Discussion points 1. What are the implications for you as a couple in becoming a family: personal, emotional, financial, career choices?

2. Timing: when would you like to start trying to conceive? You may wish to discuss what you would do if it doesn't all go to plan.

3. How long do you imagine it might take to get pregnant? How would you feel as a couple if it took one month, ten months, or three years?

3.The stages of pregnancy

Introduction.

Mostly couples like to keep the news of their pregnancy to themselves, or a select few, for the first few weeks, hoping to have some time to adjust to their new situation before having to communicate it to others. The wish is often therefore to just 'carry on as normal'. However, many women find themselves unprepared for the intense physical and emotional changes of the early days of pregnancy. Only a minority of women 'don't feel any different'; a significant number will feel exhausted, at times nauseous, possibly vomiting. Many are upset easily, tearful, anxious or irritable and generally 'not themselves'. Pregnancy for every woman is different and every pregnancy is unique. Even if you have been through it all before, this doesn't necessarily make a subsequent pregnancy any easier or any more predictable. For the father-to-be, there are not the intense biological signals to remind him of the baby's existence, so life may seem just the same as ever. It can, therefore, be difficult for him to understand what his partner is going through. He may feel unsympathetic to a partner who was rushing to get pregnant and who now is losing their temper at every opportunity. Alternatively, now you are pregnant, you may feel terrified by the pregnancy and find it difficult to understand how your partner is carrying on as if nothing has changed. For both parents-to-be it may be a time of intense anxiety and self-doubt about becoming a parent. The news may highlight difficulties in the relationship, particularly where there may have been thoughts of, or actual separation, in the past.

As the pregnancy progresses, most women move into a mid-phase, which is often characterised by feeling well, often exceptionally so: 32 mothers are often described as 'blooming'. Whether this is primarily a physical change is not clear, but feeling well does allow time for a shift in focus where parents can start preparing for the baby. This might mean practical things like shopping for prams but it may also allow time for pondering more complex emotional changes: how will I cope with a tiny baby? What will it be like having another person within our relationship: how will three work? However, having accepted that you are pregnant, with birth still a way off it can be possible to 'get on with things' almost as you did before.

Often there will be a third phase, where, as the pregnancy starts to draw to an end you may start to feel more tired. Sleep often declines.This can be explained by increasing physical discomfort but this is also a time for a return of fears and anxieties that may have subsided mid-pregnancy.

Often fears focus on labour and birth, or, coping with the baby. Many fathers may not have felt these anxieties early in the pregnancy and may have been in the role of rea.s.suring their partner.The obvious imminence of the birth may be the first point at which fathers-to-be recognise that their life is to change irrevocably too!

This chapter will look at the feelings, emotions and events of pregnancy and how these may change over the course of 40 weeks. It will also consider the changing roles for the mother-to-be and father-to-be. For some women pregnancy is a very difficult and unhappy time. They may have been depressed before becoming pregnant; they may be struggling with an eating disorder or unhappy in their relationship.We all enter pregnancy from a unique place.The next chapter will move on to consider the experience of significant emotional problems in pregnancy.

The first few weeks : fears and acceptance Will I feel like this for the whole nine months?

Pregnancy consists of three trimesters that are each about 13 weeks long and represent significant stages of the development of the baby. However, it is also possible to think about pregnancy as having three psychological phases, roughly overlapping with trimesters.The early weeks tend to focus on coming to terms with being pregnant and the fears and anxieties that may arise, coupled with the physical changes that can be surprisingly debilitating. Mid-pregnancy can be a more task-focused time as women feel better physically, time is spent in making preparations and plans for the baby. Towards the end of pregnancy fears, especially about labour, The first few weeks: fears and acceptance 33.resurface and physical discomfort increases for many, as does a sense of wanting the pregnancy to end.

Not all women will experience these phases, one after another, but the issues raised are common to many pregnancies. The emotional journey through pregnancy can be looked at through the three stages outlined above.

