WEEK5C: Psychological Changes in Pregnancy

Psychological Changes of Pregnancy

Pregnancy is such a huge change in a woman’s life, and brings about more Psychological changes than any other life event beside puberty.

A woman’s attitude towards a pregnancy depends on Psychological aspects such as:

The environment in which she was raised
The messages about pregnancy her family communicated to her as a child
The society and culture in which she lives as an adult
Whether the pregnancy has come at a good time in her life

Social Influences
Cultural Influences
Family Influences
Individual Differences
Partners Adaptation

Social Influences

The woman and her partner feel during pregnancy and prepared to meet the challenges are related to them:
- a. Cultural background
- b. Personal beliefs
- c. Experiences reported by friends and relatives
- d. Current plethora of information available
Nurse’s Role
- 1. Teaching the woman about their health care option
- 2. Continue to work with other health care provider to “demedicalize” childbirth
  - the process by which a condition or behavior is no longer considered a medical issue, removing it from clinical diagnosis and treatment.
PAST: The pregnancy was conveyed as a 9-month long illness
- TODAY: Pregnancy is viewed as a healthy span of time best shared with supportive partner and or family
PAST: The pregnant woman went alone to a physician’s office for care
- TODAY: The woman brings their families for prenatal care visits as well as to watch the birth
PAST: At the time of birth, she was separated from her family
- TODAY: The woman was hospitalized in seclusion from visitors and even from the new baby for 1 week afterward so the newborn could be fed by nurses
PAST: The woman chooses what level of pain management they want to use for labor and birth
- TODAY: They expect to breastfed their newborn

Cultural influences

Cultural beliefs and taboos can place restrictions on a woman’s behavior and activities regarding her pregnancy
During prenatal visits, ask the woman and her partner if there is anything, they believe that should or should not be done to make the pregnancy successful and keep the fetus healthy.
Examples: Beliefs
- Lifting the arms over the head during pregnancy will cause the cord to twist
- Watching a lunar eclipse will cause a birth deformity
Nurse’s Role:
- 1. Supporting these beliefs shows respect for the individuality of a woman and her knowledge of good health.
- 2. Find a compromise that will assure a woman that these are not really harmful to a fetus but that still respects these beliefs

Family Influences

The family in which woman raised can be influential to her beliefs about pregnancy
Woman and her siblings were loved and seen as a pleasant outcome is more likely to have a positive attitude towards her pregnancy
A woman who views mothering a positive activity is more likely to be pleased when she becomes pregnant than one who does not value mothering
Negative Influences - woman and her siblings were blamed for the breakup of a marriage or a relationship.

Individual Differences

A woman’s ability to cope with or adapt to stress plays a major role in how she can resolve any conflict and adapt:
- a. To being a mother without needing mothering, to loving a child as well as partner
- b. To becoming a mother for each new child depends on her basic temperament on whether she adapts to new situations quickly or slowly, whether she face them with intensity or maintain a low-key approach, and whether she had experience coping with change and stress
- c. The extent to which a woman feels secure in her relationship with the people around her
- d. Past experiences influence on how woman perceive pregnancy as a positive or negative experience
- e. To being concerned about her appearance
- f. To being worry that pregnancy will rob her financially and ruin her chances of job promotion
Nurse’s Role:
- 1. Assessing and counselling pregnant woman
- 2. Fill the role of an attentive listener

Partner’s Adaptation

The more emotionally attached a partner is to a pregnant woman, the closer the partner’s attachment is apt to be to the child.
Factors that affect the pregnant woman’s decision making:
- a. Cultural
- b. Past experience
- c. Relationships with the family members
Acceptance of pregnancy and a coming child depends on the following factors:
- a. Decision making
- b. Cultural background
- c. Past experience
- d. Relationships with the family members

Psychological Tasks of Pregnancy

1. First Trimester: Accepting the Pregnancy
- ● Task: Accepting the pregnancy - woman and partner both spend time recovering from shock/surprise of learning they are pregnant and concentrate on what it feels like to be pregnant.
- A common reaction is ambivalence, or feeling both pleased and not pleased about the pregnancy.
- The Woman
  - Accept the reality of the pregnancy, later will come the task of accepting the baby, following their initial surprise women often experience the feeling of ambivalence
  - Ambivalence – refers to the interwoven feelings of wanting and not wanting feelings which can be confusing to an ordinarily organized woman
  - Most women who were not happy about being pregnant at the beginning are able to change their attitude towards their pregnancy by the time they feel the child move inside
  - Woman often comment after such visit they feel “more pregnant” or it makes a first visit more than an ordinary one
  - Early diagnosis is important because the earlier a woman realizes she is pregnant, the sooner she can begin to safeguard fetal health by discontinuing all drugs not prescribed or approved by her health care provider.
- Health care plan:
  - 1. Routine sonogram – to assess for growth anomalies and can be a major step in promoting acceptance because women can see a beating heart or fetal outline or can learn the sex of their fetus.
  - 2. First prenatal visits - hearing their pregnancy officially diagnosed at a first prenatal visit is another step toward accepting a pregnancy
  - 3. Prenatal visit or Fetal testing – provide an outlet for both male and female partners to discuss concerns and offer parenting information
- The Partner
  - ● All partners are important and should be encouraged to play a continuing emotional and supportive role in pregnancy
  - ● Accepting the pregnancy for a partner means not only accepting the certainty of the pregnancy and the reality of the child to come but also accepting the woman in her changed state
  - ● Partner may also experience feeling of ambivalence
  - ● Partner may feel proud and happy at the beginning of pregnancy
  - ● Soon begin to feel both overwhelmed with what the loss of salary will mean to the family if the woman has to quit work
  - ● Feeling close to jealousy of the growing baby who although not yet physically apparent, seems to be taking up a great deal of the woman’s time and thought
- Health care plan:
  - o Prenatal visit or fetal testing – provide an outlet for both male and female partners to discuss concerns and offer parenting information.
2. Second Trimester: Accepting the Baby
- Task: Accepting the baby - Woman and partner move through emotions such as narcissism and introversion as they concentrate on what it will feel like to be a parent. Roleplaying and increased dreaming are common
  - Narcissism - self-centeredness
  - Introversion - or turning inward to concentrate on oneself and one’s body
- The Woman
  - Psychological task of a woman is to accept she is having a baby, a step up from accepting the pregnancy
  - The change usually happens at quickening or the first moment a woman feels fetal movement.
  - Woman who carefully planned the pregnancy, this moment of awareness may occur soon as she recovers from the surprise of learning she has actually conceived
  - She announces the news to her parents and hear them express their excitement and see a look of pride on her partner’s face
  - A good way to measure the level of a woman’s acceptance is to measure how well she follows prenatal instructions
- The Partner
  - A partner may become overly absorbed in work, striving to produce something concrete on the job that may limit the amount of time a partner spends with family
  - Some men have difficulty enjoying the pregnancy because they have been misinformed about sexuality, pregnancy, and women’s health.
3. Third trimester: Preparing for parenthood
- Task: Preparing for the baby and end of pregnancy
- Woman and partner prepare clothing and sleeping arrangements for the baby but also grow impatient with pregnancy as they ready themselves for birth
- The Woman and Partner
  - ● Couples begin “nest building” activities (Planning the infant’s sleeping arrangements, choosing a name for the infant, ensuring safe passage) by learning about birth
  - ● Couples are usually interested in attending prenatal classes and or classes on preparing for childbirth.
  - ● Childbirth education class and or preparing for parenthood can not only help a couple accept but also expose them to other parents as a role models who can provide practical information about pregnancy a concern child care.

