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The autonomy is in the relationships, in shared culture 14 and contextual conditions. In addition to access to information, the development of levels of autonomy possible requires ability to handle dependencies and to intensify participation in the therapeutic process 14 and in decision-making. Thus, in addition to sharing information about the medical problems that women have, prenatal care must direct all customer service and relations established for the development of levels of autonomy among them.

How to Have a Healthy, High-Risk Pregnancy

To this end, workers must get to know them better in their potential, weaknesses and needs, and understand their actions, their feelings and the meanings they attach to life, to the reproductive process, the problems, the care. In addition, it is important to undertake systematic and group actions of health education with the active participation of them, in which to adopt strategies based on their health needs, determined by their social conditions, education, the environment in which they develop and perceptions that have about their reproductive and sexual health 8.

Before the pregnancy, the women reveal feelings of satisfaction and happiness, by achieving the desire to have a son, from a social ideal of motherhood that they have. But, in addition, they also reveal insecurities, fears and anxiety before the imponderable. I'm happy, because a son is always welcome, is always good, but also somewhat worried, afraid of what might happen by the end of the pregnancy, but I am happy, I'm happy, I'm waiting excited, but scared, psychologically well scared Rosa, 33 years old, G2, P1, bearer of hyperthyroidism.

The diagnosis of greatest risk, when informed to the woman, produces suffering, for their possible impact especially on child health. Then, after I came here specialized services , they explained to me what was the risk. Then, I was more quiet Nigella, 34 years old, G3, P2, gestational diabetes.

The suffering of women is higher when she has no space in the service to talk, express themselves and better understand what the diagnosis means. The trivialization, by professionals, the need for knowledge of the pregnant women strengthens their insecurity. The pregnancy is accompanied by several changes - social, family, physical, intersubjective. Usual activities of the woman are magazines; often projects are stopped; new family demands appearing. Such changes often come accompanied by worries, fears, tensions, conflicts, guilt, among other feelings.

With the diagnosis of higher risk pregnancy, these feelings tend to intensify, because, besides the medical problem often unexpected, new demands and difficulties appear, related to the problems, their consequences and the care required. I'm worried by the pregnancy being of risk. I stay alone most of the time, at home, and have some crisis epileptic. This all raises concerns [ We also eat more and you have to control it, and you can't I'm eating very salty [ Study with the objective of obtaining criteria to build nursing interventions with pregnant women at greatest risk, made with 10 Colombian women, points to the presence of stress and feelings of ambivalence among them.

On one hand, the enthusiasm for pregnancy and, on the other hand, imbalances with changes affecting their quality of life 8. The impact that the news promotes, the need to re organization of life and deprivation of certain features associated with insecurity and fear. Women feel vulnerable, afraid of dying, fear of her son's death, premature birth and deformities, although they have some confidence in the success of experience 10 , This same study, showing the relationship between these women and a team of health, found that the care of professionals, to clarify doubts and give detailed guidance, eases those feelings.

High Risk Pregnancy: Diabetes

With the dialogue surrounding the diagnosis and assistance actions to women, commonly, feel more secure 10 , Systematic educational actions also can minimize the fears, concerns, blaming, conflicts, and the difficulties of managing the changes. They can provide, for women, the opportunity to speak about themselves, to express needs, feelings and concerns. Professionals should treat them with understanding, in the context of tensions that arise among the personal, interpersonal and social areas.

For that, they need to know and consider the psychosocial and cultural conditions that influence the way they experience and deal with pregnancy and problems 8. Difficulties of personal and family life: sociocultural and economic aspects. In some situations, women do not perceive themselves with personal conditions for having a baby or to give an account of the new tasks that another child will "require", in a context of division of labor in private between men and women:.

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When it was just one, it was a lot easier. Now these two twin gestation. I don't know how I'm going to do, to create two at once, the same size. The others are three, only, so each one is of a different age. So, it's different. These two I don't know how I'm going to do [ They are faced with difficulties to work around problems that arise due to personal and family conditions they have, in a less social protection. To move to the specialized service, they require making alternatives to the care of their children, during their absence from home. A lot of things I had to stop doing. Leave my children at home to be able to come to the specialized service and many things also which is the diabetes, like: I cannot lift weight, have difficulties in home services.

Some women need to broaden the number of contacts with health services FHS and hospital and, for this, they have to rearrange the house activities for which they are responsible. With this requirement, they feel tired and tension.

High-Risk Pregnancy: What Women 35 And Over Need To Know | SELF

I changed routine , because I have to come here every week specialized services , and every week on the health center. So, it is tiring, very heavy, keep coming every week here. So, it changed enough [ I have done this, the diet and take insulin Nigella, 34 years old, G3, P2, bearer of gestational diabetes.

