Psychological preparation of a pregnant woman for childbirth

Pregnancy is not only about waiting for a miracle, the birth of a new person. It's also very stressful. The expectant mother is overcome by a whole “swarm” of questions and doubts:

• Why am I feeling sick? The books say that nausea should have passed by this time.
• What if I have an undeveloped pregnancy? How to recognize it?
• God, how fat and clumsy I have become! Now my husband doesn’t love me - how can you love such a horse aunt?
• I always want to argue with my husband...or cry. This is fine?
• What will happen to me during childbirth? Will it hurt me?
• Will I die? What if the child is born defective?
• What if I don’t finish it? Will I love my child?

Add to this the influence of others: everyone is afraid of an ectopic or non-developing pregnancy, complications after abortions and diseases, poor ecology, carcinogens that adversely affect the health of the unborn child. All this creates such pressure that it becomes difficult to bear a child without nervous breakdowns.

Your internal state during pregnancy affects the health and character of the child you are carrying. All anxieties, fears, hysterics, doubts leave a certain imprint on the baby and subsequently affect the formation of his worldview and attitude towards life.

• The child learned to walk late
• The child does not study well
• The child has a weak immune system
• The child does not adapt well to the external environment (to kindergarten, school, he is unsociable and withdrawn)

Few people realize that all these problems may have a direct connection with what happened to the mother during pregnancy.

Psychological assistance for pregnant women

The emotions that the expectant mother experiences during pregnancy change physiological indicators: breathing rate, heart rate, blood biochemical composition - thus, even at the physical level, the mother’s reaction to pregnancy and her emotions have a powerful effect on the child’s body.

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Each woman reacts differently to pregnancy, and each type of reaction has its own specific risks and their consequences during the upcoming birth and postpartum period. When can we assume the likelihood of developing psychological problems during pregnancy in order to seek psychological support in advance: after all, it is known that it is easier to prevent a problem than to get rid of it.

Perinatal psychologist - about the doctor’s communication with the expectant mother when something went wrong

Is it true that men do not experience the death of a child as acutely as women? Why is it important to listen to what words the expectant mother uses when describing her pregnancy? How does a doctor get into the “burnout funnel” and how to get out of it?

Maria Golyaeva, a perinatal psychologist who worked at the Light in Hands foundation, and the author of the course “Psychological counseling and emergency psychological assistance in situations of perinatal loss,” talks about the psychological aspects of perinatal loss.

“It was a failure, but next time everything will work out”

— Maria, can we talk about some of the most typical mistakes that doctors make when talking with parents experiencing perinatal loss?

— I wouldn’t introduce the term “mistakes” at all; I would talk about what style of communication they choose. Because in order to make a mistake, you need to know how to do it right.

There are several related subjects in medical universities, but doctors usually say that they were not taught how to communicate with a patient. As a result, they act intuitively, based on their professional and everyday experience. For some it is easier, for others it is harder. We don't have protocols like the West for "how we break bad news." We at the Light in Hands Foundation have prepared a guide on communicating with people who have experienced perinatal loss, but this is not formalized at the federal level. In the training course we talk about which phrases and formulations are prohibited, and which, on the contrary, should be used. This knowledge makes life easier for doctors - we collect feedback, and doctors admit that it has become easier for them to communicate.

— What phrases are definitely prohibited?

- For example: “You will give birth to another healthy one.”
When some kind of misfortune or catastrophe happens to you, such words will not console you, but rather will cause aggression. Imagine, a man’s arm was torn off, and they told him: “It’s okay, now they are making good prosthetics!” The illness or death of a child is perceived in much the same way. And “you’ll give birth to a healthy baby” for parents sounds like: “Well, that was a failure, but it’s okay, the next one will work out!” “You are still young, give birth to a healthy baby!” Journalist Irina Kislina - about her experience of perinatal loss, words of support that do not work, and how to learn to live life to the fullest Irina Kislina
Psychology

We thus devalue the grief of the parents and do not give their deceased child the right to exist at all. And he was... And besides, when people are in such an acute situation, they do not perceive such a logical chain. In principle, it is difficult for them to look into the future: their world has now collapsed, and you want them to understand that in 10 years everything will get better for them? They have no time for this now!

- So we are talking about acknowledging their pain?

