Comparative Study To Assess The Stress Among Working And Non-Working Antenatal Mothers In Selected Hospitals Of Udupi District

Introduction :

Pregnancy is a joyful event, however pregnancy, motherhood and child birth are not at all romance and dreamy nostalgia but it is a serious reality which has its own inherent risks to health and survival both for the women and for the infant she bears, which are present in every society and in every settings.¹

Carmichael SL et al conducted a populationbased case-control study on maternal stressful life events and risks of birth defects among 1,355 case mothers and 700 control mothers in USA. Maternal stress was measured by responses to 18 yes/no questions about life events that occurred from 2 months before through 2 months after conception. An increase in the stressful life events index was associated with increased risk of cleft palate, cleft lip with or without cleft palate, d-transposition of the great arteries, and tetralogy of Fallot, after adjustment for maternal race-ethnicity, education, obesity, age, smoking, drinking, intake of folic acid-containing supplements, neighborhood crime, and food insecurity. The odds ratio for a 3-unit change in the stress index was 1.45 (95% confidence interval = 1.03-2.06) for cleft palate. Increased stress was associated with an increased risk of spinal bifida and anencephaly particularly among women who did not take folic acid supplements. A 3-unit change in stress was associated with a 2.35-fold increased risk of anencephaly among women who did not take supplements (CI =1.47-3.77) and a 1.42-fold increased risk among women who did (CI = 0.89-2.25).²

Prenatal maternal stress has been shown to be an indicator of adverse birth outcomes.

Studies have indicated that high levels of stress in pregnancy have been associated with negative outcomes such as low birth weight and preterm labour. Negative outcomes such as depression and anxiety related to the pregnancy can lead to stress and can lead to less healthy behaviours.³ Recent interest has focused on the potential etiologic roles of acute and chronic stressors, the psychological distress caused by those stressors, and the hypothalamic pituitary-adrenal axis. The maternal serum or plasma corticotrophin-releasing hormone (CRH) concentration measured in early pregnancy has been shown to be a risk marker of subsequent preterm birth.⁴

Pregnancy is a boon from God. Stress is not good for the mother during the term. It can have adverse side effects. It is very important for the mothers to remove anxiety. This is also a part of the stress management process. Anxiety during pregnancy is very harmful. It may result in false labor or premature birth. It can also cause hypertension. The effects can be disastrous for the unborn foetus.⁵

Pregnant women who are working fulltime in a high stress job should cut down their working hours to around 24 hours a week during pregnancy, Dutch researchers said babies of stressed working mums suffered adverse health effects. Pregnant women who work more than 32 hours a week in a high stress job are more likely to have babies who cry excessively; children with low birth weight and are more at risk for the dangerous pregnancy condition called pre-eclampsia, according to research published.⁶

It is evident from review of literature that stress during pregnancy is harmful to both mother and fetus and stress is more among working antenatal mothers, especially who work for more than 32 hours per week. Therefore researchers felt that it is important to avoid the stress by using appropriate stress management techniques. Hence this study was undertaken to assess the stress among working and non working antenatal mothers with a view to develop an information leaflet on antenatal stress management.

Material and Methods :

A descriptive survey design was adopted for the present study. The study was conducted in 3 local hospitals of Udupi district, Karnataka state, India. Total of 60 working and non working antenatal mothers (30 each) between the age group of 18- 40 years were selected using purposive sampling technique.

The inclusion criteria used was working and non-working antenatal mothers who were available at the time of data collection, willing to participate in the study, able to read and write Kannada and without any bad obstetrics history. Demographic Proforma and Stress Assessment Scale have been used to collect the data.

Stress Assessment Scale is a readymade tool and we obtained from a study on ‘Development of a stress scale for pregnant women in the South Asian context: the A-Z stress scale with the permission of Dr Ambreen Kazi and some modifications done to as per lifestyle of this research setting. The data collected were analyzed using the descriptive and inferential statistics with the help of SPSS 16.0 version.

Results:

Discussions :

The findings of the present study indicated that the working antenatal mothers had working hours of 6-8 hours/day and 73% were moderate workers. About 53% non-working and 57% working antenatal mothers were between 29-40 weeks of gestation. The finding of the study is supported by the following study.

Prospective Cohort Study conducted by Vrijkotte TGM et al., on First Trimester Working Conditions and Birthweight among 8266 pregnant women at Amsterdam, Netherlands. The result revealed that, a workweek of 32 hours or more and high job strain were significantly associated with birth weight.⁷

The findings of the present study revealed that there is significant difference between working and non-working antenatal mothers stress score. The mean and standard deviation (SD) of the stress scores of working antenatal mothers (mean= 21.33, SD= 9.87) was more than nonworking antenatal mothers (mean= 14.7, SD= 8.6). This is supported by the following study.

Albrecht SA et al conducted a co relational descriptive survey study on Anxiety levels, health behaviours, and support systems of pregnant women in metropolitan city. The findings showed that, there was significant positive correlation between trait anxiety with high occupation level (r = .68, p = .001).⁸

Conclusion :

The study concludes both working and non-working antenatal mothers were at more risk of developing stress. All antenatal mothers participated in this study had mild stress and there was significant difference between working and non-working antenatal mothers stress score. An information leaflet was developed by the investigators on antenatal stress management and discussed and distributed to the antenatal mothers.