1 Psychology and human development1.12 Stages of human development
1.12.12 Pregnancy and childbirth
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Written by Resident Doctor Committee · Published
Mental health in pregnancy
Suicide is less common in pregnancy than expected for women of the same age.
Depressive, anxiety, obsessional and sleep problems, by contrast, do not fall in pregnancy, and most of them rise.
Sleep is broken by discomfort, nocturia, fetal movement and anxiety, which worsens concentration, mood and pain tolerance.
Previous bipolar disorder is particularly relevant to the risk of postpartum psychosis.
Stresses of pregnancy
Ambivalence occurs even in a planned pregnancy, and unplanned is not the same as unwanted.
A previous miscarriage, stillbirth or traumatic birth sharpens anxiety, especially around the stage at which it happened.
Ask about domestic abuse sensitively, because pregnancy can be a time of greater vulnerability.
Labour
Labour has three stages: cervical dilatation, birth of the baby and delivery of the placenta.
Feature | First stage | Second stage |
|---|---|---|
Source | Contractions and cervical dilatation | Stretching of the vagina, pelvic floor and perineum |
Type | Visceral, diffuse and referred | Somatic, sharper and localised |
Cord entry | T10 to L1 | S2 to S4, mainly through the pudendal nerve |
Fear, pain and the birth experience
Tokophobia is a severe fear of childbirth that can shape birth decisions or lead a woman to avoid pregnancy altogether.
In Dick-Read's fear-tension-pain cycle, fear raises tension, tension makes pain worse, and pain feeds the fear.
Poor support, poor communication and a sense of having no control contribute to postnatal traumatic stress alongside the obstetric events.
Clear information, effective analgesia, continuous support and a real say in decisions ease both physical and psychological stress.