Chapter 5 Physical and Psychological Changes of Pregnancy

Safe Maternity and Pediatric Nursing Care Chapter 5 Physical and Psychological Changes of Pregnancy Introduction  Pregnancy causes physical and psychological changes - virtually every body system is affected  Even before a woman suspects she is pregnant, changes are occurring  Women obtain pregnancy info from many sources • Books, internet, classes • Other pregnant women, family, friends Introduction (continued)  Patient centered teaching • Assess educational needs • Plan personalized approach to teaching Diagnosis of Pregnancy  Presumptive signs of pregnancy • Subjective signs • Least reliable • Due to rapid rise of hormone levels at implantation of trophoblast • Include: ‒ Amenorrhea – absence of menstrual period - typically first sign ‒ Nausea and vomiting ‒ Fatigue Diagnosis of Pregnancy (continued_1)  Presumptive signs of pregnancy (continued) • Include (continued): ‒ Urinary frequency ‒ Breast enlargement and tenderness ‒ Quickening – fetal movement - typically felt by the mother by 20 weeks Diagnosis of Pregnancy (continued_2)  Probable signs of pregnancy • Objective signs • Include: ‒ Goodell’s sign – softening of the cervix ‒ Chadwick’s sign – a bluish-purple coloration of the vaginal mucosa and cervix ‒ Hegar’s sign – softening of the lower uterine segment ‒ Ballottement – fetus floats away from the cervix when the cervix is pushed ‒ Positive pregnancy test – human chorionic gonadotropin (hCG) is typically detectable by day 11 of gestation Diagnosis of Pregnancy (continued_3)  Positive signs of pregnancy • Attributed to the presence of a fetus • Experienced health-care provider confirms the presence of a fetus • Signs: ‒ Fetal heart auscultation by Doppler ‒ Fetal movement felt by an experienced practitioner ‒ Ultrasound – used to verify an embryo or fetus • After pregnancy is confirmed, the healthcare provider arranges visits for prenatal Normal Physiological Changes in Pregnancy  Changes occur because of effects of progesterone, estrogen, and the growing fetus  Every body system changes  Reproductive system changes: • Table 5.1 • Figure 5.1 • Patient teaching: ‒ Kegel exercises: help strengthen perineal muscles ‒ Preventing Vena Cava Syndrome - aka: supine Normal Physiological Changes in Pregnancy (continued_1)  Respiratory system changes: • Table 5.2  Cardiovascular system changes: • Table 5.3 • Figure 5.2 • Hemodilution occurs causing anemia reduction in red blood cells • Varicose veins - swollen veins raised above surface of skin Normal Physiological Changes in Pregnancy (continued_2)  Gastrointestinal system changes: • Table 5.4 • Common laboratory blood values • Patient teaching: ‒ High fiber foods to reduce/avoid constipation and hemorrhoids ‒ Method to take iron supplements • Hemorrhoids are common - swollen, bulging veins in the rectum  Urinary system: • Table 5.5 • Figure 5.3 Normal Physiological Changes in Pregnancy (continued_3)  Integumentary system: • Table 5.6 • Figure 5.4 • Hyperpigmentation occurs ‒ Melasma - mask of pregnancy - brownish patches on forehead, cheeks, and nose ‒ Linea nigra - hyperpigmented line extending from symphysis pubis to fundus • Health promotion: ‒ Skin care during pregnancy Normal Physiological Changes in Pregnancy (continued_4)  Integumentary system (continued): • Striae gravidarum - aka stretch marks • Pruritic urticarial papules and plaques of pregnancy (PUPPP) ‒ Pregnancy specific dermatosis ‒ Itchy plaques and papules with erythematous patches of papules and vesicles ‒ Appears on abdomen and occasionally involves extremities  Musculoskeletal system: • Table 5.7 Clicker Check A pregnant patient is experiencing dysuria. How should the nurse interpret this finding? A. Dysuria is linked to heartburn B. Dysuria may indicate a urinary tract infection C. Dysuria can be resolved with iron supplements D. Dysuria may lead to the development of hemorrhoids Clicker Check (continued_1) Correct answer: B Manifestations of a urinary tract infection include dysuria or painful urination. Dysuria will not cause heartburn. Iron supplements help treat anemia associated with pregnancy. Dysuria has no effect on the development of hemorrhoids. Psychological Adaptation to Pregnancy  Pregnancy and childbirth: considered a life transition or a maturational crisis  Factors that influence how pregnancy is received: • • • • • • Access to health care Financial issues Family support Availability of day care Transportation Previous experiences with childbirth and childrearing Psychological Adaptation to Pregnancy (continued_1)  The maternal role: • Per Reva Rubin, four maternal tasks to be accomplished during pregnancy lead to maternal identity: ‒ Seeking safe passage for herself