Palabras clave: vinculação, grávidas, toxicodependentes, binding, pregnant, drug

Introduction and Objectives

The great changes and the necessary psychological and physiological adaptations, which are inevitable during pregnancy, leading to what many authors consider pregnancy as a "crisis" of the maturational development can lead to the development of maternal identity. Considered for the vast majority of authors as a period of great changes and adaptations of crisis and therefore, the psychological point of view, this period must be understood as a dynamic process of construction and development (Cotralha, 2007)³.

In pregnancy, new adaptive tasks facing the individual, leading him to revive and simultaneous emergence of unresolved conflict, themselves, from the early stages of development and inadequate solutions to the loosening of the past. In the female addict, pregnancy carries risks associated with lifestyles, modes of consumption and effect of drugs on the developing fetus. If we accept too, as a given right, that the actual periods of secondary amenorrhea, common among them, makes only belatedly that the pregnancy is suspected, facilitating the denial that often is broken only too late.

The influence of interactions parents / baby in social and emotional development of children has been investigated in several studies in recent decades. These studies initially adopted a dyadic perspective (particularly the mother-baby) and more recently began to consider the triad mother-father-baby, or the family group as a whole. The concept of linking falls under the attachment theory, born from the work of John Bowlby and Mary Ainsworth Salter, the primary aim of understanding the phenomenon by which the newborn and mother establish emotional ties among themselves and privileged. According to Bowlby (1990, p.46)⁴, "the connections is a primary system specific, is present from birth with proper characteristics of the species." For Brazelton and Cramer (2004)⁷ the link between parents and baby is triggered long before the birth, when a couple wants a child, and fantasies that trigger the desire born of the binding process. According to Bayle (2006, p.117)⁶ “to build the bonds of attachment between mother and child will weave itself in part through various early interactions, the first being the desire of parents to give life to a being". To Brazelton and Cramer (1993)⁷, there are several important steps in the process of building the link: before, during pregnancy and in the period surrounding the birth.

According to these authors, according to their dreams and emotions, parents and plan to reorder the desire to have a child, preparing "ground" for the development of attachment. Many mothers are initially disturbed by feelings of distress and annoyance and stress when they become pregnant if the pregnancy was unplanned, as in most pregnant addicts, so look for this investigation to determine the level of antenatal attachment in pregnant drug abusers attend the program for replacing a narcotics Health Centre of the Central Region of Portugal, as well as assess the relationship between the number of nursing visits and frequency of travel undertaken in preparation for childbirth, with the level of prenatal attachment.

Methods

In this study we used the quantitative method, using a correlational study (Fortin, 2009), applied to a single point through a questionnaire comprising social, demographic and clinical scale and the 'Antenatal Emotional Attachment Scale' (Condon, 1993), translated and validated for the Portuguese population by Gomez & Leal (2007).

Define objectives of this research:

• Understand the social, demographic and clinical characteristics of pregnant drug users who attend the program for replacing narcotics, entered into a health center in the central region of Portugal;
• Determine the level of prenatal attachment of pregnant addicts who attend the program for replacing narcotics, entered into a health center in the central region of Portugal;
• To investigate the relationship between the numbers of nursing visits conducted surveillance of the pregnancy and the frequency of the course of preparation for childbirth, with the level of prenatal attachment.
  

Given the research questions and objectives outlined, have outlined the following assumptions:

• H1: There is a statistically significant correlation between the number of nurse consultations undertaken and the level of prenatal attachment of pregnant addicts who attend the program for replacing narcotics, entered into a health center in the central region of Portugal;
• H2: There is a statistically significant relationship between stroke frequency of preparation for childbirth, and the level of prenatal attachment of pregnant addicts who attend the program for replacing narcotics, enrolled in a health center in the central region of Portugal;

The aim of this study population is constituted by pregnant addicts who attend the program for replacing narcotics, enrolled in a health region of central Portugal. The sampling procedure used in this study was not a probabilistic kind of accidental or convenience. This research involved a sample of 26 pregnant women.

Results

Social, demographic and clinical characteristics of pregnant drug users Pregnant drug users (N=26) who participated in this research study, have an average age of 23 years (SD=2.55). On average, these women are under the replacement program of narcotics, with a daily dose of methadone in the health, there is 11.69 months (SD=5.44), while the minimum value is 3 months, and maximum time of 24 months. With a mean gestational age of 31.92 (32) weeks, these women had in general a satisfactory number of nursing visits (M=7.8, SD=2.62), there is still that the minimum number visits by nurses monitoring of pregnancy is four, the maximum number of twelve consultations (Table 1). Table 1: Distribution of answers of respondents in relation to social, demographic and clinical Regarding education, 34.6% of these women hold the 3rd cycle of schooling, such as secondary education (34.6%). Regarding the desirability of pregnancy, 73.1% for this pregnancy was not desired, and 100% of the cases it did not arise in a planned fashion. It is observed by the data in Table 2 that 53.8% of pregnant women are included among the courses of preparation for childbirth, and 46.2% do not attend at your option. Table 2: Distribution of answers of respondents to desire and pregnancy planning.