- Recognize their right to experience in general, allow them to cry and experience the grief that they already experience. When a person can experience grief openly, he can receive sympathy and, as a result, cope with a difficult situation more easily. And when people hide their grief, smile, pretend that everything is fine, it will be much harder for them internally.

— In general, is it within the competence of a doctor to psychologically support parents, or is this already the job of a medical psychologist?

— We are talking about pre-psychological assistance, emergency. For example, in medicine there is first aid, pre-medical aid, a set of the simplest actions that allow the injured person to survive until the ambulance arrives. It's the same here. In fact, anyone, not just a doctor, can provide such “pre-psychological assistance.” This emergency assistance will put a person on the right track and speed up the recovery process.

About the dangers of false hopes

- Is there any fundamental difference - from the point of view of communication between the doctor and parents - when a child is stillborn and when he is seriously ill, but can live for some time? Is the communication different, or is it about the same thing?

“It’s both different and about the same thing.” In both cases we are faced with loss. In one case it is a loss of life, in another it is a loss of health, and it is just as painful for the parents. In addition, this is the loss of the future that they drew in their imagination and planned during pregnancy. Parents invest a lot of emotions in their unborn children: fantasies, dreams, preparation - these are all “emotional investments”. And when expectations are not met, this mass of parental love and joyful anticipation encounters an obstacle: either the child is not there, he is dead, and the parents cannot realize their love, or he is there, but is sick, and therefore we must switch to saving and supporting him. And it is very difficult to do this at the same time: to love and experience pain.

Another difficulty is that if a child is born palliative - that is, with a disease that shortens his life - doctors cannot say exactly how long this will last. We often communicate with neonatologists and pediatric intensive care doctors, and they say: “We don’t know how long the child will live.” It happens that two children are born with the same diagnoses, but one of them lives for several years, and the other dies a month later. Why is that? Nobody knows for sure.

— What can a doctor offer parents if he is not at all sure about the prognosis?

— Doctors must build for parents a picture of their immediate future: what we are doing now, what we are doing in the second stage, in the third, for how long. So that parents can somehow distribute their resources and calculate. Unfortunately, this doesn't always happen.

- How is it happening?

- Differently. Sometimes doctors don’t say anything at all, limiting themselves to the phrase: “Don’t cry, everything will be fine.” Psychologists forbid her to say this phrase! Because no one knows whether it will be good or not, and when we say so, we actually take responsibility for the future of this child and his family.

- Why isn’t there an honest conversation? And what does this lead to?

— Often there is no preparation for a detailed conversation, no moral and emotional strength, and no time. Psychologists have time to be close to the patient - this is their job. Doctors do not provide this.

But an honest conversation must take place one way or another.

Every parent always believes and hopes that in some incredible way everything will work out, everything will be fine. He had already subconsciously built this picture in his head. And when we encourage him, often giving him false hope, this resonates with his hope, with the picture he has built in his head: “Nothing, we’ll get through it!” He does not understand that the child is palliative and hopes for a full recovery. What happens next? Then he is faced with the fact of the child’s death... And they promised him that everything would be fine - even if they didn’t promise, he completed it mentally like any normal loving parent. And all hopes collapsed, unexpectedly, irrevocably. Often a person experiences aggression, and it can spill over onto doctors, among others.

So, not telling anyone, giving false hope, is not useful either for parents, or for doctors, or for the child himself. A parent has the right to know what will happen to his child.

Important From methodological recommendations for interaction with patients in situations of perinatal losses (authors: Golyaeva M.N. Troitskaya K.S.).

A woman can say, and it will be important for her to hear:

• That she is not the only one - this happens,
• That the person who helps her imagines what she feels and is also experiencing,
• That the woman did everything possible, but it was an unpreventable event,
• That she is not alone, that she will be helped,
• That "I'm sorry, I have bad news for you"
• That she is a mother, but, unfortunately, the child is not with her,
• It is important to say about the significance of the child, that he was, that he lived with her for almost a year, that she did everything she could for him.

We never say:

• "I understand you",
• “Perhaps this is for the better, it could be worse,”
• “You have older children,”
• “That there are situations that are more difficult,”
• "That it's the woman's fault"
• “It was nature that suggested that something was wrong with the child - natural selection,”
• “You are young, you will give birth again,”
• “Pull yourself together”, “don’t cry”, “move on with your life”.

“Fetus”, “child”, “pregnancy” - the words are important

— Does a man experience something differently than a woman, or is this a myth?

