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| CONCEPT PAPER |
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| Year : 2022 | Volume
: 19
| Issue : 1 | Page : 83-88 |
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Well-being and pregnancy
Pallavi Talukdar, Arunjyoti Baruah
Department of Psychiatric Nursing, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| Date of Submission | 19-Jul-2021 |
| Date of Decision | 03-Oct-2021 |
| Date of Acceptance | 10-Nov-2021 |
| Date of Web Publication | 05-Jul-2022 |
Correspondence Address:
Ms. Pallavi Talukdar
Department of Psychiatric Nursing, 3rd Floor, New Academic Building, LGB Regional Institute of Mental Health (Govt. of India, Ministry of Health and Family Welfare), Sonitpur, Tezpur - 784 001, Assam
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/iopn.iopn_72_21
Well-being is a complex construct on the optimal functioning in one's life. Well-being is basically having two perspectives: hedonic approach (i.e., pain avoidance and pleasure attainment) and eudaimonic approach (i.e., living up to one's fullest potential). Over the years, researchers have explored various stages of one's life based on these approaches. Pregnancy is an important milestone of women's life. Pregnancy is a period of hope and growth. This concept paper has been drafted with the aim of having an understanding regarding well-being and its short-term as well as long-term impact on pregnant women and their unborn children. The objectives of the study were to get an overview on well-being and to understand its effect on pregnant women as well as their fetuses. The electronic literature search engines used were Google Scholar and PubMed for selecting papers related to the theme well-being and pregnancy. Again, these selected articles were further screened for more relevant literature. For the present paper, a total of 35 articles were reviewed which were published online. Assessment of well-being during pregnancy helps in the assurance of better future for both the mother and the child. In this paper, the researcher has looked into a comprehensive view of well-being, and this has an influence on the pregnant women. This understanding will help in the promotion of well-being and maternal health, which in turn will have a positive effect on the baby.
Keywords: Happiness, mother, pregnancy, well-being
How to cite this article:
Talukdar P, Baruah A. Well-being and pregnancy. Indian J Psy Nsg 2022;19:83-8 |
| Introduction | |  |
The concept of well-being is multifaceted, and it consists of positive and negative emotions and satisfaction with life. Measuring well-being in pregnancy is an important step in understanding the potential physical, psychological, and social benefits of pregnancy and in understanding how well-being can be enhanced for women and their families at this important life stage.[1] Most importantly, the measure provides an opportunity for women to express positive and negative emotions and thoughts about their pregnancy, thus reflecting the whole spectrum of well-being.[2]
Pregnancy is an important milestone in a woman's life and brings joy and responsibilities at the same time in her life. This is a transition period in a woman's life and is acknowledged to be associated with heightened levels of emotion and psychological status.[2] During pregnancy, a number of changes occur in a pregnant woman, the changes in her emotions, social interactions, and family tie.[3]
| Meaning of Well-Being | | |
According to Forgeard et al.,[4] well-being consists of the nurturing of one or more of the following five elements: positive emotion, engagement, relationships, meaning, and accomplishments. These five elements best describe the pursuit of humans for their own sake.
Being happy and satisfied with life is good, but enhancing people's sense of well-being and life satisfaction is not only about making them feel better; rather, it has practical value. People with greater subjective well-being are more successful in many life domains, and their success is at least partly due to their greater sense of well-being.
Many a times, it is seen that well-being is viewed same as happiness. However, both are not having the same meaning. Happiness gives us an idea of a person's feel moment-to-moment. On the other hand, well-being carries much broader meaning unlike happiness. Well-being is a much broader concept than moment-to-moment happiness: it includes happiness but also other things such as how satisfied people are with their lives as a whole, and things such as autonomy (having a sense of control over one's life) and purpose (having a sense of purpose in life).[5]
Various scholars have given different concepts for well-being. Well-being is often conceptualized as a broad domain of interest rather than a specific construct. In addition, Diener and Emmons[6] highlight the importance of measuring both positive and negative emotions in a full assessment of well-being. There are two major approaches to conceptualizing well-being.[7] The first approach emphasizes a person's evaluation of their own life, both emotionally and cognitively, which is known as hedonic well-being and is also referred to as subjective well-being. A second approach emphasizes on reaching one's full potential by fulfilling certain needs and qualities essential for their psychological growth and development. The concept of psychological well-being is an example of the eudaimonic concept of well-being.
| Concepts of Subjective Well-Being | | |
One of the working definitions of subjective well-being is “the experience of joy, contentment or positive well-being, combined with a sense that one's life is good, meaningful and worthwhile.” According to Ryan and Deci,[7] well-being refers to the optimal psychological experience and functioning. The subjective well-being is a psychological construct concerned not with what people have or what happens to them but with how they think about and feel about what they have and what happens to them. The study of subjective well-being makes a distinction between the objective conditions of someone's life and that person's subjective evaluation of and feelings about his or her life.
