2 Perinatal Attachment and Loss 31fetus and to have a sense of “two-ness.” By phase three, the fetus has achieved
viability and the birth experience looms large; negotiating with her care pro-
vider becomes a focus to ensure the health and safety of the baby-to-be.
Raphael-Leff (2005) asserts that a woman’s relationship with her fetus
and her care providers falls into three categories that frame the psychology
of pregnant women. The “Facilitators” are delighted to be pregnant and
gestating; they experience fusion in Phase 1, communion in Phase 2, and
relinquishment in Phase 3. “Regulators” tend to see pregnancy as a means
to an end and try to keep the mundane realities of pregnancy as far from
daily experience as possible. Phase 1 is a time of heightened self-control,
attempting to avoid being overcome by physical effects or sentimentality;
Phase 2 is also defined by self-control and an awareness of the fetus as a
kind of parasite; and Phase 3 is characterized by detachment and the desire
to get through the birth. The women classified as “Reciprocaters” blend the
two types and experience some ambivalence in Phase 1, are able to tolerate
the uncertainty of pregnancy in Phase 2, and ultimately are able to take a
wait and see approach during the third phase, which they approach with
preparation.
Bowlby, a founder of attachment theory, considers patterns of attachment
as indicative of how an individual will form relationships in adulthood.
Attachment behavior, like other forms of instinctive behavior, is medi-
ated by behavioral systems which early in development become goal-
directed.... The goal of attachment behavior is to maintain certain
degrees of proximity to, or of communication with, the discriminated
attachment figure(s). (Bowlby, 1998, pp. 39–40)Bowlby’s focus is on the relationship between born-child and the mother
and how that relationship defines future attachment patterns of the grow-
ing child. Nevertheless, the clear implication is that mothers, driven by both
species-survival forces and their own attachment patterns, will attach to new-
borns quickly. This implies that some process went on before the birth that
primed the woman for the attachment. Recent research focuses on how the
concordance or discordance between mothers’ prenatal representation of their
baby-to-be and the reality of that baby’s attachment style after birth affect
infant behaviors (exploration) and maternal depression (Huth-Bocks, Theran,
Levendosky, & Bogat, 2011).
Depression and anxiety symptoms are common during typical preg-
nancy (Glover, 2014) and even more likely during high-risk or medically com-
plicated pregnancies (White, McCorry, Scott-Heyes, Dempster, & Manderson,
2008). Robust, recent research findings show that preterm birth and low birth
weight are highly correlated with anxiety in pregnancy (Ding et al., 2014)
and that depressive symptoms and other stressors result in poor pregnancy
outcomes and poorer maternal-infant attachment (Glover, 2014; White et al.,
2008). Levels of stress are particularly high when a mother has had a prior
pregnancy loss (Gaudet, 2010) and women who have experienced pregnancy
loss often attempt to avoid early attachment as a way to protect themselves
emotionally (Cote-Arsenault & Donato, 2011). Ironically, the more women