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A Study on The psychological implications of pregnancy among women A dissertation submitted to the department of social work in partial fulfillment

for the award of Master of Arts in social work with specialization in medical and psychiatric

Submitted By Caroline Joseph (M.A.Social Work, Semester-IV)

Under the supervision of Mrs Sheeba Joseph HOD, Social Work The Department of soci The Bhopal School of Social Scienc

2011-2012 The Bhopal School of Social Sciences Habibganj, Bhopal-462024 Madhya Pradesh,


A dissertation submitted to the department of social work in partial fulfillment for the award of Master of Arts in social work with specialization in medical and psychiatric

Submitted By Caroline Joseph (M.A. Social Work, Semester-IV)

Under the supervision of Mrs Sheeba Joseph (HOD, SOCIAL WORK)

Forwarded by Rev.Fr.Joseph P.P (Principal) Mrs.Sheeba Joseph (Head of the department)

The Bhopal School of Social Science Habibganj (Bhopal) M.P 2011


I Caroline Joseph, the student of M.A.Social Work IVth Semester, hereby declare that the dissertation entitled The psychological implications of pregnancy among women, completed and submitted by me is an authentic and original work done by me under the guidance of H.O.D Mrs. Sheeba Joseph. It is a work completed by me as a partial fulfillment for the MASTERS DEGREE of Social Work. The empirical findings in the research are based on the data collected by me and it is not copied from any other study even. I have not copied from any other report submitted to this institution in this year or of previous year. I understand that any such copying is liable to be punished in any way the institute authority seems it.

Place- Bhopal Date- - -

Caroline Joseph M.A. (Final) Social WorK


This is to certify that the Dissertation entitled The psychological implications of pregnancy among women. Prepared by Caroline Joseph, M.A (SW) IV sem. Student is completed under my supervision and guidance.

Her findings and suggestions are based on the data collected by her to the best of my knowledge and belief, matters presented in her Dissertation are original and has not been submitted earlier.

Place: Bhopal Date:.

Mrs.Sheeba Joseph Head, Department of Social Work


GRATITUDE IS THE MEMORY OF HEART To the divine providence of God, I raise my heart in deep gratitude and love for all the blessings and graces; he has showered upon me during the research. It gives me an immense pleasure to express my heartfelt thanks to Fr.Dr.Joseph P.P, the principal of Bhopal School of Social Sciences, Sr.Dr.Johnsy Mathew CMC, Vice Principal for giving me a chance to do my research work for the partial fulfillment of my studies in Social Work. My sincere thanks to the, Mrs.Sheeba Joseph, Head of the Social Work Department; and the guide of this dissertation. Acknowledges are due to her, for her compliance as scholar and understanding as a person sustained me to its successful accomplishment throughout my work ,my deep gratitude goes to her for her critical evaluation, valuable guidance and constructive suggestions. I am extremely grateful to all the faculty members of the Department of Social Work for their assistance and support to enrich my studies. . I express my sincere gratitude towards my parents, friends, and dear and near ones for their prayers and blessings above all for being with me in spirit till the completion of this work.

Caroline Joseph M.A . (SW)Final B.S.S.S College, Bhopal

CONTENTS Page 1-22 23-25 26-42 43-45

Chapter 1. Introduction and review of literature Chapter 2. Research Methodology Chapter 3. Results Chapter 4. Discussions and conclusion References Appendix 1. Interview Schedule


Mother and child considered as one unit. it is because 1. During the antenatal period the fetus is part of the mother. The period of development fetus in mother is about 280 days during this period the fetus obtain all the building materials and oxygen from the mother blood 2. Child health is closely related to maternal health .A healthy mother bring s forth a healthy baby there is less chance for a premature birth still birth or abortion 3. Certain disease or condition of the mother during pregnancy (e.g. syphilis, German measles during intake )is likely to have their effects upon the fetus 4. After birth the child is depended upon the mother at least up to age of 6 to 9 month. The mental and social development of the child is also depended upon he mother. If the mother dies the childs growth and development are affected (eternal deprivation syndrome) 5. In the care of women there are few occasions when service to the child is not simultaneously called for instance postpartum care is inseparable from neonatal care and family planning advice. 6. The mother is also the first teacher of the child it is for the reasons the mother and child are treated as one unit. Pregnancy is the caring of one more offspring, known as a fetus or embryo inside the womb of a female. Prenatal defines the period of occurring around the time of birth especially from 22 complicated days after birth. When the ovum is matured and reaches the fallopian tube where it fetus with sperm cell spermatozoa. when spermatozoa fetus with ovum it teases the outer wall of ovum and enters in the nucleus immediately after this he ovum wall close so that the seconded or any other spermatozoa may not enter the ovum has a substances named yolk on which the ovum survives till it reaches embryo persons is like egg in this period which is called zygote. Which is pin assize the infant from 2nd week to eight week is called embryo. up to months its weight is 20gms up to this period many parts and organs develop like eyes , ears mouth , heart and liver est. this infant from to birth is called fetus . the length of the fetus grows fast in this period roughly up to 8 month the movement of the fuss start in mothers womb.

What Is Pregnancy? Pregnancy is the interval of time beginning when an egg and sperm unite and ending when a baby is born. A full-term pregnancy lasts 9 months (38 to 40 weeks). The 9 months are divided into trimester * one (the embryo * develops), two (the embryo turns into a fetus * ), and three (the fetus gains weight and gets ready for birth).

Trimester (tri-MES-ter) is any of three periods of approximately 3 months each into which a

human pregnancy is divided.


Embryo (EM-bree-o), in humans, is the developing organism from the end of the second week

after fertilization to the end of the eighth week,


Fetus (FEE-thus) in humans, is the unborn offspring in the period after it is an embryo, from 9

weeks after fertilization until birth.


Anemia (a-NEE-me-a) results when people have too few red blood cells to carry oxygen in the

blood. What are the signs of pregnancy? The primary sign of pregnancy is missing one or more consecutive menstrual periods. However, because many women experience menstrual irregularities that may cause missed periods, women who miss a period should see their health care provider to find out whether they are pregnant or whether there is another health problem. Others signs and symptoms of pregnancy may include: Nausea or vomiting, morning sickness Sore breasts or nipples Fatigue Headaches Food cravings or aversions Mood swings Frequent urination What is prenatal care and why is it important? Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby. In addition, health care providers are now recommending a woman see a health care provider for preconception care, before she is even trying to get pregnant.

Health care providers recommend women take the following steps to ensure the best health outcome for mother and baby: Getting at least 400 micrograms of folic acid every day to help prevent many types of neural tube defects. Health care providers recommend taking folic acid both before and during pregnancy. Being properly vaccinated for certain diseases (such as chicken pox and rubella) that could harm a developing fetusit is important to have the vaccinations before becoming pregnant Maintaining a healthy weight and diet and getting regular physical activity before, during, and after pregnancy Avoiding smoking, alcohol, or drug use before, during, and after pregnancy What is a high-risk pregnancy? All pregnancies involve a certain degree of risk to both mother and baby. But, factors present before pregnancy or that develop during pregnancy can place the mother and baby at higher risk for problems. Women with high-risk pregnancies may need care from specialists or a team of health care providers to help promote healthy pregnancy and birth. Factors present before pregnancy that can increase risk may include: y y y Young or old maternal age Being overweight or underweight Having had problems in previous pregnancies, such as miscarriage, stillbirth, or preterm labor or birth y Pre-existing health conditions, such as high blood pressure, diabetes, or HIV/AIDS

During pregnancy, problems may also develop even in a woman who was previously healthy. These may include (but are not limited to) gestational diabetes or preeclampsia/eclampsia. Getting good prenatal care and seeing a health care provider regularly during pregnancy are important ways to promote a healthy pregnancy. What Are the Normal Discomforts of Pregnancy? As a woman gains weight and her body changes to accommodate a growing fetus, she may experience some of the following signs or symptoms:
y y

Anemia * Backache

y y y

Bleeding gums Breast tenderness Constipation

Anatomy of human ovum and human sperm.

y y y y y y y y y

Edema (water retention) Fatigue Food aversions and cravings Frequent urination Heartburn Hemorrhoids * Nausea and vomiting Stretch marks * Varicose veins *

Symptoms vary from woman to woman, and even between pregnancies for an individual woman. What Are the Common Complications of Pregnancy? Most women get through pregnancy and giving birth without any major health problems. However, a few experience complications that threaten the health of both mother and baby. These problems can be very frightening, and they are hard to deal with when they result in the loss of a baby. Morning sickness Morning sickness refers to nausea and vomiting, and it is misnamed. Some women have it in the morning, others at noon, and still others at night. Some women feel queasy only occasionally, whereas others feel sick all day long. Overall, about half of all pregnant women experience some degree of morning sickness, but it usually subsides on its own after about the third month of pregnancy. Only rarely does it require medical attention. No one knows what causes morning

sickness, but probably it is related to the hormonal and other chemical shifts that occur in early pregnancy.

Hemorrhoids (HEM-o-roidz) are a mass of dilated veins in swollen tissue at the margin of the

anus or nearby within the rectum.


Stretch marks are stripes or lines on the skin (such as on the hips, abdomen, and breasts) from

excessive stretching and rupture of elastic fibers, especially due to pregnancy or obesity.

varicose veins (VAR-i-kose VAYNZ) are abnormally swollen or dilated veins.

Sonogram of a healthy fetus.

