Psychological changes of Pregnancy Effects on the patient and her family Mothers Reactions

Initial reaction may run the gamut of emotions. May be surprised, pleased, disturbed, disappointed, frightened. There is element of surprise in every pregnancy. As the pregnancy progresses must reach an acceptance.
Cultural Background Influences Acceptance

Background and society influence a mothers reaction to her pregnancy. Emphasis on pre-natal and medically oriented society. Child-bearing is a womans work. Beliefs about health of the baby
Supernatural being in total control Mother is totally responsible
Other Influences

Attitude of health care provider. Home life in childhood

people love as they as loved

Basic temperament of mother

ability to adapt and cope may view pregnancy as a threat

Mothers Emotional Responses

Narcissistic response is an early reaction. Extroversion, glowing behavior is common. Has difficulty staying focused. Emotional mood swings are frequent. Husbands need to be forewarned about these changes to expect in wife.
Psychological tasks for Pregnancy

Acceptance is the major task that must be accomplished.

For many a specific time Indications are preparations for new arrival

Resolve old fears and / or conflicts Evaluate relationships Nurses role--be a good listener and facilitate expressions of feelings to work through these tasks
Steps in Preparing for Motherhood

Mimicry and role-playing

association with other pregnant women or new mothers spend time with own mother.

Identifies parenting role she wants to mimic

Fantasy--How will it be to be a mother Grief work--giving up her current lifestyle as life will never again be the same.
Hindrances associated with a mothering breakdown

Multiple births Children born within 10--12 months apart. Moving Loss of security
job/illness of self or family

Loss of husband/ or infants father. Previous loss of a child

Practical Tasks

Physical preparation for new arrival Financial re-arrangements Household chores and responsibilities Acquisition of new knowledge regarding pregnancy and childbirth.
Fathers Reaction to Pregnancy

Fathers are becoming more involved in the childbearing process from pre-natal care to participating in the labor and
birth process.

Acceptance is also his major developmental task to be achieved. Needs to accept the reality of the child. Need preparation for the changes that will take place for his wife. Mood swings are common and emotions are unpredictable. Narcissistic or self-centered response of mother may be misunderstood. May feel left out May have feelings of jealousy. His childhood background will also influence his preparation. Needs to also identify a role-model or parenting style he wants to mimic. Preparation also includes fantasy and grief work.
Concerns of Fathers

Breadwinner--most are still primarily concerned with the financial obligations. Protective and supportive role Symptoms of pregnancy often are felt by dads.
Effects of Pregnancy of Other Children

Most parents agree children will need some warning.

Effects of the pregnancy may occur early for the children.

Mood swings of Mom and unpredictable response to behavior. Mom sick and Dad fixing breakfast. Visits to the doctor. Physical changes in the home
Preparing Children for a New Sibling

How soon to tell children depends on their ages and personality of the child. The parents reactions and acceptance of the new baby also will influence the children. The attitude of the older children often will reflect the attitude of the parents.
Preparation by Ages

School-age children should be told when the parents know for sure. Pre-School age children probably should be told when preparation for the baby begins. Toddlers are often the most affected and must give up the role of baby of the family
Answering their questions

Answer questions honestly and simply depending on age and understanding. Answer only what he is asking.
The unwed Pregnant Patient

Overall birth rate is decreasing, but for the teen -age mother under age 15, it is rising. Teens are more prone to complications than older mothers. Infant mortality is higher as well. Often may have a problem with acceptance of the pregnancy and seek to hide it.
Teen-age Mothers

Often the first major decision is to tell the parents of the pregnancy. There may be an initial reaction of anger, disappointment and even grief. After parents have time to adapt and accept the pregnancy, they can be the teen-age mothers best ally.
Options facing the teen-age Mother

Stay in school is the first option to be stressed. Marriage may be considered. Abortion--may feel initial relief, and then guilt and depression. Adoption--a beautiful option. Single-parenting.
Presumptive signs with other possible causes First trimester: 1. Amenorrhea absence of menstruation. Other possible causes of amenorrhea are: emotional stress, strenuous physical exercise, endocrine problems, chronic disease, early menopause, anovulation, low body weight.

2.

