Psychological and Physiological

Changes of Pregnancy
Topic 2.1
 Perinatal Period
• Period of physical and psychological
preparation for birth and parenthood
• Opportunity for nurses and members of
health care team to influence family health
• Healthy women seek care and guidance.
• Health promotion interventions can affect
well-being of the woman, child, and rest of
the family.

2
 Psychological Changes of
Pregnancy
• Social Influences
– Previously thought of as a illness and have to be
alone at this time

• Family Influences
– Family influences beliefs. Positive = easier to
accept pregnancy. Positive views of motherhood
generally make it easier to accept pregnancy
• Individual Differences
– How women cope with stress and change
Psychological Tasks of Pregnancy
1.Acceptance of Pregnancy
FIRST TRIMESTER

2.Accepting the baby

SECOND TRIMESTER

3.Acceptance of being parents (Preparing

for parenthood)
THIRD SEMESTER
 Maternal Adaptation
Reva Rubin, in the1960’s, studied maternal role
adaptation and identified these tasks that helps
women prepare for parenthood.

Includes:
–Accepting pregnancy
–Identifying with mother role
–Reordering personal relationships
–Establishing relationship with fetus
–Preparing for childbirth
 Maternal Adaptation
• Accepting the pregnancy:
– Accepts the idea of pregnancy
– If unplanned can feel dismayed
– If happy and pleased about pregnancy will have high self-
esteem and be confident
– Emotional liability is common
– Ambivalence (having conflicting feelings at the same time).
This is a normal response to their changing role.

– Non-acceptance of the pregnancy. Should not be equated

with rejection of the child- some women can want a baby
but do not enjoy pregnancy.
 Maternal Adaptation
• Identifying with Mother Role
– This can begin early in life for many women
Some of women have thought of having children
from a very young age so they identify with this role
easily.
– Conflicts can occur during pregnancy
Some women having trouble identifying with the mother
role as they have not always imagined themselves as
mothers

This can also be influenced by previous experience

 Maternal Adaptation
Reordering Personal Relationships
– Close relationships can undergo change and periods of
tension and conflict can occur as family members learn
their new role.
• Women relationship to her mother is significant in adopting to
pregnancy and motherhood
– Most important person is usually the father
• Two major needs that women express are feeling loved and
valued, and having the pregnancy accepted
• A woman who is nurtured by her partner experience fewer
emotional and physical symptoms as well as fewer labour and
childbirth complication!
– Changes in sexual expression
• This can be due to personal feelings, misconceptions or myths
 Maternal Adaptation
Establish relationship with fetus
– Emotional attachment begins during the prenatal period
as women fantasize and daydream about being a mother.
– Begin to imagine the types of parents they will be
– Family members may also interact with the fetus forming
a bond.
– Babies can hear at 24 weeks
 Maternal Adaptation
• Preparing for childbirth
– Many women actively prepare for childbirth by reading
books, viewing films, attending prenatal classes
– Anxiety can arise from concern about safe passage for
herself and the child. This may not be overly expressed but
rather through making plans ‘if anything should happen’
– Many women fear the pain of childbirth or fear of
mutilation. Education from the perinatal nurse can
alleviate many of these fears
– By the end of pregnancy breathing is difficult, sleep is
disrupted, and it is difficult to get comfortable. Most
women are ready for the pregnancy to be over
 Paternal Adaptation
This is a time of intense learning for the father.
•Can see couvade’s
– Where man takes on or experiences the physical symptoms
of the women’s pregnancy. In some cultures, men would
take to bed when women was in labor and imitates the
pains of childbirth until the baby is born
•Recently seen an increase in father participation
– Due to cultural and professional changes/attitudes to
encourage father participation
•Preparation for childbirth
– Surge of creative energy at home and on the job
– Can become dissatisfied with current living space
– Wanting to get things finished up
 Paternal Adaptation
• Identifying with father role
– Just as in women, this is formed by their views and
experiences of fatherhood.
• Personal relationships
– Main role in pregnancy is to nurture and respond to the
pregnant woman’s feelings of vulnerability.