Miscarriage Miscarriage (MISS-care-ij) is also called spontaneous abortion, and it means that suddenly the pregnancy terminates on its own. Bleeding, cramping, and abdominal pain often signal a miscarriage. Most miscarriages occur before the fourteenth week of pregnancy, which is why many women wait to tell their family and friends about a pregnancy until they have passed the 3month mark. Occasionally, a woman will have a "late" miscarriage, which means that it occurs during the second trimester. After the twentieth week, the unexpected end of a pregnancy is called stillbirth if the baby is born dead and premature birth if the baby is alive but born before the thirty-seventh week. Scientists estimate that as many as 40 percent of pregnancies end in miscarriage, although most of these occur so early that a woman may not even realize that she is pregnant. Early miscarriages often occur when the body naturally rejects a fetus that is not developing properly. Later miscarriages are much less common. Reasons for late miscarriages include a placenta * that is improperly attached to the uterus * , the placenta separating from the wall of the uterus for some reason, and other causes. Gestational diabetes Gestational * diabetes * is a type of diabetes that occurs when a woman does not produce enough insulin to handle the increased blood sugar that accompanies pregnancy. Any woman can

develop this common problem, but women who are older, are over-weight, and who have relatives with diabetes are at higher risk. A special diet often can control the problem without medication. Untreated diabetes during pregnancy increases the risk of certain birth defects. Such infants often have abnormally high birth weights and are prone to developing low blood sugar in the hours after birth. Most cases of gestational diabetes are temporary and disappear after the baby is born.
* *

Placenta (pla-SEN-ta) in humans is the organ that unites the fetus to the mother's uterus. Uterus (YOO-ter-us) in humans is the organ in females for containing and nourishing the

young during development in the period before birth. Also called the womb.
* *

Gestational (jes-TAY-shun-al) means relating to pregnancy. Diabetes (dy-a-BEE-teez) is an impaired ability to break down carbohydrates, proteins, and fats

because the body does not produce enough insulin or cannot use the insulin it makes.

Fallopian tube (fa-LO-pee-an tube) is either of the pair of long slender tubes connecting the

ovaries to the uterus. Typically, a fallopian tube is where conception takes place. Cesarean Law Acesarean section is the method of delivering a child by opening the abdomen and uterus. It is performed when natural delivery presents risk to the mother or child. The name of the procedure comes from the traditional story that the Roman ruler Julius Caesar (100-44 B.C.E.) was delivered by cesarean. More likely is the explanation that Cesarean law forbade the burial of a deceased mother before the baby was delivered. Written accounts of the rescuing of an infant from its dead mother were recorded as early as 500 B.C.E. Cesarean sections were known to have been practiced by the ancient Romans, Indians, and Jews in the Roman era. Ectopic pregnancy An ectopic (ek-TOP-ik), or tubal, pregnancy is one in which the fertilized egg begins to develop outside of the uterus, usually in a fallopian tube * . Cramps, nausea, dizziness, tenderness in the lower abdomen

, and light vaginal bleeding often accompany ectopic pregnancies. Early

detection and treatment of an ectopic pregnancy are essential. If the embryo continues to grow, eventually it will burst the fallopian tube and damage it permanently. An undiagnosed ectopic pregnancy can also seriously jeopardize the health of the mother.

An ultrasound * can be used to examine the abdomen and confirm the diagnosis of an ectopic pregnancy. An ultrasound sends sound waves into the body that bounce off internal structures. A computer converts the returning sound waves into an image of the internal structures. Ectopic pregnancies usually are removed surgically. Incompetent cervix An incompetent cervix * is the cause of about 25 percent of late miscarriages. The cervix is the muscular opening of the uterus into the vagina (va-JY-na). An incompetent cervix means that it opens too early because of the pressure exerted by the growing fetus. An incompetent cervix can be caused by many factors, including a genetic tendency for it, stretching or tearing of the cervix during previous deliveries, and carrying multiple fetuses. An incompetent cervix can be treated by stitching the cervix closed during the second trimester or by bed rest for the last several months of pregnancy. Preeclampsia/eclampsia and toxemia The terms "preeclampsia/eclampsia" and "toxemia" are used interchangeably to mean the same thing: pregnancy-caused hypertension (high blood pressure). Most cases of toxemia are characterized by high blood pressure; swelling of the face, hands, and ankles; too-rapid weight gain; headaches; and protein in the urine. When left untreated, toxemia can cause nausea, vomiting, blurred vision, convulsions * , and coma * . Toxemia most often affects young women during the last months of their first pregnancy, and the cause is unknown. Often, treatment involves hospitalization until the blood pressure returns to normal, followed by limited activity and sometimes bed rest at home. Placenta previa Placenta previa (PREE-vee-a) means that the placenta is lying low in the uterus. It can be dangerous if the placenta actually covers the cervix during labor and delivery. The baby still requires the blood, oxygen, and nutrients provided by the placenta during birth, and so the placenta should be the last thing out. Placenta previa can lead to premature labor, and women with this problem sometimes must limit their activity or stay in bed until the baby is born. Doctors can monitor the position of the placenta using ultrasound. When it is time to have the baby, doctors opt for a cesarean section cervix.

if the placenta is still covering or very close to the

Abdomen (AB-do-men), commonly called the belly, is the portion of the body between the thorax (THOR-ask) and the pelvis.

Ultrasound is a painless procedure in which sound waves passing through the body create images on a computer screen.

y y

Ovaries (O-va-reez) are the sexual glands from which eggs (ova) are released in women. sperm are the tiny, tadpole-like cells males produce in their testicles (TES-it-klutz) that can unite with a female's egg to result eventually in the birth of a child.

Umbilical cord (um-BIL-i-kul KORD) is a cord arising from the navel that connects the fetus with the placenta.

y y

Cervix (SER-viks) is the lower, narrow end of the uterus, which opens into the vagina. Convulsions (kun-VUL-shunz) are violent involuntary contractions of muscles normally under voluntary control.

coma (KO-ma) is an unconscious state, like a very deep sleep. A person in a coma cannot be awakened, and cannot move, see, speak, or hear.

cesarean section (si-ZAR-eve-an SEK-shun) is the surgical incision of the walls of the abdomen and uterus to deliver offspring in cases where the mother cannot deliver through the vagina.

Preterm labor and premature birth More babies are born past their expected due date than before it, but in the United States, 7 to 10 out of 100 babies are born prematurely. A premature birth means delivery before the thirtyseventh week of pregnancy. About one-third of premature babies are born early because the mother went into labor too soon (the other cases occur because the amniotic sac


prematurely or because a health problem with the mother or baby requires early delivery). Among the many risk factors for preterm labor are smoking, alcohol use, drug abuse, vitamin deficiencies, a job that requires standing for long time periods, infections like German measles, placenta previa or other physical causes, and poor nutrition. Preterm labor that results in a premature birth poses serious health problems for the baby who has not finished developing inside the uterus. Are There Risk Factors for Pregnancy Complications? Older women (over 35) have a higher probability than younger women of experiencing high blood pressure, diabetes, and cardiovascular disease while pregnant, but these conditions are

controllable with good medical care. Older women also are more prone to miscarriage, preterm labor, and postpartum (after birth) bleeding, and they have an increased risk of having a child with birth defects. On the other end of the age spectrum, teen mothers are twice more likely to have premature babies and babies with low birth weight than are older mothers. Teenagers also are prone to premature labor, prolonged labor, toxemia, and anemia. About 1/3 of pregnant teens do not receive adequate medical care during pregnancy (as compared with about 1/4 of older women). Finally, while the chance of dying from pregnancy-related complications is very low overall, the rate is much higher in women younger than 15 than in women older than 15

Psychological problem During pregnancy the women undergoes many psychological changes which are entirely norm including cardiovascular hematological metabolic , and resipiratory changes that become very important in the event of complications . the baby must changes its psychological and homeostatic in mechanism in pregnancy tonure the fetus is provided for . levels of progesterone and estrogen rise continually through pregnancy suppressing the hypothalamic .

Early settlement of the psychological problem of pregnant women Early pregnant mothers prone to psychological problems, there are three or less. Pregnant women make emotional instability, strong dependence, and even showed nervous. This is a pregnant women and fetus in a disadvantaged position.

1, excessive worry: Some pregnant women do not understand the scientific and easy to produce so happy and worried about the ambivalence. For their own child's ability to perform physical tasks, whether or not the normal fetal always skeptical of any substance can be refused on the journey of a thousand miles.

2, early reaction: Strictly speaking, early response (Yuntu) is a physical and psychological factors arising from the symptoms. However, medical experts found that Yuntu and psychological factors are closely related. If the offensive pregnant women, the vast majority of

Yuntu and will be accompanied by weight loss, if the pregnant woman is exposed character, psychological and emotional changes, will occur Yuntu and other severe reactions.

3, psychological stress: Some relatives of pregnant women and children eager hope, the future of life knows nothing about, as housing, income, infant care and other issues of concern that led to a high degree of psychological tension.

These negative state of mind, pregnant women make emotional instability, strong dependence, and even showed nervous. This is a pregnant woman and fetus in a disadvantaged position. To improve the principle that pregnant women, I have to do everything as far as possible, openminded, and do not have to care about; the event of did not matter to one's liking, not going to go to a dead end. Husbands and other relatives to care for and take care of pregnant women, pregnant women should not be too bad to stimulate, not to do so may of pregnant women suspicious of the words and deeds, so that the psychological state of pregnant women to keep in top condition.

