Prenatal Stress Coping Strategies Predict
Andrea D Clements, Beth A Bailey, & Heather Wright
East Tennessee State University
Abstract Method Method - continued
Findings were largely
During intake history a rural sample of 1312 women Delivery charts were reviewed for 1334 cases, Breastfeeding initiation was determined by the feeding consistent with
admitted for singleton birth were asked “How do you deal representing all singleton deliveries from 1/1/06 through method recorded in the medical chart by newborn nursery expectations. Exercise
with stress?” Stress coping answers were categorized 12/31/08 at a rural Appalachian hospital. Women staff for each infant. We were interested in comparing predicted
into 18 stress coping strategies, which were explored as admitted in the final stages of labor were not asked the women who breastfed at least once during the delivery breastfeeding in
predictors of infant feeding method choice, dichotomized primary question of interest in this study (N=22), bringing stay to those who exclusively bottle fed. previous studies, most
into any breastfeeding or exclusive bottle feeding. Coping the final sample size for this report to 1312. High-risk likely because women
with stress through Prayer/Religion (p = .002), taking a births were transferred to a nearby teaching hospital, thus who exercise are
Bath/Shower (p = .001), Exercise (p = .001), and the sample was of low-obstetric-risk. Data were collected attuned to health
Reading/Writing (p = .001) predicted breastfeeding. via individual chart review by research project staff using promoting activities.
Smoking (p = .003), Resting (p = .03), and “Not Well” (p = a two page study-designed data collection form. Over
.035) predicted that women would not breastfeed. 90% of the deliveries were reviewed by a single
Results Prayer/Religiosity also
examiner, with reliability checks performed early in the We found that four of the 18 coping strategies breastfeeding initiation
process. significantly predicted breastfeeding initiation: as hypothesized. This
Prayer/Religion (χ2 = 9.52, p = .002), Bath/Shower (χ2 = adds to the wealth
All women were asked the following open-ended question
10.67, p = .001), Exercise (χ2 = 10.27, p = .001), and of studies which report a positive relationship between
by the intake nurse when they arrived for delivery:
Reading/Writing (χ2 = 4.88, p = .001). Three coping aspects of religiosity and health/health behaviors. Smokers
Introduction “How do you deal with stress?” strategies predicted exclusive bottle feeding: Smoking (χ2 are known to breastfeed at a lower rate than non-smokers.
= 8.74, p = .003), Resting (χ2 = 4.63, p = .03), and This is the first report to our knowledge showing that
Despite a recent trend toward increased breastfeeding, No response choices were offered and responses were
reporting “Not Well” when asked how they cope with bathing/showering and reading as a coping strategy
the six lowest rates of initiation are in southeastern states recorded verbatim. For the first 300 exactly what was
stress (χ2 = 4.43, p = .035). positively predict breastfeeding and that resting negatively
(KY, TN, WV, MS, LA, AL) with an average initiation rate written in the chart was recorded, with qualitative
of 52%. This discrepancy (adjusted odds of not being methodology used to combine responses into 18 distinct predicts breastfeeding.
breastfed 2.5-5.15 times greater in southeastern states) and meaningful categories. These categories allowed for
exists even after controlling for sociodemographic factors. classification of all responses from the first 300 cases,
and were then used to record responses dichotomously
The benefits of breastfeeding for maternal and child
for the next 200 cases. At the end of those 200 cases it
health have been well documented. Research has
revealed many factors related to breastfeeding initiation
was clear that the categories included all possible Implications
responses seen, and were subsequently used as
including maternal age, level of education, and smoking. As hypothesized, positive coping strategies were, for the
designed for the remainder of the data collection.
Findings regarding other associated factors such as race most part, predictive of breastfeeding initiation. Smokers
and health of the neonate are less consistent across Final stress coping strategies. and women low in positive stress coping strategies could
studies. be targeted for specific breastfeeding encouragement . It
The current study evaluated the ability of stress coping is not known whether changes in coping strategies would
strategies to predict breastfeeding initiation in a sample of influence breastfeeding behavior but this is a potential
women from rural Southern Appalachia with low rates of area for future investigation.
breastfeeding. To date, no published studies have Contact:
explored the link between methods of coping with stress
prenatally and breastfeeding, so there was little to inform Andrea D Clements, PhD
predictions. However, we do know that positive coping Department of Psychology
techniques have been associated with positive health East Tennessee State University
behaviors, while negative techniques predict negative Johnson City, Tennessee 37614
behaviors. In addition, certain religious groups have been firstname.lastname@example.org
found to have high rates of breastfeeding, and maternal
religiosity was specifically of interest for this reason and
given the known associations between religiosity and
Coping Strategies Associated with Breastfeeding Initiation.
* p < .05, ** p < .01
Funding for this research was Provided by the Tennessee
Governor’s Office on Children’s Care Coordination.
*Empirically supported coping strategies.