Person-environment interactions shape maternal perceptions of stress and coping during pregnancy and postpartum: a qualitative analysis

Abstract

Maternal stress during pregnancy and postpartum is consistently associated with increased risk for maternal, obstetric, and offspring health complications, highlighting its transdiagnostic relevance for maternal and child health. While stress associated with major life events and trauma (e.g., intimate partner violence) is well-studied, comparatively far less attention has been paid to understanding how routine perinatal demands are experienced within the contextual realities of pregnancy and postpartum and how these experiences shape maternal perceptions of stress and coping across these two distinct yet interrelated periods. Data were obtained from a subset of participants ( n  = 17) enrolled in a larger prospective cohort study. Semi-structured interviews during pregnancy ( n  = 10) and postpartum ( n  = 15) were conducted remotely (i.e., Zoom, phone). Interviews were independently analyzed using inductive thematic analysis, respective to each perinatal period. Resource accessibility emerged as an overarching theme, with five core themes acting as barriers or facilitators to mental well-being. Three resources–social support, logistics, and physical health–were considered influential across both perinatal periods, to varying degrees. When resources were inaccessible during pregnancy, they became barriers to mental well-being, contributing to experiences of loneliness, frustration, worry, an increased mental load, and ultimately, increases in perceived stress. These experiences often intensified postpartum due to unmet expectations of having a higher level of support to manage increases in logistical demands (e.g., domestic labor, caregiving) while simultaneously navigating postpartum recovery and workforce participation. Conversely, with higher resource access, mother’s perceived ability to cope with stress arising from routine perinatal demands, the COVID-19 pandemic, and other logistical responsibilities increased. Findings indicate routine perinatal demands are perceived to shape maternal experiences of stress and coping during pregnancy and postpartum, emphasizing the importance of resource accessibility and contextual determinants in shaping maternal well-being. Future research is needed to build on these findings and highlight the need for multilevel interventions to increase maternal support and resources to manage cumulative perinatal demands, which can ultimately improve health trajectories for women, children, and families.