'I just don't believe it': accepting the reality of the pregnancy The early weeks of pregnancy can be awful, they can be exciting and feelings can change from one moment to the next. You may have been euphoric on discovering that you were pregnant, you might have been uncertain or you might have felt devastated. For most couples there is some ambivalence about what is happening, even in a pregnancy that was longed for. Very often the initial reaction to the discovery that you are pregnant may be surprising and disappointing. Once you are pregnant, everything can seem different. It is easy to be 100 per cent certain that you want a baby when you are trying to conceive but once you are pregnant, this certainty may be replaced by many fears. If your thoughts have been focused on getting pregnant, it may be only now that you are starting to wonder about how you will cope with a tiny baby. If the pregnancy has come as a surprise, then the sense of being unprepared or that this baby is an unwanted intrusion can be intense.

'I just don't want to believe it'

It is not unusual, especially in the early weeks of pregnancy, for women to feel negative feelings towards the baby: to feel intruded upon, to feel that you don't want this baby inside you. Some women may at times wish that the baby would miscarry or convince themselves that there has been a mistake with the pregnancy test. These sorts of feelings are seldom mentioned because women may be horrified by them; they think they are a terrible person for having such thoughts and fear that others will consider them a 'bad' person. But these feelings are not uncommon and having these thoughts does not mean you are going to act on them or be a bad parent. For most women the pregnancy will continue and normally these feelings disappear and are replaced by a different range of feelings and experiences. Men too can experience a range of feelings on discovering they are to become a father.

Their greater distance from the baby (i.e. the baby not being inside them) perhaps allows for a wider range of reactions. They can express 34 their ambivalence by ending the relationship, by avoiding thinking about the baby or by avoiding you.

Avery unfortunate outcome is where women miscarry before coming to terms with the pregnancy and are left with terrible feelings of guilt that maybe they lost the baby because they didn't want it enough.

Christopher and Abigail's story Christopher had been depressed quite severely for three years when he came to see me. He felt he had the perfect life: a good job, two children and a loving wife and yet he was depressed. He did find managing the children incredibly difficult and he admitted that he felt he lost his temper over very minor incidents with the children. However, he tended to become silent and withdrawn, brooding over what had happened and his wife would become totally exasperated with him, saying she had three children to look after. In the course of therapy it became clear that Christopher was terrified of becoming an angry father like his father had been. His depression had been triggered by his wife having a miscarriage. When Abigail had told him she was pregnant, he had 'flown off the handle' declaring it to be too soon, too much to cope with and Abigail had been shocked and upset by his reaction. The baby had miscarried at about seven weeks and Christopher had been consumed with guilt that he 'hadn't loved the baby enough while it was alive'.

Some women may go on to decide that they really don't wish to continue with the pregnancy. It is really important to get help and support on making a decision to terminate a pregnancy. Try to confide in a friend, partner or family member depending on whom you feel will be supportive.

You may find it helpful to approach your GP or a Pregnancy Advisory Service (see the list of addresses on p. 181). Many women have to go through considering termination before they can make the decision to continue with the pregnancy.

'I don't know how to be a mother': fears in early pregnancy Perhaps the other side of the coin or perhaps closely related to feeling negative towards the baby is to feel terribly fearful in early pregnancy: The first few weeks: fears and acceptance 35.will the baby be OK because I drank before I knew I was pregnant? Am I going to put on lots of weight? How do you pick up a baby? Lots of thoughts and feelings may cause both parents-to-be to feel quite anxious early on in the pregnancy or perhaps throughout. There are obviously some activities that should be avoided or foods that should not be eaten (see The Pregnancy Book given to all new mothers) but mostly fears are simply that; fears, part of a.s.similating this new life event. Nowadays we are somewhat bombarded with information in pregnancy about what not to eat or how to lead our lives and sometimes this information can seem contradictory. This disparity can in itself generate anxiety, 'If the professionals don't know the answer, then how can I know what is best?'

Resolving fears involves a number of factors: trying to understand the nature of these fears; getting more information where possible; making changes where necessary but mostly just allowing yourself time to come to terms with your new situation. Of course, fears won't necessarily go away completely, especially if you have a tendency to worry. There are many feelings that are common to this stage of pregnancy and some of them are explored below.

'I'm frightened that the baby won't be 'normal' '

For very many women and their partners there are clearly fears about the health and development of the baby, especially early on in the pregnancy.

This is extremely common and not just confined to first pregnancies. For a small percentage of women these fears are generated by a history of gynaecological or obstetric problems. Clearly if you have miscarried previously or had problems getting pregnant, then the degree of risk involved may become magnified in your mind. But for most these fears tend to be far greater than the actual risk.

