A Portfolio of Study, Practice and Research.

Pregnancy is a biological process that takes place within a particular social and cultural setting. A great number at physiological changes occur during this period of time but there is little agreement as to the psychological changes that may also occur. Since pregnancy takes place within a particular social setting, such settings undoubtedly affect the way a woman experiences being pregnant. Therefore, not only should the psychodynamics of the individual be studied but also the effects of settings where pregnancy takes place. This study aimed to investigate psychological changes in 54 primiparous women between the period of 11-20 weeks gestation in terms of their views of pregnancy, and the effects of medical settings on these views; attitudes to ultrasound screening; foetal locus of control and anxiety and depression. It was hypothesised that the medical settings would influence how women saw pregnancy with such women more likely to see pregnancy as an illness. It was also hypothesised that this in turn may affect how much in control the women felt towards themselves and towards the health of their baby. This was measured using the Foetal Health Locus of Control Scale. Whether changes in anxiety and depression occurred, as measured by the Leeds Questionnaire were also studied, with particular reference to whether pregnant women had generalised anxiety or specific anxieties relating to the pregnancy. The women were given these various scales at 11 weeks gestation and again at 22 weeks gestation together with a questionnaire regarding their views towards ultrasound screening at 22 weeks. The results indicated that contrary to expectation women started off by seeing pregnancy as requiring hospital care and medical supervision and with increasing time this view moved to be even more closely associated with other medical conditions requiring medical treatment & intervention. Women's attitudes to screening were very positive and apart from it confirming that the foetus may or may not have any abnormalities it was seen to provide women with 'visual proof' that there was actually a baby, thus increasing bonding with the baby. This sample of women started off with a high degree of belief in control by chance which changed with increasing time to a belief in control by powerful others such as physicians and nurses. This may have occurred due to women's views of pregnancy becoming more medicalised. This lack of internal control over pregnancy is discussed in terms of previous research findings of it leading to postnatal depression and difficulties over labour. No changes in anxiety and depression were noted with time, although it was noted that women had specific anxieties concerning the pregnancy and childbirth process. It is concluded from these results that although the women see pregnancy as an illness, this does not affect their psychological state and that in fact, the women like the care offered to them in the hospital. The importance of fostering personal control, particularly in primiparous women is discussed, and this loss in control is seen as a disadvantage of the high technological approach of care to pregnancy