COUNSEL ADOLESCENTS, WOMEN AND

FAMILIES ON ISSUES PERTAINING TO

PREGNANCIES, CHILD BIRTH AND
LACTATION

SUBMITTED TO

Mrs. Dhana lakshmi

SUBMITTED BY
Assistant professor
Y. Praneetha Rani
Govt college of nursing
1st year, M.Sc nursing
kurnool
Govt college of nursing

kurnool

Adolescent Counseling
 Adolescent counseling is counseling aimed at young people to help them make sense of
their feelings, behaviors and thoughts and entails the use of unique techniques that draw out
the expressive nature of a young person like art therapy or more traditional approaches like
talking therapy. This form of counseling is important in helping guiding kids transitioning into
adulthood and to understand themselves better.

The adolescence stage is the period when a child transitions from being a child to
becoming an adult and usually takes place between the ages of 10 and 19. During this period,
the young adult starts experiencing a great deal of mental and physical changes. Physically,
adolescents start seeing changes in their bodies, a process referred to as puberty, and is a time
that leaves them confused as the changes in hormones start affecting their moods and
thoughts. 
Often, when these changes start setting in, adolescents become extremely sensitive and
start experiencing mood swings and fluctuations in their confidence levels. If not properly
guided or counseled, adolescents could take to their own devices and start making their own
judgements, which are often clouded. As a result, they could end up following the wrong path
and becoming prey to negative things that could ruin their lives like drugs, peer pressure and
such. It is for this reason that adolescents should consider counseling to address their feelings
and thoughts allowing them to grow into healthy, sound-minded adults.

The Importance of Adolescent Counseling

Any parent can attest to the fact that the adolescence stage of any child can be
extremely difficult and confusing. With fluctuations in mood, your youngster could be happy
one minute and mad the next. Often, during this stage, most kids feel as though their parents
are pressuring them and just want space. That is why most kids tend to withdraw when they
reach their adolescence and don’t want much to do with their parents. During this period, they
also become more aware of their bodies and their sexuality. As a result, they tend to want to
make new friends and experiment with new things. It is a confusing time so parents need to
monitor and supervise to ensure teenagers do not end up making wrong life decisions.

Adolescent counselors are professionals who have been trained on how to listen to
young adults and to address different things an adolescent might be going through. At the same
time, they provide feedback to adolescents on how they should handle themselves amidst all
the changes that they are going through.

Before looking at the different facts about adolescent counseling, it is important to

understand that this form of counseling can be done using different methods or approaches.
Some of the available counseling methods include:
Interactive Counseling Workshops: Interactive counseling workshops are often performed with
the main intention of counseling groups of young adults all at once. During such workshops,
adolescents participate in different one on one and interactive activities like talks, games and
other practical sessions. At the same time, young adults are given information talks about
adolescence and peer pressure.

One-on-One Counseling: One-on-One adolescent counseling involves having the adolescent

attend counseling sessions. Often, this form of counseling is advised in the event a parent has
concerns about their child and/or about transitioning into adolescents or who has been
influenced negatively by different factors during this very fragile stage.

Facts about Adolescent Counseling

Adolescent counseling is not only for adolescents with personality or behavioral issues
but is for any child undergoing adolescence who may be confused or overwhelmed. While it is
important that kids with issues related to their adolescence undergo counseling, this form of
therapy is crucial for any young adult as it could help them understand the changes they are
going through and who they are becoming as it addresses basic aspects pertaining to
adolescence.

Adolescent counselors are trained professionals who have undergone extensive training
in psychology and behavioral changes and are able to professionally handle any situation a
young adult may be going through. At the same time, most counselors are people who possess
skill, knowledge and experience when it comes to adolescent counseling attained through
handling different patients over time.

Just like any other form of counseling, adolescent counseling is confidential as practicing
counselors are bound by confidentiality guidelines. As such, the patient can rest assured that
their case will be handled with discretion. Adolescent counselors will only share important
information with the parent or primary care giver to help them understand what the child is
going through and how to address the problem.

