The Subjective Journey of Motherhood in Three Moments: Pregnancy, Childbirth and Postpartum

Abstract

This article aims to analyze three fundamental phases of motherhood: pregnancy, childbirth, and the postpartum period. Special emphasis is placed on the work that the maternal psychic apparatus must undertake in managing the demands arising from the reunion with archaic contents from their past during pregnancy, in the process of childbirth, and in the exercise of mothering when engaging with the baby. Our goal is to foster a thoughtful theoretical discussion, drawing from psychoanalysis, about the subjective journey of motherhood, with its intricate complexities, connections, and disconnections. This exploration considers that the skills required for baby care involve: ability of reverie, transmission of psychological aspects across generations, and the history of interpersonal exchanges between the mother and her own caregivers.

Keywords:
motherhood; pregnancy; childbirth; mentalization; transgenerationality

Resumo

Pretende-se realizar uma revisão temática da literatura analisando o processo da maternidade em três fases: gravidez, parto e pós-parto. Destaque especial é dado ao trabalho que o aparelho psíquico materno deve assumir ao gerenciar as solicitações advindas do reencontro com conteúdo arcaicos do seu passado durante a gestação, no trabalho de parto e no exercício da maternagem no encontro com o bebê. Busca-se engendrar uma discussão teórica sensível, à luz da psicanálise, sobre a travessia subjetiva da maternidade, suas complexidades, encontros e desencontros. Levando em consideração que as habilidades necessárias aos cuidados com o bebê envolvem, a capacidade de rêverie, a transmissão psíquica transgeracional e a história de trocas intersubjetivas entre a mãe e os seus próprios cuidadores.

Palavras-chave:
maternidade; gravidez; parto; mentalização; transgeracionalidade

Classically, the process of motherhood encompasses three main stages: pregnancy, childbirth and the postpartum period. Such stages are complex and full of changes at mental, body and social level, requiring woman to make important psychic rearrangements. For Racamier (2019) this path is marked by ups and downs and happens in an analogue way to adolescence, once it unleashes considerable changes not only at a body level, but also at a psychic one, therefore generating fragilization in the sense of identity (Bydlowski, 2001). It is in this moment of pregnancy that the woman’s whole life prior to conception comes out, thus generally configuring a psychic crisis (Brazelton& Cramer, 1992; Bydlowski, 2008), mainly concerning the birth of the first child - when a permanent generational change takes place.

When generating a baby, not only the woman’s body changes but also her psyche begins to prepare for creating another human being, while also constituting herself in the role of being a mother. Houzel (2000) points the complexity of psychic works in this occasion. Indeed, according to the author, it is as if there was an attempt of the pregnant woman to repair past affective experiences and traumas, as a preparation to receive the baby. In other words, the same way there is concrete nesting of the baby in the uterus, the family environment is transformed to welcome the baby: the room is arranged, the cradle, toys, bathtub are bought. The author draws an analogy with the woman’s need to go beyond and create a space for the newborn in her mind.

Therefore, Stern (1997) considers the mother’s representational world as critically important to determine the nature of the relationship with the baby. Parental representations include current interactions as well as child memories, fantasies, fears and expectations concerning the baby. There is a strong relation between the representations of the mothers concerning the relationship with primary objects and the behavior with their babies (Main, 2000). Given the complexity of this process, there are no guarantees that a well lived pregnancy engenders all the conditions for an equally peaceful puerperium. Aragão (2007) points out that problems can occur during these initial care practices and, possibly for this reason, for some women, it might represent a threat in such a way that it can lead to defensive rearrangements. Should these rearrangements fail, psychopathological conditions could emerge.

Not for nothing, epidemiologic studies point a high prevalence of psychopathological disturbance in pre- and post-partum: baby-blues 85% (Felix & Gomes, 2008), anxiety in 18.8% of women (Georges et al., 2013), pre- and post-partum depression (Altshuler et al. 2008, Skouteris et al., 2009) in nearly 20% of the women (Pereira &Lovisi, 2008; Faisal-Cury & Menezes, 2007) and puerperal psychosis in 1 to 5 people/1000 (Dayan et al., 2015). It is also known that, in Brazil, the prevalence of postpartum depression is higher than that estimated by the World Health Organization (WHO) for low income countries, in which 19.8% of the parturients present mental disorder, mostly depression (Ruschi et. al., 2007).

