Relationships Among Stress Coping Styles and Pregnancy Complications Among Women Exposed to Hurricane Katrina

ObjectiveTo examine the relationship between maternal stress exposure, stress coping styles, and pregnancy complications.DesignQuantitative, cross‐sectional, and prospective study.SettingTulane‐Lakeside Hospital, New Orleans, LA and Women's Hospital, Baton Rouge, LA.ParticipantsThe study included 146 women (122 from New Orleans and 24 from Baton Rouge), who were pregnant during or immediately after Hurricane Katrina.MethodsParticipants were interviewed regarding their hurricane experiences and perceived stress, and coping styles were assessed using the Brief COPE. Medical charts were also reviewed to obtain information about pregnancy outcomes. Logistic regression was performed to determine possible associations.ResultsHurricane exposure was significantly associated with induction of labor (adjusted odds ratio [aOR] = 1.39; 95% confidence interval [CI] [1.03, 1.86], P = .03) and current perceived stress (aOR = 1.50, CI [1.34, 1.99], P < .01). Stress perception significantly predisposed to pregnancy‐induced hypertension (aOR = 1.16, CI [1.05, 1.30], P < .01) and gestational diabetes (aOR = 1.13, CI [1.02, 1.25], P = .03). Use of planning, acceptance, humor, instrumental support, and venting coping styles were associated with a significantly reduced occurrence of pregnancy complications (P < .05). Higher rates for gestational diabetes was found among women using the denial coping style (aOR = 2.25, CI [1.14, 4.45], P = .02).ConclusionExposure to disaster‐related stress may complicate pregnancy, whereas some coping styles may mitigate its effects. Further research should explore how coping styles may mitigate or exacerbate the effect of major stressors and how positive coping styles can be encouraged or augmented.     

Hurricane Katrina and Perinatal Health

We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post‐traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.     

Working fulltime throughout pregnancy – The Norwegian women's perspectives. A qualitative approach

Objectivethe purpose of this study was to gain a deeper understanding of aspects that influence healthy women's ability to work fulltime throughout the pregnancy, considering women's experiences and individual perspectives, as well as understanding health resources available to them.Design/Settinga qualitative approach was selected for the data collection, and the data presented is derived from in-depth interviews. Ten pregnant Norwegian women with uncomplicated pregnancies, aged 24–40, working fulltime throughout their pregnancies with no sick leave, were interviewed during pregnancy week 37–39. All participants had their regular check-ups at six local public health clinics. The transcribed interviews were analysed through systematic text condensation.Findingsthe findings included two main themes: Supporting environment and having a positive mindset. Feeling good about oneself and feeling appreciated at work provided these women with the supporting environment they needed. All the respondents had coped with different challenges that they found important when working throughout their pregnancies while facing the difficulties of a pregnancy. They emphasised that their positive attitude and coping skills contributed to normalising the pregnancy and motivated them to go to work.Conclusionshaving a positive mindset and a balanced perspective on the pregnancy and bodily changes are important factors in being able to work throughout pregnancy. Support, in various arenas, might positively influence pregnant women´s positive mindset, having a favourable effect on their health resources and ability to continue working when bearing children.     

Mixed-Methods Study of the Experience of Pregnancy During the COVID-19 Pandemic

ObjectiveTo understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.DesignA convergent mixed-methods design.SettingOnline survey that launched in April 2020.ParticipantsA total of 185 pregnant women.MethodsFor the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.ResultsThe mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.ConclusionTo meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.     

Dyadic coping,marital adjustment and quality of life in couples during pregnancy: an actor–partner approach

ABSTRACT

Objective: This study aimed to examine the impact of dyadic coping on the quality of life of couples during pregnancy and to explore the potential mediating role of marital adjustment on this association.

Background: According to the systemic transactional model, pregnancy can be characterised as a situation of dyadic stress because it affects both members of the couple. However, the impact of dyadic coping on couples’ quality of life during pregnancy is unexplored. Also, the potential mediating role of marital adjustment on this association remains understudied.

