Psychological

CHANGES

introduction
- Pregnancy is such a huge change in

a woman’s life; it brings about more

psychological changes than any other

life event besides puberty (Fletcher &

Russo, 2015).

- How a woman adjusts to a pregnancy

social influences
depends a great deal on
-From the first part of the 20th century
psychological aspects, such as the
until about the 1960s, there was such
environment in which she was raised,
heavy emphasis on medical management
the messages about pregnancy her
for women during pregnancy that it
family communicated to her as a conveyed the idea that pregnancy was a
child, the society and culture in which 9-month-long illness. The pregnant woman
she lives as an adult, and whether the went alone to a physician’s office for
pregnancy has come at a good time in care; at the time of birth, she was

her life (Silveira, Ertel, Dole, et al., separated from her family, hospitalized in

2015). seclusion from visitors, and even from the

new baby for 1 week afterward so the

- For many women, a prenatal visit is newborn could be fed by nurses.

the first time they have seen a

healthcare provider since childhood. - Today, pregnancy is viewed as a healthy

span of time best shared with a

Guidance given during this time can
supportive partner and/or family. Women
be instrumental in not only guiding a
bring their families for prenatal care
woman safely through a pregnancy
visits as well as to watch the birth.
but also connecting her back with
Women choose what level of pain
ongoing health care.
management they want to use for labor

and birth; many women choose to

breastfeed their newborn.

- How well a pregnant woman and her

partner feel during pregnancy and are

prepared to meet the challenges this new

responsibility brings is related to their

cultural background, their personal

beliefs, the experiences reported by

friends and relatives, as well as by the

current plethora of information available

on the Internet.

- Nurses play an important role in

teaching women about their healthcare

options as well as continuing to work with

other healthcare providers to

“demedicalize” or humanize childbirth

(Heatley, Watson, Gallois, et al., 2015).

 cultural influences
- A woman’s cultural background may

strongly influence how active a role she

wants to take in her pregnancy because

certain beliefs and taboos can place

restrictions

(Guelfi, Wang,
on her

Dimmock,
behavior

et
and

al.,
activities

2015). To
family influences
learn about the beliefs of a particular
- The family in which a woman was
woman and her partner, ask at prenatal
raised can be influential to her
visits if there is anything the couple
beliefs about pregnancy because
believes should or should not be done to
it is part of her cultural
make the pregnancy successful and keep
environment. If she and her
the fetus healthy. Supporting these
siblings were loved and their
beliefs shows respect for the individuality
births were seen as a pleasant
of a woman and her knowledge of good
outcome of their family, she is
health (Box 10.2).
more likely to have a positive

attitude toward learning she is

- Women react differently on realizing
pregnant than if she and her
they are pregnant based on their
siblings were blamed for the
individual circumstances and their
breakup of a marriage or a
cultural expectations. Women eat
relationship, for example. A
different foods during pregnancy based
woman
on what they perceive will be “good” or
who views mothering as a positive
“bad” for their infant. Assess women’s
activity is more likely to be
intake carefully to be certain a particular
pleased when she becomes
woman is not eating nonfood substances
pregnant than one who does not
such as ice cubes or raw flour, for
value mothering.
instance (called pica), during pregnancy.
.
These habits result from a woman

entering pregnancy with low iron stores

so iron-deficient anemia results. Cravings

such as ice cubes are harmless to a fetus,

but asking about pica can reveal women

eating substances such as paint chips or

sniffing gasoline, which could be harmful

to fetal growth.

- Before evidence-based practice was

available to scientifically support why

pregnancy brought about changes in a

woman’s body, different societies devised

differing explanations about why changes

occurred. These myths became so well

engrained in cultures that some persist to

the present. For example, a belief that

lifting your arms over your head during

pregnancy will cause the cord to twist or

that watching a lunar eclipse will cause a

birth deformity are still believed by

women in some cultures (Lauderdale,

2016). Find a compromise that will assure

a woman that these are not really harmful

to a fetus but that still respects these

beliefs.

