Alexis Jaeger dissertation

The Institute for Clinical Social Work

Maternal Reverie and the Transition to Motherhood

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Alexis Jaeger

Chicago, Illinois February, 2020

Abstract

The purpose of this study was to provide a deeper understanding of the intrapsychic world of the new mother as illuminated through the analysis of her reveries from late pregnancy through the early postnatal period. The primary question explored was: How do we understand the meaning and content of maternal reverie for first time mothers? Six women amidst first-time transformations participated in three semistructured interviews, and were analyzed using Interpretative Phenomenological Analysis. The results yielded six core themes: 1. Visualization of birth and baby 2. Maternal preoccupation 3. Intergenerational meaning making and projection 4. Me-not-me: The conflicting emotional experience of new motherhood 5. Partnership and the transition from couple to co-parents 6. Felt sense of maternal identity through attunement These themes led to four primary findings of this study: First, the prominence of visualization, which the study contends is connected to the integration of maternal identity as well as preverbal infant-mother relating. Second, the inescapably intergenerational nature of this transition. Third, emergent motherhood as conflict ridden, relevant to issues of narrative coherence and attunement. And fourth, the role of traumatic events during the transition to motherhood and their influence maternal identity integration. ii

For my parents, my husband, and my children

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Acknowledgements

Deep gratitude to my committee members and personal mentors: Freddi Freidman for her wisdom and unwavering support and friendship, Michelle Sweet for generously offering her insights and research acumen, Paula Ammerman who has shepherded my entire ICSW journey, Erika Schmidt for contributing her expertise on child development and infant-mother relating, and Connie Goldberg for her willingness to lend her keen clinical eyes to this project.

AJ

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Table of Contents

Page Abstract..............................................................................................................................ii Acknowledgments.............................................................................................................iv Chapter I.

Introduction................................................................................................1 Statement of Purpose Significance for Clinical Social Work Statement of the Problem and Specific Objectives Research Questions Explored Definitions of Major Concepts Statement of Assumptions Epistemological Framework Foregrounding

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Table of Contents—Continued

Chapter

Page II.

Literature Review....................................................................................15 Introduction Relevant contributions of Classical Analytic Theories: Drive, Object Relations and Self Psychology The Psychological State of Pregnancy: The Psychological Transition to Motherhood Attachment Theory, Classical and Contemporary Intersubjective Theory

III.

Methodology.............................................................................................45 Introduction Research Sample Research Design Data Collection Data Analysis Ethical Consideration Issues of Trustworthiness Limitation and Delimitations Background of the Researcher

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Table of Contents—Continued

Chapter IV.

Page Findings.....................................................................................................63 Introduction Participant Descriptions How Do First Time Mothers Notice, Observe, Describe, and Relate to Their Personal Reverie?

How Does Maternal Reverie Shift and Change from the Prenatal Into the Early Postpartum Phase?

What Kinds of Fears, Wishes, and Other Mental Content Are Manifest in Maternal Reverie and How Do We Understand these in Relation to Becoming a Mother?

V.

Discussion and Implications of Findings.............................................196 Introduction Theoretical Implications Clinical Implications Limitations Indications for Future Research

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Table of Contents—Continued

Appendices A.

Page Informed Consent for Participation in Qualitative Research Study...........................................................................................236

B.

Recruitment Flyer..................................................................................239

C.

Phone Script And Questions for Initial Contact with Potential Participants.................................................................................241

D.

Journaling Instructions to Be Provided to Participants via Email Prior to First Set of Interviews.................................................243

E.

Interview Guides....................................................................................245

F.

Beck's Depression Inventory.................................................................249

References...........................................................................................................253

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Chapter I

Introduction Statement of Purpose From its inception, psychoanalytic social work and psychotherapy have been concerned with the legacy of early childhood relationships and experiences. Whether we are reconstructing a narrative with an adult patient or observing a child in the presence of their parent, the focus has more often been placed on the psychological and emotional experience of the child as subject. There has been less attention paid to the subjective, psychic experience of the emergent parent. Regardless of setting, the parent-child relationship, or the legacy of that relationship, impacts the work of clinical social workers. All people have attachment histories and their own idiosyncratic, preverbal relational beginnings.

The purpose of this qualitative study was to pursue a deeper understanding of a woman’s psychological transition from pregnancy into new motherhood as illuminated by the contents of her reveries from the prenatal into the early postnatal period.

Pregnancy was defined as gestation from 16 weeks to full term; early postnatal was defined as the first 12 weeks following the birth of an infant; reverie was defined as the experience of being lost in thought. This aimed to capture broadly a woman’s thoughts, feelings, anxieties and fears—her conscious, preconscious and subconscious mental content as it relates to herself, her partner if relevant, her baby, her own attachment

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history and the transition to motherhood. Interpretative Phenomenological Analysis was the qualitative methodology that was used in an effort to better understand the meaning of maternal reverie for first-time mothers from pregnancy into the early postpartum period.

Significance for Clinical Social Work The purpose of this study was to provide a deeper understanding of the intrapsychic world of the new mother as illuminated through the analysis of her reveries from late pregnancy through the early postnatal period. The analysis of the data compiled from the reveries of women undergoing the primal transformation to first-time motherhood, revealed an in-depth understanding of how a woman’s mental content and how she relates to this mental content reflect shifts in conscious and unconscious dynamics within the mother. Moreover, these results may help clinical social workers and other treatment professionals attend to these conscious and unconscious communications in clinical treatment with pregnant woman and families in the transition to parenthood and help to make use of them in order to better support families and their emergent relationships.

Statement of the Problem and Specific Objectives “The adult…cherishes his phantasies as his most intimate possessions, as a rule he would rather confess his misdeeds than tell anyone phantasies. It may come about that, for that reason, he believes he is the only person who invents such phantasies and has no idea that creations of this kind are widespread among other people” (Freud, S. 1908/1959, p. 145).

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Although Freud rarely touched directly on the topic of maternal or parental experience, he was, of course, a master of fantasy. This profound observation is indeed particularly salient in relation to maternal fantasy and reverie; pregnancy is at once a most ordinary and extraordinary state of affairs. While the pregnant woman may be aware of the routineness of her state, she also is singularly absorbed in her own idiosyncratic experience of it. All of human experience requires us to hold the paradox of our humanity—to be alive in bodies that we know will perish, to love knowing that implicit in love is loss, to build what will certainly be eroded in time. Growing and birthing another human being may be the most profound expression of hope and fantasy there is. It requires women to stand in this paradoxical, primal space and create not just a baby, but a new self—a mother self. As Joan Raphael-Leff so succinctly says, “We often tend to forget that the purpose of pregnancy is not merely to create a baby but to produce a mother” (1982, p. 3).

The purpose of this study was to describe and conceptualize the contents and course of maternal reverie in first-time mothers from pregnancy into new motherhood.

The stated objectives at the outset of the study were: 1. To observe and describe how maternal reverie shifts and changes in an effort to learn more about how this informs the psychic experience of becoming a mother.

2. To better understand the evolution of unconscious dynamics between mother and child as revealed by a mother’s description of her reveries.

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3. To observe shifts in women’s narrative account of their reveries, both content and coherence, in an effort to better understand what these shifts reveal about psychological dynamics.

4. To provide valuable insights, which can help clinicians better attend to patients specifically in this transitional space.

5. To provide valuable insights, which can help clinicians better attend to children and adults with early attachment wounds.

Research Questions Explored The objective of this qualitative study was to describe and conceptualize the contents and course of maternal reverie in first-time mothers from pregnancy into new motherhood. The goal was to produce a text that describes and conceptualizes the psychological shifts during this primal transformation as illuminated by a woman’s reflection on her own reverie. The primary question to be explored was: How do we understand the meaning and content of maternal reverie for first-time mothers?

Sub-questions include: 1. How do first time mothers notice, observe, describe and relate to their personal reverie?

2. How does maternal reverie shift and change from the prenatal into the early postpartum phase?

3. What kinds of fears, wishes and other mental content are manifest in maternal reverie and how do we understand these in relation to becoming a mother?

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Definitions of Major Concepts For the purposes of this study, the major concepts below were defined as follows: Attachment: Biologically-based bond between a child and their caregiver rooted in ensuring the child’s safety, security and survival (Cassidy, Jones, & Shaver, 2013).

Fantasy: According to the American Psychoanalytic Association, fantasy “refers to an imagined situation that expresses certain desires or aims of the imagining individual. It can occur at the conscious level, also known as a daydream, or unconsciously, sometimes referred to as phantasy.”

Intersubjective: In “An Outline of Intersubjectivity: The Development of Recognition” (1990), Jessica Benjamin states that Intersubjectivity “refers to that zone of experience or theory in which the other is not merely the object of the ego’s need/drive or cognition/perception, but has a separate and equivalent center of self” (p. 35).

Mental representation: Internalized, psychic construction, either conscious or unconscious; symbolic mental content representing external environmental objects of significance including self, others, and self-other constellations.

Prenatal: Before birth; during or relating to pregnancy.

Pre-verbal: Mental content, memories, experiences, states of being, which occur before the brain is able to create symbolic representation and therefore unable to store mental images and content verbally; preverbal communication is communication which occurs pre-language development.

Postnatal: The period following the birth of a child, generally about three months; maternal state of being following the birth of a child.

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Reverie: The experience of being lost in thought; thoughts, feelings, fantasies, private ruminations, imaginings anxieties and fears; conscious, preconscious and subconscious mental content.

Unconscious/preconscious/conscious: The unconscious is the part of the mind that stores thoughts, feelings, desires, fears, etc., that are repressed and generally inaccessible to the conscious mind; the preconscious is where mental content is stored outside of immediate awareness but easily accessible to the conscious mind; conscious refers to the mental state and mental content in individual’s full awareness.

Statement of Assumptions The following list of assumptions are drawn from clinical and theoretical research: 1. Psychodynamic psychotherapy fundamentally understands people as relational beings, embedded in both interpersonal and intrapsychic matrixes. A woman’s reverie, her internal world, is fueled by these relationships and their mental representations.

2. During pregnancy, the child-to-be becomes integrated into this matrix. “From the moment of birth, even during pregnancy, everything the infant (fetus) does is embedded in a maze of significance” (Brazelton, T., Cramer, B., 1990, p.

133).

3. We have long understood that the self emerges both spontaneously and in response to the specifics of care and attunement, among other things.

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4. The intergenerational transmission of unconscious dynamics and defenses has a profound intergenerational influence on attachment patterns.

5. “Mothers form an essential link in the carry-over from one generation to the next. Motherhood is a three-generation experience, accompanied by the revival of past conflicts and anxieties” (Pines, 1972, p. 411).

6. Pregnancy is a period of not only physical, but also mental and psychological preparation and transformation. “The psychological preparation, conscious as well as unconscious, is closely interlocked with the physical stages of a woman’s pregnancy” (Brazelton, T., Cramer, B., 1990, p. 17).

7. A mother’s own attachment history has a significant role to play as she develops an attachment relationship with her baby. “The caregiver’s perception of the child as an intentional being lies at the root of sensitive caregiving” (Fonagy, 1998, p. 140)”

Epistemological Framework Jonathan Smith has noted that in his “reviews of research on the psychology of pregnancy and the transition to motherhood…often the pathological has been stressed, at the expense of the ‘normal’” (Smith, J.A., 1999, p. 281). He goes on to note that thus far much of this research has been quantitative in nature, using questionnaires, structured interviews “and attempting to make causal statement linking independent and dependent variables” (p. 282). This study used a qualitative methodology in its effort to better understand the meaning of a normative phenomenon—the transition from pregnancy into new motherhood. Using a qualitative approach to research allowed for a methodology

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more closely aligned with depth-psychology and psychodynamic principles. In the analytic process, rather than a focus on diagnosis, the emphasis is on reflection and observation of emergent phenomena in dynamic and intersubjective exchange. Similarly, in qualitative research, hypothesis and meanings emerge as in-depth, complex data from interpersonal exchange are carefully analyzed.

This study used Interpretative Phenomenological Analysis (IPA) to explore the meaning of maternal reverie for first time mothers. “IPA researchers wish to analyze in detail how participants perceive and make sense of things which are happening to them” (Smith, J.A., Osborn, M., 2007, p. 57). The aim of this study was to analyze how firsttime mothers make sense of the psychological and physiological transition they are undergoing as illuminated by their reveries.

I conducted semi-structured interviews in conjunction with reflective journaling so that my data collection would be a dynamic and evolving process, as per the IPA method. “This form of interviewing allows the researcher and participant to engage in a dialogue whereby initial questions are modified in light of participants’ responses and the investigator is able to probe interesting and important areas which arise” (Smith, J.A., Osborn, M., 2007, p. 57). The process was emergent, as the phenomena and their related meanings emerged. IPA’s “commitment to the exploration of meaning and sensemaking” (Smith, J.A., Osborn, M., 2007, p. 54) made it ideally suited to exploration of maternal reverie.

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Foregrounding I graduated from SSA with a master’s in social work in 2005 and began working first as a caseworker and later as a clinician with adults with chronic mental illness and developmental disabilities. I found this work to be moving, challenging, frustrating, bewildering, at times hopeless and other times deeply gratifying. Building intimate relationships with people who have battled adversity, abuse, abandonment, and poverty, among many other tremendous challenges, provided me with insight into the profound impact of circumstances and trauma on an individual psyche. As a new social worker, learning to navigate clinical relationships was difficult. I found myself without adequate supervision working within systems and organizations technically designed to aid and serve, but often so bogged down in bureaucracy and layers of dysfunction the objectives of service were greatly obscured. I cared deeply for my clients, but I struggled to feel I was providing them with thoughtful, substantial care.

I soon realized I was in need of more training and education. This led me to ICSW. The four years of coursework truly were transformative for me. Through the program I found the mentorship and theoretical grounding I had been longing for. During that time I also became a clinical supervisor at my place of employment and started a private practice.

I place the time I spent at ICSW among the most formative experiences of my life—my worldview, reflective capacities and understanding of human beings were permanently altered. The psychoanalytically informed education and clinical supervision I received through ICSW heightened my understanding of the interpersonal and intrapsychic forces that shape development. I began to see more clearly, and in a

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theoretically grounded way, how early attachment history, relational beginnings and significant relational experiences shape who we become. This has been a guiding principle in my work as a psychotherapist in community mental health and private practice for the last decade and a half.

In 2011 I gave birth to my first son, Leo. I can frankly say that nothing has ever rocked me to my core like the experience of becoming a mother. I had many hopes and expectations about the ease with which I would care for my child. Without fully realizing it, I had presumed a tremendous amount of control and influence and was very unprepared for the colicky, intense and difficult-to-soothe baby I encountered. I felt overwhelming self-doubt and helplessness in the first months of my son’s life. I have spent a lot of time thinking about this with other mothers, in my own therapy, and with my husband. Perhaps conveniently, the experience of having a child gave me a new and heightened appreciation for endowment and disposition. In moments I found myself very defensive to any insinuation that it was my anxiety or something else I was doing that contributed to my son’s intensity. But in other, more private ruminations, I worried about how Leo’s birth, which involved a vacuum procedure and left him with hematomas for the first weeks of his life, might have damaged him. I worried we were doing something terribly wrong, or that he had inherited the exact wrong combination of genes. But mostly I just felt helpless, disoriented and not my usual in-control self. When people would say things like: “enjoy this sweet, snuggly time! It’s the best,” I’d wonder what on earth they were talking about—that picture did not reflect the experience I was having. While we hear a lot about postpartum depression proper, there is less discussion of the difficulty of

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the postnatal period as a developmentally appropriate response to a major life transition.

This subject has become of great personal and clinical significance to me.

In 2014, I had my second son, Peter. This time I birthed a totally different creature, which seemed apparent within minutes of his arrival. I felt an instant bond, love at first sight. A sense of connection that took years to emerge between me and Leo. Peter was calm, quiet and easily soothed. He almost never cried unless hungry, tired, or wet.

He smiled early and easily. And I finally understood what this sweet, snuggly experience was all about.

By the time my daughter Billie was born in 2018, I was already six years into my motherhood journey. I had had time to integrate my sense of myself as a mother. Unlike the complete disorientation I felt with Leo, or the euphoria I experienced with Peter’s arrival, when Billie was born, and in the first months of her life, I felt a sense of calm and ease. She was neither hard, nor easy. But I was able to take it all in stride and enjoy what I knew were fleeting moments in time with her.

Of course, there are many ways to think about the differences between a first child and a second or third. The most apparent is that with a first child parents have to become parents, whereas with subsequent children that transformation has already occurred. People often cite parental anxiety as the culprit for behavioral differences in first versus later children. But that doesn’t feel like the whole story to me. As the months and years have passed, I have gotten to know my children. While they are still quite young, I have come to appreciate these growing people for their distinct personalities.

Leo has held true as a fiery, deep, curious, sensitive and intense person. Peter on the other hand is easy going, naturally empathic, imaginative and intrinsically motivated to please.

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Like all things, there are positives and negatives to both these character constellations.

Billie who is still quite little, only two, is extremely social, funny, buoyant and feisty. The experience of being with her reminds me of both her brothers, but also has new and different quality to it.

Being a mother, and a mother to these three people in particular, has enriched and in some ways confused my perspective on how human beings are shaped and evolve.

Adding complexity to the ideas I took away from ICSW, in particular how relationships and experience shape character and worldview, I now pay more substantial attention to both endowment and fit between parent and child. I find myself thinking more deeply about transgenerational aspects of my connection to my children. While I certainly can’t deny the role that I, along with my children’s father, play in their development, I also have realized the very significant contribution each of my children make in shaping our connections and family dynamic.

In the last several decades a new era of parenting and mothering in particular has taken hold of the culture. While a more thoughtful approach to parenting is no doubt a good thing, and an appreciation for children as intentional beings is highly beneficial, even critical—new parents, naturally plagued by doubt, can be easily overwhelmed by the various and often conflicting messages about how to get it right. There is the Attachment Parenting movement, telling women to wear their babies all day every day, co-sleep and never let them cry; meanwhile others warn against co-sleeping as dangerous and reckless and sleep training gurus instruct letting babies ‘cry it out’ to get them sleeping through the night; RIE (Resources for Infant Educarers) emphasizes respect for children as if they are fully formed adults, meanwhile the positive discipline approach

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insists on firm limit-setting and instructive, kind discipline. There are countless message boards online of women from the highly anxious to the preachy, debating, dictating, and commiserating; Professional Instagrammers choreograph the perfect representations of their parenting and their beautiful children; parenting books, websites and blogs discuss developmental schedules, behavioral modification techniques and dogmatic philosophies.

While the best approach is probably to pick and choose who and what you listen to based on your own instincts about your child and family, without getting too bogged down in philosophes, this is easier said than done, especially for the fist-time parent.

As a psychotherapist, I have been trained to pay attention to the transferential communications between my patients and myself. I am practiced at examining the intersection between my patients’ and my contributions to evolving dynamics between us. I’ve learned that my impulse to recommend a book or resources or strategies to a client often has as much or more to do with such unconscious dynamics at play than it does with my sense that the patient’s needs can truly be best satisfied through worksheets or podcasts. I suspect that parenting books have served a similar function—holding my anxiety and helping me to tolerate the powerful, unconscious dynamics at work between my children and me.

Since becoming a mother I have become preoccupied with the unseen forces at work within my family and families in general. While I certainly have great respect for the vulnerability of children, I also now see more clearly their potential power to shape evolving relationships. I am curious about the early beginnings of these relationships; how preverbal communications evolve between parent and child. I want to know more about how a mother’s unconscious, preconscious and conscious narratives about herself

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and the world influence the foundational elements of this preverbal and deeply formative connection. I am interested in the projective processes at work within families, and how the intersubjective connection between parent and child is formed and contributed to by each player.

This project aimed to use maternal reverie as an avenue to learn more about the beginnings of intersubjective relating. I hoped to gain insight into how the birth of a child, and the months before and after, influence the conscious and unconscious dynamics at play. I listened carefully to each subject’s evolving narrative from prenatal to postnatal—I listened not just for content, but the form and quality of the narratives that emerged. Talking to women during transition to parenthood provided access to a rich, emotionally and psychically fertile landscape.

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Chapter II Literature Review

Introduction The psychoanalytic literature has been reviewed for relevant discussion of following thematic content: maternal reverie and fantasy; the psychological state of pregnancy; the psychological transition to motherhood/parenthood; attachment; unconscious communication/projective processes between mother/parent and child; intersubjective relating in infancy. These themes cast a wide enough net to capture literature relevant to the topic as well as research that is in line with or similar to the proposed study.

Relevant Contributions of Classical Analytic Theories: Drive, Object Relations and Self Psychology Freud spent far more time discussing the legacy of infantile conflicts from childhood on adults than he did the experience of actual infants or psychological processes involved in being a parent. He does however make a few direct remarks about parenting. In his paper “On Narcissism; An Introduction” (1914/1957), he instructs: “Parental love which is so moving and at bottom so childish, is nothing but the parents’ narcissism born again, which transformed into object-love, unmistakably reveals its former nature” (91). While Freud is making this statement to position his theory of

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narcissism as it manifests in adults, he is also alluding to unconscious processes that drive and shape parental attachment to children. He is suggesting that parents redirect their own narcissistic impulses and fantasies toward their children: “He (the parent) shall once more really be the center and core of creation—“His majesty the baby’ as we once fancied ourselves. The child shall fulfill those wishful dreams of the parents which they never carried out…at the most touchy point of the narcissistic system, the immortality of the ego, which is so hard pressed by reality, security is achieved by taking refuge in the child” (1914/1957, 91).

What is most often taken from these statements is the idea that people procreate in response to an unconscious wish for immortality. Freud was himself concerned with the imagined anxieties of castration or other unconscious vicissitudes of libidinal impulses, but he is also alluding to parental projection of fantasy onto the child, which sets the stage for later discussion of relational communication between parent and child in the earliest days and months of life.

Therese Benedek expands on these ideas in her 1959 paper “Parenthood as a developmental phase—a contribution to the libido theory.” While Benedek explicitly positions her insights as a contribution to drive theory, and her language maintains traditional analytic structures, she posits ideas about mutual influence between mother and child that foreshadow the intersubjective and neurobiological contributions of later decades. She begins her paper by stating: “In the symbiotic process, the mother is not only a giver, but also a receiver” (p. 390). She uses the term emotional symbiosis, which “describes a reciprocal interaction between mother and child which through the processes of introjection-identification creates structural changes in each of the participants.” (p.

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392). Benedek is suggesting that through introjection (unconsciously depositing feeling states and other mental content into another) and identification (unconsciously assimilating aspects partially or wholly of another’s ego into one’s own ego) and other primitive, non-verbal forms of communication, parent and child structurally influence one another.

Benedek asserts that in the process of becoming a mother, a woman regresses, stirring up preverbal memories, which activate “the infantile relationship with her own mother” (p. 396). This echoes Freud’s assertion of the parent’s lost narcissism of childhood that is projected onto the child. But Benedek sees it as a bidirectional process—not simply a one-way projection. “The Child’s fantasies reactivate in the parent the omnipotent fantasies of his own childhood…the parent, identifying with the current fantasies of the child, accepts the role of omnipotence attributed to him. The normal parent, in spite of his insight into his realistic limitation, embraces the gratifying role of omnipotence” (p. 409). Here she describes the unconscious and psychological processes which undergird the very real circumstances of infancy—the child is utterly vulnerable to and dependent upon her caretakers. At an unconscious level, both parent and child grapple with this power and omnipotence as they forge a real and reciprocal connection.

What is most interesting about Benedek’s theory is her assertion that the child, and a parent’s relationship with her child, is responsible for structural, psychic changes in the parent. “The intrapsychic processes which result from the interpersonal relationships through the course of the child’s development establish the object representations of the child as a part of the psychic structure of the parent” (p. 416). This leads to Benedek’s conclusion that parenthood is indeed a developmental phase, which forever alters the

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psychic structure of the parent. In her view it is the parent’s task to incorporate representations of the child and those of the self as parent into their psychic structure. A more contemporary perspective based in an updated two-person versus one-person psychology (to be discussed later in this review) would see these alterations as incorporating representations of the dyadic relationships rather than self/other representations. However, Benedek clearly seems to be laying the theoretical groundwork for the intersubjective and neurobiological infant-mother research to come and which is ongoing.

Also of note are the contributions of Object Relations theory to the discussion of maternal psychology and infant mother relationships. While Melanie Klein pioneered this theory and specific attention to preverbal communication, Donald Winnicott, who famously said, ‘there is no such thing as a baby [without a mother],’ pays specific attention to the caretaker and explicitly talks about maternal reverie and fantasy in his work.

Klein, like Benedek, saw herself as expanding upon Freud’s original theories, and while her ideas are a clear move towards a relational understanding of psychology, she retains drive theory within her work. The life and death instincts, and the derivative libidinal and aggressive drives, are at the core of her understanding of what motivates and organizes people. Klein “presents [the drives] as constitutional and universal” (Greenberg & Mitchell, 1983, p. 146) and according to Mitchell and Greenberg, her use of the term positions rather than stages is in fact a “redefinition of drives as relational patterns” (Greenberg & Mitchell, 1983, p. 143). However, the distinct patterns that emerge for each individual, in her view, are the product of constitutional endowments—biologically

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determined doses of life and death instinct. The aggressive and libidinal impulses that result shape how a person experiences herself in the world. Klein’s focus was on how these impulses shape primitive and preverbal communication from an infant in the earliest months of life and beyond. While she does not pay specific attention to the parent’s contribution to the unconscious and preverbal dialog, her ideas made a critical contribution to the theoretical establishment of this kind of communication.

For Klein, psychic conflict is created by the aggressive and destructive impulses and the resulting paranoid fear of retaliation because of these wishes engendered by the death instinct. This conflict is at the heart of what Klein calls the paranoid-schizoid position. This position must be passed through and resolved if a person is to reach the depressive position. “Paranoid refers to the central persecutory anxiety and schizoid refers to the central defense: splitting, the vigilant separation of the loving good breast from the hating bad breast” (Mitchell & Black, 1995, p. 93). As primitive anxieties arise out of the death instinct, the infant splits off the part of the self, thought to contain it, and projects it onto the bad object. In “A contribution to the theory of anxiety and guilt” (1948), Klein states, “the infant projects his destructive impulses on to the breast, that is to say deflects the death instinct outwards” (Klein, 1948, p. 4). She goes on to explain, “the frustrating (bad) external breast becomes, owing to projection, the external representation of the death instinct; through introjection it reinforces the primary danger situation; this leads to an increased urge on the part of the ego to deflect (project) internal dangers into the external world” (Klein, 1948, p. 4). The danger, both internal and external, is the fear of destruction of the good by the bad. Klein is concerned with what is projected from the infant onto the mother. These projections are viewed as drive

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derivatives and the result of fantasized threats and gratifications. A move to the depressive position requires the integration of good breast and bad breast and results in a whole other, which can be ambivalently related to—both loved and hated without fear of destruction.

Winnicott, also a pioneer of Object Relations theory, offers a departure from the drives and places his emphasis on the role of the actual caretaker. Rather than understanding the early experience of the infant as polarized by the competing death and life instincts, he views the infant’s experience and growth as mitigated by the reality of their early caretaking environment. Instead of the good and bad breast, Winnicott suggests that the infant experiences two different mothers, each serving a distinct function: the object mother that is the recipient of the infant’s instinctual drives and can be “treated ruthlessly” and the environment mother that provides the attuned, responsive holding environment (Greenberg & Mitchell, 1983, p. 204). Over time, it is the survival of the object mother, despite the infant’s aggression towards her, that “adds up…to the baby’s dawning recognition of the difference between what is called fact and fantasy, outer and inner reality” (Winnicott, 1975, p. 5).

It is the integration of these two mothers, through attuned caretaking, that results for Winnicott in the depressive position. He states, “Integration in the child’s mind of the split between the child-care environment and the exciting environment (the two aspects of the mother) cannot be made except by good enough mothering and the mother’s survival over a period of time” (Winnicott, 1975, p. 5). This integration, which Winnicott views as the central task of early psychic development (Greenberg and Mitchell, 1983, p.

205) is in his view not the work of the life instinct emanating from the infant, but rather

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the efforts of the actual caretaker and reciprocal exchange between caretaker and infant.

The “good enough mother,” as Winnicott terms the effective caretaker, through responsiveness and survival becomes whole for the baby, and also helps the baby to begin operating as a whole person.

No doubt owing to his concern for the actual caretaker, Winnicott paid particular attention to the maternal state of mind. As Daniel Stern (whose own significant contributions will be discussed) points out, “With the work of Donald Winnicott (1957, 1965, 1971) and Wilfred Bion (1963, 1967) among others, the fantasy life of the mother took on a special, even unique importance. Her reveries, her preoccupations, fantasies and projective identifications (as forms of representation) involving the baby became of great interest to psychic development of the infant. In fact the mother’s fantasies about her infant took on the status of one of the major building blocks for the infant’s construction of a sense of identity” (Stern, 1995, p. 20).

One of Winnicott’s most seminal contributions to this aspect of theory is his idea of Primary Maternal Preoccupation: It is my thesis that in the earliest phase we are dealing with a very special state of the mother, a psychological condition which deserves a name, such as ‘Primary Maternal Preoccupation’. I suggest that sufficient tribute has not yet been paid in our literature, or perhaps anywhere, to a very special psychiatric condition of the mother of which I would say the following things: It gradually develops and becomes a state of heightened sensitivity during and especially toward the end of a pregnancy. It lasts for a few weeks after the birth of a child. It is not easily remembered by the mother once she has recovered from it (Winnicott, 1956).

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Winnicott shares his astute observations of the psychological state for women in the transition from pregnancy to postpartum. His term, primary maternal preoccupation, is simple, elegant and evocative. And of course, he is correct in his assessment that it has not received adequate attention, certainly in 1956, but even today. He goes on to discuss his view that the mother’s function in her infant’s life cannot be fully understood without an appreciation that “she must be able to reach this state of heightened sensitivity, almost an illness, and to recover from it” (Winnicott, 1956). He is positioning his observations of the maternal state as developmentally appropriate—a necessary “illness” that facilitates the mother/child connection and the practical and psychological care of the infant.

Christopher Bollas presents related ideas in the first chapter of his book: The Shadow of the Object; Psychoanalysis of the Unthought Known (1987). He terms the early mother (the mother to the infant in the first months and years of life), “the transformational object” (Bollas, 1987, p. 4) and suggests that the adult’s search for transformation is rooted in the memory of this earliest relationship. “She both sustains the baby’s life, and transmits to the infant, through her own particular idiom of mothering, an aesthetic of being that becomes a feature of the infant’s self. The mother’s way of holding the infant, of responding to his gestures, of selecting objects, and of perceiving the infant’s needs, constitutes her contribution to the infant-mother culture” (Bollas, 1987, p.

13). Bollas goes on to suggest that the “preverbal ego memory” of the idiomatic experience of early care is sought by adults in “experiences of uncanny fusion with the object, an event that re-evokes an ego state that prevailed during early psychic life…the sense of being reminded of something never cognitively apprehended but existentially known…” (Bollas, p. 16). He offers art, music and natural beauty as examples of

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experiences that can evoke this sense of transformation—a sense of being magically understood and known. Much like Freud, Bollas is more interested in the legacy of the transformational mother on the adult subject. However, his idea that each mother has her own idiom of mothering that imprints on her child is beautiful and compelling.

A review of infant-mother relating would not be complete without some mention of the self-psychological point of view. Although a full elaboration of this school of thought is beyond the scope of this review, a brief mention of the foundational ideas put forth by its founder, Kohut, follows. I also make mention of the ideas of Miriam Elson.

Like Winnicott, Kohut understands the development of the self as taking place within the context of a relationship with an empathically attuned caregiver. In order to further make sense of how the self, and how self-structure emerge, he introduces the concept of selfobjects. These are caregivers, important others, “objects which we experience as a part of our self” (Kohut, 1978, p. 2) and are divided into two categories: mirroring selfobjects, “who respond to and confirm the child’s innate sense of vigor, greatness and perfection,” and the idealized parent imago, “whom the child can look up to and with whom he can merge as an image of calmness, infallibility and omnipotence” (Kohut, 1978, p. 2). The relative health or fragmentation of the self-structure depends upon the quality of interactions between the self and selfobjects in childhood.

Like Freud, Kohut is most interested in how these structures manifest in the adult subject. However, there are clear implications for the emergent infant-parent dyad. These ideas are also applicable when considering how a mother’s own childhood impacts how she becomes a self-object.

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Optimal provision of the mirroring and idealizing functions by attuned selfobjects allows the forming self to modify and integrate the self-structures that emerge along the developmental line of primary narcissism. According to self-psychological theory, “primary narcissistic bliss” is unavoidably disrupted by normal parental failures, which leads to the conversion of primary narcissism into two self-structures that parallel the selfobject functions: the idealized parent imago and the grandiose self. Gradual, age appropriate disappointments in and failures of the caretakers allow the individual to internalize the idealizing narcissism and transform it into ideals, and modify and integrate the grandiose self, resulting in ambitions. However, as Siegel points out, in the event of severe trauma it is possible that “neither of these two structures is integrated into the personality, resulting in both the perpetuation of the grandiose self’s archaic demands and in the idealized parental imago’s search for an idealized tension-regulating object” (Siegel, 1996, p. 63).

Elson (1984) offers further theoretical support for the idea of parenthood altering existing psychic structure from a self-psychological perspective. In “Parenthood and the Transformations of Narcissism” (1984) which draws on Kohut’s conception of narcissism, she suggests that in supporting the psychic structure of the infant, parental psychic structure is in turn altered. She terms this process a “double helix.” As she details, “the forming and firming narcissism in the parent is within the child and the further transformation of narcissism in the parents is essentially a twin process” (p. 299).

This perspective is relevant to this review, in large part because Kohut, and selfpsychology more generally, primarily understand health versus pathology as having to do with quality of relationships and caregiving in the earliest phase of life.

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The Psychological State of Pregnancy: The Psychological Transition to Motherhood In the 1970s, 1980s and 1990s a number of contributions were made to the discussion of maternal state of mind and the psychological conditions of parenting. Most notable for this study, are the works of Selma Fraiberg, Brazelton and Cramer, Daniel Stern, Joan Raphel-Leff and Myra Leifer.

The 1975 article “Ghosts in the Nursery; A psychoanalytic approach to the problems of impaired infant mother relationships” by Fraiberg, Adelson and Shapiro, vividly implores adequate attention be paid to the past repeating itself in the present. “In every nursery there are ghosts. They are the visitors from the unremembered past of the parents…Under all favorable circumstances the unfriendly, unbidden spirits are banished from the nursery and return to their subterranean dwelling place.” However, they go on to warn, “Even among families where the love bonds are stable and strong, the intruders from the parental past may break through the magic circles in an unguarded moment, and a parent and his child may find themselves reenacting a moment or a scene from another time with another set of characters” (Fraiberg et al, 1975, p. 387). What Fraiberg and her colleagues give voice to are the largely unconscious, unseen, psychological forces at work between parent and child and within families. Ghosts are the metaphoric representation of the powerful, often confusing dynamics that can lead parents to feel possessed and out of control with respect to their children, even infants.

Fraiberg, Adelson and Shapiro pose the question: “What is it then that determines whether the conflicted past of the parent will be repeated with his child?” (Fraiberg et al, p. 419). They explain that in their view morbidity or the presence of pathological people or relationships do not predict repetition. They suggest that repetition has to do with the

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defense of the identification with the aggressor developed by individuals in response to their own childhood trauma. “We are on sound ground clinically and theoretically if we posit that a form of repression is present in this defense which provides motive and energy for repetition” (Fraiberg et al, p. 419). They go on to suggest that defensive strategies that allow access to childhood pain deter repetition, while those based in repression and splitting are more likely to lead to repetition.

In their 1990 book, “The Earliest Relationship; Parents, infants, and the drama of early attachment” Brazelton and Cramer expand on Fraiberg’s work and place emphasis on pregnancy and the psychological preparation for the transition to parenthood. They directly state, “The psychological preparation, conscious as well as unconscious, is closely interlocked with the physical stages of a woman’s pregnancy…a parent-to-be needs to withdraw or regress in order to reorganize…[this] may carry them back to the struggles of ambivalent feelings of earlier adjustments” (Brazelton and Cramer, 1990, p.

