[2] In Africa, India & South East Asia, as well as Latin America, these complications of parturition may still be as prevalent as they have been throughout human history.
[3] Women may spend anywhere from a few hours to a few days in labor, thus leading to an emotionally and physically intense experience, as shown by the frequency of post-traumatic stress disorder.
Not only is there no analgesia or skilled attendance, but there is no emotional support; on the contrary, the mother's mental state is disturbed by anger, fear, shame or despair.
Perpetrators have rarely given a personal account, but experienced obstetricians have attempted a graphic description of their state of mind.
Early authors like Ideler[11] wrote about this fear, and, in 1937, Binder[12] drew attention to a group of women who sought sterilization because of tokophobia.
[13] Factitious disorder (self-induced illness) can take many forms, and, during pregnancy, they include obstetric complications such as antepartum bleeding and hyperemesis.
[20] These extreme cases illustrate the strong wish that some women have to bring pregnancy to an end; occasionally they importunately demand premature delivery, whatever the risk to the infant.
Under the name 'parturient delirium', this is defined[21] as an acute (usually sudden) clouding of consciousness, lasting minutes or hours, with full recovery.
Any of the following may be observed – incoherent speech, misidentification of persons, visual hallucinations, inappropriate behavior such as singing, or memory loss for the episode.
[27] A diverse list of medical disorders have led to delivery during coma, including head injury, antepartum bleeding, severe hypotension and hypothermia.
[32] In a few cases the apparent motive has been psychiatric illness, but the majority were either the destruction of an unwanted child, or desperate remedies when the infant cannot be delivered and the nearest obstetric unit was beyond reach.
Before the introduction of effective pain relief (1847), obstetricians were familiar with this, and referred to it under names like parturient rage, furor uterinus, Wut der Gebärenden and colère d'accouchées.
In France, Esquirol mentioned a mother who stabbed her infant 26 times with a pair of scissors; she was acquitted because the judges considered that she was suffering from mental derangement.
[38] There is an insoluble judicial problem, because violence is sometimes a feature of delirium; in a clandestine birth, it is impossible to know whether consciousness was clouded or not.
Immediately after giving birth, an exhausted mother, fainting or in shock, may not be able to care for the new-born, who often needs resuscitation, and can suffocate in mucus or blood.
Exhaustion alone, without syncope or delirium, can prevent a mother from helping a dying infant; in clandestine labors, it can be fatal to the new-born, without mens rea.
After excessively painful labors, or those with a disturbing loss of control, fear of death or infant loss, or complications requiring forceps delivery or emergency Caesarean section, some mothers experience symptoms similar to those occurring after other harrowing experiences; these include intrusive memories (flashbacks), nightmares, and a high-tension state, with avoidance of triggers such as hospitals or words associated with parturition.
[48] Another reaction to a severe experience of childbirth is pathological complaining (paranoia querulans in the International Classification of Diseases).
[50] Occasionally the content is truly absurd – one mother's intense resentment was her husband suggesting the wrong name for the infant.
The effect on childcare is like that of severe depression, but the emotional state (furious anger, not sadness and despair) and treatment strategy are different.