For an explanation of alcohol units, ask your GP for the Health Education Authority leaflet. Don't just guess, as most people tend to under-estimate their intake, in particular, calling any size of gla.s.s of alcohol one unit.

Getting rid of bad habits: drinking and smoking issues 49 . What do Iwantto achieve? It is important to establish what you want to achieve.There is some evidence that any amount of alcohol has an effect on the developing foetus, so stopping altogether would be the ideal.

However, many women are looking at reducing their alcohol intake rather than complete abstinence. Decide on a specific goal, e.g. none or a drink on special occasions, a couple of drinks per week or one per day. If the gap between where you are now and where you want to get to is not large then it may just be a case of making your mind up to start.

However, if your drinking is heavy, regular and feels out of control, then you may need to take a number of steps to achieve your ultimate goal.

There is no recommended number of units of alcohol that it is safe to drink in pregnancy and, therefore, almost any number of units could be termed 'heavy' drinking in pregnancy. It is perhaps more relevant to focus on how much of a challenge it will be for you to reduce this to a minimum.

. Keep a diary: It is important to monitor your progress and particularly your setbacks so keeping a diary can prove enormously informative.

The way you record the information and what you record are up to you. It is useful to record for each drink where you were ( just got home from work), the reason for drinking or how you felt (felt stressed/always have one when I get in) and whether you might have done anything else (got straight into the bath). For diary sheets, see p.185.

. Set up a system of alternative rewards:The main reason that we drink is that most find it a pleasurable activity, so we need to replace this with some alternative reward. Deciding upon what you find rewarding is a very personal thing. You might need to subst.i.tute a few drinks with a nice meal, or you may save the money and buy some jewellery or go for a ma.s.sage. Try to reward yourself frequently particularly in the early stages. Saying you'll save all the money to buy something after the baby is born may not prove successful if you are going to a string of parties.

. Activities incompatible with drinking: Pubs tend to be filledwith people drinking and smoking and this is the worst place to be if you want to stop drinking. Try to expand or change your social activities to avoid such situations as much as possible. Avoiding places and people can be a very helpful strategy initially while you set up new routines and habits. Try to do activities when seeing friends (see a film, go for a walk) rather than just 'going for a drink'.

. Changeyourroutine:Often a percentage ofone's alcohol intake is purely through habit. If you always go to the pub on a Sunday or have a drink when you get in from work, then try to arrange alternative activities, 50 make a phone call, listen to some music, start a relaxation programme.

Try not to have alcohol in the house: well-stocked wine racks are not helpful.

. Try to getyour partner to give up too:This can be enormously helpful in terms of increasing your motivation and in changing your lifestyle/ social life. Many pregnant women feel that they become the 'taxi'

service while pregnant and breast-feeding and this can be the source of much resentment when these were shared social activities prior to the pregnancy.

. Review your progress: Keeping a diary can be amazingly informative. It should help you to identify some of the problems and hopefully clues to the solutions areas.What are the 'triggers' to your drinking, e.g. situations, events or emotions that lead you to drink? What were the alternatives? You may find that certain situations or feelings lead you to drink and if you are finding it difficult to make progress then it may be that some of these factors need further exploration. If you feel stressed after a day at work and must have a drink try to 'unpick' that situation: why are you feeling so stressed at work? What aspects of the situation can be changed? It may be that you go on to keep a diary to monitor other situations and begin to reward yourself for dealing with those differently.

. Now I've got other problems: The use of alcohol often masks other problems and this can be what makes it so difficult to stop. For instance, many people drink to give themselves confidence in social situations or to feel like'one of the crowd'. Stopping drinking may not be the problem but gaining more confidence in social situations may be the issue. It may be that you discover that you need help with a set of issues unre-lated to drinking.

. Getting more help: If you don't make any progress with stopping drinking within a couple of weeks, then it may be time to seek further help. In pregnancy there really is no time to waste, as every day is important to the development of the baby. Problem drinking is merely a symptom of other more complicated issues that need looking in to.

Your GP is always the best place to start in that he or she should know which particular facilities are available locally.

A similar programme or structure can be used for giving up smoking.

Again, see your GP for help and advice, as there may be facilities available locally to help you. There is an NHS 'quitline' with help for giving up smoking in pregnancy and the number is in the list of addresses on p. 181.

