Maternal Mental Wellbeing During Pregnancy, Birth, Postnatal

Period and Infant Development

Cut Meurah Yeni

Fetal Medicine Unit, Department of Obstetric and Gynecologic Zainoel Abidin General Hospital

Syiah Kuala University, Banda Aceh , Indonesia

Keywords : Mental, Pregnancy, Post Natal Period, Infant.

Abstract : The “transitional to parenthood” focuses on the emotional and social changes that happens during pregnancy

and childbirth, and recognizing that this is a stressful time which involves both men and women as a

parents. Pregnancy and childbirth are developmental phases in the family life cycle with attendant

physiological changes and stresses. The physiological processes such as abdominal enlargement or the

surplus of innervation that changes circulation of the blood, all constitute an added physical strain that

naturally must extend to the psychological sphere. This paper provides evidence about the impact of the

mother’s emotional wellbeing during her pregnancy until delivery and the transition to parenthood. The

acceptance level in every single woman is vary depending on the readiness to become a mother and her

emotional responses. Evidence from a range of disciplines highlights the importance of supporting women.

in the transition to parenthood so that they can provide the warm sensitive relationships that babies need for

optimal development.

1 NTRODUCTION

Pregnancy and childbirth are developmental phases

in the family life cycle with attendant physiological

changes and stresses. This paper provides evidence

about the impact of the mother’s emotional

wellbeing during her pregnancy until delivery and

the transition to parenthood. The acceptance level in

every single woman is vary depending on the

readiness to become a mother and her emotional

responses. The transition being a parent usually

difficult and will often involve the loss of

management and disruption to

relationships.(Huntley, Araya and Salisbury, 2012;

Phan et al., 2019)

Bonding starts before conception and its quality

is at play behind all and any relationship we build to

establish with ourselves, others and life. Skin-to-skin

contact between mother and baby immediately

postnatal reduces crying, improves mother-infant

interaction, keeps the baby warm, and also the

further tactile, exteroception and thermal cues could

stimulate babies to initiate breastfeeding more

successfully. Evidence from a range of disciplines

highlights the importance of supporting women. in

the transition to parenthood so that they can provide

the warm sensitive relationships that babies need for

optimal development.(Underdown and Barlow,

2012; Abdollahi et al., 2016; Xavier, Benoit and

Brown, 2018)

2 THE COMMON

PSYCHOLOGICAL PROBLEMS

DURING PREGNANCY

The “transitional to parenthood” focuses on the

emotional and social changes that happens during

pregnancy and childbirth, and recognizing that this is

a stressful time which involves both men and women

as a parents. Pregnancy and childbirth are

developmental phases in the family life cycle with

attendant physiological changes and stresses. The

physiological processes such as abdominal

enlargement or the surplus of innervation that

changes circulation of the blood, all constitute an

added physical strain that naturally must extend to

the psychological sphere. Personal women’s

developmental experiences, current life situation and

ability to adapt are the key role for the severity of

the problems.(Huntley, Araya and Salisbury, 2012)

276

Yeni, C.

Maternal Mental Wellbeing During Pregnancy, Birth, Postnatal Period and Infant Development.

DOI: 10.5220/0008792702760279

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 276-279

ISBN: 978-989-758-438-1

 2020 by SCITEPRESS – Science and Technology Publications, Lda. All r ights reserved

The acceptance level in every single woman is

vary depending on the readiness to become a mother

and her emotional responses. If the woman sees her

pregnancy from negative perspective, she may think

that herself as unattractive, vulnerable and

uncomfortably dependent on other. This attitudes

likely to give more anxiety and irritability which will

affect the feotus.(Phan et al., 2019)

Persistently high levels of stress hormones from

feeling such as anxiety and irritability such as

cortisol, are known to have damaging effects on the

development of neural pathways in the fetal brain.

Two primary systems that mediate the influence of

women’s moods throughout maternity square

measure the involuntary systema nervosum and

system. For example, Elevated/chronic sympathetic

nervous system activation increases release of

catecholamines and vasoconstriction which

increasing catecholamines levels will increases

maternal vasoconstriction and blood pressure and

eventually vasoconstriction alters utero-placental

blood flow reducing element and calorie intake to

the vertebrate influencing foetal Central systema

nervosum development.(Xavier, Benoit and Brown,

2018)(Phan et al., 2019)

The birth of a baby will generally place stress on

a relationship given the big changes that such an

addition to the family brings. The transition being a

parent usually difficult and will often involve the

loss of management and disruption to relationships.