.
 individual differences
- A woman’s ability to cope with or adapt to stress plays a major role in how

she can resolve any conflict she feels at becoming a mother. This ability to

adapt (e.g., to being a mother without needing mothering, to loving a child

as well as a partner, to becoming a mother for each new child) depends, in

part, on her basic temperament, on whether she adapts to new situations

quickly or slowly, on whether she faces them with intensity or maintains a

low-key approach, and on whether she has had experience coping with

change and stress (Guedes & Canavarro, 2014).

- The extent to which a woman feels secure in her relationship with the

people aroundher, especially the father of her child or her chief support

person, is usually also important to her acceptance of a pregnancy. Anxiety

as to whether her partner may soon disappear, leaving her alone to raise a

child, may make her reexamine whether her pregnancy is a wise life step. Yet

another influence on how women perceive pregnancy as a positive or negative

experience is past experiences (Muzik, McGinnis, Bocknek, et al., 2016). A

woman who thinks of brides as young but mothers as old may believe

pregnancy will rob her of her youth. If she’s concerned about her

appearance, she may worry pregnancy will permanently stretch her abdomen

and breasts. She may also worry pregnancy will rob her financially and ruin

her chances of job promotion (referred to as a “mommy track”) (Misri & Swift,

2015).

- These are real feelings and must be taken seriously when assessing or

counseling pregnant women. Women who do not have a supportive partner

may look to healthcare providers during pregnancy to fill the role of an

attentive listener (Adeniran, Aboyeji, Fawole, et al., 2015).

- The more emotionally attached a partner is to a pregnant woman, the closer

the partner’s attachment is apt to be to the child (Fuertes, Faria, Beeghly, et

al., 2016). Whether partners are able to form a close relationship with each

other, as well as accept a pregnancy and a coming child, depends on the

same factors that affect the pregnant woman’s decision making: cultural

background, past experience, and relationships with family members

(Fortinash & Holoday Worret, 2012).

- Although partners may be inarticulate about such emotional factors, they

may be able to convey such feelings by a touch or a caress, which is one

reason a partner’s presence is always desirable at a prenatal visit and

certainly in a birthing room.

.
- During the 9 months of pregnancy, a woman and her partner run a gamut of

emotions, ranging from surprise at finding out about the pregnancy (or

wishing she were not), to pleasure and acceptance as they begin to identify

with the coming child at the middle of pregnancy, to worry for themselves

and the child, to acute impatience near the end of pregnancy (Table 10.1).

Once the child is born, a woman and her partner may feel surprised again

that the pregnancy is over and they really do have a child.

PSYCHOLOGICAL DESCRIPTION
CHANGE
FIRST TRIMESTER TASK: The woman and her partner both spend time recovering from the
accepting the pregnancy surprise of learning they are pregnant and concentrate on what it
feels like to be pregnant. A common reaction is ambivalence, or
feeling both pleased and not pleased about the pregnancy.

SECOND TRIMESTER TASK: The woman and her partner move through emotions such as
accepting the fetus narcissism and introversion as they concentrate on what it will feel
like to be a parent. Role-playing and increased dreaming are
common. Begins to imagine herself as a mother (anticipatory role-
playing) Woman feels fetal movement

THIRD TRIMESTER TASK: The woman and her partner prepare clothing and sleeping
Preparing for the baby arrangements for the baby but also grow impatient as they ready
and end of pregnancy themselves for birth. “ nest-building ” activities , Role-playing,
fantasizing

- From a physiologic standpoint, it is fortunate that a pregnancy is 9 months

long because this gives the fetus time to mature and be prepared for life

outside the protective uterine environment. From a psychological standpoint,

the 9-month period is also fortunate because it gives a family time to

prepare emotionally as well. These psychological changes are frequently

termed “guaranteeing safe passage” for the fetus (Box 10.3).

- Although the average woman is happy to be pregnant, don’t underestimate

the effect the emotional and physical upheavals brought about by the

hormonal changes of pregnancy can cause. These can be so tremendous that

they can influence whether a pregnancy is carried to term, which may not

only lead to poor acceptance of the child but also to postpartum depression

or, in rare instances, psychosis (Biaggi, Conroy, Pawlby, et al., 2016;

Lilliecreutz, Larén, Sydsjö, et al., 2016).

