–367. 10.1007/s10591-019-09503-y. [DOI] [Google Scholar]
- Leonhardt, N. D. , Rosen N. O., Dawson S. J., Kim J. J., Johnson M. D., and Impett E. A.. 2022. “Relationship Satisfaction and Commitment in the Transition to Parenthood: A Couple‐Centered Approach.” Journal of Marriage and Family 84, no. 1: 80–100. 10.1111/jomf.12785. [DOI] [Google Scholar]
- Lindenboim, N. , Comtois K. A. K., and Linehan M. M.. 2007. “Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder.” Cognitive and Behavioral Practice 14, no. 2: 147–156. 10.1016/j.cbpra.2006.10.004. [DOI] [Google Scholar]
- Linville, D. , Chronister K., Dishion T., et al. 2010. “A Longitudinal Analysis of Parenting Practices, Couple Satisfaction, and Child Behavior Problems.” Journal of Marital and Family Therapy 36, no. 2: 244–255. 10.1111/j.1752-0606.2009.00168.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Locke, H. J. , and Wallace K. M.. 1959. “Short Marital‐Adjustment and Prediction Tests: Their Reliability and Validity.” Marriage and Family Living 21, no. 3: 251–255. 10.2307/348022. [DOI] [Google Scholar]
- Luoma, J. B. , Hayes S. C., and Walser R. D.. 2007. Learning ACT: An Acceptance & Commitment Therapy Skills‐Training Manual for Therapists. Oakland, CA: New Harbinger Publications. [Google Scholar]
- Martin, J. A. , Hamilton B. E., Osterman M. J. K., Driscoll A. K., and Drake P. A.. 2018. “Births: Final Data for 2017.” National Vital Statistics Reports 67, no. 8: 1–49. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08‐508.pdf. [PubMed] [Google Scholar]
- McMillan, I. F. , Armstrong L. M., and Langhinrichsen‐Rohling J.. 2021. “Transitioning to Parenthood During the Pandemic: COVID‐19 Related Stressors and First‐Time Expectant Mothers' Mental Health.” Couple and Family Psychology: Research and Practice 10, no. 3: 179–189. 10.1037/cfp0000174. [DOI] [Google Scholar]
- Mihelic, M. , and Morawska A.. 2018. “Preparation for Parenthood.” In Handbook of Parenting and Child Development Across the Lifespan, edited by Sanders M. R. and Morawska A., 567–584. Cham, Switzerland: Springer. 10.1007/978-3-319-94598-9_25. [DOI] [Google Scholar]
- Mitnick, D. M. , Heyman R. E., and Smith Slep A. M.. 2009. “Changes in Relationship Satisfaction Across the Transition to Parenthood: A Meta‐Analysis.” Journal of Family Psychology 23, no. 6: 848–852. 10.1037/a0017004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moshki, M. , Baloochi Beydokhti T., and Cheravi K.. 2014. “The Effect of Educational Intervention on Prevention of Postpartum Depression: An Application of Health Locus of Control.” Journal of Clinical Nursing 23, no. 15–16: 2256–2263. 10.1111/jocn.12505. [DOI] [PubMed] [Google Scholar]
- Nicolaus, C. , Kress V., Kopp M., and Garthus‐Niegel S.. 2021. “The Impact of Parental Relationship Satisfaction on Infant Development: Results From the Population‐Based Cohort Study Dream.” Frontiers in Psychology 12: 667577. 10.3389/fpsyg.2021.667577. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pinquart, M. , and Teubert D.. 2010. “A Meta‐Analytic Study of Couple Interventions During the Transition to Parenthood.” Family Relations 59, no. 3: 221–231. 10.1111/j.1741-3729.2010.00597.x. [DOI] [Google Scholar]
- Ramsdell, E. L. , and Brock R. L.. 2020. “Interparental Relationship Quality During Pregnancy: Implications for Early Parent–Infant Bonding and Infant Socioemotional Development.” Family Process 60, no. 3: 966–983. 10.1111/famp.12599. [DOI] [PubMed] [Google Scholar]
- Rubio, B. , Vecho O., Gross M., et al. 2020. “Transition to Parenthood and Quality of Parenting Among Gay, Lesbian and Heterosexual Couples Who Conceived Through Assisted Reproduction.” Journal of Family Studies 26, no. 3: 422–440. 10.1080/13229400.2017.1413005. [DOI] [Google Scholar]
- Savell, S. M. , Saini R., Ramos M., Wilson M. N., Lemery‐Chalfant K., and Shaw D. S.. 2022. “Family Processes and Structure: Longitudinal Influences on Adolescent Disruptive and Internalizing Behaviors.” Family Relations 72, no. 1: 361–382. 10.1111/fare.12728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Saxbe, D. , and Repetti R. L.. 2010. “For Better or Worse? Coregulation of Couples' Cortisol Levels and Mood States.” Journal of Personality and Social Psychology 98, no. 1: 92–103. 10.1037/a0016959. [DOI] [PubMed] [Google Scholar]
- Schulz, M. S. , Cowan C. P., and Cowan P. A.. 2006. “Promoting Healthy Beginnings: A Randomized Controlled Trial of a Preventive Intervention to Preserve Marital Quality During the Transition to Parenthood.” Journal of Consulting and Clinical Psychology 74, no. 1: 20–31. 10.1037/0022-006X.74.1.20. [DOI] [PubMed] [Google Scholar]
- Shapiro, A. F. , Gottman J. M., and Carrere S.. 2000. “The Baby and the Marriage: Identifying Factors That Buffer Against Decline in Marital Satisfaction After the First Baby Arrives.” Journal of Family Psychology 14, no. 1: 59–70. 10.1037/0893-3200.14.1.59. [DOI] [PubMed] [Google Scholar]
- Shaw, D. S. 1991. “The Effects of Divorce on Children's Adjustment: Review and Implications.” Behavior Modification 15, no. 4: 456–485. 10.1177/01454455910154002. [DOI] [PubMed] [Google Scholar]
- Stubbings, D. R. , Rees C. S., Roberts L. D., and Kane R. T.. 2013. “Comparing In‐Person to Videoconference‐Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial.” Journal of Medical Internet Research 15, no. 11: e258. 10.2196/jmir.2564. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tomfohr‐Madsen, L. M. , Giesbrecht G. F., Madsen J. W., MacKinnon A., Le Y., and Doss B.. 2020. “Improved Child Mental Health Following Brief Relationship Enhancement and Co‐Parenting Interventions During the Transition to Parenthood.” International Journal of Environmental Research and Public Health 17, no. 3: 766. 10.3390/ijerph17030766. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tulloch, H. , Johnson S., Demidenko N., Clyde M., Bouchard K., and Greenman P. S.. 2020. “An Attachment‐Based Intervention for Patients With Cardiovascular Disease and Their Partners: A Proof‐Of‐Concept Study.” Health Psychology 40, no. 12: 909–919. 10.1037/hea0001034. [DOI] [PubMed] [Google Scholar]