Methods: Participants were 320 pregnant women and their partners (N = 640) who completed the Dyadic Coping Inventory, the Dyadic Adjustment Scale and the World Health Organisation Quality of Life instrument. Data were analysed using the actor–partner interdependence mediation model.

Results: Results showed that there was an intrapersonal indirect effect of dyadic coping on quality of life through marital adjustment. Moreover, an interpersonal indirect effect was found with fathers’ dyadic coping being associated with mothers’ quality of life through mothers’ marital adjustment.

Conclusions: These findings highlight the importance of assessing dyadic coping strategies of couples during pregnancy and targeting them in the psychological support offered to couples as a way of improving their marital adjustment, and consequently, their quality of life.     

Relationship between domestic violence and postnatal depression among pregnant Chinese women

ObjectiveTo investigate the prevalence of domestic violence during pregnancy and postnatal depression, and to explore the relationship between domestic violence and postnatal depression among Chinese women.MethodsIn a cross-sectional survey, 846 pregnant women were screened with the Abuse Assessment Screen; 215 women completed the postnatal follow-up. All participants underwent psychosocial assessment, with the Edinburgh Postpartum Depression Scale being used for the evaluation of postnatal depression.ResultsThe overall prevalence of domestic violence during pregnancy was 11.3%, and the most common form of domestic violence was psychologic abuse. The follow-up interviews showed a higher prevalence of postnatal depression among women who had been abused during pregnancy (25.1%) than among those who had not (6.0%). Psychologic abuse during pregnancy, an unexpected pregnancy, an attitude of acceptance toward violence, and concern over the newborn's health were related with postnatal depression.ConclusionDomestic violence during pregnancy and related factors contributed to postnatal depression in a population of Chinese women. The findings emphasize the importance of intervention among vulnerable populations in low-income countries.     

Negative impact of non-evidence-based information received by women taking antidepressants during pregnancy from health care providers and others

ObjectivesThe use of antidepressants by women during pregnancy continues to be a controversial subject, with conflicting information regarding the safety of this group of drugs. We sought (1) to determine the impact of information, advice, and comments women received from health care providers, family, and media about use of antidepressants during pregnancy, and (2) to compare experiences regarding the psychosocial impact of women who continued and discontinued antidepressant therapy during pregnancy.MethodsWomen who had taken an antidepressant at some point during pregnancy were interviewed. The responses of women who continued antidepressant therapy throughout pregnancy were compared with those of women who discontinued therapy at some point in the pregnancy. A questionnaire with questions pertaining to information women had received from various individuals regarding the use of an antidepressant while pregnant was administered to both groups.ResultsNinety-four interviews were completed; 78 were with women who continued antidepressant therapy throughout pregnancy, and 16 were with women who discontinued therapy. The small number of women in the discontinuation group was a result of many women declining to participate. More than one half of the women who continued the medication throughout pregnancy had frequently considered discontinuing, despite reassurance that continuation would cause no harm to their baby. Negative information was recalled far more often than reassuring information.ConclusionInformation from friends, family, and health care providers can have a negative impact on decision-making regarding pharmacotherapy for depression during pregnancy. Health care providers should be cognizant of this when counselling patients who require antidepressant therapy during pregnancy.     

The influence of gender roles on health seeking behaviour during pregnancy in Turkey

Objectives To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth.

Methods The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants.

Results Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only ‘serious’ conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use.

Conclusions Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.     

Changes in sexual desire and activity during pregnancy among women in Shahroud,Iran

ObjectiveTo evaluate women's perception of sexual activity during pregnancy in Shahroud, Iran.MethodsData were gathered during 4 semi-structured group interviews with 33 pregnant women attending 2 obstetric outpatient clinics of a teaching hospital in Shahroud. The interviewers taped the interviews, coded and categorized their content, and performed a qualitative content analysis.ResultsMost women reported a decrease in sexual desire and frequency of intercourse during pregnancy (69.7% and 81.8%, respectively). Sexual desire, however, increased for 18.2% of the women. Some felt that accepting intercourse prevented spousal infidelity, but 65.2% worried that it might cause injury to the fetus. Only 24.2% received information on the advisability of sexual activity during pregnancy from their physicians or midwives, and the other 75.8% sensed that they should discuss the topic with a professional but were not comfortable starting the conversation.ConclusionAlong with excessive anxiety, insufficient information is the major reason why sexual intercourse is often considered dangerous, and sometimes avoided, during pregnancy in Iran. Healthcare professionals, especially midwives, should educate and counsel women, and reassure them that intercourse is safe in women with healthy pregnancies.     