17). They suggest that once the mother begins to recognize the fetus as a life, often following the first ultrasound, she can begin to identify with it and develop fantasies “based on her own infantile relationship to her own mother…this fantasied return to the womb allows for yet another working through of unfulfilled dependency needs and symbiotic wishes” (p. 21).

Brazelton and Cramer discuss in depth a mother’s imaginings of her baby, her fantasies as they progress throughout the pregnancy. “During the forty weeks of pregnancy, the growth of the fetus is paralleled by a progressive development in the mother’s image of the baby…this image is based on both narcissistic needs and yearnings and also on perceptions of the fetus’s development; quickening, activity, patterns of

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response. Thus, when the birth occurs the mother has long been prepared to cope with …a new relationship which will combine her own needs and fantasies and those of a separate being” (p. 29). They detail five tasks, which will face a mother at the birth of her child (p. 30): 1. An abrupt ending to the sense of fusion with the fetus, of the fantasies of completeness and omnipotence fostered by pregnancy.

2. Adapting to a new being who provokes feeling of strangeness.

3. Mourning for the imaginary (perfect) child and adapting to the characteristics of her specific baby.

4. Coping with fears of harming the helpless child.

5. Learning to tolerate and enjoy the enormous demands made on her by the total dependency of the baby.

According to Brazelton and Cramer, these tasks set in motion a transformation in the mother. “So pervasive is this upheaval, in fact, that it can resemble a transient pathological state…the result is a new maternal identification, a focusing of her affections, and an ability to acknowledge and adjust to an inescapable new reality” (p.

30).

Later in the book they go on to discuss the importance of meaning attribution and projective processes in mother-infant and parent-child relationships—which can be viewed as a continuation or evolution from earlier fantasies about the unborn child.

Brazelton and Cramer view meaning attribution to an infant’s behavior (the perception of intent, the projection or projective identification of motivational thoughts and feelings, etc.) as largely adaptive. “Subjective contributions made by parents to infant behavior are

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universal. While highly powerful in shaping interaction they are not pathological” (p.

134). However, “In pathological projections…parents endow a baby with characteristics that are totally at odds with the baby’s nature…Out of their own history, hidden scenarios emerge in which they act out an imaginary interaction with their infant” (p. 135).

Speaking from their clinical perspective, Brazelton and Cramer suggest that often “symptoms” in a child may be an expression of unconscious parental conflict (p. 135) owing to their view that “parents mold the infant’s behavior with reinforcement and inhibitions mediated by their own fantasies, expectations and inner conflict” (p. 136).

This seems to suggest that parental fantasy and projective communication are key elements of nurture. Echoing Fraiberg, they suggest, “while raising a child is indeed a creation, it is fueled by the re-creation of long-forgotten experiences” (p. 163).

Daniel Stern’s groundbreaking 1998 book, “The Motherhood Constellation; A unified view of parent-infant psychotherapy” combines analytic ideas, systems theory, and infant-mother research toward the end of positing and naming a psychological construct that he views as a normal part of mothering: the motherhood constellation.

Stern begins by detailing “the mother’s networks of schemas-of-being-with” (Stern, 1998, p. 21) which are parental/maternal representations that become activated in pregnancy. They include: schemas about the infant; schemas about herself; schemas about her husband/partner; schemas about her own mother; schemas about her own father; schemas about the families of origin; schemas about substitute parental figures (p.

21). Stern explains, “There is general agreement that between the fourth and seventh months of gestation there is a rapid growth in the richness, quantity, and specificity of the networks of schemas about the baby-to-be” (p. 23). Research shows that “the elaboration

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of the networks peaks at about the seventh month. The studies suggest that between the seventh and ninth months there is a kind of undoing of reported representations …the most plausible answer [as to why] is that mothers intuitively protect their baby-to-be and themselves from a potential discordance between the real baby and the too specifically represented baby. With the birth of the baby…many of the old schemas she held during pregnancy will reappear, but they will be varied and re-elaborated to fit the given reality” (p. 23). Stern suggests that this happens with second and subsequent babies, but typically with less intensity and less impact on the mother’s representational world.

Stern goes on to talk about maternal representations as a critical element in shaping not just the psychological but the actual behavior between mother and child.

“Our model insists that maternal representations can influence the observable maternal behavior with the baby; that is, they can be enacted…Maternal representation or fantasy cannot influence the baby magically. The baby cannot grasp the substance of the mother’s mental life except through her overt behavior …The mother’s fantasies and representations must first take a from that is perceivable, discriminable, directly influential and potentially meaningful to the infant. In other words, they must first be transformed into interactive behavior” (p. 41- 42). Stern then poses the question: How do we make sense of a continuity of meaning that passes from a mother’s representations, to her behavior with her baby, then from an infant’s experience to his own construction of a representational world? To get at this answer, Stern offers the motherhood constellation.

Stern states: “I am suggesting that with the birth of a baby, especially the first, the mother passes into a new and unique psychic organization that I call the motherhood constellation. As a psychic organizer, this “constellation” will determine a new set of

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actions, tendencies, sensibilities, fantasies, fears and wishes” (p. 171) According to Stern this state is temporary, and the duration is variable from months to years, but during that time becomes the dominant organizer of the mother’s psychic life. “The motherhood constellation is not seen as simply another variant or derivative of already existing psychic constructs [but] as a unique, independent construct in its own right, of great magnitude in the life of most mothers and entirely normal” (p. 171). Stern delineated three different but related preoccupations and discourses, both internal and external, that make up the psychic triad of the motherhood constellation: “The mother’s discourse with her own mother, especially with her-own-mother-as-mother-to-her-as-a-child; her discourse with herself, especially with herself-as-mother; and her discourse with her baby” (p. 172). This psychic triad is the foundation of the representational world, of each woman’s idiomatic motherhood constellation. He is careful to indicate, however, that he is “describing a phenomenon seen in Western postindustrial societies, and almost exclusively in the mothers of these societies” (p. 173).

Stern poses the question: Why is the mother’s mother the central parenting model to be followed or rejected? He invokes contemporary research on memory and cognitive neuroscience, which stress “the importance of the present remembering context” (p. 180).

Stern uses this idea to position the motherhood constellation as situational with the remembering context of the mother’s own infancy. “The present moment with all its feelings, sensations, perceptions, thoughts and contextual cues acts as the trigger…to activate many different memory networks” (p. 181). Stern refers to Selma Fraiberg’s observation (1980) that “the baby’s presence in the room elicits feelings and memories in the mother that would not have been evoked otherwise…The remembering context is

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made up of one person’s experience of both sides of the interaction or relationship as these occur simultaneously…the parts she experiences directly as a baby…and the parts of her mother’s experience…she experienced empathically” (p. 181).

Stern aptly observes that while a woman might have had plenty of experiences babysitting or being with younger siblings, nieces or nephews, or the children of close friends, “she has not until now been in a situation where empathic immersion and primary identification were fully needed and used” (p. 181-82). This a more dynamic and psychologically salient way of saying: “It’s different when it’s your own baby.”

Stern is also careful to indicate that this recalling and immersing in earlier, infantile experiences is not, in his view, an act of regression. “It is more simply the result of finding oneself in a powerful and pervasive present remembering context that has not been experienced since the early years of life” (p. 183) In the conclusion of his work, Stern discusses the clinical implications of his “motherhood constellation”. He explains, “The motherhood constellation has some features of a complex, of a psychic organization, of a specific life-span phase or issue, and of the mental organization created by an activated motivational system. We do not know the exact nature of this mental organization… [and await] further clarification [by] advances in cognitive neuroscience in collaboration with clinical sciences” (p. 185) Joan Raphael-Leff has written extensively on the psychological/dynamic aspects of pregnancy and maternity. In her 1982 article, “The Psychotherapeutic Needs of Mothers-To-Be” she outlines three major psychic tasks of pregnancy, which she sees as correlates to Mahler’s postnatal separation individuation phases: “a) achievement of emotional fusion with the fetus in early pregnancy; b) gradual differentiation of fetus and

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self after the quickening and c) progressive psychic separation of baby and mother, culminating in the physical separation at birth” (Raphael-Leff, 1982, p. 4). She indicates that in her clinical experience, women who cannot adequately make psychological use of their pregnancies tend to have corresponding troubles in their relationship with their child. “Those who are unable to achieve the early fusion in pregnancy find difficulty in early bonding and accepting the symbiotic relationship with the newborn. Conversely, women who have difficulty differentiating from the fetus after the quickening, tend to prolong the early symbiotic fusion with their infants beyond the appropriate phase” (Raphael-Leff, 1982, p. 4).

Raphael-Leff asserts that “a mother is not born with the birth of her child” (p. 3) but rather, her maternal state is gradually achieved through the emotional work of pregnancy. This leads her to wisely conclude: “It is imperative that psychotherapist and others concerned with the psychological wellbeing of parents and children begin utilizing the preparatory period of pregnancy prophylactically and therapeutically” (p. 11).

Myra Leifer’s 1980 work, “Psychological Effects of Motherhood; A Study of First Pregnancy” details the results of her intensive interviews with 19 women during the transition to motherhood. Among the many findings of this research is Leifer’s assertion that “it is important to distinguish between a woman’s response to her infant and to her maternal role” (1980, p. 230). She goes on to say, “As we have seen, it is entirely possible for a woman to relate lovingly to her infant, yet feel depressed, inadequate and anxious regarding the changes in lifestyle brought on by motherhood. We need more complex theories that can integrate the social, psychological and biological factors

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inherent in the transition to motherhood” (p. 230). Indeed. While the intervening 40 years of clinical and other research have certainly shed some light, this need remains.

Attachment Theory, Classical and Contemporary As a precursor to attachment theory, it is necessary to make mention of both Rene Spitz and Erik Erikson. Both Spitz and Erikson and made significant contributions to the study of infant-mother relating that serve as foundational to the evolving field of attachment theory.

Rene Spitz is notable for his early work on infant-mother relating. Spitz paid specific attention to the influences the baby received during pregnancy and activated during childhood. He emphasized the development from the child’s perspective. His influential studies comparing the outcomes for infants cared for in two orphanages under different conditions helped provide foundational ideas related to the “primary importance of the role of the mother and the mother-infant relationship interaction in a theory of developmental stages” (Fonagy, 2001, p. 55).

In his 1945 study, Spitz gathered his data from two orphanages, one in Argentina and one in Mexico. In both settings, the children’s basic needs were met. The infants at the Mexican orphanage had regular contact with their mothers and were breastfed. The infants in the Argentinian orphanage, however, had no contact with their mothers, were bottle fed, and received no intimate care physically or emotionally. Spitz found that while the infants in the Mexican orphanage were generally healthy physically and developmentally, the infants in the Argentinian orphanage suffered from what Spitz called hospitalism, and a surprising percentage of these babies eventually died. This and a

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number of his other “observational studies demonstrated ways in which constitutional, early environmental, and interactional factors all contributed to the structuring of the selfregulatory process leading to adaption or maladaptation” (Fonagy, 2001, p. 56).

Erik Erikson is also noteworthy for the attention he paid to infant mother relating in his seminal stage model of development. As Fonagy points out, Erikson “should be credited for being the first person to expand the problematic erotogenic zone model of Freud” (Fonagy, 2001, p. 57). In contrast to the drive model, viewing gratification of biological needs as the primary motivating factor of infant mother relating, Erikson posits “basic trust [as] the mode of functioning of the oral stage” (p. 58). Erikson’s names his Stage One (infant-18 months) as the stage of trust versus mistrust. He views the interactions between infant and mother as the vehicle through which this primary task is to be achieved, and in Erikson’s view the resolution of this first stage of development has implications for all later stages. Fonagy asserts that, “the most important link made by him [Erikson] was between trust and identity, which…draws on the notion of coherence so central to Mary Main’s framework of attachment” (p. 61). Further discussion of attachment theory follows.

John Bowlby, the originator of attachment theory, developed his ideas over years of observing the impact of loss and separation on infants, children, and adults (Bowlby, 1958). Bowlby began his training under Melanie Klein, but ultimately rejected her notion of biologically based, constitutionally endowed drives as the primary determinant of psychological health and development. Through his work at the Tavistock Clinic, Bowlby developed his belief that the quality of the attachment relationship between child and primary caregiver is a determining factor in relative health versus pathology.

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“Bowlby was dissatisfied with the prevailing views in the first half of the twentieth century concerning the origins of affectational bonds…[which were that] the emotional bond to the primary caregiver [was a] secondary drive, based on the gratification of oral needs” (Fonagy, 2001, p. 6). As Fonagy points out, “Bowlby’s critical contribution was his unwavering focus on the infant’s need for an unbroken (secure) early attachment to the mother. He thought that the child who does not have such provision was likely to show signs of partial deprivation—as excessive need for love or for revenge, gross guilt, and depression—or complete deprivation—listlessness, quiet unresponsiveness, and retardation of development” (Fonagy, 2001, p. 7).

Bowlby’s ideas were unpopular, controversial and not well received by the psychoanalytic community at the time (Palombo, Bendicksen, & Koch, 2009, p. 288).

Despite this, he originated seminal concepts that endure such as proximity seeking, attachment figure, secure base and internal working models. Bowlby eventually placed his observations of children’s reactions to separation from primary caregivers into a progressive framework: protest, despair, detachment. (Fonagy, 2001, p. 7).

Protest, which “begins with the child perceiving the threat of separation, is marked by crying, anger physical attempts at escaping and searching for the parent” (p.

7). This lasts up to a week and intensifies at night. Despair follows protest; this phase is marked by detachment, withdrawal, and hostility, and during which the child “appears to enter a phase of mourning for the loss of the attachment figure” (p. 7). The final phase of detachment is marked by a general return of sociability with other children and adults, but a child who reaches this stage “will behave in a markedly abnormal way” (p. 7) if reunited with their lost attachment figure.

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For Bowlby, attachment behaviors were seen as a part of a behavioral system with inherent motivation. This is a large part of why his ideas were so controversial at the time—they stood outside the drive model. However, he attempted to make a connection to object relations theory with this idea of Internal Working Models. This was later meaningfully expanded upon by the research of Maine and Ainsworth, Fonagy and others. Bowlby posited a representational system underpinning attachment and attachment behavior. In this view, the quality of attachment experiences and bonds has a direct correlation with an internal system of expectations for attachment figures and care, which in turn influences behavior. The theory of Internal working models suggests that our relationships with our caregiver in the first years of life set up lifelong expectations and patterns of relating to self and others.

Mary Ainsworth worked with Bowlby to develop research strategies to test his theories (Ainsworth et al., 1978). This strange situation test which has been replicated over several decades and is very well established, lead to the development of assessment tools that measure the quality of attachment between child/parent dyads, in addition to later research by Mary Maine on adult attachment patterns which resulted in the AAI (Adult Attachment Inventory) assessment tool.

Ainsworth’s “strange situation” study was a method developed to categorize attachment styles of children with their caregivers. In this study, reunion behavior with the caregiver was evaluated following two brief periods of separation. Initially three categories were defined, but later expanded research by Mary Main established a fourth category of attachment: 1. secure; 2. avoidant; 3. anxious-ambivalent; 4. disorganized.

Securely attached children were able to initiate contact with their caregiver upon reunion,

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were easily soothed if distressed, and able to return to independent play. Avoidant children ignored their caregiver upon reunion and did not seek them out for comfort.

Anxious-ambivalent children sought out their caregivers, but had difficulty being soothed and could not reengage with play. Disorganized attachment was used to describe children who did not fit into any of the other categories. These children tended to exhibit bizarre, erratic, conflicting behavior. Main and Hesse have suggested that in these cases, “the parent’s frightening, fearful, or disorganized behaviors create a state of alarm or ‘fright without solution’ which is the experiential source of this unusual and disturbing disorganization response” (Seigel, D., Hartzell, M., 2004, p. 129).

According to Fonagy, “The secure pattern of distress at separation and reassurance by the reunion is thought to reflect an internal working model characterized by confidence that the caregiver will be comforting. The avoidant pattern is thought to indicate an infant’s lack of confidence in the caregiver’s availability, leading to a strategy of trying precociously control or down-regulate emotional arousal…anxious-ambivalent, who show distress at separation but are not comforted by the caregiver’s return, appear to have adopted the strategy of exaggerated or up-regulating affect in order to secure attention. The disorganized infant seeks proximity to the mother in strange and disoriented ways” (Fonagy, 2001, p. 20).

Main and her colleagues further expanded this research by allowing for the application to attachment patterns and representational schemas of adults with the Adult Attachment Inventory. “Bowlby’s model provides the background for transgenerational studies which demonstrated a strong association between the child’s security of attachment and an assessment of the caregiver’s internal working model…the interview

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is designed to elicit the individual’s account of his or her childhood attachment and separation experiences, and the individual’s evaluations of the effects of those experiences on present functioning” (Fonagy, 1996, p. 68). This research showed that a parent’s mental representation or internal working models of attachment relationships directly influence their child’s security of attachment. Main (1991) proposed that differences in attachment organizations during childhood are strongly linked to the quality of metacognition of the parent and that “incoherent adult narratives indicating poorly structured multiple models of attachment relationships may be a key cause of the child’s insecure attachment” (Fonagy, 1996, p. 73).

Fonagy’s research focuses on the reflective capacities of caregivers, operationalized as awareness of mental states in self and other, as critical for infant security and ability to develop these same capacities. His concept of the interpersonal interpretive mechanism, which develops out of the attachment system, describes the developed capacity that allows people to view themselves and others as intentional beings. His related idea of mentalization is essentially the awareness of others as having separate minds. “The reflective function is a crucial aspect of the interpersonal interpretive mechanism, a unique human quality necessary to process and interpret interpersonal experience and make sense of it” (Fonagy et all, 2002).

Ammaniti and Gallese (2014) review Fonangy’s research and his concept of mentalization in connection with early infant mother relating. They state, “Integrated mothers are capable of keeping their yet unborn baby in mind…they are able to have a differentiated psychic image of the baby…attributing emotions and intentions to him or her, trying to give a sense to and interpret the child’s moments” (2014, p. 52-53)

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Ammaniti and Gallese speculate that this is a function of mentalization. Fonagy’s research highlights that maternal apprehension of a developed reflective function, as demonstrated by coherence of narrative, relates directly to the ability to appropriately attune to the infant at birth. “This capacity has great relevance for the mother, as well as for the relationship with her own child… the mother’s capacity to hold in her mind a representation of her child as having feelings, desires, and intentions allows the child to discover his own internal experience via his mother’s representation of it” (2014, p. 5353).

Arnott and Meins (2008) have conducted research concerning maternal mindmindedness (defined as “mothers’ tendency to focus on their children’s mental qualities, rather than their physical characteristics or behavior” (Ammaniti, Gallese, 2014, p. 54) during the pregnancy and postpartum. In this research, parents are asked during pregnancy to describe their child at six months of age, post-birth. “The expectation was that parents who were more able to recognize the child as a separate being during pregnancy would give a better prediction of the child at six months [while] parents less able to recognize the child a separate person would be less capable…(p. 54). The evidence from this research indicated that mothers able to provide a more coherent and elaborated description of their child while pregnant received higher “scores for appropriate mind-related comments” during mother-infant observations at six months post-partum. As Ammaniti and Gallese conclude, “This study emphasizes the importance of the maternal capacity during pregnancy to represent the fetus as a potential and intentional child for future parental mind-mindedness” (p. 54).

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Ammaniti and Gallese conclude their work with a 1951 quote from John Bowlby written in Maternal Care and Mental Health: “Just as children are absolutely dependent on their parents for sustenance, so in all but the most primitive communities, are parents, especially their mothers, dependent on a greater society for economic provision. If a community values its children it must cherish their parents (p. 84)” (2014, p. 177).

Intersubjective Theory A review of the literature regarding infant-mother relating would be remiss to not include the intersubjectivist point of view. While a full exploration of this school of thought is beyond the scope of this review, I have selected Benjamin and Beebe and Lachmann as prominent voices that are highly relevant.

The infant mother research of Beebe and Lachmann made many significant contributions to this field. One very important idea to come out of their work is that of mutual influence between parent and child, which hearkens back to the earlier work of Theresa Benedek and her assertions regarding bidirectional influence and structural change for both parent and child. Beebe and Lachmann take a more systems approach to analyzing mother-infant interaction: “Mother and infant generate ways of experiencing each other in the early months of life. How is this experience organized and how it is represented? ….These interaction structures are characteristic patterns of mutual influence, which the infant comes to recognize and expect. The dynamic interplay between infant and caretaker, each influencing the other to create a variety of patterns of mutual regulation, provides one basis for the representations of self and other” (Beebe, B., Lachmann, F.M., 1988, p. 4). They go on to explain, “Mutual influence refers to a

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communication process in which influence flows in both directions: Both mother and infant systematically affect, and are affected by, the other” (p. 4). Beebe and Lachmann are careful to clarify that mutual does not imply equal influence, and measure and manner of influence between the partners need not match, but that each contributes to regulating the behavior of the other.

The findings of infant research, which use the language of interactive action patterns, require a shift from the traditional use of representation as self/object representations to one more focused on representations of patterns of relating: “This definition of representation also shifts the focus from the traditional psychoanalytic concern with a representing oneself as clearly delineated from the other, to a concern with a representation of the relationship, that is, a representation of self-with-other, of how the self and other are interrelated in a constant dynamic experience” (1988, p. 8).

Beebe and Lachmann observe “various kinds of sharing, matching, ‘tuning in’ and ‘being on the same wavelength’ exist in the mutual influence structures of the first six months of life and can be considered to constitute the precursors of empathy” (p. 8). They posit that the “implication of this interactive process model of representation is that experiences of self and other are structured simultaneously. The origins of representation of the self are inextricably linked to representations of the other” (p. 20).

Both Beebe and Lachmann and Benjamin refer to Sander’s work from a regulatory systems perspective. Sander (1983) considered his conceptualizing the organization of experience from a systems point of view to be consistent with much psychoanalytic writing: Hartmann (1939), Erikson (1950), Spitz (1965), Winnicott (1974), Sullivan (1953) and Atwood and Stolorow (1984). “Sander and his co-workers

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have proposed that a basic regulatory core jells in the early weeks of life in relation to the caretaking environment” (Beebe, B., Lachmann, F.M., 1988, p. 5). This seems to suggest that mutual influence is impacted by state of mind, and thus attunement can be influenced by relative distraction versus engagement. What is being measured in these empirical studies is observable behavior, but this raises questions about the unconscious aspects of mutual influence and how we might think about the psychological underpinnings of this observable behavior.

Benjamin suggests the intersubjective lens as a way to explore these critical questions. In her 1990 article “An Outline of Intersubjectivity” Benjamin positions this theory as “deliberately formulated in contrast to the logic of subject and object that predominates in Western philosophy and science. It refers to that zone of experience or theory in which the other is not merely the object of the ego’s need/drive or cognition/perception, but has a separate and equivalent center of self” (p. 35).

Benjamin focuses on separation-individuation theory through the intersubjective lens, citing the significant contributions of Stern and Winnicott. Her ideas also seem to directly connect with Fonagy’s research regarding mentalization and reflective functioning. “Separation-individuation theory focuses on the structural residue of the child’s interaction with the mother as object; it leaves the aspects of engagement, connection, and active assertion that occur with the mother as other in the unexamined background” (1990, p. 36). She goes on to say, “This perspective is infantocentric, unconcerned with the source of the mother’s responses, which reflect not only pathology or health…but also her necessarily independent subjectivity. It also misses the pleasure of the evolving relationship with a partner from whom one knows how to elicit a response,

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but whose responses are not entirely predictable and assimilated to internal fantasy” (1990, p. 36).

Benjamin poses these questions: “How does a child develop into a person who, as a parent, is able to recognize her or his own child?” What are the internal processes, the psychic landmarks, of such development? Where is the theory that tracks the development of the child’s responsiveness, empathy and concern and not just the parent’s sufficiency or failure?” (p. 36). While some might point to attachment theory or mentalization as ways to explore and answer these questions, Benjamin suggests that the intersubjective perspective amplifies separation-individuation theory. “By focusing on affective exchange between parent and child and by stressing the simultaneity of connection and separation… connection and separation form a tension which requires equal magnetism of both sides” (p. 36).

This notion of separate but still connected echoes object relations theory, the ambivalence of Winnicott or the depressive position of Klein. Benjamin explains, “The need for recognition entails this fundamental paradox: In the very moment of realizing our own independent will, we are dependent on another to recognize it…At the moment when we understand that separate minds can share similar feelings, we begin to find out that these minds can also disagree” (p. 36.). Here is the beginning of intersubjective relating, in this view, an achievement that is necessary for attuned caregiving. From the standpoint of intersubjective theory, “The ideal resolution of the paradox of recognition is for it to continue as a constant tension between recognizing the other and asserting the self” (p. 39).

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Becoming a mother, birth, is a creation. But also a destruction, the destruction of the fantasy baby and the fantasy mother. According to Benjamin, “All fantasy implies the negation of the real other, whether its content is negative or idealized…the ongoing interplay of destruction and recognition is a dialectic between fantasy and external reality” (p. 44).

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Chapter III

Methodology Introduction This qualitative study was designed to describe and conceptualize the contents and shifts of maternal reverie in first time mothers from pregnancy into the early postnatal period. The primary question to be explored was: How do we understand the content and meaning of maternal reverie for first time mothers?

The study employed Interpretative Phenomenological Analysis (IPA), which is a form of phenomenological inquiry developed by Smith, Flowers, and Osborn (2009).

This methodology was used to explore and analyze the narrative accounts from a small number of respondents, in order to produce a text that describes and illuminates the contents and meanings of reverie for first time mothers.

Epistemology is fundamentally concerned with ways of knowing, how we know what we know. Epistemology provides us with “theories of knowledge that justify the knowledge building process that is actively or consciously adopted by the research�

(Gringeri, Barusch, Cambron, 2013, p. 55). The epistemological position of constructivism, as with qualitative research, stresses the social construction of reality, whereas quantitative research is located within an objectivist realist paradigm (Denzin &

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Lincoln, 2000). Social constructionists view interaction between researchers and participants as open, understanding, and expansive.

The qualitative method of phenomenology is explicitly intersubjective and dialogic in nature, “The participants are trying to make sense of their world; the researcher is trying to make sense of the participants trying to make sense of their world” (Smith, J.A., Osborn, M., 2007, p. 53). The researcher must remain in dialogue with the participant in order to make valid, co-constructed, interpretive meaning of the observed phenomena.

The qualitative phenomenological methodology used for this study was Interpretative Phenomenological Analysis (IPA), following from Smith, Flowers, & Larkin (2009). There are three major theoretical underpinnings of IPA: phenomenology, hermeneutics, and idiography.

“Phenomenology is a philosophical approach to the study of experience” (Smith et al., 2009, p. 11). Smith, Flowers and Larkin identify four major phenomenological philosophers that meaningfully contribute to the perspective of IPA: Husserl, Heidegger, Merleau-Ponty, and Sartre.

Husserl viewed phenomenology as a means of careful examination of the human experience—he was fundamentally concerned with identifying the essential qualities of that experience (p. 12). “For Husserl, phenomenological inquiry focuses on that which is experienced in the consciousness of the individual” (p. 13). Although he was trained as a scientist and a philosopher not a clinician, Husserl was concerned with the way psychology was beginning to identify as a natural, rather than a phenomenological, science (p. 15). Most importantly, “Husserl’s work has helped IPA researches to focus

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centrally on the process of reflection… the attentive and systematic examination of the content of consciousness, of lived experience, which is the very stuff of life” (Smith et al., 2009, p. 16).

Heidegger’s work represents a move toward a hermeneutic, existential emphasis in phenomenological philosophy. In his major work, Being and Time (1962/1927) he is “concerned with the ontological questions of existence itself, and with the practical activities and relationships we are caught up in” (Smith et al. 2009, p. 16). The main ideas that IPA researches take away from his work are that “human beings can be conceived of as ‘thrown into’ a world of objects, relationships and language; secondly that our being in the world is always perspectival, always temporal, and always ‘inrelationship-to’ something” (p. 18). Thus, interpretation and meaning making is central to phenomenology.

Merleau-Ponty also emphasizes the interpretative nature of our knowledge, but more specifically our embodied, perceptual way of making sense of things. In his view, “the lived experience of being a body-in-the-world can never be entirely captured or absorbed, but equally, must not be ignored or overlooked” (Smith et al. 2009, p. 19).

Sartre “extends the project of existential phenomenology” (p. 19). He views the self as ever-evolving, rather than a pre-existing entity, placing the emphasis on process and becoming. Sartre echoes Heidegger’s emphasis on the worldliness of our experience, but extends it to the social, relational embeddedness of our experience (p. 20).

The second significant theoretical underpinning of IPA is hermeneutics.

Hermeneutics is the theory of interpretation. Heidegger explicitly viewed phenomenology as a hermeneutic, interpretative endeavor. One important idea in hermeneutic theory is

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that of the hermeneutic circle. This concept is “concerned with the dynamic relationship between the part and the whole…it describes the process of interpretation…and speaks to a dynamic, non-linear style of thinking” (Smith et al., 2009, p. 28). As Smith and Osborn point out, “IPA is intellectually connected to hermeneutics and theories of interpretation…IPA combines an empathic hermeneutics with a questioning hermeneutics” (Smith, J.A., Osborn, M., 2007, p. 53).

The third foundational principal of IPA is ideography, which is a focus on the particular details of individual experience. “Ideography is an argument for the focus on the particular, which also leads to a re-evaluation of the importance of the single case study” (Smith et al., 2009, p. 32). Smith advocates for smaller sample size in research, with an emphasis on depth rather than breadth in research findings. “IPA is a suitable approach when one is trying to find out how individuals are perceiving the particular situations they are facing, how they are making sense of their personal and social world” (Smith, J.A., Osborn, M., 2007, p. 55). This element of IPA allowed me to analyze the depth experience of each participant toward the end of generating themes to compare and contrast and ultimately construct a narrative text that illuminated meaning.

The intent for using IPA for my study was to explore the meaning of maternal reverie for first-time mothers. From the hermeneutical frame of IPA, this study aimed “to make sense of the participant who is trying to make sense of what is happening to them” (Smith, et al., 2009, p. 3). The subjective experience of each individual participant was explored through a dynamic, depth-oriented, interpretative process. The final IPA narrative data “represent[s] a dialogue between participant and researcher and that is

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reflected in the interweaving of analytic commentary and raw extracts” (Smith et al., 2009. p. 110).

Research Sample Purposive sampling was used to recruit women pregnant for the first time for this study. This method of sampling involved selecting participants according to the needs of the study (Moustakas, 1994). “Purposive sampling finds a more closely defined group for whom the research will be significant” (Smith, J.A., Osborn, M., 2007, p. 56). Smith and Osborn indicate that their current thinking on the ideal size for students doing IPA research for the first time is a sample size of three (p. 57).

The intended sample size for this study was six to eight participants. The final study had six participants. IPA views this range as sufficient for in-depth engagement with each case while also allowing for a “detailed examination of similarity and difference, convergence, and divergence” (Smith et al., 2008). In order to be usable for the study, all subjects had to participate in both the prenatal and postnatal interviews.

Participants ranged in race, socioeconomic background, and other demographics.

However, the majority of the participants in this study were Caucasian, which is a limitation of to be discussed in the findings. Participants ranged in age from 29-37. All participants were pregnant for the first time. All of the participants in the study were partnered in heterosexual relationships with the father of their child, and five of the six were married. This is another limitation to be discussed in the findings. All of the participants lived in Los Angeles.

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Clinically significant anxiety, depression or other major mental illness were an exclusionary criterion for the study. These were screened for by inquiring in phone survey if the potential participant had ever been hospitalized psychiatrically or participated in an intensive mental health treatment program. The BECK inventory was also administered once the participant had agreed to be a part of the study. Individuals with scores over 20 were to be eliminated from the study, although this did not come up.

One participant did reveal a significant history to depression and childhood trauma during the first interview but was in an active psychotherapy and stable at the time and therefore was kept in the study.

Research design Once the Institutional Review Board approved the study and the proposal hearing was passed, the following steps were taken to conduct the research: 1. Study flyers were distributed, which included the following information: -Name and address of the investigator -Purpose of the research -A summary of the criteria that will be used to determine eligibility for the study -The time or other commitment required of the subjects -The location of the research and the person to contact for further information 2. Study flyers were distributed via email to the following recruitment sources: prenatal yoga studio; prenatal acupuncturist and massage therapy office; midwives offices; friends, acquaintances and colleagues. I also sent a recruitment email to local list-serve of area mothers and mothers-to-be.

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3. When potential participants contacted me regarding the study the following script and questions were used as a foundation to determine their eligibility for the study: Hello, my name is Alexis Jaeger - I am a PhD candidate at the Institute for Clinical Social Work. I am conducting a research study about the transition to motherhood and maternal reverie. I’m interested in talking to women who are pregnant for the first time about the thoughts and feelings they find themselves having now that they are pregnant-- about their baby, the changes they are going through and process of becoming a mother. I have just a couple of questions to ask you if you have a few minutes—all are completely voluntary.

Phone Survey Questions: 1. Are you currently pregnant for the first time?

2. When are you due?

3. Would you be willing to participate in three in-person interviews? The first when you are between four and six months pregnant, in person and lasting about an hour; a second follow-up interview when you are eight or nine months pregnant, this interview will be done in person or by phone and last up to an hour; a third and final interview in first three months after your baby is born, in person and lasting about an hour?

4. Would you be willing to participate in a journaling exercise prior to the first interview?

5. Have you ever been hospitalized psychiatrically or been in an intensive mental health treatment program?

6. Would you be willing to take a quick 21 question survey that assesses your mood?

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If the answers to questions 1-4 and 6 were yes, more contact information was gathered so that informed consent could be sent. The consent was reviewed and signed in-person before the initial interview began.

4. Subjects participated in three, semi-structured, in-person interviews.

Each

interview lasted approximately one hour and was conducted in a private space of the participants choosing: the participant’s home, my office, or a comparable, agree-upon space.

The first interviews took place when the participant was between her fourth and sixth month of pregnancy. The reason for this was that research indicated that a woman’s fantasy and reverie increases after she can feel her baby’s movement (usually when she is between 14 and 20 weeks pregnant).

The second interview took place in the third trimester, when the participant was in her eighth or ninth month of pregnancy. This interview was a followup to the first interview, intended to build rapport with the subjects over time and capture potential shifts in reverie later in the pregnancy. The third and final interview took place in the early postnatal period, within the first three months after the baby was born.

Participants were asked to engage in a journaling activity prior to the first interview to help alert them to what to pay attention to and reflect on in preparation for the interview. The intent of this activity was to orient the participants to the nature of the research. Participants received specific instructions asking them to attend to their experience of reverie and were then asked to spend time journaling about these observations during the week

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prior to the interview. Participants were asked to bring their notes to the interview to aid discussion.

5. Throughout the interviews, I conducted my own reflective journaling.

Reflective journaling was done following interviews and during the data analysis process and contributed to the quality and validity of the IPA process through the use of “interpretation and bracketing as a reflective mechanism�

(Vicary, Young, & Hicks, 2016). Of note is that I was myself pregnant and had a child during the preparation of the proposal for this project. I made efforts to attend to my maternal reveries throughout to increase my own selfreflection and capacity for listening.

6. Interviews were recorded and transcribed following each interview in an effort to best capture the data and engage with the emergent dialogue between researcher and participant.

7. Consultation with my committee chair and other committee members took place throughout the interviewing and data analysis process in an effort to better reflect on my own contributions to the process.

8. In addition to the above protocol, following data analysis and the writing phase, participants were provided a list of quotations used in the data presentation and provided the opportunity to give feedback for member verification. This increased the validity of the data.

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Data Collection The aim of this IPA research study was to use the data collected to produce a text that illuminates the meaning of a maternal reverie for first-time mothers. Using the IPA method, I gathered data using semi-structured interviews. These rich, detailed, personal accounts of individual experiences were used to explore meaning. My goal was not simply to retell the narrative of the participant, but rather to understand and interpret meaning from an explicitly psychological stance.

The advantage of the semi-structured interview is that they “facilitate rapport/empathy, allow a greater flexibility of coverage and allow the interview to go into novel areas, and tend to produce richer data” (Smith, J.A., Osborn, M., 2007, p. 59).

Participants were provided journaling instructions via email prior to the first interview. All three interviews were conducted using brief, flexible interview guides.

