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●●JOURNAL
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38
Coping with stress by women in early postpartum
(Sposoby radzenia sobie ze stresem kobiet we wczesnym połogu)
M Makara-Studzińska 1,A,D, K Zwierz 2,F, A Madej 1,B,C, A Wdowiak 2,E
Abstract – Introduction. Pregnancy is a special time in the life of
every woman. Regardless of whether having children is a dream
come true or a surprise, it is considered in the context of stressful
situations. The aim of this study is to show the ways of coping
with stress during the postpartum period. Moreover, two separate
groups of women with no symptoms and symptoms of postpartum
depression (PPD) were distinguished.
Materials and methods. The study involved 110 women in early
postpartum aged 20-41, put into the following age groups: 20-24,
25-29, 30-35 and 36-41. All women agreed to fill out an anonymous questionnaire. The research tool used was the authors’ own
questionnaire enriched with the Edinburgh Postnatal Depression
Scale (EPDS). The results were subjected to statistical analysis.
Results. When asked about the preferred styles of coping with
stress, 44 (40%) of respondents answered that they applied the
task-focused style, 43 (39.1%) – the avoidance-focused style, and
23 (20.9%) – the emotion-focused style. By means of the Edinburgh Postnatal Depression Scale, it has been found that 85
(77.3%) of women surveyed show no signs of depression, while
in 25 (22.7%) there is a high probability of its occurrence.
Conclusions:
 The most popular method of coping with stress used by
women during the postpartum period is conversation with a
close person.
 Women who underwent an unplanned Caesarean section are
more likely to develop symptoms of PPD,
 The use of emotion-focused style increases the risk of PPD.
Skalą Depresji Poporodowej (EPDS). Uzyskane wyniki badań
poddano analizie statystycznej.
Wyniki: Na pytanie odnośnie preferowanych stylów radzenia
sobie ze stresem 44 (40%) ankietowanych położnic odpowiedziało, że stosują styl skoncentrowany na zadaniu, 43 (39,1%) wybrało styl skoncentrowany na unikaniu, a 23 (20,9%) styl skoncentrowany na emocjach. Za pomocą Edynburskiej Skali Depresji
Poporodowej ustalono, iż 85 (77,3%) położnic nie wykazuje objawów depresji, z kolei u 25 (22,7%) zachodzi duże prawdopodobieństwo jej występowania.
Wnioski:
 Najczęściej stosowany sposób radzenia sobie ze stresem
kobiet w okresie połogu to rozmowa z bliską osobą,
 Kobiety, u których wykonano nieplanowane cesarskie cięcie wykazują większą tendencję występowania objawów
PPD,
 Stosowanie stylu skoncentrowanego na emocjach zwiększa
ryzyko pojawienia się PPD.
Słowa kluczowe - radzenie sobie ze stresem – połóg – depresja
poporodowa.
Author Affiliations:
1.Department of Applied Psychology, University of Lublin
2.Department of Obstetrics, Gynecology and Nursing Obstetrics
and Gynecology, Medical University of Lublin
Authors’ contributions to the article:
Key words - coping with stress – postpartum – postpartum depression.
Streszczenie – Wstęp. Ciąża to czas szczególny w życiu każdej
kobiety. Niezależnie od tego, czy jest ona spełnieniem marzeń o
posiadaniu potomstwa, czy też zaskoczeniem – rozpatrywana jest
w kontekście sytuacji stresogennej. Celem niniejszej pracy jest
ukazanie sposobów radzenia sobie ze stresem w okresie połogu.
Dodatkowo wyodrębniona została grupa kobiet bez objawów i z
objawami depresji poporodowej (PPD).
Materiał i metody: W badaniu udział wzięło 110 kobiet we wczesnym połogu w wieku 20-41 lat, w grupach 20-24, 25-29, 30-35 i
36-41 lat. Wszystkie badane kobiety wyraziły zgodę na wypełnienie anonimowej ankiety. Narzędzie badawcze stanowił kwestionariusz ankiety własnego autorstwa, wzbogacony Edynburską
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Agata Madej, Department of Applied Psychology, University of
Lublin, W. Chodźki 15 Str.,PL-20-093 Lublin, Poland, e-mail:
[email protected]
Accepted for publication: October 9, 2015.
