18 1 
Home Page  

  • SciELO

  • SciELO


Análise Psicológica

 ISSN 0870-8231

     

 

Processo gravídico, parto e prematuridade: Uma discussão teórica do ponto de vista do psicólogo

Rui C. Campos (*)

 

RESUMO

Este trabalho apresenta a gravidez segundo a conceptualização de alguns autores, como um período de crise maturacional, onde ocorre um processo de desenvolvimento psicológico por fases, ao longo dos três trimestres, com objectivos e tarefas psíquicas definidas. Hipotetizamos que perturbações, como uma paragem ou bloqueio, nesse processo de desenvolvimento gravídico, poderão resultar na ocorrência do parto prematuro, e que o prosseguir do processo até ao final, mas de forma conturbada, pode contribuir para complicações no desenrolar do parto de termo ou para distúrbios no pós-parto. São apresentados alguns estudos sobre a influência de factores psicológicos no parto prematuro, nas complicações do parto de termo e nos distúrbios emocionais do pós-parto. São revistos e discutidos alguns estudos que descrevem o ambiente físico, as manipulações a que são sujeitos os bebés nas Unidades de Cuidados Intensivos, as consequências desse ambiente e manipulações para os bebés prematuros e de baixo peso, bem como as alterações que se podem implementar nessas unidades. Finalmente, apresentamos alguns estudos sobre os programas de estimulação suplementar e de redução do stress, os seus efeitos a curto e a longo prazo, e discutimos ainda a influência que a relação pais-bebé pode ter na eficácia dos pro-gramas de estimulação e no desenvolvimento destes bebés. Ao longo do artigo e no final são tecidas considerações sobre o papel do psicólogo clínico na prevenção e intervenção terapêutica durante e após a gravidez.

Palavras-chave: Processo gravídico, parto prematuro, factores psicológicos, parto, bebés prematuros e de baixo peso, programas de estimulação, interacção pais-bebé.

 

ABSTRACT

These article presents pregnancy, following the conceptualization of some authors, as a crisis maturation period, during which a psychological developmental process occurs by phases, within the three trimesters, with defined psychological goals and tasks. We propose that disruptions, in the developmental process can result in the ocurrence of premature birth, and that the continuation of the process but in a disturbed way, can contribute to term-delivery complications or to post-term emotional disturbances. We present some studies about the influence of psychological factors in premature birth, in term-delivery complications and in the emotional disturbances of post-delivery. We review and discuss some studies that describe the physical environment of the Intensive Care Units, the manipulations and the consequences for the premature anl low birthweight babies, as well as the modifications that can be implemented in those units. Finaly, we present some studies about aditional stimulation and stress-reduction programs, their short and long-term effects, and discuss the influences that the parent-child relationship can have in the eficacy of those programs, and in the development of those babies. We make some considerations about the role of the clinical psychologist in prevention and therapeutics during and after pregnancy.

Key words: Pregnancy process, premature birth, psychological factors, term-delivery, premature and low birthweight babies, stimulation programs, parent-baby interaction.

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

REFERÊNCIAS BIBLIOGRÁFICAS

Abramovich, S., Gregory, S., Slemick, M., & Stewart, A. (1979). Hearing loss in very low birthweight infants treated with neonatal intensive care. Archives of Diseases in Childood, 54, 421-426.

        [ Links ]

Adamson-Macedo, E., & Arttree, J. (1994). TAC-TIC therapy: The importance of systematic stroking. British Journal of Mildwifery, 2 (6), 264-269.

Adamson-Macedo, E., & Werner, J. (1994). Very early tactile stimulation and later cognitive development. Infant Behaviour and Development, 17, 259.

Barnard, K., & Bee, H. (1983). The impact of temporally patterned stimulation on the development of preterm infants. Child Development, 54, 1156-1167.

Barrat, M. S., Roach, M. A., & Leavitt, L. A. (1996). The impact of low-risk prematurity on maternal behaviour and toodler outcomes. International Journal of Behavioral Development, 19 (3), 581-602.

Bernbaum, J., Pereira, G., Watkins, J., & Peckham, G. (1983). Nonnutritive sucking during gavage feeding enhances growth and maturation in premature infants. Pediatrics, 71 (1), 41-45.

Bhagwanani, S. G., Seagraves, K., Dierker, L. J., & Lax, M. (1997). Relationship between prenatal anxiety and perinatal outcome in nulliparous women: A prospective study. Journal of the National Medical Association, 89 (2), 93-98.

Bibring, G., Dwyer, T., Huntington, D., & Valenstein, A. (1961). A study of the psychological processesin pregnancy and of the earliest mother-child relationship. Psychoanalitic Study of the Child, 16, 9-24.