Nevertheless, Brazilian culture, with the idealized, naturalistic and instinctive view of motherhood, hinders the expression and elaboration of ambivalence of feelings arisen with the advent of the birth of a child (Folino, 2014). Thus, the individual features of the pregnancy-puerperal cycle lie unnoticed and the conditions for damage are created not only for the mother, but for the baby as well and the rest of the family nucleus. We take a chance to state that the maternal subjective experience, intrinsically linked to mothering, is ultimately important, and only gradually makes room for the theme of the baby as an independent being - once the mother’s subjective experience explicitly convenes the psychoanalytic paradigm, because it encompasses the main conditions for the constitution of the Other as a being. This way, it deals with a current study and investigation field of the clinical situation mother-baby (Wendland, 2001).

This work of literature review was built in the scope of questions concerning motherhood vicissitudes (Ornelas, 2023), a theme developed in the context of an international, multimethodological research (PROXIMA) that aims to analyze the processes of motherhood and has the main goal of describing the psychological profile of primiparous with no prior psychological or obstetrical disorders, during pregnancy and post-partum. This way, we shall focus on the particularities of the psychological birth of a mother in the different phases she goes through and their specificities, ups and downs in this path, considering childbirth and postpartum.

Pregnancy: Psychic Transparency, the Return of an Archaic Past and the Constitution of the Imaginary Baby

For Brazelton and Cramer (1992), pregnancy brings to the surface the entire life of the woman prior to conception. This resurgence is due to the particular psychic state in which the woman finds herself during this period called "psychic transparency," in which fragments of the unconscious and preconscious come to consciousness more easily (Bydlowski, 2001). This maternal psychic functioning is characterized by a decrease in the woman's usual resistances to repressed unconscious material. In this sense, psychic transparency is marked by an overinvestment in the personal history, including child conflicts, and is followed by an important plasticity of the mental representations centered around the narcissistic axis (Bydlowski, 2001).

Therefore, particularly during the second half of pregnancy, the mother-to-be turns to self-centered themes, which are not accessible to most women out of this period. Pregnancy changes may generate in the mother the feeling of being “inhabited” by one of her parents, or by one of their features, an experience that may be welcome as well as scary (Brazelton & Cramer, 1992). This moment may be felt as a narcissistic invasion, once the foetus is not initially an object distinct from the mother, but a part of her. Such “invasion”, along with the libidinal movement of external disengagement lies in the origin of emergence of repressed psychic contents.

In pregnancy, the woman returns to previous stages of her psychic development, identifying, on one side, with her own mother who cared for her as a newborn, as well as with the baby who needs the same care (Langer, 1986). According to Brazelton and Cramer (1992), a woman relies on the experiences she had as a baby with her own mother when performing and shaping the roles of motherhood.

Thus, it is at this moment that the woman embarks on the construction of a psychic space for the child, while at the same time constructing the maternal role. Therefore, the period of pregnancy is extremely important, precisely because it represents a time of physical and psychological preparation (Brazelton & Cramer, 1992). This time is essential for the construction of the baby representation in the mother’s imaginary.

This way, when the baby is born, she already has a place built by the desires and projections of the parents, being immediately marked by inter and transgenerational heritage, by a history dated of generations prior to his birth. In other words, every baby is inevitably subject to a transgenerational heritage. A first aspect of this heritage concerns the narcissistic missions projected in every newborn. The first one is a mission of narcissistic continuity, the second, of reparation (Ciccone, 2014).