FIRST TRIMESTER TASK:
accepting the pregnancy
The Woman-----------------------------

- The task of women during the first trimester of pregnancy is to accept the

reality of the pregnancy; later will come the task of accepting the baby. Most

cultures structure celebrations around important life events such as coming

of age, marriages, birthdays, and deaths, all of which have rituals to help

individuals face and accept the coming change in their lives. A diagnosis of

pregnancy is a similar rite of passage, but an unusual one among passages,

because the suspicion of pregnancy is made initially not on something

happening but the absence of something: a missed menstrual flow.

- With the availability and common use of reproductive planning measures

today, it would seem few pregnancies would still be a surprise. In reality, as

many as 49% of pregnancies are still unintended, unwanted, or mistimed

(Centers for Disease Control and Prevention [CDC], 2015). Because no woman

can be absolutely confident in advance that she will be able to conceive

until it happens, even planned pregnancies are a surprise to some extent

because a woman can be amazed it either happened so quickly or took so

long.

- Following their initial surprise, women often experience feelings less than

pleasure and closer to anxiety or a feeling of ambivalence. Ambivalence

doesn’t mean positive feelings counteract negative feelings and a woman is

left feeling nothing. Instead, it refers to the interwoven feelings of wanting

and not wanting, feelings which can be confusing to an ordinarily organized

woman.

- Fortunately, most women who were not happy about being pregnant at the

beginning are able to change their attitude toward their pregnancy by the

time they feel the child move inside them. Some healthcare plans provide for

a routine sonogram at about this time in pregnancy, between 18 and 22

weeks, to date the pregnancy and to assess for growth anomalies. This can be

a major step in promoting acceptance because women can see a beating

heart or a fetal outline or can learn the sex of their fetus (Lindberg,

Maddow-Zimet, Kost, et al., 2015).

- Although most women self-diagnose their pregnancy by using a urine

pregnancy test strip, hearing their pregnancy officially diagnosed at a first

prenatal visit is another step toward accepting a pregnancy. Because this

happens, woman often comment after such a visit they feel “more pregnant”

or it makes a first visit more than an ordinary one. Early diagnosis is

important because the earlier a woman realizes she is pregnant or comes for

a first prenatal visit, the sooner she can begin to safeguard fetal health by

measures such as discontinuing all drugs not specifically prescribed or

approved by her primary healthcare provider (Chakraborty, Anstice, Jacobs,

et al., 2015).
FIRST TRIMESTER TASK:
accepting the pregnancy
The Partner----------------------------

- In the past, partners were forgotten persons in the childbearing process.

Unwed fathers were dismissed as not interested in either the pregnancy or

the woman’s health. A female partner was completely ignored. In actuality,

all partners are important and should be encouraged to play a continuing

emotional and supportive role in a pregnancy.

- Accepting the pregnancy for a partner means not only accepting the

certainty of the pregnancy and the reality of the child to come but also

accepting the woman in her changed state. Like women, partners may also

experience a feeling of ambivalence. A partner may feel proud and happy at

the beginning of pregnancy, for example. Soon, however, it’s easy to begin to

feel both overwhelmed with what the loss of a salary will mean to the family

if the woman has to quit work, and a feeling close to jealousy of the growing

baby who, although not yet physically apparent, seems to be taking up a

great deal of the woman’s time and thought (Da Costa, Zelkowitz, Dasgupta,

et al., 2015). Remember, once partners feel an attachment to a coming child,

they can then feel as deep a sense of loss as the woman if the pregnancy

should end before term or the baby is born with a unique concern. In

addition, they may not have anyone to turn to for support because no one

recognizes how involved they were in the pregnancy. To help both male and

female partners resolve these feelings, be certain to make partners feel

welcome at prenatal visits or during fetal testing, provide an outlet for them

to discuss concerns, and offer parenting information as necessary.

SECOND TRIMESTER TASK:
accepting the baby
The Woman-----------------------------

- During the second trimester, the psychological task of a woman is to accept

she is having a baby, a step up from accepting the pregnancy. This change

usually happens at quickening, or the first moment a woman feels fetal

movement. Until a woman experiences for herself this proof of the child’s

existence and although she ate to meet nutritional needs and took special

vitamins to help the fetus grow, it seemed more like just another part of her

body. With quickening, the fetus becomes a separate identity. She then may

imagine herself as a mother, teaching her child the alphabet or how to ride

a bicycle. This anticipatory role-playing is an important activity for

midpregnancy as it leads her to a greater concept of her condition and helps

her realize she is more than just pregnant—there is a separate human being

inside her.

