RESEARCH ARTICLES

The perception of high-risk pregnant women about the hospitalization process

Mariane Raquel da Costa e Silva^I; Bianca Dargam Gomes Vieira^II; Valdecyr Herdy Alves^III; Diego Pereira Rodrigues^IV; Gleiciana Sant’Anna Vargas^V; Angela Mitrano Perazzini de Sá^VI
INurse, Graduated from the Aurora de Afonso Costa Nursing School at the Fluminense Federal University. Supervisor from the Nossa Senhora da Piedade Hospital, Paraíba do Sul. Niterói, Rio de Janeiro, Brazil. E-mail: marysilvanet@hotmail.com
^IINurse, Master in Nursing, Assistant Professor from the Maternal-Infant and Psychiatric Department from the Aurora de Afonso Costa Nursing School at the Fluminense Federal University. Niterói, Rio de Janeiro, Brazil. E-mail: biadargam@gmail.com
^IIINurse, PHD in Nursing, Titular Professor from the Maternal-Infant and Psychiatric Department from the Aurora de Afonso Costa Nursing School at the Fluminense Federal University. Niterói, Rio de Janeiro, Brazil. E-mail: herdyalves@yahoo.com.br
^IVNurse, Master Student in Health Care Sciences from the Aurora de Afonso Costa Nursing School at the Fluminense Federal University. Niterói, Rio de Janeiro, Brazil. E-mail: diego.pereira.rodrigues@gmail.com
^VNurse, Master Student in the Maternal-Infant Field from the Antônio Pedro University Hospital at the Fluminense Federal University. Niterói, Rio de Janeiro, Brazil. E-mail: gleicianavargas@yahoo.com.br
^VINurse, Master Student in the Maternal-Infant Field from the Antônio Pedro University Hospital at the Fluminense Federal University. Niterói. Niterói, Rio de Janeiro, Brazil. E-mail: angela.perazzini@oi.com.br

ABSTRACT: The study aimed at comprehending the hospitalization process under the view of the woman experiencing a high-risk pregnancy. This is a descriptive study with qualitative nature, whose participants were 10 pregnant women from the ward for high-risk pregnancies of the Antônio Pedro University Hospital, situated in the municipality of Niterói, State of Rio de Janeiro.  The data collection was conducted during the period from March to August 2012 by means of semi-structured interview. From the content analysis, three categories were emerged: The expression of feelings in high-risk pregnancy; The body experience - seeing and feeling; The changes in social roles. It can be concluded that pregnant women had various representations about the fact of being a woman experiencing a high-risk pregnancy focused on the transformations, adaptations of organism, experience of giving birth to a child and the changes of social roles. In this sense, it is important that health professionals incorporate the scientific knowledge to the needs of the humanized care.

Keywords: Nursing; Obstetrics; Pregnant women; Risk. 

INTRODUCTION

During their life cycle, women go through changes provoked by their biological conformations that influence in their social, psychological and biological trajectories, which often limit them to exert roles established by societies, in other words, each phase requires an identity that has direct influence in quality of life^1,2.

Pregnancy is a phase in the women’s lives, and the gestational process implies the adoption of a new social role – the one of being a mother. It represents a new lifestyle and challenges to which women tend to adapt themselves. Nonetheless, during pregnancy, some factors can entail damages to health of the pregnant woman and of her child, thereby hindering the process of adaptation to pregnancy. Pregnancy is a physiological phenomenon and, therefore, its evolution, in most cases, takes place without complications³.

Although pregnancy usually evolves in a physiological manner, there is a small portion of pregnant women who, due to having specific characteristics, or by suffering some injury, presents higher probabilities of suffering from unfavorable evolution. This portion comprises the group known as high-risk, showing an increase of 20% of pregnancy of maternal risk^3,4.

The ward for high-risk pregnant women is understood as an integral part of the hospital system, which enables the performance of appropriate and qualified care for high-risk pregnancies, thereby allowing the contribution to the health of the mother-child binomial⁴.

Thus, this study aimed at understanding the process of hospitalization in the view of the pregnant woman.

LITERATURE REVIEW

In woman's life, the pregnancy cycle is a period of transition that involves phases of personality development, characterized by complex metabolic changes and temporary state of unstable balance due to the transformations involved, including in her social role, which require new adaptations, as well as interpersonal, intra-psychic and identity-related readjustments⁵.

