The Psychosocial Challenges Faced By Women With High-Risk Pregnancies

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INTRODUCTION
Pregnancy is one of the most significant events in a woman's life, often accompanied by various physical, emotional, and psychological challenges.This process proceeds relatively smoothly for most women, but for some, especially those facing high-risk pregnancies, the experience can become much more complex and challenging.High-risk pregnancies can arise due to various factors, including pre-existing medical conditions or those that develop during pregnancy (Loisza, 2020) Research on high-risk pregnancies has gained increasing attention to better understand the unique aspects associated with this condition.One significant aspect often overlooked is the psychosocial impact experienced by women with high-risk pregnancies.These psychosocial challenges may include higher levels of anxiety, emotional stress, feelings of vulnerability, and concerns about the unborn baby's well-being (Mayasari et al., 2022) (Katili et al., 2022).
The Kudaile Slawi environment, an area with a diverse health service system, is also no exception to cases of high-risk pregnancies where 15 out of 18 pregnant women who visited in the last 3 months were high-risk pregnant women.Therefore, this research aims to reveal and understand more deeply the psychosocial challenges faced by women with high-risk pregnancies in the Kudaile Slawi environment.Through a qualitative approach, we will explore participants' personal experiences, feelings and perceptions to identify critical issues that require attention in providing appropriate care and support.
By better understanding these psychosocial challenges, it is hoped that it will be possible to improve prenatal care, provide more effective support, and ensure better emotional and psychological well-being for women with high-risk pregnancies.This condition can also improve the overall health outcomes for mothers and infants in the Kudaile Slawi neighborhood (Katili et al., 2022).
This research represents the first step in understanding the experiences of women with high-risk pregnancies in our community.In this regard, the authors hope the research findings will provide valuable insights and a better understanding to provide more holistic, patient-centered care (Setiawan et al., 2020).

LITERATURE REVIEW
Psychological stress experienced by mothers during pregnancy is stress resulting from the everyday life events they go through, known as psychosocial stress.Psychosocial stress is caused by various psychosocial stressors such as internal family issues, life changes, the residential environment, economic concerns, the current pregnancy, and work-related burdens (Nenti Herlina, 2016).
The psychological impact of emotional pressure on mothers during pregnancy affects the endocrine balance and postpartum adjustment.The psychosocial well-being of pregnant women significantly influences the mother's health during childbirth, the newborn, and the postpartum period (Sofia et al., 2019).
Changes in one's life values are frequently denoted as psychosocial transformations.These shifts, accompanied by diverse life challenges, can act as burdens or mental stressors commonly known as psychosocial stressors.These stressors encompass a spectrum of factors, such as significant life events, societal expectations, and personal growth endeavors, all of which contribute to the intricate interplay between psychological and social dimensions.The dynamic nature of psychosocial changes underscores the need for adaptive coping strategies and resilience to navigate the complexities of evolving values and life circumstances.(Elis et al., 2020).
Psychosocial stress can lead to psychobiological stress.Psychosocial stimuli or triggers disrupt the functional or organ functions, but if sustained, they can lead to disorders in the organs themselves.The physiological, psychological, and behavioral stress responses interact with the physiology of the mother and the fetus during pregnancy, significantly affecting the onset of labor.Stress conditions in pregnant women have adverse effects on the fetus.Stress conditions trigger physiological changes, increased hormonal levels, and resistance to arterial blood flow, which can disrupt normal blood flow to the placenta.Stress in pregnant women can increase delivery complications (Madiba et al., 2023) (Anggita Ratnaningtyas et al., 2023).

METHOD
This research uses a qualitative approach with case studies as the main framework.This research was conducted in January 2023 involving ten mothers identified as facing high-risk pregnancies.The selection of participants will be carried out using purposive sampling, taking into account variations in the level of pregnancy risk, maternal age, educational background and pregnancy experience.(Jayaraman et al., 2017)Triangulation in this study involved adding sources of information, such as their partners or closest family members.Data will be collected through in-depth interviews with these mothers, focusing on their psychosocial challenges during high-risk pregnancies.In addition, participant observation and medical document analysis will be used to complement the interviews.The collected data will be analyzed using a thematic analysis approach to identify and understand various psychosocial challenges experienced by participants.Efforts will be made to maintain the confidentiality of this research.The results of the analysis will provide in-depth insight into psychosocial challenges in the context of high-risk pregnancies, which could benefit the development of better care and support for pregnant women facing similar conditions.(Juharji et al., 2022) This research will employ a qualitative approach with a case study as its primary framework, aiming to explore the psychosocial challenges experienced by ten mothers facing high-risk pregnancies.The participant selection process will utilize purposive sampling, considering variations in pregnancy risk levels, maternal age, educational backgrounds, and pregnancy experiences.In-depth interviews will be conducted with the selected mothers, focusing on capturing their psychosocial challenges during high-risk pregnancies.Additionally, participative observation and analysis of relevant medical documents will be employed to complement and enrich the insights gained from the interviews.