- Women often use the term “it” to refer to their fetus before quickening but

begin to use he or she afterward. Some women continue to use it, however, so

doing so is not a sign of poor attachment but an individual preference as

some women believe referring to the child as “she” or “he” will bring bad luck

or disappointment if the sonogram report was wrong.

- Most women can pinpoint a moment during each pregnancy when they knew

definitely they wanted their child. The firmer this attachment, the less

postpartum depression they are apt to experience (Brummelte & Galea, 2015).

- For a woman who carefully planned the pregnancy, this moment of

awareness may occur as soon as she recovers from the surprise of learning

she has actually conceived. For others, it may come when she announces the

news to her parents and hears them express their excitement or when she

sees a look of pride on her partner’s face. For example, shopping for baby

clothes for the first time, setting up the crib, or seeing a blurry outline on a

sonogram screen may suddenly make the coming baby seem real and desired

(Fig. 10.1).

- Accepting the baby as a welcome addition to the family might not come,

however, until labor has begun or a woman first hears her baby’s cry or feeds

her newborn. If a woman has a complication of pregnancy, it could take

several weeks after the baby is born for her to accept that the birth was real

and to come to terms with motherhood.

-A good way to measure the level of a woman’s acceptance of her coming

baby is to measure how well she follows prenatal instructions. Until a woman

views the growing life inside her as something desired, it may be difficult for

her to substitute a high-protein food for her favorite high-calorie coffee

drink, for instance. After all, until her abdomen begins to enlarge, watching

herself gain weight may be the most certain proof she has that she is

pregnant.
SECOND TRIMESTER TASK:
accepting the baby
The Partner----------------------------
- As a woman begins to actively prepare for the coming baby, a partner

increasingly may feel as if he or she is left standing in the wings, waiting to

be asked to take part in the event. To compensate for this feeling, a partner

may become overly absorbed in work, striving to produce something concrete

on the job as if to show the woman is not the only one capable of creating

something. This preoccupation with work may limit the amount of time a

partner spends with family or is available for prenatal visits, just when the

pregnant woman most needs emotional support.

- Some men may have difficulty enjoying the pregnancy because they have

been misinformed about sexuality, pregnancy, and women’s health. A man

might believe, for example, that breastfeeding will make his wife’s breasts no

longer attractive or that after birth, sexual relations will no longer be

enjoyable. Such a man needs education to correct misinformation. Read the

pamphlets supplied by your prenatal healthcare setting and ask: Do they

contain mainly information about childbirth and pregnancy from a woman’s

perspective? Would they be relevant to a supportive partner?

THIRD TRIMESTER TASK:

preparing for parenthood
- During the third trimester, couples usually begin “nest-building” activities,

such as planning the infant’s sleeping arrangements, choosing a name for the

infant, and “ensuring safe passage” by learning about birth. These

preparations are evidence the couple is completing the third trimester task

of pregnancy or preparing for parenthood.

- Couples at this point are usually interested in attending prenatal classes

and/or classes on preparing for childbirth. It’s helpful to ask a couple what

specifically they are doing to get ready for birth to see if they are interested

in taking such a class and to document how well prepared they will be for the

baby’s arrival. Attending a childbirth education class or one on preparing for

parenthood can not only help a couple accept the fact they are about to

become parents but also expose them to other parents as role models who

can provide practical information about pregnancy and child care (Jones,

Feinberg, & Hostetler, 2014). Chapter 14 discusses the usual curriculum of

childbirth and parenthood education classes.

- Although pregnancy is a happy time for most women, certain external life

contingencies such as an unwanted pregnancy, financial difficulties, lack of

emotional support, or high levels of stress can slow the psychological work of

pregnancy or attachment to the child (Biaggi et al., 2016) (Box 10.4). During

prenatal visits, ask such questions as “Is pregnancy what you thought it would

be?” or “Has anything changed in your home life since you last came to

clinic?” to reveal if any situation that could potentially interfere with

bonding has occurred. It is unrealistic to believe any one healthcare

professional has all the solutions to the problems couples reveal when asked

these questions. An interprofessional approach (referral to a nutritionist, a

primary healthcare provider, or social services) is often necessary to help

solve some of these multifaceted problems.

