24th November 2023

Pregnancy and Childbirth

Physiological changes associated with pregnancy and childbirth

Physiological changes in pregnancy affect all bodily systems and are linked with changes in production of hormones, including progesterone, oestrogen and prolactin. As well as observable changes to the body, such as an increase in weight, oedema and changes in posture, there are significant adaptations made by the renal, cardiovascular and endocrine systems to accommodate the growing foetus. These include:

• Increase in plasma volume.
• Increase in cardiac output.
• Increased ventilation.
• Reduced gut motility.
• Changes in skin pigmentation.

Psychological changes associated with pregnancy and childbirth

The psychological impact of pregnancy can be felt through each stage of the trimester. It can vary from anxiety relating to the health and wellbeing of the foetus to mood swings and irritability. As well as possible bereavement in the event of miscarriage or stillbirth. Further, underlying mental health issues can be provoked during pregnancy for a number of reasons, including medication changes, stress and hormonal shifts. Psychological symptoms can be exacerbated when combined with physiological changes, which can make adaptation more stressful for the individual.

Specific psychological changes associated with childbirth

• Postnatal blues – Occur shortly after delivery and generally resolve after a brief period. Characterised by tearfulness, emotional lability, worries about the health of the baby, difficulty with sleep and concentration
  • According to the Royal College of Midwives, postnatal blues occur in roughly 50% of women. They may be linked to a reduction in progesterone after delivery, relationship difficulties with a partner and difficulties with adjusting to the new role of motherhood.
• Postnatal depression – Risk between 7-15% during pregnancy, increasing to 50% if there is a pre-existing episode of antenatal depression. Associated with the younger age of the mother, poor relationship with partner and poor social support.
• Puerperal psychosis – Seen within a few days to 2 weeks of birth. Incidence c.0.1%; however this is a serious mental illness requiring prompt treatment by professionals, which can include medication and admission to a specialist mother and baby unit (MBU) if possible. Symptoms include confusion and emotional lability, including mania, hallucinations and delusions. The risk is increased if there is a positive family history and background of previous affective disorder.