The collected data will undergo a thorough analysis using a thematic analysis approach, allowing for the identification and comprehension of various psychosocial challenges encountered by the participants.Maintaining strict confidentiality throughout the research process is a priority.The outcomes of the analysis are expected to provide profound insights into the psychosocial challenges associated with high-risk pregnancies, contributing valuable knowledge for the development of enhanced care and support strategies for pregnant women facing similar conditions.

RESULT AND DISCUSSION
In our investigation, we meticulously identified and scrutinized an array of psychosocial challenges confronted by women grappling with high-risk pregnancies in the Kudaile Slawi Village.Through conducting in-depth interviews with a purposively selected cohort of ten participants, we unveiled several pivotal findings encapsulating their psychosocial ordeals (Elevated Anxiety Levels, Need for Adequate Psychosocial Support and Emotional Stress During Pregnancy).
The crux of our research underscores various facets emblematic of the psychosocial journey of women navigating high-risk pregnancies.One salient revelation is the heightened levels of anxiety experienced by these women in comparison to their counterparts with normal pregnancies.Their apprehensions extend beyond personal health to encompass the well-being of their unborn infants, culminating in augmented uncertainty and stress.This sentiment is poignantly expressed by an interviewee who articulates, "I'm always worried about what will happen next.I can never truly relax during this pregnancy."The implications of these findings underscore the imperative to furnish apt psychosocial support to women grappling with high-risk pregnancies, encompassing avenues such as counseling, stress management education, and community backing (Mardiyanti & Anggasari, 2020).
Furthermore, the respondents divulged grappling with substantial emotional stress throughout their pregnancies.An array of emotions, including anxiety, fear, and frustration, pervades their daily experiences, imparting a sense of entrapment and restlessness.One respondent encapsulates this emotional turmoil, stating, "Every day, I feel anxious about my baby's health.It makes me feel trapped and restless." To ensure the confidentiality and anonymity of our participants, the exact number of informants providing each piece of information is intentionally omitted.This omission adheres to ethical considerations and safeguards the privacy of the individuals who generously shared their experiences.
Feelings of Vulnerability: High-risk pregnancies make women feel more vulnerable.They feel limited in their daily activities and sometimes rely on others for support.
Social support from family members and healthcare providers plays a significant role in overcoming these challenges.Respondents described that receiving support from people around them helped them cope with the emotional pressure and uncertainty they felt.Expressing gratitude for the unwavering support received, the individual conveyed appreciation for the presence of their husband and parents.The consistent availability and encouragement from these supportive figures contribute to a strengthened sense of resilience.This indirect statement emphasizes the positive impact of familial support on the individual's emotional well-being.
The results of the research on Anxiety and Uncertainty in women with high-risk pregnancies in Kudaile Slawi Village indicate that many women facing this condition experience higher anxiety levels than those with normal pregnancies.Some key findings related to Anxiety and uncertainty are as follows: Respondents often feel anxious about their health during high-risk pregnancies.They worry about the development of diseases or complications that may occur and their impact on their well-being.One participant expressed.She expressed that there is a constant sense of anxiety about her health during the high-risk pregnancy.Any minor symptom or discomfort triggers immediate concerns, with the persistent worry that it could negatively impact both her and her baby.The paramount focus on health is a thought that never departs from her mind.
In addition to being anxious about their health, women with high-risk pregnancies also feel very anxious about the well-being of their unborn babies.They are concerned about potential risks or complications that could affect the fetus's development.Another woman added She conveyed a broader source of anxiety, extending beyond her own health to include the well-being of the unborn baby.The constant worry revolves around potential risks or complications that could impact the fetus's development.This thought consistently occupies her mind.