There are different conceptions of subjective well-being. In hedonic (or hedonistic) conceptions, subjective well-being is defined by the balance of pleasure and enjoyable versus unpleasant events in a person's life.[8] A “good life” is one in which there is more pleasure and enjoyment than pain and suffering regardless of the sources of these events and experiences. What matters is to what extent the person enjoys his or her life, generally feels good as opposed to bad, experiences pleasure as opposed to pain and discomfort, and is satisfied versus dissatisfied with his or her happiness and life satisfaction. The opinions of other people as to whether the person is leading a “good” or “meaningful” life are irrelevant. The theorists and researchers generally agree on the conception and measurement of hedonic well-being. Diener's[9] tripartite structure consisting of measures of positive affect, negative affect and life satisfaction is most commonly employed in research. This means that a person with high Subjective well-being experiences more positive affect than negative affect and is relatively satisfied with his or her life. The hedonic well-being (subjective well-being[9]) consists of an affective component and a cognitive component. Here, the affective well-being refers to the experiences of pleasant and unpleasant feelings. Whereas cognitive well-being is based on an evaluation of how well one's life is going relative to an ideal state of affair, which is most commonly assessed with measures of life satisfaction.[6]
Eudaimonic conceptions of well-being emphasize the idea that “we flourish by fully exercising our human capacities.”[8] It primarily refers to the idea that a “good life” involves “achieving the best that is within us, each according to us, each according to his or her unique talents and capacities”[9] or “a life conditioned upon self-truth and personal responsibility.”[10] In this conception, well-being is determined not by the quality of one's sensual and emotional experiences but by the extent to which one is living up to one's potential; making progress toward attaining one's valued goals; and living a life of meaning, purpose, and virtue. In this way, eudaimonic conceptions strive to “capture core aspects of what it means to be human.”[11]
Subjective well-being has wide-ranging individual and societal benefits in domains including physical health, social relationships, productivity, and prosociality.[12],[13],[14]
| Concepts of Psychological Well-Being | | |
Ryff and Keyes[15] spoke of psychological well-being as distinct from subjective well-being and presented a multidimensional approach to the measurement of psychological well-being that has six distinct aspects of human actualization: autonomy, personal growth, self-acceptance, life purpose, mastery, and positive relatedness. These six constructs define psychological well-being both theoretically and operationally, and they specify what promotes emotional and physical health. The different stages of life, demographic characteristics, etc., may have impact on different status of psychological well-being and its components. The experience of pregnancy, with its accompanying profound physical and mental changes in women's life, affects all dimensions of life including psychological well-being.[16]
| Concepts of Social Well-Being | | |
The social model of well-being reflects the positive social health. Among the potential benefits of public life are social integration and cohesion, a sense of belonging and interdependence, and a sense of shared consciousness and collective fate.[17] Keyes had discussed various social challenges that constitute possible dimensions of social well-being in his development of social well-being scale which has been put below:
- Social integration includes a person's evaluation on how much they feel to be associated with and belonging to the community or their neighborhood and at the same time feel to be a part of it
- Social acceptance is the social analog to personal acceptance, which means that accepting others with their good and bad aspects also suggests that they have social acceptance
- Social contribution assesses one's view of their own worth. This takes into account self-efficacy and responsibility
- Social actualization is the realization of socially healthy individuals that society has the potential for growth and that they are the potential beneficiaries of this growth
- Social coherence is the perception regarding the quality, organization, and operation of the social world with a concern for knowing about the world. The socially healthy people are aware of the world around them and also care for the world they live in.
| Adaptations during Pregnancy | | |
Pregnancy reflects a normal process in the female life span. During pregnancy, there are progressive anatomical, physiological, psychosocial, and biochemical changes which are not only confined to the genital organs but to all systems of the body. In particular, the physiological changes that occur during pregnancy affect the biochemistry and anatomy of organs which may exaggerate or produce symptoms which in turn affect the well-being. This is principally a phenomenon of maternal adaptation to the increasing demands of the growing fetus.[18] Until well understood, these physiological adaptations of normal pregnancy can be misinterpreted as pathological.[18]
Physical health and functional status during pregnancy
Women's health during pregnancy has been studied primarily in terms of occurrences of obstetrical complications and worsening of preexisting chronic illnesses.[19]
Roy and Andrews[20] postulated that role performance is influenced by physical health, but little attention has been given to identification of specific variables that are related to the performances of existing roles during pregnancy.
Physical energy and functional status
Pregnancy takes a toll on the woman's physical energy. Hall et al.[21] reported that women experience an overall lack of energy during pregnancy. Behrenz and Monga[22] reported that first-trimester pregnant women experienced greater fatigue and spent more time sleeping than their nonpregnant counterparts.
No studies of the relation between energy level and overall functional status during pregnancy were located. Instead, research has focused on components of functional status and fatigue. Brown[23] found that fatigue was greater in pregnant women who were employed than in their unemployed counterparts. In addition, Reeves et al.[24] reported that fatigue had a substantial impact on women's performance of household and social activities during the first half of pregnancy.
