Psychological adaptation of women to pregnancy Coming to terms with a huge life-change

Introduction We’re going to look at: –Why is it complicated? –What emotions women might feel –What’s behind what they feel –What coping strategies there are and what might help them –Summary

Why is it complicated? Pregnancy is a very significant time It’s a journey into the unknown Brings with it a huge mix of emotions Everyone feels differently about it It takes time to work through thoughts and fears Very much depends on previous experience/stories they’ve heard

What emotions might women feel? A huge range! But may include –Happiness –Excitement –Anticipation –Relief –Incredulity –Fear –Worry (an Australian study quoted by Niven shows a 61% rise in anxiety in pregnancy) –Panic –Ambivalence

What’s behind what they feel? Hormones! Fear of the unknown Difficulty in believing what’s happening when can’t see/feel anything Previous experiences of miscarriage, stillbirth or complications Worry about post-natal mental health issues returning How they’re feeling physically – if they’re very sick it’s hard to feel happy/excited Financial worries

What’s behind what they feel (2) Feeling overwhelmed leading to confusion/anxiety Grieving for their old way of life as a couple Whether the pregnancy was planned or unplanned (can have significant effect) Anxiety about being able to love more than one child if it’s not their first Worry if they have an existing medical condition and how that will affect things

What’s behind what they feel (3) Uncertainty as to the outcome of the pregnancy Worry that what they do/eat or stress will affect the baby Worry about results of screening tests Feelings about changes to working life Excitement about embarking on a new life/journey Feelings about changes to their body Amazement or relief if they’ve had fertility problems

Coping strategies/what might help Support of partner – thought to be vital in many cultures to nurture pregnancy and create the new family unit For some, anything which makes it seem more ‘real’ Trying to think logically and make decisions Getting help to adapt their lifestyle eg giving up smoking/drugs Asking midwife for advice – she can also direct them to resources to help

Coping strategies/what might help (2) Going to antenatal classes/using websites for information to reduce fear Feeling they have choices and feeling in control Seeing a counsellor/contacting an organisation specialising in birth trauma/PTSD

Coping strategies/what might help (3) Time – taking time to think and seeking out positive stories of pregnancy and birth Seeing the baby on scans Hearing the heartbeat as well as midwife/GP appointments Health professionals being careful in choice of language For some people, screening/diagnostic tests giving good results

Summary Pregnancy is an overwhelming time, often with many conflicting emotions There are many reasons behind women’s feelings There are ways in which, with support, they can be helped to adapt to pregnancy The midwife has a role to play in supporting and directing women to the information they need to ease the transition

Footnote – appropriate care the midwife can give to help ‘Good basic psychological care involves respect, compassion, reassurance, the giving of information, the provision of choice, the acknowledgement of concerns, the sharing of joys and sorrows’ (Niven, 1992)