THE UNIVERSITY WEST INDIES

FACULTY OF MEDICAL SCIENCES

THE UWI SCHOOL OF NURSING, MONA

Psychological and Physiologic Changes of Pregnancy

Presented by: M. Emanuel-Frith and Hilton James

Date: January 19, 2023
Venue: Classroom 3
OBJECTIVES
At the end of the session students will be able to:
 Discuss some of the psychological changes that

may occur in pregnancy.

 Discuss maternal physiologic changes that occur

during pregnancy.
Terms Used in pregnancy
 Primigravida :
A woman who is pregnant for the first time.
 Gravida :

A woman who is/ has been pregnant, regardless

pregnancy outcome.

Parity:
Refers to past pregnancies that have reached
viability.
 Nullipara :

A woman who has never completed a pregnancy to

the period of viability(the woman may or may not
have experience an abortion.)
 Primipara:

A woman who has completed one pregnancy to the

period of viability regardless of the number of
infants delivered and regardless of the infant being
live or stillborn.
 Viability :
Capability of living , usually accepted as 24
weeks ,although survival is rare.
 Gestation :

The period of intra-uterine fetal development.

 Presentation :

The part of the fetus that lies in the lower part of the
uterus.
 Presenting part :

The lowest point on the presentation.

 Cephalic :
Cranial ; pertaining to the head.
 Breech :

The buttocks(i.e presentation of the buttocks

instead of the head in childbirth)
NB :It occurs in over 3% of all labors.
 Term :

The normal period of pregnancy.(forty(40) weeks)

 Brim :

An edge of margin, the beginning of the true

pelvis.
 Cephalic :
Cranial ; pertaining to the head.
 Breech :

The buttocks(i.e presentation of the buttocks instead

of the head in childbirth)
NB :It occurs in over 3% of all labors.
 Term :

The normal period of pregnancy.(forty(40) weeks)

 Brim :

An edge of margin, the beginning of the true pelvis.

Scenario
 Miss Rivers, 30 years old. LMP 19.11.2014. G2
P0+1. GA 9+4/40. EDD 26.08.2015. Visited the
clinic for her first antenatal care. In a visiting
relationship but at this moment feels like staying by
herself. The father of her child is OK with the
pregnancy. She complains of nausea and vomiting
and frequency. Exited that she is pregnant but does
not know what to expect. She has cravings for ice.
Question???

You are the student nurse assigned to the clinic,

plan a teaching plan informing her of some of the
changes she may expect and why they might occur.
Introduction
 Pregnancy is a unique time in a woman’s life.
 Dramatic alterations in her body and her appearance
and social status.
 Occurs simultaneously
 Physiologic and psychological changes occur
concurrently.
Introduction
All changes are due to the effects of specific
hormones.
These enable the mother to nurture the fetus, prepare
the body for labour, develop her breasts, and lay
down fat stores to provide calories for production
of milk during the puerperium.
INTRODUCTION

The woman will experience changes to her body

that are beyond her control. This may be the first
time since childhood that she will be both
physically and emotionally vulnerable.
Introduction

BY UNDERSTANDING THE NORMAL

CHANGES THE NURSE CAN DETECT
ABNORMALITY.
PSYCHOLOGICAL
CHANGES
Factors that influence
1. Social  History
 Confinment
 Views of relatives and
friends
 Church
 Media
 Policies
Factors that influence
2. Culture  Myths
 How does she view
herself
 Restrictions
 Nurse shows respect
Factors that influence
3. Family  Environment
 Was her home a happy
one
 Was she loved as a
child?
 Is pregnancy a
positive thing for her?
Factors that influence
4. Individual  How does she cope
and manage stress will
influence how well she
copes with pregnancy.
 Security in the home
and family
 Her views about being
a mother and rearing
children.
Ambivalence

