So let's take a step back and let's think about before a child is even born.
Pregnancy, for a woman, is a time of enormous changes.
This change happens physically. It happens emotionally.
The role of the woman changes -- she goes from being a woman to being a mom.
She is now, all of a sudden, figuring out in her relationships with others.
If she has a partner, how to share this experience that she's going through.
And, also, how is that relationship changing?
She's not going to be the girlfriend or the wife, she's going to be the co-parent or the single parent.
These are very enormous changes and they're occurring in a short period of time.
So, during this often stressful time of change,
we want to be thinking about the psychosocial well-being of the mom,
because the mom's sense of well-being, actually affects the baby.
The environment that baby, that fetus is in -- that womb, that uterus -- all of the feelings
and excitement and the depression, those transmit into hormonal changes that affect the child.
We also want to be thinking about how is this mom feeding herself
and how is she taking in food so that the child also would get enough food.
People who have mental illness already have children.
People who have eating disorders have children.
And it's important for the mom and any practitioner or nurse
who is taking care of that mom, to have a more global way of looking at how to support,
the best possibility, for both the mom and the child providing these scales for moms to be,
to assess whether or not, there's a likelihood for depression or postpartum depression.
So, what are the stressors can you identify during pregnancy?
Maybe the person has to change their job. Perhaps the person has diabetes or a thyroid condition,
and pregnancy is going to now start altering all the medication
that that person might have to take. Why don't we think about Mary?
Mary is a 25-year-old woman.
She is about 5 foot 5 inches tall and she weighs about 195 pounds.
This make's Mary's BMI 30. Now, her A1C is a 7.2.
What are we thinking about Mary when we think of this?
We're thinking, perhaps Mary is a little bit overweight
and she's now in a high risk for diabetes category with a 7.2 A1C.
She should be taking medication for that.
Mary takes that depression scale and the depression scales within normal limits,
but she tells you that there is so much stress at work
and when she gets depressed and a little stressed,
the way that she copes is that she eats and now she's come in
because she's thinking about getting pregnant, not right now, but maybe in the next year or two.
How can we help Mary?
One of the first things to think about is we are there to listen non-judgmentally.
We might agree or disagree with anything that Mary says, but it is not our life.
We are not taking over Mary's life.
If Mary wants to have a baby, we have to listen to what she wants
and try to work with Mary in order to make Mary have the healthiest pregnancy
and also have the support and protective factors
that she needs in order to have an uneventful pregnancy with a good outcome.
So, what do we think about? What should we be telling Mary? Here are some answers.
The nurse should talk to her about the benefits of losing weight,
even a small amount of weight -- on the health of the baby
and as well as the health of the mother.
Or how about the nurse should explore the client's current understanding
of the impact of obesity on pregnancy?
Maybe the nurse should tell the client that she shouldn't even consider getting pregnant now
because she's so overweight. Or maybe it's the first two.
Now, if you said the first two, you are correct.
We want to be able to think about Mary and think about what Mary wants.
And it's okay to tell Mary, "You know Mary, at this point,
if you want to think about a little bit of weight loss,
let me tell you what impact that would have on both your pregnancy
and as well as the baby's overall development. "
We can also say. "Although you're in an overweight category,"
because she is not in an obese category at this point, "
but although you're in an overweight category, there's an impact of being overweight
and you have to understand that with pregnancy comes a normal natural weight gain,
which might place you in a category for giving birth that would make you high risk."
The final decision is not the nurse's decision or the practitioner's decision.
The final decision is going to be Mary's,
and what do you think is going to help Mary make a good decision?
If you're thinking to yourself that it is by having a good therapeutic relationship with Mary,
by being respectful, by listening to what Mary wants,
then by helping Mary get to the outcome she's looking to get to, well, again, you are correct.