Pregnancy and Childbirth

Pregnancy is often regarded with excitement, but no matter how eagerly a child's birth is

anticipated, stress  and other forms of emotional distress are still likely to occur during the

challenging period of pregnancy. Pregnancy issues may be mild or serious, but they can affect

the health of the mother or child, put strain on a romantic partnership, and lead to life changes,

both predicted and unpredictable.

When concerns that arise during pregnancy or after birth cause distress or otherwise affect

one's mental health, the support of a therapist or other mental health professional  may be

helpful. 
CHALLENGES ASSOCIATED WITH PREGNANCY AND BIRTH
Though pregnancy can be challenging for both parents, in many cases the pregnant woman

experiences the greatest amount of strain. A single mother may experience even higher levels

of emotional distress, as single mothers may often lack help and support.  Pregnancy proceeds

smoothly for many women, but even an "easy" pregnancy may be accompanied by some mental or

physical concerns, and many mothers-to-be experience stress or anxiety  regarding the health of their

child, the impending birth, or the variety of complications that can occur with pregnancy. These worries

may be mild or severe, but the stress they can cause may lead some women to experience

increased physical or mental strain, depression , or poor physical health, all of which may lead

to increased risk in childbirth. 

Pregnancy can put strain on a partnership, especially when a pregnancy was unplanned and

partners have different goals. When one partner desires children and the other does not, for

example, differing views about the outcome of the pregnancy may affect

the relationship  significantly. Even when both partners wish to have a child, being unprepared

for the child's arrival financially or in other ways may still be a cause for  concern. When a

couple has unaddressed or unsolved relationship issues, their partnership may be further

tested by the varied challenges of childrearing. If one or both partners is ambivalent to the idea

of parenthood , having a baby may have a negative impact on the relationship, especially when
other strains or stressors are present. Discussing any issues or parenting disagreements before

pregnancy or before the child arrives may help a couple to become stronger, both as partners and as
parents. 

Financial issues  can also be a source of distress during pregnancy. Recent figures show that

the combined cost of pregnancy-related services and childbirth in the United States averaged

$32,000 for a vaginal birth and $50,000 for a cesarean birth (birth by C-section). These rates

are the highest in the world. Because of the high cost attached to childbirth, many women who

become pregnant may find themselves experiencing stress or anxiety as a result of impending

medical bills. While some insurers may cover a significant portion of childbirth costs,

other insurers may pay little to nothing, leaving families responsible for extensive and

unexpected medical bills that frequently include charges for unused items or unnecessary

services. 

The physical challenges that often accompany pregnancy can also be difficult for many women
to cope with. Morning sickness, aches and pains, fatigue, insomnia, and indigestion are just a

few of the concerns that a pregnant woman may face. Women who contract illnesses  while

pregnant can be more severely affected by symptoms and may have a greater risk of

complications, the most severe of which are birth defects or fetal death. In order to prevent
certain birth defects and foodborne illnesses, a physican will typically recommend certain dietary

restrictions to women who are pregnant, such as the avoidance of alcohol and raw

or unpasteurized foods. Beyond these restrictions, some women may find it difficult to eat a variety of

foods, due to morning sickness or other pregnancy-related stomach concerns. 

Some women may have the opportunity to choose their own doctor or midwife, but many

women are not able to do so and find themselves with an overburdened or distant health care

provider or one who is difficult to connect with. This can make necessary doctor visits another

source of distress, and some women may avoid essential care as a result. A therapist or

counselor may be able to help women in this situation connect with a different doctor or clinic, if

possible, and may also be able to help those in this situation explore other possible solutions. 

PREGNANCY AND MENTAL HEALTH CONCERNS

While pregnancy often elicits many positive emotions, it can also cause a woman to experience

negative thoughts and feelings. During pregnancy, past family  issues, insecurities, relationship

difficulties, and financial issues can become real and immediate concerns. A woman who is

expecting may find herself experiencing mood swings , fear , anxiety, forgetfulness, or body

image  issues. Women who experienced depression or anxiety before becoming pregnant may

be more likely to experience mental health concerns during pregnancy. When mental health

conditions do occur during pregnancy or postpartum, a woman's doctor will generally be able to

provide referrals to mental health professionals as well as immediate health care and support.  

Because some psychotropic medications can have harmful effects on developing fetuses,

women who are taking these medications and discover they are pregnant or intend to become

pregnant are advised to contact their doctor and mental health care provider. In some cases,

another medication is prescribed, and in others, a woman may receive an alternative form of
treatment for the duration of the pregnancy, such as therapy only. This may not be effective for

all individuals, but a therapist's help and support can help each woman find the right option for

her. Some mothers who have mental health concerns may become anxious when considering

the possibility of passing their illness on to their child, but information and resources obtained

from a health care professional may be helpful at addressing their concerns. 