Briscoe, J., Gathercole, S. E., & Marlow, N. (1998). Short-term memory and language outcomes after extreme prematurity at birth. Journal of Speech, Language and Hearing Research, 41 (3), 654-666.

Brothwood, M., Wolke, D., Gamsu, H., Benson, J., & Cooper, D. (1986). Prognosis of the very low birthweight baby in relation to gender. Archives of Disease in Childhood, 61, 559-564.

Case-Smith, J., Butcher, L., & Reed, D. (1998). Parent´s report of sensory responsiveness and temperament in preterm infants. American Journal of Occupational Therapy, 52 (7), 547-555.

Charles, A., Norr, K., Block, C., Meyering, S., & Meyers, E. (1978). Obstetric and psychological effects of psychoprophylactic preparation for childbirth. American Journal of Obstetrics and Gynecology, 131 (1), 44-52.

Chertok, L., Mondzain, M., & Bonnaud, M. (1963). Vomiting and the wish to have a child. Psychosomatic Medicine, 25 (1), 13-18.

Cohen, T. B., & Etezady, M. H. (1999). The vulnerable child (Vol. 3). Madison, CT: International Universities Press.

Colman, A., & Colman, L. (1973). La grossesse: Experience psychologique. Paris: Robert Laffont.

Colman, A., & Colman, L. (1991). Pregnancy: The psychological experience (revised and expanded). New York: The Moonday Press.

Cox, D., & Reading, A. (1989). Flutuactions in state anxiety over the course of pregnancy and the relationship to outcome. Journal of Psychosomatic Obstetrics and Gynecology, 10, 71-78.

Cutrona, C. (1982). Nonpsychotic postpartum depression: A review of recent research. Clinical Psychology Review, 2 (4), 487-503.

Dahl, R. (1996). The regulation of sleep and arousal: development and psychopathology. Development and Psychopathology, 8, 3-27.

Danford, D., Miske, S., Headley, J., & Nelson, R. (1983). Effects of routine care procedures on transcutaneous oxygen in neonates: a quantitative approach. Archives of Disease in Childhood, 58, 20-23.

Davids, A., & De Vault, S. (1962). Maternal anxiety during pregnancy and childbirth abnormalities. Psychosomatic Medicine, 24 (5), 464-469.

Davids, A., De Vault, S., & Talmadge, M. (1961). Anxiety, pregnancy and childbirth abnormalities. Journal of Consulting Psychology, 25, 74-77.

Douek, E., Bannister, L., Dodson, H., & Ashcroft, P. (1976). Effects of incubator noise on the cochlea of the newborn. The Lancet, 20, 1109-1113.

Eckerman, C. O., Hsu, H. C., Molitor, A., Leung, E. H., & Goldstein, R. F. (1999). Infant arousal in an enface exchange with a new partner: Effects of prematurity and perinatal biological risk. Developmental Psychology, 35 (1), 282-293.

Erickson, M. T. (1975). The relationship between psychological variables and specific complications of pregnancy, labor and delivery. Journal of Psychosomatic Research, 20, 207-210.

Field, T. (1990a). Alleviating stress in newborn infants in the Intensive Care Unit. Clinics in Perinatology, 17 (1), 1-9.

Field, T. (1990b). Interventions to alleviate stress and facilitate growth and development of the preterm neonate. Advances in Developmental and Behavioral Pediatrics, 9, 139-159.

Filed, T., & Goldson, E. (1984). Pacifying effects of nonnutritive sucking on term and preterm neonates during heel sticks. Pediatrics, 74, 1012-1015.

Field, T., Ignatoff, E., & Stringer, S. (1982). Nonnnutritive sucking during tube feedings: Effects on preterm neonates in an ICU. Pediatrics, 70, 381-384.

Field, T., Schanberg, S., Scafidi, F., Bauer, C., Vega-Lahr, N., Garcia, R, Nystrom, J., & Kuhn, C. (1986). Tactile/kinestesic stimulation effects on preterm neonates. Pediatrics, 77, 654-658.

Fleming, A., Ruble, D., Anderson, V., & Flett, G. (1988). Place of childbirth influences: Feelings of satisfaction and control in first-time mothers. Journal of Psychosomatic Obstetrics and Gynecology, 8, 1-17.

Giorlando, S., & Mascola, R. (1957). The treatment of Hyperemesis Gravidarum with hypnotherapy. American Journal of Obstetrics and Gynecology, 67 (3), 444-453.

Goldson, E. (1992). Follow-up of low birth weight infants: A contemporary review. Advances in Developmental and Behavioral Pediactrics, 10, 159-179.

Gordon, R, & Gordon, K. (1959). Social factors in the prediction and treatment of emotional disorders of pregnancy. American Journal of Obstetrics and Gynaecology, 77 (5), 1074-1083.

Greenberg, M., & Crnic, K. (1988). Longitudinal predictors of development status and social interaction in premature and full-term at age two. Child Development, 59, 554-570.

