2 Perinatal Attachment and Loss 33
behaviors into congruence with socially derived feeling rules about how to
feel (or behave as if they are feeling) (Hochschild, 1979). Feeling rules related
to gender roles and maintaining “good patient” behavior influence how the
social surround frames emotion work for pregnant/birthing women (and
their midwives) (Carter & Guittar, 2014).
The social context of pregnancy also affects outcomes of attachment and
representation. Huth-Bocks et al. (2011) found that social contexts such as
experiencing poverty, domestic violence, and poor social support interact with
balanced prenatal representations of the baby (ability to think about positive
and negative qualities/behaviors attributed to the fetus/baby prenatally) to
influence the baby’s attachment style at 1 year. Insecure attachments are more
likely under conditions of high social stress and negative maternal prenatal
representations.
This implies that attachment to the fetus and enactment of pregnancy
is powerfully shaped by social environment. It further suggests that attach-
ment may be limited in cultures that do not view pregnancy as something to
bond with prior to birth. The earlier interpretations of prenatal attachment as
a psychobiological imperative might need revision. Instead, conformity to the
determinants of culture could be a salient determinant of prenatal bonding
behavior.
New technologies of high resolution ultrasound, nuchal fold testing, cho-
rionic villi sampling and others are used frequently in Western cultures and
often viewed by pregnant women as bonding tools (as opposed to fetal health
testing, their true intent) (McCoyd, 2007, 2013). The technological imperative
which may be characteristic of highly developed countries (McCoyd, 2010a)
interacts with variable community norms about pregnancy and childbirth.
Hearing fetal heart tones, visualizing the fetus on ultrasound, and identify-
ing the fetus’s sex are now all typical experiences for pregnant women that
connect them more strongly to the fetus on emotional levels. This may enhance
bonding in normal circumstances, but may also intensify grief if a perinatal
loss is experienced.
Summary of Development in the Prenatal Period
Pregnancy involves the development of both the fetus (from multicelled
blastocyst through embryonic stages and into a fetus which is eventually
capable of living independently) and development of the woman (from
individual through pregnant woman through mother with responsibilities
toward another person). The development of a woman from a nonpregnant
individual to a new mother holding a baby is a prime exemplar of a
maturational loss as we are defining it. Maturational losses are both a form of
growth and maturation, but these events also entail losses because a known
and (usually) comfortable stage of life is left behind for a new, unknown stage.
Even in ideal circumstances—a planned pregnancy lovingly accepted by
prepared parents (and extended families) who traverse pregnancy and delivery
with no real complications—people experience losses. The woman loses true
independence in that she must consider how her self-care and nutrition affects
her pregnancy. She loses sleep, her nonpregnant body, and possibly her sense
