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The impact of the birth of the first child on a couple's relationship

10 March, 2009

The impact of the birth of the first child on a couple's relationship

The birth of a first child heralds a major life transition for couples and has an inextricable effect on their relationship as their affiliation transits from an intimate dyad to a dynamic triad. Research suggests that the birth of a first baby has a formidable impact on the couple’s relationship, even more so than subsequent progeny. Evidence Based Midwifery: March 2009


Lynda Bateman1 BHSc, RM. Kuldip Bharj2 OBE, Phd, MSc, BSc, DN, MTD, RM, RN, IHSM Cert.
1 Midwife, St James’s University Hospital, Beckett St, Leeds, West Yorkshire LS9 7TF England. Email: hcs3l5b@leeds.ac.uk
2 Senior lecturer in midwifery and lead midwife for education, Baines Wing, School of Healthcare, PO Box 214, University of Leeds, Leeds LS2 9UT England. Email: k.k.bharj@leeds.ac.uk



Abstract

Background. The birth of a first child heralds a major life transition for couples and has an inextricable effect on their relationship as their affiliation transits from an intimate dyad to a dynamic triad. Research suggests that the birth of a first baby has a formidable impact on the couple’s relationship, even more so than subsequent progeny.
Aim. This integrative review set out to answer the question: what is the impact of the first baby on the couple’s relationship?
Method. The review process comprised determining a question and the inclusion and exclusion criteria, followed by a detailed systematic search of the literature, critical appraisal of retrieved papers and the synthesis of results of the selected studies. The results were discussed within the context of broader literature, drawing conclusions, implications and dissemination plans.
Findings. Seven primary research papers were identified and included in the review, which used qualitative and quantitative approaches for investigation. Five main themes emerged that contributed to the decline of the relationship. There were clear differences between men and women’s dissatisfaction and perceptions of the relationship. Couples reported loss of intimacy, difficulties in communication and overall relationship discontentment.
Implications. Use of therapeutic interventions antenatally may ease the transition to parenthood. While marital disharmony impacts greatly on the couple’s relationship, it is nonetheless important to note the impact on the child. One-parent families have a psychological and social impact on the child together with negative consequences prior to divorce/separation. Midwives have a role to play in supporting families; they can be the first-line healthcare professional in the antenatal and postnatal period to address these problems and ensure the wellbeing of all members of the family.


Key words: Birth, first baby, first child, couple, spouse, partner, relationships, marital satisfaction, transition to parenthood, adjustment to parenthood, midwifery


Background

The birth of a child affects the dynamic of the couple’s relationship as it changes to include a third person, affecting the functioning of parents and the marital family system (Cowan and Cowan, 1999). The birth of the first child as opposed to subsequent progeny is more impactful as the couple’s relationship increases in complexity (Raphael Leff, 1991; Belsky and Pensky, 1988). The introduction of a baby into a couple’s life demands a reorganisation of the relationship. Couples need to adjust to the transition to parenthood, requiring a move from one state to another and these encompass a change in role, relationship and behavioural patterns (Tomlinson, 1996). The way in which changes are assimilated will affect the quality of the relationship.

In the seminal work by Le Masters (1957), the transition to parenthood has been described as an intense ‘crisis’ for parents as they adjust to the birth of the first child. Often there is a significant change in a couple’s relationship satisfaction during their transition to parenthood, following the birth of a first baby (Tomlinson, 1996; Dalgas-Pelish, 1993; Belsky and Pensky, 1988), with most couples experiencing a noteworthy decline in the quality of their relationship (Schulz et al, 2006; Pacey, 2004). Should the physiological processes of bonding and attachment to the newborn be affected, then the family system may be further disrupted (Perren et al, 2003).

It is, however, noted that the birth of a child affects men and women differently with dissimilar consequences on the relationship. The majority of men find it difficult to balance time with their partners, and couples develop behaviour ‘rules’ to ease relationship tensions. Men may feel a sense of loss and rejection when they experience a changing relationship with their partners. They need to re-establish and re-negotiate this as well as developing a father-child dyad (Barclay and Lupton, 1999).

Men also report emotional changes, while much attention is given to maternal postpartum depression, little is mentioned about paternal depression impacting on marital satisfaction (Beck, 2001). Paternal depression is of concern with rates as high as 50% and is closely correlated to maternal depression (Ramchandani et al, 2005; Goodman, 2004). These authors suggest that men tend to become depressed when there is marital discord or changes in maternal personality style after giving birth. Dudley and Roy (2001) found men to be more emotionally dependent on their partners and this is likely to create pressure and cause relationship dissatisfaction in women when they have to care for a needy baby and partner.

