Running Head: COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 1

Research Proposal

Coping Strategies for Postpartum Stress in Women

Walter E. Boyea

PSY 290-Research Methods

Dr. Norma Hernandez

Arizona State University

November 30, 2016

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Abstract

As we know several women every year give birth, but not everyone knows of what these

women go though mentally, and physically after conceiving. The birth of a child creates an

immediate shift in a person life. Unfortunately, for some women they experience postpartum

stress, this has an immense effect on how these women view the new world that they now live in.

We conducted a study where we implemented two coping strategies to two different groups twice

a week for 6 weeks. These groups will take two surveys one prior to being assigned to a group,

and than another one after the 6 weeks. We will be measuring the stress levels of the two groups

to see if either of the strategies can help them. The results revealed one of the coping strategies

having a significant impact on a mothers stress level. This will show that it is possible to reduce

the symptoms of postpartum stress in women, allowing them to have a normal relationship with

their family. This will in turn affect the those around her for example her child and partner. This

could be generalized to most women if they are educated about what is happening to them and

how to properly care for a child it can reduced the negative impacts that come after giving birth.

This study could push past just understanding the postpartum stress but try to either reduce or

stop the symptoms.

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Coping Strategies for Postpartum Stress in Women

Child birth is known to be a life changing event, a new life is brought into the world, and

is meant to carry on a legacy of the parents. With an event that is supposed to bring a couple

closer can cause a shift within the relationship. Often times a couple will not take into account

the difficulties of childcare. In 2004, Thorp, Krause, Cukrowicz, and Lynch found that 75% of

men and women reported that childcare is done mainly by the woman in the relationship. This

increased set of responsibilities that a mother has exponentially intensifies her stress levels. Child

birth is a complex period in a womans life, during this time she is going through biological,

psychological, and socio-cultural changes that occur simultaneously (Digregorio, 2013).

Digregorio (2013) stated that approximately 13% of all women that give birth suffer from

postpartum depression. This can lead even the most ecstatic mothers into a sense of detachment

from their child and partner. If a woman develops postpartum depression and it is left

undiagnosed and untreated the symptoms could negatively impact her ability to perform

activities of daily life, bonding with her infant, and negatively impact her personal relationships

(Digregorio, 2013).

Postpartum stress is a constraining force produced by postpartum stressors, these

stressors are conditions of change, demand or structural constraint. This can limit operating

integrity of body changes, maternal role attainment and social support (Hung, Lin, Stocker, &

Yu, 2011). Postpartum women are in a constant struggle between self-care and baby-care in

which either one or both suffer significantly. A study in 2001, conducted by Oweis found that

postpartum depression was conceptualized as a psychological problem that is related to personal

and situational variables. They continued to explain that because of the stress of childbirth, and

during postpartum period women are emotionally vulnerable and are at high risk of developing
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 4

depression. The romantic relationships that the mothers have are also affected during this period,

not only by the symptoms of postpartum but by having a child. There is an immediate shift in

roles of a once balanced relationship. Suddenly it becomes one sided when it comes to caring for

the newly born infant. Thorp et al. (2004) found that one way to decrease maternal stress during

the postpartum period is the support of their current partner. Postpartum mothers often feel as

though they have no real input when it comes to the relationship. It is important that there is

satisfaction with family decision making from both of the parents. When there is an uneven

amount of power on either side it becomes the source of conflict in martial relationships (Thorp

et al., 2004). During this sensitive time, new families should be willing to increase

communication even if they believe their opinion doesnt matter. Being open minded, and ready

to compromise with each other will allow the relationship to grow instead of falter. This is

important for the romantic relationship and the childs wellbeing. The events that unfold during

the postpartum period can influence the childs health. Maternal depression may have important

implications for child development, later in life the child can have emotional, behavioral and

cognitive problem (Gutierez-Zotes, et al. 2014). This could even form into childhood psychiatric

disorders (Gutierez-Zotes, et al. 2014).