Pregnancy in the twenty-first century is perceived to be a far less risky business than it was for previous generations. Alongside this fact we are given much information on how to have a healthy pregnancy: taking folic acid, cutting down on alcohol, and so on.Therefore, when something goes wrong it is not unusual for women to believe that they must have done something wrong. The reality is that the rate of miscarriage is now fairly constant and pregnancy loss or foetal abnormalities are rarely related to the actions of the mother (unless you are a drug user or a heavy drinker).

For most of us, pregnancy progresses without any problems but never-theless if we have transgressed the 'rules', it may cause a great deal of guilt and hence fears that the baby may have been damaged in some way. For some there is even guilt about continuing a s.e.xual relationship during 36 the pregnancy (especially if there is any history of miscarriage). Pregnancy may awaken fears and guilt about previous behaviour such as termination of pregnancy or previous s.e.xual partners.'Perhaps Iwas damaged in some way by the termination', or 'caught some sort of infection' or 'my drinking will cause the baby to be malformed'.The problem with guilt is that it can get in the way of changing behaviour. It is very important to cut down or stop drinking and especially smoking in pregnancy. Guilt can make you defeatist, 'It's too late now, I've been smoking right through the first six weeks.'

For most women these fears will diminish as the pregnancy progresses safely and the first 'contacts' are made with the baby: seeing the baby on an ultrasound scan, hearing the baby's heartbeat and beginning to feel the baby move. It is not unusual for someone who might describe themselves as a'worrier'for these feelings to continue throughout the pregnancy and some degree of anxiety is perfectly normal. For women who have had a late miscarriage or lost a baby at birth, it is not unusual for these fears to be very active throughout the pregnancy or until they have reached a self-defined marker: 'I'll feel alright once I get past 32 weeks or once the baby has been born.'

'I'm just not the 'earth mother' type'

There are clearly fears for most prospective parents about how to be a parent. It is very hard for some to get beyond the belief that parenting is something instinctive not something learned: you either have it or you don't; some women are naturally maternal and some men 'know instinctively' how to be a father. Clearly some people seem to find it easier than others to care for a child but everyone struggles at times. Many women and their partners find it takes time to feel any attachment to, or love for, the baby. But attachment almost always occurs partly through getting to know the baby.

We all have the ability to learn and change and an enormous amount of learning takes place in those early days after the baby arrives: learning to change a nappy before the baby arrives isn't really necessary because after a week with a newborn you will have had plenty of practice. The baby himself will help you to learn as you grow to know him and understand his needs. Babies have evolved ways of getting you to feed them (crying) and getting you to look after them (making eye contact with you, responding to your voice and quite quickly smiling at you).

Other experiences, such as being around other new parents can be amazingly supportive in learning to be a parent. That's not because they know how to do it but partly because you can feel rea.s.sured that everyone The first few weeks: fears and acceptance 37.else is learning too. You will see that not all babies are the same, need the same things or behave in the same way.Therefore, there is no blueprint of the 'right' way to do it. Hopefully it will be a time when you feel able to make mistakes and try things out. Donald Winnicott, an influential psychoa.n.a.lyst and paediatrician, talked about the importance of new mothers being left alone with their baby to find their own natural way with the baby, and that too much interference from professionals and family can be unhelpful (Winnicott, 1988).

So why do some people find it easier than others? It is likely that if you had a very poor relationship with your own mother or father that this may play a part in the sort of parent that you become.That is not to say that you will be a 'bad' parent or 'do it just as they did' but if you have not felt loved and cared for yourself, then you may find having children brings a range of responses and feelings. Having to look after a demanding and needy baby may reawaken feelings of neediness in yourself. In fact, at times all parents will think, 'Well, what about me?' What seems to be crucial therefore is making sure that you have enough care and support now to help you give care and love to your baby. Research clearly shows that post-natal problems are less likely where a mother feels loved and cared for and supported. It is perhaps central to becoming a parent to recognise your own experience of being a child and how that plays a role in your self as a parent.

Jasmine's story Jasmine had grown up in care and had her own baby when she was 17.

