10.3: Psychosocial Aspects of Pregnancy

Learning Objectives

By the end of this section, you will be able to:

• Explain psychosocial adaptations of the pregnant person and tasks during pregnancy
• Explain partner adaptations during pregnancy
• Explain sibling adaptations during pregnancy
• Explain extended family adaptations during pregnancy

Psychosocial adaptation to pregnancy involves many variables related to societal, family, personal, and cultural role expectations of the pregnant person and parenting. The adaptations start when the pregnancy is confirmed and are modified again when the pregnant person announces the pregnancy to family and society. Nursing care is centered on respect for the pregnant person’s needs, choices, preferences, beliefs, and values.

Psychosocial Adaptation to Pregnancy

Pregnancy initiates changes in a person’s social and family standing as the pregnant person faces new role and lifestyle expectations. The role of the birthing parent is expected to provide intense satisfaction and emotional fulfillment along with multiple societal and cultural expectations. The pregnant person’s acceptance of the role of the birthing parent is dependent on their feelings and attitudes toward these presumptions.

Reactions to Pregnancy

When a person is aware they are pregnant, several reactions can occur. Ambivalence is expected in the beginning of the pregnancy as the pregnant person goes from excitement about the new baby to concerns about finances and what effect(s) the baby is going to have on their lifestyle. A previous loss may also induce fear.

When a person first finds out they are pregnant and as they prepare for birth, the pregnant person may also be introverted. The actions of the introverted pregnant person focus on their own needs as they adapt to the physiologic changes of pregnancy and the growth and development of the fetus. The pregnant person’s introverted actions support a healthy pregnancy but often leave out the support system. For example, pregnancy increases fatigue, and the person may prefer to nap rather than socialize with others in the household. Acceptance of the pregnancy is usually apparent by the time the pregnant person feels the fetus move, around 16 to 20 weeks of gestation. Once fetal movement occurs, the pregnancy is validated, and the fetus is real.

Changes in the pregnant person’s body image occur throughout the pregnancy as the fetus grows and the pregnancy is maintained. The interpretation of the changes by the pregnant person fluctuate from feeling beautiful to feeling uncomfortable and awkward. Mood swings are also common during pregnancy. Occasionally the mood swings may be difficult for the pregnant person, the partner, and the family to understand. It is important for the nurse to communicate the normality of the variety of reactions to pregnancy when providing prenatal education and to inform the health care provider if the mood swings are extreme.

Developmental Tasks of Pregnancy

The research of Reva Rubin (1984) determined several psychosocial developmental tasks the pregnant person goes through to adapt to the pregnancy and the fetus, and to accept their new role as parent. The first developmental task of pregnancy is for the pregnant person to ensure safe passage of themselves and the fetus through the pregnancy, for example, by eating a balanced diet. The second task is acceptance of the pregnancy, the fetus as a member of the family, and the fetus as an individual. This can be demonstrated when announcing the pregnancy to family and friends. The third task is for the pregnant person to accept they are going to be a parent to the person growing in their uterus. Setting up the nursery demonstrates the third task. The fourth and final developmental task of pregnancy is for the pregnant person to accept that becoming a parent will involve putting the child first and meeting the expectations of a good parent. Going to an infant care class demonstrates the fourth task.

Factors Influencing the Pregnant Person’s Adaptation

Factors influencing the pregnant person’s psychosocial adaptation to their pregnancy are many and include their age, whether the pregnancy was intended, and body image. Who the other biological parent is, the relationship the pregnant person has with the other biological parent, and family support also affect psychologic adaptation to the pregnancy. The household environment and financial stability influence the psychologic adaptation to the pregnancy as well.

Age

Age is the first factor affecting a person’s adaptation to pregnancy. Adolescents are still trying to find their own sense of self. An adolescent who becomes pregnant is faced with extra developmental tasks as they face becoming a parent. Younger adolescents tend to hide their pregnancy, do not actively seek prenatal care, and often are unable to plan for the changes and developmental tasks of pregnancy and parenting. Many adolescents who become pregnant still live in their childhood household and face dual roles as dependents of their parents and as parents themselves. The other biological parent of the adolescent’s baby often provides minimal support or is absent, negatively affecting the pregnant adolescent’s adaptation to both the pregnancy and their upcoming role as parent.

