Psychosocial Variables Predict Complicated Birth

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Publication Date: 
10/2002
Page Count: 
26
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3
Price: $10.00
Abstract: 

The purpose of this study was to assess the possible contribution of psychosocial factors to birth outcome, through prospective assessment prior to delivery. Four hundred, eighty-six consecutive pregnant women in their first or second trimester were enrolled along with their partners; interviews were conducted with the benefit of physiological monitoring and a variety of psychological measurements. Seven categories of psychosocial variables emerged with stability and reliability. Two psychological factors-fear of birth and support from the woman's partner-most strongly discriminated between the uncomplicated and complicated birth outcome groups. The authors conclude that psychosocial factors do influence birth complications and attention to reducing their impact could potentially improve birth outcome. Obstetrical care providers should no longer ignore these factors.

References: 

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Lewis E. Mehl-Madrona, M.D., Ph.D.

Lewis Mehl-Madrona is Coordinator, Integrative Psychiatry and Systems Medicine, Program in Integrative Medicine, University of Arizona College of Medicine, Tucson. This research was supported in part by Resources for World Health, Inc., San Francisco, California; the contributions of an anonymous individual private donor from Tucson; and by the United States Air Force. The opinions expressed herein are solely those of the author and do not reflect opinion or official policy of the United States Air Force or the Department of Defense. Address communication to Dr. Mehl-Madrona at: coyotemd® earthlink.net. Website: http://www.healing-arts.org/mehl-madrona.

APPENDIX A
RATINGS FOR PSYCHOSOCIAL VARIABLES
1. FEAR
Very Negative (-3)
A. Labor & birth is a very negative, frightening, ordeal (No sense of being able to manage the fear with a quality of life or death panic to the fear).
B. Pain is inevitable, life-threatening, and cannot be managed.
C. Intense panic about losing control during birth exists.
D. Uncontrollable panic about abandonment during pregnancy and birth.
E. Panic about impending motherhood (sense of death of self with no rewards).
F. Personal conviction of a sense of failure to the extent of impending doom.
G. Personal conviction of impending doom for the baby.

