Caring for Pregnant Women
Why is Mentors-Offering-Maternal-Support (M-O-M-S) important?
Obtaining a New Identity
- Pregnancy is a period of preparation and profound change
- Pregnancy includes a progressive – systematic process involving cognitive/behavioral and physical changes
- Combination of nature and nurture
- Maternal individual influences are incorporated by the fetus
Fetal “Staging Period” for Later Life
Historical views of pregnancy and fetus
- Passive incubator
- Fetus impervious to external influence (safely sealed away)
- Fetus perfect parasite (skimming nutrients)
More recent views/understanding of pregnancy and fetus
- Fetus affected by:
- Maternal health (includes emotional)
- Maternal diet
- Maternal weight
- Maternal exercise
Physiologic Effects of Prenatal Anxiety/Stress
- Systems responsible for reproduction, growth, and immunity ALL linked to stress system
- Sustained stress activates maternal neuroendocrine stress axis – see higher fetal plasma CRH levels
- Maternal-origin CRH reaches fetal brain affects fetal learning and memory functions
- Fetal exposure to increased glucocorticoids can retard growth (maternal anxiety/stress and undernutrition)
- Increased cortisol inhibits fetal development (maternal anxiety/stress and depression)
Long-term Physiologic Effects of Prenatal Anxiety/Stress
- Altered neurodevelopment – cognitive and intellectual capabilities
- Decreased “working memory” (at 8 yrs)
- Inattention and hyperactivity
- Increased mental disorders
How Much and What Kind of Prenatal Anxiety/Stress
- Major life events (death of a family member)
- 1.4 – 1.8 times greater risk of preterm birth
- Catastrophic community-wide disasters (earthquakes, terrorist attacks)
- 6 of 9 studies showed significant effects on gestational age or preterm birth
- Chronic stress (general strain, homelessness, household strain, neighborhood stress)
- Predicted preterm birth
- Pregnancy-specific anxiety/fears (most significant)
- Significant effect on both timing of birth and birthweight
- Depressive symptoms/mood
- Decreased fetal growth and birthweight and increased preterm birth
Pregnancy Fears
- Is it the right time to have a baby?
- Will I be a good mother?
- Do I have time to be a mother?
- Do I/we have the financial resources to support a child?
- Will I be able to carry and have my baby?
- Will I or the baby be harmed in childbirth?
- Will I be able to lose the pregnancy weight?
- Will I be able to maintain control of my body and emotions in labor?
Pregnancy-Specific Anxiety (Maternal Adaptation Theory)
- Acceptance of pregnancy
- Identification with a motherhood role
- Relationship with spouse/partner
- Relationship with mother
- Preparation for labor
- Fear of pain, helplessness or loss of control in labor
- Well-being of self and unborn baby in labor
Dimensions of Prenatal Anxiety
- Acceptance of Pregnancy
- Planned and wanting the pregnancy vs. ambivalence, body changes, timing
- Identification with a Motherhood Role
- Motivation for motherhood, envisioning oneself as a mother, anticipating future as mother
- Relationship with Mother
- Availability of the grandmother, reactions to the pregnancy, respect for daughter’s autonomy
- Relationship with spouse/partner
- Availability, empathy, cooperativeness, trustworthiness, adjustment to new role
- Preparation for Labor
- Thinking vs. avoidance, congruence between fantasy vs. reality, doubts/fears, level of confidence
- Fear for Pain and Loss of Control in Labor
- Loss of control of body and/or emotions, ability to trust nursing and medical staff, attitudes towards use of medication
- Well-being of Self and Baby
- 1st trimester – focus on herself
- 2nd trimester – focus increasingly on unborn child
- 3rd trimester – concern for self and baby; well-being tied to body-image and completeness of baby
Female military beneficiaries make up 58% of those receiving military medical care (includes Active duty, retirees, eligible family members)
- Maternal conditions (pregnancy and pregnancy complications) account for 25% of all direct care bed days within the military healthcare system
- 50% of the pregnancies are unplanned – prenatal anxiety and depression are increased with unplanned (particularly unwanted) pregnancies
- Military readiness and morale are intricately linked.
- Well-being of the military family tied to military readiness and morale