Maternal Stress: Not Just a Mental Illness, but Also a Health Hazard

Maternal Stress: Not Just a Mental Illness, but Also a Health Hazard | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal Stress: Not Just a Mental Illness, but Also a Health Hazard Bohdana Dušová, Jana Chromá, Kateřina Greplová, Hana Poláková This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4411646/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Postpartum stress is a common phenomenon experienced by many mothers. It can manifest itself in various symptoms such as fatigue, irritability, insomnia, anxiety, depression and fear. In severe cases, it can lead to the development of postnatal psychosis. The objective of this study is to identify and assess the subjective perception of postpartum maternal stress in relation to selected socio-demographic characteristics and to determine the association between subjectively perceived maternal postpartum stress and midwifery care. Methodology: The study population consisted of 200 respondents who had given birth to one healthy child and their postpartum period was in the range of six months. The study was conducted in a pediatrician (referred to as a ‘general practitioner for children and adolescents’ in the Czech Republic) outpatient offices, May 2022 to January 2023. The survey utilized the standardized Maternal Postpartum Stress Scale (MPSS) questionnaire, which was supplemented with socio-demographic data and information on whether midwifery care had been provided. Results The study participants had an overall mean score of postpartum stress 32.7. The stress scores for each subscale were as follows: 15 for personal needs and fatigue of the mother, 9.9 for infant nurturing, and 7.8 for body changes and sexuality. The study found a statistically significant relationship between the number of births and body changes and sexuality (p = 0.0097). Statistical significance level 5%. However, no statistically significant effects of sociodemographic parameters or midwifery care were found in the study population. Conclusion In the study population, overall postpartum stress was mild to moderate. Sociodemographic parameters and midwife care did not have a statistically significant effect on subjective perception of maternal postpartum stress. Research shows that mothers who have had more than one birth are more prone to experiencing stress in terms of body changes and sexuality after childbirth. It is therefore important to give these mothers extra attention and offer them support and help to cope with these challenging changes stress maternity postpartum mothers stress scale questionnaire INTRODUCTION Motherhood is an unpredictable shift in a mother's life into areas that are completely unfamiliar to her and therefore often very stressful. Stress is one of the most unpleasant and exhausting experiences in everyone's life. Motherhood, especially its beginning, is stress-laden. Maternal stress is a chronic psychosocial stress. Situations that trigger this stress include unrealistic cultural expectations, the increasing demands of a complicated society and the lack of social recognition of the role of the mother. Each mother copes with maternal stress individually. Different reactions are often genetically influenced. The prevalence of reactions is reasonable and mild, yet the body secretes and keeps stress hormone levels elevated, which can cause physical and psychological difficulties [ 1 ]. Stressors come and go again over time. The course of the sextuplet plays a significant role in the experience of stress for the later stages of motherhood. During this period, a good psychological adjustment of the mother and support from the environment are important (Cerna 2019, p. 58). Social support, especially from the partner, acts as an important protective factor against the negative effects of stress. Maternal age is one factor that may play a role in the experience of stress. There are different opinions as to the appropriate age for mothers. In Czech Republic, younger mothers under the age of thirty-five are better able to integrate their children into their lives and are able to provide them with a more creative and empathetic environment, although often with less material support. On the other hand, older mothers are more stable socially and health-wise and have a more positive relationship with their children. Younger mothers see motherhood as a natural part of their lives, while older mothers plan and anticipate it. [ 2 ]. Other factors that influence mothers and may affect their experience of stress include education, support from a midwife, or whether they planned their pregnancy. Research on maternal stress examines whether these factors influence the occurrence of maternal stress in any way. As research on maternal stress continues to be ongoing and new associations between individual factors and the experience of stress continue to emerge, our research objective was to investigate subjective perceptions of maternal stress after childbirth with respect to selected sociodemographic characteristics, such as age, education, parity, and marital status. Another aim was to determine the perception of maternal stress in the use of midwifery care. METHODS Study design, setting, and participants Quantitative study design, descriptive study. The survey sample consisted of 200 mothers. Participation in the survey was voluntary. The respondents were mothers of infants who attended district pediatrician outpatient offices in Czech Republic, because mothers come to see their pediatrician more often than their gynecologist for a check-up with their child. In order to ensure accurate data collection intervals according to the established criteria. Mothers completed the questionnaire set in the outpatient clinic of a general practitioner for children and adolescents to ensure the highest possible return of the questionnaires. The inclusion criteria were full-term pregnancy, single gestation, six months postpartum. Exclusion criteria: mothers of second and multiple births, non-communicating in Czech language. Study recruitment and ethical considerations Data were collected in two outpatient clinics of district paediatricians. From May 2022 to January 2023 in the Czech Republic. Mothers were divided into two groups: without midwife support and with midwife support, i.e. a minimum of 3 midwife visits in the mother's home environment. The Committee for Ethics in Research approved this study. Research was conducted in accordance with the Declaration of Helsinki. All ethical aspects (informed consent, confidentiality, data privacy, and instructions) related to research with human beings were respected. The permission of the study participants was granted by signing the Free and Informed Consent Term (TCLE). Study variables and procedures for collecting the data For data collection, a structured form was developed by the researchers that included sociodemographic data, clinical and obstetric variables and standardized Maternal Postpartum Stress Scale (MPSS) questionnaire [ 3 ], due to its excellent psychometric properties compared to other scales assessing maternal postpartum stress. The scale included 22 items that evaluated factors in the lives of postpartum mothers. These factors were evaluated on a 5-point Likert scale where 0 indicated very low or no stress, 1 indicated below average stress, 2 indicated average stress, 3 indicated above average stress, and 4 indicated very high stress. The authors established three subscales to evaluate maternal postpartum stress in the individual items under investigation. Each subscale included items with similar meanings. The Personal Needs and Fatigue subscale assessed lack of time for personal needs and socialization, fatigue, and household chores. The Infant Nurturing subscale evaluated the infant's health, needs, and nurturing. The Body Changes and Sexuality subscale assessed mothers's satisfaction of sexual needs and their own perceptions of body changes after childbirth. Statistical analysis The collected data were coded using Microsoft Excel™. Descriptive statistical analysis was performed on absolute and relative numbers for categorical variables. The values from the questionnaires did not have a normal distribution. Thus, parametric tests were not used. For this reason, the Kruskall-Wallis and Wilcoxon tests were chosen for these calculations, with all tests examined at a significance level of p = 0.05. RESULTS The age group with the highest number of respondents was mothers aged 31 to 40, with 105 participants (52.5%). The second largest age group was mothers aged 20 to 30, with 71 respondents (35.5%). The remaining age groups were less represented, with 16 respondents (8%) over 40 years old and 8 respondents (4%) under 20 years old. In terms of education, the majority of respondents held a university degree (75 respondents, 37.5%), followed by those with upper secondary education with a school leaving certificate (66 respondents, 33%). The group consisting of 28 mothers with upper secondary education without a school leaving certificate was the third largest (14%). The group with the fourth largest number of individuals consisted of 22 mothers who had completed post-secondary vocational education, accounting for 11% of the total. The group with the smallest number of participants consisted of 9 mothers who had completed lower secondary education, comprising 4.5% of the total sample. In the survey population, the largest group consisted of 94 biparous mothers (47%), followed by 90 uniparous mothers (45%). Fifteen triparous mothers (7.5%) comprised a much smaller group, while only one mother (0.5%) had more than three deliveries. Out of the total of 200 mothers surveyed, 124 respondents (62%) gave birth naturally, i.e., per vaginam. 