— There is such a social stereotype - from the series “guys don’t cry”: that a man does not worry as acutely as a woman. But that's not true. Men worry too, but in a different way - a little belatedly. Because a woman during pregnancy can experience some moments that are, in principle, inaccessible to a man: she feels how the child pushes, how he grows, serious hormonal changes occur in her body.

Photo: Jake Melara / Unsplash

In general, each person experiences it differently. There are women who are silent in grief and do not share with anyone, do not show their experiences.

— If, for example, a woman lost a child at a very early stage, does this mean that she does not worry after the loss?

- It’s different for everyone.

First of all, we always listen to what such a woman says. Because an early loss is also a loss, but a different kind of loss. Some women formulate it this way: “I lost a child,” some will talk about the loss of pregnancy, some – about the loss of a fetus, an embryo.

A lot depends on how the woman herself perceives this event: for one it is not so traumatic, for another it is the end of the world and the loss of the whole world. Everything is individual and depends on the individual.

We are talking here about the subjective significance of what a person loses, and not about standards. For some, the very inability to become parents is a loss: we call it “reproductive loss.” There is a loss of women's health, a loss of the opportunity to have children. And someone else, after a miscarriage, will say: “Okay, so now is not the time, everything is fine, it’s okay.”

— How can a doctor communicate with such patients? Are there any key principles that are universal – regardless of the period of loss, any attitude towards it?

— Doctors and psychologists should always take a patient-centered approach to each such case. When a woman comes to an appointment, we never know that this pregnancy is for her - it could be a passing moment, or it could be the meaning of her whole life, and she has been trying to get pregnant for the last 20 years. The doctor does not always have time to test the waters and establish contact with the patient: appointments are limited. But it is important to at least listen to how the woman herself describes her condition - pregnancy, expecting a child, what words she uses, and build on this.

Patient-centeredness is an attitude towards a person as a subject of his own activities, his own decisions, his own life - and not as an object that we are treating. Then communication will take place at the “person-to-person” level, and not “parent-child”; the doctor will not look down on the patient, they will communicate at the same level. This is not about some directives and standards, but about respect, about looking eye to eye, about the phrase: “I’m very sorry.”

- Can a doctor always say this phrase sincerely? After all, he has a lot of such patients.

“A doctor is not obliged to sit and cry with every patient: if he does that, he simply won’t last long.” We are talking about the expression of this social ritual of sympathy, regret - it increases the patient’s trust in the doctor and extinguishes aggression, if it manifests itself. And it makes communication not soulless and automatic - where no one trusts anyone, and the patient leaves, as it seems to him, an insensitive doctor, to fortune-telling grandmothers or to “Google” on the Internet.

Help people remain parents, even if the child lives for a few minutes What is perinatal palliative care, and how is it developing in Russia Alexandra Kraus (Feshina) Anton OlenevElena PolevichenkoNadezhda ProkhorovaNatalia SavvaYulia Zamanaeva

About palliative care

Such an expression of sympathy makes it clear to both the patient and the doctor that their communication and, in general, everything that happens within the walls of this institution is happening for the sake of the patient, for the sake of helping him. And that people here do not formally perceive his situation, they are here to help you and alleviate your situation, whatever it may be.

— How to choose the right words when a child has died?

- First of all, we must prepare the patient for the conversation. For example, with the phrase: “I don’t have very good news for you” or “We now have a difficult conversation with you.” Then you can say: “Unfortunately, I see this and that” - for example, a frozen pregnancy. “This means this and this.” It is imperative to explain what the diagnosis means! In our practice, we are faced with the fact that 90% of patients, having heard the words “frozen pregnancy” from the doctor, leave the office with the question in their heads: “when will it die?” Or the doctor says: “The fetus has no heartbeat.” “When will it appear?” - patients ask. The point is not that they are stupid: under the influence of stress they are not able to adequately perceive information; their psyche refuses to accept such difficult news.

- So, the doctor should be ready to repeat some things? Or is it pointless, since a person is in such a state?

“At that moment when the doctor says: “I have bad news for you,” or even from the expression on his face, from his facial expressions, our psyche picks up a signal: something is wrong. And resistance, rejection arises: “No, no, no, we don’t want to know this! It hurts too much." This shock reaction is triggered at the hormonal level - the hormones adrenaline and cortisol are involved. Cognitive abilities - memory, attention - decrease.

