AFTER THE POSTNATAL EXAMINATION – CASE
Mrs A. took the progestogen-only Pill while she was breast feeding her second child but was advised to change to the combined Pill when she began to wean him. She now had a girl and a boy and felt her family was complete. She was already working part-time. Before her first pregnancy she had taken the combined Pill and again between the children, but now it did not seem to suit her. She had been back to the doctor several times with minor complaints and tried different brands. This time she asked to be fitted with a cap. The doctor noticed that Mrs A. seemed very anxious and asked a lot of questions during cap fitting. She wondered whether Mrs A. was worried about choosing a less effective method, having said she wanted no more children, or whether perhaps she really did want more children and was hoping ‘to make a mistake’, but she kept these thoughts to herself and listened.
‘Can the cap do any damage? How long does it take the Pill to get out of your system? Should I have another cervical smear?’ Instead of offering reassurance, the doctor said, ‘You seem to be rather worried about yourself.’ ‘It’s only since my son was born. It’s all so silly really, but I feel I’ve got to keep myself healthy for them. I suppose it all goes back to when my little brother was born. My mother was a long time in hospital with him. I don’t really know what was wrong, but I know she nearly died. I was only four but I still remember it.’
The doctor shared these thoughts with the patient, thoughts which had been provoked by the patient’s remarks and were therefore more relevant than her previous ideas about reliability, and after a moment or two Mrs A. said, ‘I think I’ll try just one more Pill. There’s no reason at all why I shouldn’t. I was perfectly happy on it before and I really don’t want to risk getting pregnant again.’ Two months later, having shared her anxieties with the doctor, Mrs A. had settled happily on the Pill and all was well.
In this case the experience of the birth of her son reawakened memories and feelings in Mrs A. from her early childhood. In some women the feelings may come from the deepest levels of the unconscious, and may be so traumatic that serious psychological upset can occur. However, in many women such as Mrs A. the memory can easily be dealt with once it is put it into words, and the doctor who can assist in that process has a great deal to offer.
*180/197/1*