Postpartum women are tortured with this feeling of dissonance from their child and

partner. Even though she knows for many other this is a time of happiness and celebration for

having a child. It can hard for them to admit that there is an issue, especially when it involves the

emotions they have towards their loved ones. In 2013, Deniz and Ayaz reported that it is

important to provide the mothers with a nurse, giving them training and counseling within the

first 3 months. Incorporating this into the new mothers life will remove anxiety and develop

self-confidence when it comes to baby care. There must be a way to identify ways to deal with
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 5

stress within the postpartum period, and the factors that cause this stress in women so

professionals can plan suitable nursing strategies (Deniz, & Ayaz, 2013).

I propose to conduct a study that helps mothers through the postpartum period, while

exploring two different coping strategies for women to utilize. This research if proven significant

would allow medical professional to reach out a hand to these mothers and give them the option

to have some of their worries relieved. The two coping strategies that we would like to explore

are a professional support group of mothers with postpartum stress, and having a nurse

accompany the mother. Both of these would be done for 6 consecutive weeks after the mother

has given birth. This study will use Lazarus and Folkmans transactional theory of stress and

coping. The theory refers to when stress arises from person environment interactions, giving rise

to individual physiological and psychological responses (Oweis, 2001). This theory explains on

a basic level, what happening when women suffer from postpartum stress. The hypothesis is

those who have a nurse for the coping strategy will have a significant impact on the stress levels

of women with postpartum stress. How will applying coping strategies immediately after a

mother is showing signs of postpartum reduce their stress levels? Postpartum can cause extreme

harm to a persons body so it is wise to treat it as quickly as possible. For mothers with

postpartum stress the key is to reduce the amount of stress that is affecting them, doing it with

haste will help prevent it from forming into something harmful.

In this research our independent variable will be the coping strategies that are given to the

mothers. There will be two levels of our independent variable, one is having the mothers attend

a support group for mothers with postpartum stress for 6 weeks. The other level of our

independent variable is having a nurse accompany the mother during the 6 weeks. The dependent

variable is the stress levels of the mothers. When collecting participants for this study I plan to
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 6

use the same demographics used by Deniz and Ayaz (2013), using a face-to-face interview

technique to find women who were literate, married, had babies aged 0-3 months, and consulted

outpatients with reasons such as diagnosis, and treatment of postpartum stress. The goal would to

acquire about 400 participants from three different states to better apply it to the general

populations. Half of the participants will randomly be assigned to a support group twice a week

and the other half would have a nurse visit twice a week. During the support groups there will be

a medical professional who is trained to answer any of the mothers questions or concerns, once

a week in the meetings there will be a guest speaker who has previously experienced postpartum

stress or depression. This will allow the mothers feel free to be honest to themselves and ask for

help. If the mother has a nurse visiting twice a week they will be trained on how to take care of

themselves during this period of mental and physical stress. The nurse will guide the parents into

proper childcare so they can be confident to do it on there own when the nurse isnt there. The

data for this research will be collected using primarily closed-ended questions that will indicate

their current stress levels prior to and after the 6 weeks of the coping strategy. The last question

after the 6 weeks will be an open-ended question to allow the mothers to express how the

strategy worked for them and issues that may have occurred. This will give researchers an

outline of what to do for future research on this topic. These questions will cover self-care, baby-

care, and social and working life (Deniz,& Ayaz, 2013), looking at these will give use the data on

how determine the impact the coping strategies had on the mothers stress levels.

Method

Participants
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The participants are mothers with 0-3 month old babies, and are diagnosed with

postpartum stress with no racial or ethnic group distribution. They are selected from different

areas of Maricopa County, the women are married and literate and have consulted with the

outpatient clinics with reasons such as diagnosis, and treatment (Deniz, & Ayaz, 2014). Utilizing

these demographics, the sample size that was used was 368 women. Deniz and Ayaz (2014) used

the same amount of participants to increase their reliability. There were some women who were

excluded due to them having babies ranging from 4 to 12 months old, having 368 participants

creates a buffer if there are any women who dont meet the requirements. Participants who are

not married, illiterate, and have babies over 3 months old are excluded from the study. Those

who are not married are excluded, because we want to measure how the coping strategies

influence the change of power in the relationship and its impact on the mothers stress levels.