Journaling instructions were provided to participants via email prior to first set of interviews: In advance of our interview next week, I am asking that you spend some time reflecting on your reverie and journaling about what you notice. Reverie is the experience of being lost in thought, what people might call ‘day-dreaming.’ This can include thoughts, feelings, wishes, hopes, fears, anxieties etc. Please spend some time tuning-in during the moments when you are lost in thought—your moments of reverie.

What do you find yourself thinking about while you’re driving, while in the shower, as you’re waiting in line, or while you’re trying to fall asleep? When you are trying to focus and realize your mind has wandered, where does it wander to?

Other things to consider: What kinds of thoughts and feelings have you noticed since becoming pregnant? What things do you find yourself wishing for, preoccupied with, or worried about? Have your noticed different people or places entering into your reverie lately?

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You do not have to write in full sentences and don't worry too much about logic, grammar or spelling. Try to write with as little judgment as possible—focus on what you observed and/or felt and if you find that judgment creeps in you can note that as you are writing. There is no right or wrong, I am simply interested in what you find to be on your mind.

Please spend approximately 30 minutes journaling about what you notice throughout the week. You can do this 5 minutes a day, in three 10-minute sessions, or in one longer session, whatever feels best to you and is most realistic for your busy life.

Thank you in advance for your time and effort—these notes will be very helpful to our interview process. They are not intended for me to keep, but I will ask that you bring them to our interview, so we can discuss and use them as a springboard for our conversation.

Interview guide used during the first set of interviews.

1. Tell me about your experience of reflecting and journaling over the last week; what was it like to pay attention in that way? What did you notice about your reverie? Did you find yourself noticing and writing about anything that surprised you?

2. What kinds of changes have you noticed in your thoughts and feelings since becoming pregnant?

3. What are your hopes about what it will be like once your baby is born?

4. What do you imagine your child will be like?

5. What do you find yourself preoccupied with/ worried about?

6. What are your thoughts/imaginings about the labor?

7. How do you imagine your life will change when your baby is born? (Changes to career/relationships/self?)

8. What do you find yourself thinking about your own childhood? Your parents/siblings/grandparents?

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9. What do you notice about how you are thinking about or relating to important people in your life (such as your partner [or if unpartnered, the baby’s father], friends, siblings, parents) now that you are pregnant?

10. How is this experience for you (thoughts, feelings, physically) compared with what you imagined it would be?

Interview guide used during the second set of interviews.

1. Now that you are in your final trimester, what kinds of differences, if any, do you notice in what you find yourself thinking about?

2. What have you noticed since our previous interview? Is there anything that stands out from the experience of reflecting and journaling or talking about your experience that you have noticed?

3. Are you aware of any shifts in your preoccupations or worries since earlier in the pregnancy?

4. Do you find yourself thinking about the upcoming labor/birth in different ways?

5. Do you notice any differences in how you’re thinking about or imagining the baby?

Interview guide used during the third set of interviews.

1. Please tell me a little bit about the birth of your child and if/how you find yourself reflecting on it since your baby was born.

2. What changes have you noticed in the contents of your reverie—when you find yourself lost in thought—since your baby was born?

3. What do you find yourself preoccupied with/ worried about?

4. What kinds of thoughts and feelings do you notice about your own childhood or your parents?

5. How do you find yourself thinking about or relating to important people in your life (such as your partner [or if unpartnered, the baby’s father], friends, siblings, parents) now that you are a mother?

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6. Is there anything surprising or unusual to you about what you find yourself thinking about now that you are a mother?

7. How is this experience for you (thoughts, feelings, physically) compared with what you imagined it would be?

Data Analysis As each interview was completed, it was transcribed for the process of reflecting, interpreting and analyzing using an IPA methodology. IPA data analysis “involves the investigator engaging in an interpretive relationship with the transcript. While one is attempting to capture and do justice to the meanings of the respondents to learn about their mental and social world, those meanings are not transparently available—they must be obtained through a sustained engagement with the text and a process of interpretation” (Smith, J.A., Osborn, M., 2007, p. 66). The following steps were taken for the data analysis (as outlined by Smith, Flowers, Larkin, 2009): 1. Reading and rereading: This phase of IPA research involved immersion in the data by reading and rereading the transcripts. The goal was for the participant, and the participant’s language and use of language to become the focus of analysis. “To begin the process of entering into the participants world it is important to enter a phase of active engagement with the data” (Smith et al., 2009, p. 82). I relistened and re-read the interviews many times, which helped with immersion in the data and provided new insight.

2. Initial Noting: The goal of this phase was “to produce a comprehensive and detailed set of notes and comments on the data” (p. 83). This phase allowed for examination of semantic content and language on an exploratory level to

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help identify how participants talk, understand and think about things. During this phase initial notations were made directly on the transcripts by hand. Here I continued with my immersion in the material. All of the quotes from the transcripts that were attached to an initial notation were then isolated and put into a spreadsheet for each participant, with a column next to the quote for further notation.

3. Developing emergent themes: During this phase, I developed the initial notes on emergent themes. The goal was reducing the volume of detail while maintaining the thematic complexity in terms of patterns, inter-relationships and connections. “This involves an analytic shift to working primarily with the initial notes rather than the transcript itself” (p. 91). I compiled a list of all the thematic notes for each participant and began the process of organizing these initial themes into emergent core themes.

4. Searching for connections across emergent themes: This step “involved the development of charting or mapping of how the analyst thinks the themes fit together” (p. 96). There are several strategies allowed for by the IPA methodology for looking for and making connections between emergent themes. I primarily used: abstraction, subsumption, polarization, contextualization and function. Abstraction is “a basic form of identifying patterns between emergent themes and developing a sense of what can be called a super-ordinate theme” (p. 96). Subsumption is similar to abstraction but involves the emergent theme itself acquiring super-ordinate status to bring together related themes. Polarization is examining transcripts for

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“oppositional relationships between emergent themes by focusing upon differences instead of similarity” (p. 97). Contextualization looks connections between emergent themes by identifying contextual or narrative elements within an analysis. I also used the strategy of “bringing it together” which just means using a combination of the strategies listed (which Smith et al. indicate are not mutually exclusive).

5. The final phase is the creation of a narrative text (the presentation of findings) in which the overarching themes of the data are presented in combination with direct quotes from the interviews that represent “an interweaving of analytic commentary and raw extracts” (p110). This text illuminates essential aspects of the transition to motherhood via dialogic reflection on maternal reverie.

Ethical Considerations The risks to individual participants in this study may have included heightened emotional intensity and affect due to a focus on their thoughts and feeling states that might have constituted a different way of observing and relating than was typical.

Participants may have found they were prompted to think about their own childhoods and families of origin during the course of the interviews, which for some participants could have stirred up emotions and thoughts related to past trauma. Additionally, participants may have found that answering questions about pregnancy, their child, partner or other relationships altered the way they were feeling about or relating to these important people. To address these possible adverse impacts, I took several steps to minimize the risks: I urged each participant to communicate any feelings of distress they might have

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during the interviews; I mentioned specifically to each particiant that if at any point I asked a question they were not comforable answering to please let me know and offered to stop the interview if needed or desired; I also was prepared to provide participants with appropriate referrals to various recourses such as clinicians, support groups or other community support networks if needed. However, none of these circumstances arose.

In a further effort to minimize risk, participant confidentiality was maintained throughout the entire project. To ensure confidentiality, no identifying information was placed on any materials and a chosen fictional name was provided for each participant.

All data was kept in a password protected computer database, which only I had access to.

The informed consent explicitly stated that the participants were to be asked about their family experiences. I made it clear to participants that all information they provided was voluntary and they were under no pressure to answer any questions they found upsetting or did not wish to answer for any reason.

Issues of Trustworthiness 1. Credibility- This was established in this IPA study through the perspective of each of the individual participants interviewed. The methodology of IPA was used for this study to meaningfully describe and make sense of the phenomena from the participant’s subjective lived experience of it. Specific IPA techniques for enhancing credibility were employed: prolonged engagement with participants; triangulation of data using reverie journals to record experience in addition to one-on-one interviews; peer debriefs with committee members; reflexive research journal.

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2. Dependability- I placed emphasis on the need to document and account for any changes that occurred to the research process or within the research setting and indicate and how these changes impacted the approach to the study.

3. Transferability- I can attest that I have to the best of my ability accurately and thoughtfully described the research context, processes, assumptions and limitations of the study.

Limitations and Delimitations The results of this qualitative IPA study are not generalizable. The objective of qualitative research is to pursue a meaningful, in-depth understanding of a subjective, phenomenological lived experience. I aimed to increase the trustworthiness of my analysis using Interpretative Phenomenological Analysis through reflective journaling and ongoing consultation. Further, I employed the use of bracketing, which involved a process of listing my biases, assumptions and preconceived notions and talking these through with my research advisors in an effort to set them aside for the interview process and data analysis, to the highest degree possible. This was all part of the dialogic effort to pursue essences and meanings directly from the data.

The Role and Background of the Researcher I am a licensed clinical social worker providing psychodynamically orientated psychotherapy services in a private practice setting to adults and couples in Los Angeles.

My work is informed by advanced training in contemporary psychoanalytic theory,

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Dialectical Behavioral Therapy and over fifteen years of direct clinical experience. Prior to my work in private practice, I spent several years as the coordinator of clinical services, supervising a team of therapists and case managers, in a community mental health center, serving adults with developmental disabilities and chronic mental illness.

In addition to my training at ICSW, I also completed a two-year post-graduate fellowship at Cathedral Counseling Center in Chicago, IL. Since becoming a parent in 2011, I have begun working with many individuals and families in the transition to parenthood. I specialize in treating women during pregnancy and early motherhood. I am also the mother of three small children.

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Chapter IV

Findings Introduction The following is a presentation of my findings from interviews conducted with six women during their transition to first-time motherhood. Having used the method of Interpretative Phenomenological Analysis, I have created a text that aims to describe and conceptualize the psychological shifts during this primal transformation as illuminated by the women’s reflections on their reverie.

I begin with a brief description of each of my participants in order to ground the presentation of my findings in the individual, subjective accounts from which they were derived. While I was able to identify core themes across interviews, which will be discussed in detail in the findings, the data from each individual had its own idiosyncratic texture. As this is a small sample size, it is within the scope of the presentation of these findings to provide ample context for understanding the contributions of each individual participant.

I will then present the answers, yielded by the study, to the three sub-questions I posited at the outset of my research. These questions are: 1. How do first-time mothers notice, observe, describe and relate to their personal reverie?

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2. How does maternal reverie shift and change from the prenatal into the early postpartum phase?

3. What kinds of fears, wishes and other mental content are manifest in maternal reverie and how do we understand these in relation to becoming a mother?

The answers to the first two questions will provide context and an overview of my findings. The answer to the third question leads me to a more detailed presentation of the core themes derived from the data. These core themes are: 1. Visualization of birth and baby 2. Maternal preoccupation; Overwhelm and all-consuming 3. Intergenerational meaning making and projection 4. Me-not-me: The tumultuous and conflicting emotional experience of new motherhood 5. Partnership and the transition from couple to co-parents 6. Felt sense of maternal identity through attunement The final section is a discussion of the findings, which includes the theoretical and clinical implications, implications for my own clinical work, indications for future research and the limitations of the study.

Participant Descriptions The individual descriptions of each of the study’s participants aim to provide enough relevant information to contextualize the data. They include: a chosen fictional first name for the study; age, self-described race, ethnicity, sexual orientation and gender identity; level of education and occupation; marital/partnered status; relevant family of

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origin constellations; any know relevant history of trauma; relevant information regarding history with pregnancy and fertility; basic information about the birth of her baby; experience with psychotherapy; manner and style of communication.

Claire.

Claire is a 33-year-old Caucasian, heterosexual woman. She is a clinical psychologist working in a private practice setting. Claire has been together with her husband for three years, married to him for one year. Her pregnancy was planned, and she indicated she believes she got pregnant during her honeymoon. She did not have any difficulty conceiving and has no history of miscarriage. Claire was raised in an intact family with one younger brother and has a strong connection to both her parents who live in another part of the state. Of note is that her family experienced two significant losses during the course of her pregnancy, her mother-in-law and her maternal grandmother.

The birth of her son was uncomplicated and happened as planned at a nearby birth center.

As a practicing psychologist, Claire has extensive history with psychotherapy personally and professionally and has a high level of reflection on the impact of relationships and experiences on her sense of self and the world. She is controlled in her communication style, but open, reflective and thoughtful.

Rose.

Rose is a 37-year-old Caucasian, heterosexual woman. She is a working actress, musician and writer. Rose has been married to her husband for two years, together for two before getting married. Her pregnancy was planned, and she and her husband tried

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for about six months before successfully getting pregnant. She does not have any reported history with miscarriage. Rose was raised in an intact family and was her parents’ only child, although her father had two older children from a previous marriage. She was a child theater actor and performer, and her mother was very involved in managing her career. She has an ambivalent relationship with her mother and feels the need to keep her at a distance. Her father, with whom she felt very connected, died less than a year before her pregnancy and she is still very much grieving his loss. The birth of her son was uncomplicated and happened as planned at a nearby hospital. Rose has extensive experience with personal psychotherapy. She is very identified with the idea of being creative, which lends to her reflective capacities. She actively creates narratives around her experience and prides herself on being generally in touch with inner world and her needs. She is very verbal, enthusiastic communicator.

Flora.

Flora is a 29-year-old heterosexual woman of Dominican descent. She works as an office assistant. She grew up in London with a single mother working several jobs to support their family of two. Her father, who now lives in Latin America, was absent from her life from a young age. Flora did have a large extended family nearby who was very present in her childhood and upbringing. Flora has a history of significant childhood trauma. She was raped when she was nine years old and was sexually abused by her mother’s second husband. As an adult she has a close but conflicted relationship with her mother and has suffered bouts of depression. Flora’s relationship with her husband offers the stability and security she longed for. They have been together for four years and

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married six months after first meeting. They had been trying to conceive for a year before this pregnancy, and experienced three miscarriages, all between six and eight weeks of gestation, prior to her fourth, successful pregnancy. The birth of her daughter was induced, and after a difficult labor ended in an emergency cesarean. Flora was in weekly psychotherapy at the time of our interviews. While the conflict and attachment struggles resulting from her childhood trauma loom large, she has significant awareness and is able to actively reflect and connect her experience with current ways of being.

Rachel.

Rachel is a 30-year-old Caucasian, heterosexual woman. Rachel and her partner have been together for a year and half and are not married. While she and her partner had been talking about the possibility of having children together in the future, her pregnancy was unplanned and a surprise. She had one previous pregnancy in her early 20s, which ended in an abortion. Rachel had moved to Los Angeles from New York City for the relationship about six months before getting pregnant. She is an entrepreneur working to start a new food-related company. She is originally from LA and raised in an intact family with her older brother. She has a distant relationship with her father and conflicted and anxious attachment to her mother, however with her move closer to home and the pregnancy, her level of involvement with her mother and grandmother have increased dramatically. Rachel planned to give birth to her son at home, but after a difficult and long labor she transferred to a hospital and ended up having a cesarean.

Rachel has no significant experience with psychotherapy. She is open about practical

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matters, but more private about her inner experience and does not elaborate freely on her anxieties or concerns. She is frank and matter-of-fact in her communication.

Holly.

Holly is a 37-year-old Caucasian, heterosexual woman. She strongly identifies with her Jewish ethnicity. Holly works in fundraising for non-profits but is contemplating a move to a more creative career. She and her partner have been together for four years.

They were actively trying to conceive and did so quickly. Holly’s parents separated when she was very young, and her father was uninvolved in her childhood. She was raised by her rigid, scientist mother, whom she has an ambivalent attachment to. Until meeting her partner, Holly was reluctant about the idea of marriage and children, but he offers her a kind of emotional support and connection she never knew possible. The birth of her daughter took place as planned at a nearby birth center, but there was a complication with the placenta once her daughter was born that led Holly to be transferred via ambulance to a hospital for an emergency procedure. Holly had limited experience with psychotherapy prior to her daughter’s birth but has been seeing a therapist with her husband to work through the trauma of the birth experience. Holly is controlled and intellectual in her communication, while also open and reflective.

Sarah.

Sarah is a 29-year-old Caucasian, heterosexual woman. She has worked as a nanny for the last ten years. She and her partner have been together for six years and while her pregnancy was not planned, they were open to having a baby in the near future.

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Sarah and her younger sister were raised in an intact family and she has a close connection with both of her parents and her extended family as well. Due to her work with children, she has a highly developed sense of the realities of childcare and the developmental needs of children. Sarah has a history of anxiety and depression but has felt stable for many years. The birth of her daughter was uncomplicated and took place at home as planned. She is not currently in psychotherapy but has some past exposure.

Sarah is almost dreamy in her communication style. She is able to elaborate freely and openly on her relationships, experiences and her sense of herself in the world.

How Do First-Time Mothers Notice, Observe, Describe and Relate to Their Personal Reverie?

The aim of this study was to gain some deeper understanding of the intrapsychic world of the new mother as illuminated through the analysis of her reveries from late pregnancy into the early postpartum period. At the outset of this research, the women’s reverie was the stated unit of study. For the purpose of the study, reverie has been defined as: The experience of being lost in thought; thoughts, feelings, fantasies, private ruminations, imaginings, anxieties and fears; conscious, preconscious and subconscious mental content.

This concept was introduced to the participants verbally and in writing before the interviews were conducted. Women were also asked to do a brief journaling exercise with provided writing prompts, the goal being to orient and prime them to the quality of reflection I was hoping to access.

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In the course of my data collection and analysis it became clear to me that the concept of reverie as a unit of study was somewhat problematic. The women certainly seemed to intellectually understand what I meant by reverie. But they were less able, or perhaps less interested, in identifying and lingering in specific moments of “reverie”—or of describing what was happening when they were lost in thought.

This research required that I interview women in the midst of a life-altering transitional moment. They were in the eye of the storm so to speak, without real reflective distance from the experience they were in. Perhaps another way to ask this question is: How does a person relate to her own mental and emotional content during a time of transition? How much awareness and capacity for observation is present? And of course, the answer to this is that it varies widely from person to person.

My research allowed me to join women in the liminal space of pregnancy and emergent motherhood. The six women who were gracious enough to share with me talked freely about what was on their minds. They offered fears, anxieties, preoccupations, fantasies, hopes and plans for the future. Their manner of reflecting on their state of mind ranged widely, from intellectual assertions, to active denial of fear, to resigned acceptance of the unknown. While core themes emerged across the interviews, the women presented this thematic material in distinct ways.

Rachel, who was planning for a home birth, spoke in a calm, measured at times almost flat manner. She frequently used the words like “calm” and “chill” to describe herself, her husband, her hopes for her baby and her experience. She was matter-of-fact and while she voiced some anxiety, she would quickly negate it.

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(Rachel) I think about positions where I want to be. Temperature in the room. Lighting.

Water or not. I have a big walk-in shower in my room—should I get a birth stool for it? Where would the tub be? Positions. Honestly probably the whole gamut of things. The vibe. The mood. I picked a doula and a midwife who have cool energy that’s a little more… just a cool energy to the room with the team that we picked.

I just think about wanting to hopefully, not maintain that energy—but massage it a bit. Keep it in the room. Kind of have a positive space to bring a new human into.

(Rachel) I was happy thinking it’d be a girl for a bit, then thinking a boy would be cute.

Normal things. Excited to find out and meet the person it is. Maybe there’s a calmness to it. The more the baby is formed and hears us, I want to be a calm carrier of it. Me maintaining peace and health and all these things maybe seems even more relevant now than earlier in pregnancy because the baby is so real.

(Rachel) Hopefully I can get my body back a little bit. I’m sure everything will somewhat go back to normal so I’m not too concerned with postpartum body care. There’s some planning so I have to think about what I need but I’m not concerned with my body after. Prenatally… I mean… just also in a helpful sense. Not in a

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preoccupied way…Things that are just practical. I’m not worried about any of it really.

(Rachel) It’s just so much. It’s also this age. This past Friday I was by myself with him all day and it’s just a long day when you’re alone with a two-month-old. I can’t imagine the people that do that five days a week. It’s insane to me. Thank god it goes by quickly. I have this idea in my head that four months is like the shifting point of crying a little less at night, going to sleep easier, we’ll see what he’s like.

But it goes by quickly.

(Rachel) So he didn’t nap and the whole meal I’m holding him and then I get stressed out because I feel bad that I can’t properly concentrate on my conversation with my friend because this baby is being fussy in my arms. I don’t know where my mind is going other than just I enjoy it, he’s adorable and smiling.

These quotes are presented here to provide a sense of how Rachel is relating to her reverie, her state of mind. She is clearly aware of the impending change in her prenatal quotes. She’s trying to linger in positivity, focus on the practical, and while she gives voice to worries, she asserts that she is not actually worried. Her postnatal quotes reveal a greater difficulty maintaining positivity and a more conflicted emotional state.

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This is a snapshot of Rachel, but core themes to be discussed later in the findings are evident: visualization of the baby and birth, maternal preoccupation, the conflicting emotional experience of new motherhood, me not me with respect to physical transformation.

Holly, who was raised by a single mother who worked in academia, was deeply ambivalent about motherhood before finding a partner who awakened her maternal desires. She is a high-level thinker, who seems to present her thoughts within a cogent intellectual framework. Her prenatal interview reflects this, however after her daughter was born, and some trauma surrounding the birth, her manner of relating in her postnatal interview is softer and more vulnerable.

(Holly) I had spent a lot of time thinking about whether or not I wanted to become a parent and whether I wanted to have my own child. I was very interested in reading about intersectional feminism in terms of being a millennial mother and what the reality of that picture looks like.

(Holly) Having grown up without a father in the picture I didn’t have a lot of trust in the idea of finding a partner who would treat parenthood in an egalitarian way. I had thought a lot about the cons of becoming a mother and having a baby and the effect on my career and the effect on my happiness before we got together.

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(Holly) I spend a lot of time thinking about the birth experience. I like to follow all of the Instagram accounts of different midwives and the birth videos and stuff like that. I spend a lot of time visualizing what I want. Not in a controlling way because I’m very aware that you can’t control how it’s going to go, but just in a more philosophical way. Trying to understand myself instead of putting myself into this situation seeing what happens, which I think is kind of what a lot of women end up doing for one reason or another. Thinking about what it is that my instincts tell me. What I actually want for the things I can control.

(Holly) I want to feel more at peace with it because I know lots of women have something go wrong during labor, and I never thought I was going to be that person, I'm sure no one does. I think that I was a lot more painful than at least a lot of my friends. I really educated myself about labor and I was very intentional about the whole process. So it kind of felt like, why me? That sort of thing.

(Holly) I only had glimpses of her face at first because she was sitting like this. But I remember being like, “This is a solid baby. This is a real baby. I can't believe this whole baby just came out of me.”

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(Holly) For all of the difficulties that I've experienced, I feel like I can feel really good about myself as a mother. I think I've done a really good job with her, understanding all of her cues and stuff like that, and especially now that everything is coming online more for her, you can really see it being reciprocated.

Holly took an intellectual approach to the preparation for motherhood. While she does voice an understanding of her lack of control and the anticipation of that, it is almost a footnote to her assertions of preparedness. Like all women who have traumatic birth experiences, Holly is preoccupied with what went wrong and the painful disorientation of the profound loss of control she experienced. Her postnatal quotes reveal her sense of an instinctual and far from intellectual connection with her daughter. She is awed, as many women are, by the strange reality that a fully formed baby has emerged from her body.

Core thematic content apparent in Holly’s quotes includes: visualization of birth and baby, the conflicting emotional experience of new motherhood, intergenerational meaning making and projection, and felt sense of maternal identity through attunement.

Sarah, also planning a home birth, spent the decade prior to becoming a mother as a nanny for other people’s children. As a result, she has a well-formed sense of the reality of caring for small, dependent beings. Adding to that is what appears to be a highly developed ability to tolerate uncertainty and ambivalence. Of all the women I interviewed, Sarah communicated from what felt most to be a reverie-like place. She spoke in a slow, thoughtful, almost dreamy way, but she also seemed to be connecting with her experience in the here and now.

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(Sarah) Right now it feels like I’m about to get this big present and I know it’s going to be really hard. I’m trying not to look at it that way because I don’t know what it’s going to be like. Even if the baby years are really blissful, it’s not going to be that way forever.

(Sarah) I think about it but I can’t really imagine what it’s going to be like [the birth].

That’s pretty much the way I am. I have anxiety and I worry about things but if I know there’s nothing I can do about something or no way to predict what something’s going to be like then I just kind of don’t think about it that much.

(Sarah) I think of her as being a sweet, enjoyable baby. I have this idea that bedsharing is going to make things a lot easier in a lot of ways. I think it will but I’m a little bit in denial about—I was thinking yesterday about all the toil and the diaper changing and getting up at night and all of that.

(Sarah) I just tried to put her down today to nap on her own for the first time, to fall asleep on her own. And she was okay with it. I left her on the bed and had the monitor. It didn’t totally work but she didn’t cry either. So that’s progress. It’ll be nice for

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her to fall asleep on her own eventually, but she’s only two months. There’s time.

Yeah it’s early for that. She feels really secure I think.

(Sarah) The only thing that’s sometimes coming up is… my husband is super involved and helpful and everything, but sometimes I feel a little resentful because, as tuned in and helpful as he is, he can walk out of the room whenever he feels like it. And I can’t. Or I don’t feel like I can. But that’s getting better. I’m getting better at leaving her with people when I can—with him or with a parent or an aunt or whatever.

(Sarah) My mom, when she visited, she was so great and very deferential to me as a mother. And it’s not that my mother-in-law isn’t, but if she’s holding her she’ll just walk out of the room or walk outside, and I’m not really ready for that. I think it’s a biological thing, maybe—I think she’s trying to make her mark and give lots of unsolicited advice and I feel like somebody’s trying to take her away from me.

Contained within each of Sarah’s statements are the inevitable contradicting feelings, forces and even circumstances of motherhood. Being pregnant for her feels like she’s about to receive a big, really challenging, gift. (Is she ever, as any parent can attest.)

She accepts she has no idea what the birth will be like and acknowledges some anxiety around that. She imagines her sweet baby and all the mountains of diapers in the same beat. Once her daughter is on the scene, she seems to continue to weather these conflicts.

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She gently tries some sleep training and doesn’t get too upset when it only half works.

She both resents her husband’s freedom and ability to be separate and voices her own lack of readiness to be apart from her baby. This ability to take things in stride is outside the norm, and is probably partly due to her occupation, but also other psychological factors such her disposition and attachment patterns. Sarah also had an easy birth and appeared to have an easily soothed infant.

This selection from Sarah’s interviews contains the following core themes: visualization of birth and baby, intergenerational meaning making and projection, partnership and the transition from couple to co-parents, felt sense of maternal identity through attunement, the conflicting emotional experience of new motherhood.

Rose is a successful artist and performer with a highly developed sense of self and an ability to communicate her thoughts, ideas and feelings confidently and assertively.

She is a natural storyteller who readily makes meaning of her experience. All of the women I spoke to were concerned about how the birth of their child would impact their work, practically and emotionally. Rose, who is deeply identified with being an artist, was the most concerned with how her creative life would be altered and sustained once her child arrived. For Rose this is a matter of self-preservation.

(Rose) I actually get my energy from being creative. So I can see myself being inspired by something my kid did and then writing about it. I have to get out of the house.

I do need alone time, but I’m more of a social creature. I have to be collaborating and creative. I can see myself being inspired by something my kids did and then

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creating something. When I’m not creating I’m not happy. So I do have some fears about that.

(Rose) I don’t want my mom here. I don’t want her energy. I don’t want her intruding.

But here’s the other part of it—my mom is like a battle-axe. She is a survivor. If you put her in a stressful situation she fucking rises to the occasion. She’s driven.

She’s tireless. So am I. My husband is not. If my mother walked into that birthing room and I was like, “I can’t take the pain.” She’d be like, “Yes you can. You can fucking do it.” When I was a child and I was sick, she’d be like, “You can still go on.” That mentality of like, “Yes I’m performing with a 102 fever.” I got that from my mom. Was that necessarily healthy, I don’t know. But it’s pushed me.

(Rose) What I don’t want to do is make him feel like I need him to fill the void of my father. My father was incredibly deep and wise and such a soulful person and I don’t want to be like, “Why can’t you be deep and wise and soulful!?” I’m definitely hoping that my son has those sorts of qualities—those soulful qualities.

I kind of think he will. My intuitive feeling is that he is intuitive, that he has depth. I don’t know, it’s weird, I just feel things I guess.

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(Rose) I’m figuring out how to have the baby and have me. But I’m obsessed with him.

I’m so in love with him that I don’t want to miss any moments. It’s this weird thing.

(Rose) My milk wasn’t totally coming through, although in the hospital I did have a lot of colostrum according to the lactation consultant and he did latch. I was producing milk, it didn’t seem like very much but apparently it was. And I was trying to give him more and more to get him to poop and all that stuff. So that was kind of terrifying. That was when I realized nothing else matters. Nothing else mattered to me but my baby and I didn’t even know this person. Do you know what I mean? It’s so wild that it’s so instinctual.

(Rose) So I appreciated her [her mother] in a new way and I also understand the connection with your child. I also think I had had moments in my life where I doubted my mother’s love for me because of the living through and exploitation and that kind of thing. It’s just so overwhelming—the love you feel for your child and all that you do. My mother did that for me.

Rose’s prenatal interviews were full of statements such as the first one quoted here. Losing her professional, creative self was a tremendous source of fear and concern.

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Once her son arrived, she was still wrestling with this conflict, but her immersion in new motherhood dampened the urgency. The selected quotes also reveal her active struggle to rework and renegotiate her relationship with her own mother. There is an active sense of needing to protect herself from her mother’s physical presence and influence. (In fact every participant in this study explicitly stated they did not want their mother present at the birth of their child, which I will revisit later in the discussion of findings). Rose is actively mourning her less ambivalent, more idealized father. She is consciously aware of her desire to project aspects of her father onto her unborn son, while simultaneously doing so and calling it a mother’s intuition.

Rose conjures several of the core themes found across participants: visualization of birth and baby, intergenerational meaning making and projection, felt sense of maternal identity through attunement, the conflicting emotional experience of new motherhood with regard to professional identity conflict.

Claire is a trained psychologist and therefore already tuned into the emotional and psychological aspect of pregnancy and the transition to motherhood. She readily reflects on and even interprets her own thoughts and feelings. She is not afraid to elaborate on her emotional state. Her husband’s mother died while Claire was pregnant. This very recent loss comes up in several ways. One notable manifestation is around themes of dependency and caretaking.

(Claire) I am someone who does a lot of emotional caretaking in a relationship, just in general. I find myself doing that. It’s weird because then I go to before where a big part of this has been me accepting that it’s okay to have emotional needs, you

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know? In the relationship. And to not be okay some days. That’s been tricky for me. The roles reversed a little bit. He has to do more emotional caretaking for me.

But now that’s flip-flopped back again, since his mom died. Actually, I think maybe more so we’re just really becoming a better team I would say. At least trying.

(Claire) I worry about the baby’s survival. I have a cousin who had a stillborn. We had a friend who had a stillborn baby. I really try to acknowledge those thoughts and let them go. Not trying to repress them, but… Yeah—is the baby going to make it?

But I’m sure that’s true once the baby’s out of the womb too—am I going to protect the baby?

(Claire) That renegotiation and trying to balance different demands and feeling really selfish—not selfish but there are just things that I can’t do…needy and then judging myself for that but also trying to take it easy on myself. And then when I have one of those outbursts when I’m feeling really needy, afterwards I’m judging myself for being needy but I’m trying not to feel that too much.

(Claire) The other day Colin and I were in the kitchen and the baby was napping and I just had this vision of what it will be like when he’s as big as Colin and he comes and

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hugs me. That just blew my mind. That was so sweet because my husband’s a big tall guy so I just imagine what it would be like for our son to come hug his mommy when he’s like a man.

(Claire) Now every time I see some statistic about the environment going to shit, I literally start crying because I’m imagining him growing up in this world now. I feel guilty in a way, having brought him into this. It’s totally a next level. So that’s been interesting to navigate.

(Claire) Oh my God. I cried. That was the first time I was leaving him for a good chunk of time. I was gone for probably four hours. Once I was out I was like, “Okay. It’s fine. I’m gone. It’s fine”… I’m a little on the anxious preoccupied scale, so I wonder how much of that is mine and not his, right? Probably more mine.

(Laughs). So it’s helpful to think about it that way.

Claire, like Sarah, is able to access and reflect on mental content that more closely approximates reverie. She has a less dreamy and more anxious quality to her musing. She identifies herself on the “anxious preoccupied scale,” alluding to her attachment style, and her struggles around dependency versus autonomy are evident throughout the interviews, specifically in relation to her husband and her own mother. While all the women expressed some fear and anxiety about harm befalling their baby, Claire seemed to be the most preoccupied with this both during pregnancy and postnatally.

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Thematically, Claire touches on: visualization of birth and baby, intergenerational meaning making and projection, maternal preoccupation, and the conflicting emotional experience of new motherhood.

Flora communicates in a warm and revealing way. She is open about her hopes, anxieties, conflicts and a significant history of sexual trauma. Additionally, Flora was the only woman in this study who experienced difficulty conceiving and had three miscarriages prior to her daughter’s birth. While Flora’s interviews contain many of the core themes that emerged across participants, her contributions do stand out among them.

(Flora) Even though the baby is healthy, it’s a very routine pregnancy, nothing bad is happening, when I think about it I just think how it feels uncontrollable and messy and things are not progressing the way I want them to progress or that I don’t have control over certain things.

(Flora) With a girl there’s a sense of wanting to recreate the relationship with my mom I always wanted, and I never thought for a second that because I have a husband and a father who would be a great father to my kid—there might be a competition to it. He’s also definitely going to have a bond with my kid and he’s going to be a great father so I’m sure he’ll have a strong bond… but how do I fit into that? But then I think about them having their own bond and me feeling jealous over that, it’s those kind of scenarios.

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(Flora) Because she’s in breach right now she’s kicking my bladder a lot. I told Brian, she also gets hiccups six times a day. I’m starting to feel bad that I’m annoyed at how often she gets hiccups. It’s like someone tapping you over and over again. I get so frustrated. Then I’m annoyed that I’m frustrated with my kid who’s having uncontrollable spasms.

(Flora) Then I had so much trouble breastfeeding. It hurt so much and I knew it was going to happen. So I got into this vicious cycle of her not taking the breast, she won’t take the bottle, I’ll try to pump but my milk supply is low. And it went back to, “I’m not doing enough as a mom.” Even though my child is super healthy and cared for and has loving parents, especially with the birth and breastfeeding, those are the biggest jobs you have as a mom. There’s something in, “I failed her.”

Even though I’m conscious it’s not my fault, it just happened, it’s a natural thing, I just can’t not.

(Flora) And it’s so contradicting. Because I’m also struggling with the thoughts of leaving my child and having someone else take care of her. Then I feel like I need to leave in order to continue loving my child.

In the course of the interviews Flora communicates significant worry about being able to connect with her baby and anticipates being made to feel jealous and inadequate

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by her husband’s connection with their child. While all the women expressed self-doubt, grief and anxiety in their postnatal interviews, Flora was the most significantly gripped by these affects and consumed by attachment anxiety and fear of failure. This is no doubt connected with her experiences of perinatal loss and her own trauma history and related attachment issues.

This selection from Flora’s interviews illustrates the following core themes of the study: visualization, intergenerational meaning making and projection, maternal preoccupation; overwhelm and all consuming, and the conflicting emotional experience of new motherhood.

We return to the question: How do first-time mothers notice, observe, describe and relate to their personal reverie? Or otherwise put: How does a woman relate to her own mental and emotional content during the transition to motherhood? The answer seems to be in varied and idiosyncratic ways consistent with her character, disposition, attachment history and life circumstances. Another significant factor is her experience of her pregnancy, labor and birth, a more in-depth discussion of which follows below.

What does seem evident in the data is that identity transformation is manifest in the mental content of the women. They reflect on the disorienting, conflict-ridden nature of liminal experience. They are dipping into intergenerational reflections, projective preverbal musing and standing in the spaces between multiple and conflicting identifications and identities.