Anyone who has lost someone or heard a terrible diagnosis knows this state of complete stupefaction when you do not understand what is happening around you. Therefore, the patient may leave the office and think: “What did the doctor say to do? I do not remember…".

We see such patients in the corridors of hospitals: they were told to go into the next office, but they stand in the corridor and cannot find this next office, they don’t understand anything. Therefore, it is good to have someone next to such a person who would guide him through and restore the chain of these events for him.

“Can a doctor say that what happened was an accident and that it won’t happen again?” Of course, if we are not talking about hereditary diseases.

— It all depends on the specific situation and diagnosis, of course. But if we omit the medical aspects, what is important for a person to hear? That someone will take care of him and find the cause of his trouble, and next time this will not happen to him. Naturally, any person wants guarantees, but no doctor can give guarantees. But he can say: “We will do everything possible to establish why this happened,” and this will definitely make the person feel better.

Important From methodological recommendations for interaction with patients in situations of perinatal losses (authors: Golyaeva M.N. Troitskaya K.S.).

Help for women with different types of acute stress reactions:

Hysterics

Signs: a woman can cry and scream at the same time, wave her arms, grab her head, and lament. Hysteria always happens in front of other people.

Your actions:

• ask those around you to go to another room;
• actively listen, you can nod and agree;
• speak in short, understandable phrases.

Erroneous actions:

• disputes, entering into dialogue,
• You should not slap, shake or frighten a woman.

Hysteria cannot last long, as it takes a lot of energy. When the woman begins to calm down, give her the opportunity to rest, drink water, wash, and lie down.

Aggression

Signs: a woman may swear, scream, shake her fists, threaten.

Your actions:

• ask clarifying questions to help formulate claims and demands;
• talk to the woman in short, understandable phrases, at a slow pace, without raising your voice.

Erroneous actions:

• argue with a woman, prove that she is wrong.

An aggressive reaction, like a hysteria, does not last long, you need to give the woman the opportunity to throw out her emotions.

To terminate the pregnancy or not – whose decision?

— Is it always the parents’ decision to terminate or prolong a pregnancy?

— Such decisions are always up to the parents. If, for example, a child is diagnosed with developmental defects that are incompatible with life, a medical council meets and gives permission to terminate the pregnancy (if there are defects, but they are compatible with life, such permission is not given). If they do, in any case, the final decision is always up to the parents, not the doctor! The mother can carry this pregnancy to term, while having full information, being aware of the risks - for example, knowing that the child may not survive until birth, may die in utero, or during childbirth, or immediately after. It is very important that the doctor gives parents complete information on the basis of which they will make their own decisions.

—Have you come across cases where doctors put pressure on a woman or try to condition such decisions?

— This doesn’t happen here in Moscow. But I know that in the regions it happens.

— How, in your opinion, should a doctor tell a pregnant woman that something is going wrong with her? After all, she is very sensitive and perceives everything emotionally.

— There are no official protocols of such conversations. But there are certain rules that need to be followed.

Firstly, time must be allocated for such a conversation.

Secondly, such a conversation should not take place in the corridor, but in a separate room, quiet, separate, in a calm atmosphere.

Thirdly, the doctor must “translate” diagnoses from medical into Russian, that is, explain in simple terms what is wrong, what the dangers are, what options there are.

Finally, if the doctor understands that he has a difficult conversation with a pregnant woman, he must make sure that her family is present, her husband, if he has one - so that the woman is not alone, so that she has support at this moment.

If she does come alone, it would be good to make sure that someone accompanies her after the conversation, so that she has the opportunity to call one of her relatives or friends who is ready to meet her and take her home. Anything can happen - because the woman will most likely be in an acute state of stress. She needs support.

— Willy-nilly, the doctor delves into the marital status of his patient. How to do this delicately?

— It is not at all necessary to ask who lives with whom and in what status. There are simple short phrases for this: “Is there anyone who can meet you?” If yes - “Call, let them come for you, and you can sit in the corridor for now.” If not, “Sit here, come to your senses, some water is over there.” It doesn’t take much time: it’s quite possible to fit it into a 15-minute appointment. That is, we are not talking about the fact that the doctor should communicate with the patient for an hour or two. The point is that there are short phrases that help a person feel like a human being.

