Tuesday, November 13, 2007

Psychosocial Adaptation in Pregnancy

The recent needless death of Laura Hope Smith, a prolife Christian girl who nevertheless ended up on the abortion table, underscores the need to convey to young women the fact that panic and the desire to bail out are normal and self-limiting. With that in mind, here's a reposting on my article on Psychosocial Adapation in Pregnancy.

Among the prochoice it's a given: there is a real "need" for abortion, as measured by the reality of women seeking abortions.

But is the request for abortion proof that abortion is necessary, or does it demonstrate some other principle?

Let's turn to a source that isn't addressing abortion in any way: Psychosicoal Adaptation in Pregnancy: Assessment of Seven Dimensions of Maternal Development, by Regina P. Lederman. The book grew out of a research project examining "the relationship of maternal psycholsocial adaptation in pregnancy to maternal anxiety and labor progress during childbirth." The research was mostly intended to assist prenatal educators and other involved in the birthing process.

The opening paragraph already launches into important territory:
It became apparent during the interviews with expectant mothers that all the women experienced some conflict in relation to the pregnancy and childbearing and that the patterns of response to conflict could be identified as either adaptive or maladaptive.

In other words, being conflicted about the pregnancy isn't a sign that the woman isn't ready to become a mother. It's a sign that she's normal.

The authors concluded that the pregnant woman faces the following developmental challenges:
  1. Acceptance of and adaptation to the pregnancy
  2. Progressive development in formulating a parental role and relationship with the coming child
  3. The impact of the pregnant woman's relationship with her partner on pregnancy adaptation and vice versa
  4. The pregnant woman's relationship with her mother
  5. Knowledgeability about and reasonable preparation for the events of labor
  6. Anticipation of mechanisms for coping with fears involving pain and loss of control in labor
  7. Coping with fears involving loss of self-esteem in labor

Passing through the developmental tasks of pregnancy is as natural as passing through the developmental tasks of any other life-change, such as puberty.

Lederman develops a conceptual model of pregnancy for a first-time mother as "a period of trasition between two lifestyles", that of the "soman-without-child" and that of the "woman-and-child". "Transition between the two lifestyles can be viewed as a paradigm shift, the paradigm being understood here as a constellation of current self-image, beliefs, values, priorities, behavior patters, relationships with others, and set of problem-solving skills."

Lederman notes that others before her have noted the "developmental and adaptive processes of pregnancy and childbirth".

She reiterates: "Initially, the woman's task is to accept the idea of pregnancy and assimilate it into hwer way of life. ....she may be assailed by doubts, weighing the pros and cons, rethinking her motives and the ultimate consequences of a changed reality. .... Some degree of ambivalance and vacillation is to be expected throughout pregnancy even when clear choices have been made."

In reviewing statements about the original "wantedness" of the pregnancy:
In many instances, the pregnancy was unplanned. .... All these subjects claimed that they wanted the baby anyway even though they may have initially contempltated abortion. (Emphasis mine) .... In most cases of unplanned pregnancy, the woman came to accept the pregnancy and used the 9 months to resolve conflicts and develop her motherhood role.

Lederman addresses ambivalence:
Even for women who plan, accept, and enjoy pregnancy, there might be some ambivalance at first. Surprise or shock is often the initial reaction to the falidation of pregnancy. Caplan (1959) indicated that initial rejection of pregnancy is common, but that it is generally followed by acceptance at the end of the first trimester. .... Ambivalence is widely recognized as normal.

Lederman notes that it's important to assess how honestly the ambivalence is expressed, the reason for the ambivalence, the intensity of the ambivalence, and how sustained the ambivalence is.

She also looks at causes of ambivalence. Financial worries are pretty straightforward. "A further cause of ambivalence is the prospect of anticipated changes in lifestyle. If faced honestly and worked through, these changes need not be a serious hindrance to a woman's preparation for motherhood or her enjoyment of pregnancy."

To summarize: It's normal during the first trimester to be ambivalent, or even to reject the pregnancy. The fact that the woman rejects the pregnancy during the first trimester does not mean that she will continue to reject the pregnancy, or that she will reject the baby once it is born. It simply means that she is normal.

To "treat" this ambivalence with abortion is as irresponsible as to "treat" the bleeding of menstruation with a hysterectomy. Normal, self-limiting phenomena do not need to be "treated." The conscientious doctor will instead provide support to help the patient understand and deal with her symptoms.

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