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UNIT 2 PSYCHOLOGICAL CHANGES IN
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2.0 OBJECTIVES
At the end of this unit, you should be able to:
• discuss the psychological changes in pregnancy
• discuss the psychological tasks in pregnancy.
• list and discuss the minor disorders in pregnancy.
3.0 MAIN CONTENT
3.1 Psychological changes in Pregnancy
Pregnancy can be viewed as a developmental stage with its own distinct developmental tasks. For a couple it can be time of support or conflict, depending on the amount of adjustment each is willing to make to maintain the family’s equilibrium.
Pregnancy can be considered as maturational crisis, as it is a common event in normal growth and development of the family. If the crisis, is not resolved it will result in maladaptive behaviours in one or more family members and possible disintegration of the family.
The Mother
Pregnancy alters body image and necessitates reordering of social relationships and changes in roles of family members.
First Trimester - feelings of disbelief and ambivalence are paramount, she focuses on self and her pregnancy symptoms such as breast tenderness of morning sickness are unsettling and at times unpleasant, she becomes increasingly introspective and passive mood swings from joy to despair occur.
Second Trimester: Quickening occur which gives the perception of fetal movement helps the woman to think of her baby as a separate person. The woman becomes introspective as she evaluates her life, plans and her child’s future. This helps her to prepare for her new mothering role. In some instances partner may withdrawal which may be distressing to the woman. As pregnancy become noticeable she feels great pride, embarrassment or concern. Women generally feel best during the second trimester because it is a relatively tranquil time.
Third Trimester:- The woman feels pride about her pregnancy and anxiety about labour and birth, physical discomforts increases and she is eager for the pregnancy to end, she experiences increased fatigue and interest in sexual activity decrease. There is usually a surge of energy as the woman prepares a nest for the infant (London et al 2011).
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The Father
Pregnancy is psychologically stressful fathers anxiety often stem from inadequate preparation, this can be addressed by recognizing paternal needs and including fathers for more in antepartal education (Deave, Johnson and Ingram, 2008).
First Trimester: There is initial excitement on announcement of the pregnancy after which the father begins to feel left out, he may be confused by his partners mood changes, resent attention she receives and her need to modify relationship as she experiences fatigue possibly decreased interest in sex.
Second Trimester: Pregnancy still appears vague but his involvement may increase as he watches and feels fetal movement and listen to fetal heartbeat during prenatal visit. The father needs to confront and resolve some of their conflicts about the parenting they received. An open, honest discussion about the expectations the parents have about their roles will help the father to be in his transition to fatherhood (Goodman, 2005).
Third Trimester: Concerns and fear may recur, he may worry about hurting the unborn baby during intercourse or become concerned about labour and birth. He may also wonder what kind of parents he and the parent will be.
Siblings
Bringing a new baby home often marks the beginning of sibling rivalry because the siblings views the baby as a threat to the security of their relationships with their parents constructive action can minimize the problem of sibling rivalry, consistency is important in dealing with young children.
3.2 Psychological Tasks in Pregnancy
Rubin (1984) identified four major tasks that the pregnant woman undertakes to maintain her inactiveness and that of her family which forms the foundation for a mutually gratifying relationship with her infant;
Ensuring safe passage through pregnancy labour and birth: -
- She looks for competent maternity care to provide a sense of control
- Seeks information from literature, observation of other pregnant women, new mothers and their discussions with other.
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- Engages in self care activities related to diet, exercise, alcohol consumption.
- In the third trimester she becomes more aware of external threats in the environment.
- Sleep becomes more difficult she longs for birth even though it is frightening.
Seeking Acceptance of this child by others;
- Woman slowly and subtly alters her network to meet the needs of her pregnancy.
- Mother seeks to work to ensure acceptance of the coming child by the sibling.
- Parents support and acceptance help to form a maternal identity.