The person who delays parenting until their career, relationships, and lifestyle are established is often in their late 30s or over 40 when they become pregnant. Infertility is also a cause of parenting after 35. The pregnancy is often planned in this age group, and the person is highly motivated to seek information on pregnancy and parenting. The most difficult developmental task of pregnancy for persons who are over 35 years of age and pregnant is adapting to their upcoming role of parent. The difficulty in adapting to their new role is associated with work and parenting stress and time conflicts (Nomaguchi & Milkie, 2020).

Pregnancy Plan

In the United States, the percentage of unplanned pregnancies is around 45 percent, with the highest incidence in pregnant persons who are low income or less than 100 percent of the poverty level (Guttmacher Institute, 2019). An unplanned or unintended pregnancy not accepted by the pregnant person is linked with psychologic stress during the pregnancy, postpartum depression, and lack of bonding with the newborn. Not bonding with the newborn negatively affects the psychosocial development of the child (Joas & Mohler, 2021).

Even a planned pregnancy may cause stress on the pregnant person and their partner. (Bjelica et al., 2018). The stress may be psychosocial or physiologic. Psychosocial stress can be related to the pregnant person’s career, finances, and integrating the newborn into the family structure. Physiologic stress is related to the pregnant person’s age, pre-existing medical conditions, or pregnancy spacing.

Perception of Body Image

A pregnant person’s acceptance of the changes in their physical appearance is linked to psychosocial adaptation to the pregnancy (Przybyła-Basista et al., 2020). A negative perception of a person’s body image during pregnancy is linked with depression during the pregnancy. As with nonacceptance of an unintended pregnancy, depression during the pregnancy is associated with a higher risk of poor psychosocial development in the child.

Partner Support

Strong support by the pregnant person’s partner during pregnancy is associated with higher psychosocial adaptation to the pregnancy. Research indicates the stronger the support system surrounding the pregnant person, the more successful the pregnant person is at achieving all the developmental tasks of pregnancy and adapting to parenting (Atif et al., 2023). With the changes in the structure of families today, the person supporting the pregnant person is not always the other biological parent of the fetus.

Economics

The income of the household and the physical environment in which the pregnant person lives also influence the psychosocial adaptation to pregnancy (Eick et al., 2020). Low income and poor living conditions increase stress during pregnancy and decrease the psychosocial adaptation of the pregnant person. It is difficult for the pregnant person to focus on prenatal care or take time off from work for appointments when they are worried about their next meal or if the electricity is going to be turned off.

Incarceration

Incarceration of the pregnant person or their support partner has a negative impact on the psychosocial adaptation of the pregnant person (Sapkota et al., 2022). Financial stress and lack of support occur when the partner of the pregnant person is incarcerated. When the person who is incarcerated is pregnant, psychosocial adaptation to the pregnancy is hindered by a loss of control and power. The inability to obtain consistent prenatal care and adequate nutrition, along with the lack of a support system, hinders the pregnant person’s ability to achieve the developmental tasks of pregnancy while incarcerated. Prisons are working to provide better care for pregnant and postpartum persons (as required by the Eighth Amendment of the Constitution). Prison nursery programs are becoming more common (Dodson et al., 2019).

Intimate Partner Violence

Pregnancy is a trigger for intimate partner violence (IPV) to begin or worsen in some relationships. The number of perinatal deaths (by homicide or suicide) of pregnant persons who are victims of IPV is higher than the rate of perinatal death of pregnant persons who experience preeclampsia and gestational diabetes combined (Modest et al., 2022). Nursing care in the prenatal period now includes screening for IPV more than once during the pregnancy and each time a pregnant person is triaged or admitted to a hospital. Developing a trusting relationship with the pregnant person aids in asking these personal questions.

Military Service

Active military personnel who are pregnant can be deployed in noncombat roles. Deployment separates the pregnant person from their family, changing the support system and increasing stress. When the pregnant person’s partner is deployed, the support system changes as well. If the pregnant person lives on base, community support may substitute for the geographic absence of the partner and other family support and may increase acceptance of the pregnancy. This substitution has a positive effect on the psychosocial adaptation to the pregnancy.