This form of counseling focuses on not only the patient but also on the patient’s family.
Counselors prefer involving the family as they play a crucial role in the adolescent’s life and will
determine how well the young adult will cope with the changes they are experiencing. As such,
parents should be ready to get involved in the counseling of their young adults. At the same
time, this form of counseling involves the counseling of the parents to ensure that they
understand how to handle an adolescent during this stage.
 Adolescent counseling runs for as long as it takes to achieve therapy goals or until the
patient or adolescent fully recovers. As such, it is advisable that a child’s family not try to hasten
the process as it is important for the child to get helpful counseling and advice.

Understanding the above facts about adolescent counseling will help you have a better
understanding of the process as a parent. As such, if your child is having a tough time coping
with the changes they are experiencing, it is advisable that you consider taking them for
counseling rather than wait for issues to build and get worse.

WOMEN AND FAMILIES ON ISSUES PERTAINING TO PREGNANCIES, CHILD BIRTH,

LACTATION
Behavior during pregnancy and childbirth is not as much biologically dictated as it is a result of
the cultural process. In general, our society tends to treat pregnancy as a solitary, clinical event.
In many non industrialized societies, pregnancy is invested with great religious significance. It is
seen as an altered physical and psychic state to be celebrated. Birth in all cultures is a symbol
for acts of creation and renewal. Most societies place some importance on birth and regard
pregnancy as a time when special rules apply to the pregnant woman. Often, extra physical and
emotional support is given. What varies considerably is whether birth is seen as an event of
illness or of normal physiology

Before the twentieth century, pregnancy and birth were viewed as a recurrent part of
the female life cycle as well as a social and familiar event. Wertz and Wertz, authors of an
extensive study of childbirth in America, depict birth as an important social occurrence, “a
fundamental occasion for the expression of care and love among women.” In the United States,
the history of childbirth can be divided into three periods. Until the late nineteenth century,
birth was primarily a female affair, managed by midwives and attended by friends and relatives.
From the late nineteenth century through the first decades of the twentieth century, birth was
transformed into a medical event as physicians replaced midwives. This transition was
complete by the 1920s, when the medical profession consolidated its control of birth
management.

Anticipation of either death or permanent injury was an important part of a woman is

childbirth experience throughout most of American history. Hence, the belief that pregnancy
was a disease was prevalent. Joseph DeLee whom many consider the father of modern
obstetrics, wrote: “pregnancy is a disease of nine months duration.” The great achievement of
modern obstetrics has been a reduction in both maternal and neonatal morbidity and mortality.
Modern obstetrics has also been criticized for viewing pregnancy as an illness and routinizing
childbirth. Problems develop because hospitals attempt to create a homogenized birth
experience for all women, despite the diversity of expecting women. This has resulted in an
emphasis on education and increased involvement of the woman and her family throughout
the childbearing process. Today, providers must blend advances in medical technology with the
family’s desire for autonomy.

EMOTIONAL AND DEVELOPMENTAL TASKS OF PREGNANCY

Pregnancy, birth, and parenting are pivotal events in a woman's life and are
considered biopsychosocial events. Once a woman has been pregnant, there is no turning back
to a prepregnant psychology. The desire for motherhood appears to be based not only on an
inherent biologic drive but also on identification of what is essentially female, although women
do not need to have children to achieve a sense of femininity. Pregnancy is viewed as a
developmental task, a time of crisis, and a critical phase by different social scientists. For many
women, pregnancy is also an opportunity for growth and reworking of self-concept.

All women experience pregnancy both emotionally and physically. The neuroendocrine
and biologic changes that occur during pregnancy have profound psychological effects on
expectant mothers. During the first trimester, a woman’s feelings are related to physiologic
changes (nausea, fatigue), whereas during the last trimester anxiety related to the approaching
birth becomes the predominant emotion. A woman’s socioeconomic status, her number of
previous births, and her personality type can affect the extent of these emotions as well as her
ability to cope with them. Several studies have reported that pregnant women with high levels
of anxiety are more likely to experience obstetric complications. Others have demonstrated
improved postnatal adjustment in women with moderate levels of anxiety. The difficulty in
interpreting many of these studies is the failure of researchers to differentiate between anxiety
as a stable trait of personality and anxiety as a transitory emotional state. Thus, the
psychological elements relating to pregnancy that appear to affect pregnancy and childbirth
include the personality and emotional disposition of the woman, the psychosocial background
of the woman, and life events that occur during the pregnancy.

