# Situation: A 25-year-old woman, gravida 2 para 1, comes to the Barangay Health Station (BHS) for her first prenatal visit at 8 weeks' gestation. Her first pregnancy 2 years ago was uncomplicated, and her child is healthy. She reports no danger signs. She tells the nurse, "I'm happy about the baby, but sometimes I wish it had come a year later because I just went back to work. Is something wrong with me?" How should the nurse classify her response?

> source: MyMerci (mymerci.kr)  
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> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 25-year-old woman, gravida 2 para 1, comes to the Barangay Health Station (BHS) for her first prenatal visit at 8 weeks' gestation. Her first pregnancy 2 years ago was uncomplicated, and her child is healthy. She reports no danger signs.

She tells the nurse, "I'm happy about the baby, but sometimes I wish it had come a year later because I just went back to work. Is something wrong with me?" How should the nurse classify her response?

## 보기

1. Rejection of the pregnancy that needs referral
2. Antenatal depression that needs urgent referral
3. Ambivalence that is common early in pregnancy **✔ 정답**
4. Denial that the pregnancy has really happened

**정답: 3**

## 해설

Mixed feelings about a pregnancy, even a planned one, are common in the first trimester while the woman accepts the pregnancy and adjusts her plans. She expresses happiness and doubt together, which is ambivalence, not rejection or denial. The nurse normalizes the feeling and continues routine psychosocial screening.

## 심화 해설

Clinical classification of early pregnancy emotions

The client expresses two feelings at the same time: she is happy about the pregnancy, but she also wishes the timing had been different because she just returned to work. This simultaneous presence of positive and negative feelings is the defining feature of ambivalence. In early pregnancy, ambivalence is a normal and expected part of the psychological transition to motherhood, not a sign of pathology.

Ambivalence reflects the process of accepting the pregnancy while adjusting one's identity, roles, and life plans. Pregnancy is not only a biological event; it is a major identity transition. The woman must begin integrating the maternal role into her existing sense of self, which includes her identity as a worker, a partner, and a mother of an existing child. Wishing the pregnancy had come later does not mean she rejects the baby or denies the pregnancy. It means she is actively recognizing the real-life consequences of the pregnancy and working through them.

The distinction between ambivalence and more concerning responses is clinically important. Rejection involves a persistent refusal to accept the pregnancy, often accompanied by avoidance of prenatal care or expressed desire not to continue the pregnancy. Denial involves failing to acknowledge the reality of the pregnancy despite objective evidence, such as a positive test or visible physical changes. This client has come for prenatal care at 8 weeks, reports no danger signs, and openly discusses her mixed feelings. None of those features suggest rejection or denial.

Antenatal depression is a distinct clinical syndrome characterized by persistent low mood, loss of interest, sleep and appetite disturbance, guilt, or hopelessness that impairs function. A single statement of mixed feelings about timing does not meet the threshold for depression. However, the nurse should not dismiss the comment. Routine psychosocial screening should continue at each visit, because ambivalence that becomes persistent, distressing, or associated with other depressive symptoms may warrant further assessment.

The research evidence supports this interpretation. Pregnancy involves a transition in maternal identity and role balance, and difficulties integrating the maternal role can be an early vulnerability factor for later psychological distress [1]. Ambivalent emotions are commonly observed during the transition to motherhood, particularly in the first trimester, and are linked to the process of forming prenatal expectations and caregiving representations [3]. Maternal conflict—defined as tension between the maternal role and other life roles—has been associated with psychological symptoms and lower maternal role satisfaction . The developmental process of matrescence involves shifts across biological, psychological, emotional, and identity domains, and this process unfolds over time rather than being complete at the moment pregnancy is confirmed .

| Response | Key features | Nursing action |
| --- | --- | --- |
| Ambivalence | Mixed positive and negative feelings; acknowledges pregnancy; continues care | Normalize; continue routine psychosocial screening |
| Rejection | Persistent refusal to accept pregnancy; may avoid care | Explore reasons; assess safety; consider referral |
| Denial | Fails to acknowledge pregnancy despite evidence | Gently explore perception; assess coping and support |
| Antenatal depression | Persistent low mood, anhedonia, guilt, sleep or appetite changes, functional impairment | Use validated screening tool; refer for mental health evaluation if indicated |

Watch out! A woman can be happy about a pregnancy and still feel worried about work, finances, or timing. This is not a contradiction that signals pathology; it is a normal part of adjusting to the maternal role. Key point! The nurse's role is to normalize ambivalence while remaining alert for signs that it is evolving into depression, rejection, or denial over subsequent visits.References (research sources)

- [1]Maternal Identity and Role Balance in Pregnancy: Construction and Validation of the Maternal Role Integration Questionnaire (MRIQ-P).Research articleGarcía-Romero A, Peñacoba C, Catalá P. (2026) · DOI: 10.3390/bs16040578

- [3]Attachment style and prenatal expectations from a Bayesian perspective.Research articleZaki N, Ruiz-Ruano García AM, López Puga J (2020) · DOI: 10.7334/psicothema2019.222

## 임상 시나리오

Early Pregnancy Emotional ClassificationDistinguishing Normal Ambivalence from Pathology
Ambivalence is the simultaneous presence of positive and negative feelings about the pregnancy. In the first trimester, it is a normal part of maternal role adaptation and does not require referral.

The nurse should normalize the feeling, validate the client's concerns about work timing, and continue routine psychosocial screening at each visit.

CautionDo not classify as rejection unless there is persistent refusal, avoidance of care, or expressed desire to end the pregnancy. Do not classify as denial unless the client fails to acknowledge the pregnancy despite objective evidence.

## 핵심 개념

- **Ambivalence** — Simultaneous positive and negative feelings about a situation; in early pregnancy, a normal part of maternal role transition.
- **Rejection of pregnancy** — Persistent refusal to accept the pregnancy, often with avoidance of prenatal care or expressed desire not to continue.
- **Denial of pregnancy** — Failure to acknowledge the reality of pregnancy despite objective evidence such as a positive test or physical changes.
- **Maternal role adaptation** — Psychological process of integrating the maternal identity into one's existing sense of self, roles, and life plans.
- **Antenatal depression** — Depressive disorder occurring during pregnancy, characterized by pervasive low mood or anhedonia, distinct from transient ambivalence.

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