1. Psychosocial-cultural alterations
    1. Emotional changes - affected by age, maturity, support system, amount of current stresses, coping abilities, physical and mental health status.
      2. Developmental tasks of pregnancy:
      1. Accept the pregnancy as real: “I am pregnant”; progress from symbiotic relationship with the fetus to perceiving the child as an individual.
      2. Seek and ensure acceptance of child by others.
      3. Seek protection for self and fetus through pregnancy and labor (“safe passage”).
      4. Prepare realistically for the coming child and for necessary role change: “I am going to be a parent.”
    2. Physical bases of changes
      1. Increased metabolic demands may result in anemia and fatigue.
      2. Increased hormone levels (steroids, estrogen, progesterone) - affect mood as well as physiology.
    3. Characteristic behaviors
    4. Sexuality and sexual expression - feelings and expressions of sexuality may vary during pregnancy due to maternal adaptations.
    5. Intrafamily relationships
      1. Pregnancy is a maturational crisis for the family.
      2. Requires changes in lifestyle and interactions:
        1. Increased financial demands.
        2. Changing family and social relationships.
        3. Adapting communication patterns.
        4. Adapting sexual patterns.
        5. Anticipating new responsibilities and needs.
        6. Responding to reactions of others.