Concerning the first mission, we deal with the essential functions of any child of reliving and assuring the immortality of parental narcissism. "Your majesty, the baby ", as stated by Freud (1914/2006), shall fulfill every dream and desire the parents did not realize, due to the restrictions imposed by reality. Aulagnier (1964) enhances this discussion proposing the notion of “narcissistic agreement” to talk about this child’s mission concerning not only parental narcissism, but also the narcissism of the social group. The narcissistic agreement is the formation of unconscious bond linking the child to the parent, the previous generations and especially to the whole social group. This agreement prescribes the mission developed by the newborn, namely the one to assure the continuity of the generation, in exchange for being acknowledged by the group as a participant.

The second mission of the baby is one of reparation of the parental history. Every adult has something to fix in his childhood history, and every child has something to fix in his parental history (Ciccone, 2014). Traumas, failures, frustrations shall be in part treated by the bond developed between parents and the child. The real child shall have to deal with, bear, and debate the parent’s child experience, with the wounded, traumatized, anxious child, who remains alive in the parental characters (Ciccone, 2014).

In this context, according to Bydlowski (2008), during pregnancy, the baby is dreamed by the mother as an imaginary child capable of satisfying, repairing, and filling griefs, longings, and feelings of loss. The author even states that the woman at this moment does not wish for the concrete child, but for finding herself as the baby she once was. In other words, from the parental narcissism, the parents shall be able to libidinally invest in their children.

However, this process is necessary to welcome the child. Winnicott (2000) highlights the need for the mother to progressively identify with the baby; meanwhile she builds a psychic space for him. It is generating a representation of the baby in the mother’s imaginary that, with the advent of birth, there is the mother’s gradual separation from the imaginary baby and the engagement with the real baby. But, due to those great modifications occurring in the psychic process during pregnancy, the mother’s traumatic mourning may later reverberate in the somatic changes of the baby and in the possibility and capability of fulfilling his needs. (Belot & De Tychey, 2015).

In view of these considerations, it is important to point out that there are no gestations completely accepted or rejected, and there is ambivalence in motherhood (Simas, et. al, 2013). This can be understood as the simultaneity of thoughts, feelings and attitudes that are contradictory and conflicting, highlighting the coexistence of pleasure and displeasure in face of the experience lived. This also concerns women whose gestations were totally desired, not escaping from ambivalent questions during this process (Motta, et. al, 2008; Fonseca et. al, 2018).

In summary, pregnancy is a time of high psychic and physical instability, whose nine-month duration is essential for the preparation for motherhood. Moreover, the event of childbirth does not seem to put an end to such instability. This is because, in addition to the regression in the mother's psychic functioning that begins during pregnancy, there is a real revolution after childbirth, with the emergence of a new demand for psychic work that involves not only subjective changes in the mother but also the encounters and mismatches with the baby.

Childbirth: Traumatic and Transforming Dimension

Although it is experienced differently among women, childbirth inherently carries its own traumatic dimension (Candilis-Huissman, 2010; Bydlowski, 2008). Inevitably accompanied by a rupture in the body, the encounter with the baby is only possible through what is cut by the cesarean section or by the painful contractions, accompanied by the opening, dilation, and sometimes even laceration of the flesh. This rupture, which affects the real body, must also be considered psychically, since the ego is, by definition, a bodily ego (Freud, 1923/1974). That is, it must be thought of in terms of marks that persist as psychic records that the mother-baby separation does not occur without a rupture in the body. In other words, the image of the body, whose instability is already present throughout the pregnancy, accompanies a sudden turbulence in the sense of self, arising from childbirth and all the modifications of the body schema that result from it. The psychic work of this moment requires sustaining the turbulences of labor, without the support offered by a stable body image.

While Freud (1926/1974) and Rank (2016) focus on the trauma of birth from the baby's perspective, Winnicott (1969) speaks of birth as traumatic for mothers and describes childbirth as a moment full of violence. The author emphasizes its traumatic dimension, regardless of the outcome of the birth (Winnicott, 1990).