Gregg, C., Haffner, M., & Korner, A. (1976). The relative efficacy of vestibular-proprioceptive stimulation and the upright position in enhancing visual pursuit in neonates. Child Development, 47, 309-314.

Gunnar, M., Isensee, J., & Fust, S. (1987). Adrenocortical activity and the Brazelton Neonatal Assessment Scale: Moerating effects of the newborn’s biobehavioral status. Child Development, 58, 1448-1458.

Halpern, L. F., & McLean, W. E. (1997). «Hey mom, look at me». Infant Behaviour and Development, 20 (4), 515-529.

Harrison, M. J., & Magill-Evans, J. (1996). Mother and father interactions over the first year with term and preterm infants. Research in Nursing and Health, 19 (6), 451-459.

Johnson, J., & Dubin, N. (1980). Prevention of preterm labor. Clinical Obstetrics and Gynaecology, 23 (1), 51-73.

Justo, J. (1994). A evolução da ansiedade e dos mecanismos de defesa ao longo da gravidez. Dissertação de Doutoramento em Psicologia Clínica, Universidade de Lisboa, Lisboa.

Justo, J. (1997). Os bebés prematuros, as mães deles e os psicólogos de quem eles precisam. Psicologia: Teoria, Investigação e Prática, 2, 307-322.

Kalmar, M. (1996). The course of intellectual development in preterm and fullterm children: An 8-year longitudinal study. International Journal of Behavioral Development, 19 (3), 491-516.

Kramer, L., & Pierpont, M. (1976). Rocking waterbeds and auditory stimuli to enhance growth of preterm infants. The Journal of Pediatrics, 88 (2), 297-299.

Koops, B., & Harmon, R. (1980). Studies on long-term outcome in newborns with birth weights under 1500 grams. Advances in Behavioral Pediatrics, 1, 1-28.

Korner, A. (1996). Reliable individual diferences in preterm infants' excitation management. Child Development, 67, 1793-1805.

Kumar, R., Robson, K., & Smith, M. (1984). Development of a self-administered questionaire to measure maternal adjustment and maternal attitudes during pregnancy and after delivery. Journal of Psychosomatic Research, 28 (1), 43-51.

Laucht, M., Esser, G., & Schmidt, M. H. (1997). Developmental outcome of infants born with biological and psychossocial risks. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38 (7), 843-853.

Lawson, K., Daum, C., & Turkewitz, G. (1977). Enviromental characteristics of a neonatal intensive-care unit. Child Development, 48, 1633-1639.

Leroux, S., Malcuit, G., & Pomerleau, A. (1999). Etude comparative de nourrissons prematures et nes a terme et des modes de stimulation qu’ils experimentent au cours des six premiers mois. Canadian Journal of Bahavioral Science, 31 (1), 40-53.

Lobel, M., Dunkel-Schetter, C., & Scrimshaw, S. (1992). Prenatal maternal stress and prematurity: A prospective study of socioeconomically disadvantaged women. Health Psychology, 11 (1), 32-40.

Long, J., Philip, A., & Lucey, J. (1980). Excessive handling as a cause of hipoxemia. Pediatrics, 65 (2), 203-207.

McCarton, C. M., Wallace, I. F., & Bennett, F. C. (1996). Early intervention for low-birth-weight premature infants: What can we achieve? Annals of Medicine, 28 (3), 221-225.

McDonald, R., Gynther, M., & Christakos, A. (1963). Relation between maternal anxiety and obstetric complication. Psychosomatic Medicine, 25 (4), 357-362.

McVey, C., Ibhansebhor, S., Niven, C., Carrol, D., & AlRoomi, L. (1996). A preliminary investigation of the effect of blood sampling on the bahaviour and oxygen saturation of preterm babies in intensive care. Journal of Reproductive and Infant Psychology, 14 (1), 77-79.

Murdoch, D., & Darlow, B. (1984). Handling during neonatal intensive care. Archives of Disease in Childhood, 59, 957-961.

Muylder, X. (1990). Etiologie du travail prématuré: Quel est le rôle des facteurs psychologiques? Journal of Obstetrics Biology and Reproduction, 19, 77-82.

Nettelbladt, P., Fagerstroen, C., & Uddenberg, N. (1976). The significance of reported childbirth pain. Journal of Psychosomatic Research, 20, 215-221.

Newman, L. (1981). Social and sensory enviroment of low birth weight infants in a special care nursery. The Journal of Nervous and Mental Disease, 169 (7), 448-455.

Nordentoft, M., Lou, H. C., Hansen, D., Nim, J., Pryds, O., Rubin, P., & Hemmingsen, R. (1996). Intrauterine growth retardation and premature delivery: The influence of maternal smoking and psychossocial factors. American Journal of Public Health, 86 (3), 347-354.