Women report dissatisfaction with the relationship when they perceive their partners as unsupportive. Women generally perform more household and child-caring tasks than their partners, even when in full-time employment and express displeasure with this inequitable workload. Prior to the birth of their babies, couples believed that household and childcare roles should be equally shared, however, this was not evidenced postnatally (Cappuccini and Cochrane, 2000; Tomlinson, 1996). Men have argued that this ‘balancing act’ is difficult especially when combining employment with household tasks and this leads to conflict and tension and ultimately marital dissatisfaction (St John et al, 2005).

Marital dissatisfaction following the birth of the first child can lead to dissolution of the relationship, with 25,000 children in the UK under four with divorced parents (Office for National Statistics, 2006).

Research into transition to first-time parenthood reveals a pinch-point of crisis for the couple’s relationship and the wellbeing of parents. The decline in relationship satisfaction is a serious threat to family wellbeing and places a responsibility on healthcare professionals to ease this transition.
 
Methods

An integrative review was the chosen method for this review as it includes both quantitative and qualitative research studies. Although it has been common to review quantitative and qualitative research studies separately, this is now not always the case. Increasingly, reviews are being published that include both quantitative and qualitative studies (Nicholls and Webb, 2006; Hodnett, 2002).

The importance of a clearly-developed question is well recognised (Centre for Evidence Based Medicine, 2008) and with the use of ‘population, intervention, comparison, outcome’ (PICO) framework (Centre for Reviews and Dissemination, 2006), the formulated question was: ‘What is the impact of the birth of the first baby on a couple’s relationship?’

A search strategy was designed to acquire relevant papers that encompassed the richness of the subject of the study. A combination of text words, MeSH (medical subject headings), exploded subject headings, truncation using phrases for example, ‘adjacent to’ were used together with Boolean logic using the operators ‘AND’ ‘OR’ to facilitate the combination of sets (Greenhalgh, 2001). A master template of text words and MeSH headings was compiled and each database was searched using comparable MeSH headings and text words pertinent to individual databases. Key words included ‘birth’, ‘first baby/child/infant’, ‘relationship’, ‘marriage’, ‘marital’, ‘spouse’, ‘partner’, ‘motherhood’, ‘fatherhood’, ‘parenthood’, ‘satisfaction’, ‘transition’, and ‘adjustment’.

An extensive search of bibliographical databases and websites was carried out and included the British nursing index, CINAHL, EBM Reviews, EMBASE, MEDLINE, PsychArticles, PsycINFO, MIDIRS, National Research Register, Current Controlled Trials and PubMed. Journal papers were retrieved for review, the rationale being that they contain the most recent information on the subject (Gash, 2000). Duplicates found on several databases/websites were excluded. The websites were searched using explicit search terms, for example, ‘transition to parenthood’, ‘first child/baby’, ‘marital satisfaction’ included in the title or a combination where sets could be combined.

 Papers that were not research based, in English or published prior to 2000 were excluded. The date restriction ensured that recent contemporaneous papers were included reflecting the present expectation of postnatal marital satisfaction, which would differ from expectations in earlier years (Le Masters, 1957). In total, 184 abstracts were read being mindful of the inclusion/exclusion criteria, which comprised married or cohabiting couples experiencing the birth of the first child, but excluded variables that could impact on relationship satisfaction, that is assisted conception, high-risk pregnancies and underlying maternal/paternal psychological pathology. The inclusion and exclusion criteria arose from a dissection of the question using the PICO framework (Centre for Reviews and Dissemination, 2006). A total of 29 papers met the inclusion criteria and were subject to full review. After review, seven papers were selected for in-depth analysis (see Table 1).


Process

The retrieved studies used quantitative and qualitative approaches; and therefore a selection of critiquing tools were utilised to focus the appraisal (Critical Appraisal Skills Framework, 2006; Cormack, 2000; Greenhalgh, 2006). Thus, while using the appraisal tools as a framework, an extensive analysis and thorough reading of the papers has been undertaken to ensure completeness and depth of analysis. Once this was undertaken, the academic supervisor for the study reviewed, reaffirmed, discussed and agreed the analysis. The qualitative studies were Ahlborg and Strandmark (2001) and Ahlborg et al, (2000). The quantitative studies were Schulz et al (2006), Ahlborg et al (2005), Guttmann and Lazar (2004), Killoran Ross (2001) and Shapiro et al (2000).


