Pregnancy and the postpartum period are usually characterized by deep alterations in sleep. The complex interaction of bodily changes, breastfeeding practices, and the random wake-sleep patterns of newborn babies promote significant sleep disruption and deprivation in women at this stage.
In a review of the main findings about sleep, pregnancy, and the postpartum period, Lee (1998) asserts that the main variables underlying sleep alteration are hormonal changes, physical symptoms, and infant sleep.
With regard to hormonal alterations, it has been argued that the high progesterone levels that are essential to the pregnancy process affects drowsiness and are responsible for the increased sleepiness and earlier sleep onset during the first trimester of pregnancy. Additionally, it has been argued that progesterone has an inhibitory effect on smooth muscles, which is related to increased urinary frequency at this early stage (Lee, 1998).
From a different perspective, physical symptoms during pregnancy have been widely acknowledged as a disturbing factor (Kamysheva et al, 2010). The most common somatic complaints during this stage include:
- nausea, vomiting
- heartburn and other discomforts associated to eating
- increased urination
- tender breast
- headache
- vaginal discharge
- shortness of breath, and
- backache
Finally, infant sleep has been pointed out as a significant factor underlying sleep disruption during the postpartum period due to the random sleep-wake patterns that are commonly observed in newborn babies, breastfeeding practices, and baby’s temperament (Dennis & Ross, 2005; Hiscock & Wave, 2001; Horiuchi & Nishihara, 1999; Meltzer & Mindell, 2007).
Interestingly, research has pointed out an association between sleep and mood, and has provided significant evidence to support the bidirectional influence between sleep alteration and depression (Breslau et al, 1996; Kahn-Greene et al, 2007).
In line with this argument, some evidence supporting the significant association between sleep and depressed mood during pregnancy (Jomeen & Martin, 2007; Skouteris et al, 2008) and the postpartum (Goyal, Gay and Lee, 2007) has been reported. Therefore it has been suggested that poor sleep quality might increase the vulnerability to PPD (Okun, Hanusa & Hall, 2009).
Showing posts with label Pregnancy. Show all posts
Showing posts with label Pregnancy. Show all posts
Wednesday, 4 August 2010
The role of the subjective experience of pregnancy and childbirth in the development of postnatal distress
As previously commented, a strong body of research has focused on unraveling risk factors for the development of postnatal distress, due to the negative effect this phenomenon exerts on maternal and infant well-being. The most significant findings have been yielded by the psychosocial and physiological realms, and significant and well-validated explanatory models have been proposed.
The first approach has highlighted the role of six main risk factors such as antenatal depression, antenatal anxiety, previous history of depression, social support, life events, and self-esteem; whereas the latter highlights the influence of hormonal variables, progesterone levels being the most significant.
Notwithstanding the validity of these findings, feminist scholars have argued that postnatal distress cannot be explained exclusively by objective facts and risk factors, which they claim to be strongly influenced by the cultural discourse. In line with this argument, these scholars declare that the personal or subjective experiences women have during pregnancy, childbirth, and the postpartum are to be considered a central piece of the postnatal distress’ puzzle.
Accordingly, qualitative researchers have suggested that perceptions and expectations of events related to the pregnancy process are important variables to be studied. From a phenomenological perspective, Hart (1981) argues that “the experience of motherhood is integrated into a system of existent meanings, thus, the experiences are not processed as detached information in a pure cognitive level, but incorporated into a woman’s values and beliefs, an into her particular way to experience the world she lives in” (p.285).
So, postnatal distress and postnatal depression can be understood as one of the various meanings that can be constructed regarding the experience of pregnancy and childbirth.
The first approach has highlighted the role of six main risk factors such as antenatal depression, antenatal anxiety, previous history of depression, social support, life events, and self-esteem; whereas the latter highlights the influence of hormonal variables, progesterone levels being the most significant.
Notwithstanding the validity of these findings, feminist scholars have argued that postnatal distress cannot be explained exclusively by objective facts and risk factors, which they claim to be strongly influenced by the cultural discourse. In line with this argument, these scholars declare that the personal or subjective experiences women have during pregnancy, childbirth, and the postpartum are to be considered a central piece of the postnatal distress’ puzzle.
Accordingly, qualitative researchers have suggested that perceptions and expectations of events related to the pregnancy process are important variables to be studied. From a phenomenological perspective, Hart (1981) argues that “the experience of motherhood is integrated into a system of existent meanings, thus, the experiences are not processed as detached information in a pure cognitive level, but incorporated into a woman’s values and beliefs, an into her particular way to experience the world she lives in” (p.285).
So, postnatal distress and postnatal depression can be understood as one of the various meanings that can be constructed regarding the experience of pregnancy and childbirth.