62 respondents (31%) underwent cesarean section, either planned or acute, 11 mothers (5.5%) underwent forceps delivery, and 3 mothers (1.5%) underwent vacuum extraction (hereinafter VEX). The survey also asked about the use of midwifery care by mothers. Among the respondents, the largest group with 142 participants (71%) did not receive midwifery care. In the puerperium period, 29 respondents (14.5%) received midwifery care, more than the 20 respondents (10%) who received midwifery care during pregnancy. Three mothers (1.5%) received midwifery care during both pregnancy and the puerperium, while additional 6 mothers (3%) continued to receive care until the time of the survey. The majority of mothers in the survey sample, 186 (93%), lived with a partner in either a married or partnered relationship, while 14 mothers (7%) lived without a partner. Out of the 200 mothers surveyed, 130 respondents (65%) had planned their pregnancy, while the remaining 70 respondents (35%) had unplanned pregnancies but eventually accepted them, as indicated by their giving birth. Experiencing Maternal Stress Table 1 presents the stress level evaluation for each item and subscale of the questionnaire. The overall results for each subscale show that mothers experienced the most stress in matters related to personal needs and fatigue (14.95), followed by infant nurturing (9.90). The subscale that combined items assessing body changes and sexuality was found to be the least stressful (7.84) (see Table 1 ). Table 1 Assessment of maternal stress according to the Maternal Postpartum Stress Scale MPSS in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N = 200). Maternal stress Average SD P1. Choosing the appropriate way of feeding the baby (breastfeeding or formula) 1.01 0.97 P2. Baby's irregular feeding pattern 1.15 0.88 P3. Insufficient milk supply when breastfeeding 1.33 1.15 P4. Baby's development 1.25 0.98 Maternal stress Average SD P5. Baby's health problems 1.58 1.13 P6. Recognizing the baby's needs 1.68 1.01 P7. Impossibility to soothe a crying or upset baby 1.91 1.09 P8. Adjustment to frequent wake-ups 1.76 1.03 P9. Baby's irregular patterns of daily sleep 1.60 1.03 P10. My fatigue and exhaustion 2.00 1.13 P11. The amount of the household chores 1.82 1.03 P12. Lack of help with the baby and household chores 1.66 1.18 P13. Being uncertain when to resume intercourse after childbirth 1.17 1.07 P14. Insufficient frequency of sexual intercourse 1.20 1.02 P15. Insufficient enjoyment in sexual intercourse 1.04 0.98 P16. The thought that my partner finds me unattractive 1.46 1.19 P17. The impossibility to return to the pre-pregnancy weight 1.36 1.15 P18. Lack of time for socializing with friends 1.38 1.01 P19. Lack of time for myself 1.71 1.11 P20. Physical appearance after childbirth 1.62 1.13 P21. Impossibility to complain to someone 1.41 1.23 P22. Loneliness at home with the baby 1.64 1.29 Subscale1 : Personal needs and fatigue 14.95 7.31 Subscale2 : Infant nurturing 9.90 4.92 Subscale3 : Body changes and sexuality 7.84 4.71 Sum of all items 32.68 14.49 SD – standard deviation The Influence of Maternal Age on Maternal Stress Incidence The sample of respondents was divided by age into four age groups: under 20 years of age, 20 to 30 years of age, 31 to 40 years of age, and over 40 years of age. The results showed that mothers across all age categories experienced the highest level of stress in the Personal Needs and Fatigue subscale. Among mothers aged over 40, the subscale was rated as the most stressful (6.70), while those aged 31 to 40 considered it the least stressful (4.99). Infant nurturing was considered the most stressful by mothers over 40 years of age (1.70). Body changes and sexuality was again the most stressful for mothers over 40 (3.41). The overall scores indicate a decreasing trend in experiencing stress from the oldest age group (11.81) to the youngest age group (8.94) of mothers. The Influence of Maternal Education on Maternal Stress Incidence The surveyed mothers were divided into five groups based on their level of education. The two largest groups consisted of 75 mothers with a university degree (37.5%) and of 66 mothers with upper secondary education with a school leaving certificate (33%). The other two medium-sized groups consisted of mothers with upper secondary education without a school leaving certificate, comprising 28 respondents (14%), and those with post-secondary vocational education, comprising 22 respondents (11%). The fifth and smallest group consisted of 9 mothers with lower secondary education (4.5%). The subscale Personal Needs and Fatigue was rated as the most stressful by mothers with post-secondary vocational education, with a mean score of 5.34, while the lowest level of stress in this subscale was experienced by mothers with lower secondary education, with a mean score of 4.34. No statistically significant differences were found in the subscale Personal Needs and Fatigue (p ₌ 0.7261). In the Infant Nurturing subscale, mothers with post-secondary vocational education and mothers with upper secondary education without a school leaving certificate experienced almost equal levels of stress, with the highest mean scores of 1.68 and 1.67, respectively. Mothers with lower secondary education experienced again the lowest level of stress, with a mean score of 1.29. There were no statistically significant differences found in the Infant Nurturing subscale (p = 0.1423). In the Body Changes and Sexuality subscale, mothers with upper secondary education without a school leaving certificate experienced the most stress (3.39). The overall scores indicate that mothers with upper secondary education without a school leaving certificate experienced the highest levels of stress (with an overall mean of 10.05). The results showed no statistical significance for the overall scores of stress incidence in relation to mothers's education (p ₌ 0.3380). The Influence of Mode of Delivery on Maternal Stress Incidence The survey participants were divided into four groups based on the mode of delivery they had. Out of the total of 200 respondents, 124 mothers (62%) gave birth naturally, meaning per vaginam. and 62 mothers (31%) delivered their baby via cesarean section, either planned or acute. Two smaller groups consisted of 11 mothers who gave birth to a baby by forceps delivery (5.5%) and 3 mothers who delivered by vacuum extraction (VEX) (1.5%). The two smaller groups were combined to enable statistical evaluation. Only three groups were therefore evaluated and are presented in the tables. Among mothers who delivered by cesarean section, personal needs and fatigue elicited the highest level of stress (4.95), while the lowest stress in this subscale was found in mothers who had VEX or forceps delivery (4.50). There was no statistically significant difference in this subscale (p ₌ 0.6640). In the Infant Nurturing subscale, the highest stress level was found in mothers with VEX or forceps delivery (1.70). Mothers who delivered by natural vaginal delivery experienced the least stress (1.39). However, no statistically significant difference was found in this subscale (p ₌ 0.2965). Mothers who underwent VEX or forceps delivery experienced the highest stress levels in the Body Changes and Sexuality subscale (2.96). This subscale was rated as the least stressful for mothers who delivered naturally by vaginal delivery (2.69). No statistically significant difference was found in this subscale (p ₌ 0.8247). The overall level of stress induced by the mode of delivery was lowest in mothers who delivered by natural vaginal delivery (8.89). A moderate level of stress induced by mode of delivery was found in mothers who delivered by VEX or forceps delivery (9.16). Overall, mothers who delivered by cesarean section experienced the highest level of stress (9.23). There were no statistically significant differences (p ₌ 0.6906) in the overall experience of stress based on the mode of delivery (see Table 2 ). Table 2 Mode of delivery and maternal stress (Kruskal–Wallis) in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N = 200). Maternal stress Mode of delivery N AM SD p Personal needs and fatigue Vaginal delivery 124 4.81 1.12 0.6640 C-section 62 4.95 1.16 VEX + Forceps 14 4.50 1.14 Infant nurturing Vaginal delivery 124 1.39 1.06 0.2965 C-section 62 1.41 1.10 VEX + Forceps 14 1.70 1.01 Body changes and sexuality Vaginal delivery 124 2.69 1.09 0.8247 C-section 62 2.87 1.16 VEX + Forceps 14 2.96 1.03 Overall stress Vaginal delivery 124 8.89 1.11 0.6906 C-section 62 9.23 1.15 VEX + Forceps 14 9.16 1.08 N – absolute frequency, AM – arithmetic mean, SD – standard deviation, p – significance level α = 0.05 The Influence of Number of Deliveries on Maternal Stress Incidence The mothers in the survey sample were divided into four groups based on the number of deliveries. The largest group, comprising 94 mothers (47.0%), had given birth twice (biparous). The second largest group, comprising 90 mothers (45.0%), had given birth once (uniparous). Two smaller groups consisted of 15 mothers (7.5%) who had given birth three times (triparous) and one mother (0.5%) who had given birth more than three times. To enable statistical analysis, the two smallest groups were combined into a single '3 or more' group. In the subscale of Personal Needs and Fatigue, mothers with three or more deliveries reported the highest level of maternal stress (5.65), while uniparous mothers experienced the least amount of stress (4.53). There was no statistically significant difference in this subscale (p ₌ 0.1930). Regarding the Infant Nurturing subscale, mothers with three or more childbirths experienced the highest level of stress (5.65), while biparous mothers rated this subscale as the least stressful (1.33). There was no statistically significant difference in the experience of stress (p ₌ 0.0740). Stress in the subscale Body changes and sexuality was again rated as the highest by mothers with 3 or more deliveries (3.55) and, quite expectedly, stress experienced due to body changes and sexuality was the lowest in the group of uniparous mothers (2.64). The effect of the number of deliveries on body changes and sexuality was statistically significant (p = 0.0097) (see Table 3 ). Table 3 Number of deliveries and maternal stress (Kruskal–Wallis) in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N = 200). Maternal stress Number of deliveries N AM SD p Personal needs and fatigue 1 90 4.53 1.14 0.1930 2 94 4.97 1.12 3 or more 16 5.65 1.08 Infant nurturing 1 90 1.46 1.08 0.0740 2 94 1.33 1.07 3 or more 16 1.69 1.02 Body changes and sexuality 1 90 2.64 1.09 0.0097 2 94 2.96 1.12 3 or more 16 3.55 0.99 Overall stress 1 90 8.63 1.12 0.0877 2 94 9.26 1.12 3 or more 16 10.89 1.04 N – absolute frequency, AM – arithmetic mean, SD – standard deviation, p – significance level α = 0.05 The Influence of Marital Status on Maternal Stress Incidence The sample of respondents was divided into two groups: 186 mothers (93%) in a partnership (with a husband or boyfriend) and 14 mothers (7%) living without a partner. Both groups experienced almost the same level of stress in the subscale Personal Needs and Fatigue, with mothers living without a partner having a slightly worse mean score (4.77). However, the results were not statistically significant (p ₌ 0.4519). In the Infant Nurturing subscale, the mean stress scores were again very balanced, differing by only one hundredth and again with a worse score for mothers living without a partner (1.42). No statistically significant differences were found for the Infant Nurturing subscale (p ₌ 0.7853). The subscale of Body Changes and