A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Hormonal and related biological changes associated with giving birth may initiate or precipitate a change in self-esteem. Alternatively, or additionally, the change in lifestyle associated with caring for a young infant, for example changes in normal daily activities, lack of sleep caring for the infant, change in financial security, change in the relationship with her partner, may constitute a set of stresses that have mental health consequences for the mother. Since primigravida women have no previous personal experience with childbirth they might have less of a coping strategy to deal with their emotional changes during childbirth.