The experiences of women who quit smoking during pregnancy and how they dealt with their spouses' continued smoking

Objectiveto explore how pregnant women in Taiwan dealt with their spouses who continued to smoke and with passive smoking during their own process of quitting and abstaining.Designa qualitative study using an oral history approach. Data were collected via tape-recorded open-ended interviews. All interviews were transcribed verbatim. Data were analysed using narrative analysis.Settingthe homes of the participant women living in the district of a regional hospital of eastern Taiwan.Participantsa purposive sample of 10 Taiwanese women who had quit smoking while pregnant was recruited at 1–3 months following the birth of their infants.Findingsfive major themes emerged: (1) the women coping with tobacco addiction on their own, (2) creating a non-smoking section or environment at home, (3) dealing with passive smoking, (4) conflict over the wife's sensitivity to her spouse's residual tobacco smell, and (5) allowing the husband to continue smoking to avoid conflicts.Key conclusionsthe pregnant women were expected by their spouses to quit smoking, yet the husbands continued to smoke. Women had to struggle to quit smoking on their own. The findings from this study support the need to listen to pregnant women's stories, as this is paramount to understanding their experiences of tobacco-use reduction and cessation, and for developing gender appropriate interventions to support their efforts.Implications for practicehealth care providers should encourage and help pregnant women who are willing to quit smoking. This help could be more family-centred instead of focusing on the pregnant women alone, and therefore involve educating the spouse to support his wife.     

Influences on previous contraceptive use/non-use in pregnant 16–19 year olds

Abstract

Seventy-nine pregnant women aged between 16 and 19 years were given in-depth interviews on a wide range of topics in late pregnancy. The data reported here describe influences on their contraceptive use prior to pregnancy. Four orientations to pregnancy which influenced women's contraceptive use at conception are identified. Various other factors which influenced contraceptive non-use are described. Some of these factors are age-specific, while others would apply equally to older women. Knowledge of contraception was virtually universal in the sample. Women had not become pregnant through ignorance. It is argued that reasons for pregnancy in women who are under 20 years of age can only be understood if contextual factors (such as employment careers and relationships with male partners) are taken into account.     

Illicit drug users' experiences of pregnancy. An exploratory study

Abstract

This paper reports on qualitative data from a study of drug-abusing women during pregnancy. Semi-structured interviews were conducted with 30 drug-using women focusing on their attitudes to and feelings about pregnancy. The findings do not support stereotypes of pregnant drug users as selfish and irresponsible. The women's accounts are characterized by feelings of anxiety and guilt which are often exacerbated by comments from health professionals and others. Some implications for health care services for drug-using women and their babies are discussed.     

Views on Exercise Among Black Women During Pregnancy

ObjectiveTo describe and understand exercise practices, beliefs about exercise, support for exercise, barriers to exercise, and preferences for a group exercise program in the context of individual and environmental factors among Black women during pregnancy.DesignMixed-methods design.SettingLarge university-affiliated urban midwifery practice.ParticipantsFourteen Black women who were pregnant.MethodsWe conducted semistructured interviews to determine participants’ exercise practices, beliefs about exercise while pregnant, exercise support and barriers, and preferences for a group pregnancy exercise program. Participants also completed self-report measures for exercise, neighborhood environment, symptoms of depression, and sociodemographic characteristics. We used matrices to facilitate integrated analysis of the interview and self-report data to determine areas of concordance and discordance among the data sources and to note patterns in the data.ResultsWe identified and described themes that represented concepts in our data: Exercise Misinformation and Folklore, Support for Exercise While Pregnant, Barriers to Exercise While Pregnant, Perceived Health Benefits, and Exercise Program Preferences. Data diverged for some participants on neighborhood as a barrier to exercise. Except for the two participants with high levels of symptoms of depression, data converged regarding symptoms of depression as a barrier to exercise.ConclusionHealth care providers can successfully promote exercise if they provide education about exercise during pregnancy, help pregnant women overcome barriers to exercise, prompt women to exercise with partners for tangible and social support while pregnant, and refer women to exercise programs for pregnant women if available.     

