Author Carl Jones agrees. In his book After the Baby is Born, he describes views about childbirth in Western society, and their impact on women's self-image. "The way birth has been viewed in this society affects a new mother's self image, as well as the way she thinks about childbirth during pregnancy. In this country [the U.S.A.], birth has been approached almost as if it were an illness. The overall effect of such an approach to childbearing may leave the new mother feeling more awkward, more isolated, and less sure of herself than she might otherwise."

Encouraging a positive self-image in preparation for birth is one of the caregiver's most important responsibilities. "We talk about fears that come up, especially fears around pain," says Hunking. "That's really important to talk about prenatally." She believes that women should work towards gaining an understanding of what the pain means in labour, and that they should plan their births in a way that ensures that they will have abundant support and be surrounded by people they want around them, and who feel positively about the choices they have made about the birth.

Postpartum

While many women manage to make it through pregnancy and delivery with their self-image relatively intact, it is common for many of these women to feel their self confidence slipping away during the postpartum period.

It is hard to imagine any period in a woman's life which is more demanding of her both physically and emotionally. Not only is her body experiencing tremendous changes as it returns to its non-pregnant self, but she is simultaneously struggling to adjust to the many changes in her life.

The first thing she must come to terms with is, of course, her birth experience. Many women have a specific birth plan in mind when they go into labour, and may experience extreme disappointment if the reality of their delivery in no way measures up to the birth plans that they nurtured in their hearts as their babies grew in their bellies. Many women feel a sense of inadequacy, for example, if their plans for an unmedicated birth were suddenly shattered by the need for an emergency caesarean. It is not enough for these women to be told that they should just be happy because they ended up with a beautiful, healthy baby; they should be allowed to grieve for the loss of what they had hoped for.

Women also have to come to terms with their physical appearance. The first time a woman sees herself naked after delivery can be quite a shock. Many women are not realistic about what a postpartum body should look like, and are often devastated when they see the sagging belly or the stretch marks.

"I hated my postpartum body," confesses Marie-Lane Smith, a Waterloo, Ontario, mother of two. Always conscious about the size of her hips, Marie was horrified to discover that pregnancy and childbirth had only compounded the problem. While it took her a while to find the time to join a fitness club, for Marie, that was the best thing she ever did in terms of starting to feel good about herself once again. She joined a women's health club with on-site babysitting, and was soon feeling stronger and more in touch with her body, and thrilled by the rapid loss of inches from her hips. Getting exercise during the postpartum period is "almost imperative," says Marie. "You've got to get exercise and eat well because you're not going to get a lot of sleep. I wish I had taken the step of joining a health club earlier."

Still, even a rigorous exercise program is not going to undo overnight what nine months of pregnancy has done to your body, so it is important for women to be realistic about what postpartum bodies are supposed to look like. Many new mothers comment that they feel "out of shape" when exactly the opposite is true; they are in perfect shape for having just had a baby. Still, in a society which equates slimness with beauty, is it any wonder that many postpartum women have a difficult time coming to terms with their bodies?

The end of pregnancy also can be a source of sadness for many women, particularly for those who felt extremely positively about their pregnancy experience. At the same time, after the birth, the focus almost invariably shifts from mother to baby. She is no longer as important or as interesting as the baby she carried, or so it might seem to the new mother. The best remedy for this is for friends and family "to mother the mother," says Hunking, and to recognize the important role she played in the birth process. "We forget the hard work that she did. We forget that women work hard to give birth."

Women who choose to breastfeed their infants are often subject to a great deal of hostility which may also impact upon their self-image, says Hunking. For many women, their ability to breastfeed is really tied up with their feelings of adequacy as a mother. For this reason, breastfeeding women are extremely vulnerable to remarks by others. Women with small breasts, for example, may find themselves being subject to remarks which basically amount to criticisms of their ability to feed their infants.

Diane Wolf, a Peterborough, Ontario, mother of three, recalls how devastated she was when the doctor who delivered her first child in Germany discouraged her attempts at breastfeeding by informing her that "redheads can't breastfeed." Her confidence shattered, she reluctantly switched her daughter to a bottle. Her inability to breastfeed her first child was a source of great disappointment to her until the birth of her second child. Happily, however, a move to Canada led her to switch doctors prior to the birth of her second child, and, with a lot of encouragement from her new practitioner, she went on to not only successfully breastfeed her second child but her third as well.