Indeed, delivering involves dealing with the unknown, especially for first-time mothers. Unpredictability pervades this process in several aspects, considering the intercurrences and the maternal and fetal risks that may arise. A mother who plans and dreams with a non-surgical delivery the full pregnancy time may find the baby in a position complicated to bear and go through the expulsive phase of the labor (the moment the baby needs to go through the birth canal) and get to need cesarean section, for example. Disappointments that follow frustrated expectation and idealizations of the labor moment are put in check. It is worth highlighting that a quarter of the women who gave birth during the 20^th century died during labor (Bydlowski, 2008). This way, the fear of the uncertain and of death unconsciously or consciously pervades women’s minds. Fear that is boosted by this ancestral past and socially, mediatically stirred, hindering labor. It is, therefore, a moment featured by emotions particularly contrasting, positive but also negative and, because they are not acknowledged, they are not considered legitimate by the mother herself. Thus, labor is also associated to great physical and psychological vulnerability by women.

Montmasson et al. (2012) studies reported that 22% to 48% of women described the labor as a traumatic experience. On its turn, Creedy (2002) research points that 33% of women have traumatic memories of the labor. Besides, 6% of women reported having being affected by post-trauma stress disorder after labor (Denis & Callahan, 2009). That is, this moment may be associated with particularly destabilizing events and may lead to the perception of a real threat, including death for herself and the child, a true attack to physical integrity.

More specifically, in Brazil, there is a matter that seems to be far from being solved concerning the moment of delivery: the number of unnecessary caesarian sections and medical interventions. WHO recommends up to 15% of caesarian sections and in Brazil this rate is 52%, increasing to over 88% in private hospitals (Fundação Osvaldo Cruz, 2014).

Additionally, this context is also composed of the high rates of interventions employed in childbirth and delivery care. Such fact is highlighted by the results of the research Nascer no Brasil (Leal & Gama, 2014), with total research sample of 23,940 women. It is verified that 56.8% of the women are considered at an ordinary obstetric risk, that is, with no health conditions that indicate the use of surgical intervention and procedures. Despite this, only 5.6% of these women have a vaginal delivery, with no intervention. These pieces of information become relevant from the moment studies indicate higher risks of mental illness in women subjected to emergency cesarean sections and unnecessary interventions (Rua et al., 2021). The impact of this reality in the long term is immeasurable, as it concerns both the physical and mental health of mothers as well as children. Childbirth is, therefore, an event that is not only biological but also cultural and inevitably psychological. Given its often traumatic dimension, words frequently fail to capture the full experience, leaving women with the challenging task of interpreting, finding meaning in, and articulating their experiences.

From the psychic point of view, at the moment of the birth the balance between narcissistic libido and object libido is brutally broken (Bydlowski, 2008; Labaki, 2007). According to Melier and Belot (2010), in the immediate post-partum, the subjective experiences seem confused, mixed, entwined and refer much more to an emotional magma than to well delineated feelings. While getting pregnant convenes the revival of the mother’s narcissism, being a mother intimates a radical decentralization of the self, the need to libidinally invest the child as another (Aubert-Godart, 1998; Darchis, 2002). Prat (2008) believes that, for the mother, the impact of the immediate post-partum is also related to the revelation of the baby’s absolute dependency. For the author, this discovery is brutal and, when the baby arrives, the mother becomes the person who the baby is completely dependent of. It is understood that, with the arrival of the real baby, the woman must elaborate several losses, losing parts of her prior identity, which requires considerable psychic work.

Post-partum: Primary Maternal Preoccupation, Grief and the Real Baby

After the labor, the psychic reorganization may not happen, once the mother enters the second phase of challenging hypersensitivity: primary maternal preoccupation. (Winnicott, 1969). According to Winnicott (1975), the “sufficiently good” mother must experience this phase, with the main feature of setting harmony with the baby, in order to answer to his vital need at the right moment. The mother, under those conditions, may have three main functions in her child’s development: holding, handling and presenting objects (Winnicott, 1975). Ogden (2010) highlights the high emotional cost of such experience and the time the mother needs for emotional renovation.