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I. INTRODUCTION
he role of a woman as a mother is considered to be
natural from the biological point of view. It is a general
belief that taking care of a newborn child should be a
source of joy and satisfaction [1]. Unfortunately, the reality
is in stark contrast to that. Pregnancy is a time of intense
effort for a woman’s body, which results from dynamic
changes in both hormones and the psyche [2]. Concern with
the child’s health appears and relationships with the close
ones may become disturbed. Problems may occur in professional life and self-perception. Sadness and depression
are also likely [2-5] to emerge. The sense of loneliness,
anxiety and the lack of support all result in emotional disorders which may gain intensity in the postpartum period,
even leading to postpartum depression [6-10]. Data provided in literature on the subject proves that the perinatal
period is a time of increased risk of developing anxiety or
depressive disorders which may have an adverse effect on
pregnancy, labour, and postpartum [11]. Childbirth has an
enormous impact on a woman’s body and mind. Contemporary mothers evince a lower resistance to stress and the
effects of emotional problems than women in previous generations. A genetic predisposition to such problems is
presumed to exist for pregnant women whose first-degree
relatives experienced postpartum disorders. They include:
the postpartum blues (25-83%), postpartum depression (1020%), and psychosis (0.1-0.2%) [12-17].
Postpartum is the period of 6-8 weeks following delivery
during which the anatomical, morphologigal, and functional changes related to pregnancy and childbirth retreat and
the woman’s body returns to its non-pregnant state. It begins in the period of delivering a complete placenta and it
is characterised by the highest-ever risk of developing mental disorders in the woman’s lifetime [6, 12, 18]. This is
due to the fact that postpartum mothers are less resistant to
stressful stimuli and more prone to emotional pain [13].
Stress is an indispensable element of every person’s life.
Researchers believe that people should attempt to control
stress and find ways to cope with it [19]. Such methods
alleviate stress and reduce its negative effects. Expecting a
child is interpreted as a difficult situation, especially if it is
the first child, when the parents are minors or elderly, when
pregnancy was unplanned or it occurred before marriage,
when the mother is physically/mentally disabled or when
complications appear in pregnancy and hospitalisation is
necessary. Two types of stress may be distinguished in the
perinatal period:
T
39
 acute – triggered by a sudden and important change,
i.e. childbirth or the baby’s/mother’ illness,
 Chronic – caused by the everyday routine, i.e. a lonely
mother’ care of a child, financial problems [20].
For the majority of women, childbirth and the new role in
life – that of a mother – constitutes a stressful factor and
leads to a considerable emotional burden. Usually, their
well-being depends on their mental state and relationships
with close ones in the perinatal period. Mothers who are
flexible, open to changes, with a good self-esteem, who
plan and reach their goals, communicate effectively with
the environment and have the ability to ask for help, cope
better with the difficulties of motherhood. An additional
burden for young mothers may be the financial situation. In
some sources, also the external resources related to religiousness, cultural heritage, and national tradition are mentioned [13, 20].
The starting point for the discussion on the topic mentioned
in the title is the typology by Endler and Parker, who proposed three styles of coping with stressful situations:
 the task-focused style – the subject takes action to
solve a problem by means of cognitive processing or
by attempting to change the situation,
 the emotion-focused style – it pertains to people tending to focus on their own emotions such as anger, tension, guilt, which leads to wishful thinking and fantasising in difficult situations,
 the avoidance-focused style – it takes two forms: engaging in displacement activities and seeking social
contact [21-24].
II.
MATERIALS AND METHODS
The study involved 110 women in early postpartum aged
20-41 hospitalised from April to June 2014 at the Obstetrics and Perinatology Clinic of the Autonomous Public
Hospital no. 4 in Lublin.
All the women surveyed had been informed about the purpose and rules of the study and subsequently asked to fill
out a questionnaire. Participation was voluntary and anonymous. The diagnostic survey method was used.
The research tool was the authors’ own questionnaire enriched with the Edinburgh Postnatal Depression Scale
(EPDS). The authors’ own questionnaire included demographic questions related to age, civil status, education and
place of residence; there were also questions concerning
child-bearing, the course of pregnancy, the manner of delivery (natural birth or Caesarean section), problems related
to maternity, and the ways of coping with stress triggered
by new responsibilities. The EPDS is a screening question-
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naire composed of 10 simple statements making it possible
to test the level of postpartum depression [25].
In the study group, 15 (13.6%) women were aged 20-24, 33
(30%) women were aged 25-29, 39 (35.5%) were 30-35
years of age and 23 (20.9%) were aged 36-41. For 47
(42.7%) patients, pregnancy ended in vaginal birth, and 63
(57.3%) women had a Caesarean section. In terms of civil
status, 95 (86.4%) patients were married, 12 (10.9%) were
unmarried, and 3 (2.7%) declared being divorced. Elementary education was declared by 1 (0.9%) respondent, vocational education by 5 (4.5%) women, secondary education
by 26 (23.6%), and higher education by 78 (70.9%) women. 23 (20.9%) respondents lived in a city of over 100,000
inhabitants, whereas 25 (22.7%) resided in a city of 25,000
to 100,000 inhabitants, 11 (10%) lived in a town of up to
25,000 residents, and 51 (46.4%) women lived in the country.
