CHAPTER 6 1 Describe two stages of family development pertinent to pregnancy. 2 List the developmental tasks of pregnancy. 3 List the general concepts in Rubin’s tasks of pregnancy. 4 Discuss two psychosocial findings in normal pregnancy. 5 Discuss strategies to minimize self-concept disturbances during pregnancy. 6 Discuss risks related to eating disorders during pregnancy. 7 Discuss the effects of increased technology on a woman’s psychologic experience of pregnancy. 8 Describe three needs of fathers during labor and delivery. 9 Identify two reactions of fathers to pregnancy. 10 Describe changes in sexual feelings, fears,and behaviors in pregnancy. 11 Discuss the concept of developmental crises in pregnancy. 12 Describe how to assist families in developing a birth plan and selecting childbirth education. 13 Enumerate maternal behaviors exhibited during pregnancy validation. 14 Describe maternal behaviors exhibited during fetal embodiment. 15 Differentiate maternal behaviors seen during fetal distinction. 16 List the most common maternal behaviors observed in role transition. 17 Identify maternal behaviors indicative of Rubin’s task of safe passage in the last trimester of pregnancy. 18 Describe issues seen in the last trimester involving acceptance of the child by others. (3) Pregnancy experiences of extended family and friends (4) Previous experience with infants and neonates (5) Unresolved grief or anger related to previous experiences (3) Mother’s health: healthy or unhealthy before and during this pregnancy (4) The woman’s and partner’s learning capabilities and/or limitations (5) Whether the woman has healthy or unhealthy personal relationships (6) The status of her pregnancy: low risk or high risk (Lutz & May, 2007; Sittner, DeFrain, & Judson, 2005) 2. Duvall’s (1985) stages of family development a. Married couple beginning a family (1) Attainment of a satisfying relationship (2) The dyad is the easiest and first relationship of family development. b. Expectant family: role preparation (1) Reorganization of the household for the infant (2) Development of new patterns of making and spending money (3) Realignment of tasks and responsibilities (4) Adaptation of sexual relationship to the pregnancy (5) Reorientation of relationships with relatives (6) Adaptation of relationships with friends and associates (7) Increase in knowledge about pregnancy, birth, and parenting c. Childbearing family (from the first birth to the time when the last child attains the age of 30 months) (1) Food cravings might occur during pregnancy. (2) Sexual behaviors, desires, and thoughts vary throughout pregnancy. (3) Dream life is very active in pregnancy. (4) Fatigue, especially during the first and third trimesters, might influence desires and thoughts. (1) Ambivalence about becoming a mother appears in early pregnancy in most women. (2) Irritability may increase throughout pregnancy and peak in the ninth month, as fatigue increases. (3) Increased sensitivity might exist throughout the entire pregnancy. (4) A sense of vulnerability tends to peak during the seventh month. (5) The woman might experience frustration with her own indecisiveness throughout the pregnancy. (6) Normal fears might exist (e.g., about the health of the infant and about her ability to give birth safely). Extreme fear of birth (i.e., requests cesarean to avoid vaginal birth) may be accompanied by other psychosocial problems (Nerum, Halverson, Sorlie, & Oian, 2006). 4. Pregnancy as a developmental (maturational) crisis a. Danger of increased psychologic vulnerability at this time b. Increased opportunity for personal growth c. Increased susceptibility to stress because of potential changes in areas such as work, housing needs, and access to care d. Alteration in role and identity for each parent and for each member of the family 5. Developmental tasks of pregnancy are progressive over time. (1) Most women have an initial ambivalence about being pregnant. (2) Many women experience fantasies and dreams about themselves and how pregnancy will change their lives. (1) The woman incorporates the fetus into her body image. (2) She becomes dependent on her partner or on significant others. (1) The woman conceptualizes her fetus as a separate individual. (2) She accepts her new body image and might characterize it as being full of life. (3) She typically becomes more dependent on her mother or feels closer to her mother at this time. (1) She prepares to separate from and give up the physical, symbiotic attachment with her fetus. (2) She becomes anxious about impending labor and delivery. (3) She exhibits “nesting” behaviors or a need to get all the supplies needed for the infant (preterm labor is a major disruption of the need to nest). (4) She becomes impatient with her awkward body and is anxious for pregnancy to end; she states frequently that she is tired of being pregnant. 