To Spielrein (1912/2014), the baby’s development and the birth is only possible to happen at the expense of the mother. This remarkable statement makes sense once there is a maternal identification with the baby, enough to generate a state “without subject”, and to create experiences of undifferentiation between them. It is known that a woman in a state of primary maternal preoccupation finds herself regressed to earlier, sometimes even primitive stages of psychic life, identifying with the baby she once was and experiencing states of non-integration and undifferentiation in relation to her own child (Santos, 2017).

At this moment, maternal subjectivity must make room for the baby’s subjectivity, allowing the mother to experience his needs as her own. At the same time, it is necessary that she be able to keep enough sense of her own subjectivity to manage, to interpret and to answer to the child’s needs. In other words, the mother’s alterity also needs to be felt once it is from a distinct subjectivity that the mother is able to be in the condition of baby’s interpreter, able to “return” to the baby his sensorial and affective states (Ogden, 1996). It is in this sense that Ogden (1996) states that the primary maternal preoccupation implies a dialectic of being-in-one and being separate, interdependence between subjectivity and intersubjectivity.

As one can imagine, this dialectic marked by encounters and mismatches is not easy, as it represents, to a certain extent, an annihilation of oneself in the unconscious effort not to interfere with the baby. For Bion (1962/1991, 1963/2004), this healthy return is only possible when the mother is able to exercise the alpha function, a function of the mind with the capacity to convert, through the exercise of the capacity for reverie, sensory data into alpha elements. This process occurs through the bond between the mother's mind and that of the baby, whose primal experiences are intensely distressing and intolerable, partly due to the lack of a formed psychic apparatus to think and process them. In this context, the baby projects such experiences onto the mother to be detoxified, contained, and made meaningful in her unconscious before being returned in a form that he can tolerate.

This process creates the necessary conditions for the child to internalize a model of thinking, which involves transforming unbearable aspects of the self, unprocessed sensory experiences (beta elements) projected, into thinkable and tolerable representations (alpha elements) (Korbivcher, 2010). These alpha elements, stored and transformed, constitute the contact barrier, which enables the discrimination between conscious and unconscious. In other words, through projective identification, the baby projects contents (beta elements) onto a container (the mother) who welcomes them and, through reverie, processes them, transforming them into assimilable and bearable experiences (alpha elements) that can be reintrojected by the child.

This capacity to "contain" presupposes a mother who has sufficient conditions to accommodate her own anxieties, as well as those acquired in relation to her baby, and to the reencounter with archaic contents of her own past. A mother capable of reverie is, therefore, suitable for introjection as a 'container' object by the child, and gradually leads to the development of the child's ability to think for themselves.

These assumptions are in line with the concept of mentalization, precisely because they designate the work that the psychic apparatus performs to allow the flow of excitations through the path of mental elaboration, more specifically through the preconscious system (Wachter, 2002). Research conducted by Fonagy (1999, 2000) also found that parents or caregivers with good reflective capacity have more internal resources for mentalizing and, consequently, can respond productively to the needs of a newborn. When we talk about reflective capacity, we are necessarily referring to the operationalization of psychological processes inherent to the capacity for mentalization (Fonagy et al., 2002). The maternal preconscious is what would be protecting the baby from stimuli coming from its internal world and the external world (Belot & Bonnet, 2016). However, performing such a function implies that the maternal psyche is in a condition to filter the overload of excitations coming from the external world, the baby's internal world, and also the mother's (Debray, 2001).

The acquisition of this capacity occurs in the context of secure attachment relationships, through intersubjective exchanges between the child and caregivers (Fonagy, 1999). According to Bowlby (1997), attachment is a type of bond in which the individual's sense of security is closely linked to their attachment figures. In other words, the mother's relationships, as well as the representations stemming from her relational life history, reflect on the style of attachment developed with the child, which in turn impacts the ability to understand and respond to the needs of her child (Wachter, 2002). The capacity for reflection on experiences, both one's own and others', can be passed down transgenerationally as caregivers understand, interpret, and name their experiences for the child, thus allowing them to develop such a capacity. The theme of psychic transmission in its inter and transgenerational dimension becomes relevant when discussing motherhood, especially regarding reflective capacity and the transmission of unconscious conflicts, possibly facilitating or blocking the ability to properly care for a newborn. In summary, the quality of the maternal figure's attachment directly impacts the quality of care she will be able to provide for her child postpartum.