Use of herbal medicines among pregnant women attending family health centers in Alexandria

ObjectiveThe aim of the study is to elucidate the use of herbal medicines in pregnant women and to explore patterns of herbal medication use including dietary supplements in pregnant women in Alexandria, Egypt.MethodologyA cross sectional study of pregnant females was conducted in a family health center in Alexandria between March and June 2011 utilizing a sample of 300 pregnant women (100 pregnant women in each trimester). A specially designed self administered questionnaire was used to collect the data.ResultsThe mean age of studied pregnant women was 26.9 ± 4.9 years. Only 27.3% of the studied pregnant women reported the use of herbal medicines during pregnancy while 89% reported the use of dietary supplements.The majority of pregnant women resorted to (family/friends) as primary source of information of herbal medicines (42.7% and 28%, respectively), while the majority of women using dietary supplements resorted to (physicians) as primary source of information (76%).52.4% of the studied pregnant women reported that they use ginger during the 1st trimester of pregnancy while 51.6% reported that they use fenugreek during the 3rd trimester of pregnancy.More than half of the studied pregnant women (64.6%) reported the efficacy of herbal medicines in relieving their complaints during pregnancy.ConclusionThe use of herbal medicines during pregnancy in Alexandria was uncommon while the use of dietary supplements was very common.About three quarters of studied sample reported that the physician was the person to recommend dietary supplement usage while the physician was rarely cited as the person recommending herbal usage.The most common herbs used by pregnant women were aniseed, fenugreek, ginger, while the least used was peppermint.Ginger was found to be used by a significantly higher percentage of pregnant women in the first trimester; on the other hand, fenugreek was used by a significantly higher percentage of pregnant women in the third trimester.RecommendationsResults of the following study suggest the following recommendations:General recommendationsGeneral health education for pregnant women about benefits and harms of herbal use during pregnancy in ante-natal care especially for herbs commonly used in Egypt.Specific recommendations

• ACare providers:

Training of family physicians in the family health centers on the use of herbal medicines in pregnancy and possible effects on the fetus.

• BPregnant women:

Health education program directed toward pregnant women to increase their awareness about the effects of herbal medicines.     

Pregnancy-specific coping and changes in emotional distress from mid- to late pregnancy

ABSTRACT

Objective: To examine whether pregnancy-specific coping predicts changes in emotional distress from mid- to late pregnancy.

Background: There is a need to identify ways of coping that reduce or elevate emotional distress in pregnant women as such distress increases the risk of adverse birth outcomes.

Methods: 132 women receiving prenatal care from a university hospital midwifery practice were recruited prior to 25 weeks gestation (M = 19.58, SD = 5.14). The state anxiety version of the State–Trait Personality Inventory (STPI) and the Revised Prenatal Distress Questionnaire (NuPDQ) were administered in mid- (M = 25.7 weeks, SD = 4.55) and late (M = 33.4 weeks, SD = 4.18) pregnancy and the Revised Prenatal Coping Inventory (NuPCI) at the latter timepoint.

Results: Factor analysis of the NuPCI identified five distinct, conceptually interpretable types of coping: Prayer/Spirituality, Receiving Social Support, Planning/Preparation, Positive Appraisal, and Avoidant Coping. Avoidant Coping was used least frequently and Positive Appraisal was used most. The STPI and NuPDQ were aggregated to create a measure of emotional distress. After controlling for mid-pregnancy distress, Avoidant Coping predicted greater emotional distress in late pregnancy (β = .18, R² = .61, p < .01) and Positive Appraisal predicted lower late pregnancy distress (β = ?.15, R² = .60, p < .01).