Table 1: Distribution of the respondents in relation to social, demographic and clinical

Table 2: Distribution of the respondents to desire and pregnancy planning

Binding behaviors of the pregnant addict Descriptive analysis of the scale 'Antenatal Emotional Attachment Scale', it is interesting to avail ourselves of some results. It is observed that on one hand these women 46.2% in the last two weeks have thought / worried about your baby in utero, 23.1% reported ever having this kind of thought or concern, we analyze even if 42.3% of these women show very strong emotions when they talk or think of their baby, 38.5% reported emotions too weak or lack thereof. With respect to feelings toward the baby, the polarization is high, since 50% of these women report that their feelings are mostly positive, and 50% report that their sentiments are very negative. When questioned under your baby's imagination, 34.6% of pregnant addicts who think too often emphasize the development of your baby in your belly, and 50% of pregnant women say they never do, even noting in 50% of cases think of your developing baby as' something not quite alive. “Regarding the dependence that the baby has these, 50% of pregnant women who were part of the study point out that nothing in the welfare of your baby depends on it. With regard to communication in utero, these women report that they communicate with almost all the time they are alone (50%), while 34.6% say they never communicate with your baby. For 57.7% of pregnant women, when they think your baby thoughts arise much irritation, and 42.3% have feelings too sad. If 46.2% of these women have sought to ensure a healthy diet during pregnancy, other 46.2% never reveal this concern. Baby imagined the real baby, 38.5% of women report that when they see your baby for the first time will feel an intense affection, and 46.2% report that they will feel particularly disgusted, and even noted, 53.8%, which only wanted to catch him the next day (Table 3). Table 3: Distribution of answers of respondents compared to the binding behaviour All these pregnant women reported having frequent dreams about her pregnancy and their babies, and 50% of these women never give them to touch or pass with his hand on her belly.

Table 3: Distribution of the respondents against the binding behavior

Link-level prenatal pregnant addict Regarding the level of prenatal attachment, and considering that the maximum value for scale is 80, pregnant drug users have an average of 53.53 (SD=24.10), a value above the average value of the scale, it emphasizes that these pregnant have a value of linking prenatal satisfactory. It is noteworthy that the twenty-six pregnant women who are part of this study, pregnant women are under a program of recovery from her drug addiction, and have the support of a health care team.

Factors related to linking prenatal pregnant addict Given the Kolmogorov-Smirnov, scale linking prenatal presented in this research, a non-normal distribution, as p <0.05. Thus, were applied to the two hypotheses of the study nonparametric tests. For the first hypothesis 'there is a statistically significant correlation between the number of nurse consultations undertaken and the level of prenatal attachment of pregnant addicts who attend the program for replacing narcotics, entered into a health center in the central region of Portugal', there through the Spearman correlation was statistically significant in the positive sense, that is, the greater the number of nursing visits conducted surveillance of the pregnancy, the greater the level of prenatal attachment (Table 4). Table 4: Results of applying the Spearman correlation to the level of prenatal attachment as the number of nursing visits For the second hypothesis ' there is a statistically significant relationship between stroke frequency of preparation for childbirth, and the level of prenatal attachment of pregnant addicts who attend the program for replacing narcotics, enrolled in a health region of central Portugal', observed that pregnant addicts who attend the course in preparation for childbirth, have higher levels of prenatal attachment (p <0.05) (Table 5). Table 5: Results of applying the test of Mann-Whitney U to the level of prenatal attachment as the frequency of the course of preparation for childbirth.

Table 4: Results of application of the Spearman correlation to the level of prenatal attachment as the number of nursing visits

Table 5: Results of applying the test of Mann-Whitney U to the level of prenatal attachment as the frequency of the course of preparation for childbirth

Discussion / Conclusions

The formation of interpersonal relations is one of the most significant aspects of human development, however, knowledge of these processes and the mechanisms that underlie them remains a challenge for research, attracting the interest of several authors. Lewis (1988) cited by Canavarro (2001)⁸, which considers the specific features of most human relationships are the cognitive representations that allow the interaction of each subject to think about themselves and each other and enable the continuation of the relationship even in the absence of behavior (such as after the death of one of the subjects). According to Sá (1997)⁹, the early evidence of competence for binding in humans is therefore a long process that can be split into different levels. In this investigation, which deals with pregnant drug users, we found that the level of prenatal attachment is satisfactory, however, the descriptive analysis of the different items found extreme biases regarding the behavior and attitudes binding to the baby, that is, if first we develop behaviors that pregnant addicts of great affection to your baby, other are those who fall away from her pregnancy. As we said Brazelton and Cramer (1993)⁵, on any woman, the pregnancy will reflect his life prior to conception, the desire to have a child included the desire to see reflected in the child's marks our own creativity and ability to educate someone. For these women accept the pregnancy is to accept the reality of pregnancy, namely pregnancy integrate within themselves, which may enable these women to change their life habits. Maldonado (1985)¹³ and Colman and Colman (1994)¹⁰ tell us how the pregnancy is integrated and experienced, depends on the interaction of various factors such as socio-demographic, obstetric and relational. Focusing on obstetrical factors, pregnancy planning and acceptance are two different aspects, since the fact that if planning a pregnancy does not mean this is accepted. We verified this investigation, none of these women planned their pregnancy, and for most pregnancy is not desired. For factors that promote prenatal attachment was observed that the greater the number of nursing visits conducted surveillance of the pregnancy, the greater the level of prenatal attachment, noting also that pregnant addicts who attend the preparation course for childbirth, have higher levels of prenatal attachment. These data corroborate the understanding that it is vital that we accept this is a really unique and special and that we must make efforts to meet their needs, through projects of intervention for this specific population.

Notes

Conflicts of interest
I have no relationship / property / circumstances that could be understood as a potential conflict of interest. My study has not received funding.

Ethical approval
The study was approved by the institution where it took place. The free participation of the participants was conducted with informed consent, taking into account all ethical procedures.

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