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MultiparityPregnancy tasks are often much more complex for the multipara than for the primigravida. The multipara does not have time to take specialcare of herself as she did during the first pregnancy. She is likely to experience more fatigue and may have serious concerns about her otherchildren. Mothers worry about finding time and energy for 243additional responsibilities. When seeking acceptance of the new baby, themultipara may find family members less excited than they were for the first child.The woman spends a great deal of time working out a new relationship with the first child, who often becomes demanding. This behaviormay foster feelings of guilt as she tries to expand her love to include the second child. Developing attachment for the coming baby ishampered by feelings of loss between herself and the first child. She senses that the child is growing up and away from her, and she maygrieve for the loss of their special relationship (Fig. 13.17).FIG 13.17A pregnant woman spends time with her child to provide affection and a sense of security. Nurses cannot assume that multiparas do not need information about labor, breastfeeding, and infant care. They also need specialassistance in integrating an additional infant into the family structure.Critical Thinking Exercise 13.2Emma, a 24-year-old gravida 2, para 1 at 32 weeks of gestation appears apathetic and tired when she arrives at the prenatal clinic. She statesthat she is worried about how her 2-year-old son will accept the new baby and sometimes feels guilty that she is having this baby so soon.1. How does multiparity affect the maternal tasks of pregnancy for Emma?
2. How should the nurse respond to her concerns?3. Suggest measures Emma can take to prepare her son both before and after the new baby arrives.Social SupportSocial support comes from the woman's partner, family, friends, and co-workers. Generally, support from the woman's partner and her motheris particularly important. Women who have social support as well as those enrolled in Medicaid or the Special Supplemental NutritionProgram for Women, Infants, and Children (WIC) are more likely to receive prenatal care (Potter, Pereya, Lamp, et al., 2009; Sunil, Spears,Hook, et al., 2010).Depression may occur in women who have little support during pregnancy, and they are more likely to begin prenatal care late. The nurseshould assess for signs of depression in all women and refer them for help when necessary. (See Chapter 28for a discussion of postpartumdepression that may have started during pregnancy.) When social support is inadequate, the nurse can help the woman explore potentialsources such as support groups, childbearing education classes, church, work, or school.Absence of a PartnerPregnant single women may have special concerns. Although some unmarried women have the emotional and financial support of a partner,others do not. They may experience more stress about how to tell their family and friends about the pregnancy. Enlisting social support tosubstitute for that of a partner may be important. They may also have legal concerns regarding the father's rights.