Pregnancy, high risk pregnancy, and prenatal care are documented stressors for most pregnant women and their families. These stressors have the potential to evoke physiological and psychological responses that may have a negative effect on pregnancy outcome, such as preterm birth. For many pregnant women, attending prenatal care includes problems such as transportation difficulties, child care problems, cultural differences, lack of providers in some geographical areas, overcrowded waiting rooms, long waits to see the provider, inconvenient appointment hours, and significant personal out-of- pocket costs. One alternative to the high risk pregnant woman having to travel freguently to the provider site and interrupt bedrest is to deliver prenatal care services in the home by advanced practice nurses.
The specific aim of this proposed study is to compare the differences in physiological stress responses (systolic and diastolic blood pressure, heart rate, and uterine activity) and psychological stress responses (state anxiety, depression, and hostility) in a group of women with high risk pregnancies by examining these responses during routine prenatal care visits in the clinic and during prenatal care visits in the home provided by advanced practice nurses.
