Psychological impact of the announcement of a fetal abnormality on pregnant women and on professionals.

The psychological impact of the announcement of a fetal abnormality after ultrasound examinations is examined in relation to the building up of the mother-child attachment. It represents the "psychological cost" of such techniques. Understanding the subjective experience of the patients could increase the effectiveness of clinical practice. We have assumed that the relationship between parents and professionals is a critical element that contributes to the establishment of an emotional link between the mother and her child. Pregnant women, mothers, and professionals were approached for interviews and by questionnaires including anamnestic data, opinions, and projective methods. The results showed that the women with fetopathy were less centered on themselves during the pregnancy. Long-term effects were found to be important. In pregnant women, ultrasound examination was experienced with satisfaction even if some ambivalence remained. In mothers with an impaired child, ultrasound examination was viewed as a technique with low reliability. Professionals reported not having preparation in making such an announcement. We concluded that a need exists for better management of the modalities of ultrasound examinations. Many parents have expressed their need for psychological support.

[A psychological study, using interviews and projective tests, of patients seeking anonymous donor artificial insemination]. / Etude, par entretiens et tests projectifs, du psychisme de patient(e)s ayant recours à l'insémination artificielle par donneur anonyme.

A Thematic Aperception Test was used with 13 male and 16 female patients who were requesting A.I.D. The following main psychological reactions were found in women: anxiety and depression (fear of rejection by their family and friends; lowering the image of the husband--the donor being considered as a rival), aggression (the narcissistic woman "demands" A.I.D.; the donor is esteemed highly); mother is protective ("true" paternity comes through love of the child and the need to forget the donor). They found, in men: an inability to abandon fertility as lost (with denial of sterility); ambivalence, castration anxiety and a feeling of being excluded from the mother-child symbiosis with later acceptance of loss of fertility and (sometimes excessively) identification with the "mother". Most subjects studied were not intending telling the child about his true origin; because disclosure would be tantamount to transgressing twice over the laws of paternity and the rules against Oedipus behaviour. There is often a great difference between the ways the partners view the matter and inter-relate. We strongly recommend that psychological advice should be taken before treatment with A.I.D. is started.