Sexuality was again found to be more stressful for mothers living without a partner (2.84), but no statistical significance was found for this subscale either (p ₌ 0.1475). Again, the influence of partnership on the experience of maternal stress did not prove to be statistically significant (p ₌ 0.3757). The Influence of Pregnancy Planning on Maternal Stress Incidence The sample of respondents was divided into two groups. The larger group consisted of 130 mothers who planned their pregnancy (75%), and the smaller group consisted of 70 mothers who became pregnant accidentally and did not plan their pregnancy (35%). An unplanned pregnancy is one that a woman did not plan and is not prepared for. It can occur for a variety of reasons, such as unintentional unprotected intercourse, ineffective contraception. Interestingly, the subscales Personal Needs and Fatigue (4.95) and Physical Changes and Sexuality (2.95) showed higher levels of stress among mothers who planned their pregnancy. In contrast, infant nurturing induced more stress in mothers who had unplanned pregnancies (1.46). There were no statistically significant differences in values in any of the evaluated subscales. This suggests that, in general, mothers who had planned their pregnancies (9.29) experienced higher levels of stress than those who did not (8.74). Positive or negative pregnancy planning did not have a statistically significant effect on experiencing maternal stress (p ₌ 0.3042). The Influence of Midwifery Care on Maternal Stress Incidence Mothers who did not receive midwifery support were the most represented in the sample, with 142 respondents (71%). There were 29 respondents (14.5%) who received midwifery care during puerperium and 20 respondents (10%) who received it during pregnancy. In the subscale of Personal Needs and Fatigue, mothers who received midwifery care during pregnancy reported the highest level of stress with a mean score of 5.38. However, there were no statistically significant differences between the two groups (p = 0.5197) in this subscale. Again, in the area of infant care no statistically significant differences in stress levels between the groups in this subscale (p ₌ 0.2239). There was no statistically significant difference in physical changes and sexuality (p₌0.2803). There was no statistically significant significance (p ₌ 0.3117) in the overall score of experiencing stress related to midwifery care. DISCUSSION In contrast to many other countries, in the Czech Republic, the care of pregnant, parturient, and postpartum mothers is provided by a physician. Community-based midwifery care does not receive much support from political parties, health insurance companies, or the professional medical community. The Influence of Maternal Age on Experiencing Stress in Motherhood The survey sample included respondents from all age groups. Statistical data indicates that mothers are becoming mothers at a later age, which can have negative impacts on their health and pregnancy. The increasing age of mothers giving birth is one of the major issues in obstetrics and is present throughout Europe. Expert studies indicate that mothers over the age of 40 are at an increased risk of giving birth to a child with a chromosomal disorder, experiencing a miscarriage, and giving birth before 34 weeks of pregnancy. Therefore, it is recommended that mothers over the age of 40 receive adequate monitoring. According to other research, mothers over the age of 35 are at an increased risk of gestational hypertension and diabetes mellitus, placenta previa and placental abruption, and adverse fetal outcomes such as macrosomia and growth retardation [ 4 ]. In general, older age has a negative impact on the experience of stress, both physically and psychologically [ 5 ]. Mothers over 40 years of age have been found to have the worst experience of stress compared to younger mothers. Research conducted by the authors Radoš, et al. of the questionnaire also does not statistically confirm the influence of age on the experience of stress in motherhood [ 3 ]. The Influence of Maternal Education on Experiencing Stress in Motherhood Education and its effect on experiencing maternal stress was another area that was assessed. Mothers with a university degree were the most represented in the survey sample. One might assume that these mothers would experience maternal stress the worst because of the greater life changes they are facing and also because of concerns about their professional careers either being put on hold completely or slowing down considerably due to motherhood. This may not be the case if the mother and the father of the child arrange to take turns caring for the child after maternity leave. A study conducted in Scotland on a sample of 346 mothers yielded similar results, indicating that mothers with lower and higher education experience higher levels of stress [ 6 ]. In 2019, research was conducted on the experience of stress and the impact of education. The results of the research found a statistical difference - mothers with lower education experience more stress than mothers with higher education [ 7 ]. The Influence of Mode of Delivery on Experiencing Stress in Motherhood In the survey, the majority of mothers gave birth naturally through vaginal delivery. Giving birth naturally has many advantages for both the mother and newborn. It is important for the mother's psyche to actively participate in the birth of her baby and experience maternal bonding from the very beginning. Other benefits of vaginal delivery include shorter hospital stays, lower infection risk, and improved breastfeeding outcomes [ 8 ]. A cesarean section is a surgical procedure that should only be performed when there are acute or pre-planned indications that may harm the health of the mother or newborn if not performed. Like any surgery, a cesarean section carries certain risks for both the mother and the newborn. According to an study conducted in Iran on a sample of 714 mothers, there was no statistically significant difference in stress levels between mothers who had vaginal delivery and those who had a cesarean section [ 9 ]. The lowest total maternal stress experience score, however, was found specifically among mothers who delivered naturally by vaginal delivery. The result was again consistent with the research conducted in Croatia [ 3 ]. The Influence of Number of Births on Experiencing Stress in Motherhood The survey results indicate that mothers who have given birth three or more times experience the highest levels of stress. The number of deliveries was statistically significant in experiencing stress in the subscale related to body changes and sexuality. The recovery of pregnancy and postpartum bodily changes vary greatly among mothers. These changes can have a significant impact on abdominal and pelvic floor muscles. Failure to exercise after delivery can lead to the development of pathologies in these muscle groups. For instance, the rectus abdominis muscles may separate, resulting in diastasis [ 10 ]. Mothers may also experience stress incontinence and pelvic organ prolapse due to pelvic floor pathology [ 11 ]. Appropriate exercises can help prevent these pathologies in postpartum mothers. However, it is important to inform the mother about these exercises, preferably by a midwife in a community setting where she can try them with assistance. In contrast, the Croatian study found significant stress in first-time mothers across all three subscales studied [ 3 ]. The Influence of Marital Status on Experiencing Stress in Motherhood The research found that partnership has a positive effect on maternal stress. This result is predictable if partnership is understood as social support. From a psychological point of view, adequate social support is essential for a mother caring for an infant. Additionally, appropriate social support is the best coping strategy for stress in general [ 6 ]. Support should primarily be provided by the immediate social circle and also by health professionals, such as community midwives [ 11 , 12 ]. International studies have confirmed the positive impact of quality social relationships and good partnering on reducing mothers's stress levels after childbirth, even for as long as one year [ 3 , 13 , 6 ]. The authors' [ 14 , 15 ] study also confirmed that lack of social support was associated with higher levels of stress, as well as symptoms of depressive and post-traumatic stress during and after the postpartum period. The Influence of Pregnancy Planning on Experiencing Stress in Motherhood The final factor assessed for its influence on maternal stress was a mother's decision to plan her pregnancy or leave it to chance. Mothers who became pregnant accidentally and had not planned their pregnancy reported lower overall stress levels. The element of surprise is generally considered a stress-inducing factor. Planning ahead for an event so that an individual can prepare for it reduces stress levels [ 16 , 17 ]. Therefore, this survey outcome is unexpected. It can be assumed that when a mother makes the decision to be a mother, she has the ability to adapt to negative life experiences. The Influence of Midwifery Care on Experiencing Stress in Motherhood The study found that midwife-provided care did not have a statistically significant effect on reducing maternal stress levels. Interventions by midwives may include e.g. antenatal preparation, assistance and support during labour, relaxation techniques (massage, relaxation music) and pain relief, early maternity care (breastfeeding support, newborn care, etc.) Although it was assumed that mothers who received midwifery care would experience less stress than those who did not, this assumption was confirmed but not statistically significant. This may have been due to the fact that the majority of respondents in the study population did not receive midwifery care. The non-use of midwifery care can often be attributed to a lack of awareness regarding a mother's entitlement to such care at any stage of life. Another reason may be the financial inaccessibility of midwifery care. In fact, most community midwives provide care without a contract with a health insurance company, requiring mothers to pay for the care themselves. As many research studies have shown negative birth experiences are associated with posttraumatic stress disorder, disrupted interpersonal relationships, dysfunctional mother-infant bonding [ 18 ], decreased rates of exclusive breastfeeding, and inappropriate use of maternal and newborn care. services [ 19 ], fear of childbirth, and increased desire for elective cesarean section in future pregnancies [ 20 ]. Midwife interventions before, during, and early in materhood