The point is also that in this situation there are many issues that have to be resolved very quickly, and often these are life-determining decisions for some period. For example, if I have a miscarriage, should I do a genetic test? If a child dies, should the body be taken away? How to organize a funeral? A woman is often in a state of shock; naturally, she cannot make decisions - she does not have the strength or resources for this. You can't force her.

We often come across the fact that women then say: “I’m so sorry that I didn’t take my child and bury him; I'm a bad mother." And we ask: “Darling, were you even able to get out of bed?”...

— How long does this state of shock usually last?

“It is believed that it can last up to two days.

— It happens that a woman “clings” to the doctor, asks him to decide everything for her...

“There are patients who find it difficult to cope on their own, and they try to get support. There are patients who ask the doctor: “What would you do?”

6 difficult communication situations between a doctor and a patient How to react if the patient’s relatives threaten to complain or withdraw from communication, and why the doctor should not make decisions for the family Dinara Gilfantinova

Communication

- What can I say to this?

“We suggest not answering this question directly, but asking why it is so important for the patient to know what a doctor would do in her place.

Sometimes people really need advice, they need to rely on someone else's experience. But the fact is that their experience is their experience, and someone else’s is someone else’s. We all want some kind of recipes - short, understandable and effective: the doctor did this, so I will do this. But the situation is always individual.

“Can’t a person be supported by stories like his?”

- But stories are different! And the ending is different.

— Would telling a similar story with a happy ending be good support or not?

- There is no definite answer here. It depends at what point you offer this story. And then, are you sure that everything will be fine with this family, that there will be a happy ending? If not, this is again about false hopes, which will only worsen the situation.

When work takes all your energy...

— What is most often associated with the “burnout” of doctors and nurses in children’s palliative care, in pregnancy pathology departments?

— Doctors often perceive a loss as a personal failure – as if it were “I didn’t notice.” This also fits into the Kübler-Ross stage of grief, only for a parent who has lost a child it takes years to process it, but a doctor experiences it in a few seconds. When, for example, an ultrasound diagnostic doctor does not see the child’s heartbeat. He thinks: “Oh, no...” and immediately double-checks: these are the stages of denial and bargaining. Only all this passes in a few seconds. And he already turns to the patient, having experienced all this. Such emotions actually require a lot of resources.

Sometimes doctors turn to us, psychologists, with the following phrase: “I understand everything, yes, it happens, nothing can be done, this is life. But I had a case many years ago - I still can’t get over it...” This is such a traumatic event that the doctor could not cope with. And such an experience takes a lot of resources, a lot of energy. It is necessary to deal with such moments.

- Where is the exit? Forbid yourself to worry, turn to stone?

- Find a balance.

In fact, a doctor who perceives his patient’s problems as a personal failure is a good doctor, involved, interested, but not for long. Because there is not enough strength to work in this mode for a long time.

A doctor who doesn’t care what happens to the patient is already “burned out”; he goes to work “automatically.” These are two extremes, and here we are talking about finding some kind of individual balance of energy consumption, emotions, and worries for our patients. It's all individual. If we had a recipe that was the same for everyone, psychologists could tell doctors: “You worry from the pick-up until lunch, and then don’t worry – and then everything will be fine with you!” But there is no such recipe, unfortunately.

You know, there is a joke among psychologists: “Every psychologist has his own psychologist.” This is actually true: psychologists are required to undergo supervision, because a specialist working with someone else’s grief must clearly understand where he is, his actions and his sphere of responsibility, and where the other person is.

Doctors also need psychologists, they need, for example, Balint groups, they need to learn to set boundaries of responsibility, and this is individual and difficult in each case, with each patient. Doctors need rooms for some kind of emotional relaxation, to relieve psycho-emotional stress.

Rescuers, in every squad of the Ministry of Emergency Situations, have such rooms: a person can come there, sit in silence, look at the fish in the aquarium, “reboot”, take a breath and exhale, and recover. Doctors do not have such rooms.

— Is it possible to recover outside of work?

— And here there is such a mysterious phenomenon as a “burnout funnel.” When we start working—the stage of professionalization—we come across interesting, complex cases more and more often. We get very tired at work, but this makes us absolutely happy. We are talking about those young doctors who graduate from universities: they come to work “with shining eyes”, take shifts, take on difficult cases, substitute, ask to perform some complex operations. But this takes a lot of energy, and they naturally get tired.

