The Relationship of Pregnancy Status to Job Satisfaction: An Exploratory Analysis

Forty-three women who had worked outside of the home prior to becoming pregnant and had returned to the same place of employment after the birth of their children participated in the study. To do so, they responded to a two-part questionnaire asking about their work lives (e.g., level of job satisfaction before, during, and after their pregnancies) and demographic characteristics (e.g., occupation). The results indicated that their job satisfaction was significantly greater before their pregnancies than either during or after their pregnancies. Job satisfaction during pregnancy had a significant, positive correlation with satisfaction with organizational maternity leave policies. Perceived reactions from women's coworkers and supervisors were also examined. Implications for these findings for organizations are discussed. Limitations of the study, and how they might be rectified in future research, are also addressed.     

Unplanned pregnancies and abortion counselling: Some thoughts on unconscious motivations

Abstract

My experience of abortion counselling¹ over ten years has shown me the importance of understanding the unconscious dynamics behind an unplanned and unwanted pregnancy. Unless these dynamics are made conscious and understood, the experience of abortion may have to be repeated again and again. Both becoming pregnant and having an abortion often involve unconscious conflicts and fantasies originating in a woman's early development and reflecting her relationship with her mother. These may be acted out via an unplanned pregnancy and decision to have an abortion. The central task of abortion counselling is to address and make links with the unconscious processes, and in particular help the pregnant woman recognize and acknowledge her ambivalent feelings. In this way the counselling makes use of the opportunity to reflect provided by the crisis situation of the pregnancy.     

Autonomous abortions: the inhibiting of women's autonomy through legal ultrasound requirements

Recently, we have seen various proposed laws that would require that women considering abortions be given ultrasounds along with explanations of these ultrasounds. Proponents of these laws could argue that they are assisting with autonomous abortion choices by providing needed information, especially about the ontological status of the fetus. Arguing against these proposed laws, I first claim that their supporters fail to appreciate how personalized an abortion choice must be. Second, I argue that these laws would provide the pregnant woman no control over when and to what extent emotion is inserted into her deliberation. This unjustly inhibits her autonomy, making these ultrasound laws unjustified.     

Posttraumatic Stress Among Women With Breast Cancer and Their Daughters: Relationship With Daughters' Breast Cancer Screening

Cancer-related posttraumatic stress (PTS) in women with breast cancer, perceived risk of cancer in these women's daughters, and daughters' PTS related to their mothers' breast cancer were tested for relationships to daughters' breast self-examination (BSE) and mammography activity. Daughters' mammography frequency was related to her own PTS, but not to her perceived risk or her mothers' PTS. In contrast, daughters who overperformed BSE had mothers reporting significantly greater PTS than those performing BSE at recommended rates or underperforming BSE. Daughters' BSE and mammography frequency were not correlated. Differing demands related to BSE and mammography, and their relationship to different distress variables are discussed.     

医本仁术 命大于天——反思一尸两命案

孕妇因呼吸道感染求诊,必须实施剖腹产手术,医院因陪同人员拒不在手术知情同意书上签字,未能进行手术并眼睁睁地看着孕妇和胎儿死亡。本案是个极其个别的案例,但是仔细反思足以说明当前的相关法律法规尚有不足,医院处理也有许多值得商榷之处。除了法律法规之外,不仅医患沟通出了障碍,临床医务人员之间的交流,更是需要大大加强。     

Das Drama des begabten Kindes und die Suche nach dem wahren Selbst

The clinical material for this study of female fantasies stems from a specific psychoanalytical situation where the analyst and the analysand are pregnant at the same time. The impact of this situation is powerful. The emergence of archaic fantasies is facilitated in transference and countertransference. Fantasies of damage to the baby or to the procreative function may emerge very vividly in the double pregnancy setting and working through these fantasies becomes possible. It is suggested that these fantasies are typical female castration fantasies and manifest the fear of the mother's revenge and punishment for forbidden oedipal wishes. The double pregnancy setting may sensitize the analyst to her pregnant analysand's unconscious communication and yet blind the analyst in some areas to the protection of her own baby. The duality of phallic strivings in the girl's psychosexual development is discussed. They may be employed as a defense against specific feminine anxieties, such as fear of retaliatory attacks on her inner space and its fertility: the female castration anxiety. They may also be constituents of her sexuality, coexisting with inner genital strivings. The co-existence of phallic and inner-genital strivings in the female psyche is always conflictual.     