Neutral (0)
No codable response
Mildly Positive (+1)
Fears about A. through G., which the woman is actively attempting to cope, through established coping styles and/or learning new coping styles with staff.
Positive (+2)
Healthy anticipation for the challenges of A. through G. When fear appears, there are active, working, mature coping styles through which fears are resolved.
Very Positive (+3)
Enthusiastic anticipation of the challenges of A. through G. with excellent coping skills and very realistic expectations.
2. ANXIETY-STRESS
Very Negative (-3)
A. Severe conflicts in significant relationships.
B. Excessive fatigue and lack of energy in the face of stress.
C. Significant depression in the face of stress.
D. Intense externally directed responses under stress (Blame, aggression, projection).
E. Highly unstable living situation.
F. Significant somatization during stress (headache, back pain.
G. High levels of unmanageable anxiety.
Negative (-2)
A. Moderate conflict.
B. Moderate fatigue & lack of energy.
C. Moderate depression.
D. Moderate external responses.
E. Moderately unstable living situation.
F. Moderate somatization (nausea, tension).
G. Moderate levels of anxiety.
Mildly negative (-1)
Mild levels of A. through G.
Neutral (0)
No codable response
Mildly positive (+1)
A. Significant relationships are somewhat harmonious.
B. Energy is somewhat available for coping with anxiety-stress.
C. Low levels of happiness and contentment are described.
D. Anxiety and stress are handled through internally directed processes, including relaxation and seeking support and assistance.
E. Living situation has more stability than not.
F. Coping styles are generally successful at resolving stress without somatic effects.
G. Anxiety and stress is overall tending toward management and resolution.
Positive (+2)
A. Harmonious significant relationship.
B. Energy is available.
C. Happiness and contentment are described.
D. Stress and anxiety are managed through internal means which work well for the woman.
E. Stable living situation.
F. Successful coping styles.
G. Anxiety and stress is managed and resolved.
3. MATERNAL SELF-IDENTITY
Very Negative (-3)
A. The woman feels forced into motherhood against her will.
B. The woman is very oriented toward career & believes that child will ruin her career (major identity).
C. The woman feels repulsed by thoughts of the fetus and is alienated from the experience of being pregnant.
D. The woman cannot imagine herself as a mother and feels very unsure and insecure about the prospect.
E. The woman is convinced she will be a very poor mother and will damage her child.
F. The woman feels great shame at being pregnant and about motherhood.
Negative (-2)
A. The woman is resentful at having been manipulated into motherhood.
B. The woman's primary identity is her career. Motherhood seems incompatible.
C. The woman expresses antagonism toward the fetus and regrets being pregnant.
D. The woman feels insecure about becoming a mother.
E. The woman worries she will not be a good mother.
F. The woman feels shame at being pregnant and about motherhood.
Mildly Negative (-1)
A. The woman vacillates on her decision to have a baby.
B. The woman tends away from identifying as a mother, feels unready for motherhood.
C. The woman feels unprepared for the fetus.
D. The woman is somewhat insecure about becoming a mother.
E. The woman is somewhat concerned that she will not mother well.
F. The woman is embarrassed about pregnancy and motherhood.
Neutral (0)
No codable response
Mildly Positive (+1)
A. More than less, woman feels accepting of her pregnancy.
B. Woman is working toward accepting her identity as a mother.
C. Woman is working toward acceptance of the baby.
D. Woman is working toward becoming comfortable with the reality of motherhood.
E. Woman is beginning to accept that she will mother adequately.
F. Woman is working toward feeling good about pregnancy and motherhood.
Positive (+2)
A. Accepting of her pregnancy.
B. Acceptance of identity as a mother.
C. Acceptance of the baby.
D. Comfort with reality of motherhood.
E. Acceptance that she will be/is a good mother.
F. Feeling good about being pregnant and becoming a mother.
Very Positive (+3)
A. Enthusiastic acceptance.
B. Enthusiastic identification with being a mother.
C. Enthusiastic welcoming of the baby.
D. Excitement about the reality of motherhood.
E. Valuation of herself as a excellent mother.
F. Feeling very proud about becoming a mother.
4. BELIEFS
Very Negative (-3)
A. All pain is very bad, even life-threatening.
B. Birth is disgusting, repulsive, and even life-threatening.
C. People are evil, always untrustworthy, and should be shunned and avoided.
D. Motherhood is a degrading, awful, humiliating experience.
E. Work is the only means of achieving worth, and having a baby destroys that.
F. Deep inside, I am worthless and unimportant, and am lucky to be permitted even to exist.
G. There are no comforts or sources of help anywhere.
Negative (-2)
A. Pain is bad.
B. Birth is an unpleasant experience that you go through to get a baby.
C. People are usually unhelpful and often untrustworthy and not to be relied upon.
D. Motherhood is an unpleasant experience.
E. Work is the major source of personal worth; having a baby will erode that.
F. I am an inferior person deep inside; nobody could really truly love me.
G. If there are sources of strength and assistance, they're not available for me.
Neutral (0)
No codable response
Mildly Positive (+1)
A. Pain is frightening, but can be accepted and worked with.
B. Birth is frightening, but I'm learning I can overcome those fears.
C. People have let me down, but I'm starting to learn to trust.
D. Motherhood has seemed negative in the past, but I'm learning that I can make it a positive experience.
E. Work has always been very important to me, but I'm learning it's not everything.
F. I'm starting to learn how to really trust and love myself.
G. I'm beginning to draw on inner sources of strength that I never knew I had.
Positive (+2)
A. Pain can be healthy and can be worked with as part of a satisfying experience.
B. Birth is a positive experience.
C. Other people provide a support in times of need.
D. Motherhood is a positive experience.
E. I will balance in a gratifying manner motherhood with all my other life activities.
F. I trust and love myself much of the time.
G. I draw on inner sources of strength when in need.
Very Positive (+3)
A. Pain is a healthy challenge which I will handle and will grow with.
B. Birth is an exciting and wonderful experience.
C. Other people are a real source of strength, comfort, and support to me.