Pregnancy is an experience full of growth, change, enrichment, and challenge. It is a time when you as a couple confront your fears and expectations about becoming parents and begin to determine your own parenting style. Forthcoming parenthood causes psychological changes in both mother and father. The following sections will help you understand the normal psychological changes that occur throughout the different stages of pregnancy. If you are having psychological problems that are interfering with your daily life or relationships, talk to your doctor and get help. Don't worry; these changes are normal considering a big life change like pregnancy. In the following sections, you will learn to identify common changes, including Psychological changes in the first Trimester You may not be able to see the changes that are happening during the first trimester, but they are significant. During this time, some new mothers might be filled with a feeling of anxiety about losing their new baby. These fears, though unfounded, are perfectly normal. Read about the many emotions that women experience during this critical period in fetal development. Psychological Changes in the Second Trimester

Once the stress and anxiety of the first trimester have passed, the emotional changes of the second trimester begin. Though the feelings during this time will usually be less intense, they can be equally as troubling. Many mothers begin to feel self-conscious about the weight they are putting on to support their baby, and these feelings can lead to low self-esteem. Psychological Changes in the Third Trimester In the third trimester, women are anticipating childbirth and coping with significant physical changes. While fears of losing the baby have usually disappeared by this point, a new anxiety takes its place -- the fear of the baby's arrival. Also, worries about labor and birth are also common during the last three months of pregnancy. Severe mental illness tends to occur among women in the reproductive period. These illnesses include bipolar disorders, psychotic depression, schizophrenia and other psychotic disorders. The onset is usually in the second and third decades of life and the condition is often chronic in nature with significant disability. The treatment of the condition involves long-term use of psychotropics. With the advances in psychiatric treatment, more women are responding to treatment, getting married and considering pregnancy. The treatment of mental illness that occurs during pregnancy poses various challenges to professionals. Since a majority of pregnancies among women with mental illness are unplanned, the issues become even more complicated. Most important is the effect of the mental illness on the pregnant mother, i.e., risk to herself. The other problem is the risk to the fetus, which may be due to the illness or the effect of the mother's treatment. Having untreated severe mental illness during pregnancy can adversely affect the well being of the mother. She may neglect her health, not receive adequate antenatal care, have nutritional deficiencies and also indulge in substance use secondary to the illness. The illness may impair a woman's judgment in making decisions related to the pregnancy and the fetus, resulting in further complications. Emotional Imbalance : Stress and depression during Pregnancy Depression or mental stress is a psyche condition that inhibits personal happiness and productivity during pregnancy. Moderate ("normal") depression or mental stress is a general part of survival. Ranging from person to person it may be minor to major depending in its impact and intensity. Unless persists, depression or moderate stress is a normal and unavoidable phase in our life like tears in eyes. Normally we get depressed and stressed when something bad happens, such as the death of a loved one or an end to a relationship. Usually depression alleviates over a

period of time; but in some cases it persists for much longer time. On accumulation for longer period, depression or stress can erode family relationships, and may promote other physical and mental health problems. It occurs in kids and adults. Now days, excessive depression has become common in people due to today's unique surrounding. Depression may be due to hormonal (chemical) imbalance, or as a result of psychological "upset." Anti-depression medications can reduce the symptoms to tolerable, but leaves the root cause/s of depression unhealed.

Even during pregnancy, many women who have had depression may be continuing antidepressants to prevent symptoms. If she is getting treatment under expert's guidance and taking those antidepressants, for which there is a fair amount of information suggesting that it is safe, it is fine to continue. However, if she is taking a medication for which there is little information, she should switch on to a medication thought to be safer. However most the depression symptoms are mild and short-lived; it may be more accurate to consider them as a normal experience rather than a psychiatric illness. Incase of mild depression, the experts would recommend trying to treat her symptoms with mild antidepressants. However the first trimester (12 weeks) of pregnancy is a crucial time when medication can cause malformations of the fetus. So experts may advice discontinuing medications over this period unless a woman has had multiple episodes of severe stress and depression. After three months, there is not the concern about medication causing malformation of organs. However, there are still questions about whether medication might cause a miscarriage or subtle changes in the early development of the future child.

Whether the woman remains on medication or not, it is always better to opt for some alternative way of healing that may help to prevent recurrence of depression and stress during pregnancy. Following are some of common symptoms that indicate 'Emotional Imbalance' during pregnancy: Following are some of common symptoms that indicate 'Emotional Imbalance' during pregnancy: y y y Persistent longings. Unreasonable longing desires. Delusions or hallucinations.

Noticeably depressed mood however if this depression persists without any interval between subsequent periods then it is more likely that she has another kind of mood problem.

y y y y y y y y y y y y y y y y y y y y

Blank depression. Irritability. Get depressed over trivial issues. Sadness. Aversion. Disgust or gross feeling. Fear of miscarriage. Resentful behavior. Swinging moods. Marked anxiety Feeling tensed. Feeling twitchy. Marked shifts in mood (suddenly tearful, overly sensitive) Persistent, marked anger or irritability, increased conflicts. Loss of interest in usual activities (e.g., work, hobbies) Difficulty concentrating and focusing attention Marked lack of energy, feeling very easily exhausted. Noticeable change in appetite, overeating, food cravings or aversion to food. Sleeping too much or having a hard time sleeping. Feeling overwhelmed or out of control.

Many types of antidepressants are available in market. Usually experts recommend a kind of antidepressant that increases brain levels of a chemical called serotonin. These medications are called selective serotonin reuptake inhibitors (SSRIs). The SSRIs preferred by the experts for use in pregnancy are fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). The experts also favor tricyclic antidepressants, another kind of antidepressant that affects other brain chemicals in addition to serotonin. SSRIs may cause the following side effects: nervousness, drowsiness, insomnia, restlessness, nausea, diarrhea, and sexual problems.

Stress and Depression during pregnancy and Negative Emotions co-relations.

Often the "emotional imbalance like stress and depression during pregnancy" affects psyche as well as physical body. A bad relationship, poor self image, a history of abuse, stress, frustration and many other factors can change your overall attitude towards life which may directly impede your overall performance. Such tendencies are deep-rooted in mind and nurtured by excessive Negative Emotions.

It is needless to mention that these negative emotions are tremendously powerful. They can debilitate lives extremely quick by causing disparity in energy system, which triggers a sequence of emotional imbalance (i.e. frustration, melancholia, persistent agony, mental instability, uncontrolled anger, inferiority complex etc.), which ultimately culminates in ill health.

Lessen "Negative Emotions" in psyche. (i.e. frustration, uncontrolled anger, bitterness, excessive shame, guilt, arrogance, envy, jealousy, greed, fear, suspicious nature, inferiority complex, persistent agony or melancholy, mental instability, escapism or shilly-shallying tendencies, communication apprehension, poor will power, low grasping, absentmindedness, sloth, laziness, dawdling, dodging etc.) boost latent inner ability Mold the inherent behavior in accordance with the existing circumstances and surrounding conditions get rid of worries, tensions and sufferings achieve peace of mind and bring the Ultimate Happiness!

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Broadly classified under maternal depression, prenatal mood disorders are a result of the physiological and hormonal changes the body undergoes and the stressors involved in pregnancy. There are various gestational or ante partum disorders that affect women during pregnancy and postpartum or postnatal mood disorders that occur after pregnancy. Anxiety and depression constitute the major emotional disturbances in the prenatal stage. However the clinical classification of prenatal mood disorders falls in three major groups of mental disorders during pregnancy.

Major Depression - Gestational and Postpartum Depression: Referred to as 'baby blues', depression is a common and self-limiting mood disturbance, that can severely affect the lives of the mother and child. It affects nearly 10% of pregnant women and poses a risk to the mother and the fetus. The condition referred to as postpartum depression can develop and worsen after the birth of the baby. The trigger factors could be, the rapid rise in hormone levels during pregnancy or the change in the levels of chemicals in the brain, which govern moods. A disruption in either of these, can lead to depression. The other causes of depression could be stressful life events, financial troubles, or a death in the family.

The symptoms of major depression in pregnant women include: Difficulty in sleeping or oversleeping Weight loss or change in appetite Irritability or mood swings Constant fatigue or lack of energy

Restlessness or feeling slowed down Unpredictable, uncharacteristic, or bizarre behavior Recurrent thoughts of self-harm or suicide Feeling of guilt or worthlessness

Untreated depression may lead to substance abuse, self harm or suicide and could even cause the death of the baby. Most pregnant women with depression, experience preterm birth, spontaneous abortion and low birth weights. It may also impair a mother's ability to promote the infant's cognitive and emotional development.

Clinical Mood and Anxiety Disorders: They can occur during pregnancy and following childbirth, usually within six months to a year later and often necessitate treatment. Usually as common as depression, anxiety disorders are characterized by panic attacks, hyperventilation and obsessive compulsive disorders. The woman may have repeated thoughts or images of frightening things happening to her baby.

Postpartum Psychosis: This is the most extreme form of prenatal mental illness, usually occurring within a few weeks of childbirth and constituting a medical emergency. This form of maternal depression may lead to poorer neonatal outcomes and even infanticide.

While the effect of psychotropic medications during pregnancy is not ascertained, the risks associated with untreated psychiatric illnesses during and after pregnancy have to be taken into consideration and necessary treatment should be provided. One of the best treatments for psychological problems during pregnancy, is psychotherapy. Not only is psychotherapy completely safe and healthy, for both the mom and the baby, it also works to find out the root cause of the depression and can help you to deal with feelings of sadness, guilt, or worthlessness. It is advisable that before taking antidepressants, mood stabilizers or anti- anxiety agents, a health care provider is consulted. Since mental health and pregnancy are synonymous with the well being of the mother and the child, women should formulate a treatment plan to manage this common disorder.