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How Does Maternal Reverie Shift and Change from the Prenatal Into the Early Postpartum Phase?

There is one very big, very obvious change that happens in the space between the prenatal and the postnatal, between pregnancy and postpartum: the labor and birth of a child. While maternal identity arguably begins to stir during pregnancy, there is a qualitative difference in how a woman experiences that role once there is an actual baby in her arms. And regardless of the details of the birth itself, the experience was no doubt intense, formative and meaningful. Stories of labor and birth are moving and fraught, cherished and haunting, devastating and euphoric. Birth is at once extraordinary and ordinary. It brings us closer to our humanity, our mortality, than many of us have ever been.

For each of the six participants, the story of how her baby was born, and her way of telling and reflecting on that story, serves as a punctuation to her shift in maternal reverie from pregnancy to the birth of her child. In the earlier discussion, I touched on how for the majority of the participants, the manner in which they noticed, described and related to their mental content did seem to undergo some change from the prenatal interviews to the postnatal interview. For some of the women that change was subtle, while for others more pronounced.

For the small group of women interviewed for this study, more significant shifts in reverie were observed in the three women who had complications and traumatic experiences during the birth of their child. All of the women had aspects of their child’s birth that troubled them, and the data showed the birth of a child introduced some sense

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of loss for all six women. However, that sense of loss was more prominent for those who felt a greater loss of control and profound fear during their child’s birth.

Trauma can be defined in many ways, but for the purpose of this study, the use of the word traumatic, and the phrase “traumatic birth,” reflect the woman’s own characterization of her experience. The three women in this study who I (and more importantly they) contend had traumatic birth experiences, indicated significant distress, a profound and overwhelming sense of loss of control and fear of mortal danger for herself and or her baby. They all reported flashbacks of the experience and a preoccupation with it. And for all three the experience continued to trouble and distress them when I spoke with them weeks after the event.

Rachel was focused on the practical, the here and now in both her prenatal and postnatal interviews. Her interviews gave the distinct impression of being a person organized around control and order. While pregnant, she was almost insistent on maintaining a calm affect and environment for herself and her unborn child. She would dip into anxiety but quickly bounce back to optimism. Rachel’s home birth did not go as planned and ended at the hospital in an emergency cesarean. During our postnatal interview she seemed less able to maintain that previous buoyancy. She was more in touch with her internal conflict and her struggle to integrate her maternal identity.

The following quotations from Rachel illustrate the texture of her reverie in the transition from pregnancy to motherhood, as punctuated by her birth story.

(Rachel) The way other people treat you when you’re pregnant—everyone wants to help you and everyone tells you how beautiful you look, all that good stuff—it’s like,

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great, let’s treat everyone like this always! Obviously, you get pregnant and everybody starts filling your circle with energy, with more positive vibes.

(Rachel) I’m just lucky. Physically I’ve had a somewhat easy pregnancy. I don’t think I had too many preconceived notions that I have ever actively thought about. I never actively thought pregnancy would be hard, but since being pregnant and being around other pregnant women in yoga, or friends, it seems like mine is a bit easier than—I don’t want to say the norm — but a lot of people. I’m appreciative of that.

(Rachel) I told her [the nurse] I couldn’t hold the baby because I was shaking uncontrollably. She told me it was fine and that once I was holding the baby I’d stop shaking and I kept telling her I was falling asleep and shaking uncontrollably and that I couldn’t hold the baby. Then once they brought it, my whole nervous system relaxed. We tried for a home birth so definitely thinking about if I did anything that would have made it so we couldn’t have a home birth. Like the slow dilation—what causes that. Just wondering if there’s any type of stretching or anything. When his heart rate dipped when the doctor pushed on my cervix, I had both Pitocin and epidural in me, and I asked my midwife if his heart rate really wasn’t liking it or if some of the medication I took could have been causing his heart rate to dip. Things like that. Because now I have to think about next time.

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Do I want a VBAC? Do I want an epidural? So just trying to understand medically. I’m at peace with the whole experience, but… I tried my best to do everything naturally and it was the opposite of that, but he’s out healthy so it’s fine. But just trying to understand if each step along the way was necessary.

(Rachel) I mean you just can’t set him down, you know? I try for a little bit here and a little bit there but it’s hard. He’s getting more and more interactive and entertaining himself but it’s a lot. I think my whole identity—I don’t think it would be happy with that. A career of sorts or even just a passion that I spend time on outside…There are moments where I’m so happy that I’m home taking care of him and then there are moments where I just wish I could get on my computer and do something.

(Rachel) There was one time when we had sex and it kind of hurt me. I had this flashback to the birth hurting me. I was thinking about it again yesterday. Like there were so many random people up in my vagina and some of what was being done was not pleasant. It’s weird when a hand goes over the incision. So there was one moment where I was having sex and had this feeling of wanting nobody around that area.

And then I thought about it yesterday again.

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Rachel’s birth experience was very far from what she had hoped for or imagined.

At the time of our final interview her son was ten weeks old, so she had a small amount of distance from the birth. But it was clearly still very present for her. While she falls into the pattern revealed in her prenatal conversations, of expressing negative affect and quickly retracting it, she is not as convincing. “I’m at peace with it… he’s healthy,” she insists, but still ruminates on what could have been done differently with a pained and distant look. She also alludes to difficulty and pain connecting to her body, and intrusive thoughts during sex. While the ambivalence she expresses about being alone with her infant son is typical, for Rachel, the acknowledgment of it feels quite different than her way of reflecting in the earlier interviews. It is a noticeable shift. Rachel’s sense of herself as lucky, of having it easy, has been dashed. And to the extent that this may have been a more robust narrative for her, this is quite an earth-shattering shift in personal narrative.

Holly, like Rachel, gave the impression of being a controlled and deliberate person. During her pregnancy, she was focused on her diligent preparation for labor, birth and new motherhood intellectually, emotionally, and practically. She took pride in having thought things through and considered more than the average woman does before having a child.

Holly gave birth to her daughter as planned at a birth center. At first it seemed to be the experience she was hoping to have. But when she was unable to deliver the placenta, and her midwife’s several attempts to detach it from her uterine lining were unsuccessful, she was emergency transferred to the nearest hospital, which was in a Korean neighborhood and most of the attending nurses and physicians spoke little to no

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English. A series of confusing, disorienting, and deeply upsetting events ended in an emergency surgery to remove her placenta, under full anesthesia without her consent or knowledge she was being put under. To make matters worse, at first the hospital refused to allow her daughter to join her overnight because she hadn’t been born there. Luckily her mother-in-law was able to intervene. In her postnatal interview Holly is understandably still working through this traumatic experience. She is openly preoccupied with it, despite also holding tight to her birth experience and first moments with her daughter. There is a distinctly more vulnerable quality to her reverie.

(Holly) I have a visualization of the baby’s needs. Not to toot my own horn but I think I have a better visualization of my baby’s needs than my friends did—who went into the process in more of an experiential way and I’m more introspective than some of my other friends who are parents.

(Holly) [talking about her in-laws questioning their choice of a birth center] I felt deeply misunderstood — which is a big trigger I have: not feeling understood. I felt like they thought I was doing something unsafe and I was like, “How dare you—I’m doing this because it’s actually safer.”

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(Holly) [Describing what happened after the hospital transfer] Dave wasn't there. So what happened was I was triaged in the ER by myself for a while… then they were like, “Okay, we are going to get her prepped to go into the operating room.” Dave was like, “I want to be there with her.” So they sent him to another area and took me into the operating room. The one good thing is that they actually did listen to me when I was like, “I'm not ready for that. Give me a minute.” Because I was still having contractions…. The doctor came over and he was like, “We are going to give you sedation and your husband’s coming in in just a minute.” I kind of lost it for a second and I was like, “Okay. I’m scared.” It was so sweet, he squeezed my hand. It was like actually a nice moment. He squeezed my hand and was like, “Don't be scared.”… And then they put the oxygen mask over me and the next thing I knew, I was waking up. They actually had made a decision to put me under general anesthesia, but they didn't tell me.

[Talking about when the hospital was refusing to allow her hours old daughter to stay with her] I was like, “I’m going to freak out, like, this isn’t the end all be all, this isn’t the final word. I'll sign whatever, but this isn’t happening basically.” I was like, “I’ll check myself out and go into a different hospital if this is what is happening here.” I was starting to cry a little bit, and the nurse was like, “Oh, what’s wrong, you're going to be okay.” And I was like, “Yeah, I know, but my baby is here and I can’t have her stay with me overnight, they just told me.”

And one of the nurses was like, “Oh well, you shouldn’t feel bad because some

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mothers don't get to see their babies for days because they’re in the NICU or whatever.” And I was like, “Is that supposed to make me feel better!?”

(Holly) In the first four weeks I was completely preoccupied with the hospital transfer and it felt like this domino effect. It didn't feel like this one shitty thing happened but now it's all going to be okay that we’re home. It felt like it was a domino effect…

I started seeing a therapist. I kind of just want to feel like I’m more at a place where it doesn't feel like part two, like doom and gloom story. I want to get to a place where this is all part of the experience and I’m at peace with it basically, because it just fucking was the worst at some of the points that day. It was a million miles from where I wanted to be and where anyone would want to be.

(Holly) I have really wrestled with that because when I imagined how my birth was going to be, I really wanted to see the placenta. Dave and I had talked about how we both wanted to see the placenta, you see these images of the side that has all the veins and capillaries and it looks the tree of life symbol, which is a very important concept in Judaism. And we really wanted a picture of it. When you look at all of the birth photography and stuff on Instagram and on the internet and stuff, there’s often a picture that families will do lying in bed together with the placenta cord still attached to the baby and the placenta is in the bowl, you know? I really wanted that picture.

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(Holly) There are all these other things that have been hard but I find the experience of being a mother more instinctual than I could have predicted.

Unlike Rachel, who seems to be willing herself to readily accept that she did not have the birth experience she had hoped for, Holly is acutely aware of and open about her sense of loss and disappointment. “I never thought I was going to be that person,� she says. She approached her transition to motherhood like a diligent student, but there was no way she could have prepared herself for what was to come. Intellectual knowledge is no match for the emotional, visceral, upending experience of traumatic birth. The first half of Holly’s birth experience was all within the realm of what she might have expected, it was other and it was intense, but it was not terrifying in the way the medical transfer and disorienting hospital stay were.

Holly seems very aware of her need to process and work through and integrate this experience. She has begun working with a therapist who specializes in birth trauma.

She is taking care of herself. She has been able to shift her diligence to the process of healing, which represents both continuity in her state of mind as well as a shift. She is engaging a sense of control by taking steps to repair. She is open about the placenta as a focal point of her preoccupation and sense of loss. She is allowing herself to grieve. She is making space for her emergent maternal self.

As discussed above, Flora had a history of childhood sexual abuse as well as perinatal loss. Engaged in weekly psychotherapy, she was able to freely and reflectively talk about these experiences. Her reverie was marked by anxiety and anticipation of

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attachment struggles. With Flora, the data didn’t reveal a distinct shift in the content or quality of her reverie, so much as an intensification of what was previously present.

(Flora) I hope she’s more like him. Calm. I mean, I was a terrible teenager. Again, I had a lot of issues I was rebelling against but I was also rambunctious and feisty and my husband would just be the kid that would read in the corner. So, I’m hoping she has more him and just more stable.

(Flora) A thought that recently popped into my head, I’ll be working 40 hours a week and Brian works from home. He’s going to get to see the baby more, which is great on him. But he gets to maybe be the favorite. Maybe have a stronger bond.

(Flora) I told my husband one thing is that I don’t want to be alone at any part of it. I can get around if it’s the beginning and he’s not home and needs to get home, but because we were strategizing what to do when labor kicks in. So it’s the idea of missing part of the birth of your child and me being so close to the hospital and being at the hospital at the end of the world by myself—I still don’t want to be alone through the pain, through the boredom of waiting for labor, for any of it I don’t want to be alone.

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(Flora) It all happened so quickly. Once they asked me if I was sure I wanted to do the cesarean and I said yes, a doctor in the back goes, “She said yes” and a million people came in, started unhooking me, rushing me out, giving me something so I would throw up. I’m in surgery and I don’t have time to say goodbye to my husband or my mom and I’m crying and vomiting at the same time as being rushed to the O.R. I guess we were also on a timeline because she was already a bit further down. As I’m there, they didn’t give me enough anesthesia, I started screaming “I’m feeling everything!” and they gave me more to counteract that. I had been pushing for five hours, laboring for 24, I was basically exhausted so I knocked out. I was sort of awake and drugged out when she was out. So I dealt with that guilt—not guilt—but it’s such a shame it happened that way when you plan something that you cannot plan. I had told my doctor that I didn’t have a birthing plan, just whatever it takes for her to come out healthy and keeps her healthy. As much as I didn’t expect it to be a cesarean… I had only in my mind that I would push and I would grab her myself…. I was so drugged out, I didn’t even hear her cry or see her come out. I wasn’t even conscious enough to know that they put her next to me. Even after the OR, I was still so drugged out and tired that I didn’t get to bathe in the emotion of “My daughter’s here.” So I was lamenting it for a long time.

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(Flora) I immediately go to the extreme. Someone tells me to walk her more and I’m like, “Great. I’m failing as a mom. Thank you for telling me I’m the worst mom in the world because I didn’t take my kid out on a walk yesterday.” Everything I think gets exacerbated. “I should have done this. I’m the worst mom. I’m failing as a parent.” I’ve tacked myself as a bad parent for the rest of my life, for one little thing.

(Flora) I’m scared she’s going to be like me. My husband and I were such different children. He was quiet, coy, reading in his nook all the time. I was loud and mischievous. Just the opposite of each other…She has my eyes so strongly that it’s so scary sometimes because I see literally the image of myself…now sometimes I’ll pick her up and I get a little freaked out. Like, oh gosh, you’re going to be loud like I was.

Unlike some of the other women interviewed for this study, Flora did not have a specific birth plan. But she had visualized her daughter’s birth repeatedly during her pregnancy. And while she was intellectually aware of the possibility of a cesarean, perhaps without quite realizing it, she was attached to the idea of a vaginal birth. She had imagined catching her own baby. But even more explicitly, she had not wanted to be alone. She had not wanted to be afraid and alone and out of control. Regrettably, this is what happened. Loss of physical control of is particularly activating for a person with a history of childhood trauma.

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During pregnancy Flora was already expressing worry about her husband being better able to bond with the child. She was concerned that her daughter would inherit her bad rather than her husband’s good. Once her daughter arrives everything becomes evidence of her failure as a mother. The traumatic aspects of the birth, her struggle to breastfeed, these become new magnets for guilt and shame. While feelings of maternal guilt are common in early motherhood and were expressed by all six of this study’s participants, Flora’s history of sexual abuse suggests a predisposition for deeper guilt and shame. Flora looks into her daughter’s eyes and is gripped with fear, she sees herself— she projects her bad onto her infant. Although she doesn’t explicitly say this, one could imagine what she is really afraid of is her daughter experiencing the pain and betrayal that shaped her “bad.”

The data from the remaining three participants, who all had uncomplicated birth experiences, reveals more subtle shifts in reverie from pregnancy into early motherhood.

These women seemed to notice, observe, describe and relate to their mental content in much the same way before and after the birth of their children. Their tone and manner of expression were relatively consistent across the interviews. One notable exception being that all the women seemed to have a greater appreciation for and expression of vulnerability in their postnatal interviews.

For each of these participants, her experience with the birth of her child was meaningful and profound. They all report being deeply affected by the event. And each talk about moments within the birth that were hard, painful and challenging. However, unlike the women who had more fraught birth experiences, there was not an accompanying sense of mortal fear, confusion and loss of control. These women are able

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to tell themselves and others a personal story that makes sense to them, that hangs together, that does not upend their notion of order.

What did undergo observable change was the thematic content of the women’s ideation from pregnancy into new motherhood. (This was true for all six of the study’s participants, but was less focused on in the discussion above in favor of an exploration of birth trauma.) For example, during pregnancy the women discussed a preoccupation with nesting—creating a safe space for birth and the first months with the baby. In early motherhood, this preoccupation shifted to here and now concerns related to nursing and nursing struggles and the baby’s basic functioning—sleep, eating and eliminating. A more in-depth presentation of six core themes identified in this study, and their prenatal and postnatal manifestations, will follow in next section.

There are many factors that influence how a woman greets motherhood. For these six women in particular, there are indications in the data about their support systems, life experiences and dispositions likely play a role in how they met this transitional life moment. Nevertheless, the data strongly point to the experience of the birth as a significant factor in the observable shift in maternal reverie pre and postnatally.

What follows are the birth stories of the remaining three women, bookended by selections from their pre and postnatal interviews to illustrate both the continuity in their manner of relating and making meaning, as well as shifts in content of thought and ideation.

Claire’s birth experience was uncomplicated. She delivered at a nearby birth center as planned. She tells the story in calm, matter-of-fact way. She seems to have more or less integrated that experience into her narrative of new motherhood. In her prenatal

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interviews Claire talks about imagining her first moments with her son; she discusses fearing for her physical safety since becoming pregnant and wanting new boundaries with her mom, who tends to be “codependent.” In her postnatal interview she is imagining what it will be like when her son begins to talk; she discusses getting momentarily preoccupied with mosquito bites, and she talks thoughtfully and empathically about reverie surrounding her parents’ experience with her as a colicky baby.

(Claire) I definitely fantasize a lot about what it will be like to hold him for the first time.

What it will be like to breastfeed. I guess I romanticize it a bit, which is fair enough. I definitely find myself drawn toward toddler-hood. What it will be like when he’s a bit more human-like, less larval.

(Claire) One thing that jumps out: I never used to be concerned, per se, with my own physical integrity and wellbeing. I’ve always been a healthy person but walking down the street, living in downtown LA, I never used to be concerned that somebody could jump out from around the corner and attack me. I mean, occasionally there can be some sketchy people down there, but in the first trimester I was with my husband and another friend—we were walking around downtown LA and I noticed I kept having these automatic thoughts of safety and protection, of my body and the baby.

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(Claire) I’ve noticed it [her pregnancy] causing a little bit more stress in the relationship with my mom, which is interesting. She and I get along really well. We’re in the same profession so we have a lot that we can relate on. She’s still a really big source of support. It’s been interesting to see that relationship shift. Historically my work has been about creating my own independence in that relationship— there’s a lot of that kind of co-dependent flare to it from when I was little. So noticing that pull from her—she really wants to be involved. If it were up to her she’d be here to help catch the baby… I’m just like—no thank you. I really prefer if you just met us at the house.

(Claire) I felt really supported. There was only one—I wouldn’t even call it a crisis—but they encouraged me to start pushing. They thought I was fully dilated but I was probably closer to 9.5 or 9.75 centimeters, so that wasn’t progressing, and I had to stop. I had hoped for a water birth but at that point I was like, “Get me the fuck out of the tub.” They got me out of the tub, I went and laid down, and I had some of the laughing gas to get me through…When he was crowning they were like, “You can reach down and touch his head if you’d like.” And I was like, “No!” At first I was like, “Don’t give me that suggestion!” But in the next contraction I was like, “Okay.” So then I did and that was very special to be able to touch his head and start talking to him as he was coming out. It was really really sweet.

Everything was pretty easy. My body responded as it is expected to. Not too much

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bleeding. We were home by 8 a.m.…So many women that I speak to have a traumatic birth story for one reason or another. I know that that’s really common but I’m so glad that my first experience was not that.

(Claire) When I see other little kids, who are a little bit older than him, I imagine what that phase will be like. But when I’m just here with him, alone, I spend a lot of time just thinking about what’s going on in front of me. The little development things that he’s starting to do. He’s talking a lot. He has a lot to say. And he’s starting to roll to his side and then back to his back.

(Claire) They’re fleeting. They’re not regular preoccupations, but there’s always a new one that pops up. I realize that I have eight mosquito bites on my ankles and then I was doing some exercise and the woman I work out with said it was probably the tiger mosquitos that can carry Dengue Fever or some shit like that so all day I was jumpy and jittery and I was worried that he was going to get bit. Two nights ago there was a spider on the couch. So for the last 24 hours I’ve been freaking out about bugs. I’m sure that will pass. Last night I pulled all the pillows off the bed and vacuumed everything like a crazy person.

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(Claire) I have greater empathy for my mom and dad and the experience of what it must have been like to have a very colicky baby. I was jaundiced at birth. That was back in the day when they separated you from the incubator. I have this story of my early days that’s relatively traumatic. On a personal level I feel like I’ve processed that, but now I have another perspective of what that must have been like for my mom and dad. So I think that’s brought us closer. And certainly helped me have greater empathy for what that must have been like.

The way Claire communicates her reverie is relatively consistent from pregnancy into new motherhood. She is open and reflective and vaguely anxious, but selfdeprecating about that. What does shift are the contents of her reverie. And her shift in empathic attunement with her parents, and her mother specifically, is evident.

Rose delivered her son at a nearby hospital. She was determined to have an unmedicated birth with as little intervention as possible and succeeded in that desire. This allowed her to enter motherhood with a sense of herself as powerful. Prenatally she was preoccupied with being forced into getting a cesarean section and concerned that her husband or the doctors would derail her desires for her birth experience. The visualizations she reported were largely focused on the labor itself, and she expressed concerns about how to manage her mother and hold her at a distance. In her postnatal interview she was still basking in her birthing victory and while she continued to struggle with her mother, there was a softening with respect to that relationship.

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(Rose) I’m worried about getting pushed into a c-section. I feel like more of the stories I’ve heard about birth, more have been horror stories than they’ve been great—in terms of people going to the hospital and they’re there a while and they’re like, “Well you’re not really far along yet” and you need the bed, and they give you the Pitocin, and once you get the Pitocin you get the epidural, then you can’t move your body around, and suddenly you’re in an emergency c-section. But then again you’re like, “Alright so I have a c-section, what the fuck, who cares?” I don’t know what it is I’m holding onto about really wanting to try and have the natural birth…if I do end up with a c-section, I might end up with some…grief over how I wanted the birth. It’s weird. I’m excited and I’m nervous.

(Rose) So I have this idea in my head about how I see my pre-labor going—which is in the house, with music on or not on, moving around. Then the big question mark is you don’t know how dilated you are, you don’t know what your station is at that point, and you might feel like you need to get to the hospital…The things I’m nervous about are the pain and getting to the point where the pain is beyond the threshold I was prepared for. I’ve been saying for so long that I’m not going to do an epidural, and what if I can’t take it and then I get stuck. My labor slows down and I end up in that situation. And as soon as I get to the hospital, feeling like things are out of my control…

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(Rose) My mom is a concern. The plan was to have her come out the day before the due date or around then…but there is the part of my mother who knows what I am capable of that nobody else does…but she’s terrible with boundaries. She’ll try and reason with me…There’s this part of me that thinks if I do go into labor early that she won’t be here. That’s part of the fantasy. That’s why she’s not in the fantasy. Because in the fantasy she’s not actually physically here.

(Rose) I put on Motown music, which reminded me of my father. I just sobbed. I was just sitting on a ball sobbing. But it was like really cathartic. I think in some ways I had been holding onto some stuff about him, as to hold onto the baby. And now that I was releasing the baby I could release all of this…There was lots of talk about epidural, “The guy that does the epidurals is here in case you want it.” I had to experience a lot of pain. My husband was like, “I’ll give you $2500 if you take the epidural.” I was like, “Shut the fuck up.”…Then they came in to check to see if I was dilated. I’ve puked, I’ve done this, I’ve definitely transitioned. I was thinking I gotta be at 6 cm at this point. I was 3 cm. I was like, “No way.” Then I considered taking meds. But I didn’t do it. They also offered Pitocin at 3cm and I was like, “No.” And then they offered Pitocin at 6—they were like, “We don’t want the baby to be in stress, your water broke, blah blah blah.” And I was like, “Yeah but the water wasn’t totally broken, so baby’s not stressed.” People were like “Are you sure you don’t want it? Are you sure you don’t want it? Are you

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sure you don’t want it? This will help you. Pitocin. Epidural. Blah blah blah.”

And I was like, “Thank you. Thank you.” If I hadn’t been a strong person who was determined… Right when I started to push we weren’t getting very far, and still, every step of the way I got, “The Pitocin would really help.” And I was like, “No! You’re going to kill my natural…” And they were like, “Is there a reason you don’t want to do the Pitocin?” I was like, “I don’t know how clear I was—I switched fucking OB’s and I was very clear about I wanted. This is the most important fucking day of my life... this one nurse said “Get angry.” I’m an actor. I can take those notes. Finally toward the last 30 minutes I figured out how to push.

I really didn’t know what I was doing, but this woman told me to get angry and the head came out. I got angry because I thought, “I had a lot to be pissed about right now.” He came out and I couldn’t believe it—oh my god. First of all, I couldn’t believe it’s over. Thank god. Oh my god. There is this baby and I fucking did it.

(Rose) I was so determined but I was also determined to prove everyone wrong who didn’t think that I could, including my husband. I proved everybody wrong. So when you asked me how I’m feeling, because I did it and I didn’t give up and I didn’t do the epidural and I didn’t do the Pitocin and I didn’t end up in csection… I felt like a warrior princess.

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(Rose) Okay, my mother was a stage mom. So my mom is already like, “I got the baby his first modeling job.” And we’re like, “Oh no. What’s the first modeling job?”

She was like, “To be the new baby Jesus. For the Catholic Church. It’s a big deal.

The new baby Jesus.” I was like, “What are you talking about?” …So now I’m protecting my child more. I’m laughing at this story but going, no. This is not going to happen. And I’ve had to say it a couple times. No. He’s going to do these x, y, and z, he’s not going to be modeling or acting or anything unless he’s 12 years old and he has a mind of his own and he says, “Mom I want to do what you’re doing.” So that is where I’ve had to really draw a line in terms of explaining to my mother, this isn’t going to be something we’re going to do with my kid even though that’s how your brain works.

Similar to Claire, Rose’s manner of communication is relatively consistent before and after pregnancy. She is energetic, enthusiastic, vividly descriptive and verbose—in fact her interviews were so packed with narrative detail it was difficult to condense her anecdotes. What really stands out for Rose is a through line of her determination and persistence. She had a clear expectation of what she wanted and also what/who she anticipated would present as obstacles. Her expectations were largely met. While her labor and birth were not without challenges, those challenges did not end up being outside the realm of her imaginings and expectations. She was able to maintain her basic sense of order, which is a critical difference from women who end up in situations far from what they expected, upending their sense of security, order and even sense of self.

While Rose was in touch with her desire for boundaries with her mother during

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pregnancy, she approaches this relationship with a softer tone in the postnatal interview, suggesting greater empathic attunement with her mother.

Sarah gave birth at home as she had hoped and planned without any real complications. She talks about her daughter’s birth in the same dreamy and reflective way she anticipated it. Prenatally she is visualizing the labor with both optimism and realism, thinking about her baby but with the knowledge she may be quite different than who she imagines, and thoughtfully reflecting on her own experience of being parented and how to improve. Once her baby is born, she continues to hold the balance between optimism and realism. Her birth experience did not disrupt her worldview or test her dispositional limits and allowed her to transition gently into new motherhood.

(Sarah) I feel pretty relaxed about the labor. I’m looking forward to it in a way.

Sometimes people really enjoy it. Sometimes it’s just really hard work. And the transition can especially be really hard and painful. I just feel really optimistic about it because I know I’ll be at home in a relaxed environment and I don’t have physical or sexual trauma so I’m not anticipating a lot of stuff coming up for me.

(Sarah) I think about her a lot but I can’t really picture her because I just don’t know. I visualize her a lot but I think she’ll be really different from what I visualize.

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(Sarah) I try to be really understanding of kids but I’d like to be more. My parents were mostly really great parents but my husband and I both have a lot of memories of adults making you feel really bad or stupid about something that you don’t understand. Something that they perceive as acting out and to you there’s a totally reasonable explanation behind what you’re doing. That kind of stuff really sticks with you forever and so I think about that—to wanting to do that with my kids.

But it’s hard.

(Sarah) It was a good birth. I went to 41 weeks and three days, so I was definitely over it.

I was nervous about going over the limit because you can only deliver at home with midwives up to 42 weeks, legally. My midwife gave me a recipe for a castor oil smoothie, which was pretty gentle. I didn’t have horrible side effects but I think I was really ready. Labor went pretty fast. So like four hours after I took it I started having contractions. And very quickly they were really strong and pretty close together. So they felt really unmanageable almost. So it was really hard.

My midwives got there six hours into it and I was already complete, so it had gone through everything pretty much. That was a big relief to find out, and they were all there, so I felt pretty calm. And then pushing—I got in the tub and I pushed for an hour and a half or something. It felt as long as the earlier part because it was more slowed down and just peaceful. We were listening to music.

It was a little confusing for my midwives because I talked them a couple times on

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the phone. She was like, “You’re still talking, so that’s an indication that it’s still pretty early. Usually.” Because the whole time I was pretty lucid, especially during the pushing—I was talking and making jokes and stuff. But it was really nice and gentle and then she came out. She needed a little bit of help. She was breathing but she didn’t make noise at first, she wasn’t crying. I think I wasn’t too scared, but my husband says that’s when he knew that he really loved her because he got freaked out. But it was just a minute of that. She didn’t need to be resuscitated, they were just working with her for a little while. They used the bulb thing. I think she did breathe in a little amniotic fluid because she was spitting that up for the next day or so. But she did great. Nursing was a little hard at first because she was a little sleepy and because she aspirated the amniotic fluid she was spitting that up and wasn’t into nursing. I was concerned about that but after a few days she got the hang of it and it was great… It was pretty great. It felt pretty lucky. I think of that time as a really special time and sometimes I miss it. I’m sad that it’s over because it was really special.

(Sarah) I remember it was maybe day three when she was latching fine but I was still a little worried because—you’re supposed to get a certain amount of poops and wet diapers per day—and then the third day she pooped and peed on me and it was great. I felt like we had established nursing. And then when they came back for their week visit, she had already gone past her birth weight. So that was such a good feeling.

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(Sarah) I feel like I understand more—how hard it is. She looks a lot like I did when I was a baby, so I’ve been thinking about it a fair amount. It’s nothing really specific, but I’ll think about being a baby and how we’re doing things differently. I imagine them being pretty scared when they first had me and I don’t really feel that way. It’s funny, I think of them [her parents] being scared and less experienced and I don’t know how accurate that is, but I feel like we have a little bit of a leg up. They had good childhoods and everything, but they probably—like everybody does a little bit better of a job than their parents did, that’s how it tends to go.

Sarah’s tone and stance toward her reverie did not change much from her prenatal to her postal interviews. She consistently seems able to approach important others, her experiences and how she relates to those experiences in a balanced and accepting way.

She mentions struggles and anxieties, but they do not seem to substantially overwhelm her. Sarah’s statement, “I feel like I understand more—how hard it is” is simple and to the point. She is articulating the sentiment of increased empathic attunement with her own parents, shared by all the women I spoke to. While the actual events of her birth are certainly not the only factors that aided her sense of birth and early postpartum as “a special time,” her experience lent itself to that narrative.

The intended focus of this study was not birth experience, and therefore a more in-depth exploration of what factors influence a woman’s experience of labor and birth is beyond the scope of this project and not the point of the above discussion. This is a study of the progression of maternal reverie, and therefore it should come as no surprise that the

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invariably dramatic event of childbirth is both a focal point of a new mother’s reverie and a factor which influences the content and course of that reverie.

For all the subjects of this study, there was reverie around the anticipation of labor and birth in pregnancy, and postnatally the data revealed efforts to make sense of and integrate this experience. For the participants whose birth experiences were uncomplicated and did not substantially challenge a sense of order and control, the data showed thematic shifts in mental content but manner of communicating about and relating to that mental content did not show substantial change. However, for those participants who had a more disruptive and traumatic experience, there were thematic shifts in addition to observable differences in relating to and communicating about mental content. In my effort to explore the question: How does maternal reverie shift and change from the prenatal into the early postpartum phase?, I found that the data pointed to the experience of labor and birth as a predominant factor which influenced the nature of the shift for the women in this study.

What Kinds of Fears, Wishes and, Other Mental Content Are Manifest in Maternal Reverie and How Do We Understand These in Relation to Becoming a Mother?

This leads to a more detailed discussion of the thematic data derived from the analysis of my interviews with six women over the course of their transition into motherhood. Consistent with the chosen methodology of Interpretive Phenomenological Analysis, the interviews were individually coded for meaning units which were then complied and clustered into core themes. My analysis yielded six core themes of the study:

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1. Visualization of birth and baby 2. Maternal preoccupation; Overwhelm and All-consuming 3. Intergenerational meaning making and projection 4. Me not me: The conflicting emotional experience of new motherhood 5. Partnership and the transition from couple to co-parents 6. Felt sense of maternal identity through attunement This section includes is a brief presentation of each of these core themes accompanied by supporting data from the interviews. A more in-depth, theoretically grounded exploration of the data will follow in the implications section of the results.

While I have attempted not to repeat quotes already presented, some of the more salient examples of the themes will be revisited.

1. Visualization of birth and baby.

The first, and arguably the most ubiquitous core theme identified in this study is: Visualization of birth and baby. While it might seem obvious that pregnant women and new mothers are spending a lot of time thinking about their babies and giving birth to them, the universal and dominant quality of this category of mental content is significant.

Additionally, the visceral way the women in this study reported these visualizations suggest they are more than routine imaginings of things to come, the way one might say, imagine themselves on the beach as they await a trip to Hawaii. There is important mental and emotional work happening as women anticipate labor and birth that readies them for this experience. And a woman’s visualizations of her baby during pregnancy and after are important elements of the nascent preverbal mother-child relationship.

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Visualization is arguably part of a mother’s process of integrating her child psychologically as well as a way of connecting with and perhaps even communicating with her baby in utero and beyond.

Reports of visceral visualizations were a prominent element of every interview.

During pregnancy women talk about visualizing their baby and what she might look like.

They visualize the labor and the baby’s birth, the first moments with their baby, what it will be like to nurse the baby. They imagine holding and sleeping with their babies. Once they baby arrives, they are still dwelling on the birth and those first moments, but these are no longer imaginings but rather visualizations of their memories. Women report visualizing their babies as toddlers and even teenagers. While the shift in these visualizations from pregnancy into the postnatal period is not surprising, it is notable.

All the women in this study talked about visualizations relating to labor and birth.

These quotes were selected because they offered the best demonstration of the core theme for each participant, but for each there were many more to choose from. The interviews were full of visualizations of labor and birth. This core theme at times has some overlap with the core theme of Maternal Preoccupation, and some of these quotes also touch on a woman’s thoughts of creating safe space for birth and baby, a fuller discussion of which is to come. You can see that the way the women report and relate to their visualizations is consistent with their way of communicating about other mental content from the previous discussion.

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(Sarah) I think about being in a tub and listening to music with my eyes closed and people just watching me. That’s basically it. I did this one very goofy guided pregnancy meditation —It was like, “You see a sparkling blue butterfly over your shoulder…” and at the end they talked about holding your baby and I cried. It was really touching.

(Sarah) Just dealing with the intensity of it. The pain if it’s really painful. But I’m trying not to look at it in terms of that because I know it really can be but it’s not that way for everybody. I’m in a situation where I’m going to be in a tub and free to move around and not stuck sitting in a bed. So I’m optimistic about that.

(Flora) I’m thinking of the birth itself a lot: How much would it hurt? What my vagina would look like. The feeling it would be the minute I grab my kid. The problems of, where there’s a cord around her neck. Or they have to take her away to ICU. What would it feel like?

(Flora) The closer we get to the day, the closer I start imagining pushing a live thing out of me— not just a live baby, my live baby—the more tangible that feeling becomes. And those are the times that it dawns on me—the realization that labor is coming soon. It happened—I was walking my dog a week ago—and usually I

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would think of labor as a phase in the whole pregnancy thing but I was nervous. I was excited and nervous. Excited because I finally get to have her out of this and I can sleep. But also we’ll have our child there. And of course nervous about the pain, what could happen, how long it could be, all those things.

(Holly) I spend a lot of time thinking about the birth experience. I like to follow all of the Instagram accounts of different midwives and the birth videos and stuff like that. I spend a lot of time visualizing what I want. Not in a controlling way because I’m very aware that you can’t control how it’s going to go, but just in a more philosophical way. Trying to understand myself instead of putting myself into this situation seeing what happens, which I think is kind of what a lot of women end up doing for one reason or another. Thinking about what it is that my instincts tell me. What I actually want for the things I can control.