When she first came to see me she was sure that her depression would resolve if she could have a breast enlargement operation. She hated the way she looked but believed she would be happier if she was more attractive. In time she began to recognise that she didn't really feel grown up since her own parenting had been so inadequate. Her mother had repeatedly placed her in care when she was small and eventually as a teenager the situation had become permanent and she had had a number of foster families. At 16 she was on her own: she had a baby without giving it much thought but it had made her feel as needy as a baby herself. To Jasmine the breast operation was simply about making herself look more attractive but it seemed also to represent changing herself on the outside to look like an adult woman, which she certainly did not feel on the inside. Jasmine borrowed money and saved up until she could have the operation, which did make her feel better ^ for a while.

38.'I'm terrified of getting fat (and stretch marks and varicose veins . . .)'

For many women there are intense fears about their changing body shape and the toll that pregnancy is going to exert over their body. Clearly one has to accept weight gain, an expanding stomach and b.r.e.a.s.t.s, and possibly permanent changes such as stretch marks and varicose veins. For the growth of the baby in pregnancy, healthy or 'normal' eating is important.

But what is 'normal'and what exactly does 'healthy' mean? Mostly women are advised not to change or increase their diet (we are now discouraged from'eating for two') but this a.s.sumes that you were eating reasonably well before you became pregnant. Research into women's eating behaviour, however, shows that a very large number of young women nowadays restrict their eating.Very many women control their eating very carefully; many do not eat proper regular meals and snack or binge and then miss meals to compensate. Therefore pregnancy might be the first time since you were a child that you have allowed yourself to eat freely.

Allowing yourself to lessen the control over your eating can feel very frightening. Many women hold (erroneous) beliefs that their popularity, confidence and abilities are linked to their weight and how they look.

Therefore, becoming bigger will be very frightening. I cannot count how many times I have been met in therapy with the belief that the only way someone could be more successful/popular /attractive is by losing weight.

Pregnancy therefore challenges these beliefs for some women.

Alternatively, 'losing control' may come as a great relief. It may provide a time of respite from the endless self-denial of dieting. It may offer the opportunity to relearn something about your appet.i.te and what happens to you when you eat certain forbidden foods. Alicia, with whom I worked during one of her many inpatient admissions for anorexia, said that the only time she had ever enjoyed eating had been when she was pregnant as she could imagine that everything she ate went straight into the baby.

For some the fear of weight gain may be grounded, in that many women who are obese date their weight gain to starting a family. Nature has devised women's bodies so that they store fat in order to be prepared for breast-feeding. Many women find that they put on a great deal of weight in pregnancy and therefore general advice tends to advocate control over eating. Clearly, advice needs to be tailored to individual women's situations. If you continue to work to the end of your pregnancy in a physically demanding job, then it is very important to listen to what your body is telling you and eat if you are hungry. If you stop work early and find The first few weeks: fears and acceptance 39.yourself around the home with time on your hands you may find yourself snacking through boredom. For the majority of women the fears are about loosening control over something that they have tried to keep a tight grip on ever since p.u.b.erty. (See also the later section on eating disorders in pregnancy.) 'I don't think our relationship can cope with a baby'

It really is hard for any couple to imagine the impact that a child will have on their relationship. It is fair to say, as was touched on in the last chapter, that relationships change and probably will be strained in ways that they haven't been before. It's probably realistic to have some anxieties in this area but most relationships do learn to adapt and change.

During pregnancy some women fear their changing shape may affect their attractiveness to their partner, particularly that their partner may no longer find them s.e.xually attractive. This can be more acute in the early stages of pregnancy, before the distinctive curves of pregnancy have developed, when a woman may feel that she looks'fat' rather than pregnant. For fathers-to-be there may be issues about their partners changing shape but these are perhaps less common than concerns about changes in their s.e.xual relationship. There is no medical or physical reason why your s.e.xual relationship should not continue as before (unless you have received medical advice to the contrary). However, your or your partner's feelings about s.e.x may change throughout the pregnancy. Some women feel unattractive as they change shape during pregnancy and if this is combined with feeling tired and unwell in early pregnancy, then this can severely disrupt a s.e.xual relationship. This may be quite perplexing for a partner whose s.e.xual feelings remains unchanged or if they in fact find their partner more attractive when pregnant. For some women too s.e.xual feelings increase in pregnancy and some couples may find that their s.e.xual relationship becomes better.