Miscarriage 51.Miscarriage Most pregnancies that miscarry are lost in the first trimester. Some women experience a slight bleeding during these first few weeks and the pregnancy continues without any problem. For others it signals the end of the pregnancy. Some women unfortunately discover that they have miscarried when they go for a first scan.The baby has died but there have yet to be any signs of the loss. Most parents will not know exactly why the miscarriage has occurred and only if you have three miscarriages in a row is it considered medically necessary to investigate why it happened.

The emotional experience of miscarriage is more complicated. Many parents-to-be are devastated by their loss and take many months to recover. Often recovery is hampered by guilt about having in some way caused the miscarriage or fears about what this means. Is there something wrong with me? Will I ever conceive again?

Mich.e.l.le's story Mich.e.l.le was referred for help with depression. She had miscarried two pregnancies both in the second trimester. In order to rea.s.sure her the doctors had told her that it was 'right' that nature had taken its course since her second baby had been very small for his gestational age and might have been born with a variety of problems. Rather than rea.s.suring Mich.e.l.le, this had left her with the feeling that she had produced a 'monster' and she was terrified of becoming pregnant again although she desperately wanted to try for a child.

In time, as Mich.e.l.le's grief pa.s.sed, she was able to channel some of her energies into preparing herself for another pregnancy: getting fit, eating well and trying to challenge an underlying sense of not being good enough that stemmed back to her own childhood.

Miscarriage is also very common for women who have already had children and the emotional effects can be just as acute even if you already have children. Feelings of grief can be intense whenever a pregnancy is lost. For many women who already have children, the lost pregnancy might be seen as the 'last chance'. It may signal a time for acceptance that your family is complete, particularly where a person feels they are getting too old to try again or their children are getting older and there would be too much of an age gap. This sense of loss may be particularly acute where the child was 52 conceived through a.s.sisted conception and the chances of another attempt at getting pregnant have huge personal and financial implications with the prospect of conception low.

Another pregnancy?

Many people find it difficult to react to someone who has lost a baby and try to minimise the event: 'Well, don't worry, you can try again' or 'at least you know you can get pregnant'.These often well-intentioned comments can be very upsetting when someone is still coming to terms with their loss. They were expecting to have a baby on a particular date and would have begun to plan towards that event. One of the first things people ask is 'When is it due?'Although the pregnancy may have only lasted a couple of weeks, there may be much grief to follow in the future such as the date the baby was expected. Some women/couples feel ready to contemplate another pregnancy straightaway. However, not everyone will want to have another pregnancy or be ready to think about it until some time later.

Where a woman does go ahead after a miscarriage and have another pregnancy, this can be an emotionally difficult time. Often they experience anxiety or depression related both to fears about the pregnancy and feelings of loss for the miscarried pregnancy. Some writers have talked of an 'absence of involvement' whereby the mother is unwilling to invest emotionally in the pregnancy because of fears of further loss and pain.

There is no amount of time that will be the 'right time' to embark upon another pregnancy since recovery is such an individual process.What is important is to recognise that you might feel anxious or detached in the next pregnancy.Therefore the right time is when you feel ready to face this.

In Chapter 5 stillbirth and neonatal loss will be discussed. This generally refers to a baby lost after 20/24 weeks and up to one month old.

Nikki's story Nikki came to see me for help with depression following five miscarried pregnancies. She had spent most of her thirties either pregnant, trying to get pregnant or waiting to try and get pregnant again. While waiting to see me she had conceived again and had immediately been seen by the specialist services that were to monitor her pregnancy and administer drugs to try to maintain the pregnancy through the first trimester. Nikki herself felt totally unable to feel anything positive The mid-pregnancy: making plans 53.about the pregnancy and rather reluctantly admitted that she had not wanted to take the drugs she was prescribed because of the potential risks to her own health. However, so sure were her doctors that she would do anything to maintain the pregnancy they had failed to fully check out her willingness to take the drug. Understandably, despite being pregnant, she could feel nothing other than terribly depressed and confused about her feelings towards the pregnancy. She was unwilling to feel anything positive because of the enormous risk of another loss and she was still overwhelmed with the grief of her previous losses. Sadly, the pregnancy miscarried before 12 weeks. Also part of her grief was an acceptance that this was to be the last attempt.

Her partner had distanced himself from the situation having decided some time ago that they should not try again.

A time for change The first few weeks of pregnancy may therefore have been a longer journey than you had imagined. You may have been struggling with changing your lifestyle: perhaps trying to stop smoking or drinking. Sickness may have led you to telling lots of people about your pregnancy before you had planned to. You may have felt unable to do some of your usual activities and found yourself needing more sleep. Partners may have been taken aback by the changes in you and have had to take over certain tasks at home. Your life may be changing far more quickly than you had predicted. For both of you there may have been many surprises in terms of how you have reacted emotionally.

