Exploring UP journeys among women with psychiatric vulnerability using interpretative phenomenological analysis 183 ambivalence is an independent risk factor for UPs17. Some participants in our study believed that they were sub fertile or infertile, as was found in the study by Borrero and colleagues40. Perceived in/subfertility and lack of pregnancy intentions could also explain the use of less reliable contraceptive methods. Previous data from this study group support the hypothesis that formulated pregnancy intentions may increase contraceptive adherence. Among persons with mental health problems who were sexually active but did not intend to become pregnant, 83.3% always used contraceptives36. In contrast to the previous literature, our data do not support the hypothesis that mental health symptoms such as lack of overview, depressed mood or hypersexuality make women susceptible to UPs. This is probably due to the limited sample size of the IPA, in addition to the absence of several important severe psychiatric disorders, such as florid psychotic or manic episodes. Previous literature consistently shows that UPs evoke profound emotional responses1820,41. This accords with the emotional burden illustrated in our sample of pregnant women with psychiatric vulnerability and their partners. These responses, summarized by some women as ‘grief coming over me’, resemble the five stages of grief that can be identified in persons who are mourning: denial, anger, bargaining, sadness, and acceptance42. Parents without psychiatric vulnerability also reported a profound emotional impact resulting from UPs, including mental health conditions, postpartum depression, suicide attempts or hospitalization41. Thus, we hypothesize that the impact of UPs on mental health is not specifically related to having psychiatric vulnerability. However, the notion of dreams about childhood, flashbacks to their childhood trauma and fear of transgenerational transmission of trauma and psychiatric symptomatology in our sample has not been previously described in relation to UPs. It is widely known that maternal representations, often present even before pregnancy, are derived from women’s own upbringing and parental experiences43. Maternal representations of pregnancies and babies as scary, monstrous or negative, as in our sample, could be related to these past experiences. In turn, maternal representations about the baby might impact future mother–infant attachment44. As it is possible to improve attachment problems between mothers and their offspring45, it is valuable to understand women’s maternal representations and their origin. This might be even more relevant for women with childhood traumatic experiences. Ultrasounds and feeling the baby kick were important milestones in pregnancy acceptance as well as potential bonding experiences for pregnant women and their partners. These milestones consolidated the pregnancy and provided reassurance about the health of the baby. In interviews with women without psychiatric vulnerability, similar positive effects of ultrasounds were found in the first trimester46. These experiences could be points of reference in supporting women with UPs. Most participants in our sample had an intrinsic desire to
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