Sandra and Steve's story Sandra had experienced bleeding during the early weeks of both of her pregnancies but went on to have two healthy babies. However, after the bleeding in her second pregnancy she stopped having intercourse with Steve, her husband. Steve didn't question Sandra about this, as he knew she was worried about the safety of the baby. However, a couple of months after the safe arrival of their daughter Steve began to 40 wonder how he should approach the subject with Sandra. When they did eventually discuss it, in the middle of an argument, it became clear that Sandra's reluctance to have s.e.x had had nothing to do with the safety of the baby and was all to do with being convinced that Steve didn't fancy her any more and must be attracted to someone else as he no longer seemed interested in s.e.x with her.

When will these fears go away?

It is perfectly normal to have a number of fears and concerns in pregnancy especially early on. For most women these will subside as the pregnancy progresses and 'being pregnant' becomes part of your ident.i.ty. However, if fears are too persistent or overwhelming, then they can affect your ability to get on with everyday life.This might be a time to look a little more closely at what is generating these problems either through discussion with a partner or friend or perhaps by seeking help from a professional. It may be that a discussion with a GP or midwife will provide information to challenge these fears or through discussion other issues may emerge.

It is important to learn to deal with fears, as they will carry on after the baby is born. As your baby grows and develops, you will still be full of questions about how he is doing. Should he be sitting up yet? Is his weight right? Is he saying enough? So finding a way of managing your fears is important.

'I've just got the job I want and now I'm pregnant': pregnancy as a life event Pregnancy doesn't happen in a vacuum. As was discussed in the last chapter few of us are able to 'perfectly time' our conception.We all start pregnancy from a different place in our lives: at a certain point in our career, in or not in a relationship (or not sure), happy or miserable.These life factors will play a role in how we deal with the pregnancy. Psychological research has shown that our emotional health is affected by the number of life events that we are experiencing at any one time.This isn't just referring to negative events: so if you discover that you are pregnant, decide you would really like to marry before the baby is born and think that you should move out of your flat, then you may find yourself not enjoying or able to cope with these events that you may have always longed for.

The pregnancy therefore arrives into a context and its meaning is affected by the other events that are going on in your life. If you are The first few weeks: fears and acceptance 41.desperately trying for a promotion at work, then even a wanted pregnancy can seem'ill-timed' or 'in the way'. If you are a woman who is not working, then even an unplanned pregnancy may give a new focus to your life. For an unemployed dad-to-be pregnancy could be seen as a further burden in an already difficult situation or it could prove a new, motivating factor in the search for work. For increasing numbers of men it might lead to a complete life change in terms of deciding to become the main caretaker for the baby.

Feeling depressed, irritable or fearful in early pregnancy may have as much to do with the other events in our lives as they do with hormones. It may be that the pregnancy brings into focus a number of life issues: do I want to stay in this relationship? Can I carry on with this stressful job? The problem with attributing everything to'the pregnancy'or'my hormones' is that it can contribute to avoiding decisions and choices that will need to be made. Pregnancy does give some time to work on some of these life issues but only if they are viewed as problems external to the pregnancy that can be solved. Pregnancy, like other significant life events, makes us focus on how we are managing our life and whether we can cope with new responsibilities on top of the ones we already have or whether some things are going to have to change.

'Our baby was a 'miracle' so I must be pleased'

It is not unusual for a couple who were desperate to have a baby, perhaps having fertility treatment to achieve it, to have mixed feelings about the pregnancy. Everyone is ent.i.tled to feel uncertain about having a baby. I have worked with many women who, having had a.s.sisted conception, find it terribly difficult, almost shameful to admit that they have felt anything other than total joy about their pregnancy. India and Chris, who were discussed in the last chapter, struggled with a wide range of feelings during their pregnancies especially the last. India had a deep sense of loss for the twins that had died and felt that she would never really get over the loss. She felt her current pregnancy to be ill-timed and she worried about having the energy to care for the new baby.

However, to the outside world she tried to retain an image of serenity as she felt otherwise people would think her selfish and ungrateful for the child that she did have.

It is important for all parents-to-be to be able to feel miserable, scared and confused at times about what is happening. People around you are probably going to a.s.sume that you are nothing other than happy about the pregnancy, so it may be important to share these feelings with your 42 partner or with a good friend. It becomes particularly important after the baby is born to be able to share your uncertainties and difficulties so now might be a good time to start practising.

