General

Physical and emotional health problems of pregnant women

Introduction

Pregnancy is one of the most critical and unique period in a woman’s life cycle. It is regarded as a “welcome event” for successful womanhood. A woman’s body changes dramatically during pregnancy; hence there is an array of physical and emotional health problems associated with pregnancy (Ahmed, 2011).

All women during pregnancy experience both emotional and physical problems. The physical complaints of nausea, vomiting, breast tenderness, and profound exhaustion common for many women in the first trimester may compound ambivalent feelings and lessen the initial excitement. There also tends to be a preoccupation with self and a concern for safety that encourages most women to seek obstetric services. From the moment conception is confirmed, apart from the physical problems experience the woman is faced with emotional problems (Lindheimer, 2009).

The woman begins to see the baby as an identity separate from herself and begins to feel responsible for the baby and think of herself in a maternal role. Some women feel passive or dependent and very sensitive to the attitudes and comments of others (Vinal, 2006). For most women, the feelings of ambivalence common to the first trimester tend to change to feelings of acceptance as the pregnancy progresses. At the conclusion of the second trimester, the pregnant woman has become aware of the child within her and begins the process of maternal attachment (Rubin, 2010).

Toward the end of pregnancy, a woman’s emotional state is different from that in the first or second trimester. Rofe, Blittner and Lewin (2011) conducted a study of 282 women and found that all women, to some degree, experience an approach/avoidance of conflict with regard to delivery. Women want the pregnancy to end, but fear of the birth process promotes anxiety. Maternal concerns focus on both self and baby, and women experience a heightened sense of vulnerability as a result of the enormous physical changes of the third trimester. Women often verbalize anxiety about the approaching labour, birth, and health of the infant, as well as concerns about their ability to mother and their partner’s love and support. Some women experience insomnia and/or vivid dreams (Reid & Garcia, 2007).

Conceptual framework

According to Newton (2005) pregnancy brings along with it many feelings, emotions, and experiences – many of them joyful, welcome, and wonderful. Some of the most prominent of the experiences of women during pregnancy are physical and emotional problems.

The most common physical changes during pregnancy as identified by Cohen (2009) are very difficult to hide from the outside world. As the foetus grows, so does the abdomen of the mother. This growth is noted from the fourth month through the end of the pregnancy for most women. The growth of the foetus in the abdomen creates physical changes in the interior of the body as well. As the baby grows larger, the foetus will spread up into the abdomen and down into the kidney area of the body. This growth causes the organs of the body to adjust into a smaller space. This adjustment can mean a reduced appetite, increased need to urinate, decreased lung capacity and lower back pain as the baby load on the back increases. The physical changes during pregnancy do not stop with the physical body, however. The hormonal changes and the blood capacity of the body also increase. The mother’s blood capacity will increase between 25% and 40% in order to adapt to the need for more blood by the vital organs. Baby is also fed by the blood of the mother (DeLee, 2013)

Rofe, Blittner and Lewin (2011) stated that while the hormonal changes in the body are often thought to be the cause of many emotional changes, there is another reason why pregnant women may feel a bit under the weather during and after the pregnancy. Many women grow attached to the attention the unborn foetus acquires during the pregnancy. This attention is for the baby, but the mother feels the effect of the attention just as strongly. After the baby is born, the attention continues to be on the baby, but mom is no longer holding the foetus and instantly becomes a secondary thought to baby. This is, by no means, a vindictive process, but mother’s often feel more depressed emotionally after the baby is born due to this change (Rofe et al., 2011).

Dealing with the emotional changes during pregnancy, including the possibility of post partum depression is something of obstetric importance. Emotional changes during pregnancy may include feeling uncomfortable with having a baby, feeling anxious about caring for the new baby and even negative emotions about the baby from time to time as sleep deprivation takes its toll on the new mother and father. The physical and emotional changes during pregnancy can also be linked. After the foetus is born, the mother’s hormones will return to normal levels. This can occur quickly and the mother may feel the changes of the reducing hormone levels by experiencing emotional distress. This distress can lead to post partum depression in some women (Dunbar, 2005).