Societal expectations of pregnant women and new mothers may lead many women to

experience anxiety or stress. Well-meaning individuals—family, friends, or even strangers—

may criticize the practices, diet, and weight gain (or lack thereof) of pregnant women and may

often offer unsolicited opinions or advice. Some women may experience irritation,  anger , or

frustration as a result, but others may come to doubt their own ability to be good mothers.
Soon-to-be parents may turn to parenting books or other sources of advice and become

overwhelmed by conflicting opinions on the best or safest options for delivery.  

Symptoms of mental health concerns are the most common complication of

childbirth. According to research:

 Between 15 and 20% of women experience clinically significant anxiety or depression

after childbirth.

 Two thirds of mothers diagnosed with severe postpartum depression  began

experiencing changes in mood during pregnancy.

 Sixty percent of mothers with moderate postpartum depression had pregnancy

complications such as gestational diabetes.

 Stress experienced during pregnancy, especially posttraumatic stress (PTSD)  has been

linked to premature birth, low birth weight, and risky behavior (such as drinking or

smoking) during pregnancy. 

 Many women experience "baby blues ," or a period of low mood and tearfulness, for a

week or two following childbirth. These feelings generally resolve with the support of

one's partner or family. When they do not resolve or include hopelessness , negative

thoughts about oneself or one's baby, or a loss of appetite, a more serious condition may

be indicated.
 Postpartum psychosis is rare but serious: The condition is characterized by delusions,

rapid mood swings, paranoia , and hallucinations  and carries a 5% rate of suicide and a

4% rate of infanticide. Symptoms generally appear suddenly, within two weeks after

giving birth. 

IMPACT OF BIRTH ON EMOTIONAL HEALTH

It can sometimes be difficult for parents, especially new parents, to become accustomed after

the birth of a child. A difficult birth can leave both parents emotionally and physically fatigued,

and it can be difficult and stressful for parents to adapt to new roles and responsibilities. Some

partners of women who have just given birth may wish to offer support but provide either too

little or too much, thus straining a partnership that may already be challenged by the new baby.

Both the mother and her partner may experience fatigue or have trouble sleeping, due to the
demands of a newborn, and this lack of sleep may lead to a lowered immune system,

increased irritability , and stress. While it is often possible for a couple to communicate their

issues and work through them together without outside help, often professional support is

beneficial to this process. 

Some women who have just given birth may find it difficult to accept that certain aspects of

pregnancy and delivery did not happen as expected. A mother who carefully designed a birthing

plan but was unable to use it due to medical complications may experience regret that the birth

did not go the way it was planned. Women who have a difficult recovery may feel frustrated by

their inability to do things for themselves or find it difficult to cope with pain and fatigue. Some

women who are unable to breastfeed may experience feelings of failure or frustration and

become stressed or experience symptoms of depression as a result. 

When a child cannot be carried to term, is stillborn, or is discovered to have a fatal or life-

threatening birth defect, this can cause significant grief  that, if untreated, may lead to mental

health concerns such as depression. Telling family and friends about the death of an infant

instead of announcing the birth may be an exceedingly difficult task that can have a lasting

impact on parents, especially the woman who carried the child. Therapy can help address and

treat feelings of grief. 

THERAPY FOR PREGNANCY AND BIRTHING CONCERNS
Pregnancy, childbirth, and childrearing can all be difficult, even when everything proceeds

without significant upset. Parents who have a strong bond and the support of others may still
face unavoidable health or financial challenges, among others, which can significantly strain a

partnership. The support of family and friends is considered by many to be an essential aspect

of the well-being of new parents, especially new mothers. 

Therapy can help expectant mothers, women who are facing postpartum concerns, and the

partners of these women to address the various issues that pregnancy and childbirth are likely

to cause. Women who experienced mental health issues before pregnancy may fear that the

added challenge of motherhood will exacerbate their conditions or cause further concerns to

develop, but the support of a therapist or counselor throughout their pregnancy may help them

feel more at ease. Women who experience postpartum depression or psychosis may find that

that therapeutic treatment, combined with medication when necessary, has a beneficial effect.  
The type of therapy used will generally vary based on the concerns a woman is experiencing.

Some women find the stress of motherhood and new responsibilities to be difficult to handle,

and voicing their concerns in a support group to others in the same situation may be helpful to

them. Those experiencing depression or anxiety may seek individual therapy.  Couples

therapy  can also be helpful when a couple finds that a new baby has placed added challenges

and stresses on their relationship. In therapy, couples can voice concerns or areas of

disagreement and resolve any issues in their partnership. 

Parents or single mothers who lack assistance and support may also be able to seek resources

and find help developing a support network in therapy. In any case, a therapist will be able to

offer resources and help for those experiencing difficulty. 

