9.12 Family Adaptation to Pregnancy

Psychosocial adaptation to pregnancy by the mother, her partner, and other family members is affected by societal, family, personal, and cultural role expectations of a pregnant client and parent. These adaptations begin when the pregnancy is confirmed and are modified when the pregnant client announces the pregnancy to family, friends, and society. Nursing care focuses on respect for the pregnant client’s needs, choices, preferences, cultural beliefs, and values.

Maternal Tasks of Pregnancy

The psychological work of pregnancy has been grouped into four maternal tasks based on classic work published by Rubin^[1]:

• Seeking safe passage for herself and the baby through pregnancy, labor, and childbirth
• Securing acceptance of the baby and herself by her partner and family
• Learning to give of herself
• Developing attachment and interconnection with the unknown child

Each of these tasks is discussed in the following subsections.

Seeking Safe Passage

Seeking safe passage for oneself and one’s baby is the woman’s priority task. If safety is not assured, she cannot move on to adapting to the other tasks. Behaviors that ensure safe passage include seeking care from an OB physician or nurse-midwife and following recommendations about nutrition, vitamin supplementation, prenatal care, and abstaining from substance use. In addition to following the advice of health care professionals, the pregnant woman also follows cultural beliefs and practices that ensure the safety of herself and the infant.

Securing Acceptance

Securing acceptance is a process that continues throughout pregnancy. It involves reworking relationships so that important persons in the family accept the woman in the role of mother and welcome the baby into the family. In couples experiencing their first pregnancy, the woman and the father of the baby must give up their exclusive relationship and make room in their lives for a child. When the woman’s partner expresses pride and joy in the pregnancy, the woman feels valued and comforted.

Learning to Give of Oneself

Giving is one of the most idealized components of motherhood but one that is essential. Learning to give to the coming infant begins in pregnancy when the woman allows her body to give space to the fetus. Pregnant women also learn to give by receiving. Gifts received at baby showers are more than needed items to care for the infant but also confirm interest and commitment from friends and family that enhance the woman’s ability to give. Intangible gifts from others, such as companionship, attention, and support, help increase the mother’s energy and affirm the importance of giving.

Committing Oneself to the Unknown Child

Developing attachment (i.e., strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts the idea that she is pregnant, although the baby is not yet real to her. During the second trimester, the baby becomes real as quickening occurs or an ultrasound shows recognizable parts of the baby and feelings of love and attachment surge. Mothers describe unique characteristics of the fetus with regard to sleep-wake cycles, temperament, and communication and may report feedback from their unborn infants during the third trimester. Love of the infant becomes possessive and can lead to feelings of vulnerability. The woman integrates the role of mother into her existing image of herself. She becomes comfortable with the idea of herself as mother and finds pleasure in contemplating the new role. Some women delay attachment to the fetus until they feel sure the pregnancy is normal and will continue. This is especially true for women who have previously lost a pregnancy.

Partner Adaptation

Partners of pregnant clients also must make major psychosocial changes to adapt to their new role. These changes may be more difficult because attention is focused on the pregnant client. The partner’s anxieties and concerns may remain unknown because of the lack of focus on the partner’s experience. These include anxiety about the health of the mother and baby, financial concerns, and worry about his role during the birth and about the changes that will result from the birth of the baby.

Readiness for parenthood may be impacted by a stable or unstable relationship between the partners, financial security, and a desire for parenthood. Additional factors may include the partner’s relationship with their own father, their previous experience with caring for infants and children, and their confidence in the ability to care for the infant.

The developmental processes that an expectant partner must work through include dealing with the reality of pregnancy and the new child, working to be recognized as a parent, and making an effort to be seen as relevant to childbearing and parenting.

The term couvade refers to pregnancy-related symptoms and behavior in an expectant partner. In primitive cultures, couvade took the form of rituals involving special dress, confinement, limitations of physical work, avoidance of certain foods, sexual restraint, and, in some instances, performance of mock labor. In modern practice, expectant partners sometimes experience physical symptoms similar to those experienced by the pregnant woman, such as loss of appetite, nausea and vomiting, headache, fatigue, and weight gain. Symptoms are more likely to occur in early pregnancy and diminish as the pregnancy progresses and may be caused by stress, anxiety, or empathy for the pregnant partner. They are usually harmless but may persist and result in nervousness, insomnia, restlessness, and irritability. Nurses provide anticipatory guidance to the partner regarding the pregnancy, labor and delivery, and infant care.^[2]

Grandparent Adaptation

The initial reaction of grandparents depends on a number of different factors, including age, number, and spacing of other grandchildren. Age can impact the emotional response of prospective grandparents. Older adults who have adapted to their feelings about aging may react with joy when they find that they are to become grandparents, but younger grandparents may need to resolve their self-image with the stereotype of grandparents as old people. They may have existing family and career responsibilities that can impact their accessibility to help care for the new infant because of the continuing demands of their own lives. The number and spacing of other grandchildren can also impact grandparents’ reactions. The first grandchild may be an especially exciting event that creates great joy, but the birth of additional grandchildren may be welcomed with less excitement. Nurses can provide anticipatory guidance to the pregnant client or partner about reasons for possible subdued reactions by grandparents to the announcement of pregnancy.^[3]

Sibling Adaptation

Sibling adaptation to the birth of an infant depends largely on the child’s age and developmental level.

Toddlers

Children two years or younger are unaware of the maternal changes that occur during pregnancy and are unable to understand that a new brother or sister is going to be born. Because toddlers have little perception of time, many parents delay telling them that a baby is expected until shortly before the birth.

The nurse can make suggestions about helping prepare young children for the birth and what to expect from toddlers when the new baby comes home. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby. Parents need to realize that toddlers may have feelings of jealousy and resentment when they must share attention with a baby. Frequent reassurances of parental love and affection are of primary importance.

Older Children

Children from 3 to 12 years are more aware of changes in the mother’s body and may realize a baby is to be born. They may enjoy listening to the heartbeat or feeling the fetus move. Questions about how the fetus develops, how it started, and how it will get out of the abdomen are common. Younger children may expect that the infant will be a full-fledged playmate, however, and are shocked and disappointed when the infant is small and helpless. They also need preparation for the fact that the mother will be away from home when the baby is born.

School-aged children benefit from being included in preparations for the new baby. They are interested in preparing space and supplies for the infant. They should be encouraged to feel the fetus move, and many come close to the mother’s abdomen and talk to the fetus. School-aged children may wonder how the birth of the baby will affect their role in the family. Parents should address these concerns and reassure the children about their continued importance. Providing books about children’s experiences after the birth of a sibling may be helpful.^[4]