The prospective mother-wife and father-husband must redefine their roles as a couple and as individuals. They face readjustments in their relationships with friends and relatives and must deal with new responsibilities as caretakers of the newborn and each other. Both parents may experience anxiety about their adequacy as parents; one or both partners may be consciously or unconsciously ambivalent about the addition of the child to the family and about the effects on the dyadic (two-person) relationship. A husband may feel guilty about his wife’s discomfort during pregnancy and parturition, and some men experience jealousy or envy of the experience of pregnancy. Accustomed to gratifying each other’s dependency needs, the couple must attend to the unremitting needs of a new infant and a developing child. Although most couples respond positively to these demands, some do not. Under ideal conditions, the decision to become a parent and have a child should be agreed on by both partners, but sometimes parenthood is rationalized as a way to achieve intimacy in a conflicted marriage or to avoid having to deal with other life circumstance problems.

Research is underway about the psychology of pregnancy in non-married couples or in otherwise committed relationships; one would expect that many of the observations described above would also apply in those situations.

In general, others’ attitudes toward a pregnant woman reflect a variety of factors: intelligence, temperament, cultural practices, and myths of the society and the subculture into which the person was born. Married men’s responses to pregnancy are generally positive. For some men, however, reactions vary from a misplaced sense of pride that they are able to impregnate the woman to fear of increased responsibility and subsequent
termination of the relationship. A woman’s risk of abuse by her husband or boyfriend increases during pregnancy, particularly during the first trimester. One study found that 6 percent of pregnant women are abused. Domestic abuse adds significantly to the cost of health care during pregnancy, and abused women are more likely than nonabused controls to have histories of miscarriage, abortion, and neonatal death. The reasons for abuse vary. Some men fear being neglected and not having excessive dependency needs gratified; others may see the fetus as a rival. In most cases, however, one finds a history of abuse before the woman was pregnant.

Some lesbian couples decide that one partner should become pregnant through artificial insemination. Societal attitudes may put stress on this arrangement, but if the two women have a secure relationship, they tend to bond strongly together as a family unit. Men in committed gay relationships are fathering children through artificial insemination with surrogate mothers. Recent studies show that children raised in same-sex-couple households are not measurably different from children raised by heterosexual parents with respect to personality development, psychological development, and gender identity. These children are also not more likely to be gay or lesbian themselves.

Some single, never-married women who do not wish to marry but do want to become pregnant may do so through artificial or natural insemination. Such women constitute a group who believe that motherhood is the fulfillment of female identity, without which they view their lives to be incomplete. Most of these women have considered the consequence of single parenthood and feel able to rise to the challenges.

The effects of pregnancy on sexual behavior vary. Some women experience an increased sex drive as pelvic vasocongestion produces a more sexually responsive state. Others are more responsive than before the pregnancy because they no longer fear becoming pregnant. Some have diminished desire or lose interest in sexual activity altogether. Libido may be decreased because of higher estrogen levels or feelings of unattractiveness. Avoidance of sex may also result from physical discomfort or an association of motherhood with asexuality. Men with a Madonna complex view pregnant women as sacred and not to be defiled by the sexual act. Either a man or a woman may erroneously consider intercourse potentially harmful to the developing fetus and, thus, something to be avoided. Men who have extramarital affairs during their wives’ pregnancies usually do so during the last trimester.

Fears regarding pain and bodily harm during delivery are universal and, to some extent, warranted. Preparation for childbirth affords a sense of familiarity and can ease anxieties, which facilitates delivery. Continuous emotional support during labor reduces the rate of cesarean section and forceps deliveries, the need for anesthesia, the use of oxytocin, and the duration of labor. A technically difficult or even painful delivery, however, does not appear to influence the decision to bear additional children.

Men’s responses to pregnancy and labor have not been well studied, but the recent trend toward inclusion of fathers in the birth process eases their anxieties and elicits a fuller sense of participation. Fathers do not parent the same way as mothers, and new mothers often need to be encouraged to respect these differences and view them positively.

Prenatal screening for potential or actual fetal malformation is conducted in most pregnant women. Sonograms are noninvasive and can detect structural fetal abnormalities. Maternal α-fetoprotein (AFP) is measured between 15 and 20 weeks, screening for neural tube defects and Down syndrome. The sensitivity of Down syndrome testing is increased when a triple screen is done (AFP, human chorionic gonadotropin, and estriol). Amniocentesis is indicated for women older than 35 years of age, those with a sibling or parent with a known chromosome anomaly, and those with abnormal AFP or any other risk for severe genetic disorder. Amniocentesis is usually done between 16 and 18 weeks and carries a risk that 1 in 300 women will miscarry after the procedure. In the first trimester, chorionic villus sampling (CVS) can be done, which reveals the same information concerning chromosomal status, enzyme levels, and deoxyribonucleic acid patterns. With CVS, there is a risk that 1 in 100 women will have a spontaneous abortion after the procedure.

Screening in the first trimester allows women to choose early termination, which may be physically and emotionally easier on the woman. Profound ethical questions are involved in whether or not to abort a fetus with a known defect. Some women choose not to terminate and report a strong loving bond that lasts throughout the life of the child, who usually predeceases the parent.

Lactation occurs because of a complex psychoneuroendocrine cascade that is triggered by the abrupt decline in estrogen and progesterone concentrations at parturition. In general, babies should be fed as needed rather than by schedule. Breast-feeding has many benefits. The composition of breast milk supports timely neuronal development, confers passive immunity, and reduces food allergies in the child. In subsistence-level cultures
in which children are allowed to nurse as long as they want (a practice supported by La Leche League, a breast-feeding advocacy group), most babies will wean themselves between ages 3 and 5 years if not encouraged by the mother to do so earlier. Women who decide to breast-feed need good teaching and social support, which, if lacking, may lead to frustration and feelings of inadequacy. Women must not feel pressured or coerced into breast-feeding if they are opposed to or ambivalent about it. In the long term, no discernible difference exists between bottle-fed and breast-fed children as adults.

An incidental finding about lactation is that some women experience sexual sensations during lactation, which in rare cases can lead to orgasm. In the early 1990s a woman who called a help line about such feelings was put in jail and had her infant taken from her on allegations of sexual abuse. Common sense ultimately prevailed, however, and mother and infant were reunited.

Perinatal death, defined as death sometime between the 20th week of gestation and the first month of life, includes spontaneous abortion (miscarriage), fetal demise, stillbirth, and neonatal death. In previous years, the intense bond between the expectant or new parent and the fetus or neonate was underestimated, but perinatal loss is now recognized as a significant trauma for both parents. Parents who experience such a loss go through a period of mourning much as that experienced when any loved one is lost.

Intrauterine fetal death, which can occur at any time during the pregnancy, is an emotionally traumatic experience. In the early months of pregnancy, a woman is usually unaware of fetal death and learns of it only from her doctor. Later in pregnancy, after fetal movements and heart tones have been experienced, a woman may be able to detect fetal demise. When given the diagnosis of fetal death, most women want the dead fetus removed; depending on the trimester, labor may be induced, or the woman may have to wait for spontaneous expulsion of the uterine contents. Many couples consider sexual relations during the period of waiting not only undesirable but psychologically unacceptable as well.