Psychological problems during pregnancy affects child Scientists to research and tests during pregnancy and psychological problems into a depression and nervous mothers of children prone to violence is revealed. Kings College London from Cardiff and Bristol universities, according to scientists, teenage pregnancy into a depression in women prone to violence, four times more likely to bear a child. This connection, even if women enter into depression after giving birth was stated to be valid. An earlier study, postpartum depression can affect a childs behavior was revealed. Pre-natal depression, but the link between the childs behavior reveals a new research in this area is among the first studies. 10 percent of pregnant women who are suffering from depression is estimated to 15 nin. According to the Telegraph news, research among 120 women ldi structure. Women during pregnancy, postpartum, and children in fourth, at the age of 11 and 16 were interviewed. At the end of the research, into a depression in pregnant women, the severity of their children 16 years old tend to be more than four of the cases were found. Children in other types of anti-social behavior more likely to be proved. Emotional Help During And After Pregnancy Pregnancy, delivery, and post-delivery are all times of great physical, hormonal, and emotional changes for you and for every birth mother. The links on this site should help you understand some of the emotional changes so that hopefully you can deal with them more effectively. Moods and Emotions of Pregnancy Emotional ups and downs and moodiness during pregnancy are common to most pregnant women. It is believed that these mood changes are caused by hormonal changes and the changes that must be made in the life of the pregnant woman. These emotions and feelings are often intense, varied, and unpredictable Although each pregnancy is unique the following description provides a basic picture of common emotional changes of pregnancy. During the first stage of pregnancy (the first 3 months) the woman's emotions are often unstable and feelings of depression are not uncommon, often for no apparent reason. The pregnant woman experiences many mood swings, which are often extreme and seem to come out of nowhere. The woman may start to cry, or become angry, fearful, or hurt all with little cause or no apparent reason at all.

The second stage of pregnancy (2nd trimester) is typically a little more calm than the 1st trimester. By this time the woman has begun to deal more effectively with her pregnancy and the emotions involved. Often the woman will have more energy than she has had for a few months and her overall outlook tends to be more stable, positive, and predictable. The final stage (months 7-9), and especially the last month or two, the pregnant woman's anxieties and fears may increase along with her physical discomfort. She may experience fatigue, restlessness, and sleeplessness. Many women at this time feel very vulnerable to rejection, loss or insult, and they may feel "fat" and unattractive. It is very common for the woman to be preoccupied with concerns and fears about labor and delivery, the pain and uncertainty involved, and concerns about the financial, medical and emotional future for her child. After the child has been born many women go through a period called the "baby blues" or through period of true depression. Depression that occurs during pregnancy is called prenatal depression while depression after pregnancy is called postpartum depression. Depression is one of the most common complications during and after pregnancy. Often, the depression is not recognized or treated, because some normal pregnancy changes cause similar symptoms and are happening at the same time. For information on depression during and after pregnancy, both of which are very common, and effective ways to treat depression, please visit Depression During and After Pregnancy.

Help With Your Emotions Pregnancy support groups and parenting support groups can help with some of the emotional issues of pregnancy, birthing, raising your child, and child adoption. Each site offers something a little different. For additional information about the emotions of your pregnancy, please visit the website Pregnancy And Children. Other informational websites on pregnancy and emotions include: The ivillage website has a section on the moods and emotions of pregnancy that includes physical and emotional changes during pregnancy and physical and emotional changes after the baby's birth. Emotions during all three trimesters of pregnancy are discussed in the University of Iowa's maternity unit website.

10 Myths on infertility busted The myths that surround infertility only compound the issues associated with it. Find out how to differentiate between myths and fact. Infertility takes an enormous toll on the affected individuals. It is an emotional devastating life crisis for the couple, which can impact their general health, the marriage itself, family relationships, job performance and even social interactions. The myths that surround the problem only compound the issues associated with it.

Myth: Most women get pregnant easily.

Fact: While some women get pregnant with no effort, there are many couples that struggle. In todays modern age is a big factor; many other issues that can also hinder a pregnancy.

Myth: Only women can be infertile Fact: Over the ages women have been blamed for infertility. Women always come under scrutiny when they fail to get pregnant. While women are the main cause of infertility, in as many as 30% of the cases there are male infertility issues. In most cases the causes of infertility is a combination of many factors in both male and female.

Myth: Starting and stopping birth control can affect fertility.

Fact: Stopping and starting birth control (pills, patch, etc.) has not been shown to have any long term effects on fertility. Birth control medications contain level of hormone, which are just high enough to prevent pregnancy, yet are low enough that for most women who take them they rarely cause any significant problems. Once stopped the hormones leave the system and return it back to their normal state.

Myth: If infertile, trying long enough will result in pregnancy.

Fact: Infertility is a medical problem that cannot be treated at times. In case of a problem it needs to be addressed. Positive thinking will not solve the problem.

Myth: Infertility is not a physical problem, it is psychological.

Fact: The advice often forthcoming is that its all in the mind. Stopping the worrying or stressing about it, will allow it to happen. Stress and worry contribute. However, infertility is caused by physical issues.

Myth: If you were a better person, you wouldn't be infertile.

Fact: This is an offensive and extremely judgmental myth. Moral character does not have anything to do with fertility. Infertility is the result of physical issues.

Myth: By adopting a baby infertility gets fixed.

Fact: By adopting a child the state of childlessness is fixed, not the state of infertility. The disease and all the symptoms persist.

Myth: If young and healthy, infertility will not be a problem

Fact: As women age, fertility also declines, but diseases like low sperm count and quality, endometriosis, and polycystic ovarian syndrome can also inhibit fertility.

Myth: If infertile in vitro fertilization is the only way to have a baby.

Fact: Depending on the cause there are different treatments. The treatment may be as simple as medication.

Myth: A regular period means that there will be no problem getting pregnant.

Fact: A regular period does not guarantee fertility. Number of underlying causes like blocked fallopian tubes, endometriosis, structural problems, and even STDs can cause infertility.

Psychological Consequences of Pregnancy and Delivery

Among the major and recurring psychological hemes prevalent in pregnant and new mothers include feelings of depression, emotional liability, self-esteem issues, body image issues and personal feelings regarding control.

Emotional Toll of Pregnancy and Delivery Though pregnancy is in and of itself a wonderful experience with a delightful outcome, it can wreak havoc on a pregnant woman's emotions. Hormone levels are constantly fluctuating during pregnancy and in the post partum period. This can lead to feelings of anxiety, depression, sadness, elation and even confusion.

It is not uncommon for women to report mood swings and irritability during and after their pregnancy. By and large for most women these feelings resolve themselves after a period of sufficient recovery.

The key to successful addressing of any psychological effects of pregnancy and labor is recognition that the changes that are occurring in one's body are normal. With adequate support most women will recover from pregnancy and delivery very well on an emotional basis, if they know what to expect and how to deal with it ahead of time. Dealing with Psychological Emotions There are many things you can do to improve the psychological and emotional impact of pregnancy and delivery.

First and foremost, you must seek out support. You should expect that you will be tired during your pregnancy, and likely be exhausted afterward. In the post partum period you will spend a large portion of your time up at night feeding and caring for your baby.

You should not expect to maintain a spotless home, cook meals and run errands as normal. If at all possible, enlist the assistance of your partner to help maintain the house and cook meals.

If your partner is not available turn to family members, relatives or friends that may be willing to stay and help out.

Another thing you can do to alleviate the emotional impact of delivery is limit the number of visitors you allow every day. Initially while in the hospital most women will have an influx of visitors.

Be sure that you communicate with friends and family members however and let them know when you are too tired to entertain, and don't be afraid to set limits on the length of their stay.

Finding Time to Sleep Sleep is an essential component of anyone's well being. For a new mother, sleep is often hard to come by, but still vital for maintaining her health and well being.

The best advice you can take regarding sleep is this:

SLEEP WHEN YOUR BABY SLEEPS You will be tempted to run errands or catch up on housework or chores when your baby sleeps. Remember that taking care of a newborn requires a lot of energy. The best thing you can do for your emotional well being, not to mention energy is to sleep whenever you get the chance.

If you are breastfeeding, it is vital that you get as much sleep as possible to ensure an adequate milk supply and energy to care for and feed your baby.

Body Image During pregnancy your body will go through numerous changes. You will gain weight, your skin will be stretched out and may change colors, your hair may become fuller only to seem like it is falling out after pregnancy.

Most women will go through a period of emotional adjustment to the changes that are occurring in their body. Just after delivery, you will still look four or five months pregnant until your uterus

shrinks back to its pre-pregnancy size and your stomach may not actually get back to normal for several months or more.

For many women the changes that occur during pregnancy are harder to address in the post partum period, particularly when they realize that they don't have a baby 'inside' of them anymore and feel pressure to lose weight and get back into shape quickly.

It is vital for your emotional well being however that you realize that it took nine months for your body to go through all of the changes that it did during pregnancy, and realistically speaking it should take you at least nine months to recovery fully from the changes that occur during pregnancy.

The sooner you acknowledge and accept this the less likely you will be to succumb to pressures to loose weight initially.

The best thing you can do is love yourself and appreciate the fact that your body has just completed one of the most amazing and miraculous tasks known to man - it has created life! You deserve to take the time necessary to recover, and your body certainly deserves a break.

