Mental health articles

Risk factors for psychological disturbance during pregnancy and birth Women experiencing mental health or relationship problems increasingly are identified during routine ante-natal screening. Ideally, this enables referral for appropriate assessment and intervention. A range of screening tools and processes have been developed to suit the needs of obstetric services. Questions about past psychiatric history, and current levels of social support and stress have become a more standard aspect of obstetric history taking. Risk factors for psychiatric disturbance during pregnancy and birth include: • threats to maternal or foetal health • past obstetric trauma or loss • current or unresolved conflict, trauma and loss • social isolation and/or adversity • past psychiatric or psychological difficulties • experience of trauma during labour and delivery. Threats to maternal or foetal health Many potential medical difficulties can occur during pregnancy, and concerns may arise for the physical well-being of the mother and/or the infant. An example of this is when threatened miscarriage occurs. The woman’s central focus and preoccupation becomes the survival of the foetus. She may feel powerless to ward off danger and damage to her baby and may feel guilt or imagine she has caused it by something she did, something she ate, a cold she had or even a walk she took. The normal fears every pregnant woman experiences may develop out of proportion as she attempts to find an explanation for the threatened loss. Her partner and extended family may unwittingly contribute to this sense of guilt and search for an explanation, in comments made as a result of their anxiety and concern. A woman or couple with a threatened miscarriage need a great deal of support, and the medical details need to be explained several times if necessary. Threatened miscarriage interrupts the process of preparation for parenthood, and depending on the circumstances and individuals concerned, may delay the imagining and psychological preparation for the infant’s arrival. Maternal ill health carries with it concerns about the foetus. Women with diabetes in pregnancy or pre-eclampsia, for example, require extra monitoring of their own and foetal health during pregnancy and while some women and their partners take this in their stride, for others it colours anticipation and preparation for the baby with anxiety. Alternatively, women who manage to deliver a healthy infant after a medically complicated pregnancy may feel particularly fortunate or grateful. It is important to explore the particular meaning of events to any individual or family, rather than to make assumptions about how an experience has been and what it has meant for them. Listening carefully to the way events are discussed and the language used about experiences and about the infant help the clinician to make an accurate formulation.

Tags: disturbance, pregnancy