Nursing Assessment of Psychosocial Adaptations to Pregnancy

The expected emotional lability of pregnancy often hides poor psychosocial adaptation to pregnancy. The perinatal period is associated with a higher risk of a new diagnosis of psychiatric illness, especially anxiety and depression (ACOG, 2018). The nurse needs to be vigilant in assessing the pregnant person at each prenatal visit for signs of stress. Several screening tools are available for the nurse to complete at various weeks in the pregnancy. The Perceived Stress Scale (PSS) and Prenatal Psychosocial Profile (PPP) are two screening tools. The content of the tools focuses on self-esteem, history of psychiatric counseling, feelings about the pregnancy, family violence, and partner and family support during the pregnancy (Solivan et al., 2015).

Nursing Assessment of Cultural Influences on Pregnancy

The culture of the pregnant person influences their acceptance of and adaptation to the pregnancy. Cultural beliefs and practices related to pregnancy encompass role expectations of the pregnant person and their support person(s); dietary preferences and restrictions; health promotion practices; religious preferences; and pregnancy, labor, and birth practices. When gathering cultural data on the pregnant person, the nurse should respect the pregnant person’s beliefs, values, and behaviors. Other actions by the nurse demonstrating cultural awareness include listening to the pregnant person, providing nonjudgmental care within an environment of trust, discovering religious and spiritual influences on pregnancy and birth expectations, and understanding the pregnant person’s family dynamics.

Partner Adaptation to Pregnancy

The partner of a pregnant person also goes through a series of developmental tasks (Atif et al., 2023). When the pregnancy is first announced, the partner may be enthusiastic. Congratulations are received and acknowledged, and there is an atmosphere of celebration. As the weeks of the pregnancy go by, the partner may become less interested in the pregnancy and may not appear to place the pregnant person first. The pregnant person interprets the partner’s lack of interest as a form of rejection. As the due date approaches, the partner becomes focused on the pregnancy again and begins to plan for the upcoming birth.

Factors influencing the partner’s adaptation to the pregnancy include the perceived closeness of the relationship with the pregnant person. If the partner feels secure in the relationship, the partner adapts to the pregnancy and their upcoming role as parent. The final result is that the partner and the pregnant person are more sensitive to their newborn (Atif et al., 2023).

Partners may also exhibit couvade syndrome and take on the symptoms associated with pregnancy. There is no physiologic explanation for the symptoms (Mrayan et al., 2019). Common symptoms exhibited include nausea, fatigue, weight gain, and indigestion.

There may be times when the biological parent does not accept the pregnancy. Lack of acceptance is associated with decreased or no support provided to the pregnant person (Atif et al., 2023). The nurse needs to investigate if other support persons are present for the pregnant person and provide referrals for counseling when indicated.

Sibling Adaptation to Pregnancy

Sibling adaptation to the pregnancy and upcoming birth is dependent on the age of the child and the child’s perception of the impact the new member of the family will have on them (Dağcıoğlu, 2018). If the sibling feels as if they are being replaced, the pregnant person and other members of the household need to be aware. When appropriate, the nurse should assess the pregnant person’s inclusion of the sibling in the preparation for the newborn. Sibling participation in a prenatal class or tour is one way to promote sibling adaptation. The nurse can provide guidance on prevention of sibling regression or aggression by emphasizing the importance of a loving and nurturing environment within the home. An example would be to discourage parents from taking toys from the older child to give to the new baby.

Extended Family Adaptation to Pregnancy

The extended family of the pregnant person can consist of people who live in the same household, people related by blood (such as grandparents, siblings, and cousins), friends, and support persons of the pregnant person. Each extended family member will be affected by the addition of the newborn and needs to prepare for changes. The nurse can assist the extended family members’ adaptation by assessing their knowledge of newborn care and their expectations of their role in assisting the pregnant person in caring for the newborn. Preparation is important in acceptance of the newborn, and nurses can encourage and educate the extended family in supporting the growth and development of the family as they adapt to this new person.