The participants need to be literate so they can fully understand the purpose of the study and

what is required of them. If they were illiterate, they wouldnt be able to complete the survey that

is given to them. Finally, the mother needs to have a baby between 0-3 months old, as this is

when the parents are first learning to cope with having to care for a child.

Measures

The only material that was used to measure the impact that the two coping strategies had

on the mothers stress levels was a survey given at the beginning and at the end of the study. The

first survey gives us the mothers initial stress levels. This will include close ended questions

using a 7-point rating scale from not stressed to very stressed. In the second survey there are two

close ended questions related to the effectiveness of the coping strategy, the current level of

stress they are experiencing, and one open ended question about whether or not they would

suggest this to a friend.

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Design

The design of the study is a 1(Coping strategy) X 2 (Nurse or support group) factorial

between-subject design. There are 184 women assigned to have a nurse at their house twice a

week for 6 weeks and 184 are assigned to attend to a support group twice a week for 6 weeks.

The independent variable is the coping strategies, there two levels one is having a nurse, and the

other is going to a support group. The dependent measure for this study is the stress levels after

being exposed to one of the coping strategies twice a week for 6 weeks.

Procedure

184 women will be randomly assigned to having a nurse and the other 184 will be

randomly assigned to going to a support group. Both of the groups will be exposed to one of the

independent variable levels that they are assigned to twice a week for 6 weeks. Prior to being

assigned to a coping strategy the mothers will complete the first survey to create a general idea

of their stress levels before being introduced to a coping strategy. This will serve as a base line

measurement of the dependent variable, which is the stress levels of women with postpartum

stress.

The group that has a nurse visit twice a week will have training on proper self-care and

baby-care. This will increase the parents abilities of caring for their child properly when the

nurse leaves. There will be a decrease in the stress of the participants as they wont be as

unprepared for the needs and wants of their child. Any medical questions the participant has

about themselves or the baby they will be able to give them guidance. The other group that goes

to a support group twice a week will have to sign in on their arrival to indicate they went. Every

session there will be a medical professional there to answer questions or concerns the mothers

have in relation to child or self care. Every other session there will be a guest speaker who has
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 9

gone through postpartum stress, they will explain their experience and how it affects them. The

participants will be able to ask personal questions to create a more open atmosphere and to

relieve any shame. This will relieve stress of being ashamed for being distant towards their child

or spouse, allowing them to know it is a common effect of postpartum stress. The medical

professional and guest speaker will give advice of how to reduce stress in particular situations.

After the 6 weeks of the coping strategies the mothers will be given the second survey to make

the progress of their stress levels. Possible extraneous factors of this study is not speaking to the

medical officials about health issues that maybe occurring. The medical officials will take the

time during each visit will ask the participants if they are experiencing anything that they maybe

concerned about. No matter how minimal it may seem it could reduce the stress they are

undergoing. There

Analysis

The data collected from the two surveys will be analyzed after 6 weeks of utilizing the

coping strategies. The data will show which one of the strategies has the most significant impact

of the stress levels of mothers with postpartum stress. Either of these can have an impact on the

participants stress level this can be positive or negative but with the data we will be able to

confirm which of the strategies can be used to help mothers during the postpartum stress period.

Results

The results of this study are expected to show the independent variable, the two coping

strategies having a nurse or attending a support group twice a week for 6 weeks has a significant

impact on stress levels. The t-test will be used to examine the difference between the two groups

for ways of coping with stress (Deniz &Ayaz, 2014) it is expected that the two will have a

positive influence on the participants stress levels compared to before being introduced to the
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 10

strategies. This is due to being confident in self-care and baby-care from the guidance of the

either the nurse or the support group. The coping strategy that is expected to have a greater

impact on participants stress levels is having a nurse for 6 weeks. Having a person there to teach

them hands on or to prevent additional stressors from developing will significantly reduce stress

compared to going to a support group.