are essential for maternal psychological well-being. Research assessing the impact of midwifery care on the experience of stress in early motherhood is still scarce [ 21 ], recommends that the most effective strategies for creating a positive birth experience are maternal support during labour and birth preparedness provided by a competent midwife. Midwifery care can help mothers manage stress and improve their overall mental health in the postpartum period. It is important that mothers have access to quality midwifery care that can provide support and help during this challenging time. Limitations The limitations of this study are low sample size. However, this study provides an interesting insight into this study population. Conclusion Maternal stress is a chronic psychosocial stress that can be that can be induced by various situations, such as unrealistic cultural expectations, the increasing demands of a complicated society, and a lack of social recognition of the role of the mother. Each mother copes with maternal stress individually. The course of the puerperium plays a significant role in the experience of stress in the subsequent phases of motherhood. During this period, it is important for the mother to maintain a positive psychological attitude and receive support from her environment [ 22 ]. Social support, particularly from the partner, can act as a significant protective factor against the negative effects of stress [ 23 ]. Research has shown that there are some factors in maternal stress that have a significant impact on mothers's experience of stress in early motherhood. These factors include maternal age, education, mode of delivery, number of births, marital status and pregnancy planning. Practical implications The research findings suggest some practical implications for the provision of care for mothers in early motherhood. It is important to pay attention to mothers over the age of 40 who are at increased risk of experiencing stress. It is important to support education for mothers about pregnancy and motherhood so that they are better prepared for this life change. It is important to promote natural childbirth, which has many benefits for both mother and newborn. It is important to support mothers who are planning a pregnancy so that they are better prepared for this life change. Recommendations for further research Research could be expanded to assess other factors that may influence mothers's experience of stress in early motherhood. These factors include: A mother's previous experience of caring for a child. The mother's mental health. Social and economic conditions of the family. Declarations The authors have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Data are presented in the main manuscript. Conflict of Interest We are not aware of any conflicts of interest relating to this paper. Funding Statement I declare that the submitted article was not funded by any external institution, grant, or other financial source. Author Contribution 1. Conception of the study and methodology of research - BD + JCH + KG + HP2. Review of the literature - BD + JCH + KG + HP3. Application to Ethical Committee - HP4. Collecting data - HP5. Analysis of data - BD + JCH + KG6. Writing draft of the manuscript - BD + JCH7. Critical analysis of draft of the manuscript - BD + JCH + KG8. Statistical analysis of collected material - BD + JCH + HP9. Interpretation of statistical analysis - BD + JCH +KG10. Technical preparation of the manuscript according journal guidelines - BD + JCH11. Supervision over the research and preparation of the article - BD + JCH Data Availability In order to protect the privacy of study participants, data cannot be shared in an open manner. The data are stored by the authors of the paper. Should further access to the data be required, please contact the corresponding author, Jana Chroma ( [email protected] ). References Thompson T. Mateřství se mi stalo pastí: příběhy matek s depresí . Praha: Portál. 2019. 344 p. ISBN 978-80-262-1547-9. Hřivnová M et al. In time:Kognitivní a afektivní dimenze mladých dospělých ve vztahu k těhotenství a rodičovství . Olomouc: Univerzita Palackého v Olomouci. 2020. [cit. 2023-06-10]. https://doi.org/10.5507/pdf.20.24459196 . Radoš SN, Brekalo M, Matijaš M. Measuring stress after childbirth: development and validation of the Maternal Postpartum Stress Scale. J Reproductive Infant Psychol. 2021;41(1):65–77. https://doi.org/10.1080/02646838.2021.1940897 . [cit. 2023-05-23]. Walker KF, Thorton JG. Advanced maternal age. Obstetrics, Gynaecology & Reproductive Medicine. 2019. 29(9), pp. 259–263. [cit. 2023-04-10]. https://doi.org/10.1016/j.ogrm.2019.06.001 . Ricciotti H, Hye-Chun H. Does stress management become more difficult as you age? In: Health.harvard.edu [online]. 2018. 1.4. [cit. 2023-03-01]. https://www.health.harvard.edu/newsletter_article/does-stress-management-becomemore-difficult-as-you-age . Walker LO, Murry N. Maternal stressors and coping strategies during the extended postpartum period: a retrospective analysis with contemporary implications. Mothers's Health Rep. 2022;3(1):104–14. https://doi.org/10.1089/whr.2021.0134 . [cit. 2023-04-08]. Podroužková N. Stres matek na rodičovské dovolené z návratu do zaměstnání. České Budějovice. Jihočeská univerzita v Českých Budějovicích. Zdravotně sociální fakulta; 2019. PAŘÍZEK A. 2015. Výhody a nevýhody přirozeného porodu a císařského řezu. In: Porodnice.cz [online]. Neuvedeno [cit. 12.3.2023]. Dostupné z: http://www.porodnice.cz/porod-a-z/vyhody-a-nevyhody-prirozeneho-porodu-acisarskeho-rezu . Rajani F, Vaziri F, Yektatalab S, Sharifi N, Mani A, Akbarzadeh M. The correlation between postpartum stress disorder and maternal anxiety in different types of delivery (vaginal and cesarean section). Cent Eur J Nurs Midwifery. 2022;13:707–13. https://doi.org/10.15452/cejnm.2022.13.0014 . [cit. 2023-06-06]. Poděbradská R. 2020. Základy fyzioterapie pro porodní asistentky. In: Procházka, M. Porodní asistence. Praha: Maxdorf, s. 209–220. ISBN 97880-7345-618-4. Studničková M, Dorazilová R. 2020. Kojení . In: Procházka, M. Porodní asistence . Praha: Maxdorf, 2020. 625–650 p. ISBN 978-80-7345-618-4. Ezrová M et al. 2020. Principy péče v porodní asistenci [online]. UNIPA [cit. 16.1.2023]. https://www.unipa.cz/wpcontent/uploads/2019/04/Z%C3%A1kladn%C3%AD-principyp%C3%A9%C4%8De-v-porodn%C3%AD-asistenci_v3.pdf . Hung CH, Lin CJ, Stocker J, Yu CY. Predictors of postpartum stress. J Clin Nurs. 2011;20(5–6):666–74. https://doi.org/10.1111/j.13652702.2010.03555 . [cit. 2023-05-08]. Herbell K. Zauszniewski Stress experiences and mental health of pregnant women: The mediating role of social support Issues. Mental Health Nurs. 2019;40(7):613–20. 10.1080/01612840.2019.1565873 . https://www.tandfonline.com/doi/full/ . Lagdon S, Ross J, Robinson M, Contractor AA, Charak R. Armour. C. Assessing the mediating role of social support in childhood maltreatment and psychopathology among college students in Northern Ireland. Journal of Interpersonal Violence, 36 (3–4) (2021). NP2112-2136NP https://journals.sagepub.com/doi/full/10.1177/0886260518755489?casa_token=BiDUi6NJWaUAAAAA%3Aw-7tYZ5dCOxwJGS2c97pKx2YFpInfJI4UuDpjP7NOjigdJIXsFyJxo7cq9JKef4GRU9OibrB0e7O5g . Ayers S, De Visser R. Psychologie v medicíně. Praha: Grada. 2015. 568 p. ISBN 978-80-247-5230-3. Scott E. What Is Stress? Your Body's Response to a Situation That Requires Attention or Action. In: Verywellmind.com [online]. 7. 11. 2022. [cit.2023-01-05]. https://www.verywellmind.com/stress-andhealth-3145086 . Garthus-Niegel S, von Soest T, Vollrath ME, Eberhard-Gran M. The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health. 2013;16:1–10. 10.1007/s00737-012-0301-3 . Turkstra E, Creedy D, Fenwick J, Buist A, Scuffham P, Gamble J. Health services utilization of women following a traumatic birth. Arch Womens Ment Health. 2015;18:829–32. 10.1007/s00737-014-0495-7 . McKenzie-McHarg K, Ayers S, Ford E, Horsch A, Jomeen J, Sawyer A, Stramrood C, Thomson G, Slade P. Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. J Reprod Infant Psychol. 2015;33:219–37. 10.1080/02646838.2015.1031646 . Taheri M, Takian A, Taghizadeh Z, Jafari N, Sarafraz N. Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions. Reprod Health. 2018;15(1):73. 10.1186/s12978-018-0511-x . PMID: 29720201; PMCID: PMC5932889. Černá J. Mateřský koučink: psychická průprava v těhotenství, během porodu a po něm. Praha: Portál; 2019. 144 p. ISBN 978-80-262-1512-7. Manuel JI, Martinson ML, Bledsoe-Mansori SEA, Bellamy JL. The influence of stress and social support on depressive symptoms in mothers with young children. Soc Sci Med. 2012;75(11):2013–20. https://doi.org/10.1016/j.socscimed.2012.07.034 . [cit. 2023-06-16]. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4411646","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310850516,"identity":"9609db4a-c746-4456-97bd-1b3e721cd191","order_by":0,"name":"Bohdana Dušová","email":"","orcid":"","institution":"University of Ostrava","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bohdana","middleName":"","lastName":"Dušová","suffix":""},{"id":310850517,"identity":"fdcb3a33-fd76-4e57-a611-9c9103bab4c7","order_by":1,"name":"Jana Chromá","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACxgYwdQDMfkCyFmYDUiwDa2GTIEotc/vZgx8Yau7k84sdflbx4c9hBv7+AwQc1pOXLMFw7JnlzNlpZjdnth1mkDhASEtDjoEEY8NhA4PbCWa3eRsOMxhAvYdbS/8b4x8QLenfinmADjNgJuAXxhk5ZlBbcsyYediAWtgIanljZpFw7LCB5OycYsmZbek8EmcIaDHszzG+8aHmsAG/dPrGDx/+WMsRDDHDBiCRgCTAQ8AOBgZ5gipGwSgYBaNgFAAA5JJChoZdzSEAAAAASUVORK5CYII=","orcid":"","institution":"University of Ostrava","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jana","middleName":"","lastName":"Chromá","suffix":""},{"id":310850518,"identity":"5decbd1a-81f8-47c1-a443-3a07766bf01d","order_by":2,"name":"Kateřina Greplová","email":"","orcid":"","institution":"University of Ostrava","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kateřina","middleName":"","lastName":"Greplová","suffix":""},{"id":310850519,"identity":"2d5b0dfb-dee1-43bd-b38b-43c528104c69","order_by":3,"name":"Hana Poláková","email":"","orcid":"","institution":"University of Ostrava","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hana","middleName":"","lastName":"Poláková","suffix":""}],"badges":[],"createdAt":"2024-05-13 08:14:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4411646/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4411646/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67635636,"identity":"a74253de-7712-4bf8-93a9-fddfd4db92d7","added_by":"auto","created_at":"2024-10-28 09:24:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4411646/v1/9120a6d1-828b-4503-9b57-9582b5efcfc9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMaternal Stress: Not Just a Mental Illness, but Also a Health Hazard\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMotherhood is an unpredictable shift in a mother's life into areas that are completely unfamiliar to her and therefore often very stressful. Stress is one of the most unpleasant and exhausting experiences in everyone's life. Motherhood, especially its beginning, is stress-laden. Maternal stress is a chronic psychosocial stress. Situations that trigger this stress include unrealistic cultural expectations, the increasing demands of a complicated society and the lack of social recognition of the role of the mother. Each mother copes with maternal stress individually. Different reactions are often genetically influenced. The prevalence of reactions is reasonable and mild, yet the body secretes and keeps stress hormone levels elevated, which can cause physical and psychological difficulties [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Stressors come and go again over time. The course of the sextuplet plays a significant role in the experience of stress for the later stages of motherhood. During this period, a good psychological adjustment of the mother and support from the environment are important (Cerna 2019, p. 58). Social support, especially from the partner, acts as an important protective factor against the negative effects of stress. Maternal age is one factor that may play a role in the experience of stress. There are different opinions as to the appropriate age for mothers. In Czech Republic, younger mothers under the age of thirty-five are better able to integrate their children into their lives and are able to provide them with a more creative and empathetic environment, although often with less material support. On the other hand, older mothers are more stable socially and health-wise and have a more positive relationship with their children. Younger mothers see motherhood as a natural part of their lives, while older mothers plan and anticipate it. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Other factors that influence mothers and may affect their experience of stress include education, support from a midwife, or whether they planned their pregnancy. Research on maternal stress examines whether these factors influence the occurrence of maternal stress in any way. As research on maternal stress continues to be ongoing and new associations between individual factors and the experience of stress continue to emerge, our research objective was to investigate subjective perceptions of maternal stress after childbirth with respect to selected sociodemographic characteristics, such as age, education, parity, and marital status. Another aim was to determine the perception of maternal stress in the use of midwifery care.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting, and participants\u003c/h2\u003e \u003cp\u003eQuantitative study design, descriptive study. The survey sample consisted of 200 mothers. Participation in the survey was voluntary. The respondents were mothers of infants who attended district pediatrician outpatient offices in Czech Republic, because mothers come to see their pediatrician more often than their gynecologist for a check-up with their child. In order to ensure accurate data collection intervals according to the established criteria. Mothers completed the questionnaire set in the outpatient clinic of a general practitioner for children and adolescents to ensure the highest possible return of the questionnaires. The inclusion criteria were full-term pregnancy, single gestation, six months postpartum. Exclusion criteria: mothers of second and multiple births, non-communicating in Czech language.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy recruitment and ethical considerations\u003c/h2\u003e \u003cp\u003eData were collected in two outpatient clinics of district paediatricians. From May 2022 to January 2023 in the Czech Republic. Mothers were divided into two groups: without midwife support and with midwife support, i.e. a minimum of 3 midwife visits in the mother's home environment. The Committee for Ethics in Research approved this study. Research was conducted in accordance with the Declaration of Helsinki. All ethical aspects (informed consent, confidentiality, data privacy, and instructions) related to research with human beings were respected. The permission of the study participants was granted by signing the Free and Informed Consent Term (TCLE).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables and procedures for collecting the data\u003c/h2\u003e \u003cp\u003eFor data collection, a structured form was developed by the researchers that included sociodemographic data, clinical and obstetric variables and standardized Maternal Postpartum Stress Scale (MPSS) questionnaire [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], due to its excellent psychometric properties compared to other scales assessing maternal postpartum stress. The scale included 22 items that evaluated factors in the lives of postpartum mothers. These factors were evaluated on a 5-point Likert scale where 0 indicated very low or no stress, 1 indicated below average stress, 2 indicated average stress, 3 indicated above average stress, and 4 indicated very high stress. The authors established three subscales to evaluate maternal postpartum stress in the individual items under investigation. Each subscale included items with similar meanings. The Personal Needs and Fatigue subscale assessed lack of time for personal needs and socialization, fatigue, and household chores. The Infant Nurturing subscale evaluated the infant's health, needs, and nurturing. The Body Changes and Sexuality subscale assessed mothers's satisfaction of sexual needs and their own perceptions of body changes after childbirth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected data were coded using Microsoft Excel\u0026trade;. Descriptive statistical analysis was performed on absolute and relative numbers for categorical variables. The values from the questionnaires did not have a normal distribution. Thus, parametric tests were not used. For this reason, the Kruskall-Wallis and Wilcoxon tests were chosen for these calculations, with all tests examined at a significance level of p\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe age group with the highest number of respondents was mothers aged 31 to 40, with 105 participants (52.5%). The second largest age group was mothers aged 20 to 30, with 71 respondents (35.5%). The remaining age groups were less represented, with 16 respondents (8%) over 40 years old and 8 respondents (4%) under 20 years old. In terms of education, the majority of respondents held a university degree (75 respondents, 37.5%), followed by those with upper secondary education with a school leaving certificate (66 respondents, 33%). The group consisting of 28 mothers with upper secondary education without a school leaving certificate was the third largest (14%). The group with the fourth largest number of individuals consisted of 22 mothers who had completed post-secondary vocational education, accounting for 11% of the total. The group with the smallest number of participants consisted of 9 mothers who had completed lower secondary education, comprising 4.5% of the total sample.\u003c/p\u003e \u003cp\u003eIn the survey population, the largest group consisted of 94 biparous mothers (47%), followed by 90 uniparous mothers (45%). Fifteen triparous mothers (7.5%) comprised a much smaller group, while only one mother (0.5%) had more than three deliveries.\u003c/p\u003e \u003cp\u003eOut of the total of 200 mothers surveyed, 124 respondents (62%) gave birth naturally, i.e., per vaginam. 62 respondents (31%) underwent cesarean section, either planned or acute, 11 mothers (5.5%) underwent forceps delivery, and 3 mothers (1.5%) underwent vacuum extraction (hereinafter VEX).\u003c/p\u003e \u003cp\u003eThe survey also asked about the use of midwifery care by mothers. Among the respondents, the largest group with 142 participants (71%) did not receive midwifery care. In the puerperium period, 29 respondents (14.5%) received midwifery care, more than the 20 respondents (10%) who received midwifery care during pregnancy. Three mothers (1.5%) received midwifery care during both pregnancy and the puerperium, while additional 6 mothers (3%) continued to receive care until the time of the survey.\u003c/p\u003e \u003cp\u003eThe majority of mothers in the survey sample, 186 (93%), lived with a partner in either a married or partnered relationship, while 14 mothers (7%) lived without a partner.\u003c/p\u003e \u003cp\u003eOut of the 200 mothers surveyed, 130 respondents (65%) had planned their pregnancy, while the remaining 70 respondents (35%) had unplanned pregnancies but eventually accepted them, as indicated by their giving birth.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExperiencing Maternal Stress\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the stress level evaluation for each item and subscale of the questionnaire. The overall results for each subscale show that mothers experienced the most stress in matters related to personal needs and fatigue (14.95), followed by infant nurturing (9.90). The subscale that combined items assessing body changes and sexuality was found to be the least stressful (7.84) (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssessment of maternal stress according to the Maternal Postpartum Stress Scale MPSS in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N\u0026thinsp;=\u0026thinsp;200).