Assessing events that could contribute to difficulty accepting Pregnancy: UMDLRJIMCS

Pregnancy is unintended
Learning the pregnancy is a multiple, not a single one
Learning the fetus has developmental abnormality
Pregnancy is less than 1 year after the previous one
Family has to relocate during pregnancy (Involves a need to find new support people
The main family support person suffers a job loss
The woman’s relationships end because of partner’s infidelity
There is a major illness in self, partner, or a relative
Complications of pregnancy occur (Hypertension)
The woman has a series of developing experiences (failure in school work)

Emotional responses that can cause concern in Pregnancy

Emotional responses and common reactions helpful to caution a pregnant woman and her partners that the common changes may occur so they’re not alarmed if they appear:
- Grief = give up or alter her present role as she will never be the woman, she has been in exactly the same way again and will never be able to be irresponsible and carefree, which may manifest as a form of grief
- Narcissism = self-centeredness
  - early reaction to pregnancy
  - previously barely conscious of her body begins to concentrate on the dresses so it will or will not show her pregnancy
  - lose interest in her job or community events
  - Reducing risky activities to protect her body and her baby
- Introversion versus Extroversion
  - Introversion - concentrate on oneself and one’s body, some women react in an entirely opposite fashion and become more extroverted
  - They are more active, appear healthier and are more outgoing occur in women who are finding unexpected fulfillment in pregnancy
- Body image and Boundary
  - Body image (the way the body appears to herself)
  - The woman begins to envision herself as a mother or becoming “bigger” in many different ways
  - Changes in concept of body boundaries (Perceive herself as needing body boundaries as if her body were delicate and easily harmed.
- Stress
  - Pregnancy can cause extreme stress in woman who was not planning to be pregnant
  - Stress in pregnancy, can make it difficult for a woman to make decisions, be aware of her surroundings or maintain time management with her usual degree of skills
  - If the woman was in a violent relationship before pregnancy, increased stress is apt to cause even more violence
- Depression
  - Loss of interest in usual things
  - Feelings of guilt, or low self-worth
  - Disturbed sleep, low energy and poor concentration
  - Feeling depressed during pregnancy, especially if they lack a support person
  - Screening for woman who have history of depression is important at the preconception visit as a common drug prescribed for depression can be teratogenic to a fetus and cause Hypertension
- Couvade Syndrome – (from the French word “to hatch”)
  - Partners experience physical symptoms:
  - Nausea
  - Vomiting
  - Backache to the same degree or even more
  - Gain weight along with their partner as a woman’s abdomen begins to grow
    - partners may perceive themselves as growing larger too, as if they were the ones who were experiencing same as the pregnant woman
- Emotional Liability
  - Mood changes occur partly as a symptom of narcissism (Feelings are easily hurt by remarks that would have been laughed off before)
  - Mood swings may be common that they can make a woman’s reaction to her family and health care routine unpredictable
  - Mood changes is partly because of hormonal changes, due to the Increase in Estrogen and Progesterone
  - Caution families that such mood swings occur in the beginning of pregnancy, so they can accept them as part of normal pregnancy
- Changes in Sexual Desire
  - Feeling of loss of desire because of their increase in estrogen or they might unconsciously view sexual relations as a threat to the fetus
  - 1. First trimester
    - decrease in libido because of nausea, fatigue, and breast tenderness
  - 2. Second trimester
    - blood flow to the pelvic area increases to supply the placenta, libido and sexual enjoyment can rise markedly
  - 3. Third trimester
    - sexual desire remains high or may decrease because of difficulty in finding a comfortable position and increasing abdominal size
- Changes in the Expectant family
  - Most parents are aware that their older children need preparation when a new baby is on the way
  - Preschool and school-age children
    - Need to be assured that the new baby will be an addition to the family and will not replace them or change their parents affection for them