and her fetus ‒ Securing acceptance of herself as a mother and for her fetus ‒ Learning to give of self and to accept herself as mother to the infant ‒ Committing herself to the child as she progresses through pregnancy Psychological Adaptation to Pregnancy (continued_2)  Seeking safe passage for herself and the fetus: • Concern for own health and pregnancy symptoms • Rapidly changing emotions • Observes mothers and other pregnant women for info • Obtains information on the Internet or by reading books • May be ambivalent about the pregnancy • Seeks competent prenatal care • Engages in healthy self-care Psychological Adaptation to Pregnancy (continued_3)  Seeking acceptance of the child by others: • Support and acceptance of the pregnancy by partner and family are important • Adjustments of psychological, social, and physical space within the family to make a place for the coming child • Pregnant woman’s relationship with her own mother is significant Psychological Adaptation to Pregnancy (continued_4)  Seeking acceptance of the child by others (continued): • Mother’s reaction indicates acceptance of the grandchild • Pregnant woman’s mother reminiscing helps the patient anticipate and prepare for pregnancy, labor, and motherhood Psychological Adaptation to Pregnancy (continued_5)  Bonding with the infant: • Develop bonds of attachment and feelings of love for the infant • Feels fetal movement • Feels an intimate connection with the unborn fetus • Emotional “binding-in” motivates the patient to be a good mother • Patient’s own mother is the strongest model • Mothering style either patterned after own mother or adjusted Psychological Adaptation to Pregnancy (continued_6)  Committing to the child through pregnancy: • Develop the ability for self-denial • Learn to meet the needs of another being before self • Prepare for the baby: ‒ ‒ ‒ ‒ Prepare a nursery Accumulate clothing and baby care items Read books on newborn care, parenting Attend childbirth classes Psychological Adaptation to Pregnancy (continued_7)  Unsuccessful resolution of psychological changes are associated with difficulties in pregnancy, delivery, child abuse, and neglect Pregnant Adolescent  Many psychosocial issues to manage  Completing developmental tasks of adolescence and those of becoming a mother  Priorities typical for this age: • Appearance • Peer group • Focus on own needs  May keep the pregnancy a secret  Denial until late in gestation is Pregnant Adolescent (continued)  Experience anxiety informing: • Her parents • Baby’s father • Friends  Behaviors: • Ambivalence • Resistance • Inconsistency The Father  Most important person to the pregnant patient is usually spouse or partner  The mother needs partner to accept the child  Some spouses or partners experience physical changes: Couvade syndrome  Undergoes psychological changes: • Ambivalence • Strong protective feelings • Concerned about ability to be a good The Father (continued_1)  Unplanned/unwanted pregnancy: • May not accept changes in lifestyles or life plans • May feel left out • Unsure of relationship after baby born • May engage in extramarital affairs • Express disappointment and frustration with violence  ACOG suggests screening for violence at each prenatal visit The Father (continued_2)  Concerned about ability to provide emotional support during childbirthcope by doing concrete tasks Siblings  New baby is a major crisis  Response influenced by: • Child’s age • Parents’ attitudes • How prepared for the upcoming birth  Toddlers: become clingy and irritable; baby is only a story  Preschool child: sense of loss; being replaced; jealous Siblings (continued)  Older children: interested and ask questions about conception, pregnancy, and childbirth; think of ways to be helpful  Older children and teenagers: embarrassed by parents’ sexuality Grandparents  Most are pleased  Remember their own experiences of pregnancy and raising children  “Firsts” used as a link between the generations  Face the reality of aging  May react negatively to the news: “too young to be grandparents”  Nonsupport adds stress and decreases the self-esteem of the Clicker Check (continued_2) A pregnant client is arranging clothing items and care supplies in a newly created nursery. Which maternal task is this patient accomplishing? A. Bonding B. Securing acceptance C. Seeking safe passage D. Committing to the child Clicker Check (continued_3) Correct answer: D Preparing a nursery demonstrates committing to the child. Bonding is demonstrated by feelings of love for the fetus. Securing acceptance is measured by the partner and parents’ reaction to the news of a pregnancy. Seeking safe passage is demonstrated by seeking prenatal care and practicing healthy behaviors.