Discussion

Those who had a nurse for their coping strategy will have a significant impact on the stress levels

of women with postpartum stress. The results that we collected from the study have proven this

to be true, those who had a nurse twice a week for 6 weeks had significantly less stress. This was

done by having the nurse teach the parents how to properly care for their child. The nurse had

educated them on the possible situations that can occur typically with postpartum stress. This

was one reason why the stress levels of the women decreased more significantly. Both of the

parents were subjected to the possible symptoms of postpartum stress and proper baby-care. If

the mother could not take care of the child for whatever reason, her partner could take over the

responsibilities without leaving the mother stressing over if they could do it properly. The

responsibilities could then be spilt evenly, which would relieve stress off the mother. Compared

to going to a support group where they would not be able to bring focus to their independent

issues, they have to focus on the issues of the group as a whole. There are setbacks, for example

it will take time for the mothers to feel comfortable enough to open up and share their concerns.

There could be a concern that there would be judgement for the way they feel. In the long run it

would probably take about 3 weeks for them to gain anything from the group. The majority of

the time they would be feeling even more stressed instead of it relieving that stress.
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There could be a possibility that the hypothesis is incorrect, due to the coping strategies

causing more stress. Having a nurse over twice a week cause the parents to feel as though their

privacy was being intruded on, the mothers could feel even more distant from their child as the

nurse cares for them. The support group could make them feel even worse about themselves.

From the results that was collected it seems that the hypothesis holds up. What can be taken

away from this study, is that having a nurse twice a week for 6 weeks can have a significant

impact on stress levels in mothers with postpartum stress. With this research it can serve as a

guide line, and it would allow people to pose a question of what else could we do to prevent

postpartum stress. This study can help other researchers focus more on what the nurse could do

to reduce stress levels even more. Or how to improve support groups for women with postpartum

stress so they can benefit from them. Other studies that could be conducted from this is different

coping strategies that are more accessible to those of lower income, or using one of the strategies

presented in this study but focusing on only one. Trying one strategy with two different groups

one would be utilizing that strategies but the other will not.
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References

Deniz, C., & Ayaz, S. (2014). Factors causing stress in women with babies 0-3 months old and

their coping styles. Journal of Psychiatric and Mental Health Nursing, 21, 587-593. doi:

10.1111/jpm.12119

Digregorio, R. M. (2013), Stress Appraisal, Coping Response, and Acculturation

Level

As Predictors of Postpartum Depression Symptoms in Women of

Mexican Origin. ProQuest Dissertations Publishing, 1-4.

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url=http://search.proquest.com/docview/1441939780?accountid=4485

Gutierrez-Zotes, et al. (2014), Coping Strategies and Postpartum Depressive Symptoms:

A Structural Equation Modelling Approach. European Psychiatry, 30,701-702,

doi: http://dx.doi.org/10.1016/j.eurpsy.2015.06.001

Hung, C., Lin, C., Stocker, J., Yu, C. (2011), Predictors of Postpartum Stress.

Journal of Clinical Nursing, 5-6, 1-5, doi: 10.1111/j.1365-2702.2010.03555.x

Oweis, A. I. (2001). Relationships Among the Situational Variables of Perceived Stress of the

Childbirth Experience, Perceived Length and Perceived Difficulty of Labor, Selected

Personal Variables, Perceived Nursing Support and Postpartum Depression in

Primiparous Jordanian Women Living in Jordan. ProQuest Dissertations

Publishing, 1-4.

http://search.proquest.com.ezproxy1.lib.asu.edu/psycinfo/docview/275856830/fulltextPD

F/8E6D7C711DD549F6PQ/1?accountid=4485
COPING STRATEGIES FOR POSTPARTUM STRESS IN WOMEN 13

Thorp, S.R., Krause, E. D., Cukrowicz, K.C, & Lynch, T. R. (2004). Postpartum Partner Support,

Demand-Withdraw Communication, and Maternal stress. Psychology of women

quarterly, 28, 362-363. doi: 10.1111/j.1471-6402.2004.00153.x