4-1. Emotional Reactions Experienced by a Newly Pregnant Patient
Throughout a patient's pregnancy, her emotional reactions have been described as ambivalence, fear and anxiety, introversion or narcissism, and uncertainty. These feelings predominate at different periods of the pregnancy; others tend to fade in and out as the pregnancy progresses.
a. Ambivalence. This refers to the patient's simultaneous attraction for and against the pregnancy. The negative response to the pregnancy does not mean that she doesn't want the baby. She may simply have doubts as to whether she will be a good parent, wonder if she is ready for a baby, how a new baby will affect her family and her lifestyle, and so forth. This is not to say that she doesn't feel good about the pregnancy. Even though she may be doubtful in some ways, she may be experiencing joy and excitement as well as happiness and anticipation.
b. Fear and Anxiety. This refers to the patient being concerned for her own health and the health of her baby.
c. Introversion or Narcissism. The patient becomes concerned for herself. She may be preoccupied with her own thoughts and feelings.
d. Uncertainty. Before the patient can accept the fact that she is pregnant, she must ask herself "Am I really pregnant?" This may last until a positive diagnosis of pregnancy is confirmed by a physician. "Quickening" is usually a big milestone in the process of accepting the pregnancy.
Factors that May Influence the Extent of these Reactions
The previously mentioned emotional reactions of a pregnant patient may have some bearing on the following factors:
a. Is it a planned or a wanted pregnancy?
b. Is it the first pregnancy?
c. What experiences and memories does the patient have about previous pregnancies?
First Trimester of Pregnancy
New behaviors a prospective mother may engage in includes the following:
a. Displays a Sense of Ambivalence to the Pregnancy. You, as the practical nurse, must explain to the patient that what she is feeling is not unnatural. She must not be made to feel guilty about her ambivalence.
b. Fantasize About The Pregnancy. This may be mixed with a sense of fear or dread. The patient may dream about the impact a baby will have on her life and the lives of other family members. If the fantasies become moribund or characterized by excessive fear and cause despair, the patient may require counseling.
c. Role Playing. The patient may act the part of being a mother. She may spend time playing with children or babysitting other friends' babies. She may show more interest in caring for babies. She may pick them up more or talk with other women about their babies.
d. Increased Concern For Financial and Social Problems. Paying for a child, losing a job, or losing a second income for a while, the cost of child care, loss of freedom to come and go, and the requirement for a total commitment that may prevent her from performing social obligations may all be concerns for the new mother.
e. Decreased Interest In Sex Due To Bodily Changes. Nausea, vomiting, fatigue, and fear of injury to fetus may cause a loss of interest in sex. Increased vascularity to breast may yield breast tenderness or discomfort initially but this decreases as the pregnancy continues. Increased vascularity to the genitalia area may also be of concern. Fear of a miscarriage may cause the patient not to want sexual intercourse.
Characteristics of the Second Trimester of Pregnancy
a. The patient develops a sense of well-being. Her body becomes adjusted to hormonal changes. The early discomforts of pregnancy have subsided. Usually, she has adjusted psychologically to the realities and inconveniences, which accompany pregnancy. Her fears have subsided, at least temporarily. She has passed the initial miscarriage stage; she begins telling everyone she is pregnant. She develops a "glow" of pregnancy.
b. "Quickening" is experienced. The patient actually feels life; this act of fetal movement confirms the pregnancy. The father can also feel the movement; he can then identify with the reality of pregnancy and accept it.
c. The fetus heartbeat is heard.
d. Both parents develop an interest in fetal growth and development.
e. The interest in processes of labor and delivery is expressed. At this point, the parents may enroll in classes on childbirth and read appropriate literature.
f. The patient may have wide mood swings. She may be happy to sad for no apparent reason.
Reassurance to the pregnant patient is very important to her--these are normal emotional reactions to pregnancy.
g. The patient may have a tendency to introvert or to focus on herself as the center of attention. She may concentrate on her own needs and the needs of the fetus inside her. She reflects on her own childhood and her relationship with her mother. She is preoccupied with her own thoughts and feelings. Preoccupation may cause trouble for her and those around her. Those persons close to the patient must be informed to expect her passiveness and dependency during this time. Extra love and attention should be given to her during this time, as this will allow the patient to give more of herself.
h. Changes in sexuality. The patient may have increased her interest in sex, the fear of pregnancy is no longer a problem and the fear of hurting the fetus is gone. There is an increase in sexual fantasies and dreams, and an increase in vaginal lubrication. An increase in vaginal lubrication increases comfort for the mother during intercourse. However, the partner may need to change positions for the comfort of the female.
Psychological Characteristics of the Third Trimester
a. Altered Self-Image. The patient is vacillating, going from being special, beautiful, and pretty to being ugly, awkward, unsexy, and feels fat.
b. Fear. She dreams about the infant and what the future holds for the new baby. She is concerned for the health and well-being of her baby. She is also concerned for her own safety and "performance" during labor and delivery.
c. Aggravation. The patient is aggravated over things she can't do for herself due to her size.
d. Fatigue. She becomes tired easily.
e. Obsession. She is concerned with delivery.
f. Wondering. The patient wonders what kind of parent she will be.