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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 6
Track #6 - 'The Thing to Do' - Helping Clients Choose Termination or Acceptance with Unplanned Pregnancies

CEU Question 6 | CEU Answer Booklet | Table of Contents
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs, Nurse CEUs

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On the last track, we discussed loss and depression.  This has included mothers who lose mothers and the confluence of causes regarding depression.

Do you have a client whose partner disagrees with her about keeping the baby? 

On this track, we will discuss unplanned pregnancy.  This will include when partners disagree, the acceptance technique and termination.  As you listen, think of your client.  How do you respond?

Anxiety, as you may know, is one of the ways depression frequently manifests in women, and depressive illness marked by anxiety is also likely to show itself when a woman becomes pregnant when it isn’t planned.  The depression that is sometimes attendant upon unplanned pregnancy can be described as the function of a life interrupted or simply derailed.

Unplanned pregnancy is one of the greatest risk factors associated with postpartum psychiatric problems.  Despite the fact that unplanned pregnancies are sometimes associated with women of low economic or educational level, any woman, no matter her situation, can find herself unexpectedly pregnant either because her contraception failed or because she was simply careless.

2 Factors of an Unplanned Pregnancy

Share on Facebook #1 When Partners Disagree
First, let’s discuss when partners disagree.  Many women aspire to complete their higher educations and to have careers outside the home.  These women may expect to plan their pregnancies at times when it is most convenient and least likely to interfere with other aspects of their lives.  When a woman like this becomes pregnant accidentally, it can be a tremendous disruption, and her distress can easily lead to the onset of depression. 

One might think that having relatively easy access to legal abortion would alleviate rather than exacerbate the problem of what to do in this situation.  In reality, however, making that decision can, in and of itself, create the emotional climate that puts a woman at risk, particularly if she and the child’s father disagree.

Reesa, for example... was in a relationship with a man totally driven to achieve advancement in his career.  When I met Reesa, her first child was seventeen months old.  Reesa told me that the pregnancy was unplanned, but that her partner, Riley, had reluctantly gone along with it because he thought it was "the thing to do," and they had planned to be married once the baby was born.  Now, however, Reesa had accidentally conceived again, and Riley, who was furious that she’d refused to terminate the pregnancy, had packed his bags and left.

When Reesa came to my office, with her daughter Sarah, she was terrified and cried throughout the entire session.  Although Reesa had initially been hopeful that Riley would return, she hadn’t heard a word from him and was now suffering bouts of insomnia and nightmares about her worst fears having come true.

In Reesa’s case, this second unplanned pregnancy had destroyed her relationship and the family unit she’d hoped to establish with Riley.  What is your agencies protocol for referrals or prescribing anti-depressant medication? 

Share on Facebook Technique: Acceptance
After several sessions of discussing referral of various social services available and Reesa’s condition had stablizied Reesa expressed concern about parenting her toddler, Sarah, considering she was so overwhelmed with her own feelings.  Reesa asked, "How can I take care of Sarah if I can’t even take care of myself?!  Riley rejected her at the same time that he rejected me!" 

To help Reesa feel more in control as a parent, over the course of several sessions I suggested that she try an acceptance technique.  I stated, "You may want to validate Sarah’s feelings about Riley’s absence too, and also continue to encourage her to express her feelings."  I explained to Reesa that helping Sarah accept the situation meant recognizing and respecting the differences between her needs and Sarah’s needs. 

I continued to explain that by letting Sarah develop a well-defined sense of self, with good personal boundaries and self-esteem, she could develop a sense of her own emotional and physical space that could be carried into adulthood.  Reesa asked, "How can I take steps to help Sarah develop her sense of self while I’m going through this?" 

I stated, "You can continue to offer Sarah your love, patience, understanding, empathy, praise acceptance, and a sense of self-worth.  You can continue to give Sarah opportunities for learning and mastering skills and provide her with a true standard of reality.  You can accept who Sarah is as an individual and encourage her expanding independence.  Last of all, you can help to prepare Sarah for life, instead of protecting her from life."

A year later, Reesa had accepted her situation and had a flourishing relationship with Sarah, she was still receiving counseling and continuing to take medication.  Although Reesa was able to put her life back together, it would never be what she had hoped before her unplanned pregnancy knocked it off its track.  In Reesa’s case, she decided to go through with her pregnancy, but sometimes the choice is termination.

Share on Facebook #2 Termination
Second, in addition to when partners disagree and the acceptance technique, let’s discuss termination.  Recently, I saw Jodie, a professor who had been shocked to learn that she’d conceived at the age of 42.  Jodie was already the mother of two little girls, ages five and seven, and had experienced postpartum depression after each of those pregnancies.  She was stable on antidepressant medication, happy with both her children and her work, and terrified of going through another pregnancy. 

After evaluating all the pros and cons, she and her husband, who was also a busy professor, made a mutual decision to terminate the pregnancy.  A month afterward, when I saw her again in my office, Jodie said, "The choice I made was a difficult one; I agonized over it for days on end.  I can’t tell you whether I will regret this later in life, but for now I feel relieved."  In this particular case, Jodie had carefully considered her options and felt she had made the right decision.

Clearly, when a pregnancy is unplanned, the expectant mother always has a choice, whether to go through with the pregnancy or to terminate it.  For some women, of course, they feel there will be no choice.  There are many who for moral, religious, or other personal reasons simply wouldn’t consider termination.  But then they are left to cope with this unexpected disruption in their lives, and even if they truly want the child they are carrying, the stress of dealing with what will surely be an unforeseen complication can sometimes trigger depression.

Do you have a Reesa or a Jodie?  Might she benefit from hearing this track? 

On this track, we have discussed unplanned pregnancy.  This has included when partners disagree, the acceptance technique and termination.

On the next track, we will discuss undiagnosed depression and when depression leads to addiction.

Online Continuing Education QUESTION 6
Why is unplanned pregnancy one of the greatest risk factors associated with postpartum psychiatric problems? To select and enter your answer go to CEU Answer Booklet.

 
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Postpartum Depression: Diagnosis and Treatment

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