High-Risk Pregnancy and Hospitalization: The Women's Voices

Article excerpt

Pregnancy and hospitalization are significant events in a woman's life. Both experiences have strong implications for the woman, her immediate family and extended family members, as well as professionals including physicians, nurses, and social workers. When combined--hospitalization due to high-risk pregnancy--the experience has the potential of being a powerful event (Gorman, 1995). High-risk pregnancy is defined as any pregnancy in which there is a factor--maternal or fetal--that potentially acts adversely to affect the outcome of pregnancy (Queenan, 1985).

The goal of this study was to understand the experience of hospitalization resulting from high-risk pregnancy as it is lived by the women. The study is especially relevant in today's world, as the development of medical technologies (such as in vitro fertilization) has allowed growing numbers of older and previously infertile women to conceive, and thereby has increased the number of women vulnerable to high-risk pregnancy and consequent hospitalization (O'Hara, Reiter, Johnson, Milburn, & Engeldinger, 1995). The results of this study are likely to help health care social workers improve the quality of care provided to this population, because currently there are only vague social work guidelines for such women (Honing-Bachman & Furlong-Lind, 1997).

LITERATURE REVIEW

Overall, there is very little research on the psychological experience of hospitalization due to high-risk pregnancy (Gorman, 1995). Existing studies are mainly guided by stress theory (Lazarus & Folkman, 1986), as these women are subject to the dual stresses of pregnancy and hospitalization (White & Ritchie, 1984). Stressors associated with antepartum hospitalization include the nature of the high-risk condition, confinement to the hospital, stress in family relationships, and stress in relations with health care providers (Curry, 1987; McCain & Deatrick, 1994). Recent studies added the notion of uncertainty as a characteristic stressor of women who are hospitalized because of a high-risk condition, as often the outcome of the pregnancy is unpredictable. Women do not know how their high-risk conditions will affect themselves, their babies, or their future pregnancies (Clauson, 1996; Stainton, McNeil, & Harvey, 1992).

Researchers investigating the impact of stressors associated with antepartum hospitalization have found significant manifestations of stress. Hospitalized pregnant women who are at high risk report greater anxiety and depression, lower self-esteem, and less optimal family functioning than pregnant women not hospitalized or at high risk (Mercer & Ferketich, 1988). These studies examined the experience of hospitalization due to high-risk pregnancy without paying much attention to the women's voices and subjective experiences.

The everyday, personal experience of every woman has value and needs to be understood in all its complexity and richness. The current study attempts to fill this gap in our knowledge, following Gorman's (1995) call for research that examines the psychological aspects of high-risk pregnancy.

THE RESEARCH CONTEXT

Although each woman's experience is unique, one should not lose sight of the immediate surroundings or the social and cultural context of this experience (Thompson, 1992). The immediate context of the present study involves the Division of Maternal--Fetal Medicine unit at the Edith Wolfson Medical Center in which the participants were hospitalized. The unit is in a mid-size hospital located south of a large Israeli city and serving low-to middle-income neighborhoods. The more distant context of this study is Israeli society, where normative proof of a woman's femininity is still in giving birth. Israel is one of the strongest advocates of childbearing, as shown, for example, by substantial government funding for fertility treatments. Israel has the highest number of fertility centers in the world (Ben-David, 1992). …