Accordingly, the high-risk pregnancy affects any type of social and biological change and can make it problematic for maternal and fetal health4. Thus, the woman undergoes a biologically delimited period of tension, characterized by abrupt and complex changes, which leads her to show an unstable balance due to new social role. During this period, the transformations that take place in the woman’s body might interfere in her daily life and in her role in society, since that, in addition to being a woman, will start to assume the role of mother; in her relationship with the environment, in her habits and in the view of herself^1,6.

During a risk pregnancy, the woman experiences stressful situations because of the risks and the fear of death, the afraid of raising expectations about the pregnancy and the child, the guilt for not conducting the pregnancy in a normal way and the lack of control over her own body and the pregnancy⁷. Thus, pregnant women need information about the changes of the pregnancy period that take place during this phase and the actual needs of their bodies⁸.

METHODOLOGY

This is a descriptive research, whose nature has a qualitative approach⁹, performed in the maternity of the Antônio Pedro University Hospital (known as HUAP), situated in the municipality of Niterói, State of Rio de Janeiro.

The study population was composed of 10 pregnant women hospitalized in the ward for high-risk pregnant women of the hospital unit. All were chosen through simple random sampling, as the inclusion criteria were observed: women aged over 18 years, with physical and emotional conditions that would enable the accomplishment of the interviews.

The data collection technique was the semi-structured interview, with open and closed questions. The information collection took place during the period from March to August 2012 in the study setting.

The search for new testimonies was finished when there was saturation, due to repetition of the collected information. The subjects were identified as gestantes (pregnant women in Portuguese language) and received a sequential alpha-numeric code (G1, G2, G3...G10) to ensure the confidentiality and the anonymity of their respective statements.

The interviews were recorded on magnetic tape with the agreement of the pregnant women, after the signature of the Free and Informed Consent Form (FICF), according to the dispositions of the Resolution CNS-466/12. The research was approved by the Research Ethics Committee from the HUAP / Fluminense Federal University, under the CAAE Protocol nº 0378.2.258.000-11.

The transcription of testimonies was submitted to the interviewees for validation, before the accomplishment of the content analysis in its thematic modality, which has the following steps: pre-analysis, material exploration and treatment of results. Firstly, the organization and reading of material with the aim at registering impressions about the messages of data; next, the material exploration, with the completion of several readings to enable the organization of their content, with a methodological rigor for the applicability of the formulated plans and objectives; and, lastly, the treatment of results, which comprises an analysis of data by following the criterion of choice for the construction of categories¹⁰. Thus, it was possible to construct three categories, namely: The expression of feelings in high-risk pregnancy; The body experience - seeing and feeling; The changes in social roles.

RESULTS AND DISCUSSION

Among the 10 participants, there was a predominance of women whose occupation was ‘domestic servant’. This data represents a pregnancy risk factor because of their physical effort, stress and excessive load of activity^4-13. The age group, ranging from 20 to 35 years, configured a younger population.

As for the characteristics of ethnicity of subjects, marital status and schooling, the study had a predominance of black ethnicity with consensual union, insecure marital situation that predisposes to maternal risk factor and low educational level, thereby representing a high risk for pregnancies due to unfavorable demographic conditions^4,11-13.

When investigating the reasons for hospitalization of subjects, the data showed diagnoses of type IIdiabetes mellitus, arterial hypertension, premature amniorrhexis (rupture of membranes), rheumatic heart disease, systemic lupus and labor and fetus with congenital malformation as the most frequent ones. This demonstrates that the pregnant women surveyed in the study are members of the maternal group risk, with gestational risk and of maternal and fetal mortality.

The expression of feelings in high-risk pregnancy

Pregnancy is a period of transformations in the women’s lives, in which women experience a singular gestational history with their diverse physical, emotional and social phenomena^11,12. The woman who experiences a high-risk pregnancy presents several types of feelings, such as fear, doubts, fright, sadness, discouragement and concerns. That is why she becomes whiny and feels useless, besides recognizing changes in herself, including attributes such as sensitive, lively, full, successful, happy and responsible, thereby reinforcing the idea that every pregnancy is a unique condition for each woman and emphasizing a transition full of transformations in body and psychic level; however, this does not take place in a uniform manner^1,14.