Overview of methods used in studies

The studies focused on how the baby creates a tension within the relationship and the decrease in relationship satisfaction. The qualitative studies, Ahlborg and Strandmark (2001) and Ahlborg et al (2000) used a descriptive phenomenological approach focused on ‘exploring how human beings make sense of and transfer experience into consciousness’ (Patton, 2002). They used in-depth interviews to find the ‘essence’ to validate the recollection of the lived experience of each couple.

While the qualitative studies examined the lived experience, the quantitative studies examined the changed lived experience using interventions (specialist antenatal classes) and questionnaires (see Table 1). They differed in that they interpreted the experience numerically, but the research was notable in that it revealed a new dynamic that impacted on satisfaction with the relationship.

The quantitative studies used a variety of questionnaires to validate their research and two studies introduced specialist antenatal classes to assess whether this intervention aided postnatal marital satisfaction.

Schultz et al’s (2006) randomised controlled trial selected first-time parents who were randomly assigned to an intervention group (specialised couple antenatal classes) or a control group (non-specialised couple antenatal classes). An additional couples’ group acted as further control and just completed questionnaires and interviews in the postnatal period. The null hypothesis was that the intervention of specialist classes did not impact on marital satisfaction postpartum. As a further control, Schultz et al (2006) assessed the marital satisfaction of childless couples during the same period of research utilising this comparator to add weight to the study. All participants completed a Marital Adjustment Test (MAT) – a validated instrument together with a battery of questionnaires. This study together with Guttman and Lazar (2004) and Shapiro et al (2000) (included in this review) compared childless and first-time parents to assess whether the baby is the factor in relationship decline or whether relationship decline is related to the longevity of the relationship.



Binary Data EBMmar09_3_table1

Killoran Ross (2001) also included an antenatal intervention to assess the impact on marital satisfaction. He used a quasi-experimental approach in a comparative outcome study using four groups in three different models of antenatal education together with a control group. A total of 11 questionnaires were administered pre- and postnatally to assess wellbeing, support and coping. The dependent variable was parental psychological adjustment during the transition to parenthood. Group 1 (enhanced antenatal intervention) reported greater relationship adjustment.
 
Ahlborg et al (2005) used a cross-sectional survey utilising the results of a modified validated questionnaire, the Dyadic Adjustment Scale (DAS). The authors assessed data on the quality of the intimate and sexual relationship at six months postpartum. Guttmann and Lazar (2004), in a further cross-sectional survey compared marital satisfaction between first-time parents and childless couples. Couples completed two versions of a validated, modified questionnaire. The aim of their study was to assess marital satisfaction determinants between childless couples and parents in relationships of at least two years but less than four.

The final study was Shapiro et al (2000), which is a prospective panel design longitudinal study that collected data from the same cohort at varying time intervals over a period of six years. This study comprised two groups: newly-weds who subsequently became parents and newly-weds who remained childless. Its aim was to establish underlying factors impacting on marital satisfaction. Data analyses from both groups revealed comparisons of marital satisfaction with/without children. The study used the MAT and Oral History Interview (OHI). Both instruments claim to have high predictive validity. This study analysed data over four to six years.


Sampling

The studies used a variety of sampling techniques (see Table 1) with most using a form of convenience sampling. Sample sizes in the two qualitative studies were five and ten couples and the quantitative studies ranged from 13 to 384 couples.

In phenomenological research, participants have experienced the phenomena, and diversity in individual experience is explored, thus the small sample sizes cited above are adequate (Polit and Beck, 2006).

Schultz et al’s (2006) quantitative study comprised a subset of a larger study researching family and children’s development. Inclusion criteria included cohabitating couples aged 18 or over expecting their first child. Couples were randomised using a random number table. The sample size in all four groups was less than 30. An adequate sample size can reduce sampling error, however, where a condition is common – marital dissatisfaction post delivery – a smaller sample can be studied (Cluett and Bluff, 2000). The study was not blinded or double-blinded. Participants were aware of the hypothesis, participants/researchers knew what was being tested and two of the researchers were facilitators in the intervention group. A lack of blinding may lead to bias and distortion in studies (Greenhalgh, 2006). Given such a small sample and attrition rate, generalisability may be limited. The sample was a subset of a larger study and therefore its randomness was based on this subset and not a larger, random population.

