Major mental illness during pregnancy

‘Om Langs Die Pad Te Kraam’: A Feminist Psychoanalytic Perspective on Undisclosed Pregnancy

This article focuses on the phenomenon of pregnant women not acknowledging their pregnancies. Such women typically enter the health care system at a late stage and thus get little or no prenatal care. The phenomenon of undisclosed pregnancy is explored by focusing on two case studies of pregnant research participants in a project concerned with the psychological distress of female farm workers in the Western Cape. These two pregnant women were interviewed for a total of ten hours about topics such as psychological distress and well-being, coping and resilience, family and personal history, physical health, interpersonal relationships, reproductive issues (specifically pregnancy and motherhood), and sexuality and body, but did not reveal to their interviewers that they were pregnant. Follow-up interviews were conducted with the participants in an attempt to form a psychological understanding of their failure to disclose their pregnancies during the interviews. In the follow-up interviews, it became clear that the participants also did not reveal that they were pregnant to their families, their friends, their employers, or any health care workers. The interview data suggested that these two participants construed pregnancy as something to feel guilty, ashamed, and anxious about. Their conscious or unconscious response to this material bodily event was to not recognise or acknowledge it, neither to others nor to themselves. This finding is analysed in the context of the literature concerning the subjective experience of and psychological responses to pregnancy, with specific reference to reports of ‘motivated unawareness’ or ‘denial of pregnancy’ in the pregnancy literature. The question of how to understand the participants' experiences and response to pregnancy is then analysed within a postmodern paradigm, using a feminist psychoanalytic perspective.

Childbirth and mental disorders

This review approaches the topic of childbirth and mental illness using a model of perinatal health which takes into consideration the multiple determinants of health, approached from a lifespan perspective. The paper seeks to answer four broad questions using this model and available literature: (1) What is the relationship between childbirth and mental disorders? (2) How common are mental disorders during childbearing, and what is the perinatal course of illness? (3) What are the effects of mental illness during childbearing on foetal and infant developmental outcomes? (4) How do you approach the detection and treatment of mental disorders during the perinatal period?

Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients

OBJECTIVE

To examine psychiatric symptomatology and associated functional impairment among pregnant women; and to examine the obstetrical patient's receptivity to discussion of and intervention regarding emotional distress.

METHODS

Fifty-seven patients 16 weeks or less pregnant presenting for routine obstetrical appointments at a faculty practice at a major medical center participated in this study. Each completed a self-administered assessment packet regarding psychopathology, functional impairment and service utilization attitudes. Statistical analyses were performed using chi-square and Mann-Whitney tests.

RESULTS

Seventeen subjects (29.8 percent) screened positive for at least one anxiety disorder. Fourteen of those subjects also screened positive for depression. Those with positive screens for either anxiety and/or depression had significantly higher levels of functional impairment. Only five (29.4 percent) of the 17 subjects with positive screens reported having discussed an emotional issue with their Ob/Gyn, although 14 (82.4 percent) said that they would be willing to do so. All subjects (100 percent) reported that they would see a mental health professional if their Ob/Gyn referred them.

CONCLUSION

Routine screens for mental disorders in early pregnancy appear to be a useful adjunct in an obstetrical setting. Although most had never discussed their emotional concerns with their Ob/Gyn, a substantial proportion of our study sample reported psychiatric symptomatology and significant levels of functional impairment that had not been recognized by their Ob/Gyn. All of the patients in our study sample reported a willingness to see a mental health professional if their Ob/Gyn referred them. Further studies investigating the benefits of antenatal diagnosis and treatment of psychiatric disorders are warranted.