“Balanced integration of Being, Doing and Having combine to support Deep Health in pregnancy.” This is the basic theme of a new paper on women’s perceptions of what it means to have a healthy pregnancy, integrating several wide-ranging aspects of health and healthcare.

Deep Health: A Qualitative, Woman-Centered Perspective of Health During Pregnancy. Image Credit: Nicoleta Ionescu / Shutterstock

Introduction

Even though some progress has been made in educating women about the need to have a healthy lifestyle during pregnancy, the fact is that the results are meager in terms of actual improvements in pregnancy outcomes or later health outcomes. This could be because better knowledge about a cause-effect relationship is not the same as better awareness, the latter including an emotional and volitional change that may lead to altered health behavior, unlike the merely cognitive gains associated with the former approach.

In addition, women do not think of health in the same way that their healthcare providers (HCPs) do, while some health behaviors are simply out of reach for some segments of society, either economically or socially. Thus, the understanding of what health means must be better shared by women and HCPs for their efforts to be consonant and fruitful.

The present paper, published in the journal Midwifery, looks at the women’s perspective of pregnancy health using a qualitative approach.

What does the paper say?

The present paper was based on 20 pregnant women, 70% being unmarried single mothers with 60% reporting a low income (less than USD $20,000), attending an urban women’s health clinic during mid-pregnancy or later. All had single fetuses, only 40% being first-time mothers, and none had high-risk pregnancies.

The analysis shows that for pregnant women to feel healthy during pregnancy, mere physical health is inadequate. They must have a sense of emotional well-being, be financially stable, and feel supported. These facets interweave to produce what the authors call Deep Health, “an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having).”

Being

Women said they thought of the Being aspect of health in terms of happiness, hope, resilience, social connectedness, physical and mental activity, and energy. Conversely, nausea, tiredness, uncertainty, anger, panic, or fear associated with pregnancy were viewed negatively. Some used substance abuse as a temporary coping mechanism, but without complete self-agreement. Some women stuck to rehabilitation programs mainly because of their love and concern for the developing baby.

This theme was identified as a component of health during pregnancy by younger, first-time mothers.

Doing

All women said a healthy lifestyle was important, including proper food and exercise, avoiding toxins, and including periods of rest and caring for themselves. However, many said it was difficult to act on their knowledge or even their desires due to the conflicting pulls on their time and energy from family or work. Even so, they often recognized the power of self-motivation, stemming from their active recognition of the positive impact of such practices on their emotional and physical well-being.

Doing was most often identified by women with better education and higher incomes.

Having

The availability of resources to buy what they needed was a crucial factor in whether pregnant women could actually follow healthy dietary practices. At the same time, pregnancy caused women to ponder on their current lifestyles and desires for the future, even if temporarily out-of-reach, stability, especially concerning having their own housing.

This desire was linked to their emotional stability since it would cater to their freedom and autonomy. Often, this allowed them to dream bigger about completing their education and getting a better job, being a good parent, and regaining control of their lives.

Importantly, not having good workplace support, coupled with low-wage jobs, meant that pregnant women were often forced to do physically unsuitable heavy work or too long hours, or else they were let go. This added to financial, emotional, and physical stress, as they now had to look for another job as well as a place to live once the baby came.

Furthermore, just as important was the need for support from partners, family, friends, and HCPs. Again, this was perceived as a felt need, as it helped some women to have confidence that they could look after themselves and their babies, even when they went through emotional crises.

Interestingly, this theme was more important for those with less education and lower incomes, who deeply desired stable housing and income.

What are the implications?

Most advanced societies focus on providing adequate healthcare for women in the prenatal period, including advice and help with changing lifestyle behaviors that may be of concern. However, healthcare providers often do not understand that this is not enough for a healthy pregnancy, leading to neglect of the other aspects of Deep Health.

Women benefit emotionally from activities that make them happier, such as exercise or self-care. They also feel immense responsibility for their unborn child’s upbringing in a safe and healthy home. This spurs them to get a job, stable housing, or better education.

When these are achievable, and they have support for their efforts, they feel healthy. Without such support, mere prenatal healthcare could leave them out in the cold, bereft of essential care for their actual needs.

If HCPs, especially midwives, focus on Deep Health, viz., a dynamic and holistic view of health that considers all three aspects, pregnancy may indeed become healthier for women and their babies. Midwives can provide continuous care, extending beyond physical health, as well as contact with other women via support groups that promote autonomy, enjoyment, and mutual help.

“Research has shown that group prenatal care is especially effective for women of color, women with substance use disorders, adolescents, and low-income women.”

Identifying and promoting behaviors that provide both a feeling of wellness and contribute to meaningful life goals is an important research focus for future studies.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.