Masters Theses

Date of Award

6-1988

Degree Type

Thesis

Degree Name

Master of Science in Nursing

Major Professor

Maureen Groer

Committee Members

Pat Droppleman, Johnie Mozingo

Abstract

This study addressed the effect of childbirth stress on a particular parameter of immune function, and examined the effects of childbirth preparation on this parameter. The possibility of relationships between perceived stress and anxiety, maternal and neonatal morbidity, and immune status was posited. These relationships were investigated during a 15 month study, carried out between summer, 1986 and fall, 1987. Data were collected on 40 primagravidas beginning their last trimester of pregnancy. Twenty primagravidas who had chosen to enroll in a 6-week prepared childbirth education program comprised the treatment group. The control group consisted of twenty primagravidas opting not to participate in the education program. As a parameter of immunocompetence, salivary samples for immunoglobulin A assay were collected twice, at 2-week intervals, between 30 and 34 weeks gestation (presumably a lower stress period) for baseline determination, and again immediately following delivery (presumably a higher stress period) for all subjects. Treatment subjects completed a 6-week prepared childbirth education program in the interim between baseline and final sampling. Perceived stress, due to life changes, and anxiety were measured at baseline and final sampling periods uttilizing the Holmes and Rahe Social Readjustment Rating Scale and the State-Trait Anxiety Inventory respectively. Data on maternal and neonatal morbidity were obtained from each subject's and infant's medical and hospital record. The results showed that subjects who failed to participate in the 6-week prepared childbirth education program (control group) experienced a significant decrease in salivary immunoglobulin A concentration immediately after childbirth, while subjects who had attended the education program and practiced the various techniques regularly (treatment group) failed to evidence a significant decline. This finding supports previous similar studies dealing with stress and immunity and suggests than stress-reduction strategies (such as childbirth education) promote immunocompetence. Unprepared study subjects were noted to have higher state anxiety scores than their prepared counterparts, indicating heightened worry, nervousness, tenseness and strain during the last trimester of pregnancy and at the time of labor onset. However, the prepared subjects surprisingly experienced a significant increase in state anxiety with the onset of early labor. In spite of promoting immunocompetence, the study results indicated that childbirth preparation may have inadvertently increased state anxiety in treatment subjects as labor began. The limited data from this study failed to support a relationship between high stress (secondary to life change). anxiety, and salivary immunoglobulin A concentration. This finding was in contrast to previous similar studies on stress and immunocompetence. Such studies have suggested that high stress levels cause immunosuppression and frequently precede illness . Fifty percent of the postpartum maternal complications were found to occur in parturients with non-detectable immunoglobulin A concentrations immediately following childbirth, however the small sample size and low incidence of maternal complications precluded drawing any valid conclusions from the data.

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