Childbirth can be one of the severest of human ordeals. Its torments occasionally result in acts of desperation, which are fully described in the older literature. They are much rarer now, but may still occur where obstetrics is primitive, or pregnancy denied. Auto-Caesarean section has been documented. (35) There are reports of completed suicide. Rage attacks have been described, which can endanger the fetus, and may be a factor in some cases of neonaticide.
Confusional states are rare, but well documented; they may be more common when babies are delivered without modern obstetric care or analgesia. In most cases, the delirium lasts a few hours, starting shortly before delivery and disappearing after the birth, with amnesia for the event. Engelhard (36) gave the best estimate of its frequency in a 10-year survey; there were five cases of transitory confusional states in 19 910 births. The cause is unknown, but was formerly attributed to agonizing pain. The existence of this phenomenon, albeit rare, aggravates the jurisprudence problem of neonaticide, because, in an unattended delivery, it is impossible to know whether the mother was temporarily confused.
Neonaticide is a hazard in unexpected or clandestine deliveries.
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