Information on popular complementary and alternative medical topics

Childbirth is a dramatic event, an intensely emotional occasion. It is a time of great physical and hormonal change, and of psychological readjustment. Psychoanalysts have called it a ‘maturational crisis’ – a woman’s abrupt transition from girlhood to motherhood, often bringing to mind previously unconscious recollection of the mothering she herself received. For the couple, it is a time of domestic and social upheaval and reassessment of roles. Such factors may have a profound effect on sexual feelings, which providers of contraception need to understand if they are to meet fully their patients’ individual needs.

As with any major event, the immediate effect of childbirth is one of shock; in this case usually succeeded by a need to care for and bond with a new baby. The woman’s ability to cope with the experience will depend on several important factors, namely the physical and psychological severity of the event itself, her personality and past experience, the fulfilment or otherwise of her expectations, and on the relationship she has with her partner.

*160/197/1*

read comments (0)

The decisions of this couple regarding a pregnancy and the chosen method towards success had been made outside the medical setting. They made their own choices, showing that doctors can provide every type of counselling for couples, but they will only be able to use what is comfortable for them. Counselling is a two-way process and no-one can be forced into sharing their anxieties.

*123/197/1*

read comments (0)

There are certain basic differences in counselling a woman with an unplanned pregnancy compared to other counselling situations (Coles, 1983). First, there is a definite time limit. If the woman is contemplating abortion, this is safer and easier if performed before about 12 weeks’ gestation. As it can take some time to organize a hospital appointment and a bed, this may result in little time for discussion between diagnosis of the pregnancy and arranging a possible abortion. Sometimes it is better to make the arrangements first and then allow time for counselling, cancelling the appointment later if necessary.

Second, a decision has to be made. One would normally not advise anyone to make an irreversible decision at a time of great stress, yet if the pregnant woman avoids making a decision, a baby will arrive. A further problem is that the doctor has the legal power to agree or disagree to an abortion. Some women may resent this power, or feel they have to give a good enough story to convince the doctor, thereby making it difficult for the doctor to know what they really feel. For this reason, many clinics have nonmedical counsellors. The doctor can diffuse this situation, however, by making it plain at the beginning that he or she is willing to arrange an abortion and then allowing the woman time to discuss her feelings.

*86/197/1*

read comments (0)

A man might agree to a vasectomy under pressure from his wife because she is angry at her years of contraception, and feels it is his turn now. He may even feel he is being sacrificed, but cannot resist without being thought selfish, or because of a strong need to please her. Either might see the sacrifice as a solution to, or a punishment for, a problem which is not directly one of contraception – sexual, marital, financial and so on. In this case, sterilization can be seen as part of a marital battle, and not purely a contraceptive choice.

However, where this method is chosen for good reasons, the balance for the couple is clear. They exchange total medical control of the operation, plus some discomfort, for a future sexual life completely free of any interference from doctors, no matter how well meant or caring.

For both patient and doctor, the choice of contraceptive method is a question of balancing the wanted effects against unwanted ones. For the doctor this may seem a medical decision, but it is far more complex to the user. A desire for privacy, a conscious or unconscious fear of artificial interference and an added zest to sex if a pregnancy is possible, even if not wanted, are rarely discussed in the family planning clinic. For the patient, the need to be in control of one’s sexual life is weighed against the undoubted benefits of modern contraception with the consequent medical intrusion. The health professional who understands this hidden agenda can offer care in its true meaning.

*49/197/1*

read comments (0)

A common human tendency is to project negative feelings outwards, often onto those who are seen to be in authority. The contraceptive doctor may be the recipient of negative projections when he is seen as the agent of social control, preventing what comes naturally and making value judgements about the reproductive behaviour of others, ‘stopping all the lovely babies’ as one woman put it. Alternatively, the doctor can be blamed when medical methods fail, especially when the patient has wanted the doctor to take control, and to somehow save her from her own muddle and failure.

The conflict within the individual, presenting as a contraceptive difficulty, may turn into a kind of fight between the patient and the doctor. The patient takes up an extreme position and somehow forces the doctor to take an opposing one. If the doctor can recognize that such a fight is taking place and remember that it is a product of the internal problem (no easy task in the middle of a fight!) some understanding and resolution may be possible. Thus the doctor might say, ‘You know, I’ve been wondering whether this argument we seem to have got into is something to do with different parts of you disagreeing. There seems to be that part of you saying you don’t want to get pregnant struggling with the part of you that does, so that on the one hand you do want a reliable method of contraception while at the same time anything I offer is rejected.’ This may free the woman to explore her dilemma more openly with herself.

*12/197/1*

read comments (0)