Physical changes during pregnancy

During pregnancy, women experience several physical changes. Some of these changes include:

Nausea
Fatigue
Tender breasts
Food cravings
Heartburn and constipation

Nausea: Commonly referred to as ‘morning sickness’. Nausea can set in at any time as a result of increase in certain hormones and decrease in others and all this hoopla can cause you to feel a bit queasy (Lumley & Astbury, 2006).
Fatigue: Fatigue is another very common sign when a woman first becomes pregnant. The levels of progesterone soar, blood pressure decreases, blood sugar levels falls, and increased production of blood all have the ability to drain the woman’s energy and make her very uncomfortable (Leavitt, 2009).
Tender breasts: Due to the hormonal changes in a woman’s system the breast become tender, swollen, or sore. These conditions make the breast to have a feeling of tenderness (Wertz & Wertz, 2011).
Food Cravings: Increased craving for more food is a natural way to indicate the needs for certain vitamins or minerals (Rubin, 2010).
Heartburn and constipation: For pregnant women, food takes longer to reach the stomach and the stomach also takes longer to empty. This slower pace of digestion is helpful so that the baby can receive the nutrients from the food women eat during pregnancy and this can lead to heartburn or constipation (Gay, Edgil & Douglas, 2012).

Emotional changes during the pregnancy

Pregnancy, especially during your first trimester, brings with it a cluster of varied emotional states – all of which are completely and utterly normal. The woman feels exhilarated one day and anxious the next. The most common emotional changes that occur during pregnancyinclude:

Mood swings
Worrying/ anxiousness.
Fear
Forgetfulness
Weepiness
Body image issues
Nesting instinct

Mood swing: Mood swings happen throughout the period of pregnancy which should be effectively managed to ensure that the mood swing is get within control (Carr, 2013).
Worrying/ anxiousness: Worrying/anxiousness are natural worry about everything that comes along with being pregnant. The most common worries include worrying about the baby, labour, and the overall changes throughout the entire period of pregnancy (Reid & Garcia, 2007).
Fear: Fear is another common emotion during pregnancy. In the first trimester, a woman might be afraid of having a miscarriage or doing something that will affect her baby’s health; in her second trimester, she might start to question whether she will be a good mother and be frightened by the enormous responsibilities of caring for a newborn. By the end of her pregnancy, a woman might be scared of the pain of labour or that something could go wrong during delivery (Stotland, 2011).
Forgetfulness: Forgetfulness before and after birth may be a result of hormonal fluctuations, especially higher levels of progesterone, sleep deprivation or the stress of adjusting to a major life transition. There’s some evidence that the hippocampus, the part of the brain involved in memory, may change during pregnancy (Stotland, 2011).
Weepiness: Some women may find themselves crying over very little issues, bursting into tears after throwing up in early pregnancy, or getting misty eyed after looking at baby clothes. Women may cry more easily and frequently when they’re expecting and in the early stages of new motherhood because pregnancy involves a complex mix of emotions, and as humans, sometimes tearfulness is how our emotions come out. Also fluctuating hormone levels may contribute to crying spells (Vinal, 2006).
Body image issues: During the second and third trimesters, as a woman’s baby bump becomes more visible and she gains more weight, she may feel dissatisfied with her body and its appearance, and this may affect her self-esteem. Some pregnant women marvel at their rapidly changing bodies and feel radiant and vibrant, while others worry about the weight gain and regaining their figures after delivering. These changes to a woman’s looks, shape and perceived attractiveness may bring up a complicated mix of feelings (Cohen, 2009).
Nesting instinct: These involve social activities and preparations for motherhood, such as attending a baby shower, baby-proofing the house and decorating the nursery, which can all lead to a nesting instinct. Some women may feel a strong urge to cook, clean and organize during the third trimester as a way to mentally prepare for the major changes a new baby will bring and to feel more in control of the situation (Hodnett, Gates, Hofmeyer & Kakala, 2007).