Normal psychological adaptation to pregnancy and attainment of the maternal role are
much less researched areas in modern obstetrics than are physiologic adaptations. Two notable
researchers in the field are Newton and Rubin. In the 1950s, Newton explored maternal
emotions during pregnancy and childbirth and their relation to other aspects of women’s lives.
At the time, the general psychological factors that were believed to affect birth focused on
societal influences that prevented women from accepting labor as a natural physiologic
function. Newton found that women who had negative feelings about pregnancy were more
likely to wish they were men and had fewer motherly desires. Women who felt positively
toward pregnancy had more motherly tendencies an were less likely to wish they were men.
She also noted that feelings about pregnancy often progress from those of rejection to those of
acceptance. After delivery, women who felt negatively about birth were more likely to dislike
breastfeeding, avoid rooming-in care of their babies, and have fewer children. Conversely,
women who had positive feelings after birth were more likely to enjoy breastfeeding and
rooming-in and have more children.

Newton’s research noted that women who are rendered unconscious for delivery are
more likely to have negative feelings about childbirth. Her review of birth practices at that time
revealed that pharmacologic methods of pain control led to more operative vaginal deliveries
and depressed babies at birth. Newton became an avid supporter of Dick-Read’s childbirth
preparation methods and the natural, unmedicated approach to labor that was gaining
popularity in the 1960s. This influence and her studies of women’s responses to the birth
process led her to conclude that psychological methods of pain relief were preferable to
pharmacologic methods because they emphasized the need for continuous emotional and
physical support of the laboring woman.

Rubin describes pregnancy as a time for identification reformulation, a time for

reordering of interpersonal relationships, and a time of great personal growth and maturation.
Pregnant women turn inward, with a subsequent reduction of attention and energy available
for other tasks. In 1975, she outlined four maternal tasks necessary for women to complete
during pregnancy as a prelude to motherhood.

These tasks are:

 Seeking safe passage for herself and her child through pregnancy, labor, and delivery,

 Ensuring the acceptance of the child she bears by significant persons in her family,

 Binding in to her unknown child, and

 Learning to give of herself.

Safe passage is associated with trying to protect the child and herself from danger. Seeking
prenatal care and obtaining information about pregnancy and birth reflect the working through
of this task. The second task, ensuring acceptance of the pregnancy by family, is important
because it leads to acceptance of the child by significant family members who will contribute to
the raising of the child. Binding in is the bond between mother and child that for some women
is apparent immediately—the sense at birth of already knowing the child. Giving of oneself is
the final task and marks the beginning of a mother’s nurturing behavior to her child. Each task
is accomplished during pregnancy in a unique manner by the individual woman and forms what
Rubin calls the qualitative matrix of mothering. Not all of Rubin’s publications are based on
research findings and both Rubin’s and Newton’s research contain strong Freudian
perspectives. Although these works are somewhat dated, they remain classics in the field and
provide important insight into the psychological tasks of pregnancy and new parenthood.

The psychological responses to pregnancy is recommended that When a physician is first

consulted by a pregnant woman he should assess not only the changes in her body but also in
her environment and her capacity to compensate for the stress these changes have
engendered.” Simply asking “How do you feel about being pregnant?” will often elicit
information sufficient to assess a woman's emotional state. The most common response
to the diagnosis of pregnancy is ambivalence. A survey of a large sample of expectant mothers
and fathers found two predominant and conflicting views: approaching parenthood meant both
existential satisfaction and restriction of freedom. It is important to stress the normalcy of
ambivalent feelings in pregnancy and the transition to parenthood, because it takes most
women time to adapt to the changes in self-perception and life-style.