'I've done it all before so I must know what I'm doing!'

As has been said previously, every pregnancy is different and just because you have been through it all before does not mean that you will sail through this time, or feel uncertain or ambivalent about the pregnancy.

Second, third or even a fourth time round, a number of issues can make pregnancy difficult. Perhaps the pregnancy was unplanned or just seems to be going too quickly. You may find yourself so preoccupied with your other children and responsibilities that you have hardly a moment to think about and plan for this baby.You may need to make particular efforts throughout the pregnancy to make sure that you get enough time for yourself and to think about the new baby.

So, for both parents there can be much anxiety and uncertainty in early pregnancy. How much you are able to think about these issues is clearly affected by how well generally you are feeling. This, as we have said, is often not the case.

Morning sickness I felt like a piece of delicate china; one small knock and I would completely fall to pieces.

It was like the longest and worst hangover I ever had.

The initial anxieties of pregnancy can, however, be completely over-shadowed by the overwhelming and unpleasant symptoms known as morning sickness. The term 'morning' can be misleading as the symptoms often continue throughout the day. Morning sickness can, of course, start before you know you are pregnant, almost as soon as conception has occurred. It may be what alerts you to the fact that you have conceived.

These early pregnancy symptoms can be quite distressing especially if you are still reeling from the discovery that you are pregnant. Where there are mixed feelings about the pregnancy and thoughts of possible termination, this can be intensely distressing as the sickness brings a constant reminder of the reality of the pregnancy.

Morning sickness 43.The onset of morning sickness can be very sudden. It is not unusual to go to bed wondering why you don't feel any different yet and to wake up feeling like you've been hit by a bus. All manner of symptoms, physical and emotional, can occur in early pregnancy and are explained by the umbrella term 'morning sickness'. The list below features a range of experiences women report: . Tiredness/exhaustion: the tiredness of early pregnancy can be worse than the sleepless nights after the baby is born.Women may find themselves wanting to sleep much longer or more often than usual and yet sleeping may have little impact on the feelings of tiredness and lethargy.

It's not unusual to spend a whole day in bed and still feel tired! This can be very disabling and the early weeks of pregnancy can seem unending.

You may begin to worry: how will I cope with a baby if I can't cope with feeling tired now? Fortunately this malaise does lift as the pregnancy progresses.

. Nausea and vomiting: along with tiredness, the persistent sickness that some women experience can be the most debilitating part of pregnancy. It can affect all aspects of your life, making carrying on with everyday life almost impossible. Despite its debilitating effects it is only in extreme circ.u.mstances that vomiting leads to medical intervention or hospitalisation. There is in fact little that can be done to stop vomiting in pregnancy and most women simply try to endure it and adapt their lives as much as possible, hoping that the symptom will soon pa.s.s.

. Breast changes, feeling bloated and other menstrual-type symptoms.

. Strange tastes, going 'off' foods or cravings. Many women report a metallic taste in their mouths. Cla.s.sically women reject certain foods or develop preoccupations with particular foods. There may be good adaptive reasons why women'crave'certain foods, perhaps their bodies are identifying their nutritional needs. However, the preoccupation often with one item makes this seem unlikely. In extreme cases non-food items such as coal have been the object of cravings, which would be hard to explain in physiological terms.

. Headaches, general aches and pains.

. Tearfulness, angryoutbursts, anxiety symptoms. How much thesefeel-ings are due to hormonal or physical changes is unclear but the issues highlighted earlier in combination with these physical changes make a powerful c.o.c.ktail. Nevertheless at the time these feelings can be confusing for both parents-to-be especially in a planned and wanted pregnancy.

44.Do men get morning sickness too?

Although the physical symptoms highlighted above should be common only to women, it may be that partners too experience unpleasant thoughts and feelings in early pregnancy. The early pregnancy does impact far less on the father/partner and probably he is going to be less troubled now by worries about becoming a parent. However, some may find themselves anxious and confused.Where perhaps this is not understood as 'anxiety', this may result in physical symptoms in the partner. As we have said in relation to women we cannot be sure that all of the physical symptoms of morning sickness are generated hormonally, therefore, worries in the partner may lead to feelings of nausea, headaches and pains, and so on. More often than not, anxiety can lead to behavioural changes or what Psychologists might call 'acting out'.The news of a pregnancy may lead the partner to increase alcohol or drug use. He might stay out more, stay at work later or be more argumentative. Relationships are often delicately balanced in terms of who supports who and if a woman suddenly becomes less able to function because of morning sickness, then a partner may feel uncared for, put upon, frustrated. If the situation was such that the woman was more insistent on becoming pregnant, the partner may feel resentful that the woman has brought all these problems when the situation was fine as it was.

