Level of Stress and Coping Strategies used during third trimester of pregnancy among Primi Antenatal mothers

 

Shilpa S.¹, Thenveer Banu K.², Muhammed Shameem K.²

¹Lecturer, Almas College of Nursing, Kottakkal - 676504, Kerala, India.

²Third Year BSc Nursing Students, Almas College of Nursing, Kottakkal - 676504, Kerala, India.  

 

ABSTRACT:

Pregnancy is the privilege of experiencing God’s miracles on the earth. Childbirth is a new experience to the primigravida women. It is a time when a woman’s power and strength emerge full force, but it is also a vulnerable time and a time of many changes presenting opportunities for personal growth. Pregnancy and childbirth is a normal life event, yet women are exposed to significant amount of stress. It’s just as important to look after your mental health and wellbeing during pregnancy as your physical health. If you are mentally healthy, you will be in the best position to manage the challenges of pregnancy and life with a new baby. Aim of study: To assess the level of stress and coping strategies during third trimester of pregnancy among primi antenatal mothers with a view to recommend stress relieving strategies to be under taken during the antenatal period. Methodology: A quantitative approach non-experimental prospective correlational research design was chosen for the study. The study was conducted in selected hospital in Kottakkal, Kerala, India. The sample size of 30 primi antenatal mothers admitted in gynaec wards by non-probability purposive sampling technique. After taking the consent, data were collected using socio-demographic performa, structured stress scale, structured coping strategy scale. Data were analyzed and interpreted by descriptive and inferential statistics. Results and Conclusion: The analysis revealed that 70% of primi antenatal mothers experience mild stress and 30% experience moderate stress, 80% of the primi antenatal mothers have good coping strategy and remaining 20% have excellent coping strategy. There is a significant association exists between the level of stress of primi antenatal mothers during their third trimester of pregnancy with selected socio demographic variable gestational diabetes and there is a significant correlation exists between the level of stress and coping strategies among primi antenatal mothers during their third trimester of pregnancy (p value<0.05).

 

 

INTRODUCTION:

Giving birth is an ecstatic jubilant adventure not available to males. It is a women’s crowning creative experience of a lifetime.¹

 

Child birth is a new experience to the primigravida mothers child birth in some women is a joyous relationship of hopes together with a mass of fears and anxieties whether the baby will be normal and healthy; about their own reaction do labour and also about the attitude of people who will help and care for them. As the time for labour and delivery approaches there is usually heightened sense of impending disaster.² Pregnancy on one hand, it’s a time of glorious expectations but this is also the time when undergoes physical, mental and emotional changes. These changes include increased hormonal levels, backache, morning sickness. Due to all this one is likely to experience stress.³ Pregnant women during pregnancy will perceive the situation in both negative and positive aspects. While some stress during pregnancy is to be expected, high levels stress and chronic stress can be especially dangerous.⁴ The changes one’s a body undergoes, the impending life changes, and potential concerns over the health of mother and baby can be very large and very real worries. However, experts tell us that too much stress can actually become a self-fulfilling prophecy. Excessive stress is in pregnancy can lead to potential problem with the pregnancy.⁵ Stress, unheeded and untreated, can make pregnancy a difficult period will negatively impact on pregnancy leads to complications such as preterm birth weight and even sleep and behavioral disorders.⁶ Birth is not only about making babies, it is about making mothers strong, competent capable mothers who trust themselves and know their inner strength.⁷ So, the male and female partners of pregnant women can contribute significantly toward the health of both mother and newborn by making consistent efforts to offer frequent and meaningful social and emotional support to their pregnant partner.⁸ Besides, also get social and emotional support from friends, family and community members, and from mental and professionals.⁹ Such non partner sources of support and other relaxation method such as music, books, yoga, meditation etc. have been found to have a significant impact when utilized correctly.¹⁰

 

METHODOLOGY:

A quantitative approach non-experimental prospective correlational research design was chosen for the study. The study was conducted in selected hospital in Kottakkal, Kerala, India. The sample size of 30 primi antenatal mothers admitted in gynaec wards by non-probability purposive sampling technique. After taking the consent, data were collected using socio-demographic performa, structured stress scale, structured coping strategy scale. Data were analyzed and interpreted by descriptive and inferential statistics.

 

RESULTS AND DISCUSSION:

Section 1: Distribution of demographic characteristics of primi antenatal mothers admitted in gynaecological wards.