In order to still have enough energy for work, it must be taken from somewhere, which means you have to save in other areas - in the family, at home, in hobbies. I used to have the strength to go fishing, but now I don’t have the strength. I used to recover over the weekend, but now I can’t. Previously, I could meet with friends in the evening after work - now I don’t have the strength to do that, it’s good if you meet someone once every two months. When all available resources are devoted to work, energy saving mode is activated in all other areas. But there is nowhere else to get energy. The only way to recharge yourself at all is to do something outside of work: fishing, meeting friends, going to the movies. But there is no strength for all this, and it turns out to be a vicious circle.

- How to get out of the circle?

“You’ll have to force yourself a little.” For example, it takes us some time to accustom ourselves to doing exercises in the morning. And we don’t always want to, but we force ourselves. You don’t always want to go outside and take a walk—after work, you want to lie down on the sofa, lie down, and look at the ceiling. But sometimes it’s still worth going out and taking a walk in the park. Take a walk with the dog.

Neurologist Vladimir Solovyov. As a kind of “meditation” on weekends, he likes to go to the forest and pick mushrooms. Photo: Maria Ionova-Gribina, for an article about how doctors rest/ “Such things”, https://takiedela.ru/2019/06/dela-vrachey/

— According to your observations, does searching for meaning in what happened help both patients and doctors to move on and overcome pain?

- You know, if at some point we lose all meaning in this life, will we get out of bed tomorrow? That is the question. Giving personal meaning is a step that a person takes already at a late stage of experiencing grief, already at the exit from it. There are many models of experiencing grief, and the author of one of them, Fyodor Vasilyuk, speaks not about the stages of grief, but about the tasks of grief - tasks that a person must solve for himself in order to reach a new level of understanding of the world: grief must do its work, he believed . It's also about meaning.

It is enough for doctors to know the Kübler-Ross model of grief and understand that each phase of grief is manifested by certain behavior and certain phrases. If we know this, we can understand what phase a person is going through: he denies everything - “No, this can’t be, it’s a mistake!”, he gets angry, blames himself and others - “It’s my fault” or “The doctors prescribed the wrong thing.” , it's their mistake." The next phase is bargaining, “what if”: “What if I hadn’t gone on vacation,” “What if I had started taking vitamins on time.” The next phase is a depressed person. And finally, he accepts the situation as it is. Any doctor can use such characteristic phrases to make a short “diagnosis”, understand what is happening to the patient now, and based on this build communication with him.

There is no mysterious technique here that takes years to figure out. Everything is quite simple. And when doctors begin to understand these signals that patients give them, a lot becomes clear to them. And everyone feels better.

Interviewed by Valeria Mikhailova

The material was prepared using a grant from the President of the Russian Federation provided by the Presidential Grants Foundation.

Normal psychological reaction

Normal or healthy reaction to pregnancy: this is the best option, which has the following distinctive features:

• A woman is happy about her pregnancy, this is a welcome and long-awaited event
• Treats her pregnancy calmly, without unnecessary anxiety
• She continues to live an active life, the necessary changes in lifestyle and restrictions are perceived as not burdensome and are carried out easily - pregnancy fully corresponds to her life plans
• Registers with the antenatal clinic on time, promptly follows all doctors’ recommendations, and attends prenatal training classes.
• Signs of attention from others to her “position” are perceived calmly, but do not require special attention to themselves
• Good relationships with parents and close relatives who are happy about her pregnancy and support her
• Harmonious and warm relationship with her husband: the pregnancy is planned and desired for both. The husband is not jealous of his wife's unborn child
• She happily tries to imagine her unborn child and tries to understand his emotions by his movements.
• The woman believes that she can cope with her maternal responsibilities and is initially determined to breastfeed; she treats the unborn baby responsibly and with love.

The psychologist can only be happy for this expectant mother, the child and the family as a whole: there is a great chance that this family will raise a healthy and harmonious child. Psychological consultation in such cases may be needed only to once again make sure that everything is in order and the pregnancy is proceeding according to plan.

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Symptoms

The first signs of postpartum mental disorders may include the following symptoms:

• insomnia and weakness;
• decreased concentration;
• suspiciousness and paranoia;
• hallucinations;
• delusional thoughts;
• persistent depression of mood and tearfulness;
• apathy and pessimism;
• suicidal thoughts;
• feeling of hopelessness of one's situation, helplessness;
• desire to harm the child.

