High-Risk Pregnancies Require More Emotional Support

Judith McCoyd, PhD

Women experiencing medically high-risk pregnancy are stressed by their condition and hospitalization, which leads to further distress, findings of a new study showed.

Keeping anxiety and stress low during pregnancy is important—and it’s critical for high-risk pregnancies because it could lead to premature birth.

Judith McCoyd, PhD, associate professor at the Rutgers University School of Social Work, and a team of investigators interviewed 16 women hospitalized during high-risk pregnancies and found that trying to manage their emotions alone added extra burden to something that was already stressful. The findings suggest that professional intervention using visualization, mindfulness, cognitive-behavioral work, or forms of psychotherapy could all be useful to help the vulnerable population.

Women with medically high-risk pregnancy may experience anxiety, worries, and depressive symptoms, along with a sense of powerlessness and stress. Many of the women were trying to force themselves to feel certain emotions like “thinking positive” while performing mind tricks to feel that way, McCoyd said in a statement.

“More surprisingly, the women informed us that they did not receive explicit advice on how to cope, think positive, or calm down,” she added.

McCoyd and her colleagues conducted the interview-based study to examine the experiences and interpretations of women during medically high-risk pregnancy. Interview questions focused on: maternal identity and bonding; technology use and medical decision-making; mental health/emotional coping; patient-provider relationships; and social support. The investigators focused “solely on the question of how women with (medically high-risk pregnancy) experienced and made meaning of their emotional experiences and dilemmas and how they attempted to cope.”

Participants in the study were 21—42 years old in the antepartum unit in a large, urban, university hospital. The women had medically high-risk pregnancy at the time of recruitment, were hospitalized due to the pregnancy, and were under the supervision of a Maternal Fetal Medicine physician.

Each woman participated in a conversational interview which lasted between 1 and 2 hours. The investigators gauged women’s experiences in detailed ways following their spontaneous narratives. Interviewers focused on data related to mental health and coping, which became prominent about halfway through each interview.

Interviews typically started with, “Can you talk a bit about how this high-risk pregnancy is affecting you emotionally/mentally?” Then the interviewer added questions including: “How did you feel when you were first diagnosed?”; “What thoughts and feelings about yourself do you have during this time?”; and “What is it like for you going through a high-risk pregnancy/living with [diagnosis]?”

McCoyd and her colleagues used software to code the transcribed interviews, with a focus on broad categories. Within each category were sub-codes—“coping” was a broad category, with “take it day by day,” “cry,” and “think positive” all as sub-codes.

The core finding was that women with medically high-risk pregnancy were stressed by their condition and hospitalization which led to feelings of distress. The women were scared about potential outcomes of their pregnancies and felt overwhelmed trying to cope with their emotions, which was evident by their crying during their interviews, the study authors noted.

Women feared their stress would hurt their babies. Many of the women reported strong beliefs that they must “stay/think positive” for fear that distress would harm their baby and that it was their responsibility to control their stress. The women attempted to manage and control their emotions, which led to attempts to contain and suppress negative emotions.

“It seemed self-evident that they were responsible for fetal health and the suppression of distress,” the study authors noted.

The finding reflects 3 themes concerning discourses of fetal harm due to stress, emotion work in the face of double-binds, and effortful containment and suppression of challenging emotions.

Regardless of race, socioeconomic status, or parity, the women incorporated expectations of maternal happiness and an intensive mothering discourse that indicates women should sacrifice their well-being for their pregnancies/children.

Women considering pregnancy should think about the level of emotional support they would receive if they have a high-risk pregnancy. They can also talk to the obstetrician-gynecologist about receiving consistent medical and psychosocial care, McCoyd said.

The study, “They Say, ‘If You Don’t Relax… You’re Going to Make Something Bad Happen’: Women’s Emotion Management During Medically High-Risk Pregnancy,” was published online in the journal Psychology of Women Quarterly.