 

Table 1 shows that 83.3% of the primi antenatal mothers belongs to age group of above 20 years, 13.3% belongs to age group of 18 years and 3.3% belongs to age group of above 30 years. Sixty percentages of primi antenatal mothers are residence in urban and 40% in rural area. Ninety point three % of primi antenatal mothers are mixed diet and 6.6% are vegetarians. Seventy six point six of primi antenatal mothers are house workers, 10% are mild working women, 6.6% are sedentary working women and remaining are moderately working women. Habit of 100% of primi antenatal mothers belongs to nothing. Eighty percentage of primi antenatal mothers belongs to antenatal visit group of yes and remaining 20% are belongs to no and 60% primi antenatal mothers have supporting system available during delivery and remaining 40% have no supporting system.

 

Table 1: Frequency and percentage distribution of primi antenatal mothers admitted in gynaecological wards based on the age, residence, food habits, occupation, habit, antenatal visit, supportive system available during delivery             (n=30).

Variables	Category	Frequency (f)	%
Age	18 years	4	13.30%
	Above 20 years	25	83.30%
	Above 30 years	1	3.30%
Residence	Urban	18	60.00%
	Rural	12	40.00%
Food habits	Vegetarians	2	6.60%
	Mixed diet	28	93.30%
Occupation	House workers	23	76.60%
	Mild working women	3	10.00%
	Sedentary working women	2	6.60%
	Moderate working women	2	6.60%
Habit	Nothing	30	100.00%
Antenatal visit	Yes	24	80.00%
	No	6	20.00%
Supportive system	Yes	12	40.00%
available	No	18	60.00%

 

Table 2: Frequency and percentage distribution of primi antenatal mothers admitted in gynaecological wards based on current blood pressure status, pulse rate, respiratory rate, gestational diabetes, past history of abortion, antenatal period, any chronic illness necessary to take drug                  (n=30).

Variables	Category	Frequency (f)	%
Current blood pressure	120/80mmHg	29	96.60%
	>140/90mmHg	1	3.30%
Current pulse rate	60-100 beats/minute	27	90.00%
	>100 beats/minute	3	10.00%
Current respiratory rate	16-20 breaths/minute	27	90.00%
	>20breaths/minute	3	10.00%
Gestational diabetes	Mild	6	20.00%
	Moderate	3	10.00%
	Nil	21	70.00%
Past history of abortion	Yes	8	26.60%
	No	22	73.30%
Antenatal period	Eventful	2	6.60%
	Un eventful	28	93.30%
Any chronic illness	Yes	0	0.00%
Necessary to take drug	No	30	100.00%

 

 

Table 2 shows that 96.6% of primi antenatal mothers are belongs to current blood pressure status group of 120/80mm Hg and 3.3% belongs to 140/90mm Hg. 90% of primi antenatal mothers belongs to current pulse rate group of 60-100 beats/minutes and 10% belongs to >100 beats/minute. Ninety percentage of primi antenatal mothers belongs to current respiratory rate group of 16-20 breaths/minute and 10% belongs to >20 breaths/minute. Twenty percentages of primi antenatal mothers have mild gestational diabetes, 10% have moderate gestational diabetes and 70% belongs to group of nil. 26.6% of primi antenatal mothers have history of abortion and 73.3% have no history of abortion. Forty percentages of primi antenatal mothers consume supplements regularly and remaining are 60% not consume regularly. Ninety percentage of antenatal mothers are belongs to antenatal period group of uneventful and remaining 6.6 % are eventful. Hundred percentages of primi antenatal mothers have no chronic illness necessary to take drug.                                                                                        (n=30)

 

Figure 1: Frequency and percentage distribution of primi antenatal mothers admitted in gynaecological wards according to educational status during third trimester of pregnancy.

               

Figure 1 show that 56.6% primi antenatal mothers are higher secondary qualified, 33.3% are UG/PG and remaining 10% belongs to above.                                                                            (n=30)

 

Figure 2: Frequency and percentage distribution of primi antenatal mothers admitted in gynaecological wards according to according to attend prenatal classes or refresher classess during third trimester of pregnancy.

Figure 2 shows that 66.6% primi antenatal mothers attend prenatal classes or refresher classes during pregnancy and remaining 33.3% are not attended. (n=30)

 

Figure 3: Frequency and percentage of distribution of primi antenatal mothers according to consumption of supplements.

 

Figure 3 shows that 40% of primi antenatal mothers consume supplements regularly and remaining 60% not consume supplements regularly.                                                                        (n=30)

 

Figure 4: Frequency and percentage distribution of primi antenatal mothers according to hemoglobin status.

