1. 1 Labor and Birth: Effects on Early Relationships and Attachment Priscilla Tait MS, CNM, IMH-E(IV)

2. 2 The Significance of Birth Mastery of fear and pain Sense of Accomplishment Contributes to self-worth and competence as a woman

3. 3 Expectations of Self Cultural expectations Gender role expectations Internal vs. External locus of control Historical factors

4. 4 Complications and maternal self esteem Cesarean Section (planned vs.unplanned) Preterm Birth Invasive procedures during labor and birth Perineal injury or trauma Breastfeeding complications

5. 5 Trowell Study: 1993 Compared women who had C/S and Vaginal births on their perceptions of their infants -at ONE MONTH pp, women with C/S were more likely to be depressed and to express doubt about their ability to care for their infants -at ONE YEAR, the C/S mothers were more likely to describe motherhood as negative and to describe themselves as resentful, overwhelmed or angry -at THREE YEARS, C/S mothers were more likely to report serious problems in their relationships with their children and to describe them as unmanageable, out of control, or nasty -these mothers were also more likely to report the use of physical punishment Child Abuse and Neglect, 7, 387-394.

6. 6 Support During Labor Doula care Effects of constant female support Relationship with provider

7. 7 Kennell and Klaus Doula Study Significantly shorter labors Fewer medical interventions At Six Weeks Postpartum: -with a doula significantly more likely to describe their babies as beautiful, clever, and easy to manage and to report that they cried less and were better when compared to a standard baby. also perceived themselves as closer to their babies and communicati better with them

8. 8 Range of Responses to Birth experience Pride of accomplishment Failure or defeat The extent to which she had some control influences response

9. 9 Doula study: Without a doula -more likely to describe their baby as just slightly less good or not as good as a standard baby. -they were also more likely to think that anyone could care for the baby as well as they could

10. 10 Facilitating optimal birth Begin therapeutic relationship as early as possible in pregnancy Facilitate childbirth education for all women, especially group prenatal care. Support family-centered care in your community hospitals

11. 11 Resolution of Traumatic Birth Include birth in assessment data Listen to womens stories: What does it mean TO HER Holding, assisting in the resolution of grief and trauma