Pregnancy as a reaction to early childhood sibling loss.

Surrogate mothers, illegitimately pregnant teenagers, married women seeking abortions, women convicted of manslaughter, and sister survivors of early childhood sibling loss may share a common conflict. These women may be in a state of incomplete mourning, unconsciously wishing to master a trauma by turning a passive experience into a life event they can control. Pregnancy can function as that life event. Replacement daughters and/or sister survivors can present as our patients with a search for or an avoidance of pregnancy as a crucial though unconscious issue. Literature written about this sequelae of early sibling death is reviewed according to psychosexual and object relationship stages. Common and uncommon consequences are discussed. Vignettes from the course of psychoanalytic therapy with women whose brothers had been accidently killed; whose sibling had died of metabolic disease; and those whose siblings had been relinquished to foster care are used to illustrate the immediate and long-term reactions. The range of these include varieties of separation anxiety as well as learning inhibitions in latency; exaggerated pseudo heterosexuality and other risk taking at puberty; problems in self-esteem regulation relative to either the idealized memory of the missing sibling or the omnipotence connected with survivor guilt. This paper focuses on the choice of a sexual partner and pregnancy issues as symptoms of reworking established conflicts around self-valuation and abandonment by sibling and grieving parents. As the family relationships around the lost sibling become less distorted in her analysis via transference resolution, so do the feelings about contemporary relationships. Becoming pregnant is then not an event burdened by the past.