Killoran Ross (2001) randomly assigned 123 couples to four groups, but there are no data relating to sample size. As a quasi-experimental study, the word ‘random’ may be used in a different context as true randomisation does not normally occur in quasi-experimental studies (Cluett and Bluff, 2000). However, it is possible that this study was limited by wordage in the selected journal. It is included as it met all inclusion criteria.

Ahlborg et al (2005) surveyed 384 couples from family health centres using convenience sampling. The advantage of this sampling method is that participants are readily available and easy to access. The disadvantages are that they may not be representative of the population as a whole (Cluett and Bluff, 2000). Nonetheless, the authors included detailed baseline characteristics to validate the representativeness of the sample.

Guttmann and Lazar (2004) used convenience snowballing sampling within a university setting. They surveyed 60 childless couples and 60 couples with one child. Polit and Beck (2004) argue that convenience sampling is the weakest form of sampling due to the prevalence of sampling bias and this group may not be representative of the general population.

Shapiro et al (2000) used a convenience two-stage sampling process over four years using a cohort of newly-married couples (n=130) in an area of Seattle which, through attrition reduced to 43 parents and 39 childless couples. The researchers advise that the sample is evenly distributed and representative of the city’s population, thus generalisation may be possible even though numbers are small. Clear, valid reasons are given for attrition: divorce, pregnant during data analysis, death, and participants leaving the area.


Data collection

Data collection for the studies varied and comprised in-depth, structured and semi-structured interviews and questionnaires, some which were validated, others modified validated questionnaires (see Table 1). Questionnaires were used in all the quantitative studies with some studies using questionnaires and interviews (Schultz et al, 2006; Shapiro et al, 2000).

The qualitative research collected data using in-depth interviews. Parents were interviewed separately, undisturbed in their own homes and were encouraged, using clarifying questions. Ahlborg and Strandmark (2001) interviewed parents at six and 18 months postpartum and Ahlborg et al (2000) at nine months postpartum. Both studies used audio recordings that were transcribed and analysed.

Participants in Schultz et al’s (2006) study completed pre-assessment interviews and validated questionnaires, which were administered ante- and postnatally. The intervention group was split into six subgroups comprising four couples, each of whom discussed the questionnaires, facilitated by coleaders. Each session was audiotaped to ensure the treatment protocol was strictly adhered to. No reference was made to adherence to protocol.

Killoran Ross (2001) clustered and compared five domains from a variety of questionnaires using time series observation at 24 and 26 weeks’ gestation and one, two, three, four and six months postpartum.

Ahlborg et al (2005) collected questionnaire data from two groups of first-time parents at six months postpartum and achieved a response rate of 65% and 74% respectively. The questionnaire was a pre-validated modified version of DAS translated into Swedish. The translated DAS was piloted initially with 80 first-time parents to enhance sensitivity and dimension of the subject.

Guttman and Lazar (2004) constructed a validated Marital Satisfaction Questionnaire (MSQ) via a pilot study (n=40) to check content, context and wording suitable for an Israeli cohort. An ‘exhaustive list of items’ was compiled from the answers and constituted the basis of two attitude questionnaires (MSS) and (MSS-I). The questionnaires comprised 34 items and used a Likert scale to test the degree of marital satisfaction and the importance of an item’s content in terms of marital satisfaction. The questionnaire was posted to respondents and data were collected over several months with a 60% response rate. Having to complete two questionnaires with 34 items could have led to low response rates. Postal questionnaires were self-administered and without the researcher present, it is possible that questions may have been misunderstood and erroneous answers given. Bowling (2002) argues that postal questionnaires are only suitable if the questions are straightforward.

Shapiro et al (2000) collected data from couples in the first year of marriage via the OHI instrument (interviews) when both partners were present in the home. A subset were videotaped and studied in detail in a laboratory setting (n=50). The OHI coding system relies on the researcher entering scores on a Likert scale, based on researcher’s perception of the answers. They utilised a multivariate analysis of variance (MANOVA) to examine differences in researchers OHI coding and did not find any significant differences.

All participants were followed up annually to complete the MAT questionnaire with new parents completing additional MAT questionnaires at six months antenatally and three months postnatally. This rigour of ongoing data collection ensures that attrition rates are kept to a minimum through constant contact, but equally the repetition of the questionnaires can become tiresome to participants and could account for the 37% attrition rate.