Psychological issues in pregnancy and childbirth

 First trimester

 Ambivalence

 Discomforts of early pregnancy

 Awaiting results of diagnostic testing

 Second trimester

 Quickening makes fetus a reality

 Physical changes make pregnancy a reality

 Process of maternal attachment begins

 Lowest incidence of physical and emotional problems

 Third trimester

 Pronounced alteration in body image and discomfort

 Fear of loss of attractiveness

 Fear, anxiety, vulnerability

 Preoccupation with birth

 Concerns for health of the baby

 Plans for child care and impact on life-style

Third trimester (postpartum)

 Need to review the birth experience

 Acceptance of realities and outcome of childbirth

 Acceptance of infant gender, appearance, behavior

 Choices of infant feeding

 Resumption of sexual activity, family planning

The physical complaints of nausea, vomiting, breast tenderness, and profound exhaustion
common for many women in the first trimester may compound ambivalent feelings and lessen
the initial excitement. There also tends to be a preoccupation with self and a concern for safety
that encourages most women to seek obstetric services. Women must accept the idea and
reality of the pregnancy before they can accept and bond to the child to come. Nonetheless,
from the moment conception is confirmed, the pregnant woman is a mother. As the
discomforts of the first trimester pass and the mother first feels fetal movement, the baby
becomes a reality. The mother begins to see the baby as an identity separate from herself and
begins to feel responsible for the baby and think of herself in a maternal role. Some women feel
passive or dependent and very sensitive to the attitudes and comments of others. For most
women, the feelings of ambivalence common to the first trimester tend to change to feelings of
acceptance as the pregnancy progresses. At the conclusion of the second trimester, the
pregnant woman has become aware of the child within her and begins the process of maternal
attachment. Although health care providers focus on the fetus, the pregnant woman in the
second trimester has a heightened sense of this living being within her, the fetus that is to be
her child. Prenatal care for her is now much more focused on this child and its well-being than
on herself.

Toward the end of pregnancy, a woman’s emotional state is different from that in the
first or second trimester. Rofe and colleagues conducted a study of 282 women and found that
all women, to some degree, experience an approach/avoidance of conflict with regard to
delivery. Women want the pregnancy to end, but fear of the birth process promotes anxiety.
Maternal concerns focus on both self and baby, and women experience a heightened sense of
vulnerability as a result of the enormous physical changes of the third trimester. Women often
verbalize anxiety about the approaching labor, birth, and health of the infant, as well as
concerns about their ability to mother and their partner’s love and support. Some women
experience insomnia and/or vivid dreams. Most questions for health care providers focus on
the mechanics of labor and delivery and on the postpartum period.

ADAPTATION AND MALADAPTATION

An individual woman’s ability to cope with the new situations and tasks of pregnancy
appears related to the overall balance of past and present stresses and the process of maternal
adaptation to pregnancy, birth, and parenting. The obstetric provider needs to be alert to the
signs of maladaptation. Cohen described numerous maternal behaviors that he recommends
providers screen for during the antepartum, intrapartum, and postpartum periods. He cautions
providers to be especially alert for patients who have continued faulty acceptance or
nonacceptance of pregnancy beyond quickening, an inability to develop an emotional affiliation
with the fetus, and an inability to perceive the neonate as a separate individual.

Etiologic factors contributing to maladaptation

 Lack of maternal figure in woman’s life

 Chronic conflict with own mother or other female relatives

 Prior birth of a child with anomalies or neuro developmental delays

 Chronic marital discord, especially if focused on childbearing/ child rearing

 Little or no preparation for sexual experience

 Reporting fears of having harmed the baby

 Third-trimester rejection of the pregnant state (overt or disguised)

 Absence of plans for care of baby after birth

 Inability to identify individual characteristics of newborn

Maladaptation is also more likely to occur in the presence of psychosocial risk factors, which
can be divided into social factors, psychological factors, and adverse health behaviors. Social
factors associated with increased risk include low income, inadequate housing, less than high
school education, a physically strenuous or potentially toxic work environment, and single
marital status. Adolescence (younger than 18 years of age), communication barriers, and
inadequate nutritional resources are other social risks. Psychological factors include inadequate
personal support systems and coping mechanisms, excessive ambivalence about the pregnancy,
living in an abusive environment, and feelings of chronic stress and anxiety. Finally, smoking,
illicit drug use, alcohol abuse, poor nutritional choices, and excessive exercise are health
behaviors that place women at risk for an adverse pregnancy outcome. The degree of risk
associated with some factors requires judgment, because exceptions to these categorical
classifications often occur.

