Maternal adaptation during childbearing in Norway,Sweden and the United States

The purpose of the study of 147 healthy primiparous women is to investigate the relationship between maternal adaptation during pregnancy and postpartum. This report is part of a larger study of relationships between family dynamics and maternal adaptation during childbearing in Norway, Sweden and the US. Variables included maternal adaptation, age, social status, mother's employment, type of birth, length of hospitalization and mother infant time together in the hospital. Mothers reporting greater adaptation during pregnancy reported greater adaptation postpartum. Mothers who believed themselves adapted indicated that they were better prepared for labour, had more control over their birth experience, a better relationship with their partner, and perceived greater participation in child care from their partner. Few differences were found in maternal adaptation among all mothers, and few relationships were found among selected sociodemographic variables and maternal adaptation. Formation of maternal identity and mother's confidence in her ability to cope with the tasks of motherhood was affected by mothers' prenatal identification with the motherhood role, supporting the notion that knowing what to expect provides a sense of control. Mothers' prenatal identification with the motherhood role directly or indirectly affected her satisfaction with motherhood. Nurses may want to develop practice strategies to support these findings.     

Isolation from "being alive": coping with severe nausea and vomiting of pregnancy

BACKGROUND: Despite ongoing investigations into specific causes of and treatments for pregnancy-related nausea and vomiting, it remains a common phenomenon of varying intensity that affects the quality of life for both affected women and their families. OBJECTIVE: To understand how women cope with severe nausea, vomiting, and/or retching during pregnancy. METHOD: Women hospitalized with severe symptoms (N = 24) were purposely selected to participate in 24 semistructured interviews and one focus group (N = 4). RESULTS: A process was identified wherein women experienced severe and unrelenting nausea and related symptoms which became progressively more debilitating, leaving them feeling uncertain about when and if they would recover. This caused the women to isolate themselves from their world in an effort to cope with symptoms. CONCLUSIONS: Severe nausea and vomiting of pregnancy is a complex and overwhelming syndrome. Rather than emphasizing a specific treatment for a particular symptom (e.g., vomiting), nurses can intervene to reduce the impact of factors that affect the magnitude of nausea, vomiting, and retching.     

Associations between maternal characteristics and pregnancy-related stress among low-risk mothers: An observational cross-sectional study

Background

Pregnancy is viewed as a major life event and, while the majority of healthy, low-risk women adapt well to pregnancy, there are those whose levels of stress are heightened by the experience.

Objectives

To determine the level of pregnancy-related stress experienced by a group of healthy, low-risk pregnant women and to relate the level of stress with a number of maternal characteristics.

Design

An observational cross-sectional study.

Setting

A large, urban maternity centre in Northern Ireland.

Participants

Of the 306 pregnant women who were invited to participate, 278 provided informed consent and were administered one self-complete questionnaire. Due to the withdrawal criteria, 15 questionnaires were removed from the analysis, resulting in a final sample of 263 healthy, low-risk pregnant women.

Methods

Levels of stress were measured using a self-report measure designed to assess specific worries and concerns relating to pregnancy. Maternal characteristics collected included age, marital status, social status, parity, obstetric history, perceived health status and ‘wantedness’ for the pregnancy. Regression analysis was undertaken using an ordinary linear regression model.

Results

The mean prenatal distress score in the sample was 15.1 (SD = 7.4; range 0-46). The regression model showed that women who had had previous pregnancies, with or without complications, had significantly lower mean prenatal distress scores than primiparous women (p < 0.01). Women reporting poorer physical health had higher mean prenatal distress scores than those who reported at least average health, while women aged 16-20 experienced a mean increase in the reported prenatal distress score (p < 0.05) in comparison to the reference group of 36 years and over.

Conclusions

This study brings to light the prevalence of pregnancy-related stress within a sample representative of healthy, low-risk women. Current antenatal care is ill-equipped to identify women suffering from high levels of stress; yet a growing body of research evidence links stress with adverse pregnancy outcomes. This study emphasises that healthy, low-risk women experience a range of pregnancy-related stress and identification of stress levels, either through the use of a simple stress measurement tool or through the associated factors identified within this research study, provides valuable data on maternal well-being.     

Nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy, commonly known as "morning sickness," affects approximately 80 percent of pregnant women. Although several theories have been proposed, the exact cause remains unclear. Recent research has implicated Helicobacter pylori as one possible cause. Nausea and vomiting of pregnancy is generally a mild, self-limited condition that may be controlled with conservative measures. A small percentage of pregnant women have a more profound course, with the most severe form being hyperemesis gravidarum. Unlike morning sickness, hyperemesis gravidarum may have negative implications for maternal and fetal health. Physicians should carefully evaluate patients with nonresolving or worsening symptoms to rule out the most common pregnancy-related and nonpregnancy-related causes of severe vomiting. Once pathologic causes have been ruled out, treatment is individualized. Initial treatment should be conservative and should involve dietary changes, emotional support, and perhaps alternative therapy such as ginger or acupressure. Women with more complicated nausea and vomiting of pregnancy also may need pharmacologic therapy. Several medications, including pyridoxine and doxylamine, have been shown to be safe and effective treatments. Pregnant women who have severe vomiting may require hospitalization, orally or intravenously administered corticosteroid therapy, and total parenteral nutrition.     

The relationships of social support,uncertainty, self‐efficacy,and commitment to prenatal psychosocial adaptation

Aims. To report a study of the relations of prenatal psychosocial adaptation, social support, demographic and obstetric characteristics, uncertainty, information‐seeking behaviour, motherhood normalization, self‐efficacy, and commitment to pregnancy. Background. Prenatal psychosocial assessment is recommended to identify psychosocial risk factors early to prevent psychiatric morbidities of mothers and children. However, knowledge on psychosocial adaptation and its explanatory variables is inconclusive. Design. This study was non‐experimental, with a cross‐sectional, correlational, prospective design. Methods. The study investigated Hong Kong Chinese women during late pregnancy. Convenience sampling methods were used, with 550 women recruited from the low‐risk clinics of three public hospitals. Data was collected between January–April 2007. A self‐reported questionnaire was used, consisting of a number of measurements derived from an integrated framework of the Life Transition Theory and Theory of Uncertainty in Illness. Explanatory variables of psychosocial adaptation were identified using a structural equation modelling programme. Results. The four explanatory variables of the psychosocial adaptation were social support, uncertainty, self‐efficacy, and commitment to pregnancy. In the established model, which had good fit indices, greater psychosocial adaptation was associated with higher social support, higher self‐efficacy, higher commitment to pregnancy, and lower uncertainty. Conclusion. The findings give clinicians and midwives guidance in the aspects to focus on when providing psychosocial assessment in routine prenatal screening. Since there are insufficient reliable screening tools to assist that assessment, midwives should receive adequate training, and effective screening instruments have to be identified. The explanatory role of uncertainty found in this study should encourage inquiries into the relationship between uncertainty and psychosocial adaptation in pregnancy.     

Korean mothers' psychosocial adjustment to their children's cancer

BACKGROUND: During the course of adjustment to their child's illness and medical treatment, parents of children with cancer may experience numerous challenges and difficulties. Although parental adjustment has been a research topic for many years, little research has been conducted among families in different cultures and countries. AIM: To identify factors that influence maternal psychosocial adjustment to childhood cancer using a new cultural group: Korean. METHODS: A sample of 200 Korean mothers of children with cancer was included in the study. Guided by the double ABCX model of family adjustment and adaptation, a series of variables (i.e. maternal stress, coping, social support and selected illness-related and demographic questions) were examined for their relationships with maternal psychosocial adjustment to childhood cancer. RESULTS: Using a hierarchical multiple regression, we found perceived level of stress, coping, social support, and time since diagnosis to be significant correlates of maternal psychosocial adjustment. Stress accounted for most (50%) of the total variance explained (56%) in maternal adjustment. CONCLUSION: The results suggest that the stress-coping framework may be appropriate in explaining maternal responses to childhood cancer across cultures.     