Causes of physical and emotional problems during pregnancy

Physical and emotion changes are the most common side effects during pregnancy. These problems in the opinion of Gibbs (2008) are caused different changes that occur in body of the pregnant women or her inability to adjust to the environment. Some of these conditions are:

· Hormonal changes

· Stress

· Body changes and body image

· Fatigue

a. Hormonal changes: During pregnancy, women experience an increase in the production of hormones, such as progesterone and estrogen, depending on how far along they are in their pregnancy. This increase in hormones can have an impact on their emotions and the brain’s ability to monitor those emotions (Westdahl, 2007).

b. Stress: For many reasons, pregnancy can bring on additional stress. While starting a family is exciting and filled with a lot of joy, as pregnancy progresses you may be concerned about the changes it will bring. Pregnant women may find themselves concerned with the future, finances, housing, support, employment, and medical care. This stress can cause emotions to rise, and distract from self-care that may help better manage these emotions (Elbourne, Oakley & Chambers, 2009).

c. Body changes and body image: Some women may experience more physical discomfort during their pregnancy than others. As the body changes for the growing baby, women may experience many physical discomforts, from morning sickness to body aches. Body image issues may cause women to feel less physically attractive. Any of these things can impact both mental and physical health, which adds to stress and can cause a disruption in normal emotions (McKay, 2011).

d. Fatigue: Whether from discomfort or stress, many women may experience difficulty sleeping during pregnancy.Lack of sleep has been shown to have a profound impact on a person’s emotional state (Freda, 2013).

Consequences of physical and emotional problems during pregnancy

Pregnancy can be nerve-wracking; not only does it entail a lot of physical changes, but preparing to become a parent can take a lot out of a mother, emotionally and physically. Physical and emotional problems cause the body to release hormones in response to the threat that the body perceives – the higher the physical and emotional level, the more hormones the body produces. Since different people handle challenges differently, an overwhelming situation for one person may be easily managed by another (Mahan, 2008).

Harms (2014) stated that physical and emotional problems during pregnancy can lead to some very negative consequences which include:

Preterm labour and premature birth
Miscarriage
Low birth weight
Increased risk of infection
Increased risks of problems later on

Preterm labour and premature birth

There are lots of different reasons why babies are born prematurely, but many researchers believe that women who experience high levels of physical and emotional problems while pregnant are at high risk for experiencing a preterm birth. There is a reason why pregnancy is supposed to last 40 weeks – babies born before this often do not have fully formed organs. The earlier a baby is born, the greater risk the child has of experiencing anything from minor breathing problems to lifelong diseases such as cerebral palsy.

Physical and emotional problems normally cause our brains to secrete hormones, such as corticotropin-releasing hormone (CRH). In pregnant women, CRH also helps to regulate the length of a pregnancy, and the amount naturally rises near the end of the third trimester to stimulate contractions. Jordan (2014) stated that women who delivered prematurely not only had very high levels of CRH early on in pregnancy, but they also reported high levels of physical and emotional problems.

Miscarriage

Miscarriage is every pregnant woman’s nightmare (the loss of her baby) during pregnancy, known in the medical community as a “spontaneous abortion.” As with preterm labour, there are a host of reasons why some women experience miscarriages, and sometimes, there’s no explanation at all. However, there have been some studies indicating a link between miscarriage and high levels of physical and emotional problems, especially early in the pregnancy or just before conception. The CRH targets a type of cell called a mast cell, which secretes chemicals that cause allergic reactions. Apparently, one of these chemicals, tryptase, prevents the production of membranes to develop the embryo and disrupts the whole architecture of the placenta that feeds the baby (Wertz and Wertz, 2011)

