Connection and Empathy
Enhancing Pre- and Perinatal Health Care Professionals’ Interpersonal Skills

by Antonella Sansone

[Editor’s note: This is an excerpt of an article which appears in Midwifery Today, Issue 120, Winter 2016. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today, Issue 120.]


[photo by Jennifer Mason]

When eminent psychiatrist and psychoanalyst Daniel Siegel asked over 65,000 mental health professionals face-to-face in lecture halls around the world if they had ever had a course on the mind or on mental health, 95% replied no. We can imagine what the scenario is for midwives and other birth-related professionals.

My several years of research/observational study of the “dance of attunement” between mother and infant have led me to astounding discoveries in relation to mother-infant communication. My own experience of pregnancy and motherhood provided me with a vivid sense of the sacred link between maternal life-enhancing emotions and reflective function, prenatal attachment and child well-being. I came to the ground-breaking discovery that attuned bonding can be nurtured during pregnancy and parents can prepare for birth and the postnatal mother-infant relationship, thus preventing both maternal and infant mental health issues. Therefore, it is essential that prospective parents, as well as the whole community at large, become aware of the preborn as a conscious sentient being, who needs emotional care as much as he does healthy nutrients. He is sensitive and responsive to maternal emotions, thoughts, consciousness, stress and the surrounding physical and social environment, including the birth scenario.

It is now known that fear and anxiety enhance levels of adrenaline, which inhibits the release of oxytocin, making labor and birth longer and more difficult.

At a time in history when statistics of perinatal mental illness and infant developmental problems are soaring, we must all work together, with synergistic compassion and empathy, to ensure every mother and father gets appropriate and timely care to optimize their health and mammalian competence and to prevent the adverse effects of perinatal psychological distress. We need to look at the protective function of prenatal attachment and the importance of supporting this early relationship prior to birth, since it has an impact on the welfare of our society and economy. It is time for a new awareness that the prenatal and perinatal stages are the most crucial in human life, that the preborn child is already a psychological and social partner to his/her parents, and through them, to society.

Through a communal mindfulness-based approach to pre- and perinatal care, we can protect the human mother-baby co-adaptive system—that embodied creative dialogue unfolding during pregnancy and determining the term of labor and outcome of birth. A mindfulness-based integrated program tackling the deep-rooted ignorance of the mind-body processes of the pre- and perinatal period and mothers’ psychological and emotional needs could be the route to cultural change and optimal maternity care. Our primary objective as a society should be to create the conditions for birth and for mother and baby’s interactions and bonding to unfold undisturbed. This paradigm shift also implies that we need to introduce mindfulness training for midwifery, obstetrics and all disciplines involved in pre- and perinatal care, in addition to prospective and new parents. Self-development, personal experience of life, attachment style and protosocial skills such as empathy, communication and attunement should be the main focus.

In a randomized controlled trial about doulas in Texas, the prerequisite to participate in the study was personal experience of a normal labor and vaginal delivery with a good outcome (Kennel et al. 1991). It appears obvious that laboring women are more likely to feel secure when protected by a midwife who has had a positive experience of giving birth and can, thus, better understand their needs and connect with them. Those midwives who have not had a positive birth experience would benefit from mindfulness-based training enabling them to work through any birth trauma and overcome fear. Body language and words from birth-related professionals, often reflecting their own trauma, emotional issues and attachment style, are powerful. Awareness of the effects on a mother’s emotions and mind state, pregnancy and birth outcome should be promoted through appropriate training.


  • Kennel, J, et al. 1991. “Continuous Emotional Support during Labour in a US Hospital. A Randomized Controlled Trial.” JAMA 17:2197–201.

Antonella Sansone is a clinical psychologist, researcher and infant-parent observer. She is also the author of Mothers, Babies and Their Body Language (2004) and Working with Parents and Infants: A Mind-Body Integrative Approach (2007). The topics in this article and others related are covered in Antonella’s new book, Nurtured Mothers: How Common Mindfulness Can Help Raise Children Who Thrive (to be published).

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