Conclusion

The experience of the arrival of a child is a borderline situation, marked by meetings and mismatches, potentially traumatic (Rochette, 2005) whose outcome depends not only on the prior psychological balance of the woman who goes through this experience, but also on the psychological rearrangements created before, during, and after birth, in the encounter with the baby. It is amid the instinctual, biological, and social rearrangements inherent to pregnancy that there is a movement of updating in the attempt to elaborate on lived traumatic events. The pregnancy of a first child is considered a time of labor that involves the process of differentiation and subjectivation.

For Bydlowski (2001), one of the essential tasks of the first-time mother is the rearrangement of her infantile identifications. Therefore, at this moment, the solidity of previous internalizations will be tested, mainly in relation to narcissistic foundations and the life history up to that point (Racamier, 2019). The traumatic impact of this process also stems from the revelation of the quality of the subsequent narcissistic organization. The traits of the trauma experienced in life before conception tend, in this context, to return in a raw state, in a non-representative form, offering a new opportunity for mental reorganization.

In labor, we encounter a different series of physical and psychological challenges. The woman must confront her fears of death and/or pain without the support of a stable body image. The body and mind are taken to the extreme in the process of childbirth, a process that is inevitably accompanied by a traumatic dimension.

Upon giving birth, the fusional state between mother and baby is brutally disrupted, and a physical separation is imposed. The mother faces the absolute dependence of a baby who was previously inside her body and is now outside of it. At this time, the mother has another challenging task: to gradually disinvest from the imaginary baby to focus her attention on the real baby, a task not always successful. That is, postpartum, psychological stability is still not possible, as the mother enters another state of hypersensitivity, the primary maternal preoccupation. Throughout this maternity process, the maternal mental apparatus is highly summoned and demanded, especially postpartum, since it now supports two people (the mother and the baby).

The ability to perform the functions involved in baby care depends, among other things, on the mental resources that the mother acquires throughout her life through inter and transgenerational psychic transmission. The quality of the attachment relationship between the woman and her parents is reflected in her ability to understand and respond to the child's needs (Wachter, 2002). Through the exercise of the capacity for reverie and mentalization, the mother becomes capable of converting unbearable aspects of the baby's self into thinkable and tolerable representations. Nevertheless, such skills depend on conducive subjective conditions: that the return of the infantile and the current environment move in this direction. This presupposes a mother with the conditions to accommodate her own anxieties, those coming from the reencounter with archaic contents of her past, and those of the baby.

It is verified, based on this dialectical and complex thought, that the maternal subjective experience, specifically in these three fundamental times (gestation, childbirth, and postpartum), directly summons the psychoanalytic paradigm, precisely because it encompasses the conditions of the constitution of the human being as a subject. In this sense, the theme of maternal subjective experience is of utmost importance and only gradually gives way to the theme of the baby as an independent being. Understanding the psychic process of transitioning to motherhood allows us to understand its consequences on mental health for both the mother and the baby, thus being essential for the proper diagnosis of psychic disorders that present themselves in the postpartum period and in child development itself. For this, a deep understanding of the maternal subjective processes partially responsible for mother-baby interactions is necessary, seeking to improve and update them to think about practices of interventions capable of encompassing the real complexity of motherhood.

Finally, we consider the pregnancy of a first child as a time of labor that involves complex mental processes and, therefore, deserves the full attention of the scientific community, aiming at raising awareness and developing support strategies for women who embark on this journey.

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• Data availability:
  Research data is available on request from the corresponding author.

Edited by

• Responsible editor:
  Márcia Cristina Maesso

Data availability

Research data is available on request from the corresponding author.

Publication Dates

• Publication in this collection
  18 Apr 2025
• Date of issue
  2025

History

• Received
  03 Apr 2023
• Accepted
  03 Oct 2023