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Pregnancy and Delivery

Information via accrediting organization American Association for Marriage and Family Therapy.

“You’re pregnant!” This short phrase can influence people in many ways. Emotions within the family can range from excitement, fear, happiness, confusion, or perhaps disappointment and anger. Whether planned or unplanned, a pregnancy permanently changes a family, no matter how that family is defined or what the outcome is from the pregnancy.

Through each trimester, there is opportunity for both eustress (good stress) and distress (bad stress/suffering). Some examples of eustress might include preparing the nursery, seeing the baby move on an ultrasound, or attending baby showers; whereas distress might include financial worries, complications, infertility, pregnancy loss, and the decision to place a child up for adoption. Stress is typically a natural and expected part of life; however, sometimes stress can make people feel overwhelmed or unsure of how to manage life. Each family’s adjustment to stress or distress is unique and will require resources that have benefited the individual or family in the past (such as: time with a helpful family member, use of spiritual rituals, or exercising). However, there are times when an individual, couple, or family may need additional resources beyond those that have been depended upon in the past.

When to Seek Help

It may be time to seek mental health assistance if you notice physical, emotional, or relational distress from:

  • frequent tearfulness or impulsivity
  • difficulty concentrating
  • headaches
  • unusual fatigue
  • domestic violence or not feeling physically or emotionally safe
  • abuse of alcohol or illicit drugs
  • coping with medical complications
  • grief related to the infertility process or pregnancy loss
  • unexpected experiences (from needing to be on bed rest to changes in birth plans)
  • questions related to parenting styles
  • uncertainty of paternity
  • conflicts in parental or intergenerational communication
  • concern about sexually transmitted infections/diseases
  • child safety
  • sudden infant death syndrome
  • managing the absence of a parent (e.g., voluntary, deployment, geographical barriers),
  • anxiety related to the life change
  • questions related to sibling adjustment
  • wanting to know more about how to manage a life change

Unexpected Medical Complications

An ectopic pregnancy, also referred to as a mislocated pregnancy, involves symptoms of unexpected vaginal bleeding and cramping. In most women, the fetus and placenta in an ectopic pregnancy are diagnosed early enough to be treated through the use of medication (e.g., methotrexate); however, in some cases, surgery may be necessary.

The complication of placenta previa occurs in one of every 200 deliveries when the placenta is mostly or completely covering the cervix, in the lower rather than upper part of the uterus. Placenta previa can cause painless bleeding (i.e., a sentinel bleed) from the vagina that often begins suddenly in the second trimester of pregnancy.

Preeclampsia occurs in about 5 percent of pregnant women, which is an increase in blood pressure, accompanied by protein in the urine (proteinuria). Preeclampsia usually develops between the 20th week of pregnancy and the end of the first week after delivery. One fourth of the cases of eclampsia occur after delivery, usually in the first two to four days.

Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks gestation and is related to about one-third of all preterm deliveries. In the United States, thromboembolic disease occurs when blood clots form in blood vessels that travel through the woman’s bloodstream and block an artery. This disease most commonly occurs six to eight weeks after delivery.

Sometimes a pregnancy may feel normal to the expectant mother, yet complications exist for the fetus or newborn child. Three types of loss experiences that may occur among expectant or new parents: miscarriage, stillbirth, or neonatal death. Approximately one out of every four women who becomes pregnant will miscarry at some point in her life.

A miscarriage is considered any fetal loss that occurs prior to 20 weeks gestation. About 15 to 20 percent of all pregnancies end in a miscarriage, typically within the first trimester or sometimes into the early second trimester. When a baby dies after 20 weeks gestation, this is known as a stillbirth. A specific cause of death can only be determined in about half of all stillbirth autopsies. Stillbirths do not typically occur during labor. Stillbirths occur in about one percent of all pregnancies. A neonatal death is any death that occurs in the first 28 days of a child’s life.

Who can help with mental health and relationship questions or concerns regarding pregnancy, labor, or delivery?

Marriage and family therapists (MFTs) work with individuals, couples, and families to encourage healthy communication patterns, relationships, and emotional health. MFTs typically take a strength-based approach to build on families’ positive skills and coping abilities, not only focusing on problems. MFTs commonly collaborate with other medical or mental health providers to promote family-focused and culturally sensitive care over the life span. Family therapists do this by using a systemic perspective. This means that when an individual, couple, or family meets with an MFT, they will be treated with respect and an understanding that an event or stressor that influences any one person in the relationship also influences everyone else in that person’s life.

Other providers who may collaborate with the MFT and be involved in a pregnancy, labor, or delivery experience may include:

  • Adoption Services – adoption agencies or facilitators who are invited by the mother or both parents (when adoption is a preferred choice for the future of the child) to be present during or shortly after the delivery of the child
  • Anesthesiologist or Nurse Anesthetist – physician or nurse specializing in administering anesthesia and managing the medical care of patients before, during, and after surgeries
  • Certified Lactation Consultant – teaches breastfeeding classes, counsels parents through challenges in breastfeeding, provides breastfeeding supplies, identifies problems that may need to be referred to a physician or midwife
  • Chaplain – offers pastoral care, spiritual support, and crisis intervention for patients, family, or staff
  • Child Life Specialists – use developmentally appropriate activities to help siblings of an unborn or newborn child to help them adjust to the hospital environment, prepare for a new sibling in the family, or cope with hospitalization, illness, or death of a sibling or mother.
  • Doula – provide physical, emotional and informational support during prenatal, childbirth, or post partum care
  • Neonatal Intensive Care Providers/Team – a neonatologist is a pediatrician specializing in caring for babies requiring intensive care after birth
  • Nurses – provide care in a variety of roles, including antepartum (complications), circulating (operating room during cesarean), labor and delivery (labor without complicated deliveries), postpartum (recently delivered), and scrub (directly with surgeon during cesarean)
  • Obstetrician or Certified Nurse Midwife – physician or advanced practice nurse specializing in pregnancy and childbirth
  • Parent-to-parent support – individuals who are trained to help a family who is facing something similar to the situation they previously managed in their own life, providing empathy, help in adjusting to the hospital environment
  • Pediatrician – physician specializing in the medical care of infants, children, and adolescents
  • Perinatologists – obstetrician specializing in high risk pregnancies or deliveries
  • Records Personnel – collect information from the parents toward birth certificates or discharge planning
  • Recreational Therapist – utilizes games, arts, crafts, or music to help patients build confidence and redirect their attention to activities rather than the stressful experience
  • Social Workers – collaborates with the family in case management (community referrals, shelters, adoption agencies, child protective services)

Information via accrediting organization American Association for Marriage and Family Therapy.