(Rachel) I think about positions where I want to be. Temperature in the room. Lighting.

Water or not. I have a big walk-in shower in my room—should I get a birth stool for it? Where would the tub be? Positions. Honestly probably the whole gamut of things. The vibe. The mood.

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(Rachel) Thinking more about the physicality of what you’re about to have to do—how that’s going to feel. It’s not anxious yet…it’s going to be a wild day but it is what it is.

(Rachel) Yeah. I think we have a really good team and I have felt pretty calm. I think that’s kind of what I’m like as a person, I’m not the most anxious person generally but anything could happen on that day. Hopefully I can keep a peace of mind.

(Rose) The things I’m nervous about are the pain and getting to the point where the pain is beyond the threshold I was prepared for. I’ve been saying for so long that I’m not going to do an epidural, and what if I can’t take it and then I get stuck. My labor slows down and I end up in that situation. There’s that. Those are the things I’m thinking about. And that as soon as I get to the hospital, feeling like things are out of my control. But then there’s this part of me that’s like, I’m not getting in the car to go to the hospital until this shit is real close.

(Rose) Everybody says that you get into a crazy zone. That you’re out of body. So there’s parts of me that feel like that’s going to be great. And then there’s parts of me that feel like that will be scary.

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(Claire) So the eagerness, the anticipation, the excitement—I find myself very internally focused on that sort of stuff. But in terms of the labor itself I definitely think about what it will be like, more so active labor and transition, going to those places. The what-if scenarios. We have a doula so she helped us put together a birth plan in the event of a non-emergent hospital transfer, but I try not to think too much about that.

(Claire) So I’ve been mentally preparing myself for what that’s going to be like, arriving there [birth center] and how I want that to be for me. Obviously, you don’t know which room you’re going to get, there could be another person giving birth, but envisioning that. Thinking do I want to bring an extra battery candle? Because I have a bunch at home. To set the mood. It’s going to be what it is, so…

The women also reported visualization of their babies during pregnancy. They excitedly wonder what their child will look like, and later in the pregnancy many of them talk about the baby feeling much more “real” and therefore being better able to connect with their images of the baby. Many of the women also discussed having powerful, emotionally charged visualizations of holding their child for the first time and what the first days as a mother will feel like.

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(Flora) I envision a lot of that ecstatic feeling when I hold my kid, when I watch my husband holding his daughter for the first time. I’m thinking of when we first get home—what that looks like.

(Flora) Once we have our kid, entering that home will look so different. It’ll be with a baby in tow. With different worries in tow. And a whole different scenario. I’m thinking what it’s going to look like during the day or during the evening in the apartment with a baby that’s not sleeping, that’s crying.

(Sarah) I’m looking forward to her arriving and also in the back of my mind there’s the consciousness that this is going to be a really mind-blowing change. I imagine she’s a little more of a full person partly because I’m so aware of her. She’s really strong and big now. But I think I’m also conscious of the fact that it could just be a total surprise. I have no idea what she’s going to be like. But I think of her being out here, I think about breastfeeding and bedsharing a lot. And just the first few weeks being at home together. That’s kind of as far as I can go.

(Holly) I have a visualization of the baby’s needs. Not to toot my own horn but I think I have a better visualization of my baby’s needs than my friends did — who went

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into the process in more of an experiential way and I’m more introspective than some of my other friends who are parents…So when I think about the baby I more think about the qualities that our child will probably grow into because of who we are as the child’s parents.

(Rachel) I think the idea of the baby being fully formed now makes you think more about it. When I feel something push out it’s distinctively like, “That’s its butt. That’s its foot. It’s head down.” I can talk to it, it can hear us really well right now. And if it came out like today it would be pretty self-sufficient we hope. Yeah there’s a fully formed baby in the room listening to me talk. That versus a less-developed fetus is definitely a different way to look at what’s going on inside. I was happy thinking it’d be a girl for a bit, then thinking a boy would be cute. Normal things.

Excited to find out and meet the person it is. Maybe there’s a calmness to it. The more the baby is formed and hears us, I want to be a calm carrier of it.

(Rose) Yeah, so he feels real. We’re all so curious about what he looks like. In the last fetal thing I had, he had his hand over here so he won’t let us see his face. He’s like, “No pictures please. You don’t get to see this until I come out.” I think he looks like my mother-in-law a little bit. But yeah it feels way more real. Since my friend had her baby two months ago, and I’ve held that baby…Something clicked there for me big time. “Oh I can do this.” Having the time with him, holding him,

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and that she was comfortable with me holding him, and staying with him…So that made my baby feel real to me—having another baby around.

(Claire) Since my mother-in-law died we looked at all of her photos and things and I actually hadn’t seen many photos of my husband as a baby prior to that experience so now I have more of a visual representation of what he looked like and I know what I looked like as a baby, so I fantasize about the color of his eyes, will he get mom or dad’s nose… hopefully somewhere in between. Those types of things.

(Claire) I fantasize about what his eyes will look like, his little smells and sounds. All the time for sure. I’ve been connecting more with him when I feel him move and stuff.

(Claire) I definitely fantasize a lot about what it will be like to hold him for the first time.

What it will be like to breastfeed. I guess I romanticize it a bit, which is fair enough. I definitely find myself drawn toward toddler-hood. What it will be like when he’s a bit more human-like, less larval.

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The kinds of visualizations the women reported in the postnatal interview were more varied. Some were projecting into the future while others were more in the moment visualizing their infant’s experience, and still others seemed to be visualizing and remembering the labor and birth. In the quotes presented for Claire, Flora and Holly the theme of visualization overlaps with the core theme of Intergenerational Meaning Making, further explored in the larger discussion of meaning making and projection to come.

(Claire) I think about when he’s walking and he falls down and he cries and he just wants his mommy. Stuff like that. He’s a talker. He talks a lot. So I can imagine him having words and being able to say “Momma” and stuff like that. I’m excited for those things.

(Rose) Right afterwards people were like, “You forget.” And I was like, “You don’t forget.” In terms of pain. I can go right back to that moment and remember my pain. It’s kind of masked over now and I think because my postpartum was really good, that seems better than it was. But that was really painful. I was like, “I don’t know if this natural birth is all it’s cracked up to be.” But then my postpartum was so great, I was like… “Maybe it is.” And as I told the story I’ve really remembered it and recounted it. But I don’t think about it a lot anymore. I’m now really in the present moment of figuring out things going on with him.

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(Rachel) Do you want to see a video? I have a video of us finding out the gender. They just held the baby up and told us the gender but it’s funny because I’m so high in the video. They said, “It’s a boy!” and I was like “Yeah.” (shows video) That’s him. I was so happy. We got amazing photos and videos of the birth and the whole birthing process. Every time I show this I’m crying and everyone else is crying.

(Flora) It’s exciting. The things that you are responsible for teaching them. The things you want them to see and how you want them to see it. That feels exciting. I think about certain things I want to teach her a lot.

(Sarah) I think of that time as a really special time and sometimes I miss it. I’m sad that it’s over because it was really special. I lay in bed for a long time—I didn’t do the whole 40 days but even when I started going out and about more I would be in bed at home. It was a special time. I miss it.

(Holly) Wondering who she is going to be, imagining it. My husband and I talk a lot about how people say that they, as their kids got older, they could identify certain personality traits that were evident from when they were born basically…I'm so interested to see what elements from her now are just a part of her. I like reading

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the baby development theory and looking at her and being like, “Is this the week that these neurons are going off?” Or thinking about what she's experiencing…and the way that she experiences it, and what that must be like, I try to put myself in her shoes—in her baby socks.

2. Maternal preoccupation: Overwhelming and all-consuming.

This core theme aims to capture the sense of preoccupation with birth and baby that was present in the mental content of the women I interviewed. For these women, what I am calling maternal preoccupation, in pregnancy tended to focus on “nesting” like concerns and behaviors. Concerns related to preparation and creating a safe space for birth and the first months with the baby were heavily on their minds. This is a turn inward, a slowing down but an intense focus on personal readiness and of the readiness of the environment. It also showed up as participants’ preoccupation with her own and the baby’s wellbeing. In early motherhood, this preoccupation was related to nursing and nursing struggles and the baby’s basic functioning—sleep, eating and eliminating. As in pregnancy, it also manifested postnatally for some of the women as preoccupation with the baby’s wellbeing and safety. The women were absorbed in their experiences with their babies, which had both a positive and a negative valence, sometimes simultaneously. (This theme overlaps with the theme of: Me not me; The Conflicting Emotional Experience of New Motherhood, as well as the theme of Felt Sense of Maternal Identity Though Attunement, to be discussed later).

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(Sarah) I feel really different, but you know—if it takes longer that’s okay too. I’m not feeling impatient, but it’s definitely on my mind all the time. I don’t do a lot of stuff outside of the house, I’m pretty tired, and my foot is still kind of bad. It’s okay though, I need to rest a lot and I am. Maybe a little more nervous about it than I was just because I’m thinking about it more practically. But I know it’ll just happen the way it happens. I’ve been nesting a lot and trying to get the house ready. I feel a little anxious about—I want everything to be ready beforehand, but it’s okay if it’s not…

(Sarah) I just relish the cozy feeling I have a lot. She sleeps a lot and I get a lot of time to just sit with her and think about her. Sometimes if I can carry her I’ll do stuff around the house. I still feel like I’m nesting a lot and getting things together sort of. It’s fun to talk to each other about things we want to do.

(Sarah) The first couple days I was obviously not really ready for anyone else to hold her—not obviously, but it’s really normal. And they [her in-laws] really wanted to hold her. One of the nights my mother-in-law was here she kept suggesting I give her the baby so I could eat and I told her “No, I’m okay.” And then she finished one side and she again said, “I can hold her for you if you want.” And I told her, “I’m going to give her the other side now.” It started this push and pull a little bit.

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I think she’s just trying to be helpful and also doesn’t get it… I feel like somebody’s trying to take her away from me.

(Sarah) It’s really interesting, as someone who’s done a lot of nannying, I intended to bedshare when I was pregnant with her. But I never knew what it felt like. Obviously as a nanny it’s easier for me if the child can go to bed on their own, but I can’t imagine sleep-training her or leaving her while she’s upset. I’m starting to get to that point. Today I left her, and she never cried, but she was making some noises.

Up until now I don’t think I could have even left her for a little bit.

(Rose) I woke up in the morning and I went immediately to the baby’s room and I immediately started… it was like an obsession. All day long. And then I was so exhausted yesterday that I couldn’t form sentences after. I was like—something is wrong with me.

(Rose) I’m figuring out how to have the baby and have me. But I’m obsessed with him.

I’m so in love with him that I don’t want to miss any moments. It’s this weird thing.

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(Rose) He [the baby] ended up having jaundice and we had to stay one night under the lights. It was such a weird feeling to have your baby there. It was hard for me. I kept pacing the hallways. It was this weird animalistic feeling.

(Rose) We have a night nurse two nights a week and I miss him after. So it’s a weird thing. I miss him but yet I should be appreciative. We had the night nurse last night. My husband is sick in one room. I’m in the other room. And the baby’s in the other room. I’m looking at videos of Henry and I’m sending him texts: “Is it weird that I’m looking at videos of our kid in the first break I’ve had?” And he’s like, “No it’s not weird.” It’s just a weird thing.

(Flora) I try to focus on the nursery so I can organize my thoughts and defocus away from my stress. And that creates a, “Alright, okay, well, I can order the dresser now, but no—Brian wants me to wait on his opinion and he’s not helpful” and it goes into a whole thing of what my marriage means, my husband. But my husband is super helpful. He’s the best. It’s me blaming something on someone because I guess that feels good.

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(Flora) Then I had so much trouble breastfeeding. It hurt so much, and I knew it was going to happen. So I got into this vicious cycle of her not taking the breast, she won’t take the bottle, I’ll try to pump but my milk supply is low. And it went back to, “I’m not doing enough as a mom.” Even though my child is super healthy and cared for and has loving parents, especially with the birth and breastfeeding, those are the biggest jobs you have as a mom. There’s something in, “I failed her.”

Even though I’m conscious it’s not my fault, it just happened, it’s a natural thing, I just can’t not.

(Flora) I mean for me it’s all-consuming because breastfeeding is all consuming. It takes me back to it every time I’m feeding her. It feels like an all-consuming thought right now. It’s like an all-day event. There are times where I’m like, “I’m fine.

This is what it is. My child’s fine.” And other times I’m crying. But because it’s feeding every three hours it’s a reminder every three hours, so it’s going through it all of the time.

(Rachel) The prep was so intensive—for me probably half of it was the house stuff — but in general buying everything and setting up the room and whatnot—that stuff is slowing down. So there’s also this feeling of… not just waiting, but it’s a bit calmer this month. Physically I probably shouldn’t do as much…so it’s kind of

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nice. It’s relaxing. And it’s winter here. I’m not any more nervous or anxious because it’s coming up. Just feeling very excited. Going to enjoy the last month of pre-being a mom.

(Rachel) Yeah. I wouldn’t let him out of my sight. It was fine and helpful, the nurses were great, but it’s a lot.

(Rachel) Well even my breast milk supply lowered, so I’m trying to get that back up. And I think that’s both a factor—not like stress, I haven’t been really stressed out—but just not napping enough…I think the breastfeeding is hard. I haven’t been leaving him for that many hours yet. And this past week all the inventory I’ve built up I’ve used because my supply diminished and I was really wanting to feed him extra at each feed, which is fine—I’ll pump a lot this week and hopefully get that back up.

(Rachel) I mean you just can’t set him down, you know. I try for a little bit here and a little bit there but it’s hard. He’s getting more and more interactive and entertaining himself but it’s a lot.

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(Holly) Just thinking through different iterations of how I might feel, I’d like to reserve the right to ask that they [her in-laws] wait until we get home before they come over. Thinking through how I might feel after that. Do I really want the first time I take my baby home to have there be his parents and his brother there, and food on the stove, and what if the baby is crying, I’m bleeding through my pads and I just want to change and get into bed and comfort the infant and get settled and then they come over.

(Holly) [talking about her in-laws questioning their choice of a birth center] I felt deeply misunderstood—which is a big trigger I have: not feeling understood. I felt like they thought I was doing something unsafe and I was like, “How dare you—I’m doing this because it’s actually safer.”

(Holly) We were seeing a lactation consultant at the pump station from the very beginning because I was having so much trouble and my nipples got damaged and all of that.

And then in the next couple of weeks realizing that my milk was really, really low and this is what happens to women who have this happen, basically where you lose blood and have to do a transfusion. It’s like a thing that when your hemoglobin is low, it doesn't send the right signals to your pituitary gland with making the prolactin. So it felt like it was all linked with the things that were

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difficult afterwards, like breastfeeding was really hard and I was getting even less sleep than probably a lot of other moms because I was doing the triple feeding thing… basically try to get my milk supply up. But I was also having so much trouble with the latch, so basically, I was doing practice nursing sessions but then every time I gave her a bottle I needed to pump, and doing the round-the-clock feedings, I’m doing the round-the-clock pumping on top of it. So, it’s a lot.

(Claire) I’m a little preoccupied because one of their requirements is you have to be 5-6 cm dilated before you’re admitted to Del Mar for the labor. So my husband and I met with a doula and hired her. We hit it off and she seems great. I think having another woman who knows what they’re doing around when I’m laboring in the beginning and helping me to get to that halfway mark…she’ll be a guide not just for me but for him also.

(Claire) I was with my husband and another friend—we were walking around downtown LA and I noticed I kept having these automatic thoughts of safety and protection, of my body and the baby.

(Claire) Last week there was a lot of nesting. It’s kind of been going on for a while, but last week felt like there was a really big surge. I had some things that had

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accumulated to the left of the bed and needed to be sorted through and put away. I rearranged the guest bedroom, moved the bed to another wall by myself, put on fresh sheets, and got that all ready.

(Claire) I’ll look back at pictures from when he was a wee little one and my husband actually just this week, on his trip, he sent me some photos that he’d taken while we were still at Del Mar and I was holding him, like the first time he nursed. That made me cry.

(Claire) When I’m just here with him, alone, I spend a lot of time just thinking about what’s going on in front of me. The little development things that he’s starting to do. He’s talking a lot. He has a lot to say. And he’s starting to roll to his side and then back to his back.

(Claire) They’re fleeting. They’re not regular preoccupations, but there’s always a new one that pops up. I realize that I have eight mosquito bites on my ankles and then I was doing some exercise and the woman I work out with said it was probably the tiger mosquitos that can carry Dengue Fever or some shit like that so all day I was jumpy and jittery and I was worried that he was going to get bit. Two nights ago there was a spider on the couch. So for the last 24 hours I’ve been freaking out

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about bugs. I’m sure that will pass. Last night I pulled all the pillows off the bed and vacuumed everything like a crazy person.

(Claire) The reality of it is perhaps a little different than I had imagined. I’m always aware of my relationship with him. There’s no time ever, now, when I’m not aware of the fact that I have a child. I think I knew what that would be like conceptually, but then it’s like, “Oh. Right. It’s all of the time.” He’s always on my mind. And that’s cool. And sometimes a little overwhelming.

3. Intergenerational meaning making and projection.

The theme of Intergenerational meaning making and projection is robust. This category contains several types of intergenerational material, of which I have identified three primary sub-categories: Reflection related to parental figures and experiences of being parented; meaning making and projection; and oscillation of empathic allegiance.

While intergenerational thematic content was present for all the women, the ways they engaged in intergenerational reflection was varied. Some of the women talked more from a biographical, data-driven place while others were more prone to meaning making and projection. And some more than others demonstrated shifts in empathic attunement. This thematic material is also connected to a woman’s attachment history, particularly with respect to the sub-theme of: Reflection related to parental figures and experiences of being parented, which I framed this way for the purposes of this discussion in order to cast a wider net. However, with respect to attachment more specifically, the women are

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alluding to attachment history and style when communicating about experiences of feeling or not feeling heard and seen and their sense of security in early primary relationships. It seems possible that the differing ways the women engaged with intergenerational content has something to do with their attachment histories. This will be touched upon in the discussion section.

Reflection related to parental figures and experiences of being parented.

Motherhood is an intergenerational event; becoming a parent means becoming a bridge from generations before one’s own to future generations. The liminal space from pregnancy into motherhood is a time when women revisit their relationships with their own parents and other important early caregivers, mother figures in particular. This showed up very explicitly in the data. All the women I spoke with talked about desires to rework family relationships and establish new boundaries. They reflected on their own experiences of being parented and hopes to replicate and revise. Many of them spoke of wanting to do things differently. And interestingly, every woman I spoke with mentioned not wanting her mother present at the birth of her child. While of course pregnancy does not alone create awareness of familial dynamics, the data confirms existing research that indicates pregnancy and new motherhood amplifies these concerns.

(Holly) I often reflect on the differences between me and Daniel’s upbringing. He had a lot of great things that I didn’t have. But I think I also had some things that were really good that he didn’t have. We’re bringing both of those perspectives to the table and I have a lot of appreciation for the fact that not only will our child have

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two parents but maybe even a sibling and probably cousins locally because he Daniel has a younger brother. The grandparents will be right here in the city.

(Holly) I grew up in San Diego and my grandparents were in LA, but it was really just me and my mom. Especially when I got older my mom could be really controlling.

The joke I always make is that I was grounded from age 13 onward. There was no other buffer there. I reflect a lot about how that experience will be different. I reflect a lot about the things that my mom did that I don’t want to do.

(Holly) I think my mom is just really slow to process emotional things. She doesn’t have high emotional intelligence. She has a high intelligence quotient. She’s a very educated person. She’s a scientist. But she’s not self-reflective and she can be really awkward in social situations.

(Holly) To be honest I’ve reflected on ways to manage issues that I have with her, not bringing that into the family dynamic. It’s come up since me and Daniel got together. My mom has been in a state of discomfort with the fact that I found my soul mate and decided to get married. I think it’s been hard for her. But she’s also the least self-reflective person on the planet so it’s all completely unconscious.

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(Holly) I’m also realizing that they’re [her in-laws] not perfect either. That there’s a gulf in our worldview sometimes. And that’s okay too. I’m probably growing as a person to deal with that dynamic as well. I realized it’s hard for me to ask people for help, which I know I have to do as I start this journey so I’m being strategic about things I’m comfortable asking for help with.

(Rachel) My relationship with my mom is definitely closer. She hasn’t really worked for a while. She was kind of always a mom so she has this newfound purpose in life: she’s having a grandkid. She wants to be the most active participant. That relationship is changing. My mom is suddenly like the utmost concerned about my stress levels and making sure I’m happy and making sure I have everything I need, that I’m relaxed and all that good stuff.

(Rachel) I had a Guatemalan nanny/house cleaner kind of person that was live-in who helped raise me. For the most part we’re interviewing newborn, so thinking about what that person should look like. The person we’re talking to is Guatemalan also so we’ve had conversations about that.

(Rachel) I don’t want my kid to grow up in a more sheltered environment, I don’t want

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their access to the world to be like: they wake up, I drive them to school, I drive them to soccer practice, they come home and have dinner. I am used to, personally, seeing more on my day-to-day than that, and want that for my kid.

(Rachel) My mom is and was a great mom but she can be a little bit more frantic in her energy. I have a healer guy who was talking to me about the way my mother held me as a baby and it gave me anxiety as a child—god knows if this is even true— but sometimes I just think about wanting to make sure that us as parents are very calm and anxiety-free so that the baby doesn’t pick up on things like that.

(Sarah) There are people in my life like my mom and my aunt who kind of characteristically drive me a little crazy. I have this one aunt who I really love but she can really suck you into her drama and it makes me feel bad and angry and frustrated that she does that. I noticed the last time I was there visiting her it was really different. I noticed myself consciously choosing to not get sucked in and not perpetuate the drama or the conversation even. I told her I can’t go there and that I was sorry. It’s all family stuff—she’ll get talking about my other aunt and it’s this long family pattern where I even start to participate a little bit and I feel really bad after. I felt really good about not allowing that to happen. I felt like maybe I can choose to do this more in the future… It felt connected to being pregnant and being almost a mom…I don’t want to pass that on, really. I don’t

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want to be complaining to my daughter like, “Your aunt Sue is really pissing me off today.” Or whatever.

(Sarah) My mom is a great mom and the chillest out of all of them. She doesn’t lean on me too much but I would like it if she confided in me a little bit less because it doesn’t feel great to know everything about her struggles because she’s my mom.

I think about having better boundaries and also just not wanting to pass that kind of practice down because I know how easy it is. We all pass down patterns for sure, it’s inevitable.

(Sarah) She’ll [her mother] book something as soon as I go into labor. I really want her to be here after. But if she’s here during the birth that’s fine. It’s not really a matter of not wanting her there although I don’t particularly want her there at the birth, I just don’t want her to come here and us be waiting around.

(Flora) She [her mother] lives in London. But her and I are very close. We had a tough upbringing and there’s a lot of issues that come out from that. A lot of that is her and my family always treating me like a kid. My grandma had 15 kids. We’re a big family and so I’m one of the youngest cousins. I will never be an adult to them. I’m 29 about to be a mom and I will never be an adult.

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(Flora) I always felt like I was raising my mom, that I was the stronger one in my upbringing. And in my head I thought, “I’ve got experience raising someone so I don’t think it will be that hard to take care of someone.” But I realized that my family dynamic now is completely different from the family dynamic I had as a kid. So I am coming into these new trenches that I’ve never…I never had a father.

I have a husband who will be the father to my kid. I have no idea what that looks like. That’s a whole new world to me. Someone being the father to my child is a father figure to me now, too. So I’ve started discovering that.

(Flora) Especially because I’m having a girl, switching the daughter/mom role to the mom/daughter role. Because I’m very good at that, this way around is a whole different scenario. It makes me think a lot of who I am—the transition of that personality. I’ve always been a daughter and I have this close relationship with my mom. I need help so I go to that person. Now I provide that help.

(Flora) I have the same feeling with my friend in London, trying to keep communication.

Same with my cousins in New York. My extended family in Dominican Republic—I think a lot more about disconnecting from them even more so, rather than connecting. I don’t know what from. I think…indifference? But I think I was already at the stage where I knew I needed to disconnect with them.

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(Rose) I think the feelings about my dad have definitely…he died less than a year ago so I’m still going through a mourning process…So he’s coming up and I think it’s interesting because he was masculine energy in my life and important. But also my father really understood me and had a lot of depth. I’m wondering if I’m projecting any of that onto the son that I’m having because I so want my son to fill the void of what I lost in my father.

(Rose) I was thinking about my mom. I have all of these negative feelings about my mom in regards to her thrusting me into showbiz, but then I have gratitude for it as well.

So it’s a weird place to be. I wonder which sort of realizations I’m going to have about having my own children and wanting to give them every opportunity I could, which is definitely what my mother did. And is that opportunity motivated by my need to be fulfilled through my child? Or is that motivated by just really wanting him to be exposed to as many things so he can figure out what he’s good at. It’s really tricky…My mom was not aware. At all. She’s still not aware. She can’t see how any of that was for her. It’s what I did for you. It almost comes with some price, like you owe me for this.

(Rose) I don’t want my mom here. I don’t want her energy. I don’t want her intruding.

But here’s the other part of it—my mom is like a battle-axe. She is a survivor. If

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you put her in a stressful situation she fucking rises to the occasion. She’s driven.

She’s tireless. So am I.

(Claire) I’ve noticed it causing a little bit more stress in the relationship with my mom, which is interesting. She and I get along really well. We’re in the same profession so we have a lot that we can relate on. She’s still a really big source of support.

It’s been interesting to see that relationship shift. Historically my work has been about creating my own independence in that relationship—there’s a lot of that kind of co-dependent flare to it from when I was little. So noticing that pull from her—she really wants to be involved. If it were up to her she’d be here to help catch the baby…I’m just like—no thank you. I really prefer if you just met us at the house. One thing that I thought was really helpful that the midwife said was that with parent/child relationships it depends a lot on the relationships because often the mother-to-be, it’s really important to be a mother in that moment. That’s when you’re needed most in your mother self and you can regress into your child self. That’s how she was describing it. You don’t want to be regressed when you’re giving birth. So it would really depend on the relationship that the new mom has with the parent. For me it’s no. I need to be in my own skin.

(Claire) I would say my grandma is someone I’ve been feeling a lot closer to lately. She wasn’t a huge part of my upbringing or anything but I’ve been making more of a

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concerted effort to reach out to her, checking in with her, seeing how she’s doing and since getting pregnant—I actually didn’t tell her until I hit the second trimester because she’s very much like, “God this and that” and if the baby, for whatever reason—I just didn’t want to have that conversation. But it’s been sweet to connect with her in that way. And hearing her birth stories, which I’m sure she hasn’t talked about in forever. And also obviously hearing my mom’s birth stories and stuff like that. If all goes like they had it, it’ll be an easy birth. We have good just…open up and pop right out.

(Claire) Well the thing is, the sadness from my husband’s mother dying—that’s also continued to be interlaid with everything that’s been going on. Especially in the beginning. As he gets older, the developmental milestones—I found myself thinking I wish I could call Kay. The other day there was something going on and I just wanted to call her. I wanted to have that connection with her. I guess it is present.

Meaning making and projection.

The intergenerational aspects of the transition into motherhood also showed up in less direct ways through meaning making and projection. Meaning making refers to the new mother’s efforts to interpret aspects of her pregnancy, her child’s behavior, affect, etc., as meaningful information revealing who they are and will be. Projection refers to a related process, through which the new mother (and others around her) project aspects of

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herself, important others, and other relationships onto the infant. Meaning making and projection were present in all the interviews for this study.

(Holly) So when I think about the baby I more think about the qualities that our child will probably grow into because of who we are as the child’s parents.

(Holly) I really wanted a name that would somehow symbolize like a combination of both of us. If it would have been a boy, we would have named the boy after both of our grandfathers for the first and middle name. And so, for her, my birthstone is sapphire and his is ruby, and at our wedding we had a little bit of like a ruby red/blue theme, so red and blue make purple.

(Rachel) He’s definitely got a mind of his own already. He’s a tough cookie. He wants what he wants when he wants it and he’s vocal about it. He’s adorable and he’s smiley—he was laughing from like five days old. I have pictures of him laughing, it’s bizarre.

(Rachel) There’s this healer in Santa Monica. He told me last year that my mother didn’t hold me right when I was a baby. I have no idea if it’s true—it’s not something I can really assess… Even sometimes now when she holds him I’ll really try to pay

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attention. Are you being too nervous with him? Could it be making him nervous?

Even when she’s babysitting and the most helpful and amazing with babies and so loving and he loves her, I’m still really trying to make sure everyone’s calm in the house.

(Sarah) She looks a lot like I did when I was a baby, so I’ve been thinking about it a fair amount. It’s nothing really specific, but I’ll think about being a baby and how we’re doing things differently. I imagine them being pretty scared when they first had me and I don’t really feel that way…I had a pretty good childhood but she’s probably more secure than I was because I remember being a little bit more fearful.

(Flora) With a girl there’s a sense of wanting to recreate the relationship with my mom I always wanted, and I never thought for a second that because I have a husband and a father who would be a great father to my kid—there might be a competition to it. He’s also definitely going to have a bond with my kid and he’s going to be a great father so I’m sure he’ll have a strong bond…but how do I fit into that? …It’s jealousy. Joyful that my kid will get to have something that I didn’t have, which is great, but fear of losing my child even before I had it.

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(Flora) I picture her having his brain. I consider him being very, very smart and astute, emotionally intelligent, I picture her having that side, and also being my side of curious, brave, and not feeling content with one thing, and always wanting to keep exploring.

(Flora) I’m scared she’s going to be like me. My husband and I were such different children. He was quiet, coy, reading in his nook all the time. I was loud and mischievous. Just the opposite of each other. I guess I’m only scared of her teenage phase, that it’s going to be payback for what I did to my mom back in those days. It’s hard to imagine a personality now. She has her own things like going from zero to 100 when she’s hungry and crying bloody murder—I guess just little things that could be very Sofia or could be very baby-like in every baby.

(Flora) She has my eyes so strongly that it’s so scary sometimes because I see literally the image of myself. It’s like I’m holding myself. People kept saying she looked like me and I didn’t see it at the beginning. I just thought she was a cute baby but I didn’t see the resemblance. And now sometimes I’ll pick her up and I get a little freaked out. Like, oh gosh, you’re going to be loud like I was. Even though my mom says that I was a quiet child. It’s always the quiet ones that are the tricky ones.

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(Rose) My father was incredibly deep and wise and such a soulful person and I don’t want to be like, “Why can’t you be deep and wise and soulful!?” I’m definitely hoping that my son has those sort of qualities—those soulful qualities. I kind of think he will. My intuitive feeling is that he is intuitive, that he has depth. I don’t know, it’s weird, I just feel things I guess.

(Claire) I project a lot of that on him. I’ve been trying not to but it’s hard. Looking to the stars, reading about astrology. So he’s probably going to be a Taurus. So that kind of earthiness associated with the Taurus is awesome. And in the Chinese zodiac this is the year of the earth pig, so he’s really grounding…And actually I’ve felt that kind of intuitively in myself as well…I certainly feel a sense of grounding when I connect with him.

(Claire) Since my mother-in-law died we looked at all of her photos and things and I actually hadn’t seen many photos of my husband as a baby prior to that experience so now I have more of a visual representation of what he looked like and I know what I looked like as a baby, so I fantasize about the color of his eyes, will he get mom or dad’s nose… hopefully somewhere in between. Those types of things.

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(Claire) My family’s big into surfing. My stepdad and my brother and Ryan all surf. So I’m imagining—both with excitement and fear—I’m imagining what that will be like, when they want to take him out into the ocean. I can kind of see him doing little things like running around the beach. So just imagining all of those fun things.

(Claire) He’s very observant. He’s been that way since he came out. When he first came out he had this face that almost looked like his brow was furrowed. He would look around all smushed up like that. Like, “What is this place? Where am I?”

(Claire) As he’s grown into himself, he’s a lot more secure and just taking it in from a more open and joyful place. I laugh because he started to be a lot more emotive with his likes and dislikes. I got his first laugh out of him. He’s smiling a lot more. Making what I assume is eye contact and really knowing me. So that’s sweet. And he’s a pretty content baby until he’s not—and then he’s not.

(Claire) I’m a little on the anxious preoccupied scale, so I wonder how much of that is mine and not his, right? Probably more mine. (Laughs). So it’s helpful to think about it that way.

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Oscillating empathic allegiance.

Another aspect of this theme is what I observed as an oscillation of the new mother’s empathic allegiance, in particular in the postnatal interviews. In other words, who the women seemed to be empathically tuned in to and identifying with. The women seemed to be identifying with their babies and their own mothers, and themselves as babies in different moments, sometimes in the same thought. This content overlaps with the Me not Me thematic material. In the postnatal interviews in particular, there seemed to be a distinct shift in empathic allegiance with parents and even grandparents. The women reported a deeper sense of understanding of their own parents and parents in general and some of the women even seemed to soften in their desire to create new boundaries.

(Rachel) Whenever I talk to him, I feel like I sound like my mom. All of my expressions and everything—I remember my mom treating me like this because she still does.

(Rachel) My mom co-slept, I’m co-sleeping, so it’s interesting to hear about her experience with that and me coming upon realizations that I’m making some of the same big decisions as her. That’s interesting…It definitely makes me feel better that my brother and I turned out okay, and that she made that decision too. She’s super helpful. She’s a tough cookie and a little… I don’t want to say “losing it” but she’s getting older and she’s getting more set in her ways. She’s super conservative. She’s getting a little bit tougher for me to deal with as she gets

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older. But since the baby was born it hasn’t been bothering me so much because she’s here helping me all day. She’s also shifted the way she associates with me.

(Rachel) I would always try to push her fears away from me because I didn’t want to take them in…Constant worrying that should be in my head. But since I’ve been pregnant and had the baby, she seems to want me to be as relaxed and happy as possible. She is cooling down a lot. She still gets worried with him—"is he crying because of this or that”—but she’s been a lot more manageable for me. I’m sure some of it’s been my appreciation for her help and some of it is actually in the way she’s relating to me and me to her. So that’s nice.

(Sarah) It’s funny, I think of them [her parents] being scared and less experienced and I don’t know how accurate that is, but I feel like we have a little bit of a leg up.

They had good childhoods and everything, but they probably—like everybody does a little bit better of a job than their parents did, that’s how it tends to go.

(Sarah) I felt really loved and everything, but I definitely remember missing them a lot and being more fearful. Of course, I’m remembering later on when I would go to nursery school or be with a sitter—stuff like that. Sometimes I think about what it

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would have been like if I had just bed shared. What a difference that would have made in my general psyche.

(Rose) Thinking about how much energy my mom had—I’m thinking about that in a way that I’m admiring that. And that she was an inspired mom and a joyful mom because she wanted to be a mom. I didn’t feel like I was her burden. Also, I’m thinking about how I’m going to feel when I’m in this position of having a child who’s reliant on me, how I get my energy and fulfillment.

(Rose) I appreciate her [her mother] more. I called her on my birthday to tell her thank you for delivering me. I had never done that before. Birthdays—why are the kids celebrated? The mothers should be celebrated! That’s bullshit! The Mother’s Day should be the birth of your child. That’s the person who should be celebrated for doing all of that work but it’s just one more thing the woman needs to be silent about—make a cake for your kid! This is problematic.

(Rose) So, I appreciated her in a new way and I also understand the connection with your child. I also think I had had moments in my life where I doubted my mother’s love for me because of the living through and exploitation and that kind of thing.

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It’s just so overwhelming—the love you feel for your child and all that you do.

My mother did that for me.

(Rose) I have such a more appreciation for our gender. You call me a pussy and I’m like, Thank you. This particular body part is the most powerful. It delivers life. It takes a beating. So those are a lot of the thoughts I have. Female pride and deep understanding of our gender. Those are the more abstract thoughts I’m having.

(Claire) Part of the hypnobirthing stuff we’re doing is healing any kind of negative stories you might have around your own birth, other birth stories you have in your family and stuff. I’ve been revisiting the stories that I have about my birth and I was born at home but then had to go back to the hospital and was in an incubator for a number of days. The story that I have is that I would cry and cry and cry in the incubator and she wasn’t allowed to touch me. So there’s a lot of this preverbal sadness and longing for that attachment and connectedness. So I’ve been kind of working through that, you know? Fear of abandonment stuff. It’s not being held.