– The woman’s increased introspection during the second

trimester many cause feelings of uneasiness as she
becomes preoccupied with thoughts of the child and she
become increasingly dependent on her physician, midwife
or nurse.
 Paternal Adaptation
• Establishing a relationship with the fetus
Attachment can be as strong as mothers
• Can be formed by rubbing/kissing the maternal
stomach
• Talking or singing to the fetus
• Calling the baby by a nickname
 Normal Pregnancy
• Term pregnancy = 37-41 weeks
– 1st Trimester = 1-13 weeks
– 2ndTrimester = 14-26 weeks
– 3rd Trimester = 27-40 weeks
• Pre-term = less than 37 weeks
• Postmaturity = more than 42 weeks
 Signs of Pregnancy
Presumptive - If a woman has these symptoms then we “presume” she might be pregnant but
then there could also be other explanations for them. These are the signs least indicative
of pregnancy.
- Nausea and vomiting, fatigue, urinary frequency, breast changes, uterine enlargement,
amenorrhea
Probable: are signs that can be documented, not true findings because there can be false
positive tests.
- Pregnancy test, chadwick’s signs (bluish coloration of the mucous membrane of the
cervix), Hegar’s signs (softening of the lower uterine segment), ballottement (feelings of
bouncing back on a bimanual exam), Goodells’s sign (softening of the cervix)

Positive: These are the only true signs of pregnancy

Fetal movement felt by an examiner, fetal visualization, fetal heart audible with doppler
 Physiology - Reproductive
Uterus :
Grows in length, depth, width & weight
Can usually be felt above the symphysis pubis 12 to 14 weeks
(uterus can be palpated above the symphysis pubis)
Approx. 36 weeks reaches the xiphoid process
RMEMEBER MEASURING SYMPHYSIS fundal height

Round ligament keeps the uterus midline (can cause discomfort and
grabbing pain in lower abdomen as pregnancy progresses)

What does the term “lightening” refer to?

BABY DROPS into pubis (38 WEEKS ISH)
 Physiology - Reproductive
Cervix
-Softens around 6 weeks due to increased vascularization (Goodell’s sign)
-Mucus plug forms and stays long until close to term then changes in preparation
for birth
- Chadwick’s sign is the bluish color of the cervix due to increased vascularization
Vagina
-Increased vascularisation
-Increased acidity to protect against infection =increased chance of yeast infections
-Leukorrhea (whitish discharge) - in response to cervical stimulation by
estrogen/progesterone
Breasts
-Increase in size & sensitivity due to increase in estrogen and progesterone

-Montgomery's tubercles-ducts increase in size expulsion of colostrum (yellow milk,

good milk) 16 wks
 Physiology- Cardiovascular
Heart
Position changes as pregnancy advances
– Diaphragm is pushed upwards because of enlarged uterus
– Cardiac Output Increases 30-50% due to increase in blood
volume. Occurs in response to an increased tissue
demands for oxygen.
– Heart rate can increase 10 – 15 beats/minute
– Mammary soufflé - these are heart sounds heard as blood
flows through breast tissue
 Physiology- Cardiovascular
Blood Pressure
Tends to stay at baseline however, may go down in 2nd
trimester due to placental growth. *EXAM
Supine hypotension – can cause fetal hypoxia
Cause: pressure on superior vena cava *EXAM
Treatment: go on left side *EXAM
Venous pressure
Impaired to lower extremities
– During 3rd trimester blood flow to lower extremities is impaired
due to enlarged uterus (compression of iliac veins and inferior
vena cava)
• Results in edema, varicosities, vulva edema, and hemorrhoids
 Physiology- Blood
• Blood volume increases
– Blood volume increases by approximately 1500ml or 40 – 50%
– Peaks at 32 – 34 weeks
• Physiological Anemia
• Because blood volume increases to a greater extent than RBC’s leading to
a reduction in blood viscosity and results in dilution anemia.
2nd trimester back to near normal levels
• Total WBC increases in 2nd trimester
• Greater tendency for blood to clot.
• Why do you think there would be an increase in clotting factors?
– Increase in clotting factors
– Protective mechanism to help prevent PPH (Post Partum Hemorrhage)
– Puts mothers at risk for thrombosis – especially after a section (invasion, less active,
surgery patient)
 Physiology - Respiratory
• Respiratory
– O2 needs increase due to increase in metabolic rate
– Diaphragm is displaced
– Crowding of chest cavity causes Shortness of breath
– Respiratory tract becomes more vascular in response to
estrogen giving rise to complaints of nasal/sinus stuffiness
and nosebleeds.
• Basal Metabolic Rate
– Increases in pregnancy
– Due to fetal growth, oxygen demands of uterine/placenta
and fetal unit
– Increased cardiac workload
 Physiology-Urinary System
• Frequency 1st Trimester and towards end of 3rd Trimester due to
pressure on bladder

• Increase in bladder capacity

• Urinary output increase by 60 – 80% as mother is excreting waste

for both herself and fetus

• Susceptible to UTI in pregnancy due to growing uterus and

displacement of bladder. Urinary stasis can occur.

