Cases

Chapter 4 Psychology applied to maternity care

Case 1: Health beliefs and behaviours

Carol is pregnant for the second time and during the booking interview divulges that she smokes 10-15 cigarettes a day, which she has reduced from 20. Nicola, the midwife, discusses the detrimental effects of smoking and asks Carol if she would like to be referred to the smoking cessation clinic. Carol refuses, stating that she cut down, but smoked all the way through her last pregnancy, felt well and that her baby was born perfectly normal and healthy. Nicola points out that her last baby, James, was small for dates but Carol is confident that this is because both she and her partner are only small in stature.

Questions

• a) What theoretical models might explain Carol's behaviour?

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  Correct answer:
  Carol appears to have a more external Health locus of control, hence does not necessarily believe that her own behaviours can influence health outcomes. She also has a lack of personal experience with the problem that can be caused to the fetus or herself by smoking, and that the problem has not yet appeared, so it will not appear in the future. Carol is as Weinstein suggests an individual with selective focus, in that she ignores her risk increasing behaviour and focuses on the steps she has taken to reduce the risk, i.e. reduce consumption.

• b) How might Nicola intervene to influence Carol's behaviour?

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  Correct answer:
  The stages of change and heath belief models offer the possibility for Nicola to provide Carol with evidence to support the belief that the effects of smoking are harmful to her and her baby and that the problem is preventable by individual action. Carol also has to believe she is capable of changing her behaviour as suggested in the theory of planned behaviour.

Case 2: Bonding and attachment

Jill has known Susie for many years and has been her community midwife for all four pregnancies. Susie has returned home following a difficult birth at her local hospital. Baby Joe spent two days in the Special Care Baby Unit as he had difficulties breathing at birth and developed an infection. Susie had wanted to breastfeed, but Joe is not latching on and Susie seems disinterested in looking after Joe. She is calling him her 'problem baby' and Jill notices that Susie does not go to the crib to pick him up when he is crying and is obviously distressed; Jill is needing to prompt Susie to attend to Joe.

Jill returns to visit Susie two weeks later as Susie was admitted to hospital with retained membranes which resulted in a two-day stay. Susie chose to leave Joe at home with her husband as she is not breastfeeding him and did not see the need for Joe to be in hospital with her.

Questions

• a) What might Jill's concerns be with regards to Susie's behaviour?

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  Correct answer:
  The midwife Jill, may be concerned that Susie has not bonded with baby Joe as she is not attending to him when he cries; she has labelled him as a 'problem' and she did not wish to take Joe into hospital with her. Moreover, they were separated at birth due to his breathing problems and his admission to Special Care and we do not know whether Susie was encouraged to spend time with him in the Special Care unit. It is possible that the difficult birth has impacted on Susie's emotional and mental wellbeing and she may be feeling depressed; this too may have impacted on her bonding with Joe.

• b) How might Jill intervene to influence Susie's behaviour?

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  Correct answer:
  Jill can encourage the bonding process by suggesting ways in which Susie can develop a relationship with Joe, for example close proximity, attending to his crying/ feeding cues, reframing Susie's experience of Joe as a 'problem baby' by acknowledging the normality of newborn behaviour. Furthermore, Jill can discuss her concerns with Susie and establish whether Susie is evidencing any signs or symptoms of postnatal depression. if necessary, Jill can refer Susie to her GP.
  Jill can ascertain if any other support is available and if not can suggest avenues of support, for example, local children centres, mother and baby groups, local parenting support networks such as Homestart. Jill can ensure that all relevant healthcare providers (health visitor, GP) are informed of her concerns so that Susie is given appropriate support in the postnatal period.

Case 3: Tocophobia

Jean has arrived to see the midwife Dianne. Jean has just discovered that she is 18 weeks pregnant. Jean is 35 and has been on the contraceptive pill since she was 17. She is married to John and they have no children, despite John wanting to have children - John is delighted that Jean is pregnant. Jean needed a two-week course of antibiotics 5 months ago for an infection and it would appear that this has compromised the effectiveness of her contraception. Jean is adamant that she is not going to have this baby, she has never wanted children following an experience when she lived in Africa and witnessed a woman in childbirth. Dianne is exploring with Jean, her reluctance to have this baby given John's desire to have children.

Questions

• a) Why might Jean not want to have children?

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  Correct answer:
  It would appear that Jean has been affected by observing a woman having a child in Africa - she has not elaborated on what she saw but it obviously has had a lasting impact on her.

• b) What would this condition be called?

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  Correct answer:
  Jean is suffering from tocophobia - a psychological condition which creates a fear of pregnancy and childbirth.

• c) How could Dianne support Jean?

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  Correct answer:
  Dianne could inform Jean that she is suffering from tocophobia and acknowledge that this is a known condition which affects women. Dianne could explore whether Jean would like to be referred to a counsellor or psychotherapist to explore her deep fear of pregnancy and childbirth.