ABSTRACT
Women with personality disorders have disturbances in their interpersonal relationships and social functioning which are likely to impact on their care during pregnancy and the puerperium. Their patterns of perception, thought, and response tend to be fixed and inflexible, although their behaviour is often unpredictable, and they find it difficult to respond to the changes and demands of life. Pregnancy, childbirth and becoming a parent are therefore likely to evoke particular difficulties for a woman with a personality disorder. As well as the physical symptoms and discomfort of pregnancy, women have to cope with a shifting range of emotions, from elation to anxiety and ambivalence about the pregnancy, which may at times be heightened by medical concerns about the development of the foetus, and to adjust to their changing body image and the reactions of others. They are often preoccupied by fears and anxieties about the birth itself in the final weeks of pregnancy. In the early days and weeks after delivery, women have to cope not only with the demands of a dependent baby, but also with hormonal fluctuations and tiredness, changes in their role and status, and changes in their social and family relationships. All of these are likely to present considerable challenges to women with personality disorder. Although there are no systematic data on the experience of pregnancy and childbirth in women with personality disorders, and few on parenting, practitioners caring for pregnant and newly delivered women should be aware of the difficulties which potentially face women with personality disorders.
