Emotional and social dimensions of high-risk pregnancy in specialized care
a qualitative study
Keywords:
High-risk pregnancy, Prenatal care, Obstetric nursing, Comprehensive Health CareAbstract
Objective: To analyze the emotional and social experiences of high-risk pregnant women under follow-up at a referral center, in light of Imogene King’s Theory of Goal Attainment.
Method: A qualitative study conducted with 20 pregnant women from Três Rios, Rio de Janeiro, between November and December 2024, using semi-structured interviews. Data were analyzed by lexical analysis with the aid of the IRaMuTeQ software, and subjected to thematic Content Analysis.
Results: The participants were predominantly women with a high school education, low family income, and self-declared of mixed race. The findings were organized into two central axes: Emotional experiences in the face of high-risk pregnancy and Perceptions of follow-up at the Women’s Health Specialty Center. The narratives revealed fear, shock, and concern, which were reframed through interaction with the multiprofessional team.
Final Considerations: Pregnancy demands comprehensive care that transcends the clinical dimension. Therapeutic interaction and goal negotiation contribute to autonomy and the strengthening of the therapeutic bond.
References
1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Gestação de alto risco: manual técnico [Internet]. Brasília (DF): Ministério da Saúde; 2012 [cited 2025 Jul 14]. 302 p. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_tecnico_gestacao_alto_risco.pdf
2. Pacagnella RC, Nakamura-Pereira M, Gomes-Sponholz F, de Aguiar RALP, Guerra GVQL, Diniz CSG, et al. Maternal mortality in Brazil: proposals and strategies for its reduction. Rev Bras Ginecol Obstet [Internet]. 2018 [cited 2025 Jul 14];40(9):501-6. Available from: https://doi.org/10.1055/s-0038-1672181
3. Say L, Souza JP, Pattinson RC. Maternal near miss: towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol [Internet]. 2009 [cited 2025 Jul 16];23(3):287-96. Available from: https://doi.org/10.1016/j.bpobgyn.2009.01.007
4. Tuyishime E, Ingabire H, Mvukiyehe JP, Durieux M, Twagirumugabe T. Implementing the Risk Identification (RI) and Modified Early Obstetric Warning Signs (MEOWS) tool in district hospitals in Rwanda: a cross-sectional study. BMC Pregnancy Childbirth [Internet]. 2020 [cited 2025 Jul 14];20:568. Available from: https://doi.org/10.1186/s12884-020-03187-1
5. Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia [Internet]. 2013 [cited 2025 Jul 14];68(4):354-67. Available from: https://doi.org/10.1111/anae.12180
6. Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, et al. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population-based study. BMJ [Internet]. 2022 [cited 2025 Jul 14];379:e070621. Available from: https://doi.org/10.1136/bmj-2022-070621
7. World Health Organization (WHO). Maternal mortality [Internet]. Geneva: WHO; 2023 [cited 2025 Sep 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
8. United Nations. Department of Economic and Social Affairs. The Sustainable Development Goals report 2025 [Internet]. New York: United Nations; 2025 [cited 2025 Sep 5]. Available from: https://unstats.un.org/sdgs/report/2025/
9. Chirowa F, Atwood S, Van der Putten M. Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: a secondary data analysis. Afr J Prim Health Care Fam Med [Internet]. 2013 [cited 2025 Sep 5];5(1):471. Available from: https://doi.org/10.4102/phcfm.v5i1.471
10. Brasil. Ministério da Saúde. Rede Alyne: saúde reforça ações para reduzir a mortalidade materna de mulheres negras [Internet]. Brasília (DF): Ministério da Saúde; 2024 [cited 2025 Sep 5]. Available from: https://www.gov.br/saude/pt-br/assuntos/noticias/2024/dezembro/rede-alyne-saude-reforca-acoes-para-reduzir-a-mortalidade-materna-de-mulheres-negras
11. Cecatti JG, Souza RT, Pacagnella RC, Leal MC, Moura EC, Santos LMP. Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil. Rev Panam Salud Publica [Internet]. 2015 [cited 2025 Sep 5];37(4-5):232-8. Available from: https://pubmed.ncbi.nlm.nih.gov/26208190/
12. Leal MC, Esteves-Pereira AP, Nakamura-Pereira M, Torres JA, Theme-Filha M, Domingues RMSM, et al. Prevalence and risk factors related to preterm birth in Brazil. Reprod Health [Internet]. 2016 [cited 2025 Sep 5];13(Suppl 3):127. Available from: https://doi.org/10.1186/s12978-016-0230-0