A little baby not being held. So that’s interesting. Trying to integrate it so I’m not having that recreated when he comes out. So that I can be more present for the birth—that’s how I’m thinking about it.

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(Claire) I have greater empathy for my mom and dad and the experience of what it must have been like to have a very colicky baby. I was jaundiced at birth. That was back in the day when they separated you from the incubator. I have this story of my early days that’s relatively traumatic. On a personal level I feel like I’ve processed that, but now I have another perspective of what that must have been like for my mom and dad. So I think that’s brought us closer. And certainly helped me have greater empathy for what that must have been like.

4. Me-not-me: The tumultuous and conflicting emotional experience of new motherhood.

Creating and bringing forth new life is a time of tremendous change. The gestation and birth of a child ushers in a new way of life, a new way of being. The firsttime mother is forced to reckon with past and often conflicting versions of herself as she begins to identify with and integrate her emergent maternal identity. The transition to motherhood, like all liminal experience, is strange, disorienting, and full of emotional tumult and conflict. Becoming a mother brings with it loss and tremendous gain, deep love and painful vulnerability, gratitude and resentment. Some of the initial meaning units identified in the data analysis have found a home under this core theme: conflict surrounding professional identity, conflict related to partnership, confusion around identifying with versus separating from one’s own mother. Me-not-me became a useful way to talk about the disorientation new mothers feel: This is my body and not my body;

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my baby is a part of me and separate from me; I feel like my mother but I am not my mother; I am my former self and I am not my former self.

The following sections from the data demonstrate how each of the study’s participants expressed and represented her experience of the tumult and emotional conflicts of new motherhood.

(Sarah) I’m a little worried that I will look back on these weeks and really regret not contemplating that change more or coming to grips with it or doing more stuff out on my own while I still can, but I just feel super tender and sensitive right now. I went out to get coffee yesterday and I felt too sensitive to be out in the world, you know?

(Sarah) I’m a little bit agoraphobic and have some social anxiety anyway, but when I’m feeling really sensitive and I go into a place like that—a totally normal and nice place—I just felt like an alien yesterday.

(Sarah) I definitely felt different throughout the pregnancy. Different than I did before.

I’m trying to pinpoint it…the last few days or last week or so…I feel like there’s been a transition.

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(Sarah) A lot of the time I wake up in the middle of the night and then I’m up for two hours and then I go back to sleep. That’s when my mind races and I think about all of the things that are bothering me. Partially because I’m in this weird wired anxious state in the middle of the night and I can’t go back to sleep. But it’s interesting. A lot of things come up then. That or some stupid conversation I had with a friend that I’m mad about—stuff like that in the middle of the night. And then I’m pretty mellow during the day. It doesn’t bother me that much.

(Sarah) There’s nothing that’s really bugging me. It’s not really related to her. It’ll usually be that I’m annoyed at a friend of mine. That’s a big way it manifests, actually.

I’ve noticed that. I usually take it with a grain of salt. It’s usually if I haven’t slept well the night before or if I’m in a grumpy mood—I’ll find something to be grumpy about. But it’s really not that bad. I didn’t know how it would feel. I’ve had pretty bad anxiety and some depression before so I didn’t know.

(Sarah) She was always pretty good at night but there was a period where there was some uncertainty about how the night was going to be. So I would get a little down at night. Night falling has often been a thing for me—just a time when my mood goes down a little bit. I would get kind of low and then it just kind of went away.

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(Sarah) I feel like a part of their family [her in-laws] but it’s a weird feeling when you realize that she’s actually part of this whole other family. She’s equal parts my family and this other family. So that’s been a little bit hard to grapple with.

(Sarah) I didn’t gain that much weight but my body’s really different and I’m having some challenges with that. With stuff not fitting. I’ve always had small boobs and they’re really huge right now—they’ve tripled in size. It’s hard. Things fit really differently but I’m trying to be really gentle with myself about it. I don’t want to weigh myself or any of that.

(Flora) Even though the baby is healthy, it’s a very routine pregnancy, nothing bad is happening, when I think about it I just think how it feels uncontrollable and messy and things are not progressing the way I want them to progress or that I don’t have control over certain things.

(Flora) I also never thought if I do have kids, I’m going to be sharing this experience with someone. It was always just me. My mom’s a single mom so I think I felt that way.

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(Flora) Especially because I’m having a girl, switching the daughter/mom role to the mom/daughter role. Because I’m very good at that, this way around is a whole different scenario. It makes me think a lot of who I am—the transition of that personality. I’ve always been a daughter and I have this close relationship with my mom. I need help so I go to that person. Now I provide that help.

(Flora) Actually, one of my key words was body dysmorphia. Just the thought of what my body will look like and how that will determine who I am afterwards. The idea of—which I always do—after the summer I’ll diet and I will get on the treadmill and I will look great. And it’s the same idea here, after the baby’s born I’ll diet and I’ll be on the treadmill and I have this image of succeeding in that and so going to a body preference that I have and feeling more self-confident about myself and having loads more sex in my marriage and being successful at work and being a great supermom and all of that because I dieted and went on the treadmill and look the way I want to look.

(Flora) I imagine when she’s starting to be her own person and we have to let go at some point. And then there’s a world out there that she’s going to interact with. Losing control over that.

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(Flora) There was nothing and now there’s something. And then there will be nothing again. And the postpartum will hit because there will be nothing.

(Flora) I was sitting in the kitchen, my mother-in-law and father-in-law were at the kitchen table with me, and my sister-in-law was cooking, Brian was playing with the kids. It’s the picture-perfect moment I always look forward to. I was sitting there feeling completely numb and tasting an unhappiness feeling. I told [my therapist] I think it was a chemical imbalance because I could taste it so definitively on my tongue that I was so numb. I wasn’t feeling anything. No happiness no nothing. And in the moment where you’d think I’d be happy. So, since having that experience, that’s how I envision it would feel like if I do get postpartum depression. And the fear of—I could be nursing and just feeling that numbness again. Holding my child, nursing, trying to read to it, and expecting it to be this joyous moment and then just nothing—feeling numb and not excited or happy. So that’s what I picture.

(Flora) I think I’m starting to feel the maternal instinct that I didn’t think I felt before because a lot of times everything is so gradual. The minute I found out I was pregnant—it’s the expectation that you’ll feel the motherly instinct kick in at

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some point or you’ll wake up one day and feel like I’m a mom, but it just doesn’t come like that. But the closer we get to the day the closer I start imagining pushing a live thing out of me—not just a live baby, my live baby—the more tangible that feeling becomes.

(Flora) But the other day it was my day of just going to the movies and the mall and doing some shopping, but I had such guilt of doing that. I kept telling Brian I’d be back at a certain time and he’d say, “Don’t worry. Be back whenever. I’m here.

We’re not going anywhere.” It was so hard to go have fun and not feel guilty and leave and feel like I’m having fun without my child.

(Flora) It brings me back to thoughts of finding my own identity and worth as a mom. I need that for my sanity. It was a big thing going back and forth—whether I would go back to work or not. First, I hated my job, so it was an easy excuse to be like, “Well I need to stay home with my kid.” But I just didn’t think I would be a good stay-at-home mom.

(Flora) I guess I was feeling chained up. I’ve always been so independent that being so dependent to this child and feeling like there’s no way out, even though I’m not exactly chained—we have an Ergo carrier and a stroller and we have a dog that

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we have to walk. There are ways to get out of the house or even go to a friend’s house and socialize, but the limitations of not being able to go get my mani/pedi done, even though I don’t need it but I want it. And it’s so contradicting. Because I’m also struggling with the thoughts of leaving my child and having someone else take care of her. Then I feel like I need to leave in order to continue loving my child.

(Flora) She has my eyes so strongly that it’s so scary sometimes because I see literally the image of myself. It’s like I’m holding myself.

(Flora) I put so much of an identity of what a mom is into whether I go back to work or not, so I kept going through the pros and cons list with every thought of what I wanted out of it or out of my family dynamic or my lifestyle because it was the first time I was making these decisions—I guess I also had the identity of like “What am I? Who am I? What do I want?” Which had more to do with me than it did with me and my child.

(Flora) It’s funny because it’s going from, my child just came out of my body, it’s still clinging to my body, it kind of belongs to my child—not that it belongs to anyone else—but in the sense of this conversation it belongs to my child more than it

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belongs to the bedroom and between my husband and I. Right now my body’s not mine, it’s either my child’s or my husband’s. It’s a lot of feeding or pleasuring or even my own—I’m like “I need you to rest” and I can’t do that sometimes. So yeah—a lot of needs coming from a lot of places.

(Holly) I always thought I would do something more creative and I’ve been thinking a lot about that…I’ve spent time thinking about how I miss having a creative outlet at work…I’ve been spending time thinking about what it is that I really want in my career and thinking about the fact that the whole reason I ended up in nonprofits is because I felt like it would be a risk to do something creative and be out there hustling as a single woman. There’s a lot to be said about the stability and having a full-time salary position. But I’ve realized during my pregnancy that I’m not the same person. I’m not in that same situation. I’m married now. I have a lot more stability and I have the freedom to maybe explore.

(Holly) Working full-time and being pregnant sucks. You feel this pressure to pretend that it doesn’t, to just power through it or whatever, and I have not enjoyed that…I’ve worked with many women who have gotten pregnant and sometimes I wonder if we do ourselves a disservice by grinning and bearing it. There’s this pressure to never complain about it, when it’s totally natural to complain about it. Or to feel bad about getting special treatment or getting whatever you get because you have

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a disability or whatever. Like I got a parking pass to park closer to the building— things like that. I’ve thought about how I had this vision of how I would also make it look easy but it hasn’t been easy to just show up on time every day and to do fundraising when it’s not what I care about right now.

(Holly) It’s a really weird experience to go from highest high to one of the lowest lows.

(Holly) I endured probably the most pain I’ve ever endured in one day. And then I had to recover from birth and take care of an infant and learn breastfeeding and all of that and got no sleep. And so, obviously, we condition ourselves to just plow ahead. In part of my mind I’m like, is there going to be some kind of kickback at some point? And in the immediate postpartum, the kickback was that I was very hypersensitive to pain—like nursing, you know, having problems with the latch, that it was painful. I was just like “Why, why are you feeling more pain, I don’t want to feel more pain.”

(Holly) Even though I knew it [having a baby] was a big deal, it’s always surprising in its own way. And obviously, having no sleep, it can make you really irritable— especially the first six weeks. Daniel and I would go from zero to 100 with each other. It was usually because I was irritated with him for not doing something that

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I wanted him to do, and we have really good communication though, so we would always work it out.

(Rachel) When I was first pregnant, I was really happy. Positive moods. But then a month or so later, as I started settling into thinking about the future and planning and everything it gave me a lot of anxiety because it’s just so much harder to move with a child so part of me was like, “Shoot—if we are to move in the next few years should we do it before?”

(Rachel) So the one preoccupation is just—right now I’m a little less than two months away from having a baby and I’m home a lot, and I’ll probably become pretty much exclusively here after the baby—so that’s the next four months of my life I’m pretty much going to be home a lot. Because of that we’re trying to drive up to San Francisco for New Years because I can’t fly anymore. Just so I could do a couple exciting things before the baby comes out. But that’s on my mind—just not feeling claustrophobic.

(Rachel) Yeah, it’s different. It could end up being something that I like. I could be here in a year and a half and be so glad that I live in LA and did this here. And have less

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interest in moving. Or I could still be interested in changing it up. I’m just an explorer by nature, so I want to live in different places.

(Rachel) I have one girlfriend who keeps telling me about how hard it is. She’ll say, “I’m just telling you this so you’re not alone when it’s happening.” But I’m like “That’s enough, you’ve told me enough. I get it. Thank you for telling me again.”

(Rachel) I think my whole identity—I don’t think it would be happy with that. A career of sorts or even just a passion that I spend time on outside…I was thinking that it maybe would be more motivation—not just to make him [her son] proud, but to show him that I could start something that I could give to him, show him how to run a business. But I don’t know that that’s been going through my head too much at this stage. I know I don’t want to be doing this all day every day—being a stayat-home mom—I can tell you that much.

(Rachel) Yeah. The more I try to do things outside the house, the more coordination and scheduling it takes. Sometimes that’s just a little more stressful, so I’m trying to stay home a little more at least for the next month or two.

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(Rachel) So he didn’t nap and the whole meal I’m holding him and then I get stressed out because I feel bad that I can’t properly concentrate on my conversation with my friend because this baby is being fussy in my arms. I don’t know where my mind is going other than just I enjoy it, he’s adorable and smiling.

(Rachel) There are moments where I’m so happy that I’m home taking care of him and then there are moments where I just wish I could get on my computer and do something.

(Rachel) Whenever I talk to him, I feel like I sound like my mom. All of my expressions and everything—I remember my mom treating me like this because she still does.

My mom and I are very different, but it’ll be interesting to see if I end up like her, which is probably every girl and boy’s thought through this whole thing—how much am I mirroring her?

(Rachel) There are certain moments where I’m watching him parent and it fills my heart with warmth and I’m the most appreciative and happy that we’re a family. And then there are moments where I find myself frustrated because he’s letting the

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baby cry and doesn’t seem to be able to give as much warmth to him as women— as me or my mom. So there are moments where you get frustrated

(Rachel) That’s life. Learning about sex postpartum. It’s been hurting me a bit so I’m learning about the differences in your body while you’re breastfeeding…just learning how to navigate your body romantically, sexually—it’s different.

(Rachel) There was one argument we got in right after the six-week mark and I think it did make me a little bit more upset—being a mom and having an argument. Just because it was the first time. The first of many many. But I didn’t want to pop that bubble that we were in. But it’s all just going to be life.

(Claire) I’m no longer independent. I’m sharing space in my body with another human.

That loss of one’s independence and what that shift is like is interesting. Initially I was looking at it as me losing dependence outside of myself but now that I’m sitting here I’m thinking that it’s probably a lot to do with what’s going on internally as well.

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(Claire) I definitely go into places of how this has affected my body, how my body will respond after. The whole body thing is big. I’ve gained 40 pounds already.

Granted that was counting from my wedding weight and I was a little bit thin then. That’s part of it, right. Rationalizing, going through all that. It’s like a big deal.

(Claire) It’s no longer just about me.

(Claire) One thing that I thought was really helpful that the midwife said was that with parent/child relationships it depends a lot on the relationships because often the mother-to-be, it’s really important to be a mother in that moment. That’s when you’re needed most in your mother self and you can regress into your child self.

That’s how she was describing it. You don’t want to be regressed when you’re giving birth. So it would really depend on the relationship that the new mom has with the parent. For me it’s no. I need to be in my own skin.

(Claire) That renegotiation and trying to balance different demands and feeling really selfish—not selfish but there are just things that I can’t do…needy and then judging myself for that but also trying to take it easy on myself...And then when I

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have one of those outbursts when I’m feeling really needy, afterwards I’m judging myself for being needy but I’m trying not to feel that too much.

(Claire) Initially it was very anxiety-provoking because I didn’t feel like I knew what was going on for him. It was hard for me to tell—you know it’s one of very few things when he’s that little.

(Claire) I have some social anxiety around judgment from others…And not wanting to inconvenience others, like if we go to brunch or something. But I’m starting to be a little bit more relaxed. As we take incremental steps to do things outside of the house, like we went to the beach over the weekend and that was a success. So I’m feeling more confident now that I’ve had that experience.

(Claire) Oh my God. I cried. That was the first time I was leaving him for a good chunk of time. I was gone for probably four hours. Once I was out I was like, “Okay. It’s fine. I’m gone. It’s fine.” But the night before and when she got here and I had to say goodbye to him I was like…Leaving is hard!…Like I understand logically what I’m doing and the choices I’m making. But yeah, it’s a little bit surprising how much my heart is pulled now.

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(Claire) The other thing that’s been interesting…now every time I see some statistic about the environment going to shit I literally start crying because I’m imagining him growing up in this world now. I feel guilty in a way, having brought him into this.

It’s totally a next level. So that’s been interesting to navigate.

(Claire) I’m feeling the loss of my former self and identity. Some girlfriends and I are going out for dinner on Friday. That’ll be my first time leaving him with my husband for the night. He’s going to bathe him, bed time, bottle, put him down, all of that. And I’m terrified…Just that the baby will be longing for his connection with me. And not be able to have it. And not be able to feel safe and secure and settled. It’ll be okay.

. (Claire) The reality of it is perhaps a little different than I had imagined. I’m always aware of my relationship with him. There’s no time ever, now, when I’m not aware of the fact that I have a child. I think I knew what that would be like conceptually, but then it’s like, “Oh. Right. It’s all of the time.” He’s always on my mind. And that’s cool. And sometimes a little overwhelming.

(Claire) My body put on a lot of weight. I gained 70 pounds in the pregnancy. And the

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first 40 pounds came off within three weeks. It was great, really great. And my healing felt really good, but then I got a cold and I was coughing a lot. So I started developing some incontinence—I was peeing every time I coughed and sneezed.

That was shocking to me because I’ve always been very strong physically and able to recover quickly from injury. Not that I really think of it as an injury so much, but it is. My body is not healed from the birth process. And so that was when I reached out to this woman who does special pelvic floor stuff. So that’s been weird. Always feeling like I have control of my bladder as far as the memory can recall. But it’s getting better. I’m getting stronger.

(Rose) I had this thought yesterday that you could go and live your life in this cyclical, safe way—like you’ve figured it out up to this point, how to be happy and peaceful and make your money and have your vacations and you’re coasting— and then you can continue to do that until you die or you could take the ultimate challenge and have children and just not know what to expect. Your peace is over but you have to figure it out again and you thrust yourself into that.

(Rose) It’s almost like it was when you were a child. You have no control over anything when you’re a child. Your parents are in complete control—they don’t think they are—but there are sets of rules and things you don’t know how to do when you’re a kid. And then we get to this point, especially in our late 20s and 30s, where

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we’ve focused on the things we were good at and we cultivated those things and we abandoned the things we weren’t good at. And we chose the friends that weren’t crazy-makers—maybe. We created a more safe environment for ourselves, from what we had as children. When you have kids you don’t know what you fucking get. This thing comes out and you’re like, “Whoa. Hm. How do I handle this? Is there a roadmap for this condition? Or this experience? I don’t have any roadmaps.”

(Rose) It gets you ready like, “Hey this ain’t your own anymore.” These things happening to you—these aches and pains you feel—this is just foreshadowing.

(Rose) I actually get my energy from being creative. So I can see myself being inspired by something my kid did and then writing about it. I have to get out of the house.

I do need alone time, but I’m more of a social creature. I have to be collaborating and creative. I can see myself being inspired by something my kids did and then creating something. When I’m not creating I’m not happy. So I do have some fears about that.

(Rose) The bigger thing is having to say no to opportunities that really bring me joy

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because of a child. And because of the issue with family. I do more okay being away from my husband than he does when I’m away from him.

(Rose) So what that makes me think is, I am going to have to make time for myself when this baby comes. To do those things that are creative because I need them. Even though I don’t have a baby now, I have all these other aches and pains with the baby inside, and that was a really good distraction for me. It was a jolt of happiness.

(Rose) I’m figuring out how to have the baby and have me. But I’m obsessed with him.

I’m so in love with him that I don’t want to miss any moments. It’s this weird thing.

(Rose) I was managing everybody’s emotions. And with my mom in town, I told my husband, “I feel like I’m managing everybody’s emotions. My mom’s emotions.

And your emotions.” I was emotionally exhausted from managing. And when I said I was managing his emotions with her, he was so offended and upset about it, acting like that’s not really what I felt. I’m the person that’s connected to both of these people and I’m having to do the mental gymnastics to figure out to say what to say to this person to please this person, but I don’t really fucking care.

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(Rose) I will say, “I’m going to do x, y, and z today.” And when I don’t get x, y, and z done, I make myself anxious because I’m not able to get those things done. And then I make myself upset by not having the help I needed to get those things done.

And it’s like, allowing myself to surrender.

(Rose) I’m getting so much intel all the time about what it is to be a mom. About my sisters and my mother and my grandmother.

(Rose) I feel like myself but a new self.

5. Partnership and the transition from couple to co-parents.

For women who are making the transition to motherhood in the context of a partnership, it comes as no surprise that reflections on that partnership are present in their reverie. All of the women interviewed for this study were in monogamous, heterosexual relationships with the father of their baby. (This does represent a limitation of the study, and an indication for further research to be discussed later is the need for more data collected from expectant and new mothers in same-sex partnerships, partnerships with someone other than the biological father of the baby, and other more diverse family constellations.) Nevertheless, the data collected from this study’s six participants revealed much reflection about the shared transition to parenthood between the women and their

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partners. This thematic material is divided into three sub-themes: Teamwork and connection; Role disparity and resentment; Underlying tensions.

Teamwork and connection.

All of the women interviewed for this study talked about the pregnancy bringing them closer to their partners. They talked about planning and fantasizing with their partners, discussing and aligning values and ideas of parenthood, and shoring up a sense of being able to work through challenges and be a team. In the postnatal interviews, many of the women emphasized a sense of being a good team, feeling supported and a sense of being in sync.

(Rose) I feel like this has made us closer [the pregnancy]. We’re more connected to this thing. Like, “This child is both of us? That’s crazy.” I feel more connected and he has softened and sweetened. I see that sort of happening. And his excitement about it. So I think maybe I feel more committed, not that I didn’t feel committed after getting married, but…

(Claire) I am someone who does a lot of emotional caretaking in a relationship, just in general. I find myself doing that. It’s weird because then I go to before where a big part of this has been me accepting that it’s okay to have emotional needs, you know? In the relationship. And to not be okay some days. That’s been tricky for

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me. The roles reversed a little bit. He has to do more emotional caretaking for me.

But now that’s flip-flopped back again. Actually, I think maybe more so we’re just really becoming a better team I would say. At least trying.

(Claire) We spend a lot of time fantasizing together, and that’s really nice, but that’s not necessarily different than what we did before. We fantasize about Nate—that’s the baby’s name—what Nate will be like. Similar to my own individual fantasies, we do that together. He wants to think about where we’re going to take him and what we’re going to do with him together. He’s really pragmatic so he’s like, “I’ll take the night feeding.” He kind of wants to have a plan, which is cute.

(Claire) This is very much a product of us together—bringing this life into the world. It’s great. But again, lately, every time we have these happy thoughts of us with the baby, now there’s sad, because of his mom. So that’s interesting.

(Sarah) We want to be different from our parents. I think we’re on the same page about a lot of things.

(Sarah) We’ve definitely gotten closer. He’s really nurturing so I’ve always relied on him

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a little bit, but he’s definitely a big caregiver right now. Especially after I broke my foot. I’m kind of totally dependent on him now. I think about him being a dad and us as a team a lot. I would say it’s made us closer. I don’t know what it’s going to be like, but I feel really confident about us being on the same page and our ability to get on the same page if we’re not. I feel like it’s a really solid foundation, which is really good.

(Sarah) We have a lot of the same values when it comes to kids and family too. But he also has a lot less experience than I do obviously, so that will be different. I want to make sure to not be too overbearing with all of my knowledge and experience and not undermine him.

(Sarah) I think he’ll be really helpful. I really want to let him be helpful too. I don’t want it to be one of those dynamics where the dad doesn’t know what to do with the baby for a while. And I think he’s really into figuring out ways for him to be a part of the bedtime routine.

(Sarah) We have a lot of the same values and opinions about things and we’re pretty gentle and respectful about things that we don’t agree on. I think we have a pretty good shot at being a good, happy, unified front when it comes to being parents.

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(Sarah) I had been having so much trouble with her latching. Owen helped me and it was kind of fun actually. Well, not fun, but we had some teamwork together because he would swoop her in and then she would latch. Otherwise, if I just put her to the breast, she would just fall asleep right away.

(Sarah) I feel like it’s brought us closer so far. Obviously, it’s a different thing trying to find a way to just be together, since she’s in the bed. But we’re figuring that out.

But I feel really grateful for him and for our relationship. I feel like we’re a good team and we’re on the same page a lot. We have fun and we get excited talking about how great we’re doing—we pump ourselves up a lot.

(Flora) I guess it cements the idea of what a great partner he is. I knew he was a great partner but he’s very hands-on. He wants to be involved. He wants to be a father.

And it’s so different from—my family’s Dominican so I come from a society that is, “Men don’t change diapers.” but that doesn’t mean the men don’t love their kids it’s that they don’t change the diapers because that’s a mom thing—and it’s so the opposite with Brian. He wants to the change the diapers. It’ll be us fighting to change the diapers for our kid.

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(Flora) The shift that has happened with us is how to communicate better and argue less.

We’re very adamant that we want to be on the same page on a lot of things so it’s trying to get to that before we have our family. I think a lot of it is financial too.

He’s more frugal than I am. It’s us just being on the same page about how we prioritize our spending and so forth. Being on the same page how we’re going to raise our kid. Our thoughts and process of thoughts are very similar, so it doesn’t feel like a strain or problem but ironically it feels like we’re calming down.

(Flora) Yeah, like we’ve been married for 20 years and we’ve got this. If a new problem arises we know how to handle it. We argue and get snappy with each other, but we know when to not be sour, when to give in, which battles to pick…in sync.

(Flora) She’s also sleeping longer, and one of the good effects of bottle feeding is that we both can do it—we do shifts. So we’re both having a good sleep now that she’s sleeping longer. And we zigzag between feeding. We both are getting six hours of sleep. So it feels like great teamwork.

(Holly) At the hospital he felt present to me, he was calm, he didn’t feel like a robot or

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anything. But things that we’ve talked about—how did it feel for you to see me in so much pain and see the scene in that birth center room—it was pretty crazy.

There's just like blood everywhere, you know. He was like, “Yeah, I was seeing it but not feeling any emotional response.”…We talked about everything that happened. We told one of our good friends the whole story and subsequently ended up telling a couple of other people the whole story together, which was I think just a good exercise for us to tell other people what happened and see their reaction and talk about it all together.

(Holly) The birth itself is on video and has all of these wonderful pictures that our doula had taken which we got about a week later, that whole process has been very healing for both of us—to look at all these pictures together and remember all of the crazy good things that happened. And I think we’re both very proud of the video, we'll show it to anyone who wants to see it.

(Rachel) He’s always been very “We got this. We’re going to do great. You’re going to do great.” He’s very—I don’t know if it’s naive—but he’s very chill about the whole thing and thinks it’s all going to go great. For him I’m the one that does so much of the prep and research that he’s like, “She’s got this.”…He’s like, “I get to be chill because you’re such a planner.” I’m glad he feels good about it. We’ll see.

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(Rachel) I broke my finger like two weeks ago. I slammed it in a car door. We needed to go to the E.R. and it was a whole thing…It was actually pretty painful. But it was funny because he [her partner] was consoling me. Sometimes he’s the kind of person, when I’m sick, he’s like you have to get out of bed. He’s not bringing me chicken soup to my bedside and rubbing my head, he can sometimes be like, “You’re fine.” So he made me feel so much better when I was in the hospital and I was like, “Great—these are the coping techniques that I want you to use that day.”

(Rachel) He’s a really amazing partner and dad. The friend I was just talking about—she said her husband wasn’t helpful at all. He works from home but was working the whole time. Matt and I had a month off together where he was equally a part of the caretaking as me and it was a very loving, wonderful bubble we created for ourselves here. That was really special and healing.

Role disparity and resentment.

Naturally, the women did not speak in purely positive terms about their partners.

One of the themes that emerged for several of the women was that of role disparity and resentment. Regardless of how in tune and connected a partner might be, there is an unavoidable disparity in one person gestating and giving birth while the other stands by in support. In the early postpartum period, the new mother has undergone a physically

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transformative event, and in many cases continues to be tethered to her infant through breastfeeding or pumping. There have been many cultural shifts in recent decades with regard to parental role distribution which are beyond the scope of this discussion, however the data collected for this study did contain reflection on differences and resentment around those differences.

(Sarah) My dad was a really good father but he grew up in the 50s and I just know that my mom felt how a lot of women still feel today—that if they wanted or need help from their partners they had to ask for it. It was still really seen as the mom’s job to do everything. Unfortunately that hasn’t gone away from many, many people, but I know that it’s not going to be quite like that with Oliver….In a few areas there’s a lot of “Just tell me what to do and I’ll do it.” and I’m like, “No— just try to learn these couple things so I don’t have to do that.” But it’s a pretty equal partnership.

(Sarah) The only thing that’s sometimes coming up is…my husband is super involved and helpful and everything, but sometimes I feel a little resentful because, as tuned in and helpful as he is, he can walk out of the room whenever he feels like it. And I can’t. Or I don’t feel like I can. But that’s getting better. I’m getting better at leaving her with people when I can—with him or with a parent or an aunt or whatever.

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(Flora) Someone once gave me really good advice before I was even pregnant. As a mom too, but as a controlling person—I like to take matters into my own hands—so if my baby’s crying and my husband’s soothing her, I want to go in there and grab her from him and soothe her myself. Even though I might not even do a better job.

She said, “If you see him putting on the diaper wrong, let him do it. Let him gain the experience and have the bonding moment.” It’s great advice, especially for someone as controlling as me… “You’re not doing it right I’m going to take care of this.” And I try to think about it when she’s crying a lot and he’s trying to soothe her. It’s such an impulse to go in there but I have to take a step back and hear her cry and have daddy deal with child in that moment.

(Rose) I also don’t think my husband truly understands the amount of time and energy I spend with the baby. And my mom does. And how truly helpful it is to have my mom around. I’m able to take the negative with the positive. For him, he’s not getting the kind of relief that my mom is providing. So for him, the negatives might have outweighed the positives.

(Rose) I do feel slightly resentful. I don’t get time to myself anymore where I can just sit in a chair and text or watch something or relax. So when I see my husband do it I get resentful.

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(Rose) We are tethered because we have the milk. If we’re not feeding, we’re pumping.

So, there are a number of different things, number one I don’t think he realized how much of my time I spend either feeding him with my boob or pumping.

There’s just a general lack of understanding because he’s not doing it.

(Rose) I’ve been an independent person who’s worked and who’s made money and I’m naturally shifting into my gender role. It’s unavoidable to not shift into this gender role. You fight it and you feel it and then yet you feel guilty if you’re not doing it because as a mother you should be. And then you want to because that’s your baby that you want to have that connection with. I miss him when I’m not with him.

(Rose) There’s a lot of sensitivity. But he did admit to me—one time we get up in the middle of the night, I go to change the diaper, he’s coming with me, and he puts the pacifier in while Henry is screaming. I’m like, “Is the pacifier in right?” And because I said, “Is the pacifier in right?” meaning over the tongue. But to him it was like I was saying, “Are you doing it right?” I didn’t mean it like that. My intention was to take care of my child and only my child. Think about it, if he was with the baby all day every day, he’s collecting intel. Without the baby you wouldn’t have it. So there’s a learning curve for the baby that you have to be able

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to communicate with your spouse. It’s not that you’re being bossy, you’re saying, “Hey. The baby’s preferences are this, this, and this right now.”

(Rose) My life has completely changed, and his life has partially changed.

(Rachel) I definitely lose patience a bit. Not in the way that makes me be a less good mother to him, but just Matt gets home and I’m like, “Here—I’m getting in the shower. You take him.”

(Rachel) He’s back at work, and then he’d come home and—men are just not as good with babies some of the time as women—but some of the things he was doing in the first four weeks that really worked changed and weren’t working as much and he’s still trying and got frustrated when I’d suggest he do something a different way more often than he’d like. So it was just leaving that initial bubble of that first month.

(Rachel) I’m stuck at home but he’s not, but I guess he’s staying home a lot with me most nights.

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(Claire) It’s really hard. Definitely a lot of ups and downs. I think him going back to work was really difficult for him. I saw really how painful and difficult it was for him.

The first time he traveled was really hard for him. He cried. And it’s stressful because we’re not sleeping all that well. He wants to be around. But I have some resentment around that. “Oh you just get to fly in and want to be there when you’re there and you just get to…”

(Claire) I had a real breakthrough right before we hired Lena two weeks ago, I said, “I’m resentful of you because you can leave whenever you want and I’m starting to be resentful of the baby because I can’t.” And that was huge for me to be able to say that out loud. “Okay. Time to get some support.”

(Claire) I was like, “Alright. I don’t want to be resentful of my child.” Of course that’s a part of it. I’m not upset that I felt that way or feel that way sometimes, but I had reached a limit.

Underlying tensions.

This sub-theme aims to capture the women’s reflections around varied underlying tensions and concerns in their partnerships and with the partners. The nature of these concerns was varied and seemed to reflect specific and idiosyncratic conflicts and

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tensions for the individual and her relationship. I suspect that with a larger sample size these themes and related material would emerge for larger numbers of women.

Claire, who described her relationship with her own mother as “codependent” and talked about her “anxious, preoccupied” attachment type, ruminates on issues of attachment and dependency in her marriage.

(Claire) I’ve always considered myself to be independent and strong and have taken selfdefense classes, so even if a worst-case scenario happened I felt like I could handle it. But part of this for me has really been an acceptance of my natural dependence on my husband, in particular, because I don’t have much family around here locally or others in general to do basic things. So that’s also been interesting for me to come to terms with.

This renegotiating autonomy versus dependence is really challenging. I feel very dependent on him. He had to travel for work yesterday. He was in San Francisco for the night and I was really upset. It felt like, not okay.

That renegotiation and trying to balance different demands and feeling really selfish—not selfish but there are just things that I can’t do…needy and then judging myself for that but also trying to take it easy on myself...And then when I have one of those outbursts when I’m feeling really needy, afterwards I’m judging myself for being needy but I’m trying not to feel that too much Honestly the thing that’s been coming up—I’ve really been testing my husband. (Laughs). Poor guy. For me the most intense part of the third trimester, other than the physical stuff, is the emotional lability I experience. I feel really up

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and down and easily triggered…I find myself kind of picking fights with my husband so that I can know that he’s there in a way. And I’m still trying to figure all of that out for myself. I’m aware that it’s a little illogical but it feels compulsory. I have to let some of this stuff out. I’ll be crying and crying and crying and it feels like I’ve regressed to an infant state. It’s happened two or three times.

Rose, determined to have as little intervention in her birth experience as possible, detailed conversations and conflict regarding her birth plan and negotiating control over that between her and her husband.

(Rose) His base human emotion is fear of abandonment. And mine is need for approval, I think. So I’ve had to push through his disapproval of things for my communication. We had some disagreements about a doula. And eventually it was like, I want this advocate in the hospital. And this isn’t your body. And you’re not having to go through nine months of carrying this child and then all of the after-effects of what happens to your body as a result of birth. I don’t really give a shit what you think. That was in the back of my mind. He also said, “Listen it’s your body, you’re the one carrying the child, and so ultimately it’s your decision.” But for him he didn’t want to be left out of the process.

My husband is like, “Don’t make yourself crazy. If you want an epidural, get an epidural.” There’s this other part of me that’s like, “I will prove this to you.

Don’t you fucking underestimate me.” So there’s the part of this that is really

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excited for the challenge. I’m wanting it to happen immediately because I’m excited for the challenge.

Rachel, who talks at length about her own anxious mother and wonders about the effects of that on her, struggles with her own response to what at times she feels are her partner’s misattuned responses to their baby.

(Rachel) Sometimes I look at the way he treats Mason and I wish he could also be more empathetic to him right now. I’m not sure if it’s a Matt thing or a male thing, but if he’s fussy or crying I’m getting up to try something else and then try something else. And sometimes we’ll be lying in the bed and he’ll start crying and Matt will be like, “Shh relax.” He’s telling him to relax and the baby’s crying more and more and I’m like, “Matt. He’s a baby. He doesn’t listen to you. Get up and bounce him around and go show him something else. He doesn’t understand yet.”

And he’s like, “Well I don’t understand why he’s crying.” And I say, “He’s just going to have feelings that you don’t understand and that’s okay.” I can tell Matt will probably have a little bit of trouble with accepting that he’s going to have feelings that don’t need to make sense and that’s okay. You don’t have to teach him to not feel those feelings because they’re not logical. You just have to accept them.

There are certain moments where I’m watching him parent and it fills my heart with warmth and I’m the most appreciative and happy that we’re a family.