 Her responses can be at the extreme ends

 Proud & excited and fearful & anxious

 Conflict and confusion

 Universal feeling and is normal
 Due to the expected life change and new role

 Usually in the 1st trimester

 Ambivalence evolves when FMF

Her personality, her ability to adapt and her partner’s reaction

can influence her acceptance.
Introversion
 Focuses on self, especially during the early
pregnancy.
 May withdrawn and become pre occupied with self
and fetus
 This is normal
 Will heightens later when focus shift to her
behaviours that will ensure healthy and safe
delivery.
Acceptance
 During 2nd trimester with the obvious changes
 Verbal positive feelings towards the pregnancy and
conceptualize the fetus
 May accept body image and talk about new life
within
 Nurse can generate discussion about her feelings
and offer support.
Mood Swings
 Emotional roller coaster
Change in Body Image
 Some women feel more beautiful
 Some cannot deal with the overweight
PHYSIOLOGICAL
CHANGES
Physiologic adaptations to pregnancy result in
anatomic and physiologic changes that can be
categorized as subjective or objective signs of
pregnancy.
https://www.youtube.com/watch?v=xOX3MeVl-co
 SIGNS AND
SYMPTOMS OF
PREGNANCY
Subjective (Presumptive) signs

physical signs and symptoms that suggest, but

DO NOT prove , pregnancy.

 Amenorrhea (4wk)
 Fatigue (12 wk)
 Breast tenderness (3-4 wk)
 Breast enlargement (6 wk)
 Nausea and vomiting (4-14 wk)
Presumptive signs contd.

 Urinary frequency (6-12wk)

 Uterine enlargement (7-12wk)
 Fetal movements (quickening; 16-20 wk)
 Hyperpigmentation of the skin (16 wk)
Objective (probable) signs
More indicative of pregnancy
 apparent on physical examination by health care

professionals
 They still do not confirm pregnancy because they

can be caused by other conditions.

 Probable signs .
These signs include:
 Hegar’s sign: softening of the lower uterine segment

or isthmus (6-12 wk)

 Abdominal enlargement (14 wk)

 Goodell’s sign : softening of the cervix (5 wk)

 Braxton Hicks contractions (16-28 wk)

 Chadwick’s sign bluish-purple colouration of vaginal

mucosa and cervix(6-8 wk)

 Pregnancy test
Positive signs of pregnancy

 Ultrasound (4 wk)
 Palpating foetal movements (20 wk)
 Auscultation of foetal heartbeat 10-12 weeks.
 Fetal parts palpated 24 wk
Reproductive System Adaptations
Uterus
 During the first few months of pregnancy estrogen

stimulate uterine growth,

 The uterus undergoing increase in size throughout

the pregnancy.
 Size has increased 20 times that of nonpregnant size
Cervix
 In 6-8 weeks of pregnancy the cervix begins to
soften (goodell’s sign)
 Endocervical glands increase in size and number.
 More cervical mucus is produced
 Mucous plug is formed that blocks the cervical os
and protects the opening from bacterial invasion
Vagina
 Increased vascularity
 Vaginal mucosa thickens
 The connective tissue begins to loosen
 Vaginal vault begins to lengthen
 Vaginal secretions become more acidic white and
thick( due to glycogen/sugar)
Ovaries

 Ovaries are not palpable after the 12th-14 th week

of gestation because the uterus fills the pelvis
cavity.
 Ovulation ceases during pregnancy
Breasts
 increase in fullness, become tender and grow
larger

 become highly vascular, veins become visible

under the skin

 Nipples become larger and more erect

Breast contd.
 Nipples and areola become deeply pigmented
(Secondary areola)
 Montgomery tubules-Sebaceous glands become

prominent.
 Colostrium (16 wk)

Leak in late pregnancy.

Nipples more prominent and mobile.
Breasts contd.

 Creamy, yellowish breast fluid called colostrum

can be expressed by 3rd trimester.
General body system adaptations
Gastrointestinal system
 The gums become hyperemic, swollen, and friable

with a tendency to bleed easily.

 Saliva becomes more acidic

 Delayed gastric emptying

 Bloating and constipation

 Acid indigestion or heartburn

 Nausea and vomiting

 Cardiovascular system

 Blood volume increases 40-50% above

nonpregnant levels
Heart rate
 Increases by 10-15 bpm between 14 and 20

weeks of gestation and persists to term.

Respiratory system
 Length of space available to house the lungs
decreases as the uterus puts pressure on the
diaphragm.

 Pregnant woman breathes faster and more deeply

 Need for more oxygen
Renal/urinary system

 Anatomically, the kidneys enlarge during

pregnancy
 Blood flow to kidneys increases by 35-60%
 Kidneys work harder throughout the pregnancy
 Increase in GFR by 50% starting in the 2nd
trimester.
Musculoskeletal system
 By 10th-12th week of pregnancy ligaments that hold
sacroiliac joints and the pubis symphysis begin to
soften and stretch
 The joints widen and become more movable
 The relaxation of the joints maximizes by 3rd
trimester
M/S contd.