Review of literature Coverdale et al have discussed the clinical implications of respect for autonomy in the psychiatric treatment of pregnant patients with depression and have recommended strategies for assessing decision-making abilities and for enhancing their autonomy (1). They suggest that nondirective counseling be used when the fetus is pre-viable and that directive counseling is ethically justifiable when the fetus is viable. When a pregnant woman presents with severe mental illness, the initial decision she has to make is whether to continue the pregnancy or to terminate it. Dudzinski and Sullivan have discussed the ethical dilemma faced by the clinician in the case of a woman with schizophrenia who had impaired decision-making capacity (2). The clinician faces an ethical dilemma when it comes to respecting the autonomy of a patient whose decision-making capacity may be impaired. The clinician also needs to protect the rights of the viable fetus. The clinician needs to discuss various aspects with the patient related to the treatment of the illness, the use of psychotropic drugs, the effect of these on the fetus and the effect of untreated illness on the fetus. The patient should be able to assimilate this information and then make a decision. So, before making a decision, the clinician needs to determine the decision-making capacity of the individual. McCullough et al have outlined a seven-step decision-making process that highlights the necessary cognitive, attitudinal, and evaluative capacities (3). First, the patient should be able to attend to medical information. Second, the patient needs to absorb, retain, and recall the information. Third, the patient must possess cognitive abilities to reason about the relationship of present events and decisions to future consequences. Fourth, the patient ought to appreciate that these consequences could affect her, her fetus, and her future child. Fifth, the patient should be able to evaluate consequences based on her own values and beliefs. Sixth, the patient can express a voluntary decision to accept or reject the physician's recommendation. Seventh, the patient can explain her decision.

It has been shown that even a suspect prenatal psychology is a traumatic event for the women and her partner depression rats of rates of women who restive a prenatal diagnosis of fetal abnormality correspond to those of women who are nulliparous who have height triat anxiety

levels, and women who use negative coping strategies are at risk for developing psychological problem after the prenatal diagnosis of a fetal abnormality (leithnertal. 2004) The loss of on under child hails a women at a psychological vulnerable phase (beutel1991) In two studies women who had already had children before a stillbirth . Were found to a better psychological ouatcome (kirkly best and kellner 1982 lapple and kellner 1988 ) This finding was not replicated in order other studies the emotion attachment to a fetus develops much eat earlier than has been assumed (Butel 1991 1992) women already have fantasize of a child age has been linked to decrease mourning (Butel 1991, Tocdter et al 1998) The number of preceding losses advance pregnancy were found to influence the cource and severity of mourning reactions moreover in advanced maternal has been linked to decreased mourning (Butel 1991 Todter et al 1998) We found that older women with a history of prenatal incidents are more at risk for developing depressive reactions because advanced age is associated with an increase risk of losing a child during subsequent pregnancy . In some women work may severe as a dissertation , and work place social networks may provide some support in the crises situation of a prenatal diagnosis fetal pathology or loss of pregnancy (Leither et .al.2004) Specific groups of women especially those at risk for depression may be even more vulnerable to the negative mental health consequences of domestic violence (Sato &Meiby 1992) Depression appears to be the primary violence mental health response of women who are abused (Campbell, kub Belknap &Templin.1997) Depression symptoms can seriously impair normal life functioning addionally pregnant women and those what have just given birth are also higher risk for depression relative to non pregnant women.( o Hara 1986) In an early study, Ashton (1980) interviewed 111 women before a surgical termination with eight-week and eight-month follow-up. There was a large drop-out rate, with only 22 women interviewed at eight months. Of these, six reported persistent disturbances and all six were married and had been ambivalent about having the termination. GP records were accessed for 86 women at eight months and about 10% were found to experience serious psychiatric problems. However, these were short-lived and mainly resolved by eight or nine months after the termination.

This finding is echoed in a review, published a decade after Ashtons study, of the preceding 20 years studies. The reviewers found that severe or persistent psychological disturbances were reported to occur in about 10% of women (Zolese and Blacker, 1992). A comprehensive review by Thorp et al (2002) examining multiple effects following termination included 10 studies on subsequent mental health. The studies spanned 25 years from 1974 to 2000. Three large studies in the review examined almost 600,000 records and found an increase in the risk of suicide after termination. Three studies followed women up for 30 days and one (173,279 records) followed them up for 1-8 years. Thorp et al (2002) asserted that women contemplating a termination should be cautioned about an increased risk of self-harm or suicide. However, it could be argued that such a direct approach may be counterproductive at such a sensitive time. Hess (2004) US phenomenological study found that some women who found the experience negative sought help and healing. This indicates that help should be made easily accessible to women at the time of their termination. The risk factors affecting psychological consequences are outlined to assist nurses in assessing those at risk undergoing a termination (Table 1 The majority of the research literature centering on prenatal loss and the grief process was published in the 1970s and 1980s. Very little research has been published in recent years. One must look to older studies when examining trends and reviewing the literature. The last 1020 years have brought about an increasing interest in the psychological aspects of losing a baby with much discussion on stillbirths and neonatal death and very little regarding miscarriages (Conway, 1995). Miscarriage is traditionally defined as an involuntary termination of a nonviable fetus before the age of 24 weeks, while stillbirths are characterized as the birth of a dead fetus and neonatal death as a death within the first 30 days of life (Armstrong & Hutti, 1998; Franche & Mikail, 1999). Recent statistics show that between 10%-15% of all clinically confirmed pregnancies result in a spontaneous abortion or early miscarriage while only 1%-2% result in a late pregnancy loss (Armstrong & Hutti, 1998; Franche & Mikail, 1999; Wheeler, 1994). Advancement in new technologies over the last 20 years, such as pregnancy tests and especially ultrasonography, has enabled clinicians to diagnose and follow a pregnancy at an earlier date than previously available. An increase in the use of in vitro fertilization has also raised the estimates of prenatal loss (Cote-Arsenault & Mahlangu, 1999). Therefore, clinicians now have a population of women who have received early confirmation of their pregnancy and,

most importantly, are aware when a prenatal loss occurs by utilizing this same advanced technology. The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death is a significant event for any woman and often presents as a major crisis in her life. This life crisis comprises many losses including, but not limited to, the loss of future hopes and dreams, loss of self-esteem, loss of the anticipated parent role, loss of being pregnant, loss of prenatal medical attention, and concern over the potential loss of the ability to create another new life (Rajan, 1994). This sense of loss plus the societal taboos surrounding death and the no status of either an unborn or a dead infant results in a couple mourning the loss of their pregnancy in silence and isolation (Carrera et al., 1998; Rajan, 1994). For many years the health care system viewed these losses as minor physical occurrences easily corrected medically and not requiring close follow up. Furthermore, up until the 1980s, very early pregnancy loss was regarded as an even less significant event than a late pregnancy loss (Beutel, Deckardt, von Rad, & Weiner, 1995). The last 1020 years have brought about an increase in the number of studies related to the psychological effects of women experiencing perinatal loss. The profound emotional and psychological impact that this loss may have on a woman's futureincluding, but not limited to, the effect on subsequent pregnancieswas not taken into account (Kuller & Katz, 1994; Moulder, 1999). The loss of any pregnancy through miscarriage , ectopic pregnancy , still birth , or neonatal death is a significant event for any women and often presents as a major crisis in her life . Until recently little research existed on the impact of a previous prenatal loss on a subsequent pregnancy. While it is important to consider how best to support women as they deal with a perinatal loss, it is just as important to look at the effects of grieving and how best to support women and their partners with the following pregnancy. Many researchers have found that the decision to become pregnant again following a prenatal loss is plagued with doubts, insecurities, and concern that another loss may occur. Despite these ambivalent feelings, most of the research indicates that 50%-60% of these women do indeed become pregnant again within the first year after the loss has occurred (Armstrong & Hutti, 1998; Estok & Lehman, 1983; Robertson & Kavanaugh, 1998). The purpose of this paper is to explore the literature regarding pregnancy following a prenatal loss and to examine implications for practice.

For this literature review, articles were identified through a key word search of several databases including Medline, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the online resources of Pubmed and MedPulse. Key words used in the searches included loss and pregnancy, perinatal loss and subsequent pregnancy, miscarriage and pregnancy, and pregnancy and psychological effects. The research reviewed in the literature was undertaken primarily with Caucasian, married, middle-class women and their partners. In reviewing the current state of the research related to pregnancy following a perinatal loss, the author identified four recurring themes: (1) the effect of the grief process on a subsequent pregnancy, (2) coping mechanisms of parents during the subsequent pregnancy, (3) the replacement or vulnerable child syndromes, and (4) parenting issues with the subsequent liveborn child. These themes will be discussed in detail as they relate to a pregnancy following a perinatal loss. Several studies have explored the concern that becoming pregnant and having another child too soon after a perinatal loss may result in unresolved grief issues. In addition, unresolved grief could potentially play a role in ineffective parenting for the subsequent child. Some women who became pregnant within 56 months after any type of loss exhibited inappropriate grief responses (Ney, Fung, Wickett, & Beaman-Dodd, 1994; Robertson & Kavanaugh, 1998).
unresolved grief could potentially play a role in ineffective parenting for the subsequent child.

