Andrea D Clements, Beth A Bailey, & Heather Wright East Tennessee State University

1. “How Do You Deal With Stress?”: Pregnant Women’s Methods of Coping Andrea D Clements, Beth A Bailey, & Heather Wright East Tennessee State University Abstract During intake history 1312 rural women admitted for singleton birth were asked “How do you deal with stress?” Responses were categorized into 18 stress coping strategies. Four of these (Social Support, Exercise, Prayer/Religion, Relaxation Techniques) have been empirically Results Stress coping strategies that have been empirically shown to reduce stress in pregnant and non-pregnant populations (Social Support, Exercise, Prayer/Religion, Relaxation Techniques) were reported by 18.5% of respondents. Negative coping strategies (i.e., smoking, using medications/alcohol, doing nothing, or reported not coping well) were reported by 16.6% of respondents. The majority of respondents (68.6%) indicated that they deal with stress using at least one of the remaining strategies for which there is currently little empirical effectiveness data. Most women reported only one stress coping strategy (79.3%), 15.5% reported 2, 2% reported 3, 0.2% reported 4, and 3% reported no strategies. The reported strategies were assumed to be their primary coping methods; however, because these were self-report data, the fact that the women were in labor, and the fact that there were no validation checks of actual behavior, this assumption is speculative. Conclusion Findings revealed a low rate of use of empirically supported stress coping strategies in this pregnant rural Appalachian sample. This, coupled with the known negative effects of prenatal stress indicate that the study population could potentially benefit from an intervention to bolster stress coping. References DiPietro, J. A., Costigan, K. A., Nelson, P., Gurewitsch, E. D., & Laudenslager, M. L. (2008). Fetal responses to induced maternal relaxation during pregnancy. Biological Psychology, 77, 11-19. Field, T., Diego, M. A., Hernandez-Reif, M., Schanberg, S., & Kuhn, C. (2004). Massage therapy effects on depressed pregnant women. Journal of Psychosomatic Obstetrics & Gynecology, 25(2), 115-122. doi:10.1080/01674820412331282231 Janke, J. (1999). The effect of relaxation therapy on preterm labor outcomes. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 28, 255–263. Koltyn, K. F., & Schultes, S. S. (1997). Psychological effects of an aerobic exercise session and a rest session following pregnancy. Journal of Sports Medicine and Physical Fitness, 37, 287-291. PMID: 9509828 Krause, N. (2006). Exploring the stress-buffering effects of church-based and secular social support on self-rated health in late life. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 61B(1), S35-S43. Narendran, S., Nagarathna, R., Narendran, C., Gunasheela, S., & Nagendra, H. R. R., (2005). Efficacy of yoga on pregnancy outcome. Journal of Alternative and Complementary Medicine 11, 237–244. Pargament, K. I. 1998. The psychology of religion and coping: Theory, research, and practice. New York: Guilford. Teixeira, J., Martin, D., Prendiville, O., & Glover, V. (2005). The effects of acute relaxation on indices of anxiety during pregnancy. Journal of Psychosomatic Obstetrics and Gynaecology, 26, 271–276. Wadhwa, P. D. (2005). Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology, 30, 724-743. Method Delivery charts were reviewed for 1334 cases, representing all singleton deliveries from 1/1/06 through 12/31/08 at a rural Appalachian hospital. Women admitted in the final stages of labor were not asked the primary question of interest in this study (N=22), bringing the final sample size for this report to 1312. High-risk births were transferred to a nearby teaching hospital, thus the sample was of low-obstetric-risk. Data were collected via individual chart review by research project staff using a two page study-designed data collection form. Over 90% of the deliveries were reviewed by a single examiner, with reliability checks performed early in the process. All women were asked the following open-ended question by the intake nurse when they arrived for delivery: “How do you deal with stress?” No response choices were offered and responses were recorded verbatim. For this reason, we assume that, because these answers were provided without guidance, they represent the women’s primary source of stress coping. For the first 300 exactly what was written in the chart was recorded, with qualitative methodology used to combine responses into 18 distinct and meaningful categories. These categories allowed for classification of all responses from the first 300 cases, and were then used to record responses dichotomously for the next 200 cases. At the end of those 200 cases it was clear that the categories included all possible responses seen, and were subsequently used as designed for the remainder of the data collection. The 18 stress coping categories were: shown to reduce stress and were reported by 18% of women. Four others (Smoking, Medication/Alcohol, Doing Nothing, Not Coping Well) were categorized as negative coping and were reported by 16% of women, while 69% of respondents reported at least one strategy for which there is currently little empirical effectiveness data. Findings suggest a need for intervention and further empirical study. Introduction Various aspects of stress have been studied in pregnant samples and high levels of stress have been linked to poor outcomes. Maternal stress appraisals and timing of prenatal stress have been found to be predictive of pregnancy complications (Wadhwa, 2005). A growing body of literature supports the relationship between prenatal coping resources and birth outcomes. Among those resources related to positive outcomes are social support (Krause, 2006), religious coping (Pargament, 1998), exercise (Koltyn & Schultes, 1997), medication, and relaxation techniques such as progressive relaxation (DiPietro et al., 2008; Janke, 1999), yoga (Narendran, Nagarathna, Narendran, Gunasheela, & Nagendra, 2005), guided imagery (Teixeira et al., 2005), and massage (Field, Diego, Hernandez-Reif, Schanberg, & Kuhn, 2004). Contact: Andrea D Clements, PhDDepartment of Psychology East Tennessee State University Johnson City, Tennessee 37614 clements@etsu.ecu Discussion Because of the open-ended nature of the stress coping question that was asked of pregnant women in this study, we have based our analyses on the category of stress coping that each reported. While these represent types of coping that came to mind first when asked the question, this does not mean each woman only used these types of coping. Our assumption is that the types of coping reported were the women’s primary coping strategies, but did not necessarily include all of the ways they dealt with stress. Acknowledgements Funding for this research was Provided by the Tennessee Governor’s Office on Children’s Care Coordination.