PSYCHOLOGICAL TASKS OF

PREGNANCY
 FIRST TRIMESTER:
ACCEPTING THE
PREGNANCY
 THE WOMAN
 ACCEPT THE REALITY OF
THE PREGNANCY
 SPEND TIME
RECOVERING FROM
SHOCK OF LEARNING
THAT SHE IS PREGNANT
AND CONCENTRATE ON
WHAT IT FEELS LIKE TO
BE PREGNANT
 AMBIVALENCE –
FEELING BOTH
PLEASED AND NOT
PLEASED ABOUT
THE PREGNANCY
SECOND TRIMESTER:
ACCEPTING THE BABY
 ACCEPT THAT SHE IS
HAVING A BABY
 GROWING ABDOMEN AND
FLUTTERING FETAL
MOVEMENTS HELP TO
MAKE THE PREGNANCY A
REALITY
 MOVE THROUGH EMOTIONS
SUCH AS NARCISSISM AND
INTROVERSION AS THEY
CONCENTRATE ON WHAT IT
WILL FEEL LIKE TO BE A
PARENT
 ROLE PLAYING AND
INCREASED DREAMING ARE
COMMON
THIRD TRIMESTER: PREPARING
FOR PARENTHOOD
• USUALLY BEGIN “NEST-
BUILDING” ACTIVITIES
– PLANNING SLEEPING
ARRANGEMENTS
– BUYING CLOTHES
– CHOOSING NAMES FOR THE INFANT
– ENSURING SAFE PASSAGE –
LEARNING ABOUT BIRTH
 GROW IMPATIENT WITH
PREGNANCY AS THEY
READY THEMSELVES FOR
BIRTH
EMOTIONAL RESPONSES
TO PREGNANCY
 AMBIVALENCE
 wanting to be pregnant,
yet may not be enjoying it
 interwoven feelings of
wanting and not wanting
that can exist at high levels
 GRIEF
 before a woman can take on a
mothering role, she has to
give up or alter her present
role
 incorporate new role as
mother into her other roles as
daughter, wife or friend
 NARCISSISM
 self – centeredness
 does things to
unconsciously protect
her body consequently
her baby
 INTROVERSION VERSUS
EXTROVERSION
 turning inward to concentrate
on oneself and one’s body
 more active, appear healthier
than ever before and are more
outgoing
 BODY IMAGE AND
BOUNDARY
 the way the body appears to
oneself
 a zone of separation one
perceive between oneself and
objects or other people
 STRESS
 pregnancy can be a source of
stress
 COUVADE SYNDROME
 men experience physical
symptoms such as nausea,
vomiting and backache which
result from stress, anxiety and
empathy for pregnant women
DIAGNOSIS OF
PREGNANCY
 Officially diagnosed on the
basis of the symptoms
reported by the woman
and the signs elicited by a
health care provider
PRESUMPTIVE SIGNS
 least indicative of pregnancy,
taken as single entities, they
could easily indicate other
conditions
 largely subjective –
experienced by the woman but
cannot be documented by an
examiner
SUBJECTIVE
 AMENORRHEA
 absence of
amenorrhea
 suppression of FSH by
rising estrogen
 NAUSEA AND VOMITING
 morning sickness
 severe protacted vomiting –
hyperemesis gravidarum
 systemic reaction to
increased estrogen levels
and decreased glucose levels
 BREAST SENSITIVITY
 feeling of tenderness,
fullness, or tingling because
of increased stimulation of
breast tissue by high
estrogen levels
 enlargement and
darkening of areola
 URINARY FREQUENCY
AND URGENCY
 sense of having to void
frequently because of
increased level of
progesterone
 bladder irritability, nocturia
 LASSITUDE AND
FATIGABILITY
 listlessness and fatigue
after only slight exertion
 general feeling of
tiredness
CONSTIPATION
 appears early and
may persist
throughout
pregnancy
• WEIGHT GAIN
– rapid weight gain is not
associated with early
pregnancy
• FINGERNAIL CHANGES
– sixth week some women
notice thinning and
softening of the nails
 QUICKENING
 first recognition of fetal
movements
 fluttering movements
 SIGNS
 ELEVATION OF BASAL BODY
TEMPERATURE
 noted persistent temperature
elevation spanning 3 weeks since
ovulation
 body temperature increases slightly
because of the secretion of
progesterone from the corpus luteum
• SKIN CHANGES
– pigmentation is caused by the
anterior pituitary hormone
melanotropin which increases
during pregnancy
– facial melasma – chloasma or
mask of pregnancy after 16th
week
– darkening of the nipples, areola
and vulva
–
linea nigra – abdominal skin at
the midline becomes markedly
pigmented, assuming a
brownish-black color
– striae gravidarum – reddish,
slightly depressed streaks and
fade to glistening, silvery lines
 EPULIS AND BLEEDING
GUMS
 hypertrophy of the gingival
pappilae
 Gingival granulomas may
develop as a result of dental
calculus or infection
 BREAST CHANGES
 include enlargement,
prominence of veins
 UTERINE
ENLARGEMENT
 because of growing uterus
 uterus can be palpated
over symphysis pubis
PROBABLE SIGNS
 can be documented by the
examiner
 more reliable than
presumptive signs, they
are still not positive or true
diagnostic findings
• serum laboratory tests
– based on detecting the
presence of human
chorionic gonadotropin
(hcG), a hormone created
by the chorionic villi of
the placenta, in the urine
or blood serum
 CHANGES IN
INTERNAL GENITALIA
AND PELVIS
 leukorrhea – white or
slightly gray mucoid
discharge with a faint
musty odor
chadwick’s sign or
jacquemier’s sign
 cyanosis or bluish
discoloration of the
vagina
 color change of the
vagina from pink to violet
• goodell’s sign
– softening of the cervix
– increased vascularity and
edema
• hegar’s sign
– softening of the isthmus
of the uterus (7 wk)
th
• Ladin’s sign
– softening of the cervical-
uterine junction (5 or 6
th th

wk)
• McDonald’s sign
– easy flexion of the fundus
on the cervix (7 – 8 wk)
th th
 Braun von Fernwald’s sign
– softening and slight
fullness of the fundus near
the area of implantation
 Piskacek’s sign – soft
lateral bulge with cornual
implantation (8 wk)
th
• sonographic evidence of
gestational sac
• characteristic ring is evident
• ballottement
– when lower uterine segment is
tapped on a bimanual
examination, the fetus can be
felt to rise against abdominal
wall
 braxton hick’s contractions
 periodic uterine tightening
occurs
 contractions of muscles of
abdominal wall
 fetal outline felt by examiner
 fetal outline can be palpated
through abdomen
POSITIVE SIGNS
 Demonstration of a fetal
heart separate from the
mother’s
 ultrasonographic
determination of fetal heart
beat as early as 6th to 7th wk
 fetal movements felt by
the examiner
 felt by the woman as early
as 16 – 20 wks
 felt by the examiner is
more reliable by 20 to 24
th th

wk
 visualization of the fetus by
ultrasound
 by 8th week, fetal outline can
be seen clearly within the sac
that the crown-to-rump
length can be measured to
establish the gestational age
of pregnancy