High levels of uncertainty throughout high-risk pregnancies create additional stress for these women.They often feel unsure about how the pregnancy will progress and what they should anticipate.Another participant shared, she candidly expressed experiencing a significant degree of uncertainty throughout the high-risk pregnancy.The unpredictability of what may unfold next, the progression of the pregnancy, and the anticipation of potential challenges contribute to an added layer of substantial stress.The informant honestly expressed experiencing a high level of uncertainty during the high-risk pregnancy.She conveyed that not knowing what will happen next, how the pregnancy will progress, and what to anticipate adds significant, burdensome stress to the situation.This illustrates the emotional toll of the unpredictable nature of the high-risk pregnancy on the individual.This Anxiety and uncertainty can affect the quality of life for women with high-risk pregnancies.They may feel disrupted in their daily activities and emotionally uncomfortable.Another woman stated the individual conveyed that the impact of anxiety and uncertainty on their quality of life is substantial.They expressed a sense of disruption in their daily activities and emotional discomfort.Enjoying a peaceful and happy pregnancy becomes challenging under these circumstances.This indirect statement reflects the adverse effects of anxiety and uncertainty on the individual's well-being during pregnancy.
The research results on Emotional Challenges in women with high-risk pregnancies in Kudaile Slawi Village reveal several significant findings related to the emotional aspects of their pregnancy experiences.Some key findings related to emotional challenges are as follows: Respondents in this study consistently reported experiencing significant emotional pressure during high-risk pregnancies.They described feelings of Anxiety, fear, and restlessness associated with their conditions.The individual communicates the persistent nature of their anxiety and fear, emphasizing the continuous impact on their emotional well-being and the added weight of the emotional burden they carry.
Frustration and Uncertainty: Many women feel frustrated due to the ongoing uncertainty in their pregnancy journey.They often do not know what will happen next, creating high discomfort.the individual communicates the ongoing frustration related to the unpredictable nature of the pregnancy and the lack of conclusive information even after medical consultations.The indirect form captures the emotional impact and the persistence of the frustration experienced.
Emotional challenges also include feelings of helplessness.Some respondents feel that they cannot control their situations, which can hurt their mental well-being.Encountering emotional challenges, there are moments when the individual expressed a sense of inability to control the situation, feeling too weak to handle it independently.This condition induces feelings of vulnerability and occasionally gives rise to doubts regarding their coping ability.The indirect statement captures the moments of emotional struggle, emphasizing the perceived lack of control and vulnerability experienced by the individual.
Despite facing significant emotional challenges, many respondents emphasized the importance of social Support from family, friends, and healthcare providers.This Support helped them cope with emotional pressure and uncertainty.In the absence of social support from family, friends, and healthcare providers, the individual expressed uncertainty about how to navigate the emotional pressure.They noted that these supportive figures play a crucial role in providing the necessary emotional support, thereby making the journey more manageable.The individual highlighted the stress-relieving effect of simply conversing with someone who cares.This indirect statement underscores the significance of social support in easing the emotional challenges faced during the high-risk pregnancy.
The research results on Feelings of Vulnerability in women with high-risk pregnancies in Kudaile Slawi Village reveal several findings that depict the participants' vulnerability experience.Some key findings related to feelings of vulnerability are as follows: Women with high-risk pregnancies often feel limited in carrying out their daily activities.They may have to reduce physical activities, rest more, or avoid risky situations.One respondent expressed, "I feel limited in my daily activities during this high-risk pregnancy.I can't do many things I used to do before.Often, I have to reduce physical activities, rest more, and be cautious in every action."Some respondents depend on Support from family, friends, or partners during highrisk pregnancies.They may need assistance with routine activities or attending medical appointments.Feeling a strong reliance on the support of family and friends during this pregnancy, the individual expressed that they receive assistance with routine activities and transportation to medical appointments.There are times when the individual perceives the task as something they cannot manage alone, highlighting the significance of the support provided by their family and friends.This indirect statement emphasizes the essential role of the support network in facilitating the individual's journey through the pregnancy.Families play a significant role in providing emotional and practical support to these women.Encouraging family participation in prenatal care can help reduce the burden on women (Andriani & Nugrahmi, 2020).
