Psychiatric Aspects of Child-Bearing *

In recent years there has been an increasing emphasis on the truism "one must treat the whole individual." It is generally admitted that the limitation of the physician's consideration to the disease process alone, disregarding the concomitant personality involvement, does not comprise satisfactory and comprehensive care. Various internists have stressed the-significance of "emotional factors" in diseases such as ulcers, asthma, colitis; some surgeons have come to realize the significance of "emotional factors" in abdominal pain, stormy convalescences, even delayed wound-healing. The field of obstetrics differs, one may say, from the other specialties in that pregnancy, labor, and puerperium are considered "normal," not "disease" processes; however, it cannot be denied that the profound alterations which take place during these periods are as susceptible to influence by experiential factors as by the patho-physiologic changes brought about by disease. As a matter of fact, the obstetrician must deal with three situations, albeit related; the relatively prolonged period of pregnancy, the acute period of labor and delivery, and finally the rather indeterminate post-partum period. The further fact that the complete process of pregnancy and puerperium comprises about a year of an individual's life is in itself significant for the operation of psychological factors. One wonders, however, whether the obstetrician is as aware of this as is the psychiatrist. Our survey of the literature seems to indicate that obstetrics has not kept up with the other medical specialties in appreciating the significance of psychological influences. We find, to be sure, a fair amount of material on psychoses accompanying pregnancy, but it seems to be statistical for the most part. There is also an occasional paper from various pre-natal clinics on the attitudes of pregnant women, but these also are mainly statistical. A survey of the leading texts in obstetrics serves to emphasize the point. One book2 devotes one page only to the psychological aspects of pregnancy; three pages was the largest number devoted to the subject in any of the texts. Moreover, the material given