The practice of not announcing your pregnancy until a number of weeks have elapsed probably has much to do with the complicated emotional situation of the first couple of months. It is perfectly normal to be overwhelmed by the discovery of being pregnant, after all until this point the life changes are hypothetical but now the situation has changed irreversibly: even if you were to decide not to continue with the pregnancy or you miscarry you can never return to the previous situation.

The mid-pregnancy : making plans The second trimester of pregnancy starts at 13 weeks. The baby now concentrates on growing in size and its organs continue to mature.

54.During this trimester the baby's movements are first felt. You may feel a tiny flutter early on or your first sign may be a more discernible kick! As the baby grows in size, your partner may be able to feel these movements too.

The middle months of pregnancy may be a very different time psychologically from the experiences we have talked about in early pregnancy.

Generally women feel healthier, their morning sickness having subsided and usually the pregnancy has been 'accepted', in that the woman feels more able to get on with everyday life, not as before, but in the new ident.i.ty of pregnant woman. Obviously every pregnancy is unique and if you don't start to feel better, this isn't a sign of something being 'wrong' with the pregnancy. There may be many reasons for this: if you already have a toddler to look after it may be difficult to recover from the extra demands that the pregnancy is placing on your resources ^ both physical and psychological. It may be that your relationship is still adapting to the prospect of the baby or for a variety of reasons you may simply not be enjoying pregnancy.

Feeling better Beginning to feel better physically will clearly contribute to the feeling of having entered a new stage of the pregnancy. Therefore, if we think of there being a 'psychological' mid-phase of pregnancy, this will coincide with beginning to feel better physically and this could occur anywhere from 12 to 20 weeks. Morning sickness often begins abruptly but usually trails off, with a gradual reduction in the nausea and a feeling that you are less tired and more able to carry out your life tasks as you did before.

For some women this can actually move into a stage of feeling better than they have ever done. Pregnant women are often described as 'blooming' at this time. It can be a time of feeling physically and emotionally very good. How much of this shift is due to physical changes and how much is due to the emotional fact of having accepted the pregnancy is not clear.

The mid-pregnancy can seem quite a relaxed time: you have adjusted to the pregnancy but the arrival of the baby is still some way off.The baby can still be carried around easily and for most women the pregnancy does not limit their activities. At this point the baby itself is 'safe' and reasonably undemanding ^ perhaps the odd kick to let you know he is there. So'living with the baby' may become a very positive experience: the baby can'come to life' in terms of its intermittent movements, its heartbeat can be heard at an ante-natal visit and its features can be now made out in a scan. At the same time, it can be'forgotten'about if the mother wants to get on with her The mid-pregnancy: making plans 55.work or things that made up her life before she was pregnant. This could be termed a time of compromise between mother and baby before the time when, after birth the needs of the baby seem to dominate your every waking moment! You have adjusted to being the mother of a baby that is contained within you.

'But how many babygros do I need?'

In the long journey of pregnancy nature therefore provides us with some welcome time and s.p.a.ce for preparing for the arrival of the baby, both practically and emotionally. Not every family is the same but there are some issues that are common to many women and couples at this stage.

On a practical level, one has to make a s.p.a.ce for the baby and begin to think about what he might need in those early weeks.This is really as much a psychological task as a practical one in that it involves imagining having this new person in your home and dependent on you for his needs. Awhole new area of knowledge needs to be acquired such as how to attach the baby's seat to the car or how to place a baby in a cot to sleep. In fact, most of these things don't really make sense until the baby arrives. It is easy for this planning in itself to become a source of stress and anxiety. Many parents are bamboozled by the vast array of goods, intensively marketed, that lead us to believe that we must acquire them otherwise our baby will not be safe or will not be 'stimulated'. Finding the money to pay for everything can be a source of stress: parents may feel cheated if right from the start they cannot get 'the best' for their baby. Few of the things that we buy for babies are really essential. Often hospitals or midwives provide lists of 'essentials' and attending ante-natal cla.s.ses or talking to other new mothers is helpful.

These practical tasks ^ decorating a room or buying vests ^ can help to make the baby seem more real in your life and may help you to think about how your life will change after his arrival. It can also help you to feel that you are doing something constructive, which can be a relief if you have a lot of fears that don't seem to have answers at the moment.