Pregnancy is marked by biological, psychological, psychic and social changes in the women’s lives. Thus, when this process is associated with risk, one should highlight the fragility and emotional instability, since this might trigger emotional disorders in women, which affect the quality of maternal health and, consequently, provoke connections between these facts and the maternal and fetal mortality.

There are days in which I’m lively, there are days in which I’m not, there are days when I’m in a good mood and there are days in which I’m not. I am very sensitive too. I think it’s because of my health condition. (G1)

Some women proved to be apprehensive about the health statuses of them and of their fetuses. Some women proved to be apprehensive about the health statuses of them and of their fetuses. During a risk pregnancy, the feminine being experiences stressful situations because of the risks to which the woman herself and her son are subjected, the fear of death, the guilt for not conducting pregnancy in a physiological manner and the lack of control over her own body and the gestational process, which might hinder fetal health, as one can observe through the following speech:

I’m sad because my baby has broken the bag and my baby is still premature [...], my concern is this, will it be born alive, won't it be, I’ve planned everything and suddenly... (G5)

Regarding the hospitalization, other pregnant women reported the difficulties of this process, such as the lack of family support inherent to the hospitalization routine. In this case, one should emphasize the idea of passivity of the woman in the face of her condition, who becomes unconcerned in relation to her biological and emotional condition, thereby needing to be helped and monitored in a proper way, beyond the period of hospitalization, which requires the adaptation of this pregnant woman to the hospital environment and to new habits.

I’m a woman who likes to take care of my house, of my husband. Being hospitalized is a little boring, getting out of my routine like this, but it’s for a noble cause. (G2)

I’m already on maternity leave, because of the high risk of this pregnancy, but it’s really bad to stay in the hospital. (G3)

Hospitalization might provoke changes in the familiar rhythm of women, such as the distancing from home environment, family and work, as well as feelings of fear, anxiety and loneliness.

The hospitalization, which is often common and necessary in high-risk pregnancies, is an additional stressful factor, since it makes the pregnant woman aware of her pathology or damage. It leads the woman to move away from the family context and realize a supposed loss of autonomy in relation to pregnancy and her body^15,16.

In the pregnant women’s speech, one can clearly perceive the feeling of dependence and the limitations brought about by a risk pregnancy.

In my situation in the hospital, I don’t want to bother, I stand here quiet in my [...]. We get frustrated when we’re sick. [...] I have a very large limitation with many things, so I get frustrated with several situations, mainly with regard to my health. (G9)

A high-risk pregnancy is a stressful experience because of the risks to which the fetus and the mother are subjected, which interrupt the normal course of the pregnancy and interfere in the entire family context17. Such risks are characterized by deep and complex biological, physiological and psychological changes, both for the woman and for her family, thereby generating feelings of fragility and submission on the part of the pregnant woman, who is hampered by the hospitalization process.

Nonetheless, the condition of risk does not prevent the woman to live her pregnancy with joy and satisfaction.

I find myself fulfilled, happy and meaningful, and it seems that my life has meaning now. Before I didn’t want that, I was afraid of being a mother [...] I’m feeling the happiest woman in the world. (G7)

Each woman is a unique being, with personal perceptions and idealizations of what being-woman and being-mother are, and these insights are constructed from her cultural, social and family context, which exert strong influence on the adoption of the new role and on the experience of motherhood in an integral manner.

The perception that a being is developing into her womb enables the pregnant woman to acquire a sense of responsibility, when she recognizes her social role of mother and the child as a being who must be protected and cared.  

For me, this is a new experience, because I had never gone through this; then, in one hand, it’s weird, but, in the other hand,  I’m thinking it’s really cool, since I have a person who I will protect, have a child exclusively to me.(G10)

Pregnancy, as a process, enables a new life to women, in other words, the exercise of new roles and responsibilities; thus, it is a period of transition, with the prospect of changes and adaptations in this new phase¹⁸.

As the amendments of the pregnancy are installed on the body and life of the woman, they act as stimuli for the knowledge and recognition of themselves, of their feelings and for the formation of self-image, as a woman and mother. This allows the social design of their motherhood.