• Can see bladder irritability (incontinence), nocturia and frequency

• TEST PROTEIN, GLUCOSE, and KEY TONES IN URINE ROUTINELY IN
PREGNANCY *
 Physiology - Endocrine
• Pituitary : HGH, Melanocyte stimulating hormone increase (causes
skin pigment changes), Late Pregnancy – Oxytocin & Prolactin
increase
• Adrenal Glands : Cortisol/Aldosterone increase suppressing the
inflammatory response to decrease chance of rejecting the
fetus.
• Thyroid : Enlarges, increases BMR = increased pulse, heat
intolerance, increased cardiac output
• Parathyroid : Better utilization of Ca & Vit D. Increase in size to
help with Calcium (needed for fetal growth)

»
 Physiology - Integumentary
• Darkening of: Nipples, areolae, axillae, vulva – seen around 16 weeks of
pregnancy
• Facial melisma : mask of pregnancy. Affects 50-70% of women but is seen
more in darker skin women
• Linea Nigra: Brown pigmentation on abdomen from symphysis pubis to
umbilicus
• Striae gravidarium (stretch marks): 50-90%of women. Reflects the
separation of connective tissue. Part of genetic mark up
• Diastasis : separation of abdominal muscles
• Angiomas: Vascular spiders, small red branching spots on the skin
especially thigh- from increased estrogen in body
• Palmar erythema: Red blotches on the palms of hands due to increase in
estrogen
 Physiology - ENT
• Nose – stuffy nose
• EYES – may complain of blurred vision
Cornea thickens in pregnancy
* ALSO WORRIED ABOUT HYPERTENSION
(blurred vision)
• Mouth- gum hypertrophy can occur
– Increased tooth decay.
– Change tooth paste and soft tooth brush
 Physiology - Musculoskeletal
• Lordosis: Centre of gravity changes
– adjustments in posture needed
– backache
• Relaxin: Ovarian hormone
– Helps with relaxation and softening of joints
– Permits enlargement of the pelvic dimensions to facilitate
labour and birth
– Synthesis pubis separation
– Become more flexible
 Physiology- Endocrine
• Pancreas
• First Trimester – decreased insulin production.
• 2nd & 3rd – increased insulin production.
• Insulin is LESS effective than normal.
• Overall effect is more circulating glucose for the developing
fetus

• Placenta
• Endocrine organ – Produces many hormones
»mature at 8-10 weeks/Hormones++
»produces estrogen, progesterone, hpL hcG,
relaxin and prostaglandins
 Physiology - Endocrine
• Estrogen - breast and uterine enlargement
• Progesterone - maintains endometrium, stops
contractility
• Relaxin - helps stop contractility and softens cervix
• hCG- stimulates progesterone and estrogen
synthesis. Want increase
• hpL- makes insulin less effective to allow more
glucose for fetal growth
• Prostaglandins - may be trigger to start labor
 Physiology - Gastrointestinal
• Appetite can fluctuate throughout pregnancy
– Early in pregnancy have nausea and vomiting (usually
passes after first trimester)
– Appetite increases by the end of the second trimester

• Cravings
– Pica (non-food items)

• Decreased motility
– heartburn
 Health Education Needs
• Nutrition
– Nausea/vomiting
– Heartburn
– Constipation
• Personal hygiene- shower and wear deoderant
• Prevention of urinary tract infection – wipe front to
back, empty bladder often, get medical attention can cause premature labor

• Physical activity
– Exercise/relaxation
– Posture/body mechanics
 Health Education Needs
• Clothing
– Supportive bra
– Support hose: prevent DVT
• Travel
– Not contraindicated for low risk pregnancies