Table 2. Findings of the included studies



Data analysis


The two descriptive phenomenological studies outlined the approach to their analysis, making use of meaning units transforming them into expressed meanings, rather than interpretive, in line with descriptive phenomenology. The quantitative studies produced statistical analyses of their data.

Findings

This section will report on the analysis of the seven papers selected for review (see Table 2).


Synthesis

Five main themes emerged that contributed to the decline of the relationship. There were clear differences between men and women’s dissatisfaction and perceptions of the relationship. Couples reported loss of intimacy, difficulties in communication and overall relationship discontentment.


Impact on women

Killoran Ross (2001) noted that women had higher levels of anxiety than men postnatally. Shapiro et al (2000) found a systematic decline in marital relationships, with a greater impact on women compared with men. They found that women who became mothers had more marital dissatisfaction than childless women and this decline was noted for up to two years post delivery. If the husband expressed fondness and affection towards his wife in the antenatal period, the trend towards decline was halted. Women whose partners expressed disappointment in the relationship during pregnancy reported being dissatisfied postpartum. It appeared that if couples had a strong sense of the other in the relationship – the expansiveness index – this enabled mutual support between the husband and wife before and post delivery.


Impact on men

Killoran Ross (2001) found that men and women report equal dissatisfaction with the relationship. He questioned the concept of the ‘new man’ who, in supporting his female partner does not help in reducing her relationship dissatisfaction. He too becomes dissatisfied with the increased demands of a new infant. Ahlborg et al (2005) found that men were more stressed than women due to the additional demands at home and outside the home. They also reported greater sexual desire than women (Ahlborg et al, 2000) and were more satisfied with their intimate relationship, their relationship in general and more optimistic about the future of the relationship when compared with women (Ahlborg et al, 2005).


Relationship contentment

It needs to be stated that not all couples experienced the transition to parenthood as having a negative impact on their relationship. Guttmann and Lazar (2004) reported increased marital satisfaction in first-time parents compared with childless couples. They found six factors with importance within the childless couples and parents’ relationships. Parents had higher scores than childless couples, notably in ‘agreement and consideration’, which enhanced relationship satisfaction. They do, however, note that the study had sampling limitations. Additionally, they are mindful that this Israeli study may have impacted on the results as the Jewish religion and culture place a high value on having children. Equally two of the couples in Ahlborg and Strandmark (2001) reported increased relationship solidarity although they did report more fatigue and irritation in their relationship. Most of the couples in Ahlborg et al (2005) study were happy with their relationship per se, while expressing discontent with intimacy. The couples in Schulz et al (2006) intervention study had significantly reduced martial decline in the first few years postnatally. However, by five-and-a-half years, the divorce rate was similar in the intervention and non-intervention groups. Nonetheless, they state that the opportunity for couples to normalise their experience with other group members was helpful. Additionally it may have enhanced the relationship by reducing the likelihood of blaming their partner for the stresses experienced postpartum.


Loss of intimacy

Raphael-Leff (1991) states that couples in the transition to parenthood may experience potential dangers to their relationship due to loss of sexual and intimate relationships, a reduction in the time spent with each other and less mutual nurturing. Ahlborg and Strandmark (2001) found that couples reported a loss of intimacy that resulted in parents reporting ‘missing tenderness’ and ‘yearning’ for affection. Ahlborg et al (2005) noted that both parents were often too tired for sexual activity and reported this as a relationship problem. Couples who experienced a mutual, simultaneous loss of desire and need for sexual intimacy reported low relationship conflict (Ahlborg et al, 2000). A conflict in sexual desire created relationship disharmony where the man’s interest was stronger than the woman’s. Women who breastfed reported a loss of sexual desire and libido (Ahlborg et al, 2005; Ahlborg et al, 2000).

Several studies have found that men perceive a loss of their intimate sexual partner to the baby, especially when the woman is breastfeeding (Cohen et al, 2002; Jackson, 2000; Read, 1996). Studies into breastfeeding and sexuality have noted that women find breastfeeding ‘erotic’ and have less need of erotic satisfaction from their partners (von Sydow, 1999). These factors can contribute to a loss of relationship satisfaction. Sexual desire was seen as positive when it created feelings of tenderness and acceptance, but defective when perceived as longing or a need for self-control. Some women reported the desire for intimacy without vaginal penetration and were fearful of approaching their partner in case their interest in them was misunderstood.


