In Chapter 3, we focus on the women we interviewed, specifically paying attention to their expectations about first-time motherhood as compared to the reality of motherhood after the birth of their child. To do this, we explore three areas that for many of the women provided a stark contrast between expectation and reality. The first pertained to conceiving a child, with this being more difficult for some women. The second pertained to navigating breastfeeding, with some women experiencing significant challenges. Third, we focus on experiences of postnatal mental health issues, and how this related to idealised expectations about new motherhood. As a whole, these three areas speak to normative moral claims that are often associated with new motherhood, and how the women we interviewed grappled with these.

Building on Chapter 3, in Chapter 5, we explore the emotion work that women undertook in becoming parents. Using the work of Hochschild (1979,1983/2003), we focus on how new parenthood creates feeling rules that women are expected to adhere to, and are also compelled to encourage men to engage with. To examine feeling rules associated with new parenthood for women, we first return to the topic of breastfeeding and explore how women are expected to persist with breastfeeding and expressing milk, and what it means when it comes as a significant challenge physically and emotionally. We then turn to consider the emotion work that women engage in to encourage their male partners to contribute to caring for a newborn child. Finally, we look at the moral work associated with caring for a new child, and how for some women the expectation that this would be a joyous time was in stark contrast with the monotony of new parenthood.

You are seeing a patient referred by her primary care provider for consultation at your tertiary center’s high-risk obstetrics unit. She is a 37-year-old primigravida currently at 13+2 weeks’ gestation with an incidental 7-cm complex right adnexal mass detected last week on routine first-trimester sonography performed at an external center. Although the ultrasound report is not yet available to you, the consultation note confirms a singleton intrauterine pregnancy with normal fetal morphology and low risk of aneuploidy using sonographic markers. Routine serum prenatal investigations are only significant for iron-deficiency anemia.

A patient is referred by her primary care provider for consultation and transfer of care to your high-risk obstetric unit at a tertiary center. She is a 32-year-old primigravida at 15+3 weeks’ gestation with new abnormalities on chest X-ray and a positive sputum smear for acid-fast bacilli, performed as part of investigations for a four-week history of cough and night sweats. You have arranged to see her at the end of your clinic, with appropriate infection precautions. Referral to an infectious disease expert has also been instigated. A copy of the routine maternal prenatal investigations is unavailable at this time. First-trimester sonogram and aneuploidy screen were unremarkable. She has no obstetric complaints.

You are called to the A&E (E.R.) department of your tertiary center to assist in the care of your patient, a 22-year-old primigravida at 14+4 weeks’ gestation who presents, accompanied by her partner, with a six-hour history of nausea, vomiting, and headache since her last consumed six-daily standard drinks of beer yesterday. At last week’s baseline prenatal visit, you learned that medical history is only significant for an alcohol use disorder, for which she was motivated to enroll in a treatment program. Your medical notes indicate a normal body habitus and unremarkable physical exam. Prenatal investigations and first-trimester aneuploidy screening tests were normal. You had prescribed vitamins containing folic acid; the patient was not experiencing nausea or vomiting of pregnancy.

During your call duty, a 38-year-old G5P4 with a spontaneous dichorionic pregnancy presents to the obstetric emergency assessment unit of your tertiary center at 37+5 weeks’ gestation with dyspnea and noticeable bilateral leg edema. She has no obstetric complaints. Your colleague follows her prenatal care. Routine prenatal laboratory investigations, aneuploidy screening, fetal morphology surveys, and serial sonograms have all been unremarkable. She had four uncomplicated pregnancies and term vaginal deliveries in your hospital center.

A 25-year-old primigravida at 21+5 weeks’ gestation is sent by her primary care provider for urgent consultation and transfer of care to your tertiary center’s high-risk obstetrics unit for increasing diaphoresis, body aches, and anxiousness since self-discontinuation of heroin upon recent knowledge of pregnancy.

A new patient presents for consultation and transfer of care to your high-risk obstetrics unit at a tertiary center. She is a healthy 22-year-old primigravida at 14+3 weeks’ gestation with an incidentally positive test for human immunodeficiency virus (HIV) on routine prenatal testing. A copy of the original laboratory report has been provided to you. The patient is aware of the results. Referral to a virologist has also been instigated. Her first-trimester sonogram and aneuploidy screen were unremarkable. She has no obstetric complaints.

A 37-year-old G1P1 with a three-year history of type 2 diabetes mellitus (T2DM) is referred by her primary care provider to your high-risk obstetrics clinic for preconception counseling. Six years ago, she delivered her son at another hospital center.

A 28-year-old primigravida at 27 weeks’ gestation is referred by her primary care provider to your tertiary center’s high-risk obstetrics unit with a four-week history of worsening exertional dyspnea, marked fatigue with limited daily activities, and a recent syncopal episode, witnessed by her husband. She describes palpitations immediately prior to this brief event. She is asymptomatic at rest and has not experienced chest pain. Her medical history appears non-contributory, and although she practices healthy social habits, she has long-standing exercise intolerance in the non pregnant state with breathlessness after running a few meters.

A 37-year-old nulligravida with a one-year history of well-controlled essential hypertension is referred to your high-risk obstetrics clinic for preconception counseling. Recent comprehensive investigations are free of end-organ dysfunction. Maintaining a healthy lifestyle, she lost weight over the past year; her body mass index (BMI) is now 31 kg/m2. She uses condoms for contraception and is adherent to long-acting nifedipine once daily; folic acid–containing prenatal vitamins were initiated last month.

This chapter concerns neuro-cognitive development, from conception through to childhood. Breastfeeding has been studied extensively using cross-sectional methods, finding cognitive benefits. However, after controlling for confounding variables and with better designs, beneficial effects are at best small. Maternal undernutrition can result in adverse neurodevelopmental outcomes (e.g., enhanced risk of schizophrenia). Undernutrition during infancy and early childhood causes stunting – inadequate growth for age. Stunting is common (around 500 million children worldwide) and is linked to multiple cognitive impairments, imposing lifelong costs on the individual. As stunting involves a complex interaction between nutrition, brain and environment, dietary remediation alone may not be that effective. Maternal overnutrition is also associated with adverse neurodevelopmental outcomes, but here it is unclear if this relates to poor diet quality, maternal body fat or socio-economic factors. Finally, there are a wide range of specific nutritional deficiencies that affect neurocognitive development, many having lifelong impacts (e.g., thiamine, folate iron, iodine).

In this chapter, common psychological experiences or consequences of recurrent pregnancy loss are discussed for affected women and their partners, with a focus on the experience of pregnancy after or during the course of recurrent loss. In this chapter, recurrent pregnancy loss is understood as a series of ongoing traumatic events and losses. Common experiences during pregnancies after loss, such as emotional cushioning and pregnancy-related anxiety, are conceptualized as understandable reactions to trauma and loss. Consequently, guidelines for helping patients to process trauma and loss and to mitigate associated symptoms of emotional cushioning and pregnancy-related anxiety are discussed, with a focus on the therapeutic relationship as an agent of change in individual and couples counseling.

This chapter examines the first three months after birth, integrating the experiences of mothers and fathers. There is emphasis on understanding the newborn infant, a detailed review of evidence on sleeping and settling, and an examination of the impact of becoming a parent on identity and the couple relationship. Different cultural practices during the ‘first 100 days’ are discussed. The chapter concludes with an overview of research on psychological wellbeing, including perinatal mood disorders.