PSYCHOLOGICAL CHANGES IN

PREGNANCY CULTURAL INFLUENCES

Tatyana Lauren Ajero  A woman’s cultural background may strongly
influence how active a role she wants to take in
INTRODUCTION her pregnancy, because certain beliefs and
Psychological changes of pregnancy occur in response taboos may place restriction on her behavior
not only to the physiologic alterations that are happening and activities.
but also to the increased responsibility associated with  Ask at prenatal visits if there is anything they
welcoming a new and completely dependent person into believe should or should not be done to make
a family. the pregnancy successful and keep the baby
A major responsibility of health care personnel caring for healthy.
pregnant women and their families is to help the family  Supporting these beliefs show respect for the
maintain a state of wellness throughout the pregnancy individuality of a woman and her knowledge of
and into early parenthood. good health.
Pregnancy is such a huge change in a woman’s life that it  There are certain beliefs that pregnant women
brings about more psychological changes than any other believe in when it comes to practices of pre-
life event besides puberty (Rojas, Wood, &Blakemore, delivery.
 Listen to such “tall tales” to show respect for the
2007)
person’s beliefs, but encourage a woman to also
respect that physiologically these types of action
ATTITUDE TOWARDS PREGNANCY IS INFLUENCED BY: could not affect a fetus.
Environment to which she was raised
FAMILY INFLUENCES
Messages about pregnancy communicated by family
Family influences also contribute to the views of
Society
the pregnant mother to her pregnancy journey
Culture
If she and her siblings were loved and seen as the
Whether the pregnancy has come at a good time or less
pleasant outcome of a happy marriage, she is
than a good time in her life
more likely to have a positive attitude toward
her pregnancy than if she and her siblings were
SOCIAL INFLUENCES (Previous Beliefs)
seen as intruders or were blamed for the
Pregnancy was a 9-month long illness
breakup of a marriage.
The pregnant mother went on prenatal alone
“People love as they have been loved” is said so
And she would deliver the baby on her own
often it has become a cliché.
She may be able to see her family after a week
It is highly relevant, however, to whether pregnancy
and childbirth are viewed in a positive or
SOCIAL INFLUENCES (Current Beliefs)
negative light.
Nurses have played an important role in helping bring
If a woman has difficulty loving others because she
about this change by convincing agencies that long-
did not receive love as a child, she may worry
standing protocols that separated women from their
that she will have difficulty loving and accepting
families are not appropriate.
the fetus growing within her.
Women now bring their families in for ultrasounds and
You cannot give something that you do not have.
even prenatal check ups
Instead of being given general anesthetics so they can
INDIVIDUAL INFLUENCES
“sleep through” labor and birth, they participate actively
How we adapt to stress
in the experience
This ability to adapt- to being a mother without
needing mothering, to loving a child as well as a
SOCIAL INFLUENCES
husband, to becoming a mother of each new
How a pregnant woman feels during pregnancy is
child – depends on her basic temperament
influenced by response of the husband, cultural
The extent to which a woman feels secure in her
background and personal experiences as well as what is
relationship with the people around her,
taught by health education in school.
especially the father of her child, is usually also
People’s opinions about adolescent pregnancies, “late in
important to her acceptance of a pregnancy.
life” pregnancies, or whether women who have sex with
Acceptance is usually easier if she has
women should have children have changed markedly.
confidence in the stability of her relationship
By informing women about their new health care options
with the child’s father and knows that he will be
and continuing to work with other health care providers
there to give her emotional support.
to “demedicalize” childbirth, nurses can help make
A woman needs an opportunity to express these
pregnancy and childbirth even more enjoyable for clients
feelings to a supportive person. Women who do
and their families.
not have a supportive partner often look to
health care providers during pregnancy to fill
the role of an attentive listener.
 Although men may be inarticulate in these ways,  It is recognized that all partners are important
they may be able to convey such emotions by a and should be encouraged to play an emotional
touch or a caress, one reason men’s presence is role in the pregnancy.
always desirable at a prenatal visit and certainly  This means that, as a woman adapts to