Counseling adolescents with problem pregnancies

The whole gamut of problems involved in counseling pregnant teens, from the national statistics and psychosocial context to the goals of counseling and follow-up are discussed. In the U.S. 40% of women have become pregnant by age 20 (1982 data), making this one of the highest rates of teenage pregnancy worldwide. Many factors contribute to this problem: adolescent development with its unresolved conflicts; teenage cultural myths about sex roles, such as the idea that it is harmful to deny sex to males; cultural roles for women such as being passive and therefore unprepared with contraception. The teen pregnancy, then, evokes a personal, interpersonal, moral and medical crisis. Goals for counseling are to help the young woman mjake a fully integrated, final decision; provide emotional support and referral information; to help her use the experience for growth. The decision often has to be rapid, because many teens delay revealing their pregnancy out of fear, yet prenatal care is essential, while a second trimester abortion should be avoided. Decisions about whether to bear the child, involve the father, the family, where to live, how to get financial support become complex. Even the counselor's background can be counterproductive, especially when the teen chooses STET unlikely to succeed. Issues of client's autonomy and confidentiality regarding family, the male partner, and even local regulations may confuse the process. Follow-up counseling may be indicated, for post-abortion or pregnancy support, for future contraception, for a committed relationship, or for balancing her needs versus her sexual partner's.     

Family functioning and the adolescent mother: a systems approach

This study examines unwanted adolescent pregnancy and early childbearing within the context of the family system. Fifty pregnant adolescents and their families were interviewed prenatally and again during the postpartum period. Utilizing the concepts of structural family theory and therapy as described by Minuchin, certain characteristics of family style and structure of organization were rated. These family variables were then related to aspects of the adolescent mother's adaptation postpartum. Boundaries, in terms of degree of intrusiveness and differentiation, were related to such variables as whether the adolescent is maintained in the household and to her continuing relationship with the baby's father. Similarly, the family's style of dealing with conflict was related to the relationship between the adolescent parents, among other outcome variables. Implications of the findings both for working with these families and for further research are discussed, and issues are raised about hypothesized relationships between independent and dependent variables which were not borne out.     

The perils of protection: vulnerability and women in clinical research

Subpart B of 45 Code of Federal Regulations Part 46 (CFR) identifies the criteria according to which research involving pregnant women, human fetuses, and neonates can be conducted ethically in the United States. As such, pregnant women and fetuses fall into a category requiring “additional protections,” often referred to as “vulnerable populations.” The CFR does not define vulnerability, but merely gives examples of vulnerable groups by pointing to different categories of potential research subjects needing additional protections. In this paper, I assess critically the role of this categorization of pregnant women involved in research as “vulnerable,” both as separate entities and in combination with the fetuses they carry. In particular, I do three things: (1) demonstrate that pregnant women qua pregnancy are either not “vulnerable” according to any meaningful definition of that term or that such vulnerability is irrelevant to her status as a research participant; (2) argue that while a fetus may be vulnerable in terms of dependency, this categorization does not equate to the vulnerability of the pregnant woman; and (3) suggest that any vulnerability that appends to women is precisely the result of federal regulations and dubious public perceptions about pregnant women. I conclude by demonstrating how this erroneous characterization of pregnant women as “vulnerable” and its associated protections have not only impeded vital research for pregnant women and their fetuses, but have also negatively affected the inclusion of all women in clinical research.     

