For many women pregnancy is an emotionally distressing experience, even though there is a general belief that significant psychiatric disorders and specifically suicide is rare during pregnancy.

Factors contributing to psychiatric disorders in pregnancy include:

i) Hormonal changes in pregnancy.

ii) Changes in body image.

iii) Activation of unconscious psychological process specific to pregnancy.

iv) Mental stress due to maternal role.

Emotional Changes in the First Trimester of Pregnancy

In the first trimester , women exhibit emotional ambivalence. Ambivalence refers to mixed and contradictory feeling. One one hand there could be a sense of wellbeing, joyfulness and acceptance of the pregnancy, while on the other there could be anxiety, uncertainty and low spirit.

Most women also expect extra care and protection by people around them, in the immediate environment. Some imature women may exaggerate their need in the form of making unrealistic demands for support.

During the first trimester there could also be a fear of spontaneous abortion, which is common during the first trimester.

As expected a teenage unmarried expectant mother, without a reliable male partnet may have to face extra stress of parental rebuke and also neglect by her partner.

In some women, severe signs of morning sickness in pregnancy (Vomiting, salivation, lethargy and body weakness) will also add to her emotional difficulties.

Emotional Changes in the Second Trimester of Pregnancy

Fetal movements perceived by the mother (Quickening), provides psychological support for the mother during pregnancy. Fetal movements are perceived from the fifth month onwards. It also reassures the mother about her own reproductive ability.

During the second trimester ,the mother will also be concerned about human birth defects and genetic disorders such as sickle cell anaemia. Rhesus incompatibility will also be a great concern to the mother, especially if she is D-.

It is during the second trimester that the uterus enlarges enough to restrict the woman’s physical activities (including social and occupational activities).

Low income mothers , will be worried about the financial responsibilities of buying baby’s items. Hospitals should be encouraged to work with social welfare groups ,so that they can provide help and support for individuals who cannot afford medicine and items for the baby.

Emotional Changes in the Third Trimester of Pregnancy

The important psychological changes in the third trimester is the stress of the reality of pending motherhood and the large size of the uterus. There is also the fear and uncertainty of labour pains.

Even though there is a lot of psychological strain on pregnant women, fortunately only a few of them come down with frank mental disorders. Even women who do not come down with frank mental disorders should receive psychological support from the medical staff, relatives and friends.

Post-Partum Mental Disorders

Post-partum mental disorders can be categorized into three:

i) Maternity blues

ii)Puerperal psychosis.

iii) Other depressive disorders.

References:

Page 313 to 315, Chapter 36 .Psychiatric Aspects of Obstetrics Practice. Textbook of Obstetrics and Gynaecology for Medical Students -Volume 2. 1st edition by Akin Agboola et al.

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