Statistical methods
In order to investigate the correlation between the qualitative characteristics, the Chi-Square Independence Test (χ2)
was used.
The significance level of p<0.05 was adopted to indicate
the existence of statistically significant correlations. Statistical analysis was based on IBM SPSS Statistics software
(version 21).
40
Most frequently, the respondents selected conversation
with a close person as a method of coping with stress – 77
(70%). Sleep is preferred by 47 (42.7%) women, a warm
bath by 30 (27.3%), physical activity by 25 (22.7%), and
music therapy was selected by 11 (10%) respondents. The
remaining methods of coping with stress are massage for 9
(8.2%) of the respondents and herbal infusions for 7
(7.3%). It also results from the authors’ own study that 49
(44.5%) of the recent mothers surveyed considered calm
breathing to be an effective method of overcoming stress.
The analysis of results using the Chi-Square test evinced a
statistically significant correlation between the form of
childbirth and the occurrence of postpartum depression.
Women who underwent an unplanned Caesarean section
(due to risk to the child’s life) have a higher (39.3%) tendency towards postpartum depression symptoms than
women who underwent a planned C-section (20%) or gave
natural birth (14.9%). The results are presented in table no.
2.
Table 2. The risk of postpartum depression depending on
the manner of delivery
χ2
ESDP
p
III. RESULTS
Lack of postpartum depression symptoms
Likelihood of
postpartum
depression
symptoms
N
40
7
%
85.1%
14.9%
N
28
7
%
80.0%
20.0%
N
17
11
%
N
60.7%
85
39.3%
25
%
77.3%
22.7%
Manner of delivery
Table 1 presents the analysis of the style of coping with
stressful situations by recent mothers depending on the
manner of delivery. From mothers who gave natural birth,
20 (45.5%) are characterised by a task-focused style, while
12 (52.2%) match the emotion-focused style. Both women
who gave natural birth and those who underwent a planned
Caesarean section used the avoidance-focused style to the
same degree (34.9%). No statistically significant correlation has been found between the variables mentioned.
Natural birth
Planned Caesarean section
Unplanned
Caesarean
section
Total
6.162
p= 0.046
Table 1. The styles of coping with stressful situations by
postpartum mothers depending on the manner of delivery
Manner of delivery
Styles of
coping
with stress
Taskfocused
style
Emotionfocused
style
Avoidancefocused
style
Natural
birth
N
%
N
%
N
%
N
Total
%
20
45.5
%
12
52.2
%
15
34.9
%
47
42.7
%
Planned
Caesarean section
Unplanned
Caesarean
section
16
8
36.4%
18.2%
6
5
26.1%
21.7%
13
15
30.2%
34.9%
35
28
31.8%
25.5%
χ2
p
4.274
p= 0.370
It has been demonstrated that there are no significant correlations between the number of births given by the respondents and the occurrence of postpartum depression. The percentage distribution of women showing symptoms of postpartum depression is similar in each of the groups studied.
Moreover, no correlation has been noted between the women’s age and the frequency of PPD. Taking into account the
recent mothers’ civil status, it may be observed that divorcees evince a higher (66.7%) tendency towards postpar-
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tum depression than married women (22.1%) and unmarried women (16.7%).
Table 3 presents an analysis of the correlation between the
postpartum mothers’ education and the risk of postpartum
depression. PPD symptoms were not observed in women
with elementary and vocational education, yet women with
secondary and higher education experienced PPD with a
similar frequency.
in displacement activities, merely 14% show symptoms of
PPD. In turn, 20.5% of the respondents use the most desirable style of coping with stress – the task-focused style.
Table 4. The influence of the style of coping with stress on
the appearance of PPD symptoms
Table 3. The influence of education on the risk of PPD
symptoms
Lack of postpartum depression
symptoms
Likelihood of
postpartum
depression
symptoms
N
35
9
%
79.5%
20.5%
N
13
10
%
56.5%
43.5%
N
37
6
χ2
p
Education
N
Lack of
postpartum
depression
symptoms
Likelihood
of postpartum depression
symptoms
1
0
Task-focused
style
Elementary
%
100.0%
0.0%
N
5
0
χ2
p
ESDP
Styles of coping with
stress
ESDP
41
Emotionfocused style
7.654
Vocational
%
N
100.0%
20
0.0%
6
Secondary
%
76.9%
23.1%
N
59
19
%
75.6%
24.4%
N
85
25
%
77.3%
22.7%
p= 0.022
Avoidancefocused style
%
86.0%
14.0%
N
85
25
%
77.3%
22.7%
1.885
p= 0.597
Higher
Total
Table 4 presents a statistical analysis of the correlation between the applied style of coping with stress among postpartum mothers and the risk of developing postpartum depression. Postpartum mothers applying the emotionfocused style (43.5%) show a tendency towards depression.
