Social Support through Pregnancy and The Link with Health Outcomes

While considering the physical and mental health of mothers during and following the rollercoaster-like journey of pregnancy, we make many considerations - regular health checkups, minimal physical exertion, adequate nutrition, abstinence from substances, mental health care and counselling services, the right medications, and so on. However, most such lists often exclude an extremely important factor that bears a very significant impact on the (physical and mental) health outcomes of the mother and the infant - social support.

Social support refers to communicating to an individual that they are “loved, cared for, esteemed, valued and belongs to a mutually obliging communication network” (Callaghan, & Morrissey, 1993). An overwhelming amount of research in Psychology spanning many decades has conclusively shown the critical importance of social support in the general population - social support has been shown to be able to maintain adequate health and protect against the harmful effects of environmental and social stresses. Social support correlates to better physical and mental health, as well longer and more fulfilled lives (Callaghan, & Morrissey, 1993).

In the specific context of pregnancy too, social support has been well-explored in research and its benefits have been documented. Social support can be delivered formally - through social support intervention programs provided by midwives or nurses (few such programs currently exist in India), or informally by family members and friends. Social support provided during pregnancy can be classed into three - tangible support (monetary support, or other tangible goods, helping out with various services), informational support (actual advice, suggestions, or guidance), and emotional support (active listening, empathy, reassurance, love, trust). All three types of social support have been shown to be important to pregnancy, but have different effects and impact diverse outcomes (Dunkel-Schetter, Sagrestano, Feldman, & Killingsworth, 1996).

Studies have documented that social support can act as a buffer for life stresses faced by pregnant women (Hoffman, & Hatch, 1996). What this means, essentially, is that expectant women who experience adverse life stressors like the death or illness of loved ones or financial or other troubled life circumstances may be able to overcome their negative effects and prevent them from impacting the foetus, if they have adequate social support. Not only does the presence of social support lead to favourable outcomes, but its absence may lead to certain harmful effects. For instance, the lack of social support has been found to be a risk factor for the development of postpartum depression (Hung, & Chung, 2001).

One study of 509 expectant mothers from socially disadvantaged groups empirically measured how social support would make a difference to health outcomes. At random assignment, some of these women received formal social support from midwives, while others did not. The results of the study were remarkable! It was found that babies of mothers who received social support had fewer hospital admissions of mothers during pregnancy, greater number of normal deliveries with lesser use of epidural anaesthesia. The positive effects extended to the infants too - the infants of mothers who received social support had higher mean birthweights, required less invasive methods for resuscitation and less intensive and special neonatal care, and were more healthy (Oakley, Rajan, & Grant, 1990).

As the discussion brings to light, social support appears to be a key component of a successful pregnancy for both the mother and the infant. While the the positive benefits conferred by formal and informal social support may vary based on the source, quality and quantity, the positive benefits persist regardless. Hence, it is important to consciously identify and explore ways in which we can do better - both in medical and non-medical settings - to provide expectant mothers with social support in different ways. Like in many parts of the world, assessing for maternal social support must be made a routine part of clinical care for expectant mothers, and availability and quality of social support systems must be greatly increased.

References:

1. Callaghan, P., & Morrissey, J. (1993). Social support and health: a review. Journal of Advanced Nursing, 18(2), 203–210. doi:10.1046/j.1365-2648.1993.18020203.x

2. Dunkel-Schetter, C., Sagrestano, L. M., Feldman, P., & Killingsworth, C. (1996). Social Support and Pregnancy. Handbook of Social Support and the Family, 375–412. doi:10.1007/978-1-4899-1388-3_16

3. Hoffman, S., & Hatch, M. C. (1996). Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatric and Perinatal Epidemiology, 10(4), 380–405. doi:10.1111/j.1365-3016.1996.tb00063.x

4. Hung, C.-H., & Chung, H.-H. (2001). The effects of postpartum stress and social support on postpartum women’s health status. Journal of Advanced Nursing, 36(5), 676–684. doi:10.1046/j.1365-2648.2001.02032.x

5. Oakley, A., Rajan, L., & Grant, A. (1990). Social support and pregnancy outcome. BJOG: An International Journal of Obstetrics and Gynaecology, 97(2), 155–162. doi:10.1111/j.1471-0528.1990.tb01741.x

6. Webster, J., Linnane, J. W. J., Dibley, L. M., Hinson, J. K., Starrenburg, S. E., & Roberts, J. A. (2000). Measuring Social Support in Pregnancy: Can It Be Simple and Meaningful? Birth, 27(2), 97–101. doi:10.1046/j.1523-536x.2000.00097.x