Young Pregnant Mom, Self-Cutting

I hear your concern for your client and her baby. As a healer, it must be unnerving for you to see scars "from her shoulders to her wrists," making you wonder how someone who may be psychologically fragile will handle labor, birthing, and mothering. This is compounded by your instinct that you aren't getting the full story, given physical indications that she's had a previous baby.

Many questions immediately spring to mind:

1. How old is this "young" client?

2. Will she have support once she has the baby? (Someone to live with them who can teach her how to care for the baby, monitor the baby's care, and help her with the emotions that will inevitably come up?)

3. When did she stop cutting, and how? (Was she in a residential treatment facility?)

4. Is she living in the same situation in which she grew up, which presumably either helped trigger her cutting, or did not intervene constructively?

5. Has she ever attempted suicide?

6. Does she have a history of being abused, either physically or sexually?

7. Did she have a diagnosis of borderline personality disorder?

8. How's her impulse control?

9. Is she currently in counseling?

Approximately one in every 200 adolescents (mostly girls) regularly cuts herself, so the phenomenon is not uncommon. In general, teenagers without a history of other emotional disorders, sexual abuse, or suicide attempts, can stop cutting and learn other ways to soothe themselves if they are given adequate therapeutic support. Patients diagnosed with borderline personality disorder or who have a history of attempted suicide are considered to have the worst prognosis.

I am somewhat reassured to hear that your client is not currently cutting.

The issue is that cutting is always a symptom of a more serious underlying problem. Even when someone has been removed from a problematic environment and been able to break the cutting addiction, she needs ongoing support from a good therapist to build the emotional structure necessary to tolerate intense feelings. So this young woman's current living and therapeutic situations are critical to her and her baby's mental health.

I don't know of any scientific literature on how cutters cope with labor and birthing. My assumption would be that she might feel traumatized by the birth experience, which by definition leaves the mother feeling out of control—a difficult thing for someone who has used cutting to assert some control. In your long experience as a midwife, however, you have seen many women labor and give birth. I would bet that you can offer enough support to help your client handle the birth.

More concerning to me is the question of how a young woman who has been in such psychological pain will handle the very tough job of parenting an infant. The vulnerability of infants, which reminds us of our own past vulnerability, can trigger rage in a parent who is not ready to face that part of herself.

If, in fact, your client has already had another child and is ashamed to tell you this for some reason—Did she give the baby up? Injure him or her?—that's a pretty big wild card. A new baby after such a loss would trigger lots of feelings in the mother that she would need help handling.

I would advise you to have a heart-to-heart with your client. Tell her you can't help but notice the excruciating past she wears so eloquently on her arms. Express your concern for her well-being during the months of pregnancy, through the mood swings the labor and birth, and the stresses of motherhood. Ask how you can best support her. If you can offer her a safe relationship in which she can trust, she may be willing to share the answers to the above questions with you, so that you can assess the potential risks of the situation.

As you already know, this isn't just any client. I urge you to find support for yourself in this situation as well.