Most parent can deal with this life changes such as

tiredness to take care of the baby that sometimes will

affect sexual desire, until everything are under

controlled.(Abdollahi et al., 2016)

2.1 The Mother’s Emotional Changes

During Pregnancy

Most women are aware of the enormity of the

change that is about to befall them, and are aware

that they are more prone to anxiety and worry and

more emotional than they were before the

pregnancy. There are inevitable feelings of

responsibility, or apprehension, and a sense of

embarking upon a voyage into the unknown, with

consequent alterations in emotional and cognitive

state that change as the pregnancy progresses.

(The

Royal College of Midwives, 2012)

In the beginning of pregnancy, the woman is

now in a state of 'being pregnant'. Her mood is

related to either the joy or upset at being pregnant,

and also very much related to how distressing she

finds the common problems of fatigue and nausea.

Tearful- ness and irritability are quite common. For

those women who have had a previous miscarriage

or a threatened miscarriage in the current pregnancy,

it may be a particularly anxious time. It is quite

common for women not to 'trust' their pregnancies

until they are well established, and to avoid

informing other people or making preparations for

the birth until they are convinced that the pregnancy

is viable.(Period and Revisited, 2012)

In the second trimester, the woman begins to

'expect a baby'. Fetal movements and her visible

expansion makes the developing baby an increasing

reality. It becomes personalized and many women

name and talk to their fetuses and worry about them

in a highly personalized way. Generally, women feel

both physically and emotionally well during this

stage of their pregnancy. They have to rely upon

professionals and their technology to tell them how

their baby is progressing, as most of the

complications of pregnancy are symptom-free in the

mother. This inevitable reliance upon professionals

can bring about a distressing feeling of a loss of

personal control, or autonomy, compounded by busy

and impersonal antenatal clinics, and rarely seeing

the same doctor twice. All women are anxious and

worried to a greater or lesser extent about the well-

being of their developing fetus. It is important that

they should receive adequate information as well as

reassurance at all times, but particularly about the

purpose and results of investigations no matter how

routine they may be to the clinician ordering them.

During this stage and continuing throughout the

pregnancy and puerperium, women easily become

guilty. They are likely to attribute any adverse event

in their pregnancy to their own lifestyle, personal

habits or emotional state.(Letourneau, Tramonte and

Willms, 2013)(Bildircin et al., 2014)

In the last trimester, the women's coping

resources are relatively diminished and they will

find it more difficult than normal to manage major

upheavals in their family life and events such as

moving house. During the last months of pregnancy

the anxiety and apprehensions begin to subside. As

the survival of the baby becomes assured, she

becomes increasingly impatient with the pregnancy

and wishes for delivery. Emotionally she slows

down, with a tendency to withdraw socially,

becoming increasingly preoccupied with preparing

for the baby, although she remains easily moved to

tears. During this last month to two weeks, her

concentration, recent memory and new learning

ability decline slightly and difficulty in sleeping is

common. This, together with day-dreaming, an

increasing absorption in the forthcoming birth and

physical discomfort, may lead to intellectual tasks

Maternal Mental Wellbeing During Pregnancy, Birth, Postnatal Period and Infant Development

277

becoming more difficult. This may be of importance

if the woman has high expectations of working in

intellectually very demanding positions right up to

the point of delivery, or if she intends to undertake

difficult tasks during maternity leave.(The Royal

College of Midwives, 2012)

2.2 The Doctors and Midwives

Responsibility in Supporting

Maternal with Mental Health

Problems

In this area doctors and midwive has the

responsibility so support maternal with mental

problem. Support and encourage psychological

adjustment to pregnancy, childbirth, breastfeeding

and parenthood are essential in antenatal care.(The

Royal College of Midwives, 2012)(Huntley, Araya

and Salisbury, 2012)

 Doctors and midwives has to promote

awareness of all the changes that might be

happen during pregnancy, childbirth and

postnatal period.

 Monitor the progress of pregnancy to ensure the

maternal - feotus health and wellbeing.

 Build a trusting relationship with the patient is

required since it is essential in antenatal care

giver

 Provide the patient with information which

might be useful for informed decision

It is the responsibility of the care giver such as

midwives or community nurses, to look for every

woman in the environment that need health

assistance and must be followed up to make them

come back to the health provider. Women who do

not look for health care at the right time may be at

higher risk of developing pregnancy complication.



3 BIRTH – SUPPORTING

BONDING

This section focuses expressly on the birth and

particularly the parents’ experiences of the birth and

therefore the impact of traumatic birth experiences

on the developing relationship with the baby. It

conjointly examines the proof regarding the

importance of ‘bonding’ and what midwives will do

to push the first maternal-infant relationship.

