2 Perinatal Attachment and Loss 29Physical changes involved in pregnancy clearly influence the woman’s
emotional life, and can have implications for attachment to the fetus. On the
one hand, these changes provide palpable evidence of the fetus’s presence in
her body; on the other hand, they can lead to feelings of less control over her
body. These body changes can inspire resentment and blame of the fetus if the
changes are overwhelming or unwelcome. In short, the physical changes of
pregnancy can be a reassuring reminder of the fetus’s presence or a burden
to bear. How a mother views these physical changes will likely have a strong
influence on her emotional state generally, and her attachment to the fetus spe-
cifically. Likewise, she (and likely her partner) may be creating “representa-
tions” of the fetus (ideas about the characteristics, motivations, and growth of
the fetus—e.g., “he’s such an active scamp!”) which seem to set the foundation
for the development of secure or insecure attachments after birth (Ammaniti,
Tambelli, & Odorisio, 2013).
As the fetus grows, it makes its presence increasingly known, first
by gentle brushings (quickening) often experienced as “butterfly wings
inside,” but progressing to large movements in confined spaces as the fetus
moves and tries to stretch in the latter stages of pregnancy. This corresponds
with the woman’s body getting larger, a development often connected to
her sense of attractiveness (or lack thereof). A new center of gravity and
increased weight alter body dynamics so as to increase the sense and actual-
ity of vulnerability. A sense of being a stranger in her own body may lead
to high levels of psychological discomfort, particularly for women whose
self-image is strongly tied to physical appearance, or for women who have
great need for control. These physical effects may impact the way a woman
perceives her growing fetus.
Progesterone (a primary hormone of pregnancy) is believed to help
prime “nesting” behavior—the tendency to create a safe place to house
the newborn—and obsessive nesting may be a normal aspect of late preg-
nancy (Feygin, Swain, & Leckman, 2006). As prolactin is secreted along
with oxytocin at the time of birth, the reward system of the brain is stimu-
lated, fear is buffered, and women have increased affiliative motivations
(Hahn-Holbrook et al., 2012), meaning they generally want to remain close
to the newborn as well as friends and family. Interestingly, rats raised to be
addicted to cocaine, when primed with their newborn pups to promote oxy-
tocin release, actually prefer closeness to their pups over cocaine (Mattson,
Williams, Rosenblatt, & Morrell, 2003), indicating the strong level of reward
new mothers get from physical closeness with their newborns. In the reading
by Kudeva at the close of this chapter, the hospital protocols that separate
new mothers from their newborns are seen to interfere with this bonding
and to leave some mothers bereft.
Sleep problems bridge physical and psychological aspects of pregnancy.
The aches and pains associated with a growing uterus combine with frequent
urination and hormonal influences to deprive pregnant women of easy sleep,
and loss of sleep is consequential. Recent research ties sleep disturbance to the
depressive symptoms pregnant women often experience and they urge obste-
tricians and others to attend to women’s sleep and intervene when possible
(Kamysheva, Skouteris, Wertheim, Paxton, & Milgrom, 2010).