What do the contractions feel like? Learning new skills for pregnancy and birth Lots of thoughts may be coming now about the labour and the birth and how best to prepare for this and how to care for a new baby. One aspect of this might be enrolling in ante-natal or parenting cla.s.ses, which will 56 usually begin in the third trimester. Chapter 5 will look at labour and birth in more detail but it is never too early to start researching what types of cla.s.ses are available locally. Your midwife or GP should be able to help with this. (See also the'Who can help?'section on p. 67.) There is enormous variation in what cla.s.ses are offered. Most NHS maternity services will offer cla.s.ses run by midwives and health visitors. There are also organisations such as the National Childbirth Trust that run cla.s.ses. You may be able where time, finances and availability allow, to attend more than one type.

Overall, it is probably not worth worrying too much about the content of the cla.s.ses as the chance of being with other parents-to-be and sharing your experiences of pregnancy is just as useful as the factual information given. If fathers attend groups too, this can really help a mother to feel supported and can help the father to feel more involved, more informed and less anxious. If the group can continue to meet after the babies are born, then this will offer great support in those early months with the baby. It may be hard in pregnancy to believe that you want to keep meeting with a group of 'strangers' but the shared experience of having a new baby can be very important especially if all your friends are at work during the week.

As well as preparing for labour, it may also be a time for beginning to consider what changes you are to face as a couple: how will your life be different? It really can be difficult to imagine what it will be like when the baby arrives but this should not discourage you from beginning the discussion. Prospective parents tend to worry about the tasks of caring for a baby, for example, how often should I change a nappy? Most people haven't changed a nappy before having a baby and it can seem complicated before you've tried but, rest a.s.sured by the end of first few days, you will feel like an expert after so much practice! Parents don't go to health visitors in the weeks after birth saying 'I still can't change a nappy!' They are much more likely to present with problems about who is changing the nappies.

Consequently it does no harm to begin now to think about how things are going to be different after the baby is born.What aspects of your life now do you particularly value and what do you feel you could give up? How flexible can your partner be in terms of time commitments? Who else is around to help?

So the journey to becoming a competent parent isn't fully explained by the practical tasks that have to be mastered. However difficult labour might be, it does have a finite point whereas balancing your own needs versus meeting those of your offspring is a task that continues throughout childhood.

The mid-pregnancy: making plans 57.Can I go part-time? The decisions regarding work The majority of women are probably working when they have their first pregnancy. For many it is in this stage of pregnancy that ideas begin to formulate about their work situation. Some women will just about be able to see far enough forward to decide roughly when they want to start maternity leave. Others will have clear ideas about what they want to do work-wise over the course of the next few years.

In the last chapter a number of issues were discussed in terms of women and children and work generally but now may be a time to consider your own personal situation and feelings and what is right for you. It is important to sit down with your partner and for both of you to discuss your views and expectations about what will happen after the baby arrives (see 'Discussion points' on p. 67). Although you might not know what you want to do about returning to work you can still discuss what role you might play while at home. You will find that whatever decision you make, you will have to justify it to other people: employers, friends, grandparents, and so on.

It probably doesn't matter how formed your ideas are as long as they are not too rigidly held. You may be lucky and 'do it to plan' but it's hard to imagine that anyone can plan very far ahead as there are so many things that cannot be predicted. It's easy when pregnant to think that choosing childcare is all about meeting the parent's requirements, however, after the baby is born and in the subsequent early years the child will display particular needs and these will change over time, making it unrealistic to expect yourself to work it all out in pregnancy. Although it's true that many types of childcare have waiting lists, people make decisions and change their mind right up until they go back to work (or decide not to!). For very many women this is an area where there is no choice: if you are the sole earner, for example, then you will feel you have to get back to earning as soon as possible.Whatever your situation try to allow for some flexibility after the baby is born as you may put yourself under undue pressure trying to meet everyone's needs: baby, family and work.

Remembering the time before baby This may be a time where you have accepted yourselves as mother-to-be and father-to-be but there can still be time to recapture bits of pre-pregnancy life. It might be that you want to take on a particular project at work to rea.s.sure yourself that you can still hold your own. It might also be a time where if finances allow and you are feeling well, you can take a 58 holiday. It can be very important to spend some time with your partner, not just being taken over by thoughts of the baby, but also just enjoying being together. Sometimes couples get caught up in 'I must do that before the baby is born'and set themselves overwhelming lists of things to do. It can feel as if life begins and ends on the expected delivery date! A new life for you all does start but a new sort of normality will establish itself too.

