How do we know how to behave and model ourselves when we start the journey of motherhood? Influences come from every aspect of the globe, media, magazines, health professionals, Internet and perhaps most of all from our friends and family. There is none so influential as our parents but particularly the relationship we have with our mothers.
Women aspire to be the ‘good enough mother’, which Winnicott (1957) describes as a capacity for patience, devotion and self-sacrifice and places the future of the child solely in the hands of the mother.
This unique relationship is the template by which our experiences of parenthood are based; we will choose to parent in a way we were raised or conversely reverse those experiences which we found deficient as a child. Our attachment to our parents is complicated, often tem-pered with love, loyalty, hate and disappointment. Forna (1998) writes,
‘mothers have the capacity to disappoint us, anger us, frustrate us and burden us in a way no one else can’, in fact, today many individuals seek therapy and the basis of their psychoanalysis is a dysfunctional relationship with their own mother.
In the initial stages of pregnancy, memories of early experiences are evocative with reprocessing of old events played out with ourselves as the mother. Women are inclined to place themselves in the Madonna role, the idealistic mother who is content, capable, sacrificial and whole-some. Unspoken promises made to her fetus for a future life that is free of harm, she will be her child’s guardian.
For some pregnant mothers, the absence of any real physical contact with their mothers in their formative years can present a challenge.
Motherhood is the most natural physical experience and the emotional responses to her infant may be overwhelming. If the woman’s own needs in childhood were ignored, then the ability to respond empathically to her own infant may be impaired. This experience is supported by Sigmund Freud’s exploration of the mother/infant relationship, which he explains, ‘the reason why the infant in arms wants to perceive the presence of its mother is because it already knows by experience that she satisfies all its needs without delay’ (Freud 1926).
Freud (1940a,b) based most of his original theories and psychoana-lytical practice upon adult relationship with mothers. His work was the framework for all twentieth-century analysts and today modern psy-chotherapy is deeply rooted in his philosophical theories. He stated the significance of this relationship and particularly the function of breast-feeding within the maternal role. He described the mother as ‘unique, without parallel (and) established unilaterally for a whole lifetime as the first and strongest love-object . . . the prototype of all later love reactions’ (Freud 1926). Others were to follow in the exploration of this very complex relationship.
Melanie Klein, fundamentally a great supporter of Freud, continued to investigate the relationship between mother and daughter. She herself was an unwanted child and received little affection from her parents, later seeking psychoanalysis she became academically involved within this field and wrote at length about the mother/infant affiliation (Klein 1998). The relationship with the infant and the mother’s breast is famously dysfunctional according to Klein; ‘the power of love – is there in the baby as well as the destructive impulses, and finds its first fundamental expression in the baby’s attachment to his mother’s breast, which develops into love for her as a person’ (Klein 1998).
Complex though this is, in its simplicity motherhood is incredibly powerful and influential. Infant behaviours are mediated by the pres-ence of mothering, responding to basic human needs such as warmth, food and touch. Albert Maslow’s (1943) humanist theory describes these basic human states as ‘deficiency needs’; these have to be met in order to function, the provision of food outstrips that of love. However, if food is regularly supplied but there is no human attention to love and emotional stimulation, there is a problem.
The pregnant woman is beginning to provide her unborn infant with its basic needs, she is eating for two, resting when advised and taking advantage of health services that will guide her and protect the well-being of baby. She may be unaware of her nurturing at this point but she is sending strong messages to her fetus that she cares and that she will provide all it needs.
Maslow’s (1943) Hierarchy of Needs
Origins of attachment in pregnancy
Antenatal care has become a rigorous screening event with evidence-based interventions that bind women to the service. The reduction of infant and maternal mortality has largely been ascribed to the success of antenatal screening and risk assessment-based care. It is no wonder that women are persuaded by antenatal care; we provide them with pictures of their unborn baby, which may even be put to music or screening tests that can predict a ‘perfect baby’. If women decide they do not want screening or some aspect of care we name them as ‘deviants’ or non-compliant; naming and shaming them
(Wolf 2001) There is no doubt that maternal/infant attachment begins its journey early in pregnancy. The physical changes of pregnancy are influenced by the hormonal and biochemical ebb and flow, which supports not only the changing body but also the psychological adjustments. Raphael-Leff (2001) theorises that the physical symptoms of pregnancy generate psychological interpretations by women such as resenting the fetus for making her nauseous or sick. She further describes pregnancy-related psychological experiences in three maturational phases as follows:
1. Phase one – ‘the emphasis is on the pregnancy; psychological man-ifestations are emotional disequilibrium, preoccupations with body image, food, telling others’.
2. Phase two – ‘emphasis shifts from the pregnancy to the fetus, now experienced as separate. She may be excited and fascinated by the movements and her visible body changes; she pats and soothes her fundus’.
3. Phase three – ‘the woman starts to visualise the baby existing outside of her body and she becomes preoccupied with the emotional and physical preparation for birth. The baby becomes real and shifts from an imaginary or fantasy infant. Primitive bodily anxieties emerge, which, if unresolved, may affect labour’.
A sense of knowingness emerges throughout pregnancy, a relation-ship that mother and fetus develop. This rapport is incremental as both observe each other’s pattern of activity and develop an appreci-ation of each other’s habits. It is well known that the fetus responds in utero to loud stimuli such as music and vibrations, but now we also understand the impact of maternal stressors and catecholamine biochemical surges upon fetal activity (Field et al. 2006). There is signif-icant evidence to show that persistent levels of stress hormones have a long-term impact upon fetal outcomes and consequently affect their childhood development (Gerhardt 2004).
Smoking in pregnancy is a good example – researchers have demon-strated that the fetus becomes agitated when a mother inhales a cigarette;
the theory is based upon the fact that during a smoking episode pla-cental oxygen level diminishes and therefore heightens fetal distress (Lieberman et al. 1992).
In response to stress chemicals, the fetus increases its movements;
however, if maternal anxiety continues, there is an expectation that there will be an increased prevalence of premature birth and that the fetus will suffer intrauterine growth retardation, and even mimic the mother’s prenatal biochemical/physiological profile including ele-vated cortisol, lower levels of dopamine and serotonin (Field et al.
2006).
Maternal anxiety to some degree is normal; its roots are found in a desire to be the ‘good mother’; however, the nature of modern childbearing could mean that women are exposed to significant stressors above that, which is considered normal. The ‘pregnancy police’ place a huge responsibility upon women whose every action is scrutinised and observed; any deviations are publicly confirmed (Forna 1998). This factor cannot help but interfere with the way a woman might perceive her pregnancy and fetus, ultimately determining the relationship she might have with her child.