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Section 1 :Literature Review This review explores the recent research on the nature of fear of childbirth with a focus on methods of assessmen.t and psychological intervention. Using defined criteria, thirty-five articles were identified for review. Fear of childbirth was shown to have implications for the emotional well being of women both in the antenatal and postnatal period. A number of personal and social factors were reported to influence fear. Fear of childbirth was found to be a distinct dimension of anxiety and therefore measures of general anxiety lack validity. Studies investigating the impact of psychological interventions to treat childbirth fear show initial promise however methodological flaws limit conclusions. Findings are explored in relation to implications for women in the UK. Section 2: Research Report The expectations of childbirth that women develop during pregnancy are reported to influence the actual experience of childbirth. Existing measures of childbirth expectations have limited robustness and cultural validity for pregnant women in the UK. The aim of this study was to develop a reliable and valid English-language based scale to measure pregnant women's expectations of childbirth. Items were generated via exploratory interviews with members of the target population. An initial version of the scale was developed and piloted with a large sample of pregnant women. Questionnaire data was subjected to item analysis and principal components analysis revealed six underlying factors. A final version of the scale was developed and initial assessment of internal reliability and validity were carried out.

The perinatal period can represent a transitional stage in women's lives when they are more vulnerable to psychological distress. Depression during this period can have devastating consequences, not only for the women experiencing it but also for their children, who are more likely to have cognitive, behavioural and attachment problems. One suggested mechanism for transmission of this increased risk is disturbances in mother-child interactions and maternal responsivity which have been associated with postnatal depression (PND). These may be affected by how mothers experience and perceive their infant's signals. The first paper reviews the literature regarding how women with PND and antenatal depression (AND) process emotional information such as facial expressions and vocal tone. Behavioural and neuro-imaging studies exploring processing of such stimuli in women with AND and PND are critically reviewed. The second paper investigates mothers' perceptions of emotional infant stimuli in the context of current and remitted PND. Despite maternal remission from PND, children of mothers who have experienced PND continue to be at risk of adverse outcomes. Evidence from studies of non-postnatal depression suggests that biases in the perception of emotional information can remain despite remission. Therefore a possible mechanism for the affects of PND on child outcomes is mother's impaired interpretation of information from their infants which may continue despite maternal remission from the depressive symptoms. The current study compared maternal ratings of infant facial expressions and infant vocalisations given by mothers with a current PND diagnosis (n=2 1) and those who had remitted from PND (n=52). Mothers taking part in a larger randomised control trial were asked to rate a number of infant facial expressions and infant vocalisations, each presenting a different level of emotion namely positive, muted positive, neutral, muted negative and negative. Results showed that mothers who had remitted from depression rated infant facial expressions differently to mothers with a current diagnosis of PND. However, no group differences were found for infant vocalisations. These findings suggest that the biases associated with PND for infant facial expressions are not present or do not influence mothers' interpretations of infant auditory stimuli in the same way. Alternatively, biases in interpretations of auditory stimuli may persist despite remission. This may have implications for focusing interventions that aim to improve mother-child interactions.

Previous research suggests that postpartum depression is related to psychosocial factors, such as life events and difficulties (e.g. Brown & Harris, 1978), and to relationship factors, such as insecure maternal attachment status (e.g. Bifulco et al. 2004). The current study aimed to confirm the relationships between life events/difficulties and postpartum depression, and between insecure maternal attachment and postpartum depression. The current study also aimed to investigate the relationships between life events/difficulties, insecure maternal attachment, and postpartum depression outcome following a preventive intervention for postpartum depression.

Abstract Postpartum depression (PPD) is a major health problem as it is undertreated and its pathophysiology is poorly understood. Although stress during pregnancy is a risk factor for PPD, currently there is no valid animal model of stress-induced PPO available to investigate its underlying mechanism. This thesis aimed to evaluate gestational chronic mild stress (CMS) as a valid animal model of PPD. Evaluation was done by addressing the construct, face and predictive validity. Specifically, the effect of gestational CMS in recapitulating hormone fluctuations, altering neurochemistry and behaviour, followed by reversal of CMS-induced behavioural changes by administration of chronic antidepressant drugs were assessed. Mice were either subjected to CMS or left undisturbed after the mating process until parturition. CMS involved sequential application of mild stressors (e.g. paired housing and 30° cage tilt). Exposure to gestational CMS increased the plasma corticosterone level at gestational day 13 and the level was found similarly high during late pregnancy. High-~ performance liquid chromatography analysis showed that gestational CMS altered the serotonergic levels in the hippocampus during late pregnancy. Investigation of postpartum behaviour showed no effect of CMS on maternal behaviour. However, CMS significantly increased the locomotor activity of the dams in the elevated plus maze one week after parturition and in the open field test after weaning of litters, and abolished anxiety-like behaviour in open field test. CMS impaired the retention of fear memory in contextual fear conditioning task. These results demonstrate that exposing pregnant mice to CMS resulted in changes reminiscent of PPD. Reversal of stress-induced behavioural changes could not be observed in a separate experiment, which some of the stressed mice were treated with oral clomipramine or fluoxetine at postpartum. Thus the predictive validity criterion of CMS remains to be established. In conclusion, CMS has the potential to be a valid animal model of PPD.

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Postnatal Depression (PND) can inflict profound psychological suffering on new mothers, and if not treated, this disorder can also cause significant disabling complications for the entire family (National Institute for Clinical Excellence for Antenatal & Postnatal Mental Health- NICE for APMH, 2007). NICE for APMH guidelines, (2007), suggested that in order to assess and treat PND accurately, it is unperative to know the factors associated with the development and maintenance of the illness. However, almost all of the theoretical perspectives, screening, assessment tools and interventions for PND to date had been derived from western populations, and little research had been undertaken with Asian mothers.