in a birthing room. pregnancy, her partner may go through some of
Their partner will know that a hand on hers is as the same psychological changes.
meaningful an expression of emotion as a  Accepting the changes in a woman.
spoken word.  A partner should try to give a woman emotional
support while she is learning to accept the
reality of pregnancy.
THE PSYCHOLOGICAL TASKS OF  Feeling close to jealousy of the growing baby,
PREGNANCY who, although not yet physically apparent,
seems to be taking up a great deal of the
From a physiological standpoint, it is fortunate that a woman’s time and thought.
pregnancy is 9 months long, because this gives the fetus  Partners are afraid to voice their concerns. This
time to mature and be prepared for life outside the happens if they do not want to intensify the
protective uterine environment. pregnant woman’s anxieties by appearing
From a psychological standpoint, this period is also anxious themselves.
fortunate for the family because it gives them time to  An unwed father may have a great deal of
prepare emotionally as well. difficulty accepting a pregnancy unless he is
How well a woman adjusts to the potential stress of actively involved in prenatal
pregnancy can affect her relationship with the child and
may even influence whether she is able to carry the SECOND TRIMESTER: Accepting the Baby
pregnancy to term.
The Woman
 During the second trimester, the
FIRST TRIMESTER: Accepting the Pregnancy psychological task of a woman is to accept
that she is having a baby, a second step
 The first task is to accept the pregnancy from accepting the pregnancy.
 The woman  Quickening, or the first moment a woman
- A diagnosis of pregnancy is a similar rite of
feels fetal movement
passage.
 With quickening, however, the fetus
- Receiving confirmation of pregnancy, at her
health care provider’s office, makes the mother assumes a separate identity. She begins to
feel “more pregnant”. imagine how she will feel at the birth, when
- Every pregnancy is a surprise to some extent, the physician or midwife announces, “It’s a
either because a woman had not planned on boy!” or “It’s a girl!”
becoming pregnant or because she had been  Although an ultrasound can reveal the sex
looking forward to being pregnant but the of the child, some women choose not to
reality of it happening came too quickly. know because they fear being misled by an
- If pregnancy announced itself with more reliable inaccurate ultrasound reading or they
signs than a missed period, slight breast simply wish to be surprised about the sex of
tenderness, or vague nausea and tiredness, their child at birth.
women could become more certain how they
 A good way to measure the level of a
feel about being pregnant sooner.
woman’s acceptance of the coming baby is
to measure how well she follows prenatal
Task: Accepting the Pregnancy (Woman)
 Often women immediately experience instructions.
something less than pleasure and closer to
disappointment or anxiety at the news that they The Partner
are pregnant or a feeling of ambivalence.  The partner may be overly stressed with the
 Ambivalence toward pregnancy does not mean upcoming pregnancy and the attention
that positive feelings counteract negative given by the mother to the pregnancy that
feelings so the woman is left feeling nothing he chooses to be busier with his own work.
toward her pregnancy  This preoccupation with work may limit the
 Fortunately, most women are able to change amount of time a partner spends with his
their attitude toward the pregnancy by the time family, just when the pregnant woman
they feel the child move inside them. most needs emotional support.
 He may believe that childbirth will stretch
Task: Accepting the Pregnancy (Partner)
his wife’s vagina so much that sexual
relations will no longer be enjoyable and so
will advocate for a cesarean birth.
  Common reactions include grief, narcissism,
introversion or extroversion, body image and
boundary concerns, couvade syndrome (somatic
experiences of father during pregnancy
simulating those of the pregnant mother),
stress, mood swings, and changes in sexual
desire.
THIRD TRIMESTER: Preparing for Parenthood  It is helpful to caution a pregnant woman and
her partner about common changes they may
 During the third trimester, couples usually begin expect.
“nest building” activities, such as planning the  They can misinterpret the woman’s mood
infant’s sleeping arrangements, buying clothes, swings, decreased sexual interest, introversion,
choosing a name for the infant, and “ensuring or narcissism not as changes of pregnancy but as
safe passage” by learning about birth. a loss of interest in their relationship.
 These preparations are evidence that women
are completing the third trimester task of GRIEF
pregnancy or preparing for parenthood.  Before a woman can take on a mothering role,