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal stress\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1. Choosing the appropriate way of feeding the baby (breastfeeding or formula)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2. Baby's irregular feeding pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3. Insufficient milk supply when breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4. Baby's development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAverage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5. Baby's health problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6. Recognizing the baby's needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7. Impossibility to soothe a crying or upset baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8. Adjustment to frequent wake-ups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9. Baby's irregular patterns of daily sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10. My fatigue and exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11. The amount of the household chores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP12. Lack of help with the baby and household chores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP13. Being uncertain when to resume intercourse after childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP14. Insufficient frequency of sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP15. Insufficient enjoyment in sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP16. The thought that my partner finds me unattractive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP17. The impossibility to return to the pre-pregnancy weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP18. Lack of time for socializing with friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP19. Lack of time for myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP20. Physical appearance after childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP21. Impossibility to complain to someone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP22. Loneliness at home with the baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubscale1\u003c/b\u003e: Personal needs and fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubscale2\u003c/b\u003e: Infant nurturing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSubscale3\u003c/b\u003e: Body changes and sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSum of all items\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eSD \u0026ndash; standard deviation\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe Influence of Maternal Age on Maternal Stress Incidence\u003c/h3\u003e\n\u003cp\u003eThe sample of respondents was divided by age into four age groups: under 20 years of age, 20 to 30 years of age, 31 to 40 years of age, and over 40 years of age. The results showed that mothers across all age categories experienced the highest level of stress in the Personal Needs and Fatigue subscale. Among mothers aged over 40, the subscale was rated as the most stressful (6.70), while those aged 31 to 40 considered it the least stressful (4.99). Infant nurturing was considered the most stressful by mothers over 40 years of age (1.70). Body changes and sexuality was again the most stressful for mothers over 40 (3.41). The overall scores indicate a decreasing trend in experiencing stress from the oldest age group (11.81) to the youngest age group (8.94) of mothers.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Maternal Education on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eThe surveyed mothers were divided into five groups based on their level of education. The two largest groups consisted of 75 mothers with a university degree (37.5%) and of 66 mothers with upper secondary education with a school leaving certificate (33%). The other two medium-sized groups consisted of mothers with upper secondary education without a school leaving certificate, comprising 28 respondents (14%), and those with post-secondary vocational education, comprising 22 respondents (11%). The fifth and smallest group consisted of 9 mothers with lower secondary education (4.5%). The subscale Personal Needs and Fatigue was rated as the most stressful by mothers with post-secondary vocational education, with a mean score of 5.34, while the lowest level of stress in this subscale was experienced by mothers with lower secondary education, with a mean score of 4.34. No statistically significant differences were found in the subscale Personal Needs and Fatigue (p ₌ 0.7261). In the Infant Nurturing subscale, mothers with post-secondary vocational education and mothers with upper secondary education without a school leaving certificate experienced almost equal levels of stress, with the highest mean scores of 1.68 and 1.67, respectively. Mothers with lower secondary education experienced again the lowest level of stress, with a mean score of 1.29. There were no statistically significant differences found in the Infant Nurturing subscale (p\u0026thinsp;=\u0026thinsp;0.1423). In the Body Changes and Sexuality subscale, mothers with upper secondary education without a school leaving certificate experienced the most stress (3.39). The overall scores indicate that mothers with upper secondary education without a school leaving certificate experienced the highest levels of stress (with an overall mean of 10.05). The results showed no statistical significance for the overall scores of stress incidence in relation to mothers's education (p ₌ 0.3380).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Mode of Delivery on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eThe survey participants were divided into four groups based on the mode of delivery they had. Out of the total of 200 respondents, 124 mothers (62%) gave birth naturally, meaning per vaginam. and 62 mothers (31%) delivered their baby via cesarean section, either planned or acute. Two smaller groups consisted of 11 mothers who gave birth to a baby by forceps delivery (5.5%) and 3 mothers who delivered by vacuum extraction (VEX) (1.5%).\u003c/p\u003e \u003cp\u003eThe two smaller groups were combined to enable statistical evaluation. Only three groups were therefore evaluated and are presented in the tables. Among mothers who delivered by cesarean section, personal needs and fatigue elicited the highest level of stress (4.95), while the lowest stress in this subscale was found in mothers who had VEX or forceps delivery (4.50). There was no statistically significant difference in this subscale (p ₌ 0.6640). In the Infant Nurturing subscale, the highest stress level was found in mothers with VEX or forceps delivery (1.70). Mothers who delivered by natural vaginal delivery experienced the least stress (1.39). However, no statistically significant difference was found in this subscale (p ₌ 0.2965). Mothers who underwent VEX or forceps delivery experienced the highest stress levels in the Body Changes and Sexuality subscale (2.96). This subscale was rated as the least stressful for mothers who delivered naturally by vaginal delivery (2.69). No statistically significant difference was found in this subscale (p ₌ 0.8247). The overall level of stress induced by the mode of delivery was lowest in mothers who delivered by natural vaginal delivery (8.89). A moderate level of stress induced by mode of delivery was found in mothers who delivered by VEX or forceps delivery (9.16). Overall, mothers who delivered by cesarean section experienced the highest level of stress (9.23). There were no statistically significant differences (p ₌ 0.6906) in the overall experience of stress based on the mode of delivery (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMode of delivery and maternal stress (Kruskal\u0026ndash;Wallis) in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N\u0026thinsp;=\u0026thinsp;200).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal stress\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePersonal needs and fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.6640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVEX\u0026thinsp;+\u0026thinsp;Forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInfant nurturing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.2965\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVEX\u0026thinsp;+\u0026thinsp;Forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBody changes and sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.8247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVEX\u0026thinsp;+\u0026thinsp;Forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOverall stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.6906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVEX\u0026thinsp;+\u0026thinsp;Forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eN \u0026ndash; absolute frequency, AM \u0026ndash; arithmetic mean, SD \u0026ndash; standard deviation, p \u0026ndash; significance level α\u0026thinsp;=\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Number of Deliveries on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eThe mothers in the survey sample were divided into four groups based on the number of deliveries. The largest group, comprising 94 mothers (47.0%), had given birth twice (biparous). The second largest group, comprising 90 mothers (45.0%), had given birth once (uniparous). Two smaller groups consisted of 15 mothers (7.5%) who had given birth three times (triparous) and one mother (0.5%) who had given birth more than three times. To enable statistical analysis, the two smallest groups were combined into a single '3 or more' group. In the subscale of Personal Needs and Fatigue, mothers with three or more deliveries reported the highest level of maternal stress (5.65), while uniparous mothers experienced the least amount of stress (4.53). There was no statistically significant difference in this subscale (p ₌ 0.1930). Regarding the Infant Nurturing subscale, mothers with three or more childbirths experienced the highest level of stress (5.65), while biparous mothers rated this subscale as the least stressful (1.33). There was no statistically significant difference in the experience of stress (p ₌ 0.0740). Stress in the subscale Body changes and sexuality was again rated as the highest by mothers with 3 or more deliveries (3.55) and, quite expectedly, stress experienced due to body changes and sexuality was the lowest in the group of uniparous mothers (2.64). The effect of the number of deliveries on body changes and sexuality was statistically significant (p\u0026thinsp;=\u0026thinsp;0.0097) (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of deliveries and maternal stress (Kruskal\u0026ndash;Wallis) in a quantitative, descriptive study of first-time mothers six months postpartum. From May 2022 to January 2023 in the Czech Republic (N\u0026thinsp;=\u0026thinsp;200).