Seeking Commitment and Acceptance of herself as mother to the infant (binding – in)
- Strong emotional component, motivates the pregnant woman to become competent in her role and provides satisfaction for her in the role of mother.
Learning to Give of oneself on behalf of one’s child:-
- Woman learns to delay immediate personal gratification to meet the needs of another.
Minor Disorders in Pregnancy
Minor disorders may occur in pregnancy hormonal changes, accommodation changes, metabolic and postural changes as every system of the body is affected by pregnancy.
4.2.2.6.1 Digestive System Nausea and vomiting –
Occurs in 50 percent women between the 4th and 6th week of gestation Cause – Hormonal influences, human chorionic gonadotrophin oestrogen and progesterone are all contributors. Smell of food may cause the mother to retch.
Helpful practices
• Eating of carbohydrate snacks at bedtime prevents hypoglycemia
• Dry toast and biscuit on waking up and breakfast after half an hour
• Salads and light snacks are more tolerable than full meals Heartburn
Burning pain in the mediastinal region caused by reflux of stomach contents into the oesophagus. Occurs as the cardiac sphincter relaxes during pregnancy due to the effect of progesterone.
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Helpful practices
- If heartburn is occasional, reflux can be prevented by avoiding bending and kneeling.
- Small meals that are easily digested should be taken.
- Fried and fatty foods should be avoided
- Antacids as prescribed by physician may be used Excessive Salivation
Occurs 8th week of gestation usually accompanies heartburn Pica
Craving of mothers for certain foods or substances such as coal
Cause is unknown. If the substances craved for are harmful to the unborn baby. Medical advice should be sought
Constipation
Is due to relaxant effect of progesterone on the smooth muscles causing decreased peristalsis pressure of the gravid uterus on the colon makes it worse near term.
Helpful practices
- Increase the intake of water
- Add green leafy vegetables, fruits and bran cereals to diet
- Take a glass of water early in the morning before breakfast to activate the gut and help regular bowel movements
- Regular exercise Musculoskeletal
• Backache
The gradual weight gain and change in the body’s center of gravity combined with the stretching of weak abdominal muscles often leads to hollowing of the lumbar spine
Helpful practices
- Advice relating to comfortable positions in sitting, standing, lying, general mobility and how to lift correctly
- Pillows should be placed to support the whole limb
• Cramps
Cramps has been attributed to deficiency of vitamin B1 and decreased levels of calcium. These are quite common usually in the leg and worse at night.
Helpful practice
- Gentle leg movements whilst in a warm bath prior to settling for the night
- Sleep with the foot end of the bed elevated by 20-25cm - Take vitamin B complex and calcium supplements - Once cramp has occurred gentle kneading is effective
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Genito-urinary System
• Frequent Micturition
Occurs in first trimester where there is pressure of the gravid uterus on the urinary bladder it is spontaneously relived when the uterus rises up in the abdomen it may recur late in pregnancy when the fetal head descends into the pelvic.
• Leucorrhea
Increased white non-irritant vaginal discharge in pregnancy.
Frequent washing of the vulva (3-4timesa day) with plain water would be sufficient.
She should wear cotton underwear and avoid tights
Midwife should exclude possibility of infection such as thrush and trichomonas.
Circulatory System
• Fainting
In early pregnancy fainting may occur due to vasodilation under the influence of progesterone. It may subside following the compensatory increase in blood volume. Later in pregnancy a mother may feel faint while lying flat on her back because the weight of the uterine content presses on the inferior vena cava and slows the return of blood to the heart. Turning the mother quickly on to her side bring rapid recovery.
• Variscosities
Progesterone relaxes the smooth muscles of the veins and results in sluggish circulation valves of the dilated veins become inefficient and varicosities result mostly in legs, anus haemorrhoids and vulva.
Helpful practices
- Exercising the calf muscles by rising on to the toes or making circling movements with the ankles.
- Resting with the legs vertical against the wall for a short time.
- Wearing support tights before rising or after resting with legs elevated.