孕妇非产科手术麻醉的评估和思考

临床上约有1%~2%的孕妇在孕期接受非产科手术麻醉;因孕期生理改变和手术麻醉对孕妇、胎儿的影响,加之妊娠合并心脏病、糖尿病等特殊病例以及现代腔镜手术、无痛人流特殊技术等复杂因素,为确保孕妇与胎儿安全,术前充分的评估、恰当的麻醉方法、药物选择与术中调控是我们必须重视与思考的课题。     

Pregnancy: A social stigma?

Experimental evidence is presented which explores the social stimulus value of pregnancy. It was found that, for men especially, the pregnant woman elicits avoidance and staring and that these responses occur primarily because pregnancy is a novel visual stimulus. For women, avoidance seems to be tied less to the stimulus aspects of the pregnant woman than to role expectations about her behavior. The pregnant woman is expected to be passive, but is simultaneously rejected for being so. It is argued that this constellation of responses may produce discomfort and withdrawal in the pregnant woman herself, since avoidance and staring are easily interpreted as negative reactions. How these reactions fit into the cultural response to pregnancy is discussed.     

Generations Lost: A Cancer Genetics Case Report

The process of cancer genetic counseling can unearth issues that, sometimes unbeknownst to the counselor, are emotionally and psychologically significant to the patient. The following case report illustrates how the precounseling process of obtaining a medical chart on a deceased parent affected two sister counselees. This medical chart helped these sisters to reconnect with the mother they lost as children and to better understand her struggle with breast cancer. This case also chronicles the counselor's professional growth and discovery during this process.     

Neoliberal Beliefs and Perceptions of Unintended Adolescent Pregnancy after Consensual or Forced Sex

From a neoliberal perspective, young women are free to make autonomous choices and are personally responsible for the outcomes of these choices. Neoliberal ideals may appear to empower women as free sexual agents; however, an individualistic focus on self-sufficiency and personal responsibility may lead to harsh, decontextualized responses to those who experience unintended outcomes. We hypothesized that observers with stronger neoliberal beliefs would show more stigmatizing responses to an unintentionally pregnant adolescent. We also explored whether these expected associations would be moderated by whether or not the young woman chose to consent to sex. U.S. undergraduate students (n = 200) completed a measure of neoliberal beliefs and were randomly assigned to read one of two scenarios in which an adolescent became pregnant after either consensual or forced sex. As expected, participants with stronger neoliberal beliefs were more blaming toward the adolescent for becoming pregnant, felt less sympathy toward her, and had less positive attitudes about her receiving help. These associations remained after controlling for general political ideology and regardless of whether the pregnancy was due to consensual or forced sex. Our results suggest that, for the neoliberal observer, young women are held personally responsible for even uncontrollable sexual and reproductive outcomes.     

Reasons and Justifications for Considering Pregnancy Among Women Living with HIV/AIDS

Despite the risks associated with pregnancy, available data suggest that HIV-infected women are no less likely to become pregnant than uninfected women. To understand HIV-infected women's reasons for wanting to have a child, focused interviews were conducted with a predominantly minority sample of 51 HIV-infected women in New York City. They were noted to actively weigh both the potential risks and benefits of their pregnancy decisions. Women reported three major reasons for wanting a child: (1) her husband/boyfriend really wants children, (2) having missed out on raising her other children, and (3) believing that a child would make her feel complete, fulfilled, and happy. Women also reported several justifications which they believed offset the risks of pregnancy, including: (1) other HIV-infected women were having healthy babies, (2) feeling optimistic about having a healthy baby due to the prophylactic effects of AZT (zidovudine), (3) having faith that God will protect the child, (4) being young and "healthy" will prevent transmission, and (5) feeling that she is better able to raise a child now. These findings suggest that to make fully informed pregnancy decisions, women should be encouraged to explore their reasons for wanting pregnancy, as well as discuss the potential risks.     

