This is week three in our series on working with clients at high-risk. In week one, we learned that people at high-risk don’t get the same benefit of childbirth education as people at normal risk. In week two, we explored four programs designed to provide education to people at high-risk. Today, we examine two studies of women’s reports of the care they received as a high-risk pregnant person to learn about the challenges these clients face and how we can better help them. These were all published in 2020, providing a good picture of what people experience today.

I want to start with a study that explored the struggle women faced trying to act as a decision maker. The participants reported that they had to see many different providers who had different opinions and different recommendations. The fragmented care also prevented them from voicing their questions and concerns because they were constantly navigating how to be “good patients.” The participants also reported experiencing recommendations for rest as resulting in loneliness and isolation.

As childbirth educators, we are experts at helping women make sense of the contradictory information they receive from friends, co-workers, books, the internet, and other information sources. For women at high-risk, we also need to become expert at helping families make sense of information when they receive conflicting recommendations from their obstetrician and the consulting maternal fetal medicine specialist.

In another study, the research team explored the emotion of a high-risk pregnancy for people hospitalized during the antepartum. The most important point for childbirth educators is that the women reported were in emotional distress, but felt they couldn’t express their distress because it would harm the baby. The women reported that they received repeated messages that they should not worry but were given no education on how to manage their anxiety. The women also felt pressure to conform to societal standards of being excited for the pregnancy, even when they actually felt ill or were managing bad news about their baby’s prognosis.

After reading this article, I wondered if women at high-risk felt the same pressure to conform to societal standards during childbirth education as they do during hospitalization. If there is a pressure to conform, women at high-risk may not be willing to be open about the level of distress they are experiencing and may hold back questions for fear of upsetting the rest of the class.

How do you handle these two issues? Do you have a teaching technique that helps women make sense of contradictory recommendations from providers? Do you have a strategy for helping women feel comfortable expressing distressing emotions or questions? Share your experiences by getting published on the Lamaze blog. Contact Content Manager Morgan Manghera at mmanghera@lamaze.org for more information.

In my final post, I’ll share the results of a study of what women wished they had known before they gave birth and how it can help us understand the educational needs of women experiencing a high-risk pregnancy.   

References

McCoyd, J. L. M., Curran, L., & Munch, S. (2020). They say, “If you don’t relax…you’re going to make something bad happen”: Women’s emotion management during medically high-risk pregnancy. Psychology of Women Quarterly, 44(1), 117–129. https://doi.org/10.1177/0361684319883199

Munch, S., McCoyd, J. L. M., Curran, L., & Harmon, C. (2020). Medically high-risk pregnancy: Women's perceptions of their relationships with health care providers. Social work in health care, 59(1), 20–45. https://doi.org/10.1080/00981389.2019.1683786

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