Populations at Risk Across the Lifespan: Case Studies: Psychological and Physical Abuse Among Pregnant Women in a Medicaid‐Sponsored Prenatal Program

ABSTRACT Objectives: To document psychological and physical abuse during pregnancy among women enrolled in enhanced prenatal services (EPS); explore the associations between maternal risk factors and type of abuse; and examine the relationship between abuse and EPS participation. Design and Sample: Cross‐sectional study utilizing screening data collected between 2005 and 2008. Convenience sample of Medicaid‐insured pregnant women enrolled in EPS selected from urban and rural providers. Measures: A prenatal screening tool that included measures such as Cohen's Perceived Stress Scale‐4, Patient Health Questionnaire‐2, and Abuse Assessment Screen was used. Results: Logistic regressions showed that high perceived stress and lack of father support were associated with all types of abuse and abuse history. Women with risk factors, such as a positive depression screen (odds ratio [OR]=2.36), were associated with psychological abuse but not with physical abuse during pregnancy. Less than a 12th‐grade education was associated with physical abuse (OR=1.64) but not psychological abuse during pregnancy. The amount or the timing of EPS participation was not significantly associated with abuse history or abuse during pregnancy. Conclusions: Risk factors, such as high perceived stress and lack of father support, may alert nurses to further explore abuse during pregnancy. Additional research is needed for understanding the relationship between abuse and EPS participation.     

Stress Experiences and Mental Health of Pregnant Women: The Mediating Role of Social Support

Stress in pregnancy is an exceedingly common issue that impacts the mother’s mental health and the health of her baby. Yet, women with a supportive network of friends and family may experience lower stress and improved mental health. Therefore, the aims of this secondary analysis were to (a) examine relationships between stress experiences (i.e. perceived stress, pregnancy-specific stress) and indicators of mental health (i.e. absence of depressive symptoms and resourcefulness), (b) determine the effects of social support on stress experiences and indicators of mental health, and (c) determine if social support mediates the relationship between stress experiences and indicators of mental health. A convenience sample of 82 women in their second and third trimester of pregnancy participated in the parent study. Findings indicate that stress experiences were moderately correlated with indicators of mental health and social support predicted stress experiences and indicators of mental health. All social support mediation models were not significant with the exception of social support mediating the relationship between pregnancy-specific stress and resourcefulness. This was the first study to investigate the mediating role of social support on the relationship between pregnancy-specific stress and resourcefulness. Pregnant women may benefit from social support interventions to meaningfully reduce their stress and promote mental health. Such interventions may be physical activity, group prenatal care, or even peripartum home visits.     

Prenatal examination behavior of Southeast Asian pregnant women in Taiwan: a questionnaire survey

BACKGROUND: There is growing concern about the factors affecting the prenatal examinations of immigrant women. OBJECTIVES: The purpose of this study was to examine the relationships between the knowledge of pregnancy, attitude toward pregnancy and experience of medical services, and prenatal examination behavior of pregnant Southeast Asian women in Taiwan. DESIGN: This was a cross-sectional study with a structured questionnaire administered to participants. SETTING: Participants were recruited from the community health centers in Kaohsiung County, Taiwan. PARTICIPANTS: The sampling criteria were as follows: each subject was to (a) have come from a Southeast Asian country, (b) be over 28 weeks pregnant to less than one year postpartum, (c) be able to communicate either in Mandarin or Taiwanese, and (d) be willing to participate in the research after hearing an explanation of it. As a result, 140 participants were recruited. A total of 132 participants completed the questionnaire and were used for data analysis. METHODS: The participants completed structured questionnaires, which included the Demographic Inventory Scale, Knowledge of Pregnancy Scale, Attitudes toward Pregnancy Scale, Experience of Medical Services Scale and the Prenatal Examination Behavior Scale. RESULTS: Findings show that 80.3% of the subjects attended their first-time prenatal examination during the first trimester and 59.1% of the subjects evaluated their prenatal examinations as being adequate. Their attitude toward childbearing was significantly correlated with their prenatal examination behavior, including the initial time of prenatal examination and frequencies of prenatal examinations during pregnancy. Positive attitudes toward childbearing and prenatal examination, and the number of years spent in Taiwan were all significant predictive factors of frequencies of prenatal examinations during pregnancy. The findings of this study can not only help healthcare professionals understand the prenatal examination behavior and related factors of the participants, but also provide guidance to healthcare professionals as they assist these pregnant Southeast Asian women in Taiwan in developing childbearing and family plans. CONCLUSION: The attitude toward childbearing of the participants was significantly correlated with their prenatal examination behavior. They require professional help in seeking out appropriate medical services that will improve their healthcare quality during pregnancy.     