Compounding vulnerability: pregnancy and schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal-fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.     

Blessed are the peacemakers: Commentary on making peace in gestational conflicts

The purpose of this commentary on James Nelson's article [1] is to advocate introducing the ethics of care into the arena of gestational conflict. Too often the debate gets stalled in a maternal versus fetal rights headlock. Interventionists stress fetal over maternal rights: they believe education, post-birth prosecution or pre-birth seizure of pregnant women may be permissible. In contrast to interventionists, other philosophers stress that favoring fetal rights treats women like ‘fetal containers’. I question whether we should really consider issues of moral/parental obligations to children in terms of rights. Rather, the language of care should guide moral conduct vis-a-vis children/fetuses. The particularity of each woman's story — the particulars of her human relationships — inform her story. An individual's ability to care is largely a function of whether community cares for her. We must care for others to enable them to care for themselves and their loved ones — born or unborn.     

Psychological impact of breast cancer on the patient and the family: A clinical perspective

Breast cancer is the most frequently occurring cancer in women, with 182,000 new cases diagnosed in 1993. Breast cancer will strike a sizable percentage of women during the child-rearing years impacting, therefore, not only on the woman, but on the significant others in her life. This article explores the impact of breast cancer for the patient's life partner, parents, and children. A model intervention program for cancer patients with young children, piloted at the Derner Institute and developed in conjunction with the American Cancer Society, is also discussed.     

Therapeutic assessment case study: treatment of a woman diagnosed with metastatic cancer and attachment trauma

This article presents a Therapeutic Assessment (TA) case study of a woman recovering from 4 years of intense medical treatment for stage IV cancer. The inclusion and utility of using the Adult Attachment Projective Picture System (AAP) in the TA is highlighted. The client's attachment classification as unresolved helped identify that her current experiences with dissociation and problems restructuring her life following cancer remission were related to severe childhood sexual abuse, which she had suppressed for decades. The AAP also provided information regarding the unconscious defensive processes the client employed to cope with attachment distress and her inability to find comfort and support from others. These findings were instrumental in guiding the subsequent psychotherapy. The TA process, particularly the assessor-client relationship, facilitated an experience of containing her previously unintegrated and dysregulated affect. A single-case experiment using daily measurements suggested that participation in TA coincided with symptomatic improvements in multiple domains. These improvements were maintained during 4 months of biweekly psychotherapy after the completion of the TA. This case illustrates the applicability of the TA model in health care settings, demonstrates the usefulness of the AAP in the context of TA, and provides empirical support for the effectiveness of the TA model in initiating symptom improvement.     

Seeing,mirroring, desiring: The impact of the analyst’s pregnant body on the patient’s body image

The paper explores the impact of the analyst’s pregnant body on the course of two analyses, a young man, and a young woman, specifically focusing on how each patient’s visual perception and affective experience of being with the analyst’s pregnant body affected their own body image and subjective experience of their body. The pre‐verbal or ‘subsymbolic’ material evoked in the analyses contributed to a greater understanding of the patients’ developmental experiences in infancy and adolescence, which had resulted in both carrying a profoundly distorted body image into adulthood. The analyst’s pregnancy offered a therapeutic window in which a shift in the patient’s body image could be initiated. Clinical material is presented in detail with reference to the psychoanalytic literature on the pregnant analyst, and that of the development of the body image, particularly focusing on the role of visual communication and the face. The author proposes a theory of psychic change, drawing on Bucci’s multiple code theory, in which the patients’ unconscious or ‘subsymbolic’ awareness of her pregnancy, which were manifest in their bodily responses, feeling states and dreams, as well as in the analyst s countertransference, could gradually be verbalized and understood within the transference. Thus visual perception, or ‘external seeing’, could gradually become ‘internal seeing’, or insight into unconscious phantasies, leading to a shift in the patients internal object world towards a less persecutory state and more realistic appraisal of their body image.