MU nursing professor Tina Bloom interviewed 24 pregnant rural Missouri women to learn about what makes them stress. She said what she found challenges her idyllic vision of rural life.
A high maternal stress level during pregnancy can be hard on maternal-child health. Stressed out mothers are more likely to smoke, and babies who are carried by stressed mothers have increased risks of pre-term births and having low weight when they're born.
“There are some people who have tested ways to relieve women's stress when they're pregnant," Bloom said. "So we'll teach them to meditate or teach them cognitive behavioral therapies to learn to manage their stress. But to my knowledge, nobody had really gone to pregnant women themselves and said, 'What's stressful for you? What would help you the most in dealing with your stress?’”
After interviewing 24 pregnant, low-income women who live in rural Missouri, Bloom learned that financial issues put strain on the women more than anything else.
“Hands down, the most frequent answer when I asked [the women about] what would help them with their stress was a job," Bloom said. "They really wanted a good job that was flexible, that would help them support their families, would bring up their wage. It was not what I was expecting to hear.”
During her doctoral studies at Oregon Health and Science University in Portland, Bloom studied pregnant, low-income urban women and what makes them stress. She found that urban and rural women had similar issues.
“They were very stressed out about money,” Bloom said. “They felt lonely and isolated. They had high exposure to violence.”
But the rural women also had issues that come with living in a small community far away from resources. “They had transportation issues that urban women don’t have,” Bloom said.
The women also had virtually no privacy. “Every single woman that I interviewed said to me, ‘Everybody knows everyone and everything in a small town,’” Bloom said. “They felt lonely and isolated in part because talking about their stressors was helpful to them, but it wasn’t helpful if people gossiped about them, and that happened a lot to these women.”
The women would then tend soldier on and not want to talk to other people about their issues, Bloom said.
In addition to interviewing the 24 women in her sample, Bloom also tested them for possible mental health issues. It turns out two out of three women in the sample showed symptoms of major depression and one in four had moderate to severe post-traumatic stress disorder. One in five was in an abusive relationship at the time of the interviews.
In her study, published in Issues in Mental Health Nursing, Bloom concluded that rural health-care providers need to directly introduce the women who might be in trouble with people who can help them.
“Rural health-care providers are such a precious resource,” Bloom said. “They might be the only person that’s really connecting with [a rural, pregnant woman] on a regular basis outside of her family. If she’s assured of privacy and confidentiality and assured that she’s not going to be judged when she tells you what’s happening in her life, clearly women will talk about some really difficult issues.”
Bloom said rural health care providers can help take women to the local WIC department or introduce them to advocates in domestic violence shelters. Follow-ups after the initial introduction are important, too.
"A lot of times, these women had tried to access resources before, but something went awry and they would stop," Bloom said.
Bloom believes rural health care providers should ask the difficult questions that might bring women to share their stressors. “Let women know that health-care settings are a safe place and let them know about the limits of privacy so she knows where her information is going,” Bloom said.
With a grant from the Robert Wood Johnson Foundation, Bloom is currently recruiting pregnant rural women in abusive relationships to help test a new online safety planning resource that could help the women protect themselves and their child. She can be reached at 660-537-4213 or email@example.com.