Reflexions on pregnancy, childbirth, and the postpartum period
Pregnancy, childbirth, and the postpartum trigger enormous changes in a woman’s life, which are experienced differently due to the particular characteristics, expectations, and the personal history of every woman.
Logically, one of the core aspects promoting the changes is the presence of the baby, which becomes increasingly real to the expectant mother as pregnancy progresses. This interaction between the mother and the unborn child supports the development of thoughts and ideas about the forthcoming child and about the woman as a mother (Viziello et al, 1993).
It has been argued that the whole pregnancy period can be seen as a process where the expectant mother is slowly undergoing the changes and facing the several issues that will prepare her for mothering, and the particular challenges of every trimester of have been described (Smith, 1999).
The first trimester - from conception until the end of the third month - is characterized by physiologic changes in the body, being a time of uncertainty and adjustment to the new state. At this stage “the nature of change can itself be an issue” (Smith, 1999, p.286).
During the second trimester, the pregnant woman can feel the movements of her baby, a fact that helps her acquire a more realistic perception of the infant while seeing him/her as independent from her own body (Caplan, 1959 in Trad, 1990). Withdrawing from the world has been described as another important feature in this stage. The pregnant woman would draw her attention from the public world to focus herself in her own experiences and the familial domain. The focus on relationships with her own family, and other pregnant women or mothers, may help the mother-to-be to smooth the transition into motherhood as well as reinforces her network for social support.
During the third trimester women may experience varied feelings related to the forthcoming birth, possible fears about delivery and childcare, and mixed ideas about mothering the baby, due to the proximity of childbirth (Caplan, 1959 in Trad, 1990). Attention is shifted outwards again, and the self-containing state slowly comes to an end giving way to a different and more realistic relationship to the newborn. Finally, after childbirth, women face the challenge to adjust themselves to the newborn; personal projects begin slowly to re-gain importance as the baby grows up and a new balance based in the changes in perceptions and priorities related to the new – or reinforced - state of motherhood is to be made (Smith, 1999).
References
Smith, J. (1999). Identitiy development during the transition to motherhood: an interpretative phenomenological analysis. Journal of reproductive and infant physiology.17, 281-299
Trad, P. (1990). Emergence and resolution of ambivalence in expectant mothers. American Journal of Psychotherapy. 4, 577-589.
Vizziello, G., Antonioli, M., Cocci, V. & Invernizzi, R. (1993). From pregnancy to motherhood: The structure of representative and narrative change. Infant Mental Health Journal. 14, 4-13.
Logically, one of the core aspects promoting the changes is the presence of the baby, which becomes increasingly real to the expectant mother as pregnancy progresses. This interaction between the mother and the unborn child supports the development of thoughts and ideas about the forthcoming child and about the woman as a mother (Viziello et al, 1993).
It has been argued that the whole pregnancy period can be seen as a process where the expectant mother is slowly undergoing the changes and facing the several issues that will prepare her for mothering, and the particular challenges of every trimester of have been described (Smith, 1999).
The first trimester - from conception until the end of the third month - is characterized by physiologic changes in the body, being a time of uncertainty and adjustment to the new state. At this stage “the nature of change can itself be an issue” (Smith, 1999, p.286).
During the second trimester, the pregnant woman can feel the movements of her baby, a fact that helps her acquire a more realistic perception of the infant while seeing him/her as independent from her own body (Caplan, 1959 in Trad, 1990). Withdrawing from the world has been described as another important feature in this stage. The pregnant woman would draw her attention from the public world to focus herself in her own experiences and the familial domain. The focus on relationships with her own family, and other pregnant women or mothers, may help the mother-to-be to smooth the transition into motherhood as well as reinforces her network for social support.
During the third trimester women may experience varied feelings related to the forthcoming birth, possible fears about delivery and childcare, and mixed ideas about mothering the baby, due to the proximity of childbirth (Caplan, 1959 in Trad, 1990). Attention is shifted outwards again, and the self-containing state slowly comes to an end giving way to a different and more realistic relationship to the newborn. Finally, after childbirth, women face the challenge to adjust themselves to the newborn; personal projects begin slowly to re-gain importance as the baby grows up and a new balance based in the changes in perceptions and priorities related to the new – or reinforced - state of motherhood is to be made (Smith, 1999).
References
Smith, J. (1999). Identitiy development during the transition to motherhood: an interpretative phenomenological analysis. Journal of reproductive and infant physiology.17, 281-299
Trad, P. (1990). Emergence and resolution of ambivalence in expectant mothers. American Journal of Psychotherapy. 4, 577-589.
Vizziello, G., Antonioli, M., Cocci, V. & Invernizzi, R. (1993). From pregnancy to motherhood: The structure of representative and narrative change. Infant Mental Health Journal. 14, 4-13.
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