In addition to the three main tasks of pregnancy, more subtle emotions also

surface or need to be worked through.

- An important task to complete during pregnancy is working

through previous life experiences or Erikson’s developmental tasks

of autonomy, industry, and identity (Erikson, 1993). Needs and

wishes that have been repressed for years may surface to be

studied and reworked, often to an extreme extent along these

lines.

- Fear of being separated from family or fear of dying are

common preschool fears that can be revived during pregnancy. A

clue that might signal a woman’s distress over this could be “Am I

ever going to make it through this?” Such an expression might

simply mean she is tired of her backache, but it also might be a

plea for reassurance she will survive this event in her life.

- Part of gaining a sense of identity is establishing a working

relationship with parents, which may still be an awkward one

since adolescence. For the first time in her life, a woman during

pregnancy can begin to empathize with the way her mother used

to worry because she’s already begun to worry about her child

when she feels no movement for a few hours. This can make her

own mother become more important to her and a new, more equal

relationship may develop.

- Teenagers who are pregnant need to resolve the double conflict

of still establishing a sense of identity (teenagers are still

children developmentally) at the same time they are planning to

be a mother. Unless these feelings are examined and resolved,

teenagers can have a difficult time thinking about enjoying their

pregnancy or becoming a mother.

- A partner needs to do the same reworking of old values and

forgotten developmental tasks. A man has to rethink his

relationship with his father, for example, to understand better

what kind of father he will be. Some men may have had

emotionally distant fathers and wish to be more emotionally

available to their own children. Support from healthcare

providers and exposure to caring role models can be instrumental

in helping a man achieve this goal.

- Another step in preparing for parenthood is role-playing, or

fantasizing about what it will be like to be a parent. Just as a

child learns what to do by following a mother as she sets a table

or balances her checkbook, a pregnant woman may begin to spend

time with other pregnant women or mothers of young children to

learn how to be a mother. As a part of this role-playing process,

women’s dreams tend to focus on the pregnancy and concerns

about keeping themselves and their coming child safe.

- There is concern that a young adolescent will have inadequate

role models for motherhood; they are either other teens her age,

who typically are not interested in a commitment to mothering, or

possibly her own mother, who may have struggled with poverty or

her own lack of support. Try to locate good role models (e.g., in

classes for mothers, at the healthcare agency, or in a social

agency) for adolescents so they can find a good maternal role

model to copy and modify their own behavior.

- A woman’s partner also has the same role-playing to do during

pregnancy, to imagine himself or herself as the parent of a boy or

a girl. A partner who is becoming a parent for the first time may

have to change a view of being a carefree individual to being a

significant member of a family unit. If the partner already is a

parent from a former relationship, he or she has to cast aside the

parent-of-one identity to accept a parent-of-two image, and so

forth.

- Other support persons who will have an active role in raising

the child, such as grandparents, close friends, or an ex-spouse,

also have to work out their roles with regard to the pregnancy

and impending parenthood. This may be particularly difficult

because the roles for these support persons may not be clearly

defined, and no role model may be apparent (Hayslip, Blumenthal,

& Garner, 2015).

- Because of all the tasks that need to be worked through during a

pregnancy, emotional responses can vary greatly, but common reactions

include grief, narcissism, introversion or extroversion, body image and

boundary concerns, couvade syndrome, stress, mood swings, and changes in

sexual desire. These are all normal, so it is helpful to caution a pregnant

woman and her partner that these common changes may occur so they’re not

alarmed if they appear. Otherwise, a partner can misinterpret the woman’s

mood swings, decreased sexual interest, introversion, or narcissism not as

changes from pregnancy but as a loss of interest in their relationship.

- doubt especially when unplanned

- The thought that grief can be associated with such a positive

process as having a child seems at first incongruent. But before a

woman can take on a mothering role, she has to give up or alter

her present role as she will never be the woman she has been in

exactly the same way again. She will never be able to be as

irresponsible and carefree again, or perhaps sleep soundly for the

next few years. All of this takes mental preparation, which may

manifest as a form of grief, as she incorporates her new role as a

mother into her other roles as daughter, wife, business

professional, or friend. Partners must also incorporate a new role

as a parent into their other roles in life.

