Psycho-social-cultural aspects of antepartum period-5 Flashcards
Ambivalent feelings
common during first trimester, should decrease. Could indicate unresolved conflict if it goes into the third trimester
Events that facilitate fetal attachment
Hearing the fetal heartbeat.
● Seeing the fetus move during an ultrasound examination.
● Feeling the fetus kick or move.
expected finding from new mom
● Moves from viewing herself as a woman-without-child to a woman-with-child
● Anticipates changes motherhood will bring to her life
● Seeks company of other pregnant women
● Is highly motivated to assume the motherhood role
● Actively prepares for the motherhood role
Assessment of the couple’s relationship
The partner’s concern for the woman’s needs during pregnancy.
● The woman’s concerns for her partner’s needs during pregnancy.
● The varying desire for sexual activity among pregnant women.
● The effect pregnancy has on the relationship (e.g., whether it brings them closer together or causes conflict).
● The partner’s adjustment to his or her new role.
Prep for labor
attends classes track pregnancy mentally rehearse dreams about labor and birth realistic expectations of labor and birth. nesting behavior
Prenatal fear of losing control in labor
● The woman’s degree of trust with the medical and nursing staff, her partner, and other support persons.
● The woman’s attitude regarding the use of medication and anesthesia for labor pain management.
Prenatal fear of losing self esteem in labor- depends on
Tolerance of self.
Value of self and assertiveness, and decisions about her labor process.
Positive attitude regarding body image and appearance.
factors that influence maternal adaptation
parity, maternal age, sexual orientation, single parenting, multiple gestation (twins, triples), socioeconomic factors, cultural beliefs, and history of abuse.
older mother risk
miscarriages, fetal chromosomal abnormalities, low birth weight infants, premature births, and multiple births.
women over 40
placenta previa, placenta abruptio, caesarean deliveries, preeclampsia, and gestational diabetes.
nursing actions 1st trimester
Begin psychosocial assessment at initial contact
Promote pregnancy and birth as a family experience
Assess learning needs.
Offer anticipatory guidance regarding normal developmental stressors of pregnancy
Assess for increased anxieties and fear
Listen, validate, provide reassurance, and teach expected emotional changes.
discuss common phases through which expectant fathers progress through pregnancy.
nursing action 2nd trimester
• Encourage verbalization of possible grief process during pregnancy
Discuss normal changes in sexual activity
• Encourage “tuning in” to fetal movements
• Reinforce to partner and family support
nursing action 3rd trimester
• Encourage attendance at childbirth classes
• Discuss preparations for birth, parenthood; explore expectations of labor
• Discuss preparations for birth, parenthood; explore expectations of labor
-Refer to appropriate educational materials on parenthood
-If psychosocial complications develop, plan for appropriate referrals
• Help expectant mother identify and use support systems
Antenatal Psychosocial Health Assessment
● Social support
● Recent stressful life events
● Couple’s relationship
● Onset of prenatal care
● Plans for prenatal education
● Feelings toward pregnancy after 20 weeks
● Relationship with parents in childhood
● Self-esteem
● History or psychiatric/emotional problems
● Depression in this pregnancy
● Alcohol/drug use
● Family violence
Nursing actions- mom
● Assess adaptation to pregnancy at every prenatal visit.
● Identify areas of concern, validate major issues, and make suggestions for possible changes.
● Refer to the appropriate member of the health care team and follow up.
● Establish a trusting relationship
● Assess for the need for psychotropic medications
● Use psychosocial health assessment screening tools
Effects of pregnancy on father
● Increased emphasis on his role as provider causes a reevaluation of lifestyle and job or career status.
- change in role
- struggle to feel relevant
- without models for fatherhood
- pregnancy like symptoms
couvade syndrome
partner experiencing pregnancy symptoms
The announcement phase
reaction to pregnancy
The moratorium phase
appear to put conscious thought of the pregnancy aside for some time
The focusing phase
Men will be actively involved in the pregnancy and their relationship with the child.
Nursing action- dad
-explore response
-reassure ambivalence
-reassure pregnancy like symptoms
-encourage involvement
● Encourage the man to negotiate his role in labor with his partner.
● Explore his attitudes and expectations of pregnancy, childbirth, and parenting.
Sexuality in pregnancy by trimester
● During the first trimester, fatigue, nausea, and breast tenderness may affect sexual desire.
● During the second trimester, desire may increase as a result of increased sense of well-being and the pelvic congestion associated with this time in pregnancy.
● During the third trimester, sexual interest may once again decrease as the enlarging abdomen creates feelings of awkwardness and bulk.
Nursing action- sexuality
- Discuss fears and concerns related to sexual activity.
- Encourage communication between partners and discuss possible changes with couples.
- ask about it to open the conversation
sibling adaptation by age
● Children younger than 2 are usually unaware of the pregnancy
● Children from 2 to 4 years of age may respond to the obvious changes in their mother’s body but may not remember from month to month
● Children aged 4 to 5 often enjoy listening to the fetal heartbeat and may show interest in the development of the fetus.
-School-age children (6 to 12) are usually enthusiastic and keenly interested in the details of pregnancy and birth
● Adolescent responses to pregnancy vary according to developmental level.
mental health difficulties with pregnancy adaptation
● Difficulty with taking on the maternal role, making the necessary transitions to parenthood, and mourning losses associated with the time before pregnancy
● Prenatal depression, maternal stress, and anxiety
● Rates of serious mental illness (MI) during pregnancy
● When assessing mood, emotional states, and anxiety, the nurse should consider these aspects: frequency, duration, intensity, and source
mental health nursing actions
assess adaption assess support/coping assess mood discuss expectations identify areas of concern referrals establish relationship
psychosocial adaptations to pregnancy complications
- pregnant woman may distance herself emotionally from the fetus
- Disequilibrium, feelings of powerlessness, increased anxiety and fear, and a sense of loss are all responses to the news of a pregnancy complication.
Response to pregnancy complications depends on:
● Pregnancy condition.
● Perceived threat to mother or fetus.
● Coping skills.
● Available support.
avoid crisis
Having a realistic perception of the event, adequate situational support, and positive coping mechanisms
increase the risk of crisis
Poor self-esteem, lack of confidence in the mothering role, and an inability to communicate concerns to health care providers and close unsupportive family members
Nursing actions for women with complications
Provide frequent and clear explanations let her ask questions asses and encourage support support coping mechanisms referrals
types of support
material-practical help emotional informational comparison-similar situation spiritual
social support benefits
● Attachment to infant and improved interactions with infant
● Compliance with health care regimen
● Improved functional status
● Improved coping with changes related to pregnancy
● Increased acceptance of new role in life
● Increased incidence of breastfeeding
● Reduced physical symptoms
● Reduced loneliness
● Reduced feelings of stress or a sense of concern
● Reduced postpartum depression
● Satisfaction with intimate relationships
nursing action- cultural care
enhance communication emphasize woman's strengths respect practices work with woman to change practice if harmful accommodate practices as appropriate identify family
midwives
Nurse-midwives are RNs with advanced training in care of obstetric patients.
Lay midwives- self taught to formal training
Direct-entry midwives are trained in midwifery schools or universities as a profession distinct from nursing.