THE FATHER'S ROLE

Some men actually experience physical symptoms of pregnancy similar to those their
partner is feeling. One study compared expectant fathers with a control group of men whose
wives were not pregnant and found that the expectant fathers experienced significantly more
somatic symptoms, such as loss of appetite, nausea, toothaches, indigestion, and abdominal
pain, than did the control group. Most men, however, do not experience this couvade
syndrome. Fathers should be encouraged to be present at prenatal visits and should always
given an opportunity to ask questions regarding pregnancy and birth. This will decrease anxiety
and promote paternal participation in the birth process.

There was a dramatic change in the role of the father in the late 1960s and early 1970s.
Promoting the role of husband as coach and ombudsman, women, patient advocates, childbirth
educators, and consumer groups demanded more flexibility in allowing fathers and other
support people to accompany women to the delivery room or operating suite if a cesarean
section was necessary. Medical professionals responded to this change with various feelings of
anger, neutrality, or acceptance. Hospital administrators became much more receptive to
consumer demands for family-centered care as competition for these services increased and
obstetrics came to be seen as an entry into the health care system. Thus, over the last 20 years,
the presence of the father or support person has gone from being a rarity to being
commonplace and expected. Today, very few obstetric providers would belittle the importance
of having the father present to support his wife and bond with the infant. Childbirth education
prepared the father or support person for what to expect during labor and how to assist the
laboring woman using nonpharmacologic methods of pain relief.

Men's participation in the birth process can be described as coach (those taking an
active role), teammate (those more comfortable following suggestions from the woman in labor
or nurse), or witness (those who are present as a companion and witness to the birth). Men
who are more comfortable in the witness role are more likely to recruit another woman to
assist at the birth. Some childbirth educators and professionals believe that perhaps too much
is expected of most men—to witness the pain of a loved one and still encourage her, and to act
as an advocate in the authoritative environment of most hospitals. Exploring which role the
man is most comfortable assuming during birth can help the couple prepare for who they
would like present for support.

Women without partners deserve special attention. They are more vulnerable and often
lack adequate support systems. The single mother may be at high risk for economic, social, and
physical problems. Whether the pregnancy is planned or unplanned, there are still a multitude
of decisions to be faced alone. Single mothers need to be assessed for adequacy of social
support during pregnancy, during delivery, and especially during the adjustment to parenthood.
The patient with minimal support benefits from a consistent provider throughout pregnancy,
additional labor support, and postpartum follow-up care. Single women with adequate family
and friends for support are at no greater risk than are women with partners.

EMOTIONAL SUPPORT DURING PREGNANCY AND BIRTH

To support or be with woman' during pregnancy and especially labor has been an essential
component of midwifery for centuries. Support is defined as both verbal and nonverbal
behavior that conveys caring and understanding to enhance an individual's ability to cope.
Supportive care activities include physical comfort measures, emotional support, instructions
and information, and advocacy. As advances in obstetric technology continue to concentrate on
fetal well-being, there may be a tendency among professionals to focus on the needs of the
fetus at the expense of the mother, with pregnant women perceived as little more than vessels
for their unborn children. Researchers and providers must not lose sight of the importance of
incorporating a philosophy of caring into the services provided to mothers and children.
Reviews of controlled trials of enhanced support during pregnancy showed that social and
psychological support results in improved outcomes. Women who received support during
pregnancy were less likely to feel unhappy, nervous, or worried; had fewer negative feelings
about the approaching birth; and were more confident about motherhood. Women assisted
during labor by a laywoman called a doula (a Greek word meaning 'woman's servant')
experienced fewer childbirth complications. Psychological and social support also enhances
postpartum mental and physical health and prolongs the length of time women continue
breastfeeding. A review of a controlled trial found no negative effects of enhanced social and
psychological support.