- Self-centeredness (narcissism) may be an early reaction to

pregnancy. A woman who previously perhaps was barely conscious

of her body, who dressed in the morning with little thought about

what to wear, suddenly begins to concentrate on these aspects of

her life. She dresses so her pregnancy will or will not show. She

may lose interest in her job or community events because the work

seems alien to the more important event taking place inside her.

- Narcissism may also be revealed by changes in activity. A

woman may stop playing tennis, for example, even though her

primary healthcare provider has assured her it will do no harm in

moderation. She may criticize her partner’s driving, although it

never bothered her before. She does these things to

unconsciously protect her body and her baby. Her partner may

demonstrate the same behavior by reducing risky activities, such

as mountain biking, trying to ensure he or she will be present to

raise their child.

 -This need of a woman to protect her body has implications for

nursing care. It means a woman may regard unnecessary nudity as

a threat to her body (e.g., be sure to drape properly for pelvic

and abdominal examinations). She may resent casual remarks such

as “Oh my, you’ve gained weight” (i.e., a threat to her

appearance) or “You don’t like milk?” (i.e., a threat to her

judgment).

- There is a tendency to organize health instructions during

pregnancy around the baby: “Be sure to keep this appointment.

You want to have a healthy baby.” “You really ought to eat more

protein for the baby’s sake.” This approach may be particularly

inappropriate early in pregnancy, before the fetus stirs and

before a woman is convinced not only that she is pregnant but

also that there is a baby inside her. At early stages, a woman may

be much more interested in doing things for herself because it is

her body, her tiredness, and her well-being that will be directly

affected (e.g., “Eat protein because

it keeps your fingernails from breaking” or “Protein will give you

long-term energy”).

- Introversion, or turning inward to concentrate on oneself and

one’s body, is a common finding during pregnancy. Some women,

however, react in an entirely opposite fashion and become more

extroverted. They are more active, appear healthier than ever

before, and are more outgoing. This tends to occur in women who

are finding unexpected fulfillment in pregnancy, perhaps who had

seriously doubted they would be lucky enough or fertile enough to

conceive. Such a woman regards her expanding abdomen as

public proof of her ability to fulfill the maternal role. Although

these changes may make a woman become more varied in her

interests during pregnancy, she may be puzzling to those around

her who liked her for her quiet and self-contained manner.

- Body image (i.e., the way your body appears to yourself) and

body boundary (i.e., a zone of separation you perceive between

yourself and objects or other people) both change during

pregnancy as a woman begins to envision herself as a mother or

becoming “bigger” in many different ways. Changes in concept of

body boundaries are so startling that a pregnant woman may walk

far away from an object such as a table to avoid bumping against

it. At the same time, she may perceive herself as needing body

boundaries as if her body were delicate and easily harmed.

- Because pregnancy brings with it such a major role change, it

can cause extreme stress in a woman who was not planning to be

pregnant or if she finds her lifestyle changing dramatically after

she becomes pregnant. Stress in pregnancy, like stress at any

time, can make it difficult for a woman to make decisions, be as

aware of her surroundings as usual, or maintain time management

with her usual degree of skill. This may cause people who were

dependent on her before pregnancy to feel neglected because

now that she is pregnant, she seems to have strength only for

herself. If a woman was in a violent relationship before the

pregnancy, the increased stress of pregnancy is apt to cause even

more violence. Privately asking whether intimate partner violence

has ever occurred in the past to help predict if it could occur

during pregnancy is an important part of prenatal interviewing

(Van Parys, Deschepper, Michielsen, et al., 2015).

- To help families keep their perspective for the full length of a

pregnancy, remind them that any decrease in the ability to

function that happens to a pregnant woman is a reaction to the

stress of pregnancy. A woman may need to remind an employer

that any lack of decision-making ability is no different than in

people who are feeling stress because of marital discord or a

loved one’s illness. Pregnancy may actually be less stressful and

less of a concern than those situations because of its predictable

9-month duration.