And then there are moments where I find myself frustrated because he’s letting

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the baby cry and doesn’t seem to be able to give as much warmth to him as women—as me or my mom or her. So there are moments where you get frustrated.

Holly, who was concerned about her in-laws’ presence in the first hours of her child’s life during pregnancy, postnatally talks about them having more time with her daughter at first then she did due to her surgery. She also details more general tensions and ongoing efforts to negotiate them.

(Holly) I actually had to have a little bit of a difficult conversation with my husband because his parents live here in LA, they’re super excited…I think if they had it their way they would be waiting there the whole time and I think Dave would like them to be as close as possible and we had taken the suggestion from our midwife that they could be our welcome committee when we get home. But I did say to Dave last night, “Just thinking through different iterations of how I might feel, I’d like to reserve the right to ask that they wait until we get home before they come over.” He understood where I was coming from but I think he was disappointed and felt like he needed to warn his parents that there might be a change of plan.

Dave’s parents ended up coming to the hospital…I mean, they got to spend more time than I did with her at first…I took some time to process on our own and Dave and I have talked about it a lot. He had a lot to process as he was there through the whole thing and it was traumatizing for him too.

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Dave and I would go from zero to 100 with each other. It was usually because I was irritated with him for not doing something that I wanted him to do, and we have really good communication though, so we would always work it out.

We were very conscious of the fact that we’re extremely tired and this sucks and we don’t want to be arguing with each other. So we called it out for what was happening basically…I think that was surprising because we had so many things other people don’t have. We had so much help, he took off four weeks from work, he was doing night feedings basically from the beginning because we had to add in formula and all of that. So I think I had it a lot better than other people do in comparison, but it did surprise me how easy it could get tense between us.

Flora reflects in direct and indirect ways on how her own attachment issues, perinatal loss and trauma history impact her relationship with her husband.

(Flora) The biggest argument that we have throughout our whole marriage is that I have a lot of anxiety and I don’t deal with it very well and it stresses him out more. He’s also very passive and he’s more in control, I guess, of his emotions…He tries to help me out with those but then I take those as condescending lecturing moments.

But it’s him wanting to help out and me pushing the help away. I read them as condescending or lecturing and it takes me back to the issue I have with my mom—which is, I feel, being treated like a kid and never treated as a competent adult or woman. It gives me the fear of, “Will he treat me that way when I’m trying to be a mom?

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A thought that recently popped into my head: “Well I’ll be working 40 hours a week and Brandon works from home. He’s going to get to see the baby more, which is great on him. But he gets to maybe be the favorite. Maybe have a stronger bond.

What he wants to do is take our kid to basketball games. When he mentioned it—I’m hormonal and crying all the time—I was like, “That is the cutest thing ever, just daddy and daughter going to a basketball game.” But when I think about them having their own bond and me feeling jealous over that, it’s those kinds of scenarios.

6. Felt sense of maternal identity through attunement.

While there is less data supporting this theme, the statements that have been categorized this way are powerful and were present across the participants. All the women interviewed for this study talked about getting a sense of confidence in their maternal capacities though attuned caretaking of their babies. In short, taking good care of their babies helped them to feel like mothers. The women are getting to know their children through anticipation of and successful fulfillment of needs. The small routine tasks of infant care are the building blocks of maternal identity. Several of the mothers also talked about having moments of mutual recognition with their infants that powerfully served to deepen their sense of maternal identification.

(Sarah) I just tried to put her down today to nap on her own for the first time, to fall asleep on her own. And she was okay with it. I left her on the bed and had the monitor. It didn’t totally work but she didn’t cry either. So that’s progress. It’ll be nice for

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her to fall asleep on her own eventually, but she’s only two months. There’s time.

Yeah, it’s early for that. She feels really secure, I think.

(Sarah) One of my friends said, “It’s so great to meet your daughter” and I cried. That part is definitely weird but it felt pretty organic. It feels like she’s always been here in a way. Breastfeeding felt like I had done it before, it was weird. I don’t know how the transition feels for a lot of people, but… I feel really lucky and grateful. I think about that a lot.

(Flora) It enters my mind, “What has she done? How much has she grown in the past six hours that I’ve missed out on?” And now she’s at a phase where she’s doing more and more things like starting to smile, starting to focus, so I’m constantly thinking about what I missed out on while I was sleeping. Maybe she smiled and I didn’t see it. Maybe she pointed at something and I didn’t see it. So it’s those thoughts of Mom missing out.

(Holly) I had an appointment near Dave’s office this week, and so he watched her while I was at my appointment, and then when I came back, he was hanging out with a bunch of his coworkers in their common area, and when I walked in, she kind of

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lit up. She recognized me immediately, and everybody was exclaiming about it and it felt really good.

(Holly) I find the experience of being a mother more instinctual than I could have predicted…It’s kind of like having a cat or a beloved pet that you’re very in tune with. That’s the only thing I can say, I only have lots of practice with beloved pets, and so I use a lot of those skills…It’s nonverbal communication…

(Claire) It took a while for me to realize that I was actually a mother. I realized immediately that I had a kid, that I had a baby—that was real—but only recently am I realizing that I’m his mom. I don’t know if that makes any sense to you, but it’s really sinking in now. He’s starting to develop a preference for me. He’ll track me in a room as opposed to other people, with his eyes. He’s still very comfortable being held by other people and all of that stuff, but I’m his mom. So that’s really sweet. It’s really, really sweet. I imagine that’s something that will develop even more as he gets older and has more different kinds of needs.

(Claire) As he’s grown into himself he’s a lot more secure and just taking it in from a more open and joyful place. I laugh because he started to be a lot more emotive with his likes and dislikes. I got his first laugh out of him. He’s smiling a lot

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more. Making what I assume is eye contact and really knowing me. So that’s sweet.

(Claire) Initially it was very anxiety-provoking because I didn’t feel like I knew what was going on for him. It was hard for me to tell—you know it’s one of very few things when he’s that little…I can communicate with him better…I know what to do with him if he starts losing his shit…I’m starting to be a little bit more relaxed…I’m feeling more confident now that I’ve had that experience.

(Claire) He’s a pretty easy baby. I think that’s a big part of it too. He didn’t really have a whole lot of colic or anything, and he was like that in the womb. He felt really grounded. So that experience of being an earthy baby—I felt that then—and he’s the same way now.

(Rachel) It’s hard being with him all day. But figuring out what he needs, knowing what to do for him, that feels good, that’s when I feel like a mom. When I’m calm and relaxed and we can just be together and I know what he’s needing.

(Rose) I’m figuring out how to have the baby and have me. But I’m obsessed with him.

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I’m so in love with him that I don’t want to miss any moments. It’s this weird thing.

(Rose) I feel like a mom. I think some of those times when it’s just me and Henry and a lot of bonding has taken place and I’m doing everything, then I feel like I’m sinking into the role. Latching into it.

(Rose) It’s weird, I’m with him all the time and I’m more aware of his patterns, then I’m the one who’s most intimate with him and most aware and so when everyone else is around I’m like, oh he needs this. Things like that make me feel like, Oh wow.

I’m a mom. I’m so in-sync with my kid.

(Rose) I definitely feel like the deepest sense of love I’ve ever felt before. I was doing something, making coffee, and he was like, “You’re being so nice to me, are you having an affair?” And I said, “Yes. With Henry.” I’m having a total love affair with this baby who is now even starting to give me love back. Boy is that intoxicating.

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Chapter V

Discussion and Implications of Findings Introduction The intended unit of study for this research project was maternal reverie. For the purpose of the study reverie was defined as: The experience of being lost in thought; thoughts, feelings, fantasies, private ruminations, imaginings, anxieties and fears; conscious, preconscious and subconscious mental content. My intent in choosing to investigate reverie in emergent motherhood was the hope that this would help me to gain access to deeper levels of thought. I was interested in not purely surface-level content, but the more underlying, conflict-ridden, regressive, preverbal material that women grapple with in this transitional time.

The idea of reverie, as I defined, it turned out to be less useful than I had hoped.

As discussed in the findings, the women I spoke with were not particularly interested in noticing and talking about what was going on in the background of their minds, what was generally on the fringes of conscious awareness. I suspect this is because the liminal space of emergent motherhood brings the background to the foreground. What I defined as reverie: thoughts, feelings, fantasies, private ruminations, imaginings, anxieties and fears—did not require access through a state of reverie. This mental content was easily accessible and top of mind for the women I spoke with, all in the midst of a transformational life moment. I was able to learn about this kind of ideation simply from

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listening to what they had to say. I am so grateful for the access these women granted me to their shifting interior worlds.

For the women I interviewed, identity transformation was clearly manifest in their mental content. They readily reflected on the disorienting, conflict-ridden nature of their current state. Their thoughts were full of intergenerational reflections and projective preverbal musing. The data revealed them manifestly standing in the spaces between multiple and conflicting identifications and identities.

Although reverie was not a useful concept in the way I originally conceived of it, one might say that the predominant mental state of the transition to motherhood is one of reverie. Reverie is a liminal state of mind. It is the space in between reality and fantasy, it is a space of formation, transformation, creation and re-creation. Pregnancy results in new life— a new living being, but also a new life and identity for the women who created it. This process is primal and at once ordinary and extraordinary. It is a physical transformation as well as a mental and emotional one—and as we know, the mind and body are one. There is no physical labor without emotional labor. Physical events invariably have mental and emotional correlates and ramifications.

While I did not intend to explicitly study the impact of the events of labor and delivery on a woman’s transition to motherhood, this became an unavoidable aspect of the data analysis. Of the six women interviewed for this study, half experienced what I, and more importantly, they consider traumatic aspects to their labor and birth. One of the questions posed at the outset of the research was: How does maternal reverie shift and change from the prenatal into the early postpartum phase? Through my process of data analysis, it became impossible to answer this question without paying particular attention

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to each woman’s birth story and the nature of her birth experience as the pivotal point of transition from pre to post. As I presented in the findings, the shifts in thematic material were largely consistent across all six participants. However, the manner in which the women spoke about and related to their mental content showed considerable change from pregnancy to postpartum for those who had had a higher degree of difficulty/ trauma in her birth experience, while remaining largely consistent for those who did not experience birth trauma. This is a significant finding with theoretical and clinical implications.

There were six core themes identified in this study: 1. Visualization of birth and baby; 2. Maternal preoccupation: Overwhelming and all-consuming; 3.

Intergenerational meaning making and projection;

4. Me not me: The tumultuous and conflicting emotional experience of new motherhood; 5. Partnership and the transition from couple to co-parents; 6. Felt sense of maternal identity through attunement.

Arguably all six of these aspects of maternal identity transformation are impacted by the idiosyncratic aspects of a woman’s pregnancy, labor and birth experience.

Unresolved conflicts and traumas have long been understood to influence development and life transitions. This is true for the transition to parenthood. Labor and birth are invariably intense and dramatic and affect the integration of maternal identity and the nature of the psychological transition. Additionally, any new trauma experienced during the transition to motherhood dramatically impacts the way a woman relates to her experience and apprehends and integrates her emergent identity.

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My hope in pursing this study was to add to the growing but somewhat limited body of literature that thoughtfully explores what happens for women during the transition to motherhood. The psychodynamic lens had a great deal to offer our understanding of the postpartum period. Rather than talking in binary terms about new mothers, who either have or do not have “postpartum depression,” the more useful conversation engages and attends to the varied, complex, conflicting and largely adaptive responses women have during this transformative experience.

The following discussion further explores the theoretical and clinical implications of these core findings.

Theoretical Implications The study analyzed data collected from in-depth interviews with six women in the midst of their transition to first-time motherhood. The primary question the study aimed to explore was: How do we understand the meaning and content of maternal reverie for first-time mothers? As I have stated, the concept of reverie was limited in its usefulness, and therefore mental content, and how a woman relates to her mental content more accurately describes the unit of study.

The aim of the study was to produce a text that describes and conceptualizes the psychological shifts during this primal transformation as illuminated by a woman’s reflection on her own reverie/mental content. The personal accounts provided by the study’s six participants as presented in the findings reveal much about the essential quality of this profoundly transformative human experience. While the texture of each of the interviews was a distinct reflection of the individual woman, her history, character,

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and emotional makeup etc., there were clear themes and through lines that surfaced in the data analysis. The women speak to an experience of significant emotional and psychological labor. Their preoccupation with readying themselves and their physical environments for change is paralleled by internal shifting and reorganization. While the women in this study have different ways of managing and relating to being in a transitional moment, they all have some level of awareness and engagement with this indelible fact.

The findings from this study are very much in line with existing literature. Of the findings presented, there are four which are of particular intertest. First, the prominence of visualization in the mental content of women in the transition to motherhood, which I contend is connected with the integration of maternal identity as well as preverbal relating with the infant. Second, the inescapably intergenerational nature of this transition, which is particularly of interest with regard to meaning making and projection.

Third, the seemingly universally conflict-ridden nature of emergent motherhood, which is relevant to issues of narrative coherence, attunement and identity integration. And fourth, the role of difficult and traumatic events during the transition to motherhood, and the potential challenge they pose to maternal identity integration.

Vivid and visceral descriptions of visualizations were ubiquitous in my interviews with women in the transition to motherhood, both during pregnancy and after.

Anticipation regarding any impending change can be accompanied by fantasized images of that imagined reality. And visualization is understood to be a powerful tool in combating fear and anxiety. However, in talking to these women, and later analyzing the interviews, I had the distinct feeling that there was something very active and dynamic

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about the visualization they reported. There is important mental and emotional work happening as women anticipate labor and birth that readies them for this experience. And a woman’s visualizations of her baby during pregnancy and after are important elements of the nascent preverbal mother-child relationship. Visualization is arguably part of a mother’s process of integrating her child psychologically as well as a way of connecting with and perhaps even communicating with her baby in utero and beyond.

The notion that the birth of a child alters the mother’s psychic structure is supported in the existing literature. Theresa Benedek’s 1959 paper, “Parenthood as a developmental phase—a contribution to the libido theory” posits mutual influence between mother and child, which shapes the psychic structure of the infant and alters that of the parent. Benedek suggests that introjection and identification are the processes through which this intrapsychic change occurs. Elson (1984) offers further theoretical support for the idea of parenthood altering existing psychic structure. And Raphael-Leff (1982) talks about the critical emotional work of pregnancy. I contend that visualization is a manifestation of this emotional labor.

Beebe and Lachmann, also interested in mutual influence, take a more systems approach to analyzing mother-infant interaction. They posit that the “origins of representation of the self are inextricably linked to representations of the other” (1988, p.

20). This focus on representation, and the connection between mutual influence structure and empathy supports the notion that maternal visualization during pregnancy and early motherhood is dynamic, intrapsychic, and perhaps also a part of intersubjective relating.

The powerful visualizations reported by the women in this study may well be the apprehended manifestations of these intrapsychic processes. Through the process of

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visualization, the emergent mother makes use of liminal space. She begins to feel her way to motherhood and connect with her baby.

As noted in the findings, all six of the women I spoke with specifically talked about not wanting their own mothers present at the birth of their babies. I don’t mean to suggest that this a generalizable finding, and I’m sure that with a larger sample size I would find more diversity in thoughts and feeling regarding women’s desired connection with their own mothers during birth. However, it is still notable that all of these women found the idea of her mother being present for labor and birth to be almost abhorrent and to be very actively defended against and planned for. The insight Claire shared from her midwife—that we tend to be regressed around our own parents, and to give birth we need to feel like an empowered adult woman—is quite compelling.

There is much supporting literature about pregnancy being a time when women return to earlier periods of development to rework and reorganize. Brazelton and Cramer talk about this explicitly, (1990, p 17) as well as Rapahel-Leff who frames it as a tension between fusion and differentiation (1982, p. 4). It is likely that the physical boundary set by the women in this study has different and particular meanings for each of them. This need presumably reflects the nature of their own attachments and what is being reworked for them in the reorganizing time of pregnancy and new motherhood. What is important to attend to here is the certainty these women felt. During a time of so much internal conflict and tumult, this was not an ambivalent need but a clear one.

From an attachment point of view, these needs likely reflect earlier experiences of felt security with their own mothers, and the degree to which they have felt heard and seen in these relationships. Claire and Sarah, for example, might be concerned their own

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mothers would be overly nurturing and over identified with them; Rose, that her mother would be too intrusive and overlook her actual desires; Rachel might be concerned that her own mother’s needs and anxiety would overshadowing her own; both Holly and Flora, who seemed to have the most insecure attachments, would likely fear losing a connection to themselves. Clinically, there is good indication that helping expectant and new mothers to listen to these needs and take them seriously is paramount.

Also of interest, and something I found surprising, was that there was almost no talk from these women about their own fathers, aside from Rose, who had recently lost her father. Flora and Holly, whose own fathers were absent, did reflect some on how this absence had been showing up in their reflections of how things would be different for their own children. But there was very little meaningful reflection on paternal relationships and meaning making surrounding them. Again, this would likely be shifted by a larger sample size and more diversity in family of origin constellations. However, I do wonder if this is a reflection of a generational issue to some degree. All the participants in this study were born in the 1980s, a time certainly different from the 1950s, but nevertheless when the culture was more firmly in the grip of traditional gender roles. I wonder if later generations of women would more generally find their fathers embedded in their infantile, regressive associations.

Stern does offer support, drawing on research on memory and cognitive neuroscience, for the notion that the mother’s own mother is the central paradigm to be followed or rejected (1998, p. 180). He contends that the “present remembering context” places a woman in a felt, sensory experience of her own infancy that she would not otherwise have the occasion to experience. Fraiberg (1980) also makes this assertion. In

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fact, central to Stern’s seminal motherhood constellation is the psychic triad: “The mother’s discourse with her own mother, especially with her-own-mother-as-mother-toher-as-a-child; her discourse with herself, especially with herself-as-mother; and her discourse with her baby” (p. 172). This triad, idiomatic and singular to each woman, is the foundation of her representational internal world. This lends some support to the finding of this study that women were focused on their mothers in particular. It also echoes the themes of me not me and oscillating empathic allegiance found in the data.

However, Stern posited his Motherhood Constellation nearly 25 years ago, and perhaps cultural shifts with regard to gender and gender roles and the corresponding relational dynamics call this configuration of internal representations into question.

I also expected to hear more from the women about changes in their friendships and social circles. I was surprised that the participants hardly mentioned relationships with friends during our interviews. While I did ask about friendships, there was little elaboration from the women on this topic. I wonder if this also has to do with the regressive, withdrawn nature of pregnancy and the transition to motherhood. It may be that the intergenerational upheaval of this period eclipses current relationships more firmly rooted in adult identity. The thematic material related to issues of early attachment and intergenerational connection and disconnection leave little room for less primary, less conflict-ridden characters. Rose was the one exception to this, she talked at length in all three interviews about a very old, very close friend who had a baby during her pregnancy.

This was a source of support and inspiration to her. (It is possible this friend was actually a maternal figure for Rose.) I expected to hear more material like this in the interviews.

Female friendships are powerful, and there is much collective wisdom and support to be

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gained in circles of women and new mothers. I wonder if I had spoken with these women a little further out from the birth of their babies if I might have heard more about how their close friendships were being impacted by their new maternal identities.

Another result I found surprising was the lack of reflection on intrusive thoughts about harm befalling the baby. Perhaps this is a personal bias, having been a part of my own postnatal experience as well as a feature of many of my clinical cases. But I expected the women to report more of these kinds of preoccupations and ruminations.

Claire was the only participant who revealed this kind of mental content to a significant degree. She expressed worry about the baby’s survival and harm befalling her own body during pregnancy and postnatally she had similar concerns in addition to some preoccupation with protecting the baby from unwanted threats in the environment. Again, I do think with a larger sample size I would have seen more of this. There is likely more to be understood about the circumstances and perhaps predispositional factors that influence this presentation, and no doubt a connection with anxiety.

The women’s partnerships were one area where the material that surfaced seemed to be very specific to the particular nature of the relationship and connection. The general sense that the pregnancy and new baby brought the couple closer together while also surfacing tensions and resentments was clear, and unsurprising. But for each woman I spoke with the nature of these tensions was rooted in relational dynamics.

One aspect of the shift to co-parenting I found resonant was the frustration regarding role disparity discussed by several of the women. Some of this disparity is rooted in biology, but the women also seemed to be alluding to a concept that has recently been talked about in popular culture called “the mental load.” This notion was

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popularized by a French feminist cartoonist who goes by Emma, who first published her now viral cartoon: “The mental load; You should have asked” on her website on July 10, 2017. This cartoon details the gender wars of working parents. In the comic a woman spirals out of control with to do lists, laundry and feeding and cleaning up after everyone, and when she finally explodes asking why she has to do everything, her male partner replies, “I would have helped! You should have asked?” The familiar dilemma Emma details is that so often the woman is the project manager of the house, who has to take the lead. As she succinctly says, “The mental load means always having to remember.” This is perhaps a tangent, and not a prominent finding of this study, but nevertheless an indication for future research on how couples manage the transition to parenthood and the lingering reverberations of traditional gender roles. This thematic material would, I suspect, be even more prevalent in later stages of parenting.

I also thought I would hear more about career tensions. This was talked about and referenced by all of the women, but aside from Rose it wasn’t a dominant part of the conversations. I wonder if this is an indication that I was indeed approaching a reverielike space with my participants. I was attempting to access more primal, previously unconscious, intergenerational material. Career concerns are certainly central to many women’s shifting identities, but perhaps the direction I steered my participants in didn’t lend to that kind of reflection. Rose’s work as an artist exists more in the liminal space of creativity, and so it makes sense that for her it was more integrated into her maternal transition.

One of the most compelling and rich findings of the study, largely supported by existing psychoanalytic theory, was the prevalence of intergenerational meaning making

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and projection in the participants’ shifting internal landscapes. From canonical figures like Freud, Klein and Kohut, to Benedek and Elson, to Brazleton and Cramer and Stern, projection, introjection, internal representation and meaning making are talked about as primary to identity transformation. The intersubjectivists and contemporary, neurobiological theories talk more from a systems perspective about mutual influence, but this is closely related. And attachment theorists like Fonagy posit important concepts like theory of mind and mentalization—which also gets at the degree to which we are able to recognize others as separate and intentional beings. Meaning making is connected with mentalization and reflective capacities, and the reworking of attachment models requires us to access intergenerational patterns and connections.

While there is much theory and existing research to support the prevalence of meaning making and projection in the transition to motherhood, this is not meaningfully present in common, lay dialogue. I would argue that these aspects of material reverie are without a doubt phenomenological. Intergenerational making and related projective processes are an essential aspect of maternal identity integration. Subjective parental contributions to a child’s development are generally healthy, typical and unavoidable.

There are always ghosts in the nursery. Stern succinctly asserts, “maternal representations can influence the observable maternal behavior with the baby; that is, they can be enacted” (1998, p. 41). But as Brazelton and Cramer (1990, p. 135) point out, they can be pathological when the projections and meanings we make from an infant or child’s behavior are at odds with the child’s actual nature. The meaning we make from a baby’s movements in utero, and the wishes and fantasies we knowingly and unknowingly project onto a child have real impact both on them and parent-child relationships. Brazelton and

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Cramer’s 1990 work, “The Earliest Relationship” was popular and widely read at the time of publication but has fallen out of favor in popular culture. There is a need to revisit these insights in the popular dialogue, as well as the clinical dialogue.

Intergenerational meaning making and projection is not limited to the new mother. The universal social practice of family and friends asserting who the new baby looks like, acts like, is just like—is a clear example of this phenomena. There is also significant support in the literature for the idea that pregnancy and new motherhood is a time of withdrawal and a turning inward. Women may be instinctively protecting themselves from outside noise in the form of unwanted projections, assertions, unsolicited advice and opinions. Winnicott’s notion of primary maternal preoccupation (1956) and Stern’s motherhood constellation (1998) both posit transitory states with hyper focus on the internal and the immediate present in the form of the nursery environment, the baby, and the mother-infant dyad. This state is an effort by the new mother, both consciously and unconsciously, to tighten the circle of influence around herself and her baby, practically and psychically. This was reflected in the data by the frequent concerns around boundary renegotiation with important others.

Deeply profound yet conflicting emotions are endemic to new motherhood. The British psychotherapist Rozsika Parker wrote two books on the topic of maternal ambivalence: “Torn in Two: The Experience of Maternal Ambivalence” (1995) and “Mother Love/ Mother Hate; The power of maternal ambivalence” (1996). Her aim was to normalize the internal conflict of motherhood. I discovered Kate Figes’ beautifully frank book, “Life after Birth; What even your friends won’t tell you about motherhood” (1998) toward the end of this research process. (She interviewed new mothers and

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presents a personal, historical and anecdotal but satisfyingly psychological portrait of motherhood.) Figes discusses at length the raw emotional nature of the transition to motherhood and motherhood generally. She talks about it as a “skinless feeling” (p. 93), evocatively capturing the vulnerability felt by new mothers. “The huge, new concentric circles of emotions that envelop a woman once she has a child mature and become more complex as that child grows; they never disappear” (p. 94). She is talking about a process of transformation.

A way I found to talk about this experience, once I had my own children, was that once you become a parent you have access to deeper registers of emotion you previously did not know existed. With this also comes deeper registers of doubt, guilt, insecurity, and even existential fear. Reactions to emotional tumult are varied. For some this a factor in the withdrawal in order to protect, while others seek connection and emotional intimacy, and still others gather information and look to practically prepare and protect.

Despite my small sample size, I contend this is a fundamental aspect of motherhood (and parenthood generally) that manifests in varied ways, likely related to attachment needs and experiences of how to seek and attain felt security and manage ambivalence.

There has been a spate of recent books written from varied disciplines aiming at this frank, complex and empowering portrait of motherhood. Emily Oster, a trained economist published her Expecting Better; Why the Conventional Pregnancy Wisdom Is Wrong, and What You Really Need to Know in 2014. This book was received as a powerful tool for women to take control of their bodies and pregnancies. Angela Garbes’s Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy (2019), has aspects of a memoir within this well-researched, multi-perspective but largely

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feminist work. There’s also Bumpin’; The Modern Guide to Pregnancy (Schrock, 2019) and And Now We Have Everything; On Motherhood Before I Was Ready” (O’Connell, 2019), just to name a few of the recent works inviting us as a culture to rethink our ideas about motherhood. All of these highlight the complexity and inherent emotional conflict involved.

This content was present across the board with the participants in this study. They talked about feeling deeply in love and painfully tethered; they found new motherhood at once instinctual and alien. They related to themselves and their important others in a more vulnerable and empathic way postnatally. Emergent motherhood is an in-between place. The very nature of this time is internal upheaval, which speaks to exactly why coherence in narrative is so critical. All women experience this conflict to some degree, and the integration of maternal identity cannot occur without reorganization, change and a sense of loss. However, a woman who comes to motherhood with a relatively coherent personal narrative and integrated sense of self will arguably have an easier time weathering the tumult.

Brazelton and Cramer refer to emergent motherhood and the resulting upheaval as “a transient pathological state” (1990, p. 30). Bibring (1961) similarly frames pregnancy as a “period of crisis,” when a woman is negotiating varied representations of self and baby that emerge (p. 12, 13). This is reflected in the me-not-me thematic material collected in the data. Bibring sees this as a developmentally appropriate crisis, much as in Winnicott’s characterization. These fluctuating representations are expanded on in more contemporary attachment research. Fonagy’s work highlights that maternal apprehension

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of a developed reflective function, as demonstrated by coherence of narrative, relates directly to the ability to appropriately attune to the infant at birth (2014, p. 53).

Women with more highly developed reflective capacities, and therefore more coherent personal narratives, are better able to integrate new events, even life-altering possibly traumatic events, into the existing narrative. An already fractured sense of self cannot be expected to somehow newly become whole. Without a solid foundation there is nothing to build on or integrate with. To the degree that we understand mental health as possession of an integrated sense of self, this must come to bear when considering any new developmental crisis. Colarrusso, who wrote several foundational papers on renegotiation of developmental tasks over the life course, quotes Bibring in a 1979 paper: “We find them as developmental phenomena at points of no return between one phase and the next when decisive changes deprive former central needs and modes of living of their significance, forcing the acceptance of highly charged new goals and functions” (p. 119).

Ammaniti and Gallese (2014), who have built on Fonangy’s research and his concept of mentalization, emphasize the role of maternal integration: “Integrated mothers are capable of keeping their yet unborn baby in mind…they are able to have a differentiated psychic image of the baby…attributing emotions and intentions to him or her, trying to give a sense to and interpret the child’s movements” (2014, 52-53). Flora, who seems to have the most disrupted attachment history, makes mention of feeling annoyed by her child’s hiccups in utero and refers to the experience of the baby moving within her as “the Loch Ness monster.” She is however quick to express guilt for these reactions, which demonstrates her developing reflective capacities. These remarks are

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quite different from Rose, for example, who jokes that during an ultrasound her baby didn’t cooperate and covered his face “saying no pictures please!” While both Flora and Rose do have differentiated images of their babies, Flora has trouble holding on to her baby as another human, and there is a sense that she, at least at times, interprets her child’s activity in relation to her, pleasing or not pleasing etc. Whereas Rose is more at ease with her child as separate and having his own agenda. I suspect these reactions are tied to the women’s own experiences of attachment; of being seen and heard and respected as a separate other.

This brings me to findings related to trauma. The finding that there was a greater shift from pregnancy into the early postpartum period in how the women related to their mental content for those who experienced aspects of birth as significantly traumatic was the perhaps the most meaningful piece of data yielded by the study. This speaks directly to issues related to coherence in individual narrative and interruptions in the identity integration process. All transition is fraught and complex, but traumatic events in pregnancy and childbirth introduce an added hurdle to coherence and integration.

For the three women in this study who experienced their child’s birth as traumatic, there was a profound sense of loss of control. Pregnancy and parenthood invariably revive old conflict, wounds and unresolved aspects of other life transitions.

Birth trauma can compound this upheaval and complicate a woman’s ability to rework and resolve conflicts old and new. In addition to integrating a new identity, a woman who has experienced birth trauma must simultaneously work at integrating a traumatic event.

A traumatic birth experience affects everything: a woman’s sense of self, her sense of integrity, her sense of competency and control. All of these elements are also deeply

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impacted by emergent motherhood. I suspect that the shift observed in the data in how these women related to their mental and emotional content had to do with the double integration so to speak—their efforts to simultaneously integrate trauma and their emergent maternal self.

While all three of the participants who had a traumatic birth experience demonstrated changes in how they were relating to their mental and emotional content postnatally, the quality of that shift was specific to the individual.

For both Holly and Rachel, labor and delivery were far from what they had hoped and planned for. They both expressed a sense of lack of control, disorientation and grief surrounding the birth experience. For Holly especially there was a real sense of mortal danger contained in her birth story. However, Holly and Rachel presented quite differently in their prenatal interviews, and those differences are reflected in their divergent responses to disappointing and traumatic birth.

Holly, who seems to rely on intellectualization, also presents with a high level of self-awareness. She was diligent in her efforts to prepare for the birth and arrival of her baby, intellectually and practically. Postnatally she is less intellectualized and far more emotionally present and has her sense of loss in focus. She is in touch with her sense of grief and explicitly reflects on being preoccupied with it. Holly applies her diligence to healing and tries to regain a sense of narrative coherence though therapy and retelling of the birth story with her partner. Her dutiful approach to healing is also a reflection of an attempt at coherence.

Rachel on the other hand is more practical and tends to disavow negative emotional content. While postnatally Rachel is unable to avoid expression of ambivalent

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feelings, she is much less willing than Holly to focus on her sense of loss. Rachel is able to speak to the physical aspects of the trauma, for example her painful scar and pain during sex, but the emotional pain is less within reach.

Holly is ready to grieve while Rachel is not. This has implications for clinical work. While a woman like Holly might be ready to do grief work, a woman presenting more like Rachel needs to be met where she is, perhaps with an initial focus on body work and somatic experiencing.

Flora clearly stands out among the study’s participants. Not only did she have traumatic aspects to her birth, she also experienced perinatal loss (relatively common in general but she was the only participant in this study with that experience) as well as a significant history of childhood sexual abuse.

Flora’s talk both during her pregnancy and after about jealousy and her worry about her daughter and her husband having a connection that she is not a part of speaks to her attachment anxiety. Flora seemed to be deeply connected to her husband, in an almost parental way. If her husband was perhaps providing a corrective attachment experience for Flora, serving as a stable attachment figure, the baby represents a disruption, a potential threat. In essence her daughter is set up to be in competition with her. Flora was in psychotherapy during the time of our interviews and was able to speak very directly to these issues. In fact, I am doing little interpretation to illuminate them. I suspect that Flora’s self-awareness and developing reflective capacities will offset her attachment anxiety and help her rework old and conflicted patterns. But these dynamics have significant clinical implications for working with women with complicated and fractured attachment histories.

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The shift for Flora from prenatal to postnatal was not so much a change but an amplification. For Flora, integrating trauma was not a new endeavor. Experiences of profound loss of control, grief and betrayal were already a part of her narrative and sense of self. It seems that her marriage and her experience with psychotherapy had begun the healing and were helping her to integrate, but her perinatal losses and the disruption of the pregnancy and new baby presented new challenges to her sense of an integrated self.

Flora’s sense of anxiety about being able to care for her baby, her worries about being able to be an attachment figure were also amplified postnatally. While self-doubt is a very common aspect of new motherhood, Flora was gripped by it. Her previous history of trauma and abuse is certainly connected with the prevalence of issues of self-worth and shame.

Recent trauma research provides new insights, based in evolutionary biology and neurophysiology, into the role of shame in trauma. Stephen Porges’ polyvagal theory focuses in on the functions of the autonomic nervous system to help better understand responses to stress and trauma, including immobilization or shutdown response, which is a correlate to fight and flight. He supports this notion, much like the psychodynamic concept of dissociation, with insights from neurobiological research. I will not attempt a full elaboration of his theory here, but I do want to quote one passage which I find relevant to Flora and to birth trauma more generally. “Shutdown (hyper-aroused) individuals frequently experience pervasive shame. This corrosive and debilitating emotion is also locked in the shutdown autonomic nervous system and in a particular collapsed somatic posture. Indeed, until this pattern is altered (deconstructed and

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renegotiated), it is difficult if not impossible to exit those debilitating shame states” (2018, p. 17).

Porges seems to be suggesting that there is an evolutionary and biological underpinning to the connection between trauma and the experience of shame. It is an aspect of the immobilized posture our nervous systems, and bodies with them, adopt in an effort to survive a predatory threat. Porges talks about diverting eye contact and submissive stance as related phenomena (p. 17). It is not a leap to suggest that shame is actually a defense. And like all defenses, they serve us until they don’t. Porges’ word corrosive is apt.

For Flora, this somatic posture, and the associated emotional experience of shame, was both familiar and easily activated. Self-doubt was already present in her mental content during pregnancy and would likely have been amplified during her postpartum experience even if her daughter’s birth had been uncomplicated. However, the traumatic aspects of her birth experience likely fanned the flames of Flora’s well of shame and pervasive sense of failure.

This insight from polyvagal theory does not only apply to women with previous histories of abuse or trauma. Traumatic birth induces a sense of profound loss of control for all women, and likely places many in a shutdown, immobilized state. (This was the state that Rose fought actively to avoid and fortunately for her she succeeded.) As I have stated earlier, self-doubt is a common and pervasive aspect of new motherhood. And the birth experience, traumatic or not, is physically intense and primal. I wonder if the emotion of shame, “locked in the shutdown autonomic nervous system” as Porges says, offers another way of understanding this phenomenon. “Mom-guilt” is a common

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colloquial idea, but also a very real experience for women, and new mother’s in particular. (As Sheryl Sandberg, founder of the Lean In movement, points out, “Guilt management can be just as important as time management for mothers” (2014, p. 147).)

Of course, there are many other aspects to this phenomenon and ways to understand it, but perhaps evolutionary biology has a perspective to offer.