Partners often try to change their behaviour and att.i.tudes when a woman becomes pregnant, especially where there is bad morning sickness or a history of pregnancy difficulties. The partner may start to do more of the domestic ch.o.r.es, he may avoid areas of conflict and try to adapt to how the woman is feeling. This can inevitably lead to tension: if you have done your best to tidy up or prepare a meal and your partner goes straight to bed without noticing, you may find yourself feeling resentful or frustrated. Often the partner finds himself in the role of confused bystander attempting to offer support but feeling totally perplexed by what is going on: 'You wanted to be pregnant and now you are, you're miserable the whole time.'

How to cope with morning sickness There is no clear explanation for what causes morning sickness other than the obvious physiology of early pregnancy. However, nothing has been specifically indicated, such as an excess of a particular hormone, that would explain why some women sail through early pregnancy feeling no How to cope with morning sickness 45.different and others are practically confined to bed for three months! Nor is their any interesting psychological research looking at whether the emotional aspects of pregnancy and the physical symptoms can be managed any differently. This leads us on to consider possible ways of managing morning sickness.

Information about morning sickness What seems quite amazing is the fact that women do cope so well with morning sickness. Clearly if one were to feel like this without an explanation, then we would all be queuing at the doctor's surgery for treatment and probably absent from work. This doesn't seem to be the case. Generally, even with quite debilitating symptoms, women seem to carry on with their lives and don't demand specific help. An important factor therefore seems to be that we have a reason for our symptoms, which suggests that the more we are informed about what is happening to our bodies, the better able we are to cope. It is probably worthwhile at this time finding out what is happening to your body as it may help to put things into some sort of context. Your GP will probably give you some written information at your booking visit that will give diagrams and details of the development of the baby. All women should be given a copy of The Pregnancy Book by the Health Education Authority.

Once conception has occurred, an amazingly complex physiological process gets under way with remarkable speed. By 12 weeks your baby is fully formed, in that it has all its organs, muscles, limbs and bones, although it would not be 'viable' or able to live outside of the womb until at least 24 weeks. This is a staggering achievement for your body, and with such rapid development of the baby perhaps it is not surprising that we feel a little swept off our feet at times.When we consider the remarkable processes going on within the woman's body, it is perhaps more difficult to understand why some women feel nothing at all.

Lifestyle changes It is certainly true that for most problems in life, whether physical or psychological, the more that we feel that we have some influence over them, the less we become victim to them, and the same thinking can be applied to morning sickness. Many women view morning sickness as a sign from their body that they need to change their lifestyle, perhaps change their diet, limit the range or type of activity they engage in, increase the amount of sleep/rest they are getting, limit their drinking, 46 and so on. This approach can of course prove unpopular if you have told yourself that 'having a baby won't change my life' or 'I'm not going to give up my interests just because I'm having a baby'. Perhaps it's important to remember that morning sickness doesn't last for ever and there is no harm in doing it differently for a while. Getting more sleep, avoiding where possible stressful situations, leaving aside troublesome tasks until you feel better and changing your diet may all help. There are books offering more specific advice but perhaps what is most important is to respond to what your body is telling you: rest when you are tired, eat when you feel hungry. As mentioned earlier, women seem to be remarkably adaptive at dealing with these symptoms and finding their own individual solutions.

Relaxation Often during pregnancy women learn the skill of relaxation to cope in labour but it may also help to cope with morning sickness. The reading list on p.188 includes some relaxation tapes, which can be purchased.

Simply follow the instructions on the tape. You may be able to borrow tapes from your local library.You may also find that using your own selec-tion of music is more relaxing. People dealing with a whole range of unpleasant symptoms, such as chronic pain, find that learning the skill of relaxation can significantly reduce their experience of pain. Partly this can work by learning to focus on positive images and thoughts rather than the distressing symptom, which can reduce their experience of pain.