Many symptoms can be confused with the usual condition after childbirth, so to rule out dangerous signs, it is recommended to sign up for a psychological consultation.

Indifferent attitude towards pregnancy and the unborn child

Such women try to “not notice” their pregnancy themselves and react rather painfully when others pay attention to it. Signs of indifferent perception:

• A woman is upset when she finds out she is pregnant
• She gets irritated when people around her try to show attention, inquire about her health, or try to give up her seat on public transport.
• She tries not to think about her pregnancy and does not experience positive emotions about it
• A woman does not think about the birth ahead, or about motherhood in general.
• Tries to ignore symptoms of pregnancy; in later stages, they experience irritation about changes in figure and weight gain
• If the expectant mother is under 20 years old, such an attitude towards pregnancy is explained by general psychological immaturity at this age. For her, a child is more of an obstacle to freedom and life plans.
• Older women who do not want to change their usual, established lifestyle. They have neither the time nor the desire to register, undergo the necessary examinations and attend training classes
• An unregistered marriage, a man’s reaction does not interest her; he is often simply not informed, however, like parents and other close people - considering that the event is not particularly important.
• The woman tries not to notice the child, does not track his movements, does not try to imagine him
• Waiting for childbirth as an opportunity to get rid of the burden and continue a “normal” life

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Complications

A woman’s psychological health can deteriorate during pregnancy and after childbirth. The fact is that the influence of hormones often causes the manifestation of various mental illnesses. Doctors are aware of the pathologies characteristic of pregnant women that occur in the last trimester and after the birth of a child.

Main pathologies:

1. Postpartum depression is a persistent decrease in mood caused by sudden endocrine changes after the birth of a child. A woman develops apathy, an indifferent attitude towards the child, fear of responsibility and self-doubt. Postpartum depression often interferes with breastfeeding and prevents a woman from properly caring for her baby. The duration of postpartum depression usually varies from 1-3 days to several months.
2. Postpartum psychosis is a more dangerous mental disorder that occurs a few weeks after the birth of a child. Psychosis is characterized by sudden emotional and personality changes that are noticeable to others. The danger of this condition is the risk of harm to the child. Many women suffering from psychosis leave the child and run away.

It is very important to pay attention to dangerous signs in time and make an appointment with a specialist.

Risks for the child as indications for psychotherapy

In cases of indifference or rejection of one’s pregnancy, the child, even before his birth, becomes a potential client of a child psychologist and more. It has been revealed that such children suffer from hyperactivity syndrome at an early age, and in adolescence they may have a tendency to antisocial protest behavior, possibly the use of psychotropic drugs. They are often diagnosed with neuropsychiatric diseases.

Based on the interests of the child, family, and society as a whole, such a woman is certainly indicated for psychotherapy to help her solve the following problems:

• Improve your relationship with your husband, help the couple get closer
• Help you think about and understand the system of life priorities, where a child cannot be in last place
• To help realize your responsibility to the future little man, to feel his complete dependence on his mother’s attitude
• Help a woman feel warmth and sympathy for her child

Maternity coaching

After returning from the maternity hospital, even the most emotionally ready women for motherhood are at a loss when faced with managing everyday life with a baby. However, you can also prepare for this event by contacting a motherhood instructor.

This is a specialist who advises the mother on any questions she may have. He helps to establish breastfeeding, gives recommendations on caring for the baby, helps to build individual time management for a young mother, teaches her to provide first aid to the baby, explains how to identify certain needs of the baby in the early stages and how not to forget about your own needs.

If a woman after giving birth does not seek the service of a nanny, which we wrote about in the previous article, then, having undergone instruction in motherhood, it will be much easier for her in matters of life with a baby.

Motherhood is an important stage in a woman’s life. Recently, it has received a lot of attention from the scientific and practical sides. It has been proven that the role of a mother in a child’s life is colossal. And so that as many children as possible have a wonderful childhood and as many mothers as possible consciously go into motherhood, now there are so many new professions created by women for women in order to help them cope with motherhood, make it comfortable and happy.

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Euphoric perception of pregnancy

From the moment the fact of pregnancy is established, a woman experiences an exaggeratedly wonderful mood, which differs from a normal good mood in the absence of an adequate perception of reality. No matter what happens, everything is fine with such a woman, which may not always correspond to reality.