On a related note, Claire alludes to what she understands to be her own experience of trauma as an infant. She has always known that she was jaundiced at birth and had to spend several days in an incubator separated from her parents. The family story is that she would cry and cry but her parents weren’t allowed to hold her, and she was later a colicky, difficult to soothe baby. It wasn’t until her pregnancy, however, that she began to tap into, what she termed, preverbal sadness. She felt regressed and needy during her pregnancy and connected this with what she understood to be her early attachment wounds. Claire is herself a psychologist, with significant psychological knowledge and insights. Not all women are capable of doing this kind of work on their own. Rachel also alludes to early attachment wounds. Her insight came from a healer who suggested to her that her mother, “didn’t hold her properly as an infant,” and this resonated enough with Rachel to stick with her. In our conversations Rachel did not reveal much about her understanding of how this affected her at an emotional level and did not seem to be in touch with her infantile self in the way Claire was. However, she did reflect on her mother’s anxiety and her need to protect herself from it. Her mental content was full of concerns about creating a calm environment for and being a calm carrier of her child. Rachel was determined to “properly” hold her son, which for her seemed to mean calmly hold him.

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Clinical Implications This study reveals several indications for clinical work with women, pregnant women, new mothers, and families during the transition to parenthood. My analysis of interviews with women in pregnancy and early motherhood pointed to the significant value in paying close attention to the way’s women communicate and relate to their reverie/mental content during this critical and transitional moment.

With respect to the role of visualization in maternal identity formation, I see several clinical indications. If these visualizations are to be viewed as a manifestation of the important emotional and psychic labor of pregnancy, it is advisable that clinicians working with pregnant women and new mothers attend with care to maternal visualizations of labor, birth, and baby. They provide a valuable entry point to a woman’s shifting internal landscape, her fears, wishes and hopes, but also her representations and identifications and attachment patterns.

It is the role of psychotherapists to help the patient in the transition to motherhood tap into her own rich tableau of visualizations. There is great benefit in finding a way to help women make use of and honor this creative, generative work. The cornerstone of psychodynamic psychotherapy is to use the power of reverie in the form of free association to illuminate previously unconscious mental and emotional content. When we are talking about emergent motherhood, what is surfacing is not just the unconscious, but the preverbal; women in this state are attuned with primal and infantile versions of the self and others that were previously inaccessible. The process of psychotherapy can help women to build narrative coherence around their own infancy and earliest relationships through the visualizations that surface. This is of critical value, given that these early

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experiences will come to bear on the woman’s nascent motherhood and her relationship with her infant regardless of whether or not they are meaningfully and thoughtfully integrated.

The process of psychotherapy can be of significant use in the integration process.

In particular in cases where the clinician is aware that a new mother has underdeveloped reflective capacities, work can be done to encourage and facilitate visualization of her baby and herself as a mother to her baby. This may involve questions aimed at helping the patient to elaborate her visual sense of her baby, what the baby might feel, and what the baby’s needs are. Additionally, elaborating the visual images such as holding her child for the first time, for example, and what she might feel holding her baby or watching her partner hold the baby.

The intergenerational nature of maternal identity formation and the role of meaning making and projection is clearly a rich area with many implications for clinical work.

During this time of reorganization, mental content that is typically unconscious, or at the very least not readily in conscious awareness, becomes top of mind. For new mothers already in therapy, this is a clear opportunity for deep and perhaps new work around intergenerational and attachment issues. The state of mind of the transition to parenthood is other—it allows for a different kind of access and brings previously unresolved conflict to the surface. It often requires that people revisit and rework aspects of themselves and their relationships that previously were seemingly stable. It is the role of psychotherapists to pay particular attention to these dynamics and help patients to understand this as a normal, healthy and inevitable part of becoming a parent.

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It is also advisable that we speak directly to patients in the transition to parenthood (and beyond) about the role of meaning making and projection in their relationships with their children, and the impact this has on the dynamic interplay between their parental identities and their children’s sense of self. Using the therapeutic process to call direct attention to the role of meaning making and projective communication can help families see their way out of pathological enactments, and in some cases help to avoid them.

While this implication for clinical work is not a new revelation, and foundational to analytic work, I do find value in stating it here. Psychotherapy helps patients at all phases of life to revisit conflicts and patterns, to identify and to process attachment issues, and rework relational boundaries internally and practically. All of this work is of paramount importance during pregnancy and new motherhood. Additionally, I think there is a need for more talk about these phenomenological aspects of motherhood and parenthood more generally in the larger cultural dialogue.

The finding of this study that emotional upheaval and internal conflict are a universal aspect of new motherhood suggests that clinicians working with this population should honor this reality and the way it shows up in the experience of women. It is the role of clinicians to speak to the tumult and ambivalence women feel, normalize it, and help women tolerate it. There is significant clinical value in trying to prepare women for the inevitability of internal upheaval. It is certainly a trope that other people offer all sorts of unwanted advice to new parents about how their lives will change once a baby comes, and the ways new parents take this in (or don’t) are varied and complicated. And to a degree it is necessary that expectant parents protect themselves from these messages and

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projections of the experiences of others. At the same time, a therapist is in a unique position to offer constructive and nuanced input to emergent parents on the nature of the impending change. In ideal circumstances, the safety of the psychotherapeutic holding environment, which is designed to contain and process ambivalence, can allow women in this primal transition the room they need to prepare for and process the upheaval they will surely feel inside.

When working with patients who present as less integrated, it would be useful for clinicians to do work aimed at helping to develop narrative coherence. This study adds to the established body of research on infant-mother relating that points to the critical role of a mother’s reflective capacities, and her use of mentalization, which allows for a differentiated psychic image of her baby. The question of how to build these capacities in clinical work is an area of current and ongoing research. I suspect that the holding environment and corrective action of the psychotherapeutic process is a part of that. But that is a long-term endeavor. In the more immediate, here and now, of clinical work with pregnant women and new mothers, it is indicated that it would be clinically useful for psychotherapists to model this kind of thinking, to actively talk to women about their babies in ways that demonstrate and prompt this kind of reflection and emphasizes the baby as having a separate center of self.

This study has several clinical indications related to the role of trauma in maternal identity formation. It is no surprise that complications and traumatic experiences during the transition to motherhood are disruptive for maternal identity formation. Arguably all women experience some sense of loss of control and disorientation during this transition.

But for those who experience not just a profound loss of control, but a sense of real

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mortal danger and an initial inability to regulate and make sense of what has happened for and to them, this presents a potentially significant challenge to maternal identity integration. (This study did not touch upon cases where the woman or baby sustains significant injury, which is an area for future research.)

The results of this study emphasize the role of narrative coherence in the transition to motherhood. When working with women who have had difficult or traumatic aspects to their transition to motherhood, it is advisable that we pay particular attention to their innate reflective capacities and help to support and build them. As stated above, the basic clinical idea of meeting people where they are at is relevant here. Some women can articulate that they feel traumatized right away; others are not ready or may never be ready to frame it that way, but may still be struggling to reconcile or integrate. Therapists can help women who are ready to grieve their experience develop and narrate their birth stories in an effort to help them integrate. It is important that we help women understand how the loss of control and fear they felt is reverberating in the postpartum period. For those who are having a harder time reflecting on the negative aspects of their birth, as stated in reference to Rachel above, a somatic experiencing approach or referrals for body work are clinically indicated.

In work with clients like Flora who have a previous history of abuse, there is a clear need to help process and grieve these experiences. Flora, who was in a seemingly productive psychotherapy, demonstrated its buffering impact. It is advisable that women who experienced childhood abuse seek psychotherapy before becoming mothers if at all possible. And meaningful work to resolve and integrate childhood trauma to the highest degree possible is of paramount importance during pregnancy and in the transition to

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motherhood. Because this transition is a period of psychic reorganization when previously inaccessible material surfaces, this is an ideal time for psychotherapy for all women, but especially those with unresolved childhood trauma. The cases of Claire and Rachel suggest that processing personal trauma as an infant and working toward some narrative coherence around a woman’s own experience of infancy is clinically indicated and another area for future research.

Of course, all psychotherapists do some version of “trauma work”; it’s unavoidable. But I would not say that my clinical area of expertise is trauma with respect to the current neuro bio physiological modalities. This project was not intended to meaningfully provide clinical insights to trauma work. However, the consideration of Porges’s recent work seems to suggest clinical implications for pregnant women and new mothers. Porges writes about the hierarchy of responses to trauma, seen through the sympathetic nervous system and the ventral vagal system. These systems certainly are at work during traumatic birth, when a woman has reason to fear mortal danger. Even prior to this research, I had become interested in the potential use of EMDR and other somatic experiencing work for women with difficult or traumatic birth experiences. This is another area for future clinical research. I am particularly interested in the connection between the experience of shame and the effects of the shutdown autonomic nervous system. This is also an area of future research with clinical implications.

The larger field of mental health care suffers from the problematic tendency to intervene at the symptom level to all manner of psychological and mental health concerns, rather than facilitating deeper, dynamic treatment. There are of course many deep-rooted academic, economic and sociopolitical causes and ramifications of this

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unfortunate reality. However, with respect to the treatment of pregnant women and women and families in the transition to parenthood, we should avoid falling prey to onesize-fits-all symptomatic treatment models. What was very clear to me in the course of this research project—aimed at describing the essential qualities of this transformation— was that while there were certainly identifiable core themes and much to be said about various analyzable phenomena, each of my subjects presented a dynamic and idiosyncratic version of maternal identity apprehension. As is indicated by an IPA methodology, in order to meaningfully analyze and present my data, my understanding of it had to be firmly rooted in the six subjective accounts from which it came.

The clinical implication I make from this is the reminder that motherhood, and the transition to motherhood, do not lend to any-one-size-fits-all treatment model. Just as no two people are exactly alike and no two women are exactly alike, no two mothers are exactly alike. We cannot treat the mother without a deep and complex understanding of her attachment and relational history, her level of integration and reflective capacities, a sense of how other life transitions have been resolved, any history of trauma, and the dynamic of her current partnership and support system. Each woman’s transition to motherhood is her own. And each woman’s maternal identity is unique. The iconic feminist writer and activist Betty Friedan claims: “We broke through the feminine mystique and women who were wives, mothers and housewives began to find themselves as people. That didn’t mean they stopped, or had to stop, being mothers, wives or even liking their homes” (1992). Part of clinical work with pregnant woman and new mothers is about tolerating ambivalence, but it is also about helping women to claim and integrate their own, unique, rich and complex maternal sense of self.

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Bollas’s notion of the mother as the transformational object for the infant might be problematic from a feminist perspective, but I find it to be beautiful and empowering.

He says of the mother: “She both sustains the baby’s life, and transmits to the infant, through her own particular idiom of mothering, an aesthetic of being that becomes a feature of the infant’s self” (Bollas, 1987, p. 13). The notion that each mother mothers in her own idiomatic way, which forever imprints a preverbal experience of transformation on to her child speaks to the fundamental truth of motherhood (and parenthood) that I have stated several times: it is ordinary and extraordinary. As psychodynamic psychotherapists, our role arguably in all clinical work, but certainly in work with emergent mothers, is to normalize and speak to the phenomenological aspects of the experience while listening for and honoring the particular.

Implications for my own clinical work.

One of the most rewarding parts of going through this process has been the flow of insight and attunement back into my clinical work with patients. I have been working with pregnant woman and families in the transition to parenthood for several year.

However, since conducting these interviews and analyzing them, I have begun to notice myself listening a little differently and drawing on insights gained from this research in session.

Below is a dream, which a long-term patient of my reported in a recent session. I was so blown away by the profundity of it that I asked her to write it down for me. I share it here with her permission. I have seen this woman for over 10 years now, and there are many parts of this dream that I recognize as particular to her life experience and

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psychological makeup. But what strikes me is that it is also a salient and encapsulating example of the thematic texture of the liminal state of pregnancy.

Chris and I met my family at Grandpa’s cottage in Michigan for a family gathering. My mom, my stepdad, my brother, grandparents, aunts uncles, cousins, everyone is there. It’s a place I loved as a child. Chris and I decided that we wanted to go into town to get doughnuts for breakfast. In the car I tell him I’m upset that he had sex with our friend Kate while I was sleeping. (Something I just seem to know happened.) Chris says that it isn’t a big deal and it doesn’t mean anything. He doesn’t understand why I’m upset. I let him know that things will never be the same now, but somehow I’m calm. We drive back to the cottage with our doughnuts.

As we get back, the rest of my extended family are arriving at the cottage, twenty plus people. When I go into the kitchen, my mom tells me that it’s been decided that Chris and I have to go stay at Kate’s house down the road. I tell her that I do not know who Kate is and I don’t want to go anywhere. She tells me, “Yes, you know Kate, you met her a long time ago. When you were an infant. You remember her.” I start crying saying I don’t understand why I’m the only one who has to go sleep somewhere else and at a strangers house nonetheless.

I head towards the backdoor crying. I see all the doughnuts have been eaten and I didn’t get any. There are so many people there, blocking all the pathways. They see me crying and start making fun of me, calling me a big baby for crying. Saying that I should act like an adult. I try to explain that I’m pregnant. As I’m trying to make my way outside, I see Chris out on the dock,

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getting a fishing pole ready. I look out at him and smile to see him so happy. I start making my way to him, pushing my yelling family members out of my way.

The backdrop of the dream is a small cabin with “everyone” in it. Her entire family comes together to fill the space. As reflected in the findings, in pregnancy and the ensuing experience of parenthood, the intergenerational influences come flooding in and loom large. They are the “ghosts in the nursery” that haunt us whether we acknowledge their existence or not. In my patient’s dream, her family seems to fill the cabin with warmth as well as to trap, suffocate and torment her. This reflects the ambivalence with which most people meet the influence of their actual family members and their legacy.

The only person who gets a voice in the dream is her mother. This is quite consistent with data from my research. Invariably, for better and for worse, a woman’s own mother, and her experience (or lack thereof) of being mothered by her mother, comes to bear as her own maternal identity is forming. In this dream my patient’s mother tells her she must go, leave the family cabin, to be with a woman who she has only met before when she was herself a baby. She assures her she will remember her.

Pregnancy and the birth of the child bring a woman into contact with her own infantile self, and her mother as she knew her then, in a way that is not otherwise possible. This is what Daniel Stern calls, “the present remembering context,” the sensory perceptual experience that activates the visceral memory of the woman’s own infancy.

The woman my client is being sent to be with is a person she only knew as a baby: She is her mother to her as a baby but also her own self as a baby. And in some sense a true stranger—her new mother-self. This is the “me-not-me” of new motherhood.

She doesn’t know this woman, but she does. She doesn’t remember her, but her mother

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assures her she does remember. She is crying, crying “like a baby.” Asserting to her family, calling her a baby, that she is not a baby but a pregnant woman. She is regressed and simultaneously assertive. Her family is telling her to leave, she doesn’t want to go but then does want to go. Pregnancy is a crossroads. It is full of contradictions and conflicting feelings, as is motherhood. She is afraid of being alone, but also wants to escape her family. All the doughnuts have been eaten—will there be anything left for her?

The other major player in this dream is her husband. He has apparently slept with another woman, a woman who has the same name as the woman they are being sent to stay with. Her husband, it seems, has already begun an intimate relationship with her emergent mother-self. He assures her it’s no big deal, and my client accepts this but tells him “things will never be the same.” And they will never be the same. This statement is invariably true when one becomes a parent. This part of the dream conjures my client’s personal but arguably universal worry about how this experience will change her relationship, her body, her sexuality. This is a transformational time. And in the dream, she seems to be distinctly more aware of this than her husband.

As she tries to disentangle herself from her family, who see her as a baby and not as a woman and a mother, she sees her husband outside the cabin, happily fishing and smiles. She wades through the family matrix toward him.

I am sure I would have taken note of my patient’s dream regardless of my ongoing research on maternal identity formation—but the thematic material she communicated to me is startlingly parallel to the thematic material revealed in the analysis of my interviews with other new mothers.

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My immersion in the essential qualities of the transition to motherhood through the research process has allowed me to pay particular attention to my patients. It has helped me to hold my knowledge of their circumstances, family and attachment histories, disposition and reflective capacities, while also tending to what I now consider to be the phenomenological aspects of this transition: the power of visualization and meaning making, the surfacing of intergenerational dynamics, the strange and disorienting experience of self and other, and the confusing and heightened emotions that accompany psychological reorganization.

Limitations of Study This study was narrow in its scope and therefore the findings have a multitude of limitations. This was a purposive sample, which by design is small in size and is not intended to be representative. Rather it is a more closely defined, small sample. While this is consistent with IPA methodology, and the multiple interviews provided a significant depth of data, the relative homogeneity of the participants does represent a limitation.

Four of the six women who participated in this study were recruited through friends and acquaintances of mine. One participant was directed to me by a colleague, with whom she was in therapy. And the sixth was a client of the homebirth midwife who delivered my third child. The social proximity contributed to the majority of the participants being professional, middle-class women living on the East Side of Los Angeles. The women all had access to information, support, good prenatal care, and the financial means to care for themselves and their child. While some of the women did

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mention financial concerns, none of the six participants were in financially precarious situations and for the most part their reverie was free from immediate and acute practical anxiety about basic security. The research would benefit from a more economically diverse sample.

Five of the six participants aspired to have an unmedicated birth, four of six delivered attended by midwives, two of six delivered at birth centers, and two women planned for home births, although one of those ended up having a cesarean at the hospital. Just 8.8 percent of American women choose to receive prenatal care and deliver with midwives. While one could make some generalizations and speculations about the type of women who choose midwifery care, it is evident that the types of reveries and preoccupations regarding preparation for childbirth, readying your home space or birth center for the birthing process, and having birth partners in place, is certainly impacted by the aspiration to have an unmedicated birth.

All of the women who participated in this study were partnered in heterosexual relationships. Five of the six were married to those partners. This is clearly a significant limitation to the study. The research would benefit from data provided by women whose sexual and gender identities are more varied, and whose partners are not strictly heterosexual men. It would be useful to also have data from non-partnered women. It is likely there would be clinically significant variation in the reveries of women who are not planning to have the support of the other genetic parent of their child.

All six of the study’s participants conceived without medical intervention. While one participant did report perinatal loss on the path to conception, she was the only respondent who discussed any challenges with fertility or conception. Research in this

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area would benefit from more a more in-depth look at the reveries of women who have struggled to conceive, experienced perinatal loss prior to pregnancy, and who used assisted fertility treatments, including those that employ egg and sperm donation.

Five of the six participants are Caucasian, one is Latina. The study’s lack of racial diversity is a significant limitation. It would be very useful and important to have a data that provides a more diverse look at women’s reverie across varied races and ethnicities.

All of the participants of the study have at least some exposure to psychotherapy, which did lend to their ability to meaningfully reflect and participate, but also represents another way the study’s participants are homogenous.

The proposal stated that clinically significant anxiety, depression or other major mental illness were exclusionary criteria of the study. However, of note is that one of the study’s participants revealed significant childhood trauma and a likely related history of depression during the first interview. Because this woman was referred to the study by her therapist, with whom she was in a well-established weekly therapy, and also reported that her depression had been well-managed for several years, I decided to keep in her in the study. In reviewing the data however, it is evident that her thought process, reveries and preoccupations stand out among those of the other women. In her prenatal interviews she reported clinically significant attachment anxiety, projection of her own deprivation onto her baby, and profound fear of not being able to care for her daughter and anticipation of maternal rupture between them. While all the women expressed selfdoubt, grief and anxiety in their postnatal interviews, this participant was the most significantly gripped by these affects and consumed by attachment anxiety and fear of failure.

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Indications for Future Research The results of this study suggest several indications for future research with pregnant women and women and families in the transition to parenthood.

As stated above in the limitations of the study, research would benefit from replication of this or a similar study with more demographic diversity. It would be important and useful to understand how race, ethnicity, socioeconomic status, sexual and gender identity, and more varied partner status and family constellations influence the mental content of women during the transition to motherhood. It would also be useful to look at women who are not planning to raise their child with the other genetic parent, or women who are carrying a child who is not genetically related to them.

Only one of this study’s six participants had difficulty conceiving and experienced perinatal loss prior to pregnancy. And none of the participants used assisted reproductive technology to conceive. Replication of this study or a similar study looking at the mental content and the shifts in how women relate to that mental content through the conception process, pregnancy and beyond could provide insight into how these experiences impact maternal identity formation, especially for women in same sex couples who are using assisted fertility and will not be raising the child with the other genetic contributor.

It would also be beneficial to look at women who are not pregnant but are awaiting a child through adoption or surrogacy in an effort to understand how their reverie and other mental content is consistent with and/or different from women who carry a child and give birth. These women are of course undergoing a major identity transformation and reorganization, however their emergent sense of maternal self is

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shaped by other outside factors and influences, in addition to presumably many of the same experienced by pregnant women. There is likely an essential quality to entering motherhood through adoption and surrogacy which is qualitatively different.

Further research is needed that includes women who themselves come from more varied family-of-origin constellations, such as two mothers, two fathers, a single parent, grandparent or non-genetic parent as primary caretaker. It would be useful to understand how these different early attachment figures and experiences influence the visualizations and the intergenerational meaning making and projective processes that surface during the transition to motherhood.

Although this study did not reveal much material related to female friendships, I suspect this had to do with the nature of the questions asked and the emphasis placed on intergenerational material. I see this as a rich area for future research on the transition to motherhood. The body of research would benefit from a contemporary understanding of how friends are relating to one another’s emergent maternal identities. I am interested in what interpersonal dynamics lend to the support and deepening of friendships as opposed to factors that undermine and prohibit meaningful connection and intimacy. I suspect there are intergenerational, attachment, and current partner relationship factors involved.

This study also did not yield a wealth of data with respect to the conflict between professional and maternal identity, however this is an area of active and ongoing research.

More research is indicated on the function of maternal visualization, what factors internal and external, influence the types of visualizations that are present for individual women, such as disposition, attachment history, previous history of trauma, etc. Research

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in this area has direct clinical usefulness. Looking at these psychological factors with respect to the presence and nature of intergenerational meaning making and projection in the mental content of women in the transition to motherhood is also an indication for future research.

A clinical implication noted in this study was the potential benefit of working with expectant and new mothers in psychotherapy to encourage and build reflective capacities and mentalization. This is already an active area of study. Clinicians would benefit from specific input on how to effectively do this within the treatment relationship.

Another area for future research is the role of traumatic birth in maternal identity formation. The finding of this study, that women with a higher degree of trauma associated with the birth experience tended to relate to their mental content in a more divergent way, would benefit from replication and further verification as well as further exploration of what meaning can be made from this difference. I am suggesting that women who have traumatic birth experiences must simultaneously integrate trauma and maternal identity. This assertion would benefit from further testing and exploration.

Additionally, more research on how to clinically help women who have experienced birth trauma is indicated. This research suggests narrative therapy to help women integrate their birth stories as well as somatic experiencing therapies as areas for further study.

Another indication for future research related to trauma is the potential connection between the experience of loss of control and fear of mortal danger during birth and the activation of the shutdown/ immobilization response of the nervous system, and how this relates to correlating emotional states. There is a need for further understanding on how

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this physiological phenomenon might offer a way to partially understand some women’s experience of pervasive shame, self-doubt and guilt postnatally.

Another area indicated for further study is the experience of women in the transition to motherhood who have themselves experienced trauma in utero or as an infant. How does the knowledge of these events or the psychic (or perhaps even physical) legacy of them emerge for women as they become mothers themselves, and how can clinical work help to integrate these experiences? These questions would benefit from further exploration. On a related note, this study did not include any women for whom birth trauma resulted in serious injury for themselves or their babies. This is another clinically and theoretically significant variable to be explored in the future.

More generally speaking, I would like to see the proliferation of research on women, mothers and maternal identity that respects the largely adaptative and healthy ways women meet this transformational, complex and life-altering experience. The body of research benefits greatly from accounts that honor the psychic creation of maternal identity as fully as the biological creation of a baby.

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Appendix A Informed Consent for Participation in Qualitative Research Study

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Title of the study: Maternal Reverie and the Transition to Motherhood Researcher: Alexis Jaeger, PhD Candidate at the Institute for Clinical Social Work in Chicago, IL 1. I agree to participate in three interviews with the researcher, Alexis Jaeger.

During the first and second interviews, I agree to allow the researcher to ask me a series of questions about my pregnancy. In the third interview, I allow the researcher to ask me a series of questions about my transition to motherhood.

2. I agree to participate in three, 60-minute interviews that will be audio recorded and transcribed for the purpose of analysis. After the interviews are transcribed and the data analyzed, I may request a copy of the verbatim extract that will be published in the final report.

3. The purpose of asking these questions is to pursue a deeper understanding the meaning of maternal reverie (thoughts, feelings, fears, anxieties, fantasies etc.) during the transition from pregnancy into new motherhood. The research expects to examine how the findings may inform an understanding of the shifts in identity, relationships and self during a woman’s transition to motherhood.

4. I understand that I can choose a pseudonym or permit the researcher to assign a pseudonym to me in order to disguise my identity. I realize that the researcher will use a transcription service to transcribe the audio recording. I am aware that the transcriber will not know my identity, and will be committed to respecting confidentiality.

5. I understand the interview is for academic research and the benefit I may gain from participating in the study is the opportunity to reflect on my experience and deepen

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my understanding of it. I am aware that there will be no monetary compensation for my participation in the study.

6. The researcher has discussed with me the time and location of the interview. I am aware that I can contact the researcher to answer any questions regarding the interview process by calling 773.550.5823 from 9:00 am – 9:00 pm.

7. I understand that there is a risk that some questions may cause psychological discomfort. I am aware that participation in this study is voluntary and I can decide to refuse to answer any questions during the interviews or discontinue my participation in the study at any time without any consequences. Conversely, I understand that the researcher may decide not to interview me or use my interview for the final analysis.

Should I choose to withdrawal from the study, the researcher will delete the audio files and the transcripts of my interviews. I understand that the researcher will confidentially preserve the interview records of this study for five years. The records will be kept in a locked file.

8. I understand this research will be part of a dissertation study at The Institute for Clinical Social Work and will be conducted under the supervision of Dr. Freda Friedman.

I may also contact the Institutional Review Board of The Institute for Clinical Social Work, c/o Dr. Freda Friedman, 401 South State Street, Chicago, IL 60605, with questions or concerns regarding the study.

I have read the above information and I consent to participate in the study.

Signature______________________________________________Date________ ______

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Appendix B Recruitment Flyer

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Seeking participants for qualitative research study: MATERNAL REVERIE AND THE TRANSITION TO MOTHERHOOD I am a PhD candidate at The Institute for Clinical Social Work in Chicago, IL conducting a research study on the transition to motherhood. I am looking to interview women pregnant with a first child about their experiences of becoming mothers.

I will be conducting three interviews with each participant: -the first during the second trimester of pregnancy (4- 6 months pregnant) -the second during the third trimester of pregnancy (8- 9 months pregnant) -the third in the first three months after your baby is born.

I will be asking you to tune-in to and reflect on your maternal reverie, your experiences of being lost in thought, since becoming pregnant. I am interested in your thoughts, feelings, fears, wishes etc. related to pregnancy and the birth of your baby. I will also be asking about how your pregnancy and later becoming a mother has been affecting your sense of yourself and other important people in your life.

This is an opportunity to be part of a clinical study that will contribute valuable insights about this major life transition—participation in this study will also provide you with a unique opportunity to meaningfully reflect on your own personal journey into motherhood.

Each interview will be approximately 60 mins long and take place in your own home, the researchers office, or another agreed upon private space.

To qualify for the study: -you must be at least 26 years of age -be pregnant with your first baby -be willing to meet for three, 60 min interviews: two before and one after the birth of your child.

-be willing to do 30 mins of journaling during the week prior to our first interview

For any further questions regarding this study, or to sign up, please contact: Alexis Jaeger alexis.jaeger@gmail.com 773.550.5823 About the researcher: I am a licensed clinical psychotherapist with over 12 years of experience working with adults and couples. I specialize in working with issues related to fertility, pregnancy, post-partum depression, and transition to parenthood. I have a private practice in Silverlake.

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Appendix C Phone Script and Questions for Initial Contact with Potential Participants

242 Hello, my name is Alexis Jaeger - I am a PhD candidate at the Institute for Clinical Social Work. I am conducting a research study about the transition to motherhood and maternal reverie. I’m interested in talking to women who are pregnant for the first time about the thoughts and feelings they find themselves having now that they are pregnant-- about their baby, the changes they are going through and process of becoming a mother. I have just a couple of questions to ask you if you have a few minutes—all are completely voluntary.

Phone Survey Questions: 7. Are you currently pregnant for the first time?

8. When are you due?

9. Would you be willing to participate in three in-person interviews? The first when you are between four and six months pregnant, in person and lasting about an hour; a second follow-up interview when you are eight or nine months pregnant, this interview will be done in person or by phone and last up to an hour; a third and final interview in first three months after your baby is born, in person and lasting about an hour?

10.

Would you be willing to participate in a journaling exercise prior to the first interview?

11.

Have you ever been hospitalized psychiatrically or been in an intensive mental health treatment program?

12.

Would you be willing to take a quick 21 question survey that assesses your mood?

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Appendix D Journaling Instructions to Be Provided to Participants via Email Prior to First Set of Interviews

244 In advance of our interview next week, I am asking that you spend some time reflecting on your reverie and journaling about what you notice. Reverie is the experience of being lost in thought, what people might call ‘day-dreaming.’ This can include thoughts, feelings, wishes, hopes, fears, anxieties etc. Please spend some time tuning-in during the moments when you are lost in thought—your moments of reverie. What do you find yourself thinking about while you’re driving, while in the shower, as you’re waiting in line, or while you’re trying to fall asleep? When you are trying to focus and realize your mind has wandered, where does it wander to?

Other things to consider: What kinds of thoughts and feelings have you noticed since becoming pregnant? What things do you find yourself wishing for, preoccupied with, or worried about? Have your noticed different people or places entering into your reverie lately?

You do not have to write in full sentences and don't worry too much about logic, grammar or spelling. Try to write with as little judgment as possible-- focus on what you observed and/or felt and if you find that judgment creeps in you can note that as you are writing.

There is no right or wrong, I am simply interested in what you find to be on your mind.

Please spend approximately 30 minutes journaling about what you notice throughout the week. You can do this for example in 5 minutes a day, three 10-minute sessions, or in one longer session-- whatever feels best to you and is most realistic for your busy life.

Thank you in advance for your time and effort—these notes will be very helpful to our interview process. They are not intended for me to keep, but I will ask that you bring them to our interview, so we can discuss and use them as a springboard for our conversation.

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Appendix E Interview Guides

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Interview Guide to Be Used During the First Set of Interviews 1. Tell me about your experience of reflecting and journaling over the last week; what was it like to pay attention in that way? What did you notice about your reverie?

Did you find yourself noticing and writing about anything that surprised you?

2. What kinds of changes have you noticed in your thoughts and feelings since becoming pregnant?

3. What are your hopes about what it will be like once your baby is born?

4. What do you imagine your child will be like?

5. What do you find yourself preoccupied with/ worried about?

6. What are your thoughts/imaginings about the labor?

7. How do you imagine your life will change when your baby is born? (Changes to career/relationships/self?)

8. What do you find yourself thinking about your own childhood? Your parents/siblings/grandparents?

9. What do you notice about how you are thinking about or relating to important people in your life (such as your partner, friends, siblings, parents) now that you are pregnant?

10. How is this experience for you (thoughts, feelings, physically) compared with what you imagined it would be?

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Interview Guide to Be Used During the Second Set of Interviews 1. Now that you are in your final trimester, what kinds of differences, if any, do you notice in what you find yourself thinking about?

2. What have you noticed since our previous interview? Is there anything that stands out from the experience of reflecting and journaling or talking about your experience that you have noticed?

3. Are you aware of any shifts in your preoccupations or worries since earlier in the pregnancy?

4. Do you find yourself thinking about the upcoming labor/birth in different ways?

5. Do you notice any differences in how you’re thinking about or imagining the baby?

Interview Guide to Be Used During the Third Set of Interviews 1. Please tell me a little bit about the birth of your child and if/how you find yourself reflecting on it since your baby was born.

2. What changes have you noticed in the contents of your reverie—when you find yourself lost in thought—since your baby was born?

3. What do you find yourself preoccupied with/ worried about?

4. What kinds of thoughts and feelings do you notice about your own childhood or your parents?

5. How do you find yourself thinking about or relating to important people in your life (such as your partner, friends, siblings, parents) now that you are a mother?

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6. Is there anything surprising or unusual to you about what you find yourself thinking about now that you are a mother?

7. How is this experience for you (thoughts, feelings, physically) compared with what you imagined it would be?

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Appendix F Beck's Depression Inventory

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Beck's Depression Inventory This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.

1.

0 I do not feel sad.

1 I feel sad 2 I am sad all the time and I can't snap out of it.

3 I am so sad and unhappy that I can't stand it.

2.

0 I am not particularly discouraged about the future.

1 I feel discouraged about the future.

2 I feel I have nothing to look forward to.

3 I feel the future is hopeless and that things cannot improve.

3.

0 I do not feel like a failure.

1 I feel I have failed more than the average person.

2 As I look back on my life, all I can see is a lot of failures.

3 I feel I am a complete failure as a person.

4.

0 I get as much satisfaction out of things as I used to.

1 I don't enjoy things the way I used to.

2 I don't get real satisfaction out of anything anymore.

3 I am dissatisfied or bored with everything.

5.

0 I don't feel particularly guilty 1 I feel guilty a good part of the time.

2 I feel quite guilty most of the time.

3 I feel guilty all of the time.

6.

0 I don't feel I am being punished.

1 I feel I may be punished.

2 I expect to be punished.

3 I feel I am being punished.

7.

0 I don't feel disappointed in myself.

1 I am disappointed in myself.

2 I am disgusted with myself.

3 I hate myself.

8.

0 I don't feel I am any worse than anybody else.

1 I am critical of myself for my weaknesses or mistakes.

2 I blame myself all the time for my faults.

3 I blame myself for everything bad that happens.

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9.

0 I don't have any thoughts of killing myself.

1 I have thoughts of killing myself, but I would not carry them out.

2 I would like to kill myself.

3 I would kill myself if I had the chance.

10.

0 I don't cry any more than usual.

1 I cry more now than I used to.

2 I cry all the time now.

3 I used to be able to cry, but now I can't cry even though I want to.

11.

0 I am no more irritated by things than I ever was.

1 I am slightly more irritated now than usual.

2 I am quite annoyed or irritated a good deal of the time.

3 I feel irritated all the time.

12.

0 I have not lost interest in other people.

1 I am less interested in other people than I used to be.

2 I have lost most of my interest in other people.

3 I have lost all of my interest in other people.

13.

0 I make decisions about as well as I ever could.

1 I put off making decisions more than I used to.

2 I have greater difficulty in making decisions more than I used to.

3 I can't make decisions at all anymore.

14.

0 I don't feel that I look any worse than I used to.

1 I am worried that I am looking old or unattractive.

2 I feel there are permanent changes in my appearance that make me look unattractive 3 I believe that I look ugly.

15.

0 I can work about as well as before.

1 It takes an extra effort to get started at doing something.

2 I have to push myself very hard to do anything.

3 I can't do any work at all.

16.

0 I can sleep as well as usual.

1 I don't sleep as well as I used to.

2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.

3 I wake up several hours earlier than I used to and cannot get back to sleep.

17.

0 I don't get more tired than usual.

1 I get tired more easily than I used to.

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2 I get tired from doing almost anything.

3 I am too tired to do anything.

18.

0 My appetite is no worse than usual.

1 My appetite is not as good as it used to be.

2 My appetite is much worse now.

3 I have no appetite at all anymore.

19.

0 I haven't lost much weight, if any, lately.

1 I have lost more than five pounds.

2 I have lost more than ten pounds.

3 I have lost more than fifteen pounds.

20.

0 I am no more worried about my health than usual.

1 I am worried about physical problems like aches, pains, upset stomach, or constipation.

2 I am very worried about physical problems and it's hard to think of much else.

3 I am so worried about my physical problems that I cannot think of anything else.

21.

0 I have not noticed any recent change in my interest in sex.

1 I am less interested in sex than I used to be.

2 I have almost no interest in sex.

3 I have lost interest in sex completely.

INTERPRETING THE BECK DEPRESSION INVENTORY Now that you have completed the questionnaire, add up the score for each of the twenty-one questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circles zero on each question.

You can evaluate your depression according to the Table below.

Total Score____________________Levels of Depression 1-10____________________These ups and downs are considered normal 11-16___________________ Mild mood disturbance 17-20___________________Borderline clinical depression 21-30___________________Moderate depression 31-40___________________Severe depression over 40__________________Extreme depression

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