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal stress\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of deliveries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePersonal needs and fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.1930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInfant nurturing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.0740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBody changes and sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.0097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOverall stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.0877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eN \u0026ndash; absolute frequency, AM \u0026ndash; arithmetic mean, SD \u0026ndash; standard deviation, p \u0026ndash; significance level α\u0026thinsp;=\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Marital Status on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eThe sample of respondents was divided into two groups: 186 mothers (93%) in a partnership (with a husband or boyfriend) and 14 mothers (7%) living without a partner. Both groups experienced almost the same level of stress in the subscale Personal Needs and Fatigue, with mothers living without a partner having a slightly worse mean score (4.77). However, the results were not statistically significant (p ₌ 0.4519). In the Infant Nurturing subscale, the mean stress scores were again very balanced, differing by only one hundredth and again with a worse score for mothers living without a partner (1.42). No statistically significant differences were found for the Infant Nurturing subscale (p ₌ 0.7853). The subscale of Body Changes and Sexuality was again found to be more stressful for mothers living without a partner (2.84), but no statistical significance was found for this subscale either (p ₌ 0.1475). Again, the influence of partnership on the experience of maternal stress did not prove to be statistically significant (p ₌ 0.3757).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Pregnancy Planning on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eThe sample of respondents was divided into two groups. The larger group consisted of 130 mothers who planned their pregnancy (75%), and the smaller group consisted of 70 mothers who became pregnant accidentally and did not plan their pregnancy (35%). An unplanned pregnancy is one that a woman did not plan and is not prepared for. It can occur for a variety of reasons, such as unintentional unprotected intercourse, ineffective contraception. Interestingly, the subscales Personal Needs and Fatigue (4.95) and Physical Changes and Sexuality (2.95) showed higher levels of stress among mothers who planned their pregnancy. In contrast, infant nurturing induced more stress in mothers who had unplanned pregnancies (1.46). There were no statistically significant differences in values in any of the evaluated subscales. This suggests that, in general, mothers who had planned their pregnancies (9.29) experienced higher levels of stress than those who did not (8.74). Positive or negative pregnancy planning did not have a statistically significant effect on experiencing maternal stress (p ₌ 0.3042).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Midwifery Care on Maternal Stress Incidence\u003c/h2\u003e \u003cp\u003eMothers who did not receive midwifery support were the most represented in the sample, with 142 respondents (71%). There were 29 respondents (14.5%) who received midwifery care during puerperium and 20 respondents (10%) who received it during pregnancy. In the subscale of Personal Needs and Fatigue, mothers who received midwifery care during pregnancy reported the highest level of stress with a mean score of 5.38. However, there were no statistically significant differences between the two groups (p\u0026thinsp;=\u0026thinsp;0.5197) in this subscale. Again, in the area of infant care no statistically significant differences in stress levels between the groups in this subscale (p ₌ 0.2239). There was no statistically significant difference in physical changes and sexuality (p₌0.2803). There was no statistically significant significance (p ₌ 0.3117) in the overall score of experiencing stress related to midwifery care.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn contrast to many other countries, in the Czech Republic, the care of pregnant, parturient, and postpartum mothers is provided by a physician. Community-based midwifery care does not receive much support from political parties, health insurance companies, or the professional medical community.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Maternal Age on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eThe survey sample included respondents from all age groups. Statistical data indicates that mothers are becoming mothers at a later age, which can have negative impacts on their health and pregnancy. The increasing age of mothers giving birth is one of the major issues in obstetrics and is present throughout Europe. Expert studies indicate that mothers over the age of 40 are at an increased risk of giving birth to a child with a chromosomal disorder, experiencing a miscarriage, and giving birth before 34 weeks of pregnancy. Therefore, it is recommended that mothers over the age of 40 receive adequate monitoring. According to other research, mothers over the age of 35 are at an increased risk of gestational hypertension and diabetes mellitus, placenta previa and placental abruption, and adverse fetal outcomes such as macrosomia and growth retardation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In general, older age has a negative impact on the experience of stress, both physically and psychologically [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Mothers over 40 years of age have been found to have the worst experience of stress compared to younger mothers. Research conducted by the authors Radoš, et al. of the questionnaire also does not statistically confirm the influence of age on the experience of stress in motherhood [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Maternal Education on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eEducation and its effect on experiencing maternal stress was another area that was assessed. Mothers with a university degree were the most represented in the survey sample. One might assume that these mothers would experience maternal stress the worst because of the greater life changes they are facing and also because of concerns about their professional careers either being put on hold completely or slowing down considerably due to motherhood. This may not be the case if the mother and the father of the child arrange to take turns caring for the child after maternity leave. A study conducted in Scotland on a sample of 346 mothers yielded similar results, indicating that mothers with lower and higher education experience higher levels of stress [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In 2019, research was conducted on the experience of stress and the impact of education. The results of the research found a statistical difference - mothers with lower education experience more stress than mothers with higher education [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Mode of Delivery on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eIn the survey, the majority of mothers gave birth naturally through vaginal delivery. Giving birth naturally has many advantages for both the mother and newborn. It is important for the mother's psyche to actively participate in the birth of her baby and experience maternal bonding from the very beginning. Other benefits of vaginal delivery include shorter hospital stays, lower infection risk, and improved breastfeeding outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A cesarean section is a surgical procedure that should only be performed when there are acute or pre-planned indications that may harm the health of the mother or newborn if not performed. Like any surgery, a cesarean section carries certain risks for both the mother and the newborn. According to an study conducted in Iran on a sample of 714 mothers, there was no statistically significant difference in stress levels between mothers who had vaginal delivery and those who had a cesarean section [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The lowest total maternal stress experience score, however, was found specifically among mothers who delivered naturally by vaginal delivery. The result was again consistent with the research conducted in Croatia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Number of Births on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eThe survey results indicate that mothers who have given birth three or more times experience the highest levels of stress. The number of deliveries was statistically significant in experiencing stress in the subscale related to body changes and sexuality. The recovery of pregnancy and postpartum bodily changes vary greatly among mothers. These changes can have a significant impact on abdominal and pelvic floor muscles. Failure to exercise after delivery can lead to the development of pathologies in these muscle groups. For instance, the rectus abdominis muscles may separate, resulting in diastasis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mothers may also experience stress incontinence and pelvic organ prolapse due to pelvic floor pathology [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Appropriate exercises can help prevent these pathologies in postpartum mothers. However, it is important to inform the mother about these exercises, preferably by a midwife in a community setting where she can try them with assistance. In contrast, the Croatian study found significant stress in first-time mothers across all three subscales studied [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Marital Status on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eThe research found that partnership has a positive effect on maternal stress. This result is predictable if partnership is understood as social support. From a psychological point of view, adequate social support is essential for a mother caring for an infant. Additionally, appropriate social support is the best coping strategy for stress in general [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Support should primarily be provided by the immediate social circle and also by health professionals, such as community midwives [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. International studies have confirmed the positive impact of quality social relationships and good partnering on reducing mothers's stress levels after childbirth, even for as long as one year [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe authors' [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] study also confirmed that lack of social support was associated with higher levels of stress, as well as symptoms of depressive and post-traumatic stress during and after the postpartum period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eThe Influence of Pregnancy Planning on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eThe final factor assessed for its influence on maternal stress was a mother's decision to plan her pregnancy or leave it to chance. Mothers who became pregnant accidentally and had not planned their pregnancy reported lower overall stress levels. The element of surprise is generally considered a stress-inducing factor. Planning ahead for an event so that an individual can prepare for it reduces stress levels [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, this survey outcome is unexpected. It can be assumed that when a mother makes the decision to be a mother, she has the ability to adapt to negative life experiences.