When haemorrhoids occur advise to;
- Avoid constipation by including fiber in the diet and adequate fluids.
- Seek medical advice for tropical applications for vulva varicosities panty – girdle or sanitary pad may give support
• Edema
It results from venous and lymphatic stasis blood pressure of the woman should be checked to rule out pregnancy induced hypertension. Advise to elevate the legs, sleep in left lateral position and avoid sitting with the feet hanging down
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Intergumentary System
• Skin
Some mothers complain of generalized itching, which often starts over the abdomen this is thought to have some connection with the liver’s response to the hormones in pregnancy and with raised bilirubin levels.
It clears soon after the baby is born and comfort can be gained from local applications. Antihistamine may be prescribed if there is vulva irritation, infection such as thrush and glycosuria as a result of diabetes must be excluded. Washing with mild soap and cotton underwear may ease the irritation.
Nervous System
• Carpal Tunnel Syndrome
Mothers complain of numbness and pins and needles’ in their fingers and hands. It usually happens in the morning. Wearing a splint at night with the hands resting on two or three pillows sometimes helps.
Restriction of salt intake and flexing the fingers while the arm is held above the head can be helpful. The syndrome resolves spontaneously following delivery.
Bell’s palsy a rare condition may develop in last trimester due to oedema compressing the facial nerve. It resolves in 3 to 4 weeks following delivery.
• Insomnia
Occurs due to discomfort caused by fetal movements, frequency of micturition and difficulty in finding a comfortable position. The woman should be advised to;
- Take rest in the afternoon
- Drink a glass of warm milk at bed time
- Tuck a pillow under the abdomen when lying in a lateral position - Talk about her fears and anxieties so that she can have a sense of
normality and lightness SELF-ASSESSMENT EXERCISE
i. List the disorders of pregnancy -Explain the causes and measures for the relief of discomforts
ii. Outline the disorders that can possibly ameliorate the disorders requiring immediate intervention
iii. Discuss how emotional and psychological changes that commonly occur in a woman and her family during pregnancy can be addressed and provide necessary management.
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Notes on the Self Assessment Questions
We have looked into the psychological changes in pregnancy and the tasks, which includes ensuring safe passage through pregnancy ,labour and birth; seeking acceptance of this child by others; acceptance of herself as the mother of the infant; learning to give oneself on behalf of one’s child. Also the minor disorders in pregnancy such as disorders in the digestive system(e.g. Nausea and Vomiting, Heartburn, constipation and excessive salivation); Musculoskeletal, Urinary Circulatory and Nervous disorders were discussed. I do hope that the information here will make a better understanding of this subject matter.
4.0 CONCLUSION
Pregnancy can be viewed as a developmental stage with its own distinct developmental tasks. For a couple it can be time of support or conflict, depending on the amount of adjustment each is willing to make to maintain the family’s equilibrium.
5.0 SUMMARY
Pregnancy can be considered as maturational crisis, as it is a common event in normal growth and development of the family. If the crisis, is not resolved it will result in maladaptive behaviours in one or more family members and possible disintegration of the family
6.0 TUTOR-MARKED ASSIGNMENT
Interview five pregnant women in your community on how they feel about their pregnancy and why they feel that way.
7.0 REFERENCES/FURTHER READING
Cunningham, FG, Leveno, KJ, Bloom, SL, Hauth, JC, Rouse DL. And Spong CY (2010) Williams Obstetrics 23rd edition, New York McGrawHill medical
Deave, T. Johnson, D. and Ingram, J. (2008); Transition to parenthood:
the needs of parents in pregnancy and early parenthood.
Pregnancy and Childbirth (8) 30 – 35
Goodman, JH (2005) Becoming an involved father of an infant. Journal of Obstetric, Gynaecology and Neonatal Nursing 34 (2) 190 – 200
Rubin, R. (1984) Maternal identity and the maternal experience. New York, Springer
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