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maternal psychological response during the 1st trimester

  • uncertainty
  • ambivalence: often experience conflicting feelings (b/c half of pregnancies are unintended)
  • excitement
  • self-focused: fetus seems vague/unreal, but she notices physical changes and n/v
    • nurse should focus on the mother's physical and psychological needs during this period


maternal psychological response during the second trimester

  • physical evidence of pregnancy make the fetus seem real
    • can see on U/S, experiences quickening
  • fetus as focus: concerned about producing a healthy infant
    • very interested in info about diet and fetal development
  • narcissism and introversion:
    • women concerned about ability to provide for fetus and this manifests as narcissism and introversion
  • changes in body image and sexuality
    • can be a negative or positive change in body image 
    • sexual interest may inc, decline, or remain unchanged, but her physical comfort and sense of wellbeing are linked to her sexual activity
    • intercouse is safe as long as no complications


maternal psychological response during 3rd trimester

  • vulnerable: worry about harm to baby
  • increasingly dependent: relies on others and seeks help in making decisions
    • often have fear about safety of partner and love is often more pronounced
    • better for woman when she knows partner is concerned and willing to help her
  • accept that fetus is separate but totally dependent
  • preparing for birth
    • more fear if first pregnancy
    • seek out information
    • nesting takes place


steps in maternal role taking

  • mimicry: observing and copying the behavior of other women who are pregnant or mothers in an attempt to discover what the role is like
  • role play: acting out aspects of what mothers actually do
    • "practice" her role as mother by wanting to care for other infants
  • fantasy: allow the woman to consider possibilities and "try on" a variety of behaviors
    • often revolve around the way the infant will look and the characteristics it may have
  • search for a role fit: occurs once the woman has established a set of role expectations for herself and internalized view of a good mother's behavior
  • grief work: sense of grief when realize they must give up aspects of their previous selves




  • begins during pregnancy
    • by 2nd trimester, feelings of love and attachment surge, especially when experience quickening and see fetus on U/S
    • 3rd trimester: love becomes possessive and leads to feeligs of vulnerability
  • previous loss can disrupt attachment
    • may wait to attach to infant until they can feel sure that the pregnancy is normal and will continue


4 maternal tasks of pregnancy

  • seeking safe passage: priority
    • to ensure safe passage: seek prenatal care and follow recommendations of HCP
  • securing acceptance: throughout pregnancy
    • involves reworking relationships to help important ppl in her life accept her in the role of mother
    • esp need support from partner and her own mother
  • learning to give of herself
  • committing herself and developing attachment to the unknown child


variations in paternal response to pregnancy

  • some men are emotionally invested and comfortable as full partners exploring every aspect, but others are more task oriented and may view themselves as managers
    • some men prefer just to observe
  • readiness for fatherhood more likely if a stable relationship, financial security, and desire for parenthood are present
  • common concerns: health of mother and baby, financial concerns, apprehension about his role


3 developmental processes that an expectant father must address

  • grappling w/ the reality of pregnancy and new child
    • some things help make child more real like seeing fetus on U/S, hearing fetal heart beat, and feeling infant move
    • also have to prepare room and accumulate supplies for baby
  • struggling for recognition as a parent
    • have to focus on both the father and mother as our patients
  • making an effort to be seen as relevant to childbearing
    • work on relationship with their own father
    • "try on" fathering behaviors to see where they are comfortable
    • couvade: pregnancy related S/S and behaviors in expectant fathers
      • sometimes they experience n/v, HA, fatigue, and weight gain
      • may be cause by stress/anxiety for their partner


adaptation of grandparents

  • age: determines emotional responses of prospective grandparents
  • number and spacing of other grandchildren
    • first: very exciting, joyful
    • another may be welcomed, but w/ less excitement which may disappoint the couple
  • perceptions of role of grandparents
    • help prepare for baby, give gifts, watch older children
    • give advice
    • parents should communicate with the gparents about what their expectations are


adaptation of toddlers to pregnancy

  • unaware of maternal changes occurring and are unable to understand that they will have a new sibling
  • any changes in sleeping arrangements should be made several weeks before birth so they don't feel displaced by the new baby
  • may show feelings of jealousy and resentment, so need frequent reassurance that they are loved


adaptation of older children to pregnancy

  • from 3-12 yo: more aware of changes in mom's body and may realize a baby is to be born
  • may have lots of questions
  • need preparation for when baby is born and mom has to be away at the hospital for several days
  • benefit from being included in preparations for the new baby
  • provide time along with the parents to ensure a sense of security
  • sibling classes can be helpful


adaptation to adolescents during pregnancy

  • depends on developmental level
    • some are embarrassed b/c pregnancy confirms the continued sexuality of their parents
  • may be indifferent or very involved


factors influencing psychosocial adaptations

  • age of parents
    • teens: major task of "forming sense of self" in adolescence vs "giving of self" needed for pregnancy
  • multiparity: may experience guilt in expanding love to include 2nd child
    • they don't have as much time to take care of themselves as they did w/ 1st pregnancy
  • social support
    • depression may occur if lack of support during pregnancy
  • absence of partner: may lack financial and emotional support
    • inc risk for delaying prenatal care
  • socioeconomic status


barriers to prenatal care

  • limited by financial, systemic, and attitudinal barriers
    • financial are of most importance
      • may have no insurance
      • Medicaid application is burdensome and length
    • systemic: institutional practices that interfere w/ care
      • insurance controls when can have 1st prenatal visit
      • prenatal care often done during the day
      • lack of transportation
    • attitudinal: unsympathetic attitude of some health care workers for those who can't pay
  • nurses must tx each family w/ respect
    • assess for barriers to care
    • schedule prenatal visits in the evening/weekend, offer Medicaid and WIC applications, decreasing wait time before appintments


cultural differences in pregnancy

  • belief in fate: may not prepare for baby (Southeast, Middle East, Russian)
  • prevent illness: involve using foods, charms, amulets
  • restoring health: charms, herbs/plants, holy words
  • modesty: may prefer not to be exposed to men (Muslim, Hindu, Hispanic, Orthodox Jew)
  • female genital cutting
  • communication:
    • use interpreters if language barrier
    • decision making: determine who makes decisions for the family
    • eye contact:
      • in US, most say eye contact=honesty
      • avoiding eye contact is a sign of respect in some cultures
      • Latino: evil eye-->if an indiv with special powers admires a child too openly
    • touch:
      • offensive to men: Hindu, Muslim
      • appreciate: Hispanics


female genital cutting (FGC)

  • also called female genital mutilation
  • practiced in parts of Africa, Asia, and Middle East
    • illegal in the US
  • involves removal of part or all of the clitoris, labia minora, and labia majora
  • SEs: urinary retention, incontence, infection, inc morbidity and mortality
  • assoc with premarital chastity and is a prerequisite for marriage in some cultures
  • nurse and physician need to be knowledgable and help woman maintain privacy
    • vaginal exams may be painful and a pediatric speculum may be used