 Postural changes of pregnancy

 Increase weight gain add to discomfort
 Endocrine system
 Hormonal changes meets needs of the growing fetus
 Controls the supply of maternal glucose, amino acids
and lipids to the fetus.
 Progesterone and estrogen (-estrogen Responsible for
growth , elasticity and contractility of the uterus,
breast and external genitalia.)
 responsible for maintenance of pregnancy by

inhibiting uterine contractility and maintaining

endometrium.(progesterone)
 FSH & LH inhibited
Immune system
 Enhances innate immunity (inflammatory
response and phagocytosis).Decreased resistance to
infection
 Suppression of adaptive immunity (protective

response to a specific foreign antigen).

 Improvement in certain autoimmune conditions

resulting from the depressed leukocyte function.

 These immunologic alterations help prevent the

mother’s immune system from rejecting the fetus.

Pancreas

 INSULIN –increased production

 GLUCOSE NEED the fetus is dependent on
glucose for body and brain growth. The human
placental lactogen alters maternal metabolism.
 NB: HPL decreases the effectiveness of insulin
Pregnancy and sexuality
 Changing shape
 Emotional status

 Pressure on the bladder

 Breast size

 Confusion

 Anxiety
Sexuality contd.
The way the woman feels and experiences her body
during pregnancy can affect her sexuality.
Physiological changes can produce stress
Sexual desire of pregnant woman
 First trimester -less interested

 Second trimester-interest may increase

 Third trimester –discomfort during sexual activity.

Pregnancy and Partner
• Maternity nursing emphasis move from mother to
family-related, social and emotional needs.
• Gain weight around the middle
• Experience nausea and GI disturbances-
COUVADE SYNDROME (sympathetic response to
their partner.
• Ambivalence
• Extreme emotion bride and joy
• Overwhelming sense of responsibility
Pregnancy and Partners
• Second semester accept role as breadwinner, care
taker and support person.
• Reality of the fetus (fetal movement)
• Confusion (mothers mood swing)
• Third trimester prepares for the reality
• Negotiates what the role will be during labour and
delivery
• Find concrete task eg painting the baby’s room,
getting care seat, attending Lamaze classes
Partner psychological adaptation
 Stage 1 Expectations
1. Preconceptions about what home life be like with a
newborn.
2. Eye-opening experience
 Stage 2 Reality

1. Realized that their expectations in stage 1 are not

realistic.
2. Feelings change from elation to sadness, ambivalence,
jealousy and frustration. (Maybe fun but not prepared
to take it on)
Partner psychological adaptation
 Stage 3 Transition to mastery
1. Both parents make conscious decision to take
control and be at the centre of the newborn life
regardless of his preparedness
2. Incorporate the newest member to the family.

NB During the first three weeks.

Influencing factors: participation in child birth,
relationship with partner, method of infant feeding,
cultural factors, family role organization,
competence in child care, etc.
Pregnancy and siblings
• Sibling reaction is age dependent
• Excitement and anticipation

• Negative reaction

• Engages in outside activities

• Sibling rivalry

Prevention
• Preparation

• Constant reinforcement of love

• Involvement
Nursing Process

Assessment Nursing Diagnoses

 Begins before pregnancy  Anxiety

 Her expectations
 Health
 Disturbed body image
 Previous surgery  Knowledge deficit
 During pregnancy  Imbalance nutrition
 Nurse/client relationship
 Health – health history
 Fetus health
 investigations
Nursing Process

Interventions Evaluation

 Physical examinations  The family is

 Advice adjusting well
 Nutrition
 Rest
 Supplements
Conclusion
• Despite the magnitude of changes, they are all
considered normal. This makes pregnancy
represent a time of wellness, not illness.
• The nurse is to help the family maintain a state of
wellness throughout the pregnancy.
• Early diagnosis is important so that a woman can
begin to change unhealthy habits or, if she desires,
have adequate time to carry out a therapeutic
termination of pregnancy.
Thank you
References
 Kozier B.et al (2004). Fundamentals of nursing,7th
ed. New Jersey: Prentice Hall
 Ricci S. C., (2007). Essentials of Maternity,
newborn and women’s health nursing. New York:
Lippincott Williams & Wilkins.
 Ricci S., & Kyle, T. (2009). Maternal and
pediatric nursing. Philadelphia: Lippincott
Williams & Wilkins
Pre read
 Antenatal care
 Minor disorder