Davis, Stewart, and Harmon (1989) examined the decision to postpone subsequent pregnancies as it related to the doctor's advice. The Prenatal Loss Interview was administered to 24 mothers who were raising a child following a previous prenatal loss. The results of this retrospective study showed that mothers were dissatisfied with physicians' advice regarding postponement of a subsequent pregnancy. The mothers felt that the timing of the subsequent pregnancy was a personal decision influenced by many individualized factors. Such factors included maternal age, spacing of children, fear of infertility, feelings of readiness, and stage of grieving the previous loss. Another descriptive study by de Montigny, Beaudet, and Dumas (1999) found that parents are offered a great deal of contradictory advice regarding when to become pregnant again. The researchers corroborated that parents want to be presented with the facts to permit an informed decision, ultimately leaving the decision itself up to the parents.

A classic descriptive study by Theut and associates (1989) utilized the Prenatal Bereavement Scale, a tool developed to contrast specific pregnancy-related anxiety with generalized measures of depression and anxiety. A sample of 25 pregnant couples who had experienced a previous loss (stillbirth or miscarriage) were interviewed during the eighth month of pregnancy. The research showed that any prenatal loss, whether early or late, was associated with specific rather than generalized anxiety during the next pregnancy. Parents in the late-loss group grieved more with the potential for unresolved grief issues than parents in the early-loss group; mothers grieved more than the fathers; and parents grieved less once the birth of a viable live child occurred than during the pregnancy itself (Theut et al., 1989). Other investigators also have found that grief increases in relation to the length of gestation of the perinatal loss and decreases in intensity with the subsequent pregnancy and birth (Janssen, Cuisinier, Hoogduin, & de Graauw, 1996; Robertson & Kavanaugh, 1998). A prospective, longitudinal study by Nikcevic, Tunkel, Kuczmierczyk, and Nicolaides (1999) found that the identification of the exact medical reason for the previous miscarriage or loss (usually a fetal chromosomal abnormality) reduced the intensity of grieving and feelings of self-blame and responsibility, but was not significant for decreasing the concern over future pregnancies. Coping Mechanisms of Parents during the Subsequent Pregnancy The vast majority of the research literature regarding prenatal loss and subsequent pregnancies has focused on anxiety and depression. A variety of other parental behaviors and coping mechanisms have also been documented. The anxiety experienced by mothers during a subsequent pregnancy has been noted consistently by multiple investigators in the literature. Studies by Armstrong and Hutti (1998), Cote-Arsenault and Mahlangu, (1999), Franche and Mikail (1999), and Janssen et al. (1996) found that women with a history of a previous reproductive loss demonstrated more symptoms of depression and pregnancy-related anxiety than women without a history of loss. Anxiety was measured using the Pregnancy Outcome Questionnaire in two different studies (Armstrong & Hutti, 1998; Franche & Mikail, 1999). Armstrong and Hutti (1998) utilized a descriptive, comparative design to examine 31 expectant mothers who were in their second and third trimester and had experienced either an early or late loss. A descriptive study by CoteArsenault and Mahlangu (1999) utilized a questionnaire format for 72 women in the second trimester with a history of one or more losses. This study expanded on the issue of anxiety.

Although anxiety was the major finding common to all three studies, other coping mechanisms were evident. These included guarded emotions, marking off or benchmarking the progress of the pregnancy, and individual coping mechanisms such as avoidance behaviors (avoiding foods, caffeine, exercise, alcohol, and additional information) or, on the other hand, seeking-out behaviors (identifying all resources of additional information regarding pregnancy). Franche and Mikail (1999) found that, in addition to increased pregnancy-related anxiety, significantly more depressive symptoms existed in couples (both mother and father) who had experienced a previous loss than in those couples who had never had a loss. These depressive symptoms manifested themselves in self-criticism and interpersonal dependency on others where women tended to have more depressive symptoms than their partners. Intensified anxiety surrounding routine prenatal tests and the anniversary of the previous loss are also well documented in the literature (Armstrong & Hutti, 1998; Cote-Arsenault & Mahlangu, 1999; Estok & Lehman, 1983; Robertson & Kavanaugh, 1998). Replacement Child Syndrome/VulnerableChild Syndrome Replacement child syndrome is characterized by parents using another pregnancy and subsequent child as a substitution for the child that they previously lost (Robertson & Kavanaugh, 1998). The term replacement child syndrome was coined from case reports of families who were raising children following the unexpected death of an older child. A variant of this syndrome is the vulnerable child syndrome, which is characterized by parents being overprotective of the subsequent child (Davis et al., 1989). Very little research related to prenatal loss has been completed regarding these topics, although they have been mentioned in various descriptive and qualitative prenatal-loss studies (Davis et al., 1989; Robertson & Kavanaugh, 1998). The parents of children used as a replacement have been shown to be dealing with unresolved grief issues (Davis et al., 1989) and are overprotective with unrealistic expectations of the infant due to the fear of forgetting their previous loss and/or the fear of losing this child (Ney et al., 1994). The child is often expected to be just like the deceased child and may never live up to that image or develop her/his own identity (Robertson & Kavanaugh, 1998). The vulnerable child syndrome is a concept used to describe a distortion of maternal perceptions of the child that leads to over protectiveness similar to the replacement child syndrome, but results in difficulty with separation and individualization as the child grows.

Davis et al. (1989) found that, regardless of the timing of the subsequent pregnancy following a loss, mothers in their descriptive study talked freely about feelings of replacement and over protectiveness during the interview process. It is unclear whether these feelings are normal maternal feelings or represent a maladaptive grieving process. Over 25 years ago, both of these syndromes were introduced into the literature in the context of death and dying without specifically considering prenatal loss (Robertson & Kavanaugh, 1998). Therefore, additional research regarding these syndromes must be performed to validate how applicable these concepts are to prenatal loss and subsequent pregnancies. Parenting Issues with Subsequent Pregnancies and Live-Born Children Parenting children after a previous prenatal loss and the effects of prenatal loss on parenting behaviors are not completely documented or understood. Studies of the effects of prenatal loss on parenting behaviors have only touched the surface and much more research is needed. To understand this experience, researchers speculate that unresolved grief issues, past episodes of depression and anxiety, and the replacement or vulnerable child syndrome lend themselves to ineffective parenting skills and patterns (Davis et al., 1989). Again, the concepts of replacement or vulnerable child syndromes and, in particular, the development of ineffective parenting skills are speculation and receive limited evidence in the research literature. Other studies have documented that both parents showed very little pleasure when finding out about being pregnant following a previous prenatal loss. At times, they postponed confirming the pregnancy and seeking medical prenatal care while waiting until after the date of a previous early loss both to confirm the pregnancy and to announce the event to family and friends (Ney et al., 1994). According to Ney et al. (1994) and Robertson and Cavanaugh (1998) (based on an unallocated secondary source by Phipps), it was asserted but not well substantiated that in subsequent pregnancies less emotional attachment occurred during the pregnancy, followed by overprotective behaviors after the birth (e.g., monitoring the sleeping baby's breathing and isolating the baby from family or friends in order to prevent illness). Another study by Armstrong and Hutti (1998) supported these findings by Ney et al. (1994) and examined the relationship between anxiety and prenatal attachment using the Pregnancy Outcome Questionnaire and the Prenatal Attachment Inventory. This study of 31 women who had experienced both early and late losses found that women with a previous late prenatal loss had a higher level of pregnancy-related anxiety and decreased prenatal attachment with the current

pregnancy (Armstrong & Hutti, 1998). It remains unclear whether the decrease in prenatal attachment is simply a protective tool used by some mothers as a healthy coping strategy or a maladaptive coping mechanism. Other investigators have described various other parenting attitudes and behaviors toward children born after a prenatal loss. Hunfeld, Agterberg, Wladimiroff, and Passchier (1996) performed a case-control study to examine quality of life and anxiety during pregnancies after a late perinatal loss. Fifty women with and without a previous loss due to congenital anomalies were compared for quality of life and anxiety during their pregnancy before and after the second trimester ultrasound. An increase in pregnancy-related anxiety along with a lower quality of life (focusing on feelings of social isolation, negative emotional reactions, and pain) were experienced by the women who had dealt with a late pregnancy loss. A follow-up case study by Hunfeld, Taselaar-Kloos, Agterberg, Wladimiroff, and Passchier (1997) expanded on this previous work and examined trait anxiety, negative emotions and maternal adaptation to an infant born following a late pregnancy loss. Hunfeld and associates compared psycho logic distress, depression, anxiety, and mother-infant adaptation in 27 women who had a history of a late prenatal loss due to congenital anomalies with that of 29 postpartum women without a history of loss. Data was collected at 4 and 16 weeks postpartum using several structured tools including the Spielberger State-Trait Inventory, Neonatal Perception Inventory, and the General Health Questionnaire. Results of this study demonstrated that at 4 weeks postpartum women with a history of prenatal loss were significantly more anxious and depressed and identified more problems or negative emotions with their infant in relation to sleeping, crying, eating, and settling into a regular routine. At 16 weeks postpartum, these differences were not apparent; however, mothers with a history of loss continued to view their infants as being less ideal than did the group of women without a history of loss. The potential for inadequate or ineffective mother-infant relationships, adaptation, and bonding are of major concern. These preliminary results on potential ineffective parenting techniques indicate that more rigorous research must be undertaken to examine these issues. The four recurring themes found in the literature lend credibility and support to the necessity for the health care system to address these issues with women dealing with an immediate pregnancy loss and especially as they become pregnant again. Assistance may be needed to deal with the subsequent unresolved feelings and turmoil associated with a previous loss. To further advance