Grief counseling, typically recommended after the loss of a child, can help parents come to

terms with their loss, cope with their grief, and prepare to try again, should they wish to do so.   

REDUCING STRESS IN PREGNANCY

Stress reduction is considered to be one important way an expectant mother can achieve better

health and prevent certain complications. The causes of stress during pregnancy are often

varied. A woman may become stressed as her body begins to change, as she experiences the

effects of pregnancy-related hormones, or as a result of anxiety or fears about pregnancy and

childbirth. Individuals who experience negative or catastrophic life events during pregnancy
or who have chronic stress, PTSD, or other mental health concerns may also experience greater levels

of stress during pregnancy. 

A health care professional will likely advise a woman experiencing stress to cut back on

stressful activities, stay healthy and fit by eating nutritious foods and keeping as active as

possible, maintain a support network and keep in contact with friends and family, seek and

accept help when needed, participate in childbirth education classes, and take up relaxation

techniques such as prenatal yoga or meditation . Professional help from a therapist or counselor

may also be recommended. 

PREGNANCY LOSS
Stillbirth and miscarriage are two pregnancy complications that lead to fetal death. Miscarriage

is pregnancy loss occurring within the first 20 weeks of pregnancy, while a stillbirth occurs after
20 weeks. About 1 in every 160 pregnancies will end in stillbirth, and between 10% and 25% of

all clinically recognized pregnancies will end in miscarriage. Up to 50% of all pregnancies end

in miscarriage, but a number of these occur before the pregnancy is recognized.  

Miscarriage and its causes are often misunderstood and stigmatized . In most cases, the cause

of a miscarriage cannot be determined. Some possible causes include chromosomal

abnormalities, hormonal concerns, improper egg implantation, maternal age, and exposure to

toxic substances. Stillbirth is somewhat more understood than miscarriage.  Its causes, which

include placental problems, birth defects, restricted fetal growth, and bacterial infections,

among others, can more often be determined.   

Pregnancy loss can lead to complex emotions, such as grief, shame, guilt, and isolation. Some

of those who have experienced pregnancy loss believe they could have prevented it, but this is

not often the case. Because pregnancy is not yet apparent in many of those who have a

miscarriage, many feel isolated following this loss. Experts say acknowledging the pain and

loss, and having it acknowledged by others, can help reduce these feelings and allow the

processes of grieving and healing to take place.

CASE EXAMPLES
 Therapy to help resolve uncertainty regarding unplanned pregnancy: Tonia, 27, enters

therapy with symptoms of stress and depression. She has recently discovered that she

is pregnant and is unsure of what to do. The father has no interest in helping her raise

the child, and she tells the therapist that she does not want to give the baby up
for adoption  or have an abortion . But because she is unmarried, single, and does not

have many resources, she thinks one of those choices may be best and is distressed as

a result. Tonia tells the therapist that has been unable to sleep well or focus on her work,

as she constantly cycles through her options in her head and dreads having to make a

choice. The therapist helps Tonia list all of the options available to her and visualize the

best and worst outcomes for each option. Together they address Tonia’s values and

goals for the future. Tonia reveals that she has not yet told her parents, although they

have a fairly close relationship and she visits them often. The therapist encourages her

to do so, and Tonia returns for her next session with the news that her parents want her

to return home and raise the child with their help. Tonia has mixed feelings about this, as
 she did not want to become dependent on her parents again, but she tells the therapist

that it is the best option for her.

 Relationship difficulties after difficult birth: Alejandro, 32, and Desiree, 28, enter couples

therapy shortly after the birth of their first child. Desiree expresses anger and frustration with

Alejandro, who she says does not help out around the house enough, spends time with his friends

instead of helping with the baby, and "is not supportive." Alejandro protests her claims, saying

that he does whatever he can to help her and offers to do more, but that she snaps at him for not

doing things correctly and tells him to just "go out" and leave her alone. He tells the therapist

that Desiree had a difficult birth and that she expresses discontent with her inability to exercise

and move easily and that she is disgusted with her post-pregnancy figure, although he thinks she
is "more beautiful than ever." Desiree states that she feels unattractive and that she knows

Alejandro does not want to be intimate with her. He disagrees, saying that he only wanted to give

her time to recover after the birth. The therapist encourages them to communicate their feelings

to each other. Through discussion, he discovers that Desiree is still distressed that her doctor

insisted on a C-section when she wanted to give birth manually and that she fears having a scar

and being unable to regain her pre-pregnancy body. Desiree admits that she experiences feelings

of anger and frustration with Alejandro, who experienced no bodily changes or pain, although

she recognizes that it is not his fault. Alejandro apologizes for being unable to entirely

understand what Desiree is going through, and the two begin to be better able to communicate

their feelings and understand each other. They continue in therapy for a few more sessions,

exploring ways that they can better support each other and strengthen their marriage. 

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