- Depression Depression—a feeling of sadness marked by loss of

interest in usual things, feelings of guilt or low self-worth,

disturbed sleep, low energy, and poor concentration—is a common

finding in late adolescents. Depression causes as many as 15% of

women to enter pregnancy feeling depressed; others grow

depressed during pregnancy, especially if they lack a meaningful

support person (Chojenta, Lucke, Forder, et al., 2016). Screening

for women who have a history of depression is important at a

preconception visit as common drugs prescribed for depression

can be teratogenic to a fetus as well as cause hypertension in

the woman (Zoega, Kieler, Nørgaard, et al., 2015). It is also

important to investigate if the woman has a meaningful support

person or the stress and anxiety that can come with pregnancy

can increase depression substantially and lead to postpartum

depression (see Chapter 25).

- A woman with few support people around her almost

automatically has more difficulty adjusting to and accepting a

pregnancy and a new child than women with more support. A

woman who begins a pregnancy with a strong support person and

then loses that person through trauma, illness, separation, or

divorce needs special attention with regard to loneliness and

depression. Evaluate her carefully as to how she is managing and

give her extra support as needed because her feeling of loss is

likely to be extremely acute. Knowing she has supportive

healthcare providers she can call on when needed is the one

thing that may make her pregnancy acceptable to her.

 - Many partners experience physical symptoms such as nausea,

vomiting, and backache to the same degree or even more

intensely than their partners during a pregnancy; some begin to

gain weight along with their partner. As a woman’s abdomen

begins to grow, partners may perceive themselves as growing

larger too, as if they were the ones who were experiencing

changing boundaries the same as the pregnant woman. These

symptoms apparently result from stress, anxiety, and empathy for

the pregnant woman. The phenomenon is common enough that it

has been given a name: couvade syndrome (from the French word

“to hatch”). The more a partner is involved in or attuned to the

changes of the pregnancy, the more symptoms a partner may

experience. A close marital relationship, which this reflects, can

increase the strength of the partner–infant attachment (Fuertes

et al., 2016). Such symptoms are only worrisome and require

psychological attention if they become so extreme that they

create intolerable emotional stress.

- Mood changes occur frequently in a pregnant woman, partly as

a symptom of narcissism (i.e., her feelings are easily hurt by

remarks that would have been laughed off before) and partly

because of hormonal changes, particularly the sustained increase

in estrogen and progesterone. Mood swings may be so common

that they can make a woman’s reaction to her family and to

healthcare routines unpredictable. She may cry over her

children’s bad table manners at one meal, for example, and find

the situation amusing or even charming at the next. Caution

families that such mood swings occur beginning with early

pregnancy so they can accept them as part of a normal pregnancy

(Box 10.5).

- Most women report their sexual desire changes, at least to some

degree, during pregnancy. Women who formerly were worried

about becoming pregnant might truly enjoy sexual relations for

the first time during pregnancy. Others might feel a loss of desire

because of their increase in estrogen, or they might unconsciously

view sexual relations as a threat to the fetus they must protect.

Some may worry coitus could bring on early labor.

-During the first trimester, most women report a decrease in

libido because of the nausea, fatigue, and breast tenderness that

accompany early pregnancy. During the second trimester, as

blood flow to the pelvic area increases to supply the placenta,

libido and sexual enjoyment can rise markedly. During the third

trimester, sexual desire may remain high, or it may decrease

because of difficulty finding a comfortable position and

increasing abdominal size. When a couple knows early in

pregnancy such changes may occur, it’s easier for them to

interpret these in the correct light or as a normal change, not as

loss of interest in a sexual partner or as a diminishment of the

strength of the total relationship (Yıldız, 2015). Suggestions for

helping women and their partners adjust to these circumstances

are discussed in Chapter 12.

- Most parents are aware that their older children need

preparation when a new baby is on the way; however, knowing

preparation is needed and being prepared to explain where

babies come from are two different things. For this reason, many

couples appreciate suggestions from healthcare providers as to

how this task can be accomplished. Both preschool and school-

age children may need to be assured periodically during

pregnancy a new baby will be an addition to the family and will

not replace them or change their parents’ affection for them.

Preparing a child for the birth of a sibling is discussed in

Chapters 14 and 31 with other growth and development concerns.