 

Figure 4 shows that 83.3% primi antenatal mothers belongs to hemoglobin level of 12-15.5mg/dl and remaining 16.6% belongs to <12mg/dl.

 

Section II: Assessment of stress among primi antenatal mothers in their third trimester of pregnancy.

 

Table 3: Assessment of stress among primi antenatal mothers during their third trimester of pregnancy with structured stress scale         (n=30)

Grade	Frequency (f)	%
Structured stress scale
Mild	21	70.0%
Moderate	9	30.0%

 

Table 3 shows that 70% primi antenatal mothers experience mild stress and 30% experience moderate stress.

 

Section III: Identification of coping strategies adopted by primi antenatal mothers during third trimester of pregnancy.

 

 

Table 4: Identification of coping strategies adopted by primi antenatal mothers during third trimester of pregnancy with structured stress coping strategy scale.                                                                                   (n=30)

Grade	Frequency (f)	Percentage (%)
Structured stress coping strategy scale
Good	24	80.0%
Excellent	6	20.0%

Table 4 shows that 80% of the primi antenatal mothers have good coping strategy and remaining 20 % have excellent coping strategies.

 

Section IV: Association of the level of stress of primi antenatal mothers in their third trimester of pregnancy with selected socio demographic variables.

 

Table 5: Section deals with the analysis of association between the level of stress of primi antenatal mothers in their third trimester of pregnancy with selected socio demographic variables such as age, residence, food habits, occupation, educational status, attend prenatal classes, current blood pressure status, current pulse rate, current respiratory rate, gestational diabetes, past history of abortion and Hb status.                                                 (n=30)

Variables	Category		df	Chi-square value	P value
	Mild	Moderate
Age
18 years	2	8	1	0.549	0.458
Above 20 years	9	10
Above 30 years	0	1
Residence
Urban	12	6	1	0.263	0.608
Rural	7	5
Food habits
Vegetarians	2	0	1	0.404	0.52
Mixed diet	14	14
Occupation
House workers	11	12	1	0.04	0.841
Mild working women	0	3
Moderately working women	0	1
Sedentary workingwomen	1	2
Educational status
Higher secondary	10	9	1	0.074	0.791
UG/PG	6	4
Above	1	2
Attend prenatal
Classes
Yes	6	4	1	0.016	0.899
No	10	10
Current blood pressure status
120/80mmHg	15	14	1	0.004	0.949
>140/ 90mmHg	1	0
Current pulse rate
60-100 bpm	13	13	1	0.288	0.591
>100 bpm	2	2
Current respiratory rate
16-20 breaths/minute	11	13	1	0.208	0.648
<16 breaths/minute	1	0
>20 breaths/minute	3	2
Gestational diabetes
Mild	5	1	1	9.186	0.0024*
Moderate	5	0
Nil	5	14
Past history of abortion
Yes	2	5	1	0.215	0.642
No	11	12
Hb status
12-15.5 mg/dl	12	12	1	0.019	0.89
<12 mg/dl	2	4

 

Table 5 shows that there is a significance association exists between the level of stress among primi antenatal mothers in their third trimester of pregnancy with selected socio demographic variable gestational diabetes (p value < 0.05) and there is no significant association exist between the level of stress among primi antenatal mothers in their third trimester of pregnancy with selected socio demographic variables such as age, residence, food habits, occupation, educational status, attend prenatal classes, current blood pressure status, current pulse rate, current respiratory rate, past history of abortion and Hb status (p value > 0.05).

 

Section V: Correlation of the level of stress with coping strategies adopted by primi antenatal mothers.

 

Table 6: deals with the analysis of bivariate table of co-relation between the level of stress of primi antenatal mothers in their third trimester of pregnancy and coping strategies adopted by primi antenatal mothers.  (n=30)

 

Table 6 shows that there is a significance association exists between the levels of stress with coping strategies adopted by primi antenatal mothers in their third trimester of pregnancy (p value < 0.05). Here, the correlational coefficient between mild stress and good coping strategy is 0.83, which indicated that they are positively correlated.

 

DISCUSSION:

The study results reveals that there is a significant association between the level of stress and coping strategies during third trimester of pregnancy with selected socio demographic variable gestational diabetes and correlation between mild stress and good coping strategies. The study suggest that stress can be identified in initial stages and reduced by better coping mechanism such as regular exercise, eat healthy, write a daily journal, taking vacations or long weekends, take regular naps - god's gift to a stressful life, yoga, reading books, social support, etc.

