Pregnancy Counselling

Pregnancy and Childbirth Find a counsellor or psychotherapist dealing with Pregnancy and Childbirth

Never is a woman more in need of emotional and psychological support than when she discovers she is pregnant. Pregnancy and the prospect of childbirth are most often, of course, an occasion for happiness, if not joy. However, few women get through the whole process without some degree of anxiety, and for some pregnancy can be an endurance test of nausea, exhaustion and even depression.

An unwanted pregnancy or an unexpected miscarriage create considerable distress. However both of these issues are discussed at greater length in other pages (see our Abortion page and our Miscarriage page to find out more).

On This Page
	Pregnancy: a time of anxiety
	Antenatal depression
	Trauma or shock reactions to a difficult labour
	What helps in these circumstances?

Pregnancy and anxiety go hand in hand. Pregnant women have always had fears that their baby should 'be alright'. In the modern world however, the media abounds with scare stories of things pregnant women should or should not do, and this can make the early pregnancy, particularly, a very anxious time. The first rejected glass of wine, or plate of shellfish, gives away what might otherwise be kept secret and women can be bombarded with conflicting advice. In the past, it is tempting to think that ignorance, to some extent, was bliss.

Anxiety is only increased by the many and complex screening tests that are routinely offered to women in early pregnancy. Their objective is to rule out abnormality. However, for some women testing brings an enormously stressful wait to receive results for risky conditions they had been happily ignorant about. They may even be faced with an option of termination where the results only suggest abnormality. The risk now is of terminating a much wanted, possibly completely healthy baby. Women need unbiased information and support through this time. An experienced and well- informed source of information and advice is needed to help negotiate this worrying process. Antenatal screening can be a double-edged sword, creating anxiety where there was none. Emotional support can be hard to find in the rapid turnover of the antenatal clinic, but help and reliable information are essential. Trained counsellors can provide this.

In early pregnancy, nausea and exhaustion are two symptoms that cause distress even though the baby is a much wanted one. Where a mother has to work or look after older children the symptoms can make her quite desperate for help, they can even lead her to need hospitalization.

Another unexpected side effect of pregnancy can be the quite sudden onset of anxiety and panic in a woman who has been happy to be pregnant and who may have no obvious causes for distress.

Antenatal depression is not widely discussed or acknowledged and yet studies since the 1990’s show that 10% of women can be affected by it. The common symptoms may include:

•	constant crying or being ‘on the edge’ of tears
•	guilt around ‘forbidden’ foods or activities or inability to eat because of nausea
•	exhaustion: of both physical energy and emotional enthusiasm
•	isolation: everyone else is happy so a mother’s distress may become a guilty secret
•	shame: fear of admitting negative thoughts and feelings
•	relationship problems: partner finds it difficult to understand
•	despair about nausea if it persists well into late pregnancy
•	chronic anxiety.

The causes of this horrible experience are not clearly understood but the enormous hormonal shifts of pregnancy undoubtedly play a part as do the prospective life changes, responsibilities and financial burdens having a baby entail. For some women their fear of labour becomes overwhelming.

The fact that many mothers are afraid of the consequences of taking medication to help their depressive condition may make them feel trapped in a prison of fear and desperation.

• her family

• her friends

• her GP may suggest anti-depressants but this would need to be carefully considered. GPs may or may not consider drugs safe during pregnancy and there is a danger of adding anxiety about drugs to the woman’s existing burden

• her health visitor

• an experienced and well-informed counsellor.

All sources of support should work towards encouraging and normalizing the mother’s experience. Reassuring her that:

she has not gone mad

she is unlucky, not incompetent

strategies for distraction and re-engaging in a social life can help

symptoms often reduce as a woman is taught about caring for a baby and setting up a post-natal support system

ante-natal classes can greatly reduce fear of labour and provide a group of pregnant friends

two thirds of depressed mothers recover when the baby is born

Most pregnant women who have a planned pregnancy, and indeed many who have an unplanned one, do not suffer from antenatal depression. However, for the few that experience this condition these sorts of help, therapy and ‘treatment’ are available and women who actively seek them are most likely to experience an improvement in their symptoms

Also see: Postnatal Depression

Trauma or shock reactions to a difficult labour

While childbirth is a routine event in the life a busy maternity unit, a newly delivered mother will tell you that it is certainly not a routine experience for her. Even when the event is straightforward and problem-free, this is a powerful event in a woman’s life and one, which will live in her memory as perhaps few others.

A popular modern icon is that of the happy mother who, on holding her newborn baby, declares that the pain of labour is diminished or forgotten entirely. Because of this, childbirth is generally anticipated as a happy event and most first-time mothers look forward excitedly to a time when their babies will at last be seen, be held and be realised as whole and healthy.

Some mothers have more ambivalent feelings in anticipating the onset of labour and some weep as they describe and discuss their first-time experience. Some put off the conception of a second child for a long time, or for ever, because of their fear of a repetition of the pain and panic they experienced first time round.

It has been suggested that as many as 3-6% of mothers suffer great emotional distress after difficult and traumatic labours, and that this distress is disruptive enough to fulfill the criteria for a diagnosis of Post Traumatic Stress Disorder. The consequences of this condition remaining undiagnosed and untreated can be a disruption of a couple’s relationship and of domestic life in general, an inhibition of the developing mother/baby relationship and postponement or abandonment of plans to have more children. Some mothers will insist on a physiologically unnecessary Caesarean section second time round, so that they can thus control the unpredictability of labour.

Symptoms of stress reactions to traumatic labour:
	Reliving the experience in nightmares or flashbacks; thinking that the event is taking place again.
	Avoidance of things that remind the mother of her labour; she may drive miles to avoid passing the hospital where she had her baby or avoid pictures or films of any hospital. Post natal check ups with the hospital or even a GP may be seen as intolerable and thus avoided.
	A mother may experience difficultly bonding with her baby because of his/her association with the labour; this may make it impossible for her to cope with the baby’s demands or with constant crying.
	A mother may be ‘on edge’ all the time displaying heightened irritability; she may find it impossible to relax and be constantly scanning the world for danger.
	A woman may cry very easily and feel helpless in trying to take care of her baby.

What helps in these circumstances?
	Information - many maternity units have trained midwives who can go through the mother’s notes and explain what happened. Labour can be a confusing event and drugs often interfere with memory. To have the story told in a calm environment with reassurance that mother and baby were not at risk can be immensely helpful
	In some instances a formal letter of complaint where things were not well managed makes a couple feel less helpless than they did during labour. Some couples have had apologies from hospitals where this has been the case
	A plan for any subsequent labour may help.
	Social Support - the beneficial effects of having other mothers to discuss and describe experience with cannot be overstated. The acknowledgement by peers that an individual has had a difficult time is validating and supportive. It is important, however, that a support group is selected carefully so that they are looking towards a positive resolution of distress, not dwelling in the detail of their stories.
	A trained counsellor will be able to explain some of the panic based reactions and gradually desensitise the trauma.
	An understanding GP will wait until a mother is recovered and has developed some relaxation skills before any gynaecological procedures are suggested.
	Having a baby can and most often is a joyous and wonderful experience, but for those who are unlucky enough to experience psychological or emotional difficulties, help and support is available. It can transform a time of distress and fearfulness into a happy and fulfilling experience.
	Find a counsellor or psychotherapist dealing with Pregnancy and Childbirth
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