Spiritual Coping: A Strong Buffer Used By Women At Risk for Preterm Birth

Purpose:

Nurses are taught to provide holistic care. This is vital when working with women at risk for preterm births. As Mexican women become more acculturated to the United States, their risk for poor birth outcomes increases. This has been called the Latino paradox as the movement from health to illness is also present in other health areas. The purpose of this study was to investigate the relationship between stress (state, perceived and pregnancy-related stress), stress buffers (social support, coping and optimism), acculturation, and birth outcomes (length of gestation and birth weight) of infants born to 81 Mexican and Mexican-American women. 

It was hypothesized that in pregnant Mexican and Mexican-American women:

1. Pregnancy-related stress rather than state or perceived stress would penetrate all lines of defense resulting in poorer birth outcomes.
2. Perceived social support during pregnancy would strengthen the flexible line of defense thus resulting in better birth outcomes.
3. Optimism would strengthen the normal line of defense more than a subject’s coping style.
4. Women with less acculturation to the Anglo culture would have stronger normal lines of defense (buffering variables) thus resulting in better birth outcomes.
5. There would be a negative relationship between stress indicators at Time 2 (third trimester) and buffering variables at Time 1 (first or second trimester), such that women who had higher levels of optimism, proactive coping and high perceived social support would have less perceived stress and pregnancy related-distress at Time 2.

Methods:

An interrupted times series design was used to collect data prior to labor and delivery: sescond and third trimesters. Neuman’s Systems Model was used as the theoretical framework as it illustrates how stress impacts health outcomes. Women were recruited from local health and community agencies. Interviews were conducted in English or Spanish as desired by the subject using standardized questionnaires: Acculturation Rating Scale for Mexican Americans – II (ARSMA-II), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10),  Prenatal Distress Questionnaire (PDQ),  Interpersonal Support Evaluation List (ISEL-12), Prenatal Coping Inventory (PCI), and, Life Orientation Test-revised (LOT-R). 

Results:

Acculturation was negatively correlated with age (r = -.378, p < 0.001) and social support (r = -.258, p = .02). Bicultural women had the highest mean birth weight, and very Mexican–oriented women had the longest gestation. The women least integrated in either culture, e.g. marginalized (ARSMA-II), had the most stresss in all categories: current stress (r = .344), stress over the last month (r = .288) and pregnancy-related stress (r = .264).

For all women, the third trimester of pregnancy was significantly different from the second trimester for stress, coping and social support.

Spiritual coping predicted weight (β = .278) while pregnancy distress (β = -.237) and sense of belonging (β = -.258) predicted length of gestation. Using Neuman’s Systems Model, pregnancy distress was able to penetrate all lines of defense while a sense of belonging and spiritual coping strengthened them.

Conclusion:

Pregnancy-related distress was able to penetrate all lines of defense and impacted the core per Neuman’s Systems Model. Women who had strong spiritual coping and a sense of belonging were able to deflect stress and thus protect their core resulting in healthy birth outcomes. Nurses could thus promote healthier birth outcomes by focusing on social support and coping, especially with women who are culturally marginalized. These results add to the understanding of the Latino paradox.