Physical Activity and Depressive Symptoms After Stillbirth Informing Future Interventions
Jennifer Huberty, Jenn A Leiferman, Katherine J Gold, Lacey Rowedder, Joanne Cacciatore, Darya Bonds McClain
BMC Pregnancy Childbirth. 2014;14(391)
“This was the first study to determine women’s preferences for and experiences with physical activity after stillbirth. As such, it offers information necessary for healthcare providers to design and implement inter-conception interventions that include physical activity to improve the mental and physical health of women after stillbirth, an area which is lacking. Women who have experienced stillbirth are a high-risk population for poor maternal and infant health outcomes because of the negative health implications (i.e., depressive symptoms, weight retention) due to the traumatic event (i.e., stillbirth) and the high rate of conceiving within a year after the stillbirth. The encouragement of positive health behaviors such as physical activity in women who have experienced stillbirth during inter-conception care may positively impact maternal and fetal health outcomes in subsequent pregnancies. Unfortunately, health care providers are not prescribing physical activity for women who have experienced stillbirth. Women who have experienced stillbirth have reported that physicians do not counsel about exercise beyond “returning to normal activity” and that they would have liked information about physical activity and/or advice from their physician about being active for their health after their stillbirth. The promotion of positive health behaviors and the positive implications of this is evident in the literature related to women of live births that are active before, during, and after their pregnancies.[32,33] It is important to understand the specific and unique needs of women who have experienced stillbirth in order to design interventions to help improve their mental, and physical health outcomes.
Despite a decrease in the number of women who reported participating in regular physical activity during their pregnancy (47%) compared to before their pregnancy (60%), 61% of women reported participating in regular physical activity since their stillbirth. This may have been because women who were active knew that exercise might help them feel better. In a study by Huberty and colleagues, women who experienced stillbirth and were active prior to their stillbirth reported using physical activity to cope, feel better, and have time alone. This may also be because despite needing to physically recuperate, low to moderate intensity physical activity (i.e., walking, yoga) offers an outlet in which to feel better and have alone time. This is important, as exercise is a well-known non-pharmacological method to decrease depressive symptoms and reduce episodic recurrences.[16,34] However, in our sample less than half of women who reported being active since stillbirth were currently meeting recommendations for physical activity. This is similar to other studies in non-bereaved women during pregnancy and postpartum. It is well known that pregnant women are less active than non-pregnant women and that pregnancy leads to a decrease in physical activity participation. Additionally, physical activity levels post-partum may not return to what they were pre-pregnancy.[36,37] Strategies are needed to help encourage and guide women who experienced stillbirth to use physical activity as a means to cope and to help them maintain this activity in the long-term. This is especially important because our study suggests that women who have experienced stillbirth and participate in regular physical activity have less depressive symptoms than women who are not regularly active. Similar findings were reported in women who have postpartum depression after a live birth and participate in exercise programs.[19,38] Thus, healthcare providers may consider suggesting exercise after a mother experiences stillbirth as a way to cope with grief and depressive symptoms. Additional research in this area is warranted.
In our study, 38% of women reported using activity as a means to cope with depressive symptoms, anxiety, and/or grief associated with the death of their baby. Others reported engaging with family/friends, and support groups to cope with their symptoms. Medical and mental health providers may consider offering group-based exercise programs for women who have experienced stillbirth that incorporate both a social support and exercise component. For example, support groups’ session times could be shortened (30 minutes as opposed to 60 minutes) and 30 minutes of yoga or walking could be incorporated. Similar approaches were used in chronic conditions and social support (i.e., group-based) was a known facilitator to improving physical activity participation.[39–41] More research is warranted.
Yoga has burgeoned as an exercise trend in Western society because it positively affects psychological conditions, pain, cardiovascular, autoimmune and immune conditions, and pregnancy outcomes. Based on findings in studies in pregnant and postpartum women and other chronic conditions, yoga represents a potential means of care that may help women build their capacity to be resilient and cope with depressive symptoms both immediately after their stillbirth and in the months and years that follow.[41–43] Even though less than 20% of women in this study used yoga to cope, 50% were interested in yoga and of those, most preferred yoga in their home. Studies that examine the feasibility of in-home versus in-studio yoga settings may further inform the design of interventions and help guide low-cost, sustainable strategies for coping after stillbirth.”