'Slap in the Face after Slap in the Face:' The Phenomenology of Medically Complicated Pregnancy

Background and Purpose

The American College of Obstetrics and Gynecology reports that 15-20% of pregnant women experience medically complicated pregnancies (MCP). A growing body of literature suggests that these women may be at increased risk for psychological distress, including postpartum depression and PTSD symptoms. Women with MCP must submit to medical tests, procedures, medications, bedrest and hospitalization(s). They are often separated from social support networks and typically deliver their infants prematurely.  Moreover, women face these bio-psycho-social stressors while developing a foundational maternal identity and maternal-fetal attachment.

Despite growing knowledge about the risks associated with maternal stress for the  fetus/infant, little research exists concerning the phenomenology of MCP or women’s subjective experiences and interpretations of their pregnancy complications.  Likewise, little is known about effective preventative support for these women to reduce associated risks.  This study begins to fill this research gap. Our research questions explore the psychosocial experiences and stresses of women with MCP, including mental health symptomology, medical decision-making, maternal attachment and maternal identity development, and relationships with health care providers and other social support networks. 

Methods

Sixteen in-depth, semi-structured interviews were conducted with pregnant women hospitalized for MCP. Participants ranged in age from 22 to 42. The sample was approximately half white (7) and half African American (8), with one Hispanic woman. Nurses or their designees on a maternal-fetal medicine unit of an urban hospital recruited subjects for the convenience sample. Interview domains included maternal identity and maternal-fetal attachment, patient-provider relations, social support and decision-making about medical interventions. Interviews were transcribed verbatim and coded using Atlas 6.0 qualitative software. Tenants of grounded theory and phenomenology guided the analysis of the qualitative data and the development of conceptual categories.  

Findings

Findings suggest that women with MCP were overwhelmed by the concurrent and often-conflicting demands associated with their newly acquired roles of mother and patient. Our core analytic concept of role navigation explained women’s emotional exhaustion and their sense of being overwhelmed.  Women struggled with a series of behavioral and emotional dialectics or tensions as they navigated their new roles and environments.  They contended with emotional management (containing emotion vs. letting it out); their sense of control (autonomy vs. deferring to others);  appraisals (good vs. bad); and relational self (meeting expectations vs. not meeting expectations). Women’s efforts managing these dialetics influenced their emerging maternal identity and attachment, relationships with their healthcare providers and support system, as well as their inner emotional lives. Analysis indicated that aspects of the health care environment, including a lack of continuity and coordination of medical and psychosocial care, exacerbated these tensions and  yielded a sense of being overwhelmed.

Conclusion/Implications

Findings indicate that a best practices model for working with women with MCP includes the following: 1) providing informed psychosocial support for women and families; 2) training for healthcare team members about the psychosocial implications of MCP, and 3) strong care coordination to reduce stressors associated with fragmented services.  Future research should employ larger sample sizes to confirm findings and build a best practices model.