Labor During labour, help women maintain control. Factors that induce stress should be prevented, or at least minimized key factors related to women's perception of control during labour

continuity of care with career one-to-one care in labour not being left for long periods being involved in decision-making. positive parenting relationships and self-esteem

E motional changes during labour Fear of the unknown Fear of technology, intervention and hospitalization fear and anxiety about pain Concerns about the wellbeing of the baby Fear of death a fear of lack of privacy

The puerperium The puerperium is ‘fourth trimester’ it is the period from birth to 6–8 weeks postpartum, when the woman is readjusting physiologically, socially and psychologically to motherhood.

New mothers tend to be easily upset and oversensitive. Exhaustion is also a major factor of women's emotional state.

Normal emotional changes during the puerperium feelings ranging from satisfaction, joy and elation to exhaustion, helplessness, A feeling of closeness to partner or baby; equally the woman may feel disinterested in the baby Exhaustion and increased emotionality Pain (e.g. perineal, in nipples) loss of libido, disturbed sleep and anxiety

The postnatal ‘blues’ 50–80% of women depending on parity The onset typically occurs between day 3 and 5 postpartum, but may last up to 1 week or more, The main features are mild and may include: labile emotions (e.g. tearfulness, despair, irritability to euphoria and laughter)

The actual etiology is unclear but hormonal influences (e. g The actual etiology is unclear but hormonal influences (e.g. changes in estrogen, progesterone and prolactin levels) increased emotionality appears to coincide with the production of milk in the breasts. self-limiting and will resolve spontaneously, assisted by support from loved ones. persistent features could be indicative of depressive illness.

Emotional distress associated with traumatic birth events factors such as a history of childhood sexual abuse or a morbid fear of childbirth can negate a woman's experience of childbirth. What is intended to be one of the happiest days in a woman's life can quickly turn into anguish and distress. environmental factors may lead to a sense of loss of control, for example effects of intense pain, use of technological intervention

(PTSD), Obstetric PTSD occurs when women feared they or their baby were in danger of dying. it is commonest after emergency CS or obstetric emergencies

nightmares, panic attacks or ‘flashbacks’ Symptoms of PTSD nightmares, panic attacks or ‘flashbacks’ Avoidance especially of issues relating to pregnancy/birth Sleep disturbances Irritability or angry Anxiety/depression obstetric distress after childbirth appears to be directly linked to the stress, fear and trauma of birth

Summary of key point s Women during pregnancy, labour and puerperium are in a state of transition punctuated by heightened emotions and anxiety. Family life and daily routines become disrupted by the arrival of a new baby Vulnerability factors such as domestic abuse, poverty and social isolation, can impact on the mother–baby relationship with consequences for child development