 It is helpful for most couples to attend childbirth she has to give up or alter her present roles. She
education classes or classes on preparing for will never be a daughter in exactly the same way
parenthood as attending these classes can help again. She will never be as irresponsible and
a couple accept the pregnancy, expose them to carefree as she is now again.
other parents as role models, and provide  She will not even sleep soundly for the next 18
practical information about pregnancy and years. She must incorporate her new role as a
childcare. mother into her other roles as a daughter, wife,
or friend.
REWORKING DEVELOPMENTAL TASKS  This becomes a big step for her to take
 Relationship with the rest of the family. especially if the pregnancy comes at the time
 Fear of being separated from family or dying are that the individual is not prepared for the shift
common childhood fears that can be revived of responsibilities.
during pregnancy.
 A clue that might signal a woman’s distress over NARCISSISM
this could be, “Am I ever going to make it  A woman who previously was barely conscious
through this?” of her body, who dressed in the morning with
 A pregnant woman’s partner needs to do the little thought about what to wear, who was
same reworking of old values and forgotten unconcerned about her posture or her weight,
developmental tasks. A man may rethink his suddenly begins to concentrate on these aspects
relationship with his father to understand better of her life.
what kind of father he will be.  She dresses so her pregnancy will or will not
show, making dressing a time-consuming, mirror
ROLE-PLAYING AND FANTASIZING studying procedure.
 A pregnant woman begins to spend time with  She makes a ceremony out of fixing her meals.
other pregnant women or mothers of young She may lose interest in her job or community
children to learn how to be a mother. events because the work seems alien to the
 She is drawn into a world of talk about babies more important events taking place in her body.
and pregnancy with these women.  Men may demonstrate the same behavior by
 As a part of the role-playing process, women’s reducing risky activities such as mountain biking,
dreams tend to focus on the pregnancy and trying to ensure that they will be present to
concerns about keeping herself and her coming raise their child.
child safe.
 Try to locate good role models (in classes for INTROVERSION VERSUS EXTROVERSION
mothers, at the health care agency, or from a  Some women react in an entirely opposite
social agency) for adolescents so they can find a fashion and become more extroverted. They
good maternal role to copy and integrate into become more active, appear healthier than ever
their own behavior. before and are more outgoing.
 He has to imagine himself as the father of a boy  This tends to occur in women who are finding
or as the father of a girl. A first-time father may unexpected fulfillment in pregnancy, perhaps
have to change his view of himself from being a who had seriously doubted that they would be
carefree individual to being a significant lucky enough or fertile enough to conceive.
member of a family unit. If he already is a  Such a woman regards her expanding abdomen
father, he has to cast aside a father-of-one as proof she is equal to her sisters.
identity to accept a father-of-two image, and so
forth. BODY IMAGE AND BOUNDARY
 In addition to being a daughter or wife, she
EMOTIONAL RESPONSES TO PREGNANCY begins to see herself becoming “bigger” in many
 different ways. This change in body image is part
of the basis for narcissism and introversion. CHANGES IN THE EXPECTANT FAMILY
Changes in concept of body boundaries leads to  Both preschool and school-age children may
a firmer distinction between objects, yet at the need to be reassured periodically during
same time her body boundary is perceived as pregnancy that a new baby will be an addition
extremely vulnerable, as if her body were to the family and will not replace them in their
delicate and easily harmed. parents’ affection.
STRESS
 This stress of pregnancy, like any stress, can
make it difficult for a woman to make decisions, DIAGNOSIS OF PREGNANCY
be as aware of her surroundings as usual, or
maintain time management with her usual Presumptive (Subjective) Signs of Pregnancy
degree of skill. Presumptive signs of pregnancy are those that are least
 If a woman was in an abusive relationship indicative of pregnancy; taken as single entities, they
before the pregnancy, the increased stress of could easily indicate other conditions
pregnancy is apt to cause even more abuse.
 Asking whether intimate partner abuse has ever Probable Signs of Pregnancy
occurred in the past to help predict if it could In contrast to presumptive signs, probable signs of
occur during pregnancy is an important part of pregnancy are objective so can be documented by an