Nursing Practice Strategies for Prenatal Care of Homeless Pregnant Women

Women who are homeless are less likely to receive preconception care or prenatal care in the first trimester, and they tend to have fewer prenatal visits overall than their housed counterparts. Homelessness during pregnancy can increase the risk for many maternal, fetal, and neonatal complications. Barriers to proper prenatal care can be categorized as logistical, psychosocial, intellectual, and attitudinal. Although all women face potential barriers to optimal care, women who are homeless are particularly vulnerable and experience these barriers to a greater degree. Nursing strategies for prenatal care of homeless pregnant women include therapeutic communication, focused assessment, and upstream interdisciplinary approaches.     

Social interactions, perceived support, and level of distress in HIV-positive women.

Although powerful pharmacological therapies are helping women with HIV infection live longer, women continue to experience the stressors of chronic illness. This study used a person-environment systems framework to describe social interactions, perceived social support, and psychological distress in HIV-positive women. A convenience sample of 104 HIV-positive women living in the San Francisco Bay Area completed a questionnaire on social interactions, perceived social support, and distress. Women reported limited social interactions with family and friends and a low level of perceived social support. Social support and level of distress did not differ by ethnicity. Limited perceived social support was a significant predictor of distress in this sample of women. Supportive interactions from health care providers can be useful in mediating the relationship between the stressor of HIV disease and distress in HIV-positive women. Community-based nurses can enhance HIV-positive women's support network by providing positive and supportive interactions as they intervene with women in symptom management, case management, and other health care services.     

Social support,life stress,and anxiety as predictors of pregnancy complications in low‐income women

Prospective repeated measures were used to examine attachment, social support, life stress, anxiety, and psychological wellbeing among low‐income women in early and late pregnancy and the relationships of these variables to prenatal, intrapartum, and neonatal complications. One hundred and eleven medically healthy, low‐income, Medicaid‐eligible women ages 18–35 years, between 14 and 22 weeks of pregnancy were recruited from prenatal clinics. Self‐report questionnaires and hospital records were used to collect data. Discriminant analysis was performed. The most important discriminating factors for prenatal complications were state anxiety and total functional social support. The factors for neonatal complications were negative life events and the interaction of emotional support with negative life events. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32: 391–404, 2009     

Adaptation to multiple sclerosis: the role of social support, functional disability, and perceived uncertainty

This study was designed to test a path model depicting the relationships among social support, functional disability, perceived uncertainty, and psychosocial adaptation in 38 men and 80 women with multiple sclerosis, a chronic, unpredictable disease. Results from the regression analyses indicated that 35% of the variance in depression and 33% of the variance in purpose-in-life, respectively, were explained by age, sex, social status, and the perceived supportiveness and unsupportiveness of social network interactions. The path analyses showed that the perceived supportiveness of interactions was directly related to purpose-in-life but not to depression; both the direct path between the perceived unsupportiveness of interactions and adaptation and the indirect one through perceived uncertainty were related to depression and to purpose-in-life; and functional disability had a direct effect on adaptation, but the indirect path through perceived uncertainty was not corroborated.     

Experiences of security associated with pregnancy and childbirth: a study of pregnant women

The aim of this study was to describe the sense of security associated with pregnancy and childbirth and to identify factors associated with it. Security was conceptualized in accordance with Kaufmann as a human need and as a human value. The instrument used was a questionnaire with a 4-point scale. The sample consisted of 481 pregnant Finnish women. The response rate was 69%. Rotated factor analysis was carried out and sum variables were produced. The effects of various background variables were calculated using the Kruskal-Wallis test and the Mann-Whitney U-test. The elements creating security were social support, knowledge, prenatal health-care experiences, support from the partner, livelihood, positive stories and, in multiparae, positive previous childbearing experiences. The most salient finding concerning factors related to security was that women who had no pregnancy-related problems in the current pregnancy reported social support, prenatal health-care experiences and support from the partner as security-creating elements more often than women with such problems. This was the only factor related to manifestation of security. The findings suggest that all pregnant women should be assisted by professionals to find security-creating elements in their particular situation to promote and strengthen the sense of security, paying special attention to women with pregnancy-related problems.     