Feelings of vulnerability are often triggered by worries about their well-being and the well-being of their unborn babies.They may feel unable to protect themselves or their babies from potential risks or complications.Expressing constant concerns about the wellbeing of both herself and her baby, the individual conveyed that the ability to shield herself and her baby from potential risks or complications is often beyond her control.This perpetual state of vigilance and worry characterizes her experiences throughout the pregnancy.The indirect statement captures the ongoing nature of the worries and the underlying sense of vulnerability faced by the individual.(Heller et al., 2021) These women often feel uncertain about what will happen next in their pregnancy.The sensation of uncertainty creates a deep sense of vulnerability.Another woman added, haunted by the sensation of uncertainty, the individual expressed a lack of knowledge about what will unfold next in the pregnancy journey, rendering them vulnerable.This sensation of uncertainty contributes to a profound sense of vulnerability.In this indirect statement, the individual communicates the ongoing impact of uncertainty on their emotional state, emphasizing the persistent vulnerability experienced throughout the pregnancy.Developing specialized education programs that address the psychosocial challenges women face with high-risk pregnancies can help them feel better prepared to face the uncertainties that may arise during their pregnancy journey (Yuniarti et al., 2022).
The research results on the Role of Social Support in women with high-risk pregnancies in Kudaile Slawi Village indicate that social Support plays a crucial role in helping women cope with their pregnancy challenges.Some key findings related to the role of social Support are as follows: Most respondents emphasized the importance of support from family members, especially spouses and parents, in facing high-risk pregnancies.Emotional, physical, and practical support from family helps them feel supported and more capable of dealing with stress.Highlighting the paramount importance of family support, particularly from her husband and parents, the individual expressed that they consistently offer both emotional and physical assistance.The husband aids with household chores and accompanies her to medical appointments, while the parents provide crucial moral support.The comprehensive support from her family contributes to a heightened sense of strength and confidence.This indirect statement underscores the ongoing nature and multifaceted nature of the support received, emphasizing its positive impact on the individual's wellbeing during the high-risk pregnancy.
Some respondents also noted the significant role of their friends in providing emotional and social support.Meeting with friends can be a source of happiness and moral assistance during pregnancy.Underscoring the essential role of friends in offering support during the pregnancy, the individual conveyed that they frequently visit, engage in conversations, and provide social support.These interactions contribute to an increased sense of happiness and connection to the outside world.The friends also offer meaningful moral support.In this indirect statement, the ongoing and meaningful contributions of friends to the individual's well-being during the pregnancy are emphasized.
Support from healthcare providers is also considered crucial.These women feel more confident and gain a better understanding of their condition when they feel listened to and supported by the medical team.Another respondent explained, "Support from the medical team is essential.I feel more confident when they listen to my concerns and explain my condition clearly.Their Support gives me a better understanding of what I'm going through, which is meaningful."Some respondents stated that joining a support or community group such as a group for pregnant women in a class for pregnant women with similar conditions helped them feel more connected and gain insight from people who had similar experiences.Another woman shared, "Joining a support group for pregnant women with similar conditions was a positive experience.There, I feel connected with people going through the same thing.We can share stories and insights.It gives me a sense that I'm not alone in this journey, and there is Support from peers I can rely on."Healthcare providers need to adopt a holistic care approach that considers the physical and psychosocial aspects of high-risk pregnancies (Loisza, 2020).
The main findings of this study reveal the complexity of the psychosocial challenges faced by women with high-risk pregnancies in Kudaile Slawi Village.These four main findings, namely anxiety and uncertainty, emotional challenges, feelings of vulnerability, and the role of social support, reflect interrelated aspects in the experiences of these women.

CONCLUSION
This research revealed that women with high-risk pregnancies in the Kudaile Slawi neighborhood face significant psychosocial challenges, including anxiety, emotional stress, feelings of vulnerability, and uncertainty.Among the four most frequently felt by several respondents is that this anxiety may be related to the health of the mother and baby, the development of disease or complications that may arise during pregnancy.Social support from family and healthcare providers positively impacts helping them cope with these challenges.To improve the well-being of these women, a holistic care approach that considers psychosocial aspects is essential.Based on the results of this research, it is recommended that maternal healthcare providers in the Kudaile Slawi neighborhood enhance their understanding of the psychosocial challenges faced by women with high-risk pregnancies.These conditions may include training to identify and manage anxiety and emotional stress during pregnancy.In addition, a more inclusive treatment approach is needed that involves the family as important emotional support.Additionally, educational programs such as prenatal classes and community support can help women with high-risk pregnancies feel better prepared to face challenges that may arise during their pregnancy journey.

ACKNOWLEDGEMENT
Thanks to the mothers who shared their experiences.We would also like to thank the pregnant women in the Kudaile neighborhood for their hospitality and cooperation during the data collection process.