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Psychological stress of pregnant women in Pakistan

By Romina Rajab Ali

On Feb 26, 2010, a woman delivered a baby in Rickshaw during a traffic jam caused by a VVIP movement in Quetta. My idea of writing this article is to describe about the psychological stress of pregnant women who faced so much anxiety due to not easily accessible to health services on time. This incidence gives me motivation to write an article. As nurse, if I can think and imagine how that pregnant woman suffered and faced that strange situation? I become traumatized.

I would like to share my clinical and community experiences and observations about the level of tension, stress and anxiety that have crept in our everyday life. But what about that pregnant woman who faced stress, anxiety, getting worried about her baby, and we should not forget about the possibility of complications related to gynecological problems. Prolonged, severe stress is dreadful for pregnant women and for that we blame our stress hormones. When stress hormone levels run high, women are less likely to conceive and more likely to miscarriage. Fetuses have higher rates of premature birth and low birth weight.

I observed so many incidences as nurse that women delivered baby due to delay reaching to emergency and eventually, women delivered in rickshaw or taxi that would lead to premature low birth weight infants or many a times baby got death in her mother’s womb due to complications. It happens because that woman is bearing so much stress and pain and baby has to come out due to completion of pregnancy term. With the influx of hormones during pregnancy and the effects of emotional stress during pregnancy can be quite severe that would end up with complications on both mother and unborn baby.
Although releasing of stress hormones gives much benefit to pregnant women. According to Gwen Dewar (2008). “In his article author offers an overview of the typical pattern of hormone secretion during pregnancy. When you perceive a crisis or think a stressful thought your brain secretes corticotrophin-releasing hormone (CRH). This master stress hormone triggers the release of glucocorticoid stress hormones, such as cortisol. Stimulated by glucocorticoids and other stress hormones (like adrenaline), the brain and body shift into crisis mode.”

As nurse, I experienced women came with increase in breathing pattern and pulse rate, making more oxygen available to muscles, blood sugar levels rise because in an emergency mind gets alert, muscles ready for action. But when the crisis is over, your stress hormones are supposed to slip back to their previous, lower, baseline levels. But what if your baseline levels are pretty high? Elevated basal cortisol is usually bad news. It’s a sign that your body is on perpetual red alert and the body suffers more wear and tear. Even an uncomplicated pregnancy can result in some stress during pregnancy.

For a pregnant woman and her fetus elevated cortisol is associated with an increased risk of early miscarriage, also cause preeclampsia (pregnancy-induced hypertension), fetal growth retardation, premature birth, and postnatal developmental delays. Stress hormone levels rise in pregnancy and this hormone have a direct effect on the mother’s brain, making women more vigilant and emotionally aroused. The stress results when hormones transferred from anxious mothers reach to the baby through the placenta. Not only that, it has been known to cause severe anxiety conditions and also hypertension.

Alternatively, higher cortisol levels do not promote good brain chemistry and bonding between mother and infant but on the other hand, high basal cortisol in mother’s causes diagnostic of Cushing’s syndrome in new born, a condition associated with a variety of health problems and mood disorders, like anxiety, irritability, mood swings, and insomnia. Given these associations, it seems plausible that elevated stress hormones could contribute to mood changes in pregnant women. The psychological effects might extend to the postpartum depression as well.
As nurse, I saw many cases in my unit that people rush to Emergency and they declared death on arrival due to delay reaching at hospitals because of the major roads are blocked and everything comes to bring a standstill and including ambulance are held up with patients in them, who in some cases die because of the delays. At that time the level of stress becomes so high and people have no choice and they take wrong and quick decisions to save their family members and outcome was very bad they will bear with so many complications in the end. Later on it will affect psychological and physiological effects on individual, family and society. Even an uncomplicated pregnancy can result in some stress during pregnancy.

It is important that as nurse, need to minimize stress and anxiety of mother during pregnancy to provide better and optimal environment for baby and mother both. I recommend as nurse, that there should be surveys conducted to see the geographical accessibility of the population for the health care facility. Especially maternal health care facilities should be established in both rural and urban areas that could provide maximum coverage and accessibility. By this way, in future the above mentioned scenario will not occur again and we can decrease the level of mortality, morbidity and psychological stress in pregnant women in our society.