'I haven't had a chance to think about my pregnancy': building a relationship with the baby As the pregnancy progresses, the baby begins to'communicate' with you: little kicks and movements can be felt. Eventually when looking at your b.u.mp you may be able to make out how the baby is lying, where he likes to be. At ante-natal appointments you will hear your baby's heartbeat and at the mid-pregnancy scan you will see your baby in some detail: right down to the four chambers of his heart. You may also decide to find out whether you are having a boy or a girl. It becomes easier therefore to begin to imagine what this little person might be like. If he kicks a great deal, you might imagine him to be a lively, active baby and if this happens in the middle of the night, you may fear that he won't be a good sleeper! You may now be 'trying out' names and imagining many things about what your baby might look like or what his personality might be.

For some women, especially in a second or third pregnancy, you may feel you haven't had a chance to think about the baby but it's never too late to start.

Many fathers-to-be find that there are fewlinks with the baby during the pregnancy so beginning to get to know the baby can be enormously difficult as it still doesn't feel very real.This can be helped by trying to go to the scans and maybe an ante-natal appointment. However, partners can do one thing that mothers can't, which is to put their ear to the b.u.mp and listen to the movements of the baby! Mother and father can feel the b.u.mp together and experience the movements of the baby. All these things can help to bring the pregnancy to life for both parents and help them to begin to feel that they have a baby.

A generation ago this interest in the'foetus' would have seemed bizarre to many people as the baby was really only seen as'alive'once he had left the womb.Today we are much more aware of the womb as an environment and that we can influence the development of the baby by looking after ourselves. Some have taken this further and feel that they can begin to affect the baby's temperament and possibly even their intelligence by, for 'I haven't had a chance to think about my pregnancy'

59.example, playing music to the baby while still in the womb.The evidence for this is equivocal and really so much less important than the fact that trying to get to know your baby and being aware of him before he is born can improve your relationship with him after he is born. Many health visitors who work with women who are not coping or are depressed in pregnancy find that where mothers are encouraged to think about or imagine their baby, this helps to prevent emotional problems post-natally.

So if you want to talk to your unborn baby while doing the housework, then do it: it's good for you both!

Discovering the s.e.x of your baby It may seem very early to be thinking about the baby and how to care for him but often in late pregnancy women become preoccupied with thoughts of labour and birth so now is a good time to think about having a new person around the house.

It is possible now at the 20-week scan to find out the gender of your baby.

This is not 100 per cent accurate as it is done by scanning the genital area and a.s.sessing what can be seen! Should you have amniocentesis, which involves chromosomal a.n.a.lysis, then identification is accurate. So how do parents-to-be decide?

For some, the decision is straightforward: if the information is available, we want to know. Others want the discovery to be part of the arrival of the new person. It seems to become more complicated where only one of the parents wants to know, or where there is a strongly held wish for the child to be of a particular gender. You may feel that in the latter situation, finding out will give you time to come to terms with any feelings of disappointment rather than facing this at the birth. However, without the baby there, it may be more difficult to a.s.sess the significance of this information, especially for a first baby. If you wait until the baby is born, then the gender is just one part of this new person that you have to get to know. Having a boy or having a girl may not be quite what you expected. It would be interesting to see more research into the impact that this knowledge has on parents. There is some evidence that it can have a negative impact on pregnancy and labour where the baby is discovered not to be of the hoped-for gender. Whatever you decide to do, it is worth being decided by the time you arrive for the scan and letting the sonographer know: many parents inadvertently find out because terms such as 'he' or 'she' are used or because they can see the genitals clearly.

60.'I'm not feeling that great'

Not all pregnancies are the same. Different women will have different experiences and the same woman can have very dissimilar experiences in different pregnancies. There may have been no sickness early on and life has been ticking over as usual right through. If you are very ambivalent about being pregnant, then it may be possible to continue to ignore the pregnancy well into the second trimester. Alternatively you may continue to feel a bit 'under the weather' throughout the pregnancy. You may be dealing with significant life events that have nothing to do with pregnancy.

All these experiences are common. However, this shouldn't stop you from beginning to think about the baby and how your life will change.

