Caring for Pregnant Women

Why is Mentors-Offering-Maternal-Support (M-O-M-S) important?

Close-up of a baby's face wearing a knit beanieObtaining 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

Over the shoulder of a woman on a video call with several mentor womenPhysiologic 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
  • Image of a soldier greeting his child in a groupFemale 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