Chapter 5: The Psycho-Social-Cultural Aspects of Pregnancy (Davis Advantage for Maternal-Newborn Nursing: Critical Components of Nursing Care - 4th Edition)

Relevant nursing diagnoses associated with the Psycho-Social-Cultural Aspects of Pregnancy

Risk for fear, related to unknown processes of pregnancy and birth

Ineffective communication related to cultural differences

Risk for ineffective coping

Relevant nursing outcomes for the Psycho-Social-Cultural Aspects of Pregnancy

Increase acceptance of changes in the body

Be accepting and definitely communicate

Demonstrate knowledge to your patient regarding body changes

Maternal tasks of pregnancy

Ensuring safe passage for self and child

Keeping everyone safe

Ensuring social acceptance of child by significant others

Attaching to the child

Giving of oneself to the demands of motherhood

What are some examples that a mother can do to prepare for labor?

Classes, Reading, Fantasizing, Dreaming, Support Groups

Common fears associated to pregnancy / labor

Fear of losing control

Fear of losing self esteem

Fear of losing identity

Types of relationship issues in pregnancy

Self as mother

Mothers' Mother

Partner / Significant other

Maternal Adaptation to Pregnancy Complications: Frustration

Woman expresses anger or aggression

Withdrawal from pregnancy or partner

Maternal Adaptation to Pregnancy Complications: Fear

Woman states she is afraid of fetal death

Woman states she is afraid of newborn disability

Woman is crying

Maternal Adaptation to Pregnancy Complications: Anxiety

Unexpected pregnancy complication

Unanticipated interruption in normal pregnancy

Maternal Adaptation to Pregnancy Complications: Threat to Self-Esteem

Woman feels lack of self-confidence related to pregnancy

Woman reports feeling she has failed as a woman

Woman feels little confidence to be a mother

What are some factors affecting maternal adaptation?

Multiparty (Multiple children), Age (Teen Mothers and Geriatric), Single Parenting, Sexual Orientation, Gender Orientation, Multi-gestational Pregnancy, Socioeconomic Factors, Abused woman and IPV (Intimate Partner Violence)

General Nursing Actions for the Psycho-Social-Cultural Aspects of Pregnancy

Assess Adaptation (How is the patient responding to the pregnancy? How does the partner feel about the pregnancy?)

Recognize and respond to IPV (Educate, Support, and Provide Resources)

Raise awareness of racial / ethnic disparity

Understand the roles

Support others, advocate, and ensure woman are free from racism and bias

Best Health Assessment Tool for the Psycho-Social-Cultural Aspects of Pregnancy?

ALPHA bitchhhhh

Partner Adaptation: Announcement Phase

Lasts for few weeks

"Congrats on the Pregnancy"

Their task is to accept the biological fact of pregnancy.

Partner Adaptation: Moratorium Phase

Put the conscious thought of pregnancy aside

The baby is going along and the partner is not stressed / sick

Some jealousy comes into play

Partner is too pre-occupied with other things

Partner Adaptation: Focusing Phase

Help with planning

Start negotiating with the partner

Think of themselves as fathers / mothers / partners

Nurses' Role in Partner Adaptation

Educate, Explore, Provide Resources, etc.

Sexuality in Pregnancy: Impact of anatomical and hormonal changes

In the first trimester, the drive for sexuality goes down

Hormones make the patient feel weird

Second trimester rise

Third semester decrease

Nursing Actions for Sexuality in Pregnancy

Education, Evidence, Resources, Explore, etc.

Examples of Family Developmental Tasks

Acquire knowledge and make plans

Preparing to provide

Adapt the financial patterns

Realign tasks

Expanding communication

Adapting those set in stone relationships

What can be a major crisis for the future sibling of a soon-to-be child?

The actual birth

Strategies for siblings to cope with a new pregnancy in the family

Take the child to appointments

Play with other people's babies (in the waiting room for example)

Take the sibling on a tour of the hospital to become accustomed to the environment

Nurses' Role in Sibling Adaptation

Teach, Guide, Listen, Reassure, and encourage sibling visitation if allowed

Preexisting, severe and persistent mental illness can lead to complications in pregnancy that include:

Altered pregnancy adaptation and having to stop taking certain mental health medications

Nursing Actions for social support

Information support, education, spiritual support, provide resources, comparisons, etc.

4 C's of Trauma Informed Care

Calm, Contain, Care, Cope

Obstetrics Traumatic Events can lead to loss of:

Autonomy;

Blatant misuse and disrespect can greatly impact a way that an obstetric patient views their care during pregnancy

For what type of patients should we be creating culturally diverse interventions?

Immigrant and Refugee Women

(and granted be open to creating these environments for everyone if it comes up)

Culturally Sensitive Practice Examples

Decision making appropriate? Making the decision for themselves

Understanding communication

Religious beliefs that may be impacted by their choice

World View

How do they feel about modesty?

How do we feel about gender roles in their culture?

Barriers to culturally sensitive care

Lack of diversity

Protocols may impact culturally sensitive care / beliefs

Unfamiliar environment and lower health literacy

Who can help assist with the birthing process

Providers (OBGYNs, Family Practice Docs, Midwifes)

Certified Nurse-Midwife (CNM)

An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes

Certified midwives (CM)

Certified in midwifery but come from profession other than nursing

Direct-entry midwife (DEM)

Is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing.

Lay midwife

A non-medically trained person who helps deliver babies