Among women who avoid solving the problem by engaging
Total
When it comes to the correlation between methods of coping with stress and the frequency of PPD symptoms – no
significant correlation may be observed between these variables. Postpartum mothers who have chosen massage, aromatherapy and breathing exercises do not show symptoms
of postpartum depression. The percentage distribution of
women with PPD symptoms in the remaining groups has
been presented in table no. 5.
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IV. DISCUSSION
The main problem discussed in the study is the manners
of coping with stress among women in early postpartum.
The results concerning the preferred styles of coping with
stressful situations have been presented. Also, groups of
women with and without postpartum depression symptoms
have been distinguished.
Based on his own research, Czapiński [26] observed that
the strategies of coping with stress differentiated the level
of mental well-being regardless of the intensity of stress
experienced in life. As a result, individuals following an
active task-oriented strategy had better well-being rates
than individuals who used passive strategies or gave up in
the face of difficulty.
The results presented in this study as well as those obtained
by Podolska et al. [23] have demonstrated that there exists
a correlation between the style of coping with stress preferred by women and the occurrence of postpartum depression symptoms. Postpartum mothers who underwent
Caeserian sections statistically significantly more often
selected the emotion-focused and avoidance-focused styles.
Furthermore, no statistically significant differences have
been observed between women as far as age and education
are concerned. This data overlaps with the results obtained
by Gebuza et al. [12] and Kowalska et al. [2].
There are reports in the literature of the subject pointing to
the factors preventing the use of constructive methods of
coping with stress. This stems from the mother’ sintensified
neuroticism correlating with the experience of negative
emotions such as anxiety, depression as well as the sense of
hopelessness and guilt. The most desirable style would be
that focusing on the task [27]. According to the research by
Kossakowska-Petrycka et al. [3], stress levels are lower in
women with a correct course of pregnancy compared to
women in high-risk pregnancy.
Research by Bączek et al. [28] points to the prevalence of
fatigue (49%) in the group of postpartum mothers studied,
which is a natural state following labour. Depression affected 12% of the female respondents and it mainly resulted from the change in lifestyle and the appearance of new
responsibilities. 39% of the mothers surveyed enjoyed wellbeing. Many authors point to civil status as a predictor of
postpartum depression [24, 26]. Research by Kettunen et
al. [29] has shown that the mental state of recent mothers
ought to be monitored during 6 weeks after labour. Selfobservation is not sufficiently effective. It is also crucial to
inform women about PPD and to discuss the alarming
symptoms so that women may recognise them on their own.
Therefore, two groups of women aged 18-40 were exam
42
ined: the experimental group comprised 104 mothers with
PPD symptoms, whereas the control group comprised 104
women without PPD symptoms. It emerged that 46.2% of
mothers showed symptoms of postpartum depression one
and a half weeks after childbirth, 74% after fourth weeks,
83.7% after six weeks, and 98.1% after three months.
The results of research by Kowalska et al. [2] confirm the
thesis that the recent mother’s civil status has an influence
on the postpartum stress levels. The best average wellbeing and the lowest average stress levels were experienced
by patients in a relationship, and the worst well-being and
highest stress levels affected lonely mothers.
Guardino et al. [30] have found that women applying the
avoidance-focused style are in the group with risk of developing postpartum depression symptoms. From 306 women
examined by them, who had given birth to their first child,
those who avoided confrontation with difficult situations in
the last trimester of pregnancy exposed themselves to the
risk of PPD symptoms in the sixth week following labour.
V. CONCLUSIONS



The diagnosis of styles of coping with stress should
take place as early as possible because it allows
choosing the best course of action having a positive influence on the emotional state of women in
the difficult period of pregnancy and postpartum.
Continuous education about the postpartum period
is necessary and it provides the woman with useful
knowledge and competences relating to her new
life situation.
It is crucial that pregnant women and mothers in the
postpartum period should be offered contact with
medical peronnel in the form of individual consultation or lectures organised for larger groups of
women interested in the subject.
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