The body experience – seeing and feeling

Pregnancy is a period of several changes, including the perception of women in relation to their own bodies, which is experienced in different ways by each woman. These changes can generate satisfaction or even unhappiness, thereby causing changes in the feminine self-image and self-esteem. The perception of changes experienced in the body generates satisfaction in pregnant women, as the testimony below confirms:

I’m happy, my belly is growing and I’m seeing this big belly, I feel pretty happy about it! (G5)

Accordingly, the pregnant body manifests one of the phases of transformation and of transition of the woman’s life, which will be incorporated to her previous history and create rich conditions for the growth and enhancement of the feminine being¹⁶. The expression of being pregnant and the growth of the abdomen, a particular feature of pregnancy, provide visions to the femininity and reaffirm pregnancy as something that magnifies her womanhood^{4,11,12,17,18}.

Nonetheless, some pregnant women recognize the negative transformations experienced in relation to body, self-image and self-esteem.

My self-esteem is more or less, I’m not coloring my hair. I’m not thinking I’m beautiful, even more because of this device in my teeth; I’m dying to withdraw this device. (G3)

As the months go by, we will increase the weight, increase the size [...] I’m not thinking I’m beautiful too, we change totally; I’ve changed completely, in physical appearance. (G8)

These women reported a conflict with their bodily appearances, due to mood fluctuations, the fact of having contraindications to the use hair dyes during pregnancy and the use of orthodontic apparatus, besides the typical changes of pregnancy, such as weight gain, thereby emphasizing the feminine vanity. In this sense, the esthetics brought them the dislike of themselves. The pregnant body that refers to an identity of pregnancy^4,11,18 and motherhood highlights the attribute of a pregnant belly, with the need to deal with their anxieties and difficulties related to their bodies, which permeates their esthetic value as women¹⁹.

Pregnancy might provoke conflicts in the female self-image and identity, and is often considered a period of crisis in the woman’s life, with meanings ranging from positive to negative levels; thus, the antenatal period is a time that modifies the entire feminine complex.

Therefore, it is necessary to emphasize the esthetic value of body, which is rarely addressed by women during pregnancy. They worry about the biological aspects of pregnancy, thereby undervaluing esthetic aspects that are shaped in the motherhood. With the pregnant body, the woman starts to feel and see the things under a different viewpoint, through a construction of a new identity¹⁹.

In addition to body changes, pregnancy is marked by progressive adaptations of the maternal organism that allow the developing of the baby, as well as prepare the woman for the stage of motherhood.
The changes caused by the adaptations of the maternal organism imposed by the pregnancy might be observed in the several organs and systems of the woman’s body. In a way, these modifications are intertwined in the speeches. They are: increase of abdomen, edema, increased appetite, excessive sleep, heartburn, weight gain and pain. Such effects are influenced by the hormonal load that provokes changes in the systems of the human body, thereby triggering the typical signs and symptoms of the pregnant body^1,4,11,18. 

My belly is growing, this is a good sign? Because my child is growing! (G1)

I feel my feet very swollen when I’m walking, it bothers me a lot; I cannot maintain myself standing for a long time. (G3)

 I'm feeling a lot of heartburn; I’m very hungry and very tired and sleepy, besides the shortness of breath. Usually, I feel physically ill during the night shift. (G4)

In pregnancy, the woman undergoes a period characterized by abrupt and complex changes, which makes her balance unstable due to motherhood. The lack of knowledge on the part of women in relation to the maternal organism’s answers to the pregnancy usually prevents them to deal with their discomforts.

The knowledge of these answers is a responsibility of the nursing professional, as well as the fact of being a source of information for pregnant women²⁰, so that they might acquire skills about the gestational process, abilities to perform self-care and capacity to act appropriately under certain discomforts, thereby promoting the quality of health throughout the hospitalization process.

The changes in social roles

In light of the foregoing, pregnancy, which might be regarded as a natural phase in the women’s lives, implies the adoption of a new social role – the one of being a mother –, as well as the modification of other roles and new responsibilities, although this physiological process requires an adequate follow-up.

Pregnant women, predominantly, commented the modification of their social roles, due to the high-risk pregnancy and the hospitalization process.

Thus, one should pay attention to the speech of feeling the motherhood through the expressions of the pregnancy process, and this is a time of reorganization of the woman, in her role of mother. Furthermore, women reported positive changes in the family support and relationship, which have reinforced their roles as wives and have been important in the construction of the maternal identity.