D. Motherhood is the most wonderful experience of a woman's life.
E. I'm really excited to experience the integration of mothering and work.
F. I trust and love myself and am a very worthwhile person.
G. I'm constantly nourished by inner, spiritual resources.
5. PSYCHOSOCIAL SUPPORT FROM BABY'S FATHER
Very Negative (-3)
A. Overtly hostile relationship.
B. Extreme conflict present.
C. Father is actively rejecting.
D. No intimacy; no contact.
E. No communication.
F. No marriage or relationship.
G. No skills at conflict resolution.
Negative (-2)
A. Covert hostility with occasional eruptions into overt hostility.
B. Moderate conflict present.
C. Father is removed and distant.
D. Low levels of intimacy; live separate lives with little contact.
E. Very poor communication.
F. Very unhappy with marriage.
G. Minimal skills at conflict resolution (conflict is generally not resolved).
Mildly Negative (-1)
A. Mild hostility present.
B. Mild conflict present.
C. Father is generally unemotional, but present.
D. Occasional intimacy, but generally separate.
E. Poor communication.
F. Unhappy with marriage.
G. Conflict is resolved, but with threat to the relationship.
Neutral (0)
No codable responses
Mildly Positive (+1)
A. Attempting to work on reducing hostility present
B. Working to resolve conflict in the relationship.
C. Father working to become more emotionally available in the relationship.
D. Couple is actively working to improve intimacy.
E. Couple is working to improve communication.
F. Couple is working to improve problems that contribute to their marital satisfaction.
G. Couple is learning to resolve conflict without threatening the relationship.
Positive (+2)
A. Partner is generally accepting of the other and the pregnancy.
B. Couple is in harmony with each other.
C. Father is interested and involved in the pregnancy and birth plans.
D. Trust, intimacy, and closeness are dependable parts of the relationship most of the time.
E. Good communication exists most of the time.
F. Overall sense of marital satisfaction despite the existence of some problem areas.
G. Ease of conflict resolution without threat to the relationship.
Very Positive (+3)
A. Partner is very accepting of the woman and the pregnancy.
B. High levels of harmony exist; for example, baby may have been planned together.
C. Father is thrilled about the pregnancy and baby.
D. Very high levels of trust and intimacy are present.
E. Excellent communication of emotions, including anger and love.
F. Very high levels of marital satisfaction.
G. Strength of the relationship allows resolution of conflict before problems arise.
6. PSYCHOSOCIAL SUPPORT FROM MOTHER'S MOTHER
Very Negative (-3)
A. Very negative statements about childbirth, such as "birth will rip your insides out" or "women die in childbirth," or that mother's mother almost died in childbirth.
B. Parenting is a very negative experience.
C. Mother's mother refuses to have anything to do with her once she is pregnant.
D. No contact; no intimacy or sharing.
E. No communication.
F. Very strong childlike dependency.
G. Very actively rejecting.
Negative (-2)
A. Mostly negative statements about childbirth.
B. Parenting is a negative experience.
C. Mother's mother avoids contact.
D. Contact is superficial.
E. Poor communication.
F. Mother is overprotective and fosters dependency.
G. Mother's mother is anxious and rejecting.
Mildly Negative (-1)
A. Mildly negative statements about childbirth, such as women lose health and beauty from pregnancy.
B. Parenting is mildly negative experience.
C. Woman is stressed and anxious in presence of her mother.
D. Sharing exists at the level of concern about the mother's mother reactions and disapproval.
E. Communication is indirect.
F. Relationship fosters feelings that mother's mother is strong and mother is weak.
G. Mother's mother is mildly disapproving.
Neutral (0)
No codable response
Mildly Positive (+1)
A. Mother is mildly positive about birth.
B. Mildly positive about parenting.
C. Can turn to mother for support when in crisis.
D. Sometimes can share intimately with mother.
E. Sometimes easy and good communication exists with opportunity for clarifying feelings.
F. Generally adult relationship, with return to mother-child relationship when in crisis.
G. Mother is conditionally accepting with periods of genuine warmth.
Positive (+2)
A. Positive statements about childbirth.
B. Positive statements about parenting.
C. Mother is available for support.
D. Mother and daughter maintain a good relationship with intimacy and sharing.
E. Good, direct communication.
F. Consistent, adult-adult relationship with opportunities for both to give and receive.
G. Mother is warm and accepting.
Very Positive (+3)
A. Very positive statements and enthusiasm about childbirth.
B. Very positive statements and enthusiasm about parenting.
C. Mother is very available for support.
D. Very good opportunities for intimacy and sharing.
E. Excellent, direct communication.
F. Very strong personal friendship.
G. Very close ties with warmth and acceptance.
Positive (+2)
A. Positive statements about childbirth.
B. Positive statements about parenting.
C. Good friendships available for support.
D. Good friendships with intimacy and sharing.
E. Good direct communication.
F. Adult give and take relationship.
G. Strong social support system (friends organize baby shower, etc.).
Very Positive (+3)
A. Very positive statements and enthusiasm about childbirth, describing it as a joyous experience.
B. Very positive statements and enthusiasm about parenting.
C. Excellent friendships, very available for support.
D. Very good opportunities for intimacy and sharing.
E. Excellent, direct communication.
F. Adult give and take relationships with opportunities for both to be weak and strong.
G. Excellent social support system (friends involved in birth preparations and plans).

APPENDIX B
Table 1
Comparison of Means and Standard Deviations for the Demographic Variables Between Uncomplicated and Complicated Birth Outcome Groups

Table 2
Comparison of Means and Standard Deviations for the Past Obstetrical History Variables Between Uncomplicated and Complicated Birth Outcome Groups

Table 3
Comparison of Means and Standard Deviations for the Emotional State Between Uncomplicated and Complicated Birth Outcome Groups

Table 4
Comparison of Means and Standard Deviations for the Psychosocial Support Factors Between Uncomplicated and Complicated Birth Outcome Groups
Table 5
Comparison of Means and Standard Deviations for the Birth Data Between Uncomplicated and Complicated Birth Outcome Groups