The situation requires further change everyday habits of rest, activity and food with personal implications, for the whole family and finances. New demands of care expand the expenses, and they do not always have the financial resources to supply them. I ate once in a while, at lunch, but a lot of vegetables. I'm not much for eating rice. Now, in pregnancy, I haven't been able to eat rice, beans, meat and vegetables. Women in the study live with adverse social conditions.

All them reside in poor areas with little service structure. Ten live with their partners, but one still resides with her parents and brothers and another with one only with one daughter. Only five of them have their own home, the other live in a rented house or borrowed.

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Four have paid employment; the two interrupted with pregnancy and school activity; and five are unemployed. All have an education degree reduced, between incomplete elementary school four and the high school incomplete five and complete three. Four of them are pregnant for the first time.

Among the multiparous women, three have previous negative experiences of pregnancy, with the death of their partner, with pathologies and the child's death. The medical problem they have, the lack of information about their own health, the difficulty to move with possible independence, fears, tensions and other feelings interlace with other limitations of women's lives - the difficulty of reconciling the care of home, family and themselves, cultural and socioeconomic conditions in deficit, lack of broad support from health services and other social services.

Looking at these problems from the angle of the vulnerabilities, and overcoming the unique risk reasoning implies identifying the aspects and the conditions that can compromise the health of women and, recognizing the interweaving between them, and that they both affect their physical and emotional health, as limited their possibilities of decision-making and care about themselves. The vulnerability concept embraces different dimensions of experiences relating to requirements, to the health care services 15 and social protection. It refers to the totality of hinged of individualized aspects and characteristics of the contexts and social relations, which determine the first ones 2 , It is where people live that needs, potential and mechanisms for social protection and unprotection manifests.

This is in their living spaces answers to their needs are given, or not Although these aspects have not been dealt in this study, from the perspective of the vulnerabilities, in addition to seize medical problems and needs expressed, in this case, for women with higher risk, gestational must also identify the resources that they access where they live, i.

Thus, for operationalizing assistance practices in this perspective, it is necessary to establish another look and other social contexts, governed by extended health practices, individual and collective, that allow health services approach the diverse set of problems on which lie the health needs 15 of women. The quality of their life is not only a reflection of choices, feelings and perceptions, but also a result of the political and social situations they imposed. It is important that pre-natal professionals approach the reality of life for women with a pregnancy diagnosed at greatest risk, seizing and understanding not only the implications of the new situation for their life and the lives of their family, but also the conditions that have to manage it and the resulting susceptibilities they produce.

Although the women in the study report non-medical events of their lives - of affective, cultural and social order - influencing in their health and care, they do not relate directly to the professional practices of prenatal services. These are appreciated, especially based on the actions of control of the medical problems that they have. Thus, they oppose the perspective of prioritized risk in the assistance received. Pregnancy with aggravations is a concrete experience, accompanied by difficulties, needs and sufferings that are expressed in their bodies and special medical care are essential to their resilience.

Thus, based on the medical problems experienced in the existing care alternatives and in their effects, known or expected, women build that reference and act based on it. The diagnosis of gestational higher risk associated with a given medical problem is embedded by women like what translates their needs on health services. Thus, they recognize the specialized prenatal care space as appropriate.

Yes, for sure agreeing with the medical diagnosis and referral to specialized service , because of fear that I had in my first pregnancy; the risk, which I also run now; because of hyperthyroidism. So, I agreed to do this monitoring more closely, in the hospital [ In general, women are satisfied with the assistance received, both on FHS and referral service. In prenatal, women assess whether they are "well treated" by workers and if they obtained explanations they consider important, regarding the reasons for the referral to specialized services, their health conditions, and of the son, of the findings of the examinations, and explanations to the questions and inquiries.

They the specialized service workers are good, both the girl who stays here reception as to who measures the pressure; are very nice, the doctors are pretty friendly with us [ In addition, they enjoy the proximity of the service and service agility. I went to the consultations, there she weighed me, did the tests, asked how I was, looking at the baby's heart, looked at my belly, talked with me [ So, they're all good people, I have nothing to complain about anyone, since the vaccine I took the exam I needed to do, the referrals of exams that I needed to do and there FHS , the girls FHS receptionist do the appointment for me, the girls there are really good Girassol, 27 years old, G4, P3, twin pregnancy.

In the specialized prenatal, access to resources that the FHS does not have are highlighted, certain diagnostic tests, the assistance in any day or time and the immediate hospitalization, if necessary.

4 High-Risk Pregnancy Conditions and How to Cope

I like more here specialized services , because it has more resources, the health center has almost no recourse. Here is a great hospital, so it has more resources [ So, here is best Flor-de-Lis, 29 years old, G2, P1, visually impaired, neonatal death previous history and current hypertension. Women give preference to specialized service, for its ability and agility of research and intervention in gestational problems.

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