Nausea and vomiting (Morning sickness) begins about 6 weeks after the last menstrual period and usually disappears by about 14 weeks. Other possible causes include: gastrointestinal virus, food poisoning, emotional stress. 3. Breast changes begins at about the sixth week of pregnancy. The expectatnt mother experiences breast tenderness, tingling, feelings of fullness, increase in size and pigmentation of the areaolae. Other possible causes are premenstrual changes and the use of oral contraceptives. 4. 4. Fatigue other possible causes are illness, stress and sudden lifestyle changes. 5. Urinary frequency urinary tract infection may also cause urinary frequency. Second trimester: 1. Quickening other possible causes are intestinal gas, peristalsis or pseudocyesis 2. Increased skin pigmentation: chloasma, linea nigra - Other possible causes are premenstrual changes and the use of oral contraceptives. 3. Striae gravidarum Probable Signs First trimester: 1. Chadwicks sign can also be possibly caused by hormonal imbalance. 2. Goodells sign can also be possibly caused by hormonal imbalance. 3. Hegars sign can also be possibly caused by hormonal imbalance. 4. Positive HCG Hydatidiform Mole can cause a positive HCG Second trimester: 1. Enlarged abdomen could also be caused by abdominal or uterine tumors 2. Braxton hicks contractions presence of myomas can cause false and painless contractions 3. Ballottement other possible cause of this occurrence is the presence of uterine or cervical polyps. Pregnancy produces many physical changes. Aside from weight and body shape, other alterations in your body chemistry and function take place. The heart works harder, your temperature registers slightly higher, body secretions increase, joints and ligaments are more flexible and hormones are altered. Mood changes are common, resulting from a combination of hormonal changes and greater fatigue, as well as normal anxiety over body image, sexuality, finances, marriage roles and impending parenthood. The following is a list of the most common discomforts of pregnancy and some guidelines for coping with them.

Nausea and Vomiting

Eat small frequent meals. Going too long without eating during pregnancy can cause nausea or make it worse. If you experience continuous nausea, eat every one to two hours. Avoid greasy, high-fat foods. They are more difficult to digest. Consume dry starch foods, such as crackers, toast or cereal, in the morning before you get out of bed. Also, it helps if you stay in bed for 20 minutes or so after eating and get up slowly from the bed for a sudden change of position can aggravate nausea. Drinking carbonated beverages as well as peppermint, spearmint and chamomile teas may help. Eat plenty of carbohydrate-rich foods such as cereal, fruit, bread and rice. They are easy to digest and provide energy. Take prenatal vitamins only as directed. If they cause stomach upset, ask your practitioner if you can delay taking them for a few weeks. Some foods, such as milk or tea, that are soothing to one woman may be upsetting to another. However, most women find cold foods and beverages easier to tolerate than hot ones. Eat a high-protein snack before bed to stabilize blood sugar. Limit your consumption of coffee. It stimulates acid secretion, which can make the nausea worse. Consume liquids separately from meals, waiting about 20 to 30 minutes.

Wear sea sickness wrist bands. These can be found at most pharmacies.

Constipation

Increase the amount of fiber in your diet, eating foods high in fiber such as fruits, raw vegetables, whole grain products, nuts and dried fruits. Choose a breakfast cereal that has at least 5 grams of fiber per serving. These foods help soften the stool and promote natural bowel activity. Drink a lot of fluids. Exercise, even walking, will help relieve constipation. Eat prunes or figs, or drink prune juice. These fruits contain a natural laxative. Avoid laxatives. If the problem is not resolved with the above suggestions, let your health care practitioner know. Stool softeners that are safe during pregnancy can be prescribed. Iron supplements can aggravate constipation the prescription for iron can be adjusted if it becomes a problem.

Hemorrhoids

To help avoid hemorrhoids, prevent constipation by maintaining a diet that is high in fluids and fiber. Witch hazel or Tucks pads can be applied to the hemorrhoid area to relieve symptoms. Avoid over-the-counter laxatives. If hard stools are aggravating hemorrhoids, stool softeners can be used, but first consult your practitioner for specific suggestions.

Fatigue
This is very common during the first trimester. Get as much sleep or rest as you can even short naps will help. Your energy level will pick up after the first three months. However, fatigue and insomnia tend to recur in the last months of pregnancy. A warm bath, massage or hot drink before bed often helps you relax and get ready to sleep.

Breast Tenderness
Breast tenderness is most pronounced during the first three months. The breasts enlarge in size and can be quite tender. Wearing a good support bra may help you feel more comfortable.

Frequent Urination
Frequent urination is another pregnancy symptom that is most pronounced during the first trimester as well as the end of pregnancy. Do not restrict fluid intake in an effort to decrease the frequency of urination. As long as you do not experience burning or pain with urination, increased frequency is normal and will go away with time.

Leg Cramps
Cramps in your calf or thigh occur most frequently at night. One remedy may be to increase your intake of calcium. Ask your provider about a calcium supplement. While in bed, stretch with your heels pointed, not your toes. This will help relieve a cramp.

Heartburn

Try eating smaller but more frequent meals. Avoid highly seasoned, rich and fatty foods. Do not lie down flat after eating. If you must lie down, elevate your head and shoulders with pillows. Carbonated beverages and milk often can help alleviate heartburn. Certain antacids are not recommended during pregnancy. Check with your health care provider before using overthe-counter antacid preparations.