Bonding starts before conception and its quality

is at play behind all and any relationship we build to

establish with ourselves, others and life. A prime

quality bonding is predicated on immediate response

to the unborn baby’s primal needs. Otherwise the

baby feels lonely, neglected or abandoned, in

despair, loses contact of his true identity,

disconnected from his internal rhythm, etc., and a lot

of healing work needs to be done to re-establish the

balance lost. Women's emotional experiences during

childbirth are so varied that it is difficult to make

generalized statements. However, no matter how

well prepared the woman is, the experience of first

delivery must always come as something of a shock.

It can take place in the middle of the night, usually

in the unfamiliar surroundings of a hospital, and in

the company of professionals who the woman will

not have met before. No matter how well rehearsed

in antenatal classes, the physical sensations of labour

are powerful, uncomfortable and strange.(Van Der

Waerden et al., 2015)

All women will be in a high state of arousal and

it is very common for women to feel depersonalized

(as if it is happening to somebody else) or derealized

(in that everything around them seems strange and

unfamiliar). They may be successfully coping with

the first stage of labour with the help of the exercises

they have been taught, only to find the sudden

transition from first to second stage produces

alarming and unexpected sensations, frequently

producing transient episodes of panic and fear of

losing Control

(Huntley, Araya and Salisbury, 2012)

Unfamiliarity with procedures and the sensations of

delivery, together with a fear of the unknown, can

lead to high levels of distress in a woman in labour,

which can interfere with her management and later

with her memories of, and satisfaction with, the

experience of childbirth. Of all the factors which

impact upon this state, one of the most important

would seem to be the continuous presence of a

midwife during delivery. Despite the now almost

universal practice of the woman's partner, or other

relative, being present during delivery, the fear of

being left alone during labour is as real as in the past

and the continuous social support of a midwife

reassuring and explaining is as important as it ever

was.(Van Der Waerden et al., 2015)

Skin-to-skin contact between mother and baby

immediately postnatal reduces crying, improves

mother-infant interaction, keeps the baby warm, and

also the further tactile, exteroception and thermal

cues could stimulate babies to initiate breastfeeding

more successfully. Newborn babies tend to be a lot

of alert among the primary 2 hours of life, and this

could be thought-about a crucial time for initiating

triple-crown mother and baby interaction.(The Royal

College of Midwives, 2012)

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

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4 POSTNATAL PERIOD

Postpartum period may vary in every woman, If all

has gone well and a normal, good birth-weight baby

has been produced which can be handed to the

mother immediately, then the commonest immediate

reaction is one of ecstasy and relief. However, any

concern whatever for the baby, no matter how

trivial, will be extremely alarming to the mother. Her

perception of time will be altered so that attention to

the infant that lasts only for a few seconds will

appear to the mother to be lasting for hours. Those

mothers whose infants require resuscitation or

transfer to the neonatal unit will be extremely

anxious and fearful, and should be given an

opportunity to see their baby and handle it as soon as

possible, as well as the appropriate reassurance and

information about its welfare.(Bildircin et al., 2014)

Under normal circumstances, with the infant

given to the mother as soon as it is born, there.is a

culture constant pattern of behaviour which involves

the mother greeting the baby and engaging in eye-to-

eye contact with her infant. The baby at this stage is

usually awake and relaxed. She begins to explore her

baby, peripherally first, but then eventually will

unwrap and examine its body. Towards the end of

this process the baby may make sucking movements

and the mother may indicate that she wishes to

suckle her baby.

A sensitive attendant will notice the clues and

facilitate this process. However, it is important not to

rush the mother or to force her to do something

which she is not comfortable about. An opportunity

to feed the baby after delivery is related to later

satisfaction with the baby and ease of feeding. For

those women who have decided not to breast-feed,

the opportunity to bottle-feed their baby in the

delivery suite should be offered. This phase, which

lasts up to eight hours, is usually terminated by sleep

on the part of both mother and infant. Although it is

obviously an important and pleasurable time of

mother/infant attachment, it is probably not crucial

to the human being

(Bartels et al., 1999)

The majority of mothers deprived of this

experience, because of early neonatal separation,

make perfectly good attachments to their babies at a

later stage and develop close relationships with

them. For a minority of women the immediate

response to their newborn baby is one of flatness and

an absence of emotion, and even for an unfortunate

few, one of active distaste. Sometimes this is the

result of a long and distressing delivery, or the use of

analgesia or anaesthetics. Most of these women will

gradually settle over the next 24 to 48 hours, and

only a very few will have a more prolonged

difficulty in establishing a relationship with their

newborn child.(Van Der Waerden et al.,

2015)(Aitken et al., 2016)

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