The negative birth experience of prolonged labour: a case-referent study

Aims. This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. Background. In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. Method. Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks’ pregnancy at three hospitals in northern Sweden were recruited to a case–referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. Results. Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, ‘Pain relief during the delivery saved me’ (OR 4.5, 95% CI: 1.9–11.1) and ‘My difficulties during the delivery will mark me for life’ (OR 12.4, 95% CI: 4.4–35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. Relevance to clinical practice. To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.     

Comparing Taiwanese women's biopsychosocial features by location of postpartum recovery

BackgroundIn Taiwan, a culturally sanctioned ritual of maternal rest and recuperation has been traditionally practiced patrilocally during the first postpartum month. However, in recent years, the places where women may observe the ritual have become more diverse.AimOur goal was to compare women's psychosocial features based on where they stayed during their postpartum recovery.MethodsUsing proportional stratified quota sampling of 18 hospitals and clinics in Taiwan by birth rate, we recruited 784 postpartum women.ResultsWomen stayed in their own home (17.1%), with their parents-in-law (33.3%), with their parents (36.0%), or in a postpartum nursing center (13.6%). Women who stayed in their own residence or who stayed in their parents' residence perceived greater social support than women who stayed with their parents-in-law.ConclusionsFurther research should compare women's adjustment to motherhood and their competence in childcare based on where they stay during postpartum recovery.     

Male violence, stress, and neuroendocrine parameters in pregnancy: a pilot study

Stress during pregnancy has been associated with a number of adverse outcomes. This study compared and correlated neuroendocrine parameters in women (n=8) who self-reported battering during their pregnancy to those in women who did not (n=8). Women who identified themselves as having a violent relationship with an intimate partner were recruited from a rural midwestern community. They were matched on age, self-reported ethnicity, parity, gestational age, and personal and family income with nonbattered controls. Midgestational measures of self-reported stress levels showed that battered women reported markedly higher levels of anxiety and depression. Neuroendocrine levels were not different between groups (battered vs. nonbattered); however, the relationships among hormones were different between groups. In nonbattered women, adrenocorticotropic hormone (ACTH) and cortisol levels were correlated but not in battered women. Beta endorphin and ACTH levels in battered women showed a significant linear relationship but not in nonbattered women. These results suggest that the maternal experience of stress alters the relationship of hypothalamic-pituitary-adrenal-placental axis hormones despite the lack of absolute differences in blood levels.     

Mastery over stress among women with HIV/AIDS.

To better understand how women with HIV infection deal with the stress of their disease, the authors explored the relationships between stressors, resources for managing stress, and mastery over stress in 80 HIV-positive women. Nurses and other professionals recruited participants in a variety of settings in 10 states. Participants completed a packet of research instruments that measured the stressors of perceived stress intensity, interpersonal conflict, and severity of illness; the resources of social support, support networks, and spiritual perspective; and the outcome of mastery over stress. Participants reported high levels of social support, spiritual perspective, interpersonal conflict, and perceived stress intensity. Twenty-nine women (36%) had achieved mastery over stress. Mastery over stress was significantly and positively correlated with social support, spiritual perspective, and physical functioning, a measure of severity of illness. Mastery over stress was significantly and negatively correlated with interpersonal conflict. An exploratory stepwise multiple regression analysis yielded two predictors of mastery over stress: social support and spiritual perspective. Although a comparison of these results with those reported in the literature for men suggests that men and women differ in how they respond to stressors, further research will be needed to enhance our understanding of these gender differences. Stress management training, especially related to interpersonal conflict, may be an effective intervention to facilitate mastery. Other potential interventions include assessing social support and spiritual perspective, discussing the potential benefit of these resources, and making referrals for psychosocial services as needed.