Backache

Lower back pain is common during pregnancy. It is caused by the shift in posture necessitated by carrying extra weight in front.

Try not to stand in one position for too long. An exercise called the pelvic rock will help alleviate back pain and strengthen the lower back muscles that experience the most stress. Elevating the feet onto a stool while sitting will help.

Dizziness
Dizziness or lightheadedness can be caused by low blood sugar or a sudden change of position. To help avoid this feeling:

Move slowly when getting up from a sitting or lying position. Eat well and frequently. Women who are prone to low blood sugar should carry snacks at all times. Juices and fruit are particularly good choices.

Swelling of the Hands and Feet

Slight swelling of the hands and feet are common in the later stages of pregnancy. Adequate fluid intake is always important. Improve the circulation in your legs and feet by elevating them as often as possible. Lie on a bed or floor and raise your legs up on the wall keeping your knees bent. If you are wearing elastic hose, drain your legs this way before putting them on.

Danger Signs in Pregnancy Symptom Vaginal Bleeding Pelvic or Abdominal Pain Persistent Back Pain Gush of Fluid from Vagina Swelling of the Hands/Face Severe Headaches, Blurry Vision Regular Contractions prior to 37 Weeks No Fetal Movement Potential Problem Miscarriage, placental abruption, placenta previa Miscarriage, ectopic pregnancy, abruption Miscarriage, preterm labor Preterm labor, preterm rupture of membranes, miscarriage Pregnancy Induced Hypertension (PIH) PIH, Ecclampsia Preterm labor Fetal distress, Fetal Demise Other possible causes Hormonal bleeding, Implantation bleeding Cyst, uterine growth, ligament pain Kidney/bladder infection, cyst, normal pregnancy pain Leaky bladder, watery mucous Swelling

Gastric upset Slowed movements, anterior placenta

Six Signs that Labor is Within a Few Weeks or Days: 1. Lightening: You can breathe again! This is an indication that the baby has dropped, settling deeper into your pelvis and relieving some of the pressure on your diaphragm, so you are not so short of breath. You may feel increased pressure on your bladder, which means more trips to the bathroom. Others may comment on your changed appearance, although you might not be aware of it at all. 2. Bloody show: Loss of mucus plug. During pregnancy, a thick plug of mucus protects your cervical opening from bacteria entering the uterus. When your cervix begins to thin and relax, this plug is expelled. Some women think the plug will look solid like a cork, but it is actually stringy mucus or discharge. It can be clear, pink or blood tinged and can appear minutes, hours or even days before labor begins. Not all women notice this sign.

3. Rupture of membranes: Your water breaks! Only 1 in 10 woman experience a dramatic gush of the amniotic fluid and even then it usually happens at home, often in bed. Sometimes the amniotic sac breaks or leaks before labor begins. Your uterus is sitting directly on top of your bladder, which can cause you to leak urine. Sometimes it can be quite difficult to distinguish urine from amniotic fluid. If your membranes have ruptured and you are leaking amniotic fluid, it will be an odorless fluid. This can occur with a sudden gush or a constant trickle. If you notice fluid leaking, you need to try to determine if it smells like urine or if it is odorless. If it does not seem to be urine, you would want to contact your health care provider. Until you see your physician or midwife do not use tampons, have sexual intercourse or do anything that would introduce bacteria to your vagina. Let your health care provider know if the fluid is anything other than clear and odorless, particularly if it's green or foul smelling, because this could be a sign of infection. 4. Nesting: Spurt of energy. For most of your pregnancy you have probably been fighting the urge to take a nap, so you'll know when you experience this. One day you will wake up feeling full of energy! You'll start making a long list of things to do, things to clean, things to buy and everything you've put off doing will become a high priority. In all your preparations, don't forget that Labor Day may be just around the corner so save some energy. 5. Effacement: Thinning of the cervix. Usually in the last month the cervix begins to stretch and thin. This process means the lower segment of the uterus is getting ready for delivery. A thin cervix will also allow the cervix to dilate more easily. Your health care provider may check for effacement in the final 2 months of pregnancy. Effacement is measured in percentages. You may hear your health care provider say,You are 25% effaced, 50% effaced, 75%... The Braxton Hickscontractions or practice contractions you have been experiencing may play a part in the effacement process. You will not be able to determine your effacement process, this can only be done by a health care provider's exam. 6. Dilation: Opening of the cervix. Dilation is the process of the cervix opening in preparation for childbirth. Dilation is measured in centimeters or, less accurately, in fingers during an internal (manual) pelvic exam. Fully dilated means you're at 10 centimeters and are ready to give birth. In the same way that your health care provider may be checking for effacement in the last 2 months, your health care provider may also tell you how many centimeters your cervix has dilated.