Conclusion: This is one of the first studies to demonstrate that specific ways of coping with stress during pregnancy predict changes in pregnant women’s emotional distress. The NuPCI is a psychometrically sound self-report instrument to examine coping and its association with emotional distress.     

Choosing motherhood: The complexities of pregnancy decision-making among young black women ‘looked after’ by the State

Objectivethis paper addresses the experiences of a group of young black teenage mothers looked after by the State, most of whom were also either migrants or asylum seekers. The paper explores the experience of discovery of pregnancy, attempts to seek professional help and the eventual decision to continue with the pregnancy.Designan interpretative study with in-depth interviews.Settingsinterviews were carried out in the participants' homes and focussed on their experiences of pregnancy decision-making.Participants15 young women (aged 16–19), from black minority ethnic groups, with a history of care (past or present), currently pregnant or mothers of a child no older than two years of age.Findingsall the pregnancies were unexpected: eight of the informants conceived as a result of rape and seven while in a relationship. All the young women chose motherhood over abortion despite their complex social and pregnancy background.Conclusionsthe importance of social positioning of migrants in terms of the cluster of negative aspects and environmental disadvantage generally experienced by most immigrants in the host country is raised in this paper. Care practices of pregnant women with complex social factors were little observant of woman-centred care approaches.     

Abuse‐Related Post‐Traumatic Stress,Coping, and Tobacco Use in Pregnancy

ObjectiveTo examine the relationship between trauma history, posttraumatic stress disorder (PTSD), coping, and smoking in a diverse sample of pregnant women, some of whom are active smokers.Designecondary analysis from a prospective study on PTSD and pregnancy outcomes.SettingMaternity clinics at three health systems in the midwestern United States.ParticipantsWomen age 18 or older (1,547) interviewed at gestational age fewer than 28 weeks.MethodsParticipants were classified at nonsmokers, quitters (stopped smoking during pregnancy), and pregnancy smokers. Demographic, trauma, and pregnancy factors, substance use, and use of tobacco to cope were compared across groups. Logistic regression assessed the influence of these factors on being a smoker versus a nonsmoker and a quitter versus a pregnancy smoker.ResultsSmokers differed from nonsmokers on all demographic risk factors (being African American, being pregnant as a teen, having lower income and less education, and living in high‐crime areas), had higher rates of current and lifetime PTSD, and were more likely to report abuse as their worst trauma. Pregnancy smokers had lower levels of education, were more likely to classify their worst trauma as “extremely troubling,” and were more likely to exhibit PTSD hyperarousal symptoms. In regression models, smoking “to cope with emotions and problems” doubled the odds of continuing to smoke while pregnant even after accounting for several relevant risk factors.ConclusionSmoking behavior in pregnancy may be influenced by the need to cope with abuse‐related PTSD symptoms. Clinicians should consider using trauma‐informed interventions when working with tobacco‐using pregnant women.     

Women's decision making regarding choice of second trimester termination method for pregnancy complications

ObjectiveTo describe how women terminating a pregnancy for fetal or maternal complications decide between surgical (dilation and evacuation [D&;E]) and medical abortion.MethodsA qualitative study was conducted among women who underwent D&;E or medical abortion before 24 weeks of gestation for fetal anomalies or pregnancy complications at an academic medical center where both methods are offered. Women were interviewed by phone 1 week after the procedure about their counseling experiences and reasons for choosing a particular method. Data were analyzed by 3 researchers using a grounded theory approach, and interviews were stopped upon thematic saturation.ResultsOf the 21 women, 13 (62%) chose D&;E and 8 (38%) chose medical abortion. Key themes that emerged from the interviews were valuing the ability to choose the method, and the importance of religious beliefs, abortion attitudes, and emotional coping style. Women's preferences for a method were largely based on their individual emotional coping styles.ConclusionDecisions to undergo D&;E or medical abortion are highly personal and could affect how women recover after ending a desired pregnancy. Women should be offered counseling about and access to both methods. Understanding these decision processes may help when counseling women faced with these diagnoses and decisions.