It may be that you feel unhappy or depressed throughout the pregnancy or feel unable to contemplate the prospect of being a mother.You may feel it's best to just try not to think about things at the moment. If this is the case or if you have been having significant emotional problems before the pregnancy started then this can be a time to start doing something about it. As previously emphasised, pregnancy does last a long time and it may be a time to identify problems and look for solutions before the baby comes along. If you feel uncertain about what to do then it may be time to seek professional help.Try to speak now to your GPor midwife who can put you in touch with someone who can help. (See Chapter 4, 'Specific psychological problems in pregnancy'and 'Who can help?' on p. 83.) The pregnancy coming to an end Doctors and scientists have yet to discover the exact mechanisms that cause a pregnancy to end and labour to begin. Many women find that as the pregnancy draws to a close their mood may begin to change, perhaps becoming more unpredictable.This is probably partly due to the physical and practical changes that are going on. Your ever-increasing size may make your everyday life more difficult and more tiring. Sleep often becomes more disturbed now as you find it more difficult to get comfortable, as the baby lies on your bladder you need to get up to go to the toilet and probably too you find some of the anxieties of early pregnancy return.

It is not unusual to become increasingly nervous about being a mother (or father) and more aware, especially when you stop working, of how your life is to change. Often, however, the fears and anxieties are focused around coping with the labour and birth. Health visitors and midwives who run parenting cla.s.ses often comment that it can be difficult for a 'I still don't think I'm ready to be a parent': changing roles for all 61 woman to think about anything other than labour in the cla.s.ses.

Although they are keen to cover the first few weeks of looking after a baby, parents especially mums-to-be, understandably, want to know about pain relief!

'I still don't think I'm ready to be a parent': changing roles for all Psychologists often think about life in terms of events or stages and as a social world made up of roles and functions. The arrival of a baby brings together some of the biggest changes in these social systems that we are ever likely to experience in a short period of time. As we have said, the event of being pregnant often precipitates other life events such as choosing to move house, sometimes partners change job, or there is increased financial pressure. Both mother-to-be and father-to-be will also become 'parent', 'mother', and 'father': a new generation will be coming after them. You are no longer just a 'child'

but a 'parent' too. For women having to lose the role of career person, even if only temporarily, may be significant in how they feel about themselves. These changes in status affect others too: your parents become grandparents; sisters and brothers become uncles and aunts.

What does it mean to be a 'mother'? Changes for women The last chapter considered how we construct a view of being a mother and this will change in the course of the pregnancy.Where a pregnancy is progressing well with the mother-to-be reasonably happy with her situation, she is likely to gradually become more identified with other mothers, especially her own where the relationship was good. This may make it easier to begin to withdraw investment from other activities and begin to picture the new life ahead.

How certain or not you may feel about what it means to be a mother, clearly, certain changes of role do and perhaps have to take place. As a woman close to giving birth, you may be struck by the inevitability of change in your life. However, it may feel that for your partner change still involves choice: he may decide to stop football practice for those first few weeks after the baby is born but he doesn't have to, he can choose to.There may be a deep sense of loss for you about what you are giving up to become a mother and these feelings may become even more intense in those early months with your baby. Sometimes working until your due date may just 62 be a way of avoiding these feelings and not thinking about the new life ahead. Gradually most women will begin to lessen their investment in the former life situation and begin to look ahead to the new situation.

What does it mean to be a father? Changes for partners It may be late in the pregnancy that partners become more aware of the imminent arrival. Often it can be something as simple as planning to take some time off from work or cancelling regular activities that can bring it home that life is to change. This probably is a time when partners' roles begin to diversify, with the majority of fathers-to-be a.s.suming the role of financial provider. For women with a good maternity package, who take no unpaid leave, the actual financial changes may be short-lived. However, this is often the first time that a couple have made such financial arrangements and the feeling for the woman can be that of 'dependant'even where the reality is different.This role of provider, especially where the mother will not return to work, can feel like a substantial burden, especially where the partner's earning opportunities are limited. Not all men expect to become the main earner and may feel their choices severely restricted by this new role. It may be that where there is ambivalence about becoming a father, the financial realities serve as a focus for those feelings.

It is not always true that becoming the main earner is a burden; in fact where the couple have had comparable careers, it may release them from a state of compet.i.tion and rivalry. It may be that in a.s.suming a role more like his father's, the man feels more secure, even if financially they are going to be worse off. For some men a.s.suming the role of provider, with a partner at home with the children, brings a sense of 'family' that is familiar and makes it easier to a.s.sume the role of 'father'. However, with changing employment patterns in recent years many families are very dependent on the woman's wage and this can cause the partner to feel even more devalued if he cannot find reliable work while his partner is caring for a newborn.