6. Rubin’s (1984) tasks of pregnancy occur concurrently with each other. (1) Pregnancy progressively becomes a part of the woman’s total identity. (2) The woman is able to share little of her sensory experience with others, making her feel unique. (3) The woman’s focus turns progressively inward as the pregnancy advances. (4) The woman generally becomes overly sensitive. (5) She seeks the company of other women, especially other pregnant women. (6) The absence of a female support system during pregnancy is an index of a high-risk pregnancy. b. “Binding-in” is acceptance of pregnancy and incorporating the reality of pregnancy into her self-concept. (1) First trimester: she accepts the idea of pregnancy, but not of the child (2) Second trimester: there is a dramatic change, with the sensation of fetal movement (quickening); she becomes aware of the child as a separate entity within her (3) Third trimester: she wants the child and is tired of being pregnant (1) First trimester: acceptance of the pregnancy by herself and others (2) Acceptance of the child by others is the keystone of a successful adjustment to pregnancy (3) Second trimester: the family needs to relate to the infant (e.g., as a son or brother) (4) Third trimester: the critical issue is the unconditional acceptance of the child; conditional acceptance implies rejection d. Reordering of relationships and learning to give of herself (1) First trimester: examines what needs to be given up (2) Second trimester: identifies with the child (3) Third trimester: has decreased confidence in her ability to become a good mother to her child e. Safe passage: Rubin (1984) suggested this task usually receives most of the woman’s attention 7. Expectant fathers: less is known about men’s transition to parenthood (Halle, Dowd, Fowler, Rissel, Hennessy et al., 2008). a. Psychosocial findings during pregnancy (1) Couvade: some men actually experience symptoms of pregnancy (2) Expectant fathers vary widely in their reactions to pregnancy as well as to the psychologic and physical changes in the woman. b. Paternal tasks of pregnancy (1) First trimester: announcement phase (a) Must cope with ambivalence about becoming a father (b) Strives to accept the biologic fact of pregnancy (2) Second trimester: moratorium phase (a) Often has a delay of “binding-in” to the pregnancy compared with the woman (b) Accepts the woman’s changing body (c) Accepts the reality of the fetus, particularly when fetal movement is felt (d) Adapts to the changes in their sexual relationship [i] Frequently has fears about harming the fetus during sexual intercourse [ii] Might experience a potential rivalry with a male obstetrician (e) Experiences confusion when dealing with the woman’s intense introspection (f) Fantasizes about the father-child relationship (not as an infant but as an older child—playing ball, for example) (3) Third trimester: focusing phase (a) Negotiates what his role will be during labor and delivery (b) Prepares for the reality of parenthood (c) Might change his self-concept and image (e.g., might shave his beard and buy new clothes). (d) Engages in preparing the nursery (e) Copes with fears about the mutilation or the death of his partner and child (a) Might dispel his feelings of alienation (b) Might increase his sense of significance and importance (c) Might increase his sense of control (d) Might increase his appreciation for his laboring woman/partner (e) Might develop a closer attachment to his newborn earlier in the father-child relationship (2) Roles of fathers during labor and birth (a) The father as a labor coach is very involved and needs a high level of control. (b) A father as a teammate needs less control but provides emotional and physical support. (c) A father as a witness is there as a companion, providing support, but looks to others for instruction and support; needs very little control. (3) There is a need for sensitivity to a father’s unfamiliarity with such things as: (a) Unfamiliar sights; for example: (b) Unfamiliar sounds; for example: (c) Unfamiliar smells; for example: (d) The father has his own needs to meet. (4) Other considerations about expectant fathers at labor and birth 8. Other family members’ psychosocial reactions to pregnancy and childbirth (1) Reaction to pregnancy is age dependent. (2) Siblings might express excitement and anticipation. (3) Siblings might verbalize negative reactions. (4) Siblings might be unaware or noncommittal. (5) Siblings present at birth need a caretaker whose major focus is meeting the needs of the sibling (i.e., involvement or withdrawal from the process). (6) Siblings might exhibit ambivalent reactions to a newborn in the home. (1) Often express excitement and anticipation (2) Might express resentment (e.g., “I’m too young to be someone’s grandmother!”) (3) Might verbalize anger if the pregnancy was unplanned or if the mother is a teenager or is unwed (4) Often express anxiety about the health and well-being of the expectant mother and fetus (5) Might be concerned about the expectant parents’ age, income, and emotional stability 9. Single expectant mother’s psychosocial needs a. Reason for single status needs to be assessed to better understand the meaning of pregnancy (1) Single by choice: pregnancy might have been by artificial insemination (2) Single by accident: becoming a widow after conception or pregnant through rape (3) Single by divorce or separation after conception (4) Single and pregnant by a casual acquaintance (unplanned or planned) b. Presence or absence of strong support persons can significantly influence the woman’s adaptation to pregnancy. c. Future plans for the child are an important factor influencing the mother’s psychologic needs (i.e., is she planning to keep and raise the child or planning to place the child for adoption? Is she a surrogate parent?). 10. Ethnocultural considerations a. In the United States, there are mixed cultural messages about behavior during pregnancy and birth. b. Technologic culture is dominant in U.S. health care. (1) Use of technology creates a potential to increase stress and anxiety in the pregnant woman (Kornelsen, 2005). (a) Moral and ethical dilemmas frequently are associated with diagnostic tests. (b) The woman’s interpersonal and emotional needs and feelings might be missed or ignored in favor of technologic information.
Psychology of Pregnancy
CLINICAL PRACTICE
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