Stress in pregnancy is recognized as a predictor of negative obstetrical outcomes and behavioral/emotional problems in infants and children. These maternal and child outcomes underscore the need for systematic clinical research into the sources of stress in pregnancy and strategies for reducing pregnancy stress.  This pilot study focuses on one important source of pregnancy stress, history of pregnancy loss.  Studies have shown that women fear another loss, feel more vulnerable, and less competent when pregnant after a loss experience. We focus on pregnancies subsequent to perinatal loss because they are known to be stressful, as evidenced by heightened pregnancy anxiety (Côté-Arsenault, 2003), reduced prenatal attachment (Armstrong, 2002; Armstrong & Hutti, 1998), greater depression (Armstrong, 2002; Franche & Mikail, 1999), increased parental concerns (Theut, Moss, Zaslow, et al., 1992) and disorganized attachment to the new infant (Heller & Zeanah, 1999; Hughes, Turton, et al, 2001).
The purpose of this pilot study is to test the feasibility and acceptability of methods and procedures planned for a larger 2-group intervention efficacy study of a nurse-caring intervention delivered through home visits and a guided pregnancy diary. The overall goal is to reduce women’s stress, both psychological and physical, during pregnancy. The theory guiding the intervention process is Swanson’s descriptive, middle-range Theory of Caring (Swanson, 1991). Caring is defined as a “nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (Swanson, 1991, p. 165). The content of the intervention is evidence-based from descriptive and correlational studies of women pregnant after perinatal loss.

Thirty-two women in their first or second trimester received either the intervention (N=20) or control condition (N=12). Data collection occurred at entry (6-25 wks), 22-24 wks, and 32-34 weeks. Sample characteristics were 22-41 years of age (M=32); 10-20 years of education (M=15.6); 81% Caucasian, African American 10%, American Indian 4%, Hispanic 5%. Incomes varied widely from the lowest to the highest income brackets ($1 to > $120,000).  Pregnancy losses ranged from 1-6 per woman, at 3-38 weeks gestation. Participants were recruited equally from Syracuse (16) and Rochester (16).  Feasibility. We demonstrated our ability to recruit women; 89% of interested women consented and completed the study. Ineligibility or time constraints prevented full participation, but all who started the control or intervention conditions completed all study components. Usable salivary cortisol samples were received from all women for each data collection day. Home visits were completed within the allotted time frame.
Acceptability.  Those in the intervention group found the visits very helpful. Women desired more than the four home visits initially planned, so the proposed study includes 5 home visits and 5 phone calls minimum for each woman.  Participants liked the Pregnancy Diary format; many wrote frequently. Qualitative themes that emerged from field notes and study evaluations included feeling understood, cared for, listened to, and hopeful; gaining confidence, skills, and a sense of control; and reduced anxiety and fears.