'I thought you'd be delighted': changes for those around you too Your pregnancy changes everyone's relationship to you and with you.This may seem like an enormous burden to shoulder but the acknowledgement of this state of affairs may help to explain why those around you behave in ways that surprise you and can be both positive and negative. Everyone needs time to get used to his or her new role. For a long-time friend who does not have children, it may signal a new and frightening change: will 'I still don't think I'm ready to be a parent': changing roles for all 63 you still be close if you have less common experiences to share?; will you be able to empathise with and understand each other like you used to?

It also means a change for other family members: brothers and sisters become uncles and aunts, parents become grandparents. What may be upsetting for you as parent-to-be is where another family member is troubled by this shift. The dynamics and structure of all families are different: for example, in terms of who looks after and supports whom. It may be that you are playing a supportive or even caring role for a sister or a parent and the imminent birth may threaten that connection. There is a strong stereotype of the role of the grandmother. In an ideal world mother and daughter become closer through this shared experience of parenting and grandmother is there to provide emotional and much needed practical support. However, in our modern society where extended families are more the exception rather than the rule, this may be practically impossible.Where the relationship between mother and daughter has been poor, this can be the source of much disappointment as the mother-to-be perhaps hopes for but does not get this support.

Meg and Richard's story Meg and her husband Richard came to see me when she was advanced in her pregnancy. Initially they sought help with arguments between themselves but it became clear that their fighting, sometimes physical, was generated by the pressure that their extended families were putting them under and they were being pulled in different directions to provide support. Meg's mother had been looking after her sister, a recovering heroin addict, and would constantly phone Meg if Alice were 'missing' for too long. Richard's father had died suddenly not long after Meg had become pregnant. Richard's mum expected him to call around every night after work and Meg was worried that this would not change after the baby was born. The more that Meg and Richard attempted to pull away and think about their new roles and responsibilities, the more their respective families seemed to fall into crisis.

Many people may be surprised by the reactions of their extended family to the pregnancy. Grandparents-to-be may be delighted about their new situation and yet find themselves reliving some of their own disappointments and problems of that time. This can translate into heavy-handed advice or not being available in a way that might have been hoped for.

64.Pregnancy is a time when you may be offered lots of 'advice' especially from your own and other parents, which may not always be helpful and may feel undermining. But it is important to remember everyone is going to be learning his or her new role.

Relationships: issues and problems The pregnancy, especially towards the end, is probably where a divergence of role begins for the couple. All of a sudden the mother-to-be is at home ready to carry out a different role, which may awaken certain expectations for both partners. Does being at home equate with a.s.suming all the domestic tasks? Often there is this expectation, although it may not always be articulated. If your mother always had the dinner on the table when dad got home, then this may be what you expect of yourself and may be what your partner imagines will happen. Consequently, late pregnancy may be a good time to sit down and discuss how you will manage the new domestic situation. It may be important to include in this discussion aspects of your life that you value and would like to retain after the baby is born. (See'Discussion points' on p. 67.) Pregnancy may bring to a head pre-existing relationship difficulties particularly where one person was ambivalent about the relationship prior to the pregnancy or where one partner has problems making a long-term commitment.

Alan's story Alan had been with his partner for five years when she became pregnant. They had never talked about having children and although they rented a house together, Alan at times went back to live in a flat that he owned. He said that he had simply not thought about the pregnancy and spent more time in his own flat. He did not tell any of his family, friends or work colleagues about the baby and perhaps hoped it would all just go away. After the birth of the child he had still mentioned it to no one and began wondering how he might explain the situation to his family. His ambivalence about his baby was clearly related to problems in his own early life but these he had hoped to avoid thinking about too.

His partner subsequently returned to her former husband, which offered Alan a route out. In some ways this made it more difficult for him to acknowledge that he was a father.

'I still don't think I'm ready to be a parent': changing roles for all 65 Often there can be a hope in pregnancy that the arrival of a child will bring the couple closer together. In fact, research has shown that all relationships deteriorate in quality with the arrival of children: good relationships remain good, however, just not quite as good. This may well be a temporary state of affairs while this process of change is gone through but it is important to have the right expectations: that child-rearing puts a strain on even the strongest relationships.

'When should I start maternity leave?'

Apart from the odd 'Superwoman' most women will take a period of maternity leave starting any time from 12 weeks prior to the estimated delivery date and carrying on for, in some cases, up to a year after the baby is born. Certain public services organisations like the National Health Service allow for up to one year of maternity leave. However, most of this is unpaid leave but service remains continuous. Until fairly recently women had to stop working at 28 weeks which was extremely frustrating for those who were willing and able to continue, and who wanted to 'save'

the time for after the birth of the baby. Now maternity leave can start at any time after 28 weeks up until the day that the baby is born. This allows for individual women to decide what best suits their needs and their family's needs. However, unfortunately this has in some cases led to a mispercep-tion that all women can or should work until they're practically in the delivery room.The time to begin maternity leave is different for everyone depending on their work situation, their financial constraints, other children or responsibilities, and so forth. Nevertheless, allowing yourself some time to prepare practically and emotionally for the arrival of the baby should not be under-estimated. This amount of time will vary from woman to woman depending on her needs.

