The Impact of a Holistic Care Program for High-Risk Pregnancies on Stress and Mental Health

Introduction: The presence of increased health risks or complications for either the mother, the fetus, or both during pregnancy or childbirth is referred to as high-risk pregnancy. Visual and socially enriched individualized educational programs for high-risk pregnancies are emerging as an essential component of providing holistic care that addresses medical and emotional needs. These educational programs aim to reduce stress and uncertainty that pregnant women may encounter during the perinatal period by helping them better understand their health conditions and the baby's condition. It is believed that individualized education provided to high-risk pregnant women receiving care in perinatology clinics can strengthen their stress-coping mechanisms and allow them to respond more effectively to emotional needs during this period.

Objective: This study aims to evaluate the effects of a holistic care program on the stress levels and mental health of high-risk pregnant women. In this context, the study seeks to explore the program's potential to enhance stress-coping mechanisms, positively influence mental health, and increase overall health awareness among high-risk pregnant women.

Methods: The study was conducted as a randomized controlled trial in the pregnancy follow-up outpatient clinic of a maternity hospital in Istanbul between April 1, 2024, and December 31, 2024. A total of 100 pregnant women were included in the study and randomly assigned to one of two groups:

Intervention Group: 50 participants Control Group: 50 participants Data were collected at two time points: a pre-test on the first day of group assignment and a post-test on the day of discharge. Research data were gathered through face-to-face interviews using five forms: Informed Consent Form, Demographic Information Form, Perceived Stress Scale for High-Risk Pregnancies Based on Neuman Systems Model, Brief Symptom Inventory, and Holistic Care Program Evaluation Form for High-Risk Pregnancies.

The intervention group received midwifery counseling and care accompanied by the Holistic Care Program for High-Risk Pregnancies. The control group received only the standard midwifery care provided by the clinic.

Intervention Group Applications: High-risk pregnant women admitted to the perinatology clinic and assigned to the intervention group participated in a Holistic Care Program for High-Risk Pregnancies in addition to the midwifery care provided at the clinic. The implementation of the program involved two phases: preparation and application.

Preparation Phase: The content of the Holistic Care Program for High-Risk Pregnancies, shaped by Neuman's Systems Model, was developed. Existing childbirth preparation programs and topics essential to high-risk pregnancy counseling were considered. Experts, including childbirth preparation instructors and academic midwifery professionals (2 Professors, 3 Associate Professors, 3 Assistant Professors, 2 Research Assistants, and 1 Lecturer), reviewed the program, and modifications were made based on their recommendations.

Application Phase: After finalizing the program content, the education sessions were scheduled. Sessions were held in a dedicated clinical space, taking into account clinical conditions, working schedules, and the treatment hours of the participants. The total program duration was planned for 6 hours and 15 minutes, delivered across three sessions and six meetings.

Session 1: Group education focused on physiological information and preparation from high-risk pregnancy to childbirth. This 2-hour session, conducted in two meetings, covered physiological aspects, body structures, and functions.

Session 2: Individual education focused on psychological support and preparation, aiming to enhance emotional resilience during pregnancy. This 2-hour session, conducted in two meetings, addressed psychological, sociocultural, and spiritual aspects of life.

Session 3: Group education titled "The Compassion of Hands: Bonding and Relaxation Techniques During Pregnancy" was conducted as a 2-hour and 15-minute session. This session focused on spiritual and emotional aspects, emphasizing bonding between the pregnant woman and her baby.

Control Group Applications: Routine midwifery care procedures followed in the perinatology clinic were applied to the control group.

Data Analysis: Data were analyzed using SPSS (Statistical Package for Social Sciences) for Windows 25.0. Descriptive statistical analyses (frequency, percentage, minimum-maximum values, median, mean, and standard deviation) were employed. The suitability of data for normal distribution was tested using Kolmogorov-Smirnov and Shapiro-Wilk tests.

Inclusion criteria

• Being willing to participate in the study and over the age of 18,
• Ability to understand and speak Turkish,
• Being a primiparous woman,
• Being in the third trimester of pregnancy.
• Being hospitalized in the perinatology ward and receiving care for at least 3 days
• Having at least one diagnosed high-risk pregnancy condition

Exclusion criteria

• Not willing to participate in the study
• Presence of a fetal anomaly
• Risk of fetal loss
• Having previously received childbirth preparation education