Look, I'm happy, I’m really delighted, my belly is growing and I’m seeing this big belly, that’s pretty cool to see it grows fast. (G1)

Other women made ​​clear their social roles of wives and mothers in their speeches. They depicted the distancing from the household, their activities and their partners, due to the risk condition and the hospitalization process. These items hinder their quality of life through their personal satisfaction, from which, among the various social roles assumed by women, one should highlight the one of being a mother and wife21. Hence, their removal favors the non-acceptance of their social role.

My husband and I are always close to each other and now [he] is distant. It’s too bad [...] we work in the same place, and now we stay separated like this! It’s very bad. [...] I’d really like to be at home around my kids and my husband. (G5)

Because of the high-risk pregnancy, some conflicts and changes might take place in the relationship with the partner and in the family rhythm, which directly influences in the maternal and fetal health and well-being.

In fact, my relationship with my husband is very difficult; it’s not the same thing. [...] My other son is with his grandmother, I’m worried, with him, even more because I’m here in this condition. (G5)

The experience of a risk pregnancy has shown reflects on the entire family context, with negative changes in the relationship between the woman and her partner, thereby involving the distancing of the mother in relation to her other children²². One should also realize the expression of fear towards the life itself, since the mother has demonstrated to know that the complications could cause damages to her health, which is one of the stressful factors in case of a risk pregnancy.

Nevertheless, some women commented about the changes in the family rhythm with a focus on their social roles of mothers, due to the distancing in relation to the other children.

I’m also worried, because I have two children, then they are with my parents and their stepfather, but I’m missing them. (G9)

I realize myself as a fulfilled and happy woman [...] it seems that my life has meaning now. Before I [...] was afraid of being a mother, that’s why I delayed it so much, until now, with thirty-nine years old. [...] I’m feeling the happiest woman in the world, more fulfilled. (G7)

These changes are problems faced by pregnant women during the hospitalization process, by reinforcing feelings such as anxiety, fear and anguish, which hampers their readiness to perform self-care^20,23,24.

In this sense, one should take into account the context where the pregnancy was conceived, in which the experience is a personal fulfillment, according to the woman’s expectations and idealizations in relation to the fact of being a mother. The experience of pregnancy is a unique experience, not only faced by the woman, but also by her partner, her family and the society at large¹⁸. It is a singular moment for her, with intense transformations in the social level, experienced in different manners by each one, which permeates her biological, psychological and social aspects, thereby activating her ideological construction of being a mother and wife^4,11,12.

CONCLUSION

This study has allowed us to verify the perceptions of pregnant women about the fact of being a woman hospitalized during the experience of a high-risk pregnancy, focusing on the feelings that emerge from the experience of giving birth to a child in a risk situation, the changes in body level, the adaptations of the organism to the pregnancy process, as well as the modifications in their social roles.

The first category, The expression of feelings in high-risk pregnancy, depicts the emotional fragility and instability of pregnant women, the concern with regard to the health statuses of them and of their babies, the lack of family support because of the hospitalization routine and the dependence and limitations arising from the risk situation, which does not prevent them to experience the gestational process with joy and satisfaction. The second category, The body experience – seeing and feeling, points to changes related to the body, due to pregnancy, which generate positive and negative transformations. The third category, The changes in social roles, highlights the positive changes in the family relationship, which reinforces the women’s role of wives and mothers, despite their distancing from the household due to the hospitalization process. Furthermore, conflicts and transformations in the relationship with their partners and in the family rhythm emphasize their social role of mothers.

The feelings of pregnant women are mostly different for each woman and almost always are mixed between the happiness and satisfaction in conceiving a child and the senses of fear, concern, passivity and insecurity, as well as the mismatches in the family rhythm arising from the restrictions imposed by the risk condition.

In this context, in order to transform the reality of health care of pregnant women, it is important that the nursing professionals incorporate scientific knowledge of psychosocial care needs of these women, thereby breaking with the idea of the biomedical model focused on the disease.

One should point out as limitations of this study the impossibility of staying in touch with some women and the refusal of others to participate on it. The reduced number of participants and a single research setting also prevent the generalization of the research findings.

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