The effect of a supportive companion on perinatal problems, length of labor, and

mother–infant interaction was studied by Sosa and associates in a public hospital in Guatemala.
Women in the control group received routine care. Women in the experimental group received
constant support from a doula, who guided the new mothers in their infant care tasks. The
experimental group had significantly shorter labors (8.8 versus 19.3 hours), were awake more
after delivery, and interacted more with their babies than did the control group.

Continuous emotional support during labor at a US hospital was studied by Kennell and
co-workers. Four hundred and twelve healthy primiparous women were randomly assigned to
three groups. The first received the continuous support of a doula, the second group was
monitored by an inconspicuous observer who kept a record of all staff contacts but never spoke
or interacted with the laboring women, and the third group served as the control. Continuous
labor support reduced the rate of cesarean section (supported group 8%, observer group 13%,
control group 18%) and also reduced forceps deliveries, epidural and oxytocin use, duration of
labor, prolonged infant hospitalization, and maternal fever. Even an untrained observer who
simply sat in the room with the laboring woman had a positive effect on the labor.

Nurses are an essential part of the labor support team, but their time is often filled with
other activities, such as extensive documentation, that have little to do with labor support. One
study measured the amount of time labor and delivery nurses spent at the bedside engaged in
supportive care activities versus all other activities and found it to be 9.9%.A trained doula may
be appropriate for women who lack support or whose partners are more comfortable in the
witness role. The doula is not meant to replace either the father or nurse but rather serves to
augment labor support with her training and experience. Certified nurse-midwives consider
support to be an integral part of caring for the laboring woman. They will usually provide one-
on-one support from the onset of active labor through delivery.

THE HIGH-RISK PREGNANCY

All pregnancies carry with them an element of uncertainty, and this uncertainty is
heightened with the diagnosis of a high-risk pregnancy. The woman's reaction to the diagnosis
depends on her coping skills and reactions to past stressors. A woman's self-esteem is affected
by this diagnosis, and she may feel as if she has failed as a woman and a mother. This injury to
self-esteem makes negotiation of the emotional and developmental tasks of pregnancy all the
more difficult. It is essential that providers consider the psychological, social, and economic
impact of a high-risk pregnancy on both the woman and her family. Special educational needs,
standard childbirth preparation and preparation for more invasive monitoring or a cesarean
birth, and the risks of preterm birth must be discussed.

Most women diagnosed with a high-risk pregnancy manage fairly well. Wolreich
hypothesizes that this adjustment is facilitated by several factors particular to pregnancy.
Feelings of dependency and the normal passivity and regression of pregnancy make the
heightened scrutiny more tolerable and facilitate compliance. Women are often comforted by
the time-limited nature of pregnancy, knowing the end is in sight. However, prolonged
hospitalization or bed rest and home health care are inherently stressful for the woman and her
family. Recommendations to assist the family include: tours of the neonatal intensive care unit,
meetings with pediatric specialists, early psychosocial screening and assessment of adaptation,
modified hospital routines that promote autonomy and independence, and continued contact
with the primary care provider if the patient was transferred to a tertiary care facility.
Flexibility, added support, and the patient's involvement in all aspects of her treatment are
essential components of the emotional care of high-risk women.

Although beyond the scope of this chapter, the possibility of an adverse outcome must
be considered. Pregnancy loss is an obstetric responsibility, and the primary provider must
coordinator short- and long-term care for affected families. Several publications outline in
detail the medical and psychological care recommended for families experiencing a pregnancy
loss.

CONCLUSION

In summary the authors would like to concur with Oakley, who stated: “human communication
may contribute more to the health of women than obstetric technology.” 72 Although
tremendous technological advances have occurred in obstetrics in the last century, the
emotional and educational needs of pregnant women have often been neglected. The
challenge for the next century is to recognize the importance of individualized education and
emotional support for pregnant women and their families. Only then will providers be able to
develop true partnerships with women. What is needed is a partnership in which power is
shared, and acknowledgement that all health care decisions involve consideration of not only
the physical ramifications but also the emotional and social consequences. Birth practices in the
twenty-first century must reflect the best of these efforts, as we continue to seek a balance
between technology and humanity.