Nurcombe, B., Howell, D., Rauh, V., Teti, D., Ruoff, P., & Brennan, J. (1984). An intervantion program for mothers of low-birthweight infants: Preliminary results. Journal of the American Academy of Child Psychiatry, 23 (3), 319-325.

Odon, S., & Chandler, L. (1990). Transition to parenthood for parents of special technology-assisted infants. Topics in Early Childhood Special Education, 9 (4), 43-54.

Omer, H., Elizur, Y., Barnea, T., Fiedlander, D., & Pal-ti, Z. (1986). Psychological variables and premature labour: A possible solution for some methodological problems. Journal of Psychosomatic Research, 30 (5), 559-565.

Omer, H., Friedlander, D., & Palti, Z. (1986). Hipnotic relaxation in the treatment of premature labor. Psychosomatic Medicine, 48 (5), 351-361.

Omer, H., Fiedlander, D., Palti, Z., & Shekel, I. (1986). Life stresses and premature labor: Real connection or artifactual findings? Psychosomatic Medicine, 48 (5), 362-370.

Omer, H., Nishiri, R., & Neri, A. (1987). Psychological characteristics of women with postterm pregnancies. Psychosomatic Medicine, 49, 610-615.

Parmelee, A., Bruck, K., & Bruck, M. (1962). Activity and inactivity cycles during the sleep of premature infants exposed to neutral temperatures. Biologia Neonatorum, 4, 317-339.

Powell, L. (1974). The effect of extra stimulation and maternal involvement on the development of low-birth-weight infants and on maternal behaviour. Child Development, 45, 106-113.

Raphael-Leff, J. (1985). Facilitators and regulators: Vulnerability to postnatal disturbance. Journal of Obstetrics and Gynaecology, 4, 151-168.

Rizardo, R., Magni, G., Andreoli, C., Merlin, G., Andreoli, F., Fabris, L., Martinoli, G., & Cosentino, M. (1985). Psychossocial aspects during pregnancyand obstetrical complications. Journal of Psychosomatic Obstetrics and Gynaecology, 4, 11-22.

Róiste, A., & Bushnell, I. (1996). Tactile stimulation: Short and long-term benefits for pre-term infants. British Journal of Developmental Psychology, 14, 41-53.

Scarr-Salapatek, S., & Williams, M. (1973). The effects of early stimulation on low-birth-weight infants. Child Development, 44, 94-101.

Schanberg, S., & Field, T. (1987). Sensory deprivation stress and supplementary stimulation in the rat pup and preterm human neonate. Child Development, 58, 1431-1447.

Schmidt, K., Rose, S., & Bridger, W. (1980). Effect of heartbeat sound on the cardiac and behavioral responsiveness to tactil stimulation in sleeping preterm infants. Developmental Psychology, 16 (3), 175-184.

Schothorst, P. F., & Van-Engeland, H. (1996). Long-term behavioral sequelae of prematurity. Journal of the American Academy of Child and Adolescent Psychiatry, 35 (2), 175-183.

Simbruner, G., Coradello, H., Fodor, M., Havelec, L., Lubec, G., & Pollak, A. (1981). Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants. Archives of Disease in Childhood, 56, 326-330.

Speidel, B. (1978). Adverse effects of routine procedures on preterm infants. The Lancet, 22, 864-866.

Teichmann, A., & Breull, A. (1989). Ein neues konzept psychosomatischer Forschung am beispiel der vorzeitigen Wehentatigkeit. Zsch. Psychosom., 35, 256-276.

Thompson, M., & Khot, A. (1985). Impact of neonatal intensive care. Archives of Disease in Childhood, 60, 213-214.

Wertheim, E., & Morriss, N. (1987). Origine prénatale des relations parent-enfant. Journal of Obstetrics, Gynaecology, Biology and Reproduction, 16, 433-441.

Wolke, D. (1987). Enviromental neonatology. Archives of Disease in Childhood, 62, 987-988.

Worobey, J., & Belsky, J. (1982). Employing the Brazelton Scale to influence mothering: An experimental comparison of three strategies. Developmental Psychology, 18, 736-743.

Zeskind, P., & Iacino, R. (1984). Effects of maternal visitation to preterm infants in the Neonatal Intensive Care Unit. Child Development, 55, 1887-1893.

Zuckerman, B. (1986). Alcohol and psychoactive substance use during pregnancy. In J. Pedro (Ed.), Biopsychology of early parent-infant communication (pp. 93-98). Lisboa: Fundação Calouste Gulbenkian.

 

(*) Departamento de Pedagogia e Educação, Universidade de Évora, Palácio da Inquisição, 7002-554 Évora. Psicólogo Clínico no Instituto de Psicologia das Relações Humanas.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License