the knowledge regarding the impact of a prenatal loss on a subsequent pregnancy, health care professionals must recommendations. Much of the prenatal loss literature focuses on various aspects of the grieving process, while very little has been published related to pregnancy following a prenatal loss. Within the prenatal loss literature, the vast majority of the research focuses primarily on psychological traits such as depression and anxiety, which is consistently documented. Larger longitudinal and prospective studies regarding pregnancy issues subsequent to a prenatal loss could further support the previous literature (Robertson & Kavanaugh, 1998). The concepts of the replacement and vulnerable child syndromes were developed from case reports with a population of parents mourning the loss of an older child. These concepts must be further researched as they apply to perinatal loss to determine whether they accurately portray parenting behaviors following the death of an unborn child or a child shortly after birth. Additional research needs to be conducted to identify potential parents who are at risk for developing these syndromes (Armstrong & Hutti, 1998; Davis et al., 1989; Robertson & Kavanaugh, 1998). Future research studies should also focus on parenting styles and behaviors for children born subsequent to a prenatal loss. The majority of the research thus far focuses on the newborn and infant period. Additional information is needed regarding long-term effects of alternative parenting styles, which may be harmful not only to the mother-infant relationship but also to the father, future siblings, and the child as an adult (Conway, 1995; Robertson & Kavanaugh, 1998). Further research must also look at attachment theories and what effects a prenatal loss and potential unresolved grief may have on subsequent pregnancies. Another issue would be the time period that these negative emotions; depression, anxiety, and fear of losing another child persist following the birth of a healthy child (Theut et al., 1989). Additional research is necessary to determine how a pregnancy following a prenatal loss is affected by lower socioeconomic status, alternative family lifestyles, and the birth of a child needing long-term hospitalization in the neonatal intensive care unit for a serious medical condition (Robertson & Kavanaugh, 1998; Theut et al., 1989). Who is coping well? Are there factors such as religion, marital relationship, cultural background, etc. that mitigate the impact of prenatal loss? conduct research and make appropriate evidence-based practice

Many studies advocate increased awareness of the issues with which pregnant mothers may be dealing after a previous prenatal loss. These studies also address the provision of additional support by health care providers. Hunfeld et al. (1997) discussed the importance of recommending more frequent prenatal visits for women with high anxiety levels following a previous late-pregnancy loss due to the potential for ineffective mother-infant adaptation and attachment. If health care providers proactively address the effect of the previous loss and explore the mothers' thoughts and feelings, they can facilitate a positive adaptation to the subsequent pregnancy and to parenthood (Robertson & Kavanaugh, 1998). Once the pregnancy is diagnosed, prenatal care should include not only a thorough obstetrical history to determine the occurrence of previous prenatal loss or other problems, but also an indepth exploration of what the loss meant to the parents and how it may affect their current pregnancy. This offers reassurance that the prenatal loss was real and assists in building a supportive, trusting relationship that will become crucial if and when pregnancy-related anxiety develops (Armstrong & Hutti, 1998; Robertson & Kavanaugh, 1998). Many of the studies document the importance of recognizing milestones or critical points in the pregnancy and the necessity of longer scheduled appointments at these times to allow for open discussion of emotions and concerns (Cote-Arsenault & Mahlangu, 1999; Robertson & Kavanaugh, 1998). Charts could be flagged by the health care providers to remind them of the need for a prenatal visit or phone call during these crucial periods. For others, more frequent scheduled, routine prenatal visits and additional testing (e.g., ultrasounds, no stress tests, or fetal monitoring) within the constraints of health insurance mandates may be necessary to alleviate anxiety (Armstrong & Hutti, 1998). Robertson and Kavanaugh (1998) further recommend that the staff responsible for performing these routine prenatal tests be made aware of the parents' previous history and heightened anxiety levels. Cote-Arsenault and Mahlangu (1999) discussed the importance of understanding some of the protective mechanisms that women have utilized when pregnant following a loss, such as avoiding attachment or seeking out all resources and literature regarding pregnancy in an effort to compensate for the loss. Communication of physical findings and the stage of pregnancy in a positive manner may be key factors upon which to focus at each prenatal visit, thus providing reassurance that the pregnancy is progressing in a normal fashion (Cote-Arsenault & Mahlangu, 1999; Robertson & Kavanaugh, 1998).

Several sources have identified the necessity for special considerations to be provided for parents experiencing a pregnancy following a prenatal loss. These include special childbirth preparation classes and the potential benefits of attending a support group comprised of parents dealing with a pregnancy subsequent to a prenatal loss (Armstrong & Hutti, 1998; Robertson & Kavanaugh, 1998). Most women are urged, especially with the first child, to attend childbirth preparation classes, which generally spend a total of 5 minutes or less on possible tragic outcomes with delivery. Estok and Lehman (1983) found that childbirth educators do not routinely question the class about past obstetric complications and, therefore, are unaware of parents who are dealing with loss issues. Childbirth educators are in a unique position to provide the anticipatory guidance needed to assist a couple experiencing a pregnancy following a previous prenatal loss. This guidance could be particularly useful in reassuring the couple about the impact of milestones and recurring thoughts and fears surrounding the previous lossfeelings that are normal and expected at this time (Armstrong & Hutti, 1998; Estok & Lehman, 1983). Only recently have support groups been formed for parents who are pregnant following a previous perinatal loss. No one would understand better what these couples are living through other than couples who have had a successful pregnancy and who are raising a child following a perinatal loss. These support groups could be expanded to include not only parents, but also health care providers who could assist with reassurance and could deal professionally with the anxiety and hope that any new pregnancy evokes (Armstrong & Hutti, 1998; Robertson & Kavanaugh, 1998). PRESENT STUDY The researcher dealt with psychological implications of pregnancy among women. The study gave special attention towards the causes and measures of psychological implications Of pregnancy among women in this research the researcher would like to collect information from maternity hospital. RESEARCH QUESTION 1. What is the psychological effect (stress, anxiety) of pregnancy among women? 2. What are the causes of psychological implications among women? 3. What are the measures to reduce the psychological implications among women? OBJECTIVES 1. To understand the psychological effect of pregnancy among women.

2. To find out the causes of psychological implications among women. 3. To examine the well being of pregnant women.

HYOTHESIS y y Pregnancy will have psychological implications among women. Greater the family support lesser the stress level.


According to P.V. Yong It is defined that social research as the systematic method of discovering new facts on verifying old facts, their sequences, inter relationship, causal explanations and the natural laws which govern them. The researcher is an attempt to know new things, facts and information about any particular place. For this researcher used the following methods:

SAMPLIE The method used for the data collection is the purposive sampling method & the researcher has completed her study with the help of the 40 womens of different hospital in Jabalpur

TECHNIQUES USED FOR DATA ANALYSISThe researcher used the interview technique for eliciting information from the researches the tool administer used the interview schedule which compromises of standardized as well as self develop measure the proposed section were measure to assist the stress and anxiety . Examine the well being of pregnant women .The study will tried to a look into the causes of psychological implication among women and items pertaining to all the above section would be included in the interview schedule


Below table represent the age wise distribution of the respondents 5 respondents (M=35.40000) belong to (18-25)age groups. Whereas 26 respondents (M= 34.9015)belong to (26-35 )age groups and 8 respondents (M = 33.2500)belong to age group 36& above. The total no. of respondent are39. it was found that the level of anxiety is less in 36& above age group (M=33.2500)compare to (18-25)age group(35.40000)

Table No 1 Level of Anxiety Age wise distribution of the respondents 18-25 26-35 36& above Total Mean 35.4000 34.9615 33.2500 34.6667 N 5 26 8 39 Std. Deviation 2.88097 5.91595 7.97765 6.01460

Below the table throws the light on the measures of stress level . the table shows that stress level was high in the age Group of (26-35)(M-17.3462)and (36&above)(M-17-7500). Whereas stress level found low under the age group of ()

18-25 (M- 14.4000) Table 2. Measures of stress Age wise distribution of the respondents 18-25 26-35 36& above Total Mean
14.4000 17.3462 17.7500 17.0513

5 26 8 39

Std. Deviation
2.50998 2.56035 2.37547 2.66506

Below table and graph highlight the well being of pregnant women . from the study it was found that participant belong to the age group() To the age group (18-25)highest well being value than other age group(M-16.8000)and the participant belong to the Age group 36&above have lowest well being value than other age group (M=11.7500)

Table 3. Measures of well being Age wise distribution of the respondents 18-25 26-35 36& above Total Mean
14.4000 17.3462 17.7500 17.0513

5 26 8 39

Std. Deviation
2.50998 2.56035 2.37547 2.66506

Below the table represent the measures of anger. The study was found that the participant belong to the age (26-35)have highest level Anger (24.4615) whereas the participant who belong to the age (18-25 )and (36&above) have lowest level of anger (M-15.0000) and () (M- 15.5000).

