Becoming Parents and Overcoming Obstacles: Understanding the Experience of Miscarriage, Premature Births, Infertility, and Postnatal Depression

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There are many books that deal with pregnancy and maternity, and a large number of magazines and articles on paediatric nursing that examine these subjects from different points of view. This volume is not a manual and is not intended to explain to future parents what to do and what to avoid. The objective is rather to look at the most significant and problematic aspects of this delicate phase of a woman's life and that of a couple. It seeks to offer a key to understand the deep significance and complexity of the path to follow to become parents and to face fears linked to the difficulty of procreation, using the tools of observation and psychoanalytic listening. Reviewing several experiences of clinical work, the authors offer reflections on the personal experiences of women and couples and the difficulties which can be met when the desire for a child is disappointed. A maternity and parenting project can be frustrated by miscarriages and encounter the fear of infertility. How are the problems of sterility or spontaneous abortion experienced? What are the consequences on a psychological and emotional level for parents and within the relationship with the child who is born after these painful experiences? The authors deepen some problematic issues, describing ways of intervening with the important preventive aim of avoiding that the suffering of the parents compromises the emotional development of the child. The central idea of this work is that it is possible to get over a difficult beginning or relationship and that unresolved problems can be renegotiated at every stage of development. It is possible to recover from a moment of misunderstanding and disharmony within a couple and promote the development of the relationship between mother and child. The authors have tried to show how the bond between them is formed in the absolute uniqueness of every relationship, facing the inevitable human limits which ensure that nothing is perfect. This study is intended above all for parents, but naturally also for psychologists, doctors, gynaecologists, obstetricians and paediatricians, who can consider the complexity of these experiences from a new point of view.

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Chapter One - A Paradoxical Pain: Recurrent Miscarriage

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Emanuela Quagliata

Despite a growing interest in matters regarding pregnancy and infertility, the impact of a woman's emotional response to the traumatic event of her previous miscarriages during a current pregnancy has received little research attention, although the broader category of stillbirth has been the subject of many studies. The existing literature has identified various emotional states associated with the interruption of pregnancy but seems to lack a deeper understanding of a meaningful connection between them.1

What particularly struck me was the degree of distress and the depth of loneliness that this event, so invisible from the outside but so traumatic and present inside, could elicit in the couples I met. As happens when a couple faces the news of the death of a baby that is already born, the moment of the negative ultrasound result represented the end of all the parents’ unconscious fantasies about their unborn child and the collapse of all their plans, dreams, and hopes for the future of their child and their family: this reality was often faced in total isolation.

 

Chapter Three - Emotional Turmoil around Birth

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Hendrika C. Halberstadt-Freud

The time before and after the birth of a baby is heavily loaded with emotions. Especially with the first child, as a relationship of two persons becomes a threesome. Great adaptations are required of both partners. The mother is preoccupied with her baby and the father might feel excluded. The young mother can feel trapped in a situation from which no turning back is possible. “Once a mother always a mother” makes her anxious. A man can walk away, a woman can't as easily. A mother will harbour many fantasies and dreams about the unborn baby. She might be more exuberant or more anxious, for a large part depending on her relationship with her own mother. Being a mother transcends the generations, as styles of mothering are transmitted from mother to daughter. The puerperium, meaning the period around being pregnant and giving birth, implies risks as well as chances to find a new equilibrium. When emotional problems do arise, the possibility exists to reconsider many feelings as the sluices are open during the time around birth.

 

Chapter Four - Parenting the Next Child in the Shadow of Death

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Marguerite Reid

Little has been written about the experience of mothering or parenting a child when the new baby's birth follows a previous perinatal death. It is a topic that many people do not wish to think about. For some parents however, this is their experience. The feelings that are stirred up when a new baby follows a previous loss are complex; there is obviously joy but for many parents memories associated with the loss are still raw and undigested. Instead of feelings of pleasure and delight associated with a welcomed pregnancy, parents often struggle with a number of fears and concerns that do not necessarily lessen following their new infant's birth. If there are other children in the family, they too have worries and anxieties about the new baby.

In this chapter I will focus on the experience of both parents when they lose a baby and the way they describe their feelings about the conception of their next infant. I will then describe the difficulties some mother's encounter during this pregnancy and following the birth. Although I am focusing on perinatal death,1 some of the details I write about may be helpful to parents who have lost an older child. In the second part of the chapter I will consider the difficulties experienced by some children when their birth follows the death of a baby or child.

 

Chapter Five - “Opening Shut Doors”—the Emotional Impact of Infertility and Therapeutic Issues

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Joan Raphael-Leff *

“You know”, says my patient Melissa, after trying to conceive for almost a year, “for a long time it wasn't that important to me to have a child. In fact earlier in my life I positively didn't want one, but now the desire is so intense it takes my breath away. The world is full of other people's babies. I also took it for granted I could just become pregnant. But why am I being denied?! I'm not asking for something unreasonable—incredible yes, but not unreasonable…”

This chapter addresses the emotional turmoil experienced if heterosexual partners repeatedly fail to become a mother and a father, when ready to do so.1 Childbearing may indeed seem “incredible” yet the “reasonable” nature of the desire to be a parent (expressed by Melissa above) is echoed by the World Health Organization's charter recognising “the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children”. I will suggest that our sense of entitlement is embedded in a tacit assumption from early toddlerhood that we each have a natural capacity to make babies. Our “generative identity” in childhood and adolescence contributes to the emotional significance of infertility when it strikes in adulthood.

 

Chapter Six - Overcoming Obstacles

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Lisa Miller

The foregoing chapters have been about difficulties—serious difficulties—which some parents encounter in the lives of their babies. I should like to put this in perspective by doing two things: by thinking about the ways in which life puts obstacles in the way of everyone, and about how we overcome these obstacles; and also by considering how psychoanalytically informed intervention can help these natural processes to progress and develop. For while it is helpful to think about precise difficulties and the problems they bring, it is also helpful to remember that we can locate them in a wider spectrum, too—the spectrum of experience common to us all. As a young mother who had given birth unexpectedly to a Down syndrome baby said, when confronted by what she felt was too much professional advice: “I thought I'd just like to get to know my baby in the ordinary way first”. This chapter is about overcoming obstacles in the ordinary way, remembering that this process is part of everyone's life, that no life is without difficulty and that few are without tragedy.

 

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