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eThe Influence of Midwifery Care on Experiencing Stress in Motherhood\u003c/h2\u003e \u003cp\u003eThe study found that midwife-provided care did not have a statistically significant effect on reducing maternal stress levels. Interventions by midwives may include e.g. antenatal preparation, assistance and support during labour, relaxation techniques (massage, relaxation music) and pain relief, early maternity care (breastfeeding support, newborn care, etc.) Although it was assumed that mothers who received midwifery care would experience less stress than those who did not, this assumption was confirmed but not statistically significant. This may have been due to the fact that the majority of respondents in the study population did not receive midwifery care. The non-use of midwifery care can often be attributed to a lack of awareness regarding a mother's entitlement to such care at any stage of life. Another reason may be the financial inaccessibility of midwifery care. In fact, most community midwives provide care without a contract with a health insurance company, requiring mothers to pay for the care themselves. As many research studies have shown negative birth experiences are associated with posttraumatic stress disorder, disrupted interpersonal relationships, dysfunctional mother-infant bonding [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], decreased rates of exclusive breastfeeding, and inappropriate use of maternal and newborn care. services [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], fear of childbirth, and increased desire for elective cesarean section in future pregnancies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Midwife interventions before, during, and early in materhood are essential for maternal psychological well-being. Research assessing the impact of midwifery care on the experience of stress in early motherhood is still scarce [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], recommends that the most effective strategies for creating a positive birth experience are maternal support during labour and birth preparedness provided by a competent midwife. Midwifery care can help mothers manage stress and improve their overall mental health in the postpartum period. It is important that mothers have access to quality midwifery care that can provide support and help during this challenging time.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe limitations of this study are low sample size. However, this study provides an interesting insight into this study population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMaternal stress is a chronic psychosocial stress that can be that can be induced by various situations, such as unrealistic cultural expectations, the increasing demands of a complicated society, and a lack of social recognition of the role of the mother. Each mother copes with maternal stress individually. The course of the puerperium plays a significant role in the experience of stress in the subsequent phases of motherhood. During this period, it is important for the mother to maintain a positive psychological attitude and receive support from her environment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Social support, particularly from the partner, can act as a significant protective factor against the negative effects of stress [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Research has shown that there are some factors in maternal stress that have a significant impact on mothers's experience of stress in early motherhood. These factors include maternal age, education, mode of delivery, number of births, marital status and pregnancy planning.\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003ePractical implications\u003c/h2\u003e \u003cp\u003eThe research findings suggest some practical implications for the provision of care for mothers in early motherhood.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIt is important to pay attention to mothers over the age of 40 who are at increased risk of experiencing stress.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIt is important to support education for mothers about pregnancy and motherhood so that they are better prepared for this life change.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIt is important to promote natural childbirth, which has many benefits for both mother and newborn.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIt is important to support mothers who are planning a pregnancy so that they are better prepared for this life change.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for further research\u003c/h2\u003e \u003cp\u003eResearch could be expanded to assess other factors that may influence mothers's experience of stress in early motherhood. These factors include:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA mother's previous experience of caring for a child.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe mother's mental health.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocial and economic conditions of the family.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.\u003c/p\u003e\n\u003cp\u003eData are presented in the main manuscript.\u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflict of Interest\u003c/h2\u003e \u003cp\u003eWe are not aware of any conflicts of interest relating to this paper.\u003c/p\u003e\u003ch2\u003eFunding Statement\u003c/h2\u003e \u003cp\u003eI declare that the submitted article was not funded by any external institution, grant, or other financial source.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1. Conception of the study and methodology of research - BD + JCH + KG + HP2. Review of the literature - BD + JCH + KG + HP3. Application to Ethical Committee - HP4. Collecting data - HP5. Analysis of data - BD + JCH + KG6. Writing draft of the manuscript - BD + JCH7. Critical analysis of draft of the manuscript - BD + JCH + KG8. Statistical analysis of collected material - BD + JCH + HP9. Interpretation of statistical analysis - BD + JCH +KG10. Technical preparation of the manuscript according journal guidelines - BD + JCH11. Supervision over the research and preparation of the article - BD + JCH\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eIn order to protect the privacy of study participants, data cannot be shared in an open manner. The data are stored by the authors of the paper. Should further access to the data be required, please contact the corresponding author, Jana Chroma ([email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThompson T. \u003cem\u003eMateřstv\u0026iacute; se mi stalo past\u0026iacute;: př\u0026iacute;běhy matek s depres\u0026iacute;\u003c/em\u003e. Praha: Port\u0026aacute;l. 2019. 344 p. ISBN 978-80-262-1547-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHřivnov\u0026aacute; M et al. \u003cem\u003eIn time:Kognitivn\u0026iacute; a afektivn\u0026iacute; dimenze mlad\u0026yacute;ch dospěl\u0026yacute;ch ve vztahu k těhotenstv\u0026iacute; a rodičovstv\u0026iacute;\u003c/em\u003e. Olomouc: Univerzita Palack\u0026eacute;ho v Olomouci. 2020. 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[cit. 2023-06-16].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"stress, maternity, postpartum, mothers, stress scale, questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-4411646/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4411646/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003ePostpartum stress is a common phenomenon experienced by many mothers. It can manifest itself in various symptoms such as fatigue, irritability, insomnia, anxiety, depression and fear. In severe cases, it can lead to the development of postnatal psychosis. The objective of this study is to identify and assess the subjective perception of postpartum maternal stress in relation to selected socio-demographic characteristics and to determine the association between subjectively perceived maternal postpartum stress and midwifery care.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eThe study population consisted of 200 respondents who had given birth to one healthy child and their postpartum period was in the range of six months. The study was conducted in a pediatrician (referred to as a \u0026lsquo;general practitioner for children and adolescents\u0026rsquo; in the Czech Republic) outpatient offices, May 2022 to January 2023. The survey utilized the standardized Maternal Postpartum Stress Scale (MPSS) questionnaire, which was supplemented with socio-demographic data and information on whether midwifery care had been provided.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study participants had an overall mean score of postpartum stress 32.7. The stress scores for each subscale were as follows: 15 for personal needs and fatigue of the mother, 9.9 for infant nurturing, and 7.8 for body changes and sexuality. The study found a statistically significant relationship between the number of births and body changes and sexuality (p\u0026thinsp;=\u0026thinsp;0.0097). Statistical significance level 5%. However, no statistically significant effects of sociodemographic parameters or midwifery care were found in the study population.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn the study population, overall postpartum stress was mild to moderate. Sociodemographic parameters and midwife care did not have a statistically significant effect on subjective perception of maternal postpartum stress. Research shows that mothers who have had more than one birth are more prone to experiencing stress in terms of body changes and sexuality after childbirth. It is therefore important to give these mothers extra attention and offer them support and help to cope with these challenging changes\u003c/p\u003e","manuscriptTitle":"Maternal Stress: Not Just a Mental Illness, but Also a Health Hazard","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-18 08:54:58","doi":"10.21203/rs.3.rs-4411646/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29727da5-1baa-4579-a1a0-e76aa782dabf","owner":[],"postedDate":"June 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T09:23:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-18 08:54:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4411646","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4411646","identity":"rs-4411646","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}