They Say "If You Don't Relax...You're Going to Make Something Bad Happen": Emotion Management and Medically High-Risk Pregnancy

Background and Purpose: Medically high-risk pregnancy (MHRP) threatens the health of a woman, her fetus, or both.  Robust literature documents associations between maternal anxiety during pregnancy and poor fetal outcomes. This pilot study examines narratives of women hospitalized for MHRP focusing on messages they received about expression of anxiety and sadness from health care providers (HCPs) and others in their social support networks. The study further explores women’s “emotion work” (attempts to manage and control emotion in response to internalized messages (Hochschild, 1979)) from HCPs and others. While contemporary research details the relationship between stress and pregnancy outcomes, women’s lived experience of emotion management in the context of MHRP has been largely overlooked. We aim to fill this gap in the literature.

Methods: We conducted sixteen in-depth semi-structured interviews with women hospitalized for MHRP on a maternal-fetal medicine unit. Interviews were transcribed verbatim and coded using Atlas 6.0 qualitative software. Tenets of phenomenology guided the data analysis.

Results: Our core finding is that women are anxious and fearful about the MHRP but worry that ‘negative’ emotions will “hurt their baby”: Attempts to control those emotions result in double-binds and feeling that they must contain all negative emotions, an untenable situation. Women reported that HCPs and family members indicated they should limit negative emotions or risk harming their fetus. An internalized societal discourse of their responsibility for fetal health was implicit in their narratives. Women felt authentic emotions, believed that expression of their anxiety/tears would harm their fetus, and felt guilty when they could not control their emotions. No one offered evidence-informed advice about anxiety- or depression-reducing strategies. This led to double binds wherein they felt emotions they believed they should not feel/express. Women felt they must contain their emotions, contain their fears about fetal health, and contain their responses to the hospital environment.

Conclusions and Implications: Women with MHRP are understandably anxious about medical threats to themselves and their hoped-for baby. They longed for validation of their experiences and help to manage anxiety and sadness. HCP responses telling them to “calm down” are not evidence-based, nor helpful. Although advice to avoid negative emotional expression may be a reductive response to medical literature, little help was provided and women worked to suppress their emotions. Stifling emotional expression contrasts with longstanding evidence-informed psychosocial approaches that prescribe self-regulated ventilation and reflection on emotion. Medical team members, especially social workers, should share accurate information about risks and provide strategies for reducing anxiety and sadness. It may be beneficial to interpret emotion management as an adaptive coping strategy rather than as vital to fetal health. We need further development of evidence-based approaches to emotional management and stress reduction for implementation by psychosocial professionals on the health care team.