Learning to relax certainly won't make the sickness and fatigue go away but at the very least it may just encourage you to take ten minutes out every day to put your feet up: after all, the weeks when sickness occurs are crucial in the development of the baby.

'I still can't believe I'm pregnant': the increasing role of technology in our experience of pregnancy If you 'feel your usual self' in early pregnancy, then it may be hard to believe that you are pregnant and impossible to imagine that there is a baby growing inside of you. However, in recent years technology increasingly plays a role in our understanding and experience of pregnancy. For our mothers and grandmothers the first sight of the baby was at birth but today almost all women have at least one ultrasound scan. Many women are now offered a (nuchal) scan at10^13 weeks pregnant to a.s.sess the risk of 'I still can't believe I'm pregnant'

47.Down's Syndrome or they may have an early scan to confirm the pregnancy itself. Nearly all women will have a scan at 20^24 weeks to a.s.sess the development of the baby.

The scan can be a magical moment for both mother-to-be and father-to-be as the baby can be viewed with remarkable clarity, its tiny movements are visible and its limbs and structures can be identified. This can be a highly emotional moment for the couple, who may feel they have 'become parents' in seeing their baby for the first time. There is evidence to show that the scan helps to make the baby seem more real to the parents but this doesn't actually influence the later relationship with the baby.

Bonding with the baby is a more complicated process. Nevertheless, when asked in research, women said they would like more scans, as they feel they bring rea.s.surance about the growth and well-being of the baby.

As previously mentioned many women have anxieties about the development of the baby and scanning might seem an obvious way of reducing these but in fact a scan does not seem to reduce levels of anxiety except in a very temporary way. For further information on the psychology of ultrasound scans, see Clement et al. (1998). Overall, ultrasound scans seem to be a positive experience for parents-to-be.

Twin and multiple pregnancies Discovering that you are having more than one baby can come as an enormous shock. Sometimes parents-to-be are aware of a family history of twins but even so the news can be quite overwhelming until you get used to it. Medically twin pregnancies are more complicated as usually the babies are born earlier and more intervention is common. However, your psychological adaptation does not necessarily need to be more negative although the likelihood of more medical complications can increase the psychological risks. After the babies are born, there may be a greater risk of them needing special care and you also have more than one new person to get to know! These factors can make a multiple pregnancy more complicated but clearly your expectations are going to be different: you will probably be more prepared for uncertainty and intervention concerning your delivery which may make the experience easier to come to terms with.

Today many multiple pregnancies are the result of fertility treatment and therefore may have been expected.The meaning here can be different too. You may be delighted with more than one baby if you have struggled for years with the prospect of no children or if this is your last attempt at a.s.sisted conception. Alternatively you may have agreed to the 48 implementation of more than one egg with the very strong hope that this would produce just one baby and now feel overwhelmed by this news.

There are now restrictions on the number of eggs that can be implanted for this reason.

Getting rid of bad habits : drinking and smoking issues We probably all agree that in an ideal world pregnant women would avoid alcohol and never smoke or take any other form of non-prescribed drug.

However, many women are not aware that they are pregnant until well into the first trimester, others may find it more difficult than they had imagined to change their habits. It is unhelpful when people are told in a matter-of-fact way to give up drinking or smoking as if it were as easy as changing your clothes. For many people making such changes is enormously difficult. It is important to make these changes, not just in pregnancy, therefore getting as much advice and support as possible is crucial. Below follows some general suggestions but it is always worth seeing if your GP can recommend any further agencies or individuals that can help.

How can I cut down on my drinking?

For some women discovering that they are pregnant will be enough motivation for them to stop drinking or cut it down to the occasional drink. For others though this will be more difficult especially where you'don't feel any different' or your social life revolves around drinking. It may be that you need to apply some structure to dealing with the problem.

. Getting started:The best time to start is probably before you get pregnant but it may be more difficult to motivate yourself when the pregnancy is still a possibility. For others the pregnancy may occur in a less planned way and you may be a few weeks into the pregnancy before you decide to take this step. Some women are fortunate that the pregnancy itself leaves them turned off by the smell or taste of alcohol.

. How much am I drinking now? Take a look back over the last couple of weeks and see how many units of alcohol you are drinking per week.