prenatal interviewing. examiner. Although they are more reliable than
 A woman with fewer support people around her presumptive signs, they still are not positive or true
almost automatically has more difficulty diagnostic findings.
adjusting to and accepting a pregnancy and a  Laboratory Tests
new child than do women who have more - detecting the presence of human chorionic
support. gonadotropin (hCG), a hormone created by the
 Knowing that she has supportive health care chorionic villi of the placenta, in the urine or
providers she can call on when needed is the blood serum of the pregnant woman.
one thing that may make this pregnancy
tolerable.  Home Pregnancy test
- appointment to have a pregnancy confirmed can
COUVADE SYNDROME be an anxious, stressful time for many women.
 Many men experience physical symptoms such - For this type of test, a woman dips a reagent
as nausea, vomiting, and backache to the same strip into her stream of urine. Home tests can
degree or even more intensely than their detect as little as 35 mIU/mL of hCG. They take 3
partners during a pregnancy. to 5 minutes to perform.
 These symptoms apparently result from stress, - Advise any woman who thinks she might be
anxiety, and empathy for the pregnant woman. pregnant but gets a negative result from a home
 For the most part, these are healthy happenings pregnancy test to repeat the test 1 week later if
and require psychological attention only if the she is still experiencing amenorrhea.
man becomes emotionally stressed or - If symptoms persist after two tests, she needs to
delusional see a health care provider as she might have a
condition such as an ovarian tumor causing the
EMOTIONAL LIABILITY amenorrhea and needs appropriate diagnosis
 Mood changes may be caused by hormonal for this condition.
changes particularly the sustained increase in
estrogen and progesterone. Note: Women taking oral contraceptives also may have
 Mood swings may be so common that they false-positive results; for such a test to be accurate, oral
make a woman’s reaction to her family and to contraceptives should have been discontinued 5 days
health care routines unpredictable. before the test. Women who have proteinuria, are
postmenopausal, or have hyperthyroid disease also may
CHANGES IN SEXUAL DESIRE show false-positive results.
 Women who formerly were worried about
becoming pregnant may truly enjoy sexual Positive Signs of Pregnancy
relations for the first time during pregnancy • Demonstration of a fetal heart separate from
 Others might feel a loss of desire because of the mother’s
their estrogen increase, or they might • Fetal movements felt by an examiner
unconsciously view sexual relations as a threat • Visualization of the fetus by ultrasound
to the fetus they must protect.
 Some may worry that having sexual relations
could bring on early labor. DEMONSTRATION OF A FETAL HEART SEPARATE FROM
THE MOTHER’S
 FIRST TRIMESTER: decreased  Ultrasonic monitoring systems that convert
 SECOND TRIMESTER: increased ultrasonic frequencies to audible frequencies
 THIRD TRIMESTER: increased (Doppler technique) can detect fetal heart
 sounds as early as the 10th to 12th week of
gestation
 Echocardiography can demonstrate a heartbeat
as early as 5 weeks.
 Although the fetal heart has been beating since
the 24th day after conception, it is audible by
auscultation of the abdomen with an ordinary
stethoscope only at about 18 to 20 weeks of
pregnancy.
 They are heard best when the position of the
fetus is determined by palpation and the
stethoscope is placed over the area of the
fetus’s back. The fetal heart rate usually ranges
between 120 and 160 beats per minute.

FETAL MOVEMENTS FELT BY AN EXAMINER

 Fetal movements may be felt by a woman
as early as 16 to 20 weeks of pregnancy.
 Those felt by an objective examiner are
considered much more reliable because a
woman could mistake the movement of gas
through her intestines for fetal movement.
 Fetal movements can be felt by an
examiner at the 20th to 24th week of
pregnancy unless a woman is extremely
obese.

VISUALIZATION OF FETUS BY ULTRASOUND

 High-frequency sound waves projected
toward a woman’s abdomen are useful in
diagnosing pregnancy
 If a woman is pregnant, a characteristic ring,
indicating the gestational sac,
 will be revealed on an oscilloscope screen
as early as the fourth to sixth week of
pregnancy. This method also gives
information about the site of implantation
and whether a multiple pregnancy exists.
 By the eighth week, a fetal outline can be
seen so clearly within the sac that the
crown-to-rump length can be measured to
establish the gestational age of the
pregnancy. Seeing the fetal outline on an
ultrasound is clear proof for a couple that a
woman is pregnant if they had any doubt
up to that point.

PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS

OF PREGNANCY