Reading material on improving patient communication

Psychosocial condition and emotional health in pregnant
A range of demographic, obstetric, and psychosocial factors may influence pregnant women’s psychological health. Studies on risk factors for emotional distress have shown mental health problems during pregnancy to be associated with demographic factors like young maternal age [12], low educational level [13], single status, high life stress [14], low annual income/unemployment, financial hardship [15, 16], obstetric factors like previous pregnancies and miscarriages [15], unintended pregnancies [14], mental health problems, personal and relationship factors such as poor relationship satisfaction [17] and low or absent support from partners, extended family, and friends [14].

Pregnancy is always associated with changes in psychological functioning of pregnant women. It is usually associated with ambivalence, frequent mood changes, varying from anxiety, fatigue, exhaustion, sleepiness, depressive reactions to excitement. During pregnancy, changes include body appearance, affectivity, and sexuality, whereas the position and role of women attains a new quality. Even thoughts of pregnancy can bring about numerous worries about its course and outcome, and especially of the delivery itself.
Becoming a mother is an important life event and although most women see pregnancy as a positive experience, worries and concerns increase during pregnancy. In fact, worries during pregnancy, i.e. concerns (worries content) about the health of the baby and additional concurrent worries, both general and pregnancy-related, also impact maternal emotional functioning. These worries can be anticipatory (before giving birth, e.g. going to hospital), concurrent with other general worries (e.g. financial matters), and post-partum (after giving birth, e.g. worries about the baby’s health and development [18].

Emotional changes during the different trimesters:
First trimester
-During this time, there may be emotional fluctuations between positive feelings (such as excitement, happiness, and joy) and rather negative ones (such as disbelief, anticipation, worry, and tearfulness).
-This depends on a variety of factors, such as pregnancy ailments (nausea/ vomiting, reflux diseases, insomnia), planned/ unplanned pregnancy, financial situations, family support, a perception of lifestyle restriction, and a sense of loss of independence.

Second trimester
-Although the mood fluctuations continue even during the second trimester, the negative feelings could sometimes lessen.
-This is due to reduced nausea/ vomiting, more adaptation to changes, some idea about the pregnancy care (from healthcare professionals).
-Research has suggested that the mental health problems (such as anxiety and depression) occur less commonly in the second trimester (in comparison to the first and third trimesters).

Third trimester
-Negative feelings could come back more again during this time. This could be due to increasing discomfort (such as due to pelvic girdle pain/ a backache), insomnia, tiredness/ exhaustion,

Moreover, the following psychological changes become more prominent during the third trimester (compared to the first and second trimesters):
1. Transition to parenthood
Pregnancy is the beginning of a significant psychological transformation for parenthood. This is a quite complex psychological process of establishing a new identity a parent.
This involves a tremendous change/adaptation within her pre-existing sense of self-identity (‘mental reworking’). Some emotional changes (such as emotional lability, temporary low mood, fear/ anxiety, ambivalence, conflict, and regression) are the result of such a massive transformation. These symptoms are temporary, mild, quite normal, and common during pregnancy. Therefore, pregnant women should be reassured. However, if the symptoms are persistent and significant, and having an impact on the quality of life, then a further assessment is needed to rule out any mental health condition.

Pregnancy activates the following two basic psychological reorganizations:
A) Internal Reorganization:
This involves rediscovering the self-identity and includes the following three processes:
• Reflective Functioning
• Mental Representation
• Object Relationship
• Prenatal Attachment

All these (except prenatal attachment) are described in detail below.
B) External Reorganization:
This is the change of mindset with regards to the relationship with other individuals. After the arrival of the baby, the woman’s (and the partner’s) relationship with others family members (such as her own mother and other children) takes a new shape due to the changing roles.

The pregnancy and birth experience are significantly influenced by:
• the relationship with the partner/ family.
• the social support.
• the culture/customs of the community she belongs to.

2. Pregnancy-related anxiety.
Pregnancy as a stressful event: Pregnancy is identified as a potent stressor that can seriously affect the psychic status of pregnant women, perinatal outcome, but also psychic functioning of the new-born individual. Appropriate relationship of partners and support of the society play an important role in overcoming anxiety during pregnancy.

Ways to deal with injury-related stress
The interaction with pregnant play a role in their coping strategy about their environment and social factors. Physiotherapists’ attitudes may play a role, for example paying too much attention to pain and not encouraging patients’ independence may affect the course in a negative way. Also, low back pain due to lack of exercise, weight gained during pregnancy and growing uterus, fatigue in the muscles as a result of the lengthening of the abdominal and gluteal muscles, decreased blood flow to the pelvis and lumbar region due to the pressure of the uterus on the vena cava, and psychological and emotional changes can decrease quality of life expectation with severe pain for pregnant. Whole changes in pregnancy can demonstrate perceive of body image so communication cannot be easy. Also, these symptoms may be different in cross-cultures. Some society who has more stability about decrease pregnancy symptoms, increase the spine’s flexibility, provide balance, and improve low back function on threshold in low back pain should be interaction with who has not. So it can be get interaction from each partner on particularly sensitive issues and how to deal with them in their culture.

The basic recommendations for a pregnant has low back pain are:
– Using pharmacological treatment and performing follow-up examinations as recommended by the gynecologist,
– Work systematically with a physiotherapist,
– Do the recommended exercises between your appointments with the physiotherapist,
– Follow recommendations for modification of daily physical activity, diet, sleep and rest.

Factors interfering with rehabilitation
The main factor interfering with the rehabilitation process and constituting the greatest obstacle to its effectiveness is pain. Thus, one of the most important tasks of medical personnel is to help relieve pain.

Other difficulties interfering with the course of rehabilitation can be divided into:
Emotional problems
Examples: negative emotions, emotional suppression, depressiveness, and sleep problems
Support that can be provided: presence, showing interest and concern, talking, listening, creating opportunities to express concerns and release negative feelings
Consequences of lack of support: deterioration of well-being and increasing tension associated with suppressing emotions

Kinesiophobia and fear of harm to the fetus
It is the fear of a pregnant woman experiencing back pain, of moving and getting injured. It is an exaggerated reaction, but a common situation, for a mother with back pain to experience kinesiophobia and lead a completely sedentary, sedentary life. As the mother’s pain intensity decreases and she makes exercise a part of her daily life, her fear of movement should decrease.

One of the most used tools to assess fear of movement is the Tampa Kinesiophobia Scale. This scale consists of 17 statements, such as “I am afraid of harming myself if I exercise”, “Pain always means that I am harming my body”, “No one should exercise when they are in pain”. Statements are scored on a Likert scale from 1 to 4: 1 – strongly disagree / 2 – disagree / 3 – agree / 4 – strongly agree (higher scores indicate greater severity of kinesiophobia). The participant may score between 17 and 68, and a score of 37 or more indicates kinesiophobia. Free access to the electronic scale calculator in English can be found at: https://www.physiotutors.com/questionnaires/tampa-scale-kinesiophobia/