Physical symptoms and functional status
The literature supports a relation between physical symptoms and functional status during pregnancy. In general, good physical health during childbearing period is associated with a higher level of functional status, in the forms of work productivity and parental competence, than poor health.[25]
Weight gain and functioning during pregnancy
Weight has been linked to functional status in nonpregnant population. Stewart and Brook[26] assessed functional status and found that 19% of normal-weight persons, 28% of moderately overweight persons, and 34% of severely overweight persons experienced limitations in personal functioning, defined as mobility and performance of self-care activities.
Anticipating delivery and motherhood
Pregnancy is certainly a physical experience but, according to Schroeder-Zwelling and Hock,[27] “is most often defined as a psychological or emotional experience.” Although there is some evidence that anxiety is higher in the first and third trimesters than in the second trimester.[28]
| Well-Being and Pregnancy | | |
The measurement of well-being in pregnancy and childbirth has remained underdeveloped. This is surprising as it is acknowledged that the aim of quality care during pregnancy is to optimize maternal and fetal health, to enhance women's experience of pregnancy and birth, and to prepare women for motherhood whatever their risk status rather than simply focusing on ill-health.[29]
Specifically, the hedonic concept of well-being has been widely reported to consist of two distinctive affective and cognitive components.[30] Huppert[31] defines the cognitive component as involving the development of one's potential, having some control over one's life, having a sense of purpose (e.g., working toward valued goals), and experiencing positive relationships. Life satisfaction is the cognitive component of well-being. The cognitive component also includes domain satisfaction which represents a focused evaluation of some specific aspect of one's life (such as health, work, and family). There is limited agreement on core domains of our well-being; however, researchers tend to agree that this includes family circumstances.[1] Experience of pregnancy and childbirth is a major component of our family circumstances.[1]
Although domain satisfaction and life satisfaction are generally highly correlated, measurement of domain satisfaction allows exploration of variations in well-being related to specific circumstances. A similar rationale can be used with pregnancy-specific well-being measures.[32] Hereby, it is recommended that domain satisfaction be measured along with more general well-being measures to provide a more complete picture of well-being in this growing field of measurement.[33]
| Importance of Well-Being: During and After Pregnancy | | |
The various challenges faced by the pregnant women during the attainment of motherhood may have a variety of outcomes. For some, these challenges may strengthen their coping skills, while for others, the same challenges may produce inadequate coping skills and result in distress. During this period, their contact with the health-care delivery system increases, and at the same time, they are encouraged to speak out the problems faced by them, in the hope to provide a better tomorrow for both the mother and the baby and hence affecting both of their well-being.
Maternal mental well-being is crucial for optimal infant health and extends beyond the direct interactions between the mother and child which are key in early postnatal development.[34] Accumulating evidence has now shown that poor maternal mental well-being (PMWB) can affect the developing fetus, contributing to detrimental perinatal outcomes such as an increased risk of preterm birth and lower birth weight for gestational age.[35] PMWB, including high levels of perceived stress, depression, and anxiety, is common, and expected to become increasingly frequent in the modern social environment.[36] Over 75% of women experience some degree of antenatal stress,[37] a quarter significant anxiety symptoms,[38] and up to one in five women experiences clinically relevant depressive symptoms during pregnancy[39] Hedegaard et al.[40] stated that untreated mental health conditions during pregnancy may give rise to poor pregnancy outcomes, including preterm delivery, low birth weight, and other pregnancy outcomes.
PMWB can also influence fetal brain development,[41] and cognitive development,[42] leading to delays in speech,[43] a deficit in concentration and attention,[44] and altered brain activity during cognitive processing.[45] These effects have been observed even after controlling for birth weight. Emotional regulation in children can also be comprised, with an increased risk of behavioral problems,[46] antisocial behavior, and violence.[47] Prenatal exposure to high levels of maternal perceived stress and major stressful life events (i.e., natural disasters) has been associated with an increased risk of attention deficit hyperactivity disorder,[48],[49] schizophrenia,[50] and autism in middle childhood.[51] Further, adolescents whose mothers experienced depression and anxiety during pregnancy are themselves at an increased risk of these mood disorders.[49] The magnitude of these effects of PMWB on infant health also appears to be relatively large, highlighting the clinical relevance of these associations. For example, one study has estimated that 15% of the attributable load of emotional or behavioral problems in childhood is due to PMWB.[51]
It is also interesting to find that even childbirth itself can have effect on the well-being levels of mother. In a study conducted by Bassi et al.,[52] a significant correlation was found between depression and psychological well-being dimension among 81 pregnant women who were interviewed during and postpartum period, and primiparous women were having better environmental mastery and self-acceptance than multiparous women. Kuleshova[53] in a study done among pregnant women in Moscow concluded that social well-being of a pregnant woman influences her psychic well-being and the quality of her life.
| Conclusion | | |
The international maternity care documents outlines and ensures women empowerment through control, choice and continuity,[54] and it provides an important foundation for enhancing well-being in pregnancy and childbirth. Investigating the various aspects of maintaining well-being during pregnancy is important, which will be contributing in the knowledge regarding strategies to promote maternal health. Huppert[31] highlights the need to comprehensively assess well-being in pregnancy. Hence, the antenatal period may be utilized as a period of preparation of the women for childbirth and may help in increasing the overall well-being not only for the to-be mother but also for the unborn child.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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