Table No. 4 Measures of anger Age wise distribution of the respondents 18-25 26-35 36& above Total Mean
15.0000 24.4615 15.5000 21.4103

5 26 8 39

Std. Deviation
3.67423 11.24004 13.61722 11.73999

Table 5 represent the education wise distribution of the respondent . the tabvle reveals that . participant who are Educated up to 5th standered have highest level of anxiety other than illlitrate (M 34.6667) or aboe 10th (M -34.1724

Table No 5 Shows Level of anxiety

Education wise distribution of the respondents Illiterate Up to 5th 6th to 10th 10th to above Total Mean

Std. Deviation

34.6667 46.0000 35.6667 34.1724 34.6667

6 1 3 29 39

Below the table represent the stress level . table and graph shows that participant who are educated up to 5th Have highest stress level (M- 20.0000)compere toparticipant who are educted up to 6th to 10th (M- 15.6667

Table No 6 Measures of stress level

Education wise distribution of the respondents Illletrate Up to 5th 6th to 10th Above 10th Total Mean N Std. Deviation

17.3333 20.0000 15.6667 17.0345 17.0513

6 1 3 29 39


3.05505 2.67906 2.66506

Table NO. 7 Shows that . the educational qualification of the respondent in the measures of anger is above 10th (M-22 .334) other than less in the 6th to 10th group (M- 15.6667)

Table No . 7 Measures of anger

Education wise distribution of the respondents Illiterate Up to 5th 6 to 10 th 10th to above Total Mean N Std. Deviation

20.0000 20.0000 15.6667 22.3448 21.4103

6 1 3 29 39

15.41428 4.04145 11.76944 11.73999


Age wise Pearson distribution Correlation of the respondents Sig. (2tailed) N Level of Pearson Anxiety Correlation Sig. (2tailed) N Measure of Pearson Stress Correlation Sig. (2tailed) N Measure of Pearson Well being Correlation Sig. (2tailed) N Measure of Pearson Anger Correlation Sig. (2tailed) N

Age wise Level of distribution Anxiety of the respondents 1 -.113

Measure of Stress

Measure of Well being -.346(*)

Measure of Anger



. 39 -.113 .493 39 .321(*) .046 39 -.346(*) .031 39 -.059 .722 39

.493 39 1 . 39 -.202 .216 39 -.101 .539 39 .231 .157 39

.046 39 -.202 .216 39 1 . 39 -.033 .842 39 .046 .779 39

.031 39 -.101 .539 39 -.033 .842 39 1 . 39 .097 .556 39

.722 39 .231 .157 39 .046 .779 39 .097 .556 39 1 . 39

* Correlation is significant at the 0.05 level (2-tailed).

Correlation This study shows correlation. The study was found that as age is increasing the level of anxiety is also increasing in the pregnant women.

Measures of stress level. Correlation is shoeing that as age is increasing in pregnant women the stress level is also increasing.

Measures of well being correlation showing that as age increased the level of well being decrease with the age wise.

Measures of anger also show that negative correlation between age and anger. as age increased in the pregnant women . Anger also increased.



The present study focused on the 3 objectives that is to understand the psychological effect of pregnancy among women. The researcher found that pregnant women are facing many psychological problems during pregnancy the problem is related to anxiety, stress, and anger. In study it was found that anxiety, stress, and anger higher among the age group of (26-35) (M34.9615) stress (M- 17.3462) anger (M-36.9615). Study also found that participant who are educated up to 5th having high level of anxiety , stress , anger up to 5th (M-46.0000)stress (M-20.0000) anger (20.0000) Study also found the well being level of pregnant women .it was found that well being level was found high under the age group of (18-25) (M-16.8000) other than (36&above)(11.7500).

Study also tried to look on the measures to reduce the psychological problem during pregnancy In which 77.5% pregnant women suggested good environment to reduce the psychological problem during pregnancy and 57.5% women suggested using leisure s time.


During study researcher observed that. Participant who got the pregnancy before 20th they are not able to give proper answer what problem are they facing during pregnancy due to immaturity. and participant who are doing job during pregnancy they are felling stress during pregnancy due to mental pressure and bad environment in their job field. Researcher was also found that many pregnant women whether they are littermate or illiterate. They are not aware about the counseling and medical care which is being provided by the government. In this regard NGOS and Government will make help such psychological support f


There is mounting evidence that exercise participation is likely to benefit persons with general depressive symptomatology and two small randomized trials have suggested that exercise may provide benefits for women with postpartum depression. Observational evidence has suggested that community-based exercise programmes are acceptable to postpartum women and they consistently report benefits from participation. Given the high prevalence and considerable consequences of postpartum depression to the mother, the baby, and the family, exercise may have a treatment role to play as a therapeutic option, particularly given the reported reluctance of some postpartum women to take drug interventions and the limited availability of psychological therapies. While initial trial evidence is encouraging, these were small, and larger, high-quality RCrequired to further assess the feasibility and effectiveness of exercise as an adjunctive treatment in women with postpartum depression

Many participants revealed that Good environment and sharing with husband and family support can help to overcome the psychological problem during pregnancy. Participant shared that through good support of husband they can face any problem in any situation.



Education Anxiety


Well being Anger


Laxmi Baghel Soniya sherly tomi Sangeeta silina Reetu sharma Chandrika tirkey Runeet bhatiya vaishali Asha Ceji reji Zinewa thomas Poonam ambrose Meenakhi tiwri kiran pashi Shahida sekh Bharti Sandhya





2 3 2 2 3

4 4 3 3 4

37 25 36 29 39

16 19 13 15 17

10 12 13 16 8

45 1 20 15 5

11 11 10 11 7







2 2 2 3

4 1 4 4

37 29 32 27

18 18 16 20

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agrwal Caroline Ambrose Pooja Yadev Elezabeth joseph Seema Maity Reena kashvani Mabel gregory Reena maity Neha aswani Antu Mary Preeti M arkhand Sarita Sahu Amdia Joshi Rani Sarthe 2 Archana 2 4 4 4 4 4 34 27 22 29 33 19 19 19 21 16 18 20 20 20 16 15 26 27 24 16 6 8 8 7 9 3 2 4 4 45 35 16 17 12 6 23 27 6 6 2 1 4 1 32 39 14 15 19 18 25 15 6 6 1 4 38 10 14 19 6 2 4 43 14 14 30 1 3 4 29 19 14 22 6 2 4 40 14 19 20 9 2 4 37 13 17 12 9 2 4 33 18 16 43 20 2 4 46 19 14 43 9 3 4 43 20 10 31 10

Basundhara 2 Anjira Ramvati Bai Savita Bai 1 2 1




0mvati Bai Laxmi Bai Muskan Koriya

1 2 2

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34 37 36

15 22 18

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Age wise distribution of the respondents

Frequenc y Valid 18-25 26-35 36 & above Total 5 26 8 39 Percent 12.8 66.7 20.5 100.0

Valid Percent 12.8 66.7 20.5 100.0

Cumulative Percent 12.8 79.5 100.0

Educational Qualification of the Respondents

Frequenc y Valid Illiterate up to 5th 6th to 10th above 10th Total 6 1 3 29 39 Percent 15.4 2.6 7.7 74.4 100.0

Valid Percent 15.4 2.6 7.7 74.4 100.0

Cumulative Percent 15.4 17.9 25.6 100.0


Age wise distribution of the respondents Age wise distribution of the respondents Pearson Correlation Sig. (2-tailed) N Level of Anxiety Pearson Correlation Sig. (2-tailed) N Measure of Stress Pearson Correlation Sig. (2-tailed) N Measure of Well being Pearson Correlation Sig. (2-tailed) N Measure of Anger Pearson Correlation Sig. (2-tailed) N 1 . 39 -.113 .493 39 .321(*) .046 39 -.346(*) .031 39 -.059 .722 39 Level of Anxiety -.113 .493 39 1 . 39 -.202 .216 39 -.101 .539 39 .231 .157 39 Measure of Stress .321(*) .046 39 -.202 .216 39 1 . 39 -.033 .842 39 .046 .779 39 Measure of Well being -.346(*) .031 39 -.101 .539 39 -.033 .842 39 1 . 39 .097 .556 39 Measure of Anger -.059 .722 39 .231 .157 39 .046 .779 39 .097 .556 39 1 . 39

* Correlation is significant at the 0.05 level (2-tailed).


Level of Anxiety Age wise distribution of the respondents 18-25 26-35 36 & above Total 35.4000 34.9615 33.2500 34.6667 5 26 8 39 2.88097 5.91595 7.97765 6.01460 Mean N Std. Deviation


Measure of Stress Age wise distribution of the respondents 18-25 26-35 36 & above Total 14.4000 17.3462 17.7500 17.0513 5 26 8 39 2.50998 2.56035 2.37547 2.66506 Mean N Std. Deviation


Measure of Well being Age wise distribution of the respondents 18-25 26-35 36 & above Total 16.8000 14.2692 11.7500 14.0769 5 26 8 39 2.28035 4.25730 4.23421 4.23261 Mean N Std. Deviation


Measure of Anger Age wise distribution of the respondents 18-25 26-35 36 & above Total 15.0000 24.4615 15.5000 21.4103 5 26 8 39 3.67423 11.24004 13.61722 11.73999 Mean N Std. Deviation


Level of Anxiety Educational Qualification of the Respondents

Illiterate up to 5th 6th to 10th above 10th Total 34.6667 46.0000 35.6667 34.1724 34.6667 6 1 3 29 39 6.50641 6.23967 6.01460


Std. Deviation


Measure of Stress Educational Qualification of the Respondents Illiterate up to 5th 6th to 10th 17.3333 20.0000 15.6667 6 1 3 2.65832 . 3.05505 Mean N Std. Deviation

above 10th Total

17.0345 17.0513

29 39

2.67906 2.66506


Measure of Anger Educational Qualification of the Respondents Illiterate up to 5th 6th to 10th above 10th Total 20.0000 20.0000 15.6667 22.3448 21.4103 6 1 3 29 39 15.41428 . 4.04145 11.76944 11.73999 Mean N Std. Deviation