 

CONCLUSION:

The present study was undertaken to assess the level of stress and coping strategies during third trimester of pregnancy among primi antenatal mothers admitted in the gyneac wards of selected hospital, Kottakkal.

 

The important findings of the study are as follows:

·       Seventy percentage of primi antenatal mothers experience mild stress and 30% experience moderate stress.

·       Eighty percentage of the primi antenatal mothers have good coping strategy and remaining 20 % have excellent coping strategy.

·       There is a significance association exist between level of stress among primi antenatal mothers during their third trimester of pregnancy with selected socio demographic variable gestational diabetes (p value < 0.05).

·       There is a significant positive correlation exist between mild stress and good coping strategies of primi antenatal mothers during their third trimester of pregnancy (p value < 0.05). Here, the correlational coefficient between mild stress and good coping strategy is 0.83.

 

NURSING IMPLICATIONS:

Nursing can play vital role in assessing causes of stress and identifying the appropriate coping strategies to reducing stress during pregnancy. The curriculum of nursing education should prepare nurses who are competent enough to assess the causes of stress and plan adequate coping strategies. Continuous nursing education programmes can improve the coping strategies adopted by primi antenatal mothers to reduce stress and to make the gynaecological department more stress free environment. Health care system should play more attention to train the nursing students on family centre maternity care approach, role of midwife in quality assurance, consumer roles in obstetric care services. Hence the use of education devise strategies should encourage involvement of primigravida mothers in maternity education program to impart education to promote better maternal, child and family health.

 

LIMITATION:

·       Small study setting was selected.

·       Inadequate resources.

·       Inadequate sample size.

·       Short time period.

·       Implementation to other trimester.

·       High risk deliveries are not included.

 

RECOMMENDATIONS:

·       The study can be replicated on larger sample in different settings.

·       Follow up study can be conducted to evaluate the effectiveness of health information booklet.

·       The same study can be replicated on the primigravida mothers in antenatal OPD with different government hospital and private settings.

·       A comparative study can conduct in a similar manner to identify stress and coping strategies among primi and multipara mothers.

·       An experimental study can be conducted in a similar manner to identify stress and coping strategies.

·       An experimental study can be conducted with structured learning programmed on level of stress and coping mechanism adopted by the primigravida mothers.

 

REFERENCES:

1.      Kathleen R Beebe et al. 2007, The effects of childbirth self-efficacy and anxiety during pregnancy on pre hospitalization labour [Journal of Obstetric,           Gynecologic and Neonatal Nursing, volume 36, issue 5, 1 September- October, page no: 410-418] available in https://doi.org/10.1111/j.1552-6909.2007.00170.x.

2.      Mohni Sonawane, Supriya Chinchpure. 2018, Assess association of fear of childbirth (FOC) among primigravida women with labour outcome in selected Municipal Corporation Hospital [International Journal of Nursing Education and Research, volume 6, issue 4, page no: 338-344] available in https://ijneronline.com/ AboutJournal.aspx.

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5.      Fiona A. Lynn, et al. 2011, Association between maternal characteristics and pregnancy related stress among low risk mothers: An observational cross-sectional study. [International Journal of Nursing Studies, volume 48, issue 5, May; page no: 620-627] available in https://doi.org/10.1016/ j.ijnurstu.2010.10.002.

6.      Kathleen R Beebe et al. 2007, The effects of childbirth self-efficacy and anxiety during pregnancy on pre hospitalization labour [Journal of Obstetric,           Gynecologic and Neonatal Nursing, volume 36, issue 5, 1 September-October, page no: 410-418] available in https://doi.org/10.1111/j.1552-6909.2007.00170.x.

7.      Hamilton J et al. 2008, Types, pattern and predictors of coping with stress during pregnancy: Examination of the revised prenatal coping inventory in a diverse sample. [Journal of Psychomatic Obstetrics and Gynecology, volume 29, issue 2, July; page no: 97-104] available in https://doi.org/10.1080/01674820701690624.

8.      Shamsaei F, et al. 2018, The relationship between general health and coping style with perceived stress in primigravida healthy pregnant women: Using the PATH model. [Journal Women and Health, volume 59, issue 1, 24 July, page no: 41-54] available in https://doi.org/10.1080/03630242.2018.1434587.

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Received on 13.03.2021         Modified on 08.04.2021

Accepted on 21.04.2021     © AandV Publications all right reserved