28 Grief and Loss Across the Lifespan
Developmental Aspects of Pregnancy
The beginning of a pregnancy is a time of anticipation, uncertainty, and
hope. Samantha’s experience highlights how emotionally charged the expe-
rience of pregnancy and childbirth can be. Success in achieving pregnancy
is often complicated by older maternal age, which leads to fatigue (mean-
ing that attempts at pregnancy are limited), lowered fertility, and ultimately
the anxiety about getting pregnant that can cause difficulties in becoming
pregnant. Once a woman is pregnant, the attachment to the dreamed-of baby
grows rapidly, yet technology from ultrasound through genetic screening and
testing means that difficult decisions may be part of many women’s experi-
ence of pregnancy. Here, we will consider the development of the prenatal
attachment in a typical pregnancy, focusing primarily on the mother as the
pregnancy occurs in her body. This, of course, differs for those who adopt
a child, use a gestational surrogate, or otherwise create their family in less
typical ways.
The development of an emotional bond between the mother and the
growing fetus is a primary task of pregnancy. Nearly all credible behavioral
theory focuses on the relationship between the infant and the mother or
primary care giver as the formative force behind most relational behavior.
Relatively recently, research and theory exploring how that bond develops
prior to the birth (which Bowlby had identified as the beginning of attach-
ment) has exploded (Brandon, Pitts, Denton, Stringer, & Evans, 2011).
Here we will explicate what is known about the biological, psychological,
and social aspects of the formation of the bond with a fetus during pregnancy
and what is lost when a pregnancy ends prior to birth. The mother’s perspec-
tive on that bond, including the role of the mother’s biopsychosocial context
during pregnancy and the ways it sets the stage for the beginning attachment
once a baby is born, is critical to how the mutual attachment process begins
once the baby is born. Obviously, parental attachment to the fetus frames the
experience of perinatal loss.Biological Developmental Context of Pregnancy
The beginning of pregnancy causes radical changes in a woman’s body. Instead
of moving through a roughly 28-day hormonal cycle to which she has become
accustomed since adolescence, she is suspended in a phase of her cycle during
which high levels of estrogen and especially progesterone are secreted. Other
hormones including human chorionic gonadotropin (HCG) are secreted in
ever increasing amounts. Aside from the physical effects of breast tenderness,
bloating and nausea that accompany these hormones, emotional effects such
as increased irritability, labile moods, and an increased sense of vulnerability
are believed to be related to these hormones as well. Recent research suggests
that pregnancy-related nausea may actually be associated with both HCG and
progesterone, priming women to have aversions to the smells, flavors, and
textures of foods and other substances that are unhealthy during pregnancy
(Hahn-Holbrook, Holbrook, & Hanselton, 2012).