Communication

Ahlborg and Strandmark (2001) noted that a lack of communication prevailed in parents expressing dissatisfaction with the relationship. Indeed one of the couple’s only form of communication related to the baby. The baby became the focus of attention to the detriment of the relationship. The intervention in Schulz et al (2006) enabled couples to communicate more fully and express their feelings, which aided relationship satisfaction. Ahlborg et al (2005) found that positive dyadic communication was associated with satisfaction within the relationship and that it enhanced the couple’s intimate relationship. Shapiro et al (2000) found that a buffer against relationship decline was a positive relationship, where spouses communicated their respect and friendship for each other and formed a strong bond to support them through periods of transition. Communication is an important factor within any relationship and is a complex skill that many couples fail to develop.


Validity and reliability

For any evidence to inform change of practice, we need to ensure that the data is valid and reliable (Hamer and Collison, 2003). The research processes described in the qualitative studies relating to the quality of the intimate and sexual relationship can indicate results that are trustworthy. Ahlborg et al’s (2005) quantitative data on the loss of intimate and sexual relationships had significant results. Killoran Ross (2001) did not have the data to support their findings. Schulz et al (2006), while using a complicated statistical process, did nonetheless show a decline in relationship dissatisfaction with less in the group with ante- and postnatal intervention. Guttmann and Lazar’s (2004) results albeit positive, may be due to the limited sample size with bias and cultural factors influencing results, which they acknowledge. Finally, Shapiro et al (2000) had clear, simple well-described statistical analysis that produced significant results indicating that marital dissatisfaction increases following the birth of the first child.

There are limitations in all these studies; all the quantitative studies had small sample sizes (with the exception of Ahlborg et al, 2005) and additional research with larger sample sizes could produce more reliable conclusions. Schulz et al (2006) and Killoran Ross (2001) used interventions to affect relationship satisfaction, but results from Killoran Ross (2001) could not be validated. Nonetheless, the results evidenced overall that there was relationship dissatisfaction in one form or another following the birth of the first child.
 

Implications for practice and recommendations

Midwives have an important role in the wellbeing of the family and need to be cognisant of current research. Disseminating information gives women and practitioners choice, it is important therefore to disseminate information to colleagues. Foy and Crilly (2004) describe the gap that exists between evidence and practice and the necessity of disseminating evidence into practice.

The decline in marital satisfaction following the birth of a child has important public health and social implications. The main focus postnatally tends to be on the physical health of the woman and infant, with limited attention paid to emotional and psychological wellbeing unless the woman displays (or discloses) signs of postnatal distress (Perren et al, 2003; Morse et al, 2000). One of the themes running through these studies was the importance of good communication to enhance the relationship. Schulz et al’s (2006) research on the effect of therapeutic relationship support to enhance marital satisfaction is an important finding and warrants further research to establish the efficacy of therapeutic relationship interventions on couples. This intervention focused on resolution of relationship difficulties, utilising communication and conflict-resolving skills and has implications for practice when considering education for expectant and delivered couples.

On a practical level, midwives can support couples to make conscious decisions on how they wish to conduct their relationship postnatally, especially in the early weeks when new patterns of behaviour emerge within the relationship. The introduction of a baby into a couple’s life demands a reorganisation of the relationship. The way in which changes are assimilated can affect the quality of the relationship. Midwives can facilitate parents to discuss the development of their parenting roles and how they incorporate this new dynamic into their relationship. Increased use of therapeutic interventions, such as psychotherapy and couple counselling could facilitate the transition to parenthood and create healthier, happier parents and families.


Conclusion

This integrative review sought to bring together qualitative and quantitative research to examine the impact of the birth of the baby on a couple’s relationship.

 The overall conclusion is weighted towards relationship dissatisfaction following the birth of a first child and this review confirms previous findings. The studies critiqued document the negative aspects of relationship problems on the emotional and psychological health of couples following the birth of their first child and reveal the extent of relationship difficulties in the transition to parenthood together with the dissatisfaction and hardships experienced.

There are, however, factors that can strengthen and enhance a relationship and these are good couple communication and relationship interventions. Guttmann and Lazar (2004) found no significant relationship dissatisfaction although, as discussed above, the sample was limited and cultural factors may have influenced the results.

Critiquing research in this depth provides much needed knowledge of the limitations of research and it facilitates researchers in designing better research protocols.


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