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.     

Abortion and Mental Health

Abstract

Unwanted pregnancy and abortion are common life events, and therapists are likely to work with clients who experience them. Legal abortion currently entails little physical or mental health risk; most women currently cope effectively with these life events without need of clinical intervention. But current abortion politics include efforts to make abortion a more threatening, stressful, and stigmatized experience and to create a “postabortion syndrome.” Using a stress and coping framework, we examine how antiabortion activists spread myths and misinformation aimed at women's appraisal processes, and discuss approaches therapists can use to enhance women's strategies for coping with abortion. We also discuss specific issues and useful techniques for counseling about abortion concerns, including cultural sensitivity and strategies for promoting positive sexual health.     

Predicting Antenatal Class Attendance: Attitudes Of Self And Others

Abstract

Attendance at antenatal classes has been found to improve birth outcomes, yet many women do not attend. This study investigates the extent to which we can predict attendance and whether women's expectations of classes are confirmed by their subsequent experiences. Intention to attend was the most predictive variable in the 529 primigravidas women studied. It was best predicted by women's general attitudes about coping and the value of attendance, rather than by specific expectations of classes. Women's perceptions of the attitudes of the baby's father and of the hospital doctor were also important. Although there were demographic differences between attenders and non-attenders, they were less predictive than attitudes. These findings are consistent with the Theory of Reasoned Action. Women's experiences of classes were much more positive than their expectations. Giving this information to women and their partners may change their attitudes and, hence, attendance.     

The relationship of diabetes knowledge to regimen compliance and metabolic control during pregnancy

Abstract

The relationship of diabetes knowledge to regimen compliance and metabolic control was examined in a sample of pregnant women with preexisting insulin-dependent and noninsulin-dependent diabetes mellitus (N = 27) and women who developed gestational diabetes during pregnancy (N = 45). Subjects completed self-report measures of diabetes knowledge and compliance with their diabetic regimen and blood glucose levels were monitored. Knowledge was positively, although modestly, related to dietary compliance, compliance with insulin administration and insulin reaction management recommendations, as well as fasting blood glucose levels. Findings suggest that among pregnant women, efforts to increase knowledge of diabetes specific to pregnancy may result in some improvement in selected aspects of the diabetic regimen.     

妊娠期急性脂肪肝诊治中的科学思维应用

现代科学思维方法中系统思维及模糊思维方法具有普遍适用意义。妊娠期急性脂肪肝临床上极为罕见,并发症多,病死率极高,1例并发腹部卒中的妊娠期急性脂肪肝患者通过科学诊疗转危为安,及时终止妊娠、对症处理、多学科协作联合治疗,积极预防并发症是确保救治成功的关键。本文尝试介绍科学思维方法在该病诊疗中的一些体会。     

Counseling Women Who Have Experienced Pregnancy Loss: A Review of the Literature

The authors review pregnancy loss scholarly literature and discuss themes of silence, grief, psychological distress, role of social support, satisfaction with health care, and coping strategies from a counseling standpoint. Counseling needs of women who have experienced pregnancy loss are delineated, and recommendations for future research in this area are made.     

Emotional inhibition of effective contraception

Negative emotional responses to sex such as anxiety, guilt and fear tend to inhibit sexual behavior. When they are not sufficient to inhibit sexual intercourse, however, they frequently interfere with the ability to plan for, or cope with the consequences of sexual activity. More specifically, these emotional responses to sex frequently interfere with the ability to apply thoughtful and careful logic to contraceptive decision making, and thereby inhibit the use of effective methods of birth control. The current article is a review of the empirical support for emotional inhibition of contraception, and an examination of the psychological mechanisms by which these responses to sex mediate birth control behavior.     

Addiction in Maternity: Prevalence of Mental Illness,Substance Use,and Trauma

Women living in vulnerable neighborhoods experience higher rates of poverty, homelessness, psychiatric issues, illicit substance use, rates of HIV, and a lowered life expectancy. The aim of the study was to further explore the history of mental illness and trauma in a sample of women (N?=?31) who had recently given birth and had a substance use problem while pregnant. We investigated sociodemographic characteristics, history of trauma and post-traumatic stress disorder (PTSD), rates of substance use and dependence, and psychiatric symptoms. Childhood and adult traumatic experiences were found in the majority of the sample, and one-third presented with suspected PTSD diagnosis at the time of the interview. Women-centered services are in great demand, as well as trauma informed care, and further research on appropriate treatment for substance using, traumatized, women with a mental illness.     

Witch-mother is which? The potential role of the analyst in facilitating authentic motherhood

Abstract

This paper explores challenges in the treatment of women suffering from disturbances in maternal identification. A review of the psychoanalytic and developmental literature focuses on the frequent finding of early-onset mother–daughter relational disturbance involving maternal narcissistic fragility and exaggerated dependency needs, intergenerational trauma, and related psychopathology including mutual affect dysregulation. A case example of a young woman with a severe anxiety disorder is presented and discussed to illustrate the challenges to the traditional psychoanalytic technique. This patient avoided pregnancy into her late thirties and entered analysis with feelings of inauthenticity, characterological masochism, and a “secret mission” to unmask the witch recurring in her dreams. Through an elaborate working-through of negative maternal transference, the analyst and patient saw through the birth of the patient’s authentic self, a new approach to her career, her relationships with men, and her anticipation of the birth of a child by the sixth year of treatment. The author posits that psychoanalytic technique benefits from contemporary, attachment, and trauma research that supports the analyst’s playing a more active role in approaching, co-regulating, tolerating, and integrating avoided affects and memory traces that are associated with early-onset relational disturbances worsened by the effects of violence, maltreatment, and loss.