Low birth weight

Birth weight is an important statistic. A baby is considered to be of low birth weight if he or she weighs less than 5 pounds, 8 ounces (2,500 grams) at 37 weeks. Some babies are just small and don’t have any problems associated with their size, but others have low birth weights because they experienced intrauterine growth restriction (IGR). This is a result of babies not getting adequate nutrition while in the womb. Babies with low birth weight are at greater risk for health problems like hypoglycemia (low blood sugar) and must be closely monitored to ensure that they are growing at a normal rate (Car, 2013)

A baby can have IGR even if the mother ate adequately while pregnant. Stress hormones such as epinephrine, norepinephrine and cortisol can all cause blood vessels to constrict, and this potentially includes the blood flow to the baby via the umbilical cord. In this case, the foetus may not be absorbing enough nutrients from the mother’s body. Often, the potential for low birth weight is identified in utero, and your doctor can suggest ways to change the behaviours that may be causing it – such as cutting down on your stress levels (Dunbar, 2005).

Increased risk of infection

In addition to directly causing problems during pregnancy, the hormones produced by stress can also weaken your immune system. People who are highly stressed are in a constant state of alert, but the burst of hormones like cortisol involved in the fight-or-flight response is supposed to be short-term. Chronic stress, however, can result in reduced numbers of cells that fight off viral and bacterial infections. The stress response can also cause the nervous system to secrete substances that bind to white blood cells (which defend the body from disease) and make them less effective. Pregnant women already have lowered immune systems, so physical and emotional problems have even more of an impact on them. This equals an increase in illnesses that the body would normally be able to fight off.

Often, pregnant women can’t take the same kinds of medications that would normally bring them quick relief when they’re sick, so illnesses can last longer or they’re more likely to have to suffer through some of the symptoms. Many different kinds of ailments can impact pregnancy, as well. In addition, pregnant women also can be more vulnerable to uterine infections when they have a compromised immune system. These may involve the placenta and amniotic sac and can be extremely dangerous (Gibbs, 2008).

Increased risks of problems later on

He further said that chronic physical and emotional problems during a pregnancy can result in issues that may not manifest until later in life. Physical and emotional problems may affect the development of the baby’s brain when the high levels of hormones cross into the placenta. These problems may be emotional, behavioural or physical. Physical and emotional problems in pregnant women, especially in the first trimester, may result in irritable, anxious babies.

Physical and emotional problems can also cause behavioural problems. And once the baby is born, the child may be more vulnerable to a wide array of stress-related issues. This can mean learning difficulties and slower development. It may even predispose the baby to diseases such as heart disease, obesity and type II diabetes, etc.

Measures to reduce physical and emotional problems during pregnancy

Measures to reduce physical and emotional problems during pregnancy, which include:

Self-care: During pregnancy, women are advised to listen to their body and mind and be aware of what they need. Listening to oneself and getting what is needed at any particular time can help to reduce the consequences of physical and emotional problems (Dick-Read, 2008).
Sleep: Getting 8 hours of good sleep daily can go a long way to improve physical and emotional state.While in some causes, this may not always be possible, women are advised to everything they can to get a healthy amount of sleep. This can include experiment with sleeping positions (Centre for Disease Prevention and Control, CDC, 2006).
Diet: Like sleep, what a pregnant woman eats is a great natural way to help with her mood and emotions. Eating healthy and natural foods, instead of processed foods, promotes both physical and mental health, which contributes to increased emotional stability (Jack, 2010).
Support: A supportive and encouraging group of people surrounding a pregnant woman is incredibly important during pregnancy. Making close family and friends aware of her emotions and having people to talk to when she feels overwhelmed is extremely helpful for her emotional health (Binstock & Wolde, 2005).

References

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Centre for Disease Prevention and Control (2006). Modern perspectives in psycho-obstetrics. New York: CDC.

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