Inevitably as you prepare to leave work there is recognition that it will never be the same again. Even if you intend to return to work full-time as soon as possible, the situation will not be the same.Work is different when you have a baby to get home to. Although women are now'free' to return to work, it is usually mothers who drop off and collect children from childcare. There can be a great sense of loss while preparing to finish at work.

What will it be like not having to get up and go to work? Although we may at times resent the routine of work, routines are in fact very important for our psychological well-being. Work generally is very protective against depression: working women are less likely to be depressed than the unemployed or homemakers.Work provides a social world and for some their social life. Even where there are conflicts at work, this may still give a 66 person a sense of involvement in life. It can be very frightening to see this disappearing, even if only for a few months. Possibly also you may feel resentful of other work colleagues, especially if you feel they might overtake you while you are away. Often colleagues have mixed feelings when someone is leaving: feeling perhaps envious that they are stuck here while your life is moving on and changing. Consequently your last weeks at work may be emotionally difficult.

Pregnancy's end The end of pregnancy is the beginning of a new life but before the new can begin there are many endings to overcome. It is the end of a child-free life and a major shift of role to being a parent, a mother, and a father. There may be many aspects of your life; many freedoms that you feel you are about to lose. Strangely enough too, you may start to mourn the ending of the pregnancy. For those who have not enjoyed these weeks that may seem unbelievable, but where pregnancy has been a positive and 'safe'

time, its ending may be mourned. This may be acutely so for a woman who acknowledges that this is her last pregnancy. For a partner such feelings can be perplexing especially where their thoughts are clearly elsewhere such as the quickest route to the hospital!

Who can help ?

For general issues Where you have a good relationship with your GP, then he or she is usually a good place to start. GPs should be able to advise you about the choices available to you in terms of ante-natal care and also be able to recommend more specific services for complications ^ physical or emotional.

Where you are interested in 'complementary' therapies, try to look for organisations that can recommend registered individuals rather than just picking a name out of the telephone book. Again, many progressive GPs will have lists of complementary pract.i.tioners such as acupuncturists or homeopaths. (The list of addresses on p.181 contains contact numbers for the professional organisations.) Throughout your pregnancy you will be seen by a midwife although your first 'booking' visit may not be until the second trimester. You will be given the option to choose 'hospital care' or 'shared care' where your routine ante-natal appointments are at your GP's surgery rather than at the hospital. Late in pregnancy your appointments will be weekly and you may appreciate being able to attend your local surgery rather than Discussion points 67.face possibly a long wait at a more distant hospital.Your midwife should be able to explain any aspects of pregnancy that you are concerned about, including emotional issues. However, in practice, most early visits to the midwife are fairly routine and swift, so it is best to write down a list of questions to take with you.

Your health visitor may also make contact with you towards the end of pregnancy and perhaps visit just to get to know you a little bit. It's much easier for them to a.s.sess how you are coping after the birth if they know how you were doing before.

For parenting cla.s.ses Everyone is ent.i.tled to attend parenting cla.s.ses before the birth of their baby and these are usually run by the local midwives and health visitors.

If you are lucky, they may take place at your surgery. Most cla.s.ses are open to partners too. For partners who have mixed feelings about attending, there is research to show that the more partners are involved in supporting the mother after the birth, the less likely that mother is to get depressed. Parenting cla.s.ses may help you to feel more involved in the pregnancy.

For those particularly interested, the National ChildbirthTrust (NCT) run parenting cla.s.ses in most areas. These cla.s.ses tend to take a more informal and less medical approach. The NCT also runs a number of groups and events to support new mothers. If you don't have time for their ante-natal cla.s.ses they can still put you in touch with other new mothers, so it is worth thinking about becoming a member of your local organisation.

Discussion points 1. Make a list of the aspects of your life that you value highly now. Cover the areas of work, social life, hobbies and family? What could you give up and what must stay?

2. How are tasks, especially domestic, currently shared out in your home and how were these decisions made? Are you happy with the current situation? How will these roles change, if at all, following the arrival of the baby?