Signs of euphoria:

• Hysterical personality type, prone to mood swings - emotions from dissatisfaction to delight
• Pregnancy is desired, but for one or another mercantile reasons
• From the moment pregnancy is established, she demands special attention from everyone: from family members to doctors, she insists on fulfilling all her whims
• When turning to doctors, he requires the best specialists, at a level not lower than a professor.
• Uses her pregnancy to manipulate loved ones
• She often shows dissatisfaction when those around her, as it seems to her, are not “impressed” enough with her “outstanding” position
• Manifestations of emotions towards the unborn child are clearly exaggerated and hypertrophied: excessive delight, excessive fantasies, excessive love
• She believes that she will be the best mother and the child will be simply outstanding: the smartest, most beautiful, talented and brilliant

Features of the psyche of a pregnant woman

The emotional state of a pregnant woman is unstable. This is due to the physiological aspect - changes in hormonal levels, as well as the psychology of the expectant mother. Instability of emotional reactions, mood swings, self-absorption - this is how you can characterize the psychology of a pregnant woman.

Pregnancy is a time of big changes

This is a new social role, a new status. A kind of initiation, the border of transition between states. A unique situation in human life - mother and child are fused into one whole. And this has a tremendous impact on the condition of the expectant mother. In addition, not every pregnancy is desired.

A woman may experience great difficulty in building contact with others - her husband, family members, older children, her own parents, friends.

Risks of a euphoric attitude towards pregnancy and the need for psychological support

• If any problems or difficulties arise during pregnancy or childbirth, the woman is completely unprepared for them, is unable to cooperate with doctors, due to her pretentiousness, capriciousness and irresponsibility, or quickly falls into panic
• The born child causes disappointment in the mother: he is completely far from the ideal that she imagined for herself.
• Subsequently, when raising a child, such a mother strives for hyperprotection, depriving the child of all initiative and limiting independence. The mother actively resists his growing up, raising an infantile personality. This parenting model can also cause the husband’s disagreement and lead to conflict situations.

Choose an ecotherapy program

Concern for the baby's health.

Sometimes a pregnant woman begins with fear to go through all the risk factors that she has been exposed to since the beginning of pregnancy and think about how they will affect the child. These include memories of drinking a glass of wine or taking aspirin when you were not yet aware of pregnancy, thoughts about the polluted air of your hometown or radiation from the computer monitor on your desktop. You never know what else can affect the baby’s health. There are dangers here and there.

Psychologist's answer

Do not exaggerate the degree of risk. Congenital defects are very rare. Think that unnecessary worry is much more harmful to your child than the mistakes you made. Don’t indulge in feelings of guilt, it’s better to find a way that can compensate for your “misses” - be it active walks in the park or a balanced diet or listening to classical music. And try to often imagine how healthy, strong and beautiful your baby will be. Such fantasies have a very beneficial effect on the development of the baby.

Signs of the beginning formation of increased anxiety and fear:

• Ambivalent attitude towards pregnancy: joy combined with fears
• A woman is embarrassed about her pregnancy
• The first movement of the fetus causes negative emotions - questions arise: is everything okay?
• Constantly bad premonitions and doubts about the favorable outcome of pregnancy and childbirth, anticipation of unpleasant events without any reason or predisposing factors
• He is very suspicious of the words of medical personnel, interpreting them exclusively in a negative way
• The psyche is very easily traumatized, which makes it difficult for medical personnel and even a perinatal psychologist to work with such a patient

Such women may be contraindicated in group classes to prepare for childbirth - their own anxieties, combined with the anxieties and worries of other pregnant women in the group, conversations about complications are tried on themselves and can induce the emergence of fears. For women of an anxious type, individual consultations and sessions with a perinatal psychologist are required. Psychotherapy for fear of pregnant women is a complex task that requires work and serious effort to solve it.

How a psychotherapist works with pregnant women. Methods and techniques

There are many techniques for working with fears. Pregnant women especially love working in psychotherapy with Metaphorical Associative Cards (MAC). There are special decks that are used to work with pregnant women: with sexuality, emotional states, marital and child-parent relationships.

It is also very good to use art techniques in your work. Drawing, modeling, making collages, working with kinetic sand, doll therapy, fairytale therapy.

Any of the methods and approaches will be good if the specialist understands the topic and has the skill of working with pregnant women.