13. King IM. A theory for nursing: systems, concepts, process. Albany (NY): Delmar; 1981. Cap. 4, p. 61.
14. King IM. King's conceptual system, theory of goal attainment, and transaction process in the 21st century. Nurs Sci Q [Internet]. 2007 [cited 2025 Sep 5];20(2):109-11. Available from: https://doi.org/10.1177/0894318407299846
15. Påfs J, Musafili A, Binder-Finnema P, Klingberg-Allvin M, Rulisa S, Essén B. Beyond the numbers of maternal near-miss in Rwanda: a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy. BMC Pregnancy Childbirth [Internet]. 2016 [cited 2025 Sep 5];16:257. Available from: https://doi.org/10.1186/s12884-016-1051-4
16. World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. Geneva: WHO; 2016 [cited 2025 Sep 5]. Available from: https://www.who.int/publications/i/item/9789241549912
17. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care [Internet]. 2007 [cited 2026 Jan 18];19(6):349-57. Available from: https://doi.org/10.1093/intqhc/mzm042
18. de Souza MAR, Wall ML, Thuler ACMC, Lowen IMV, Peres AM. The use of IRAMUTEQ software for data analysis in qualitative research. Rev Esc Enferm USP [Internet]. 2018 [cited 2025 Sep 5];52:e03353. Available from: https://doi.org/10.1590/S1980-220X2017015003353
19. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2015. 288 p.
20. Brasil. Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 de dezembro de 2012. Aprova as seguintes diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Brasília (DF): Ministério da Saúde; 2012 [cited 2025 Sep 5]. Available from: https://www.gov.br/conselho-nacional-de-saude/pt-br/acesso-a-informacao/atos-normativos/resolucoes/2012/resolucao-no-466.pdf/view
21. Lansky S, Friche AAL, da Silva AAM, Campos D, Bittencourt SDA, de Carvalho ML, et al. Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care. Cad Saude Publica [Internet]. 2014 [cited 2025 Sep 4];30(Suppl 1):S192-S207. Available from: https://pubmed.ncbi.nlm.nih.gov/25167179/
22. de Melo EMOP, Ferreira PL, de Lima RAG, de Mello DF. The involvement of parents in the healthcare provided to hospitalized children. Rev Lat Am Enfermagem [Internet]. 2014 [cited 2025 Sep 5];22(3):432-9. Available from: https://pubmed.ncbi.nlm.nih.gov/25029054/
23. Silva CS, de Souza KV, Alves VH, Cabrita BAC, da Silva LR. Nurse's performance in prenatal consultation: limits and capabilities. Rev Pesqui Cuid Fundam Online [Internet]. 2016 [cited 2025 Sep 5];8(2):4087-98. Available from: https://www.ssoar.info/ssoar/handle/document/53776
24. Brufatto JPT, Dias TM, D'Abreu NB, Rehder PM. Reproductive planning and the choice of long-acting reversible contraceptive in primary health care: a cross-sectional study. Rev Bras Ginecol Obstet [Internet]. 2023 [cited 2025 Sep 5];45(8):e456-e64. Available from: https://doi.org/10.1055/s-0043-1772188
25. da Silva SC, Morais BX, Munhoz OL, Ongaro JD, Urbanetto JS, Magnago TSBS. Patient safety culture and missed nursing care in obstetrics. Rev Lat Am Enfermagem [Internet]. 2021 [cited 2025 Sep 5];29:e3461. Available from: https://doi.org/10.1590/1518-8345.4855.3461
26. Ferreira MBG, Silveira CF, da Silva SR, de Souza DJ, Ruiz MT. Nursing care for women with pre-eclampsia and/or eclampsia: integrative review. Rev Esc Enferm USP [Internet]. 2016 [cited 2025 Sep 4];50(2):320-30. Available from: https://doi.org/10.1590/S0080-623420160000200020
27. Coates D, Thirukumar P, Henry A. Women’s experiences and satisfaction with having a cesarean birth: an integrative review. Birth. [Internet]. 2020 [cited 2026 Abr 26];47(2):169-182. Available from: https://doi.org/10.1111/birt.12478
28. Leal MC, Bittencourt SA, Esteves-Pereira AP, Ayres BVS, Silva LBRAA, Thomaz EBAF, et.al. Progress in childbirth care in Brazil: preliminary results of two evaluation studies. Cad Saúde Pública [Internet]. 2022 [cited 2026 Apr 25];35(7):e00223018. Available from: https://doi.org/10.1590/0102-311X00223018
29. Brasil. Lei nº 9.263, de 12 de janeiro de 1996. Regula o §7º do art. 226 da Constituição Federal, que trata do planejamento familiar, estabelece penalidades e dá outras providências. [Internet]. Brasília (DF): Presidência da República; 1996 [cited 2025 Sep 5]. Available from: https://www.planalto.gov.br/ccivil_03/Leis/L9263.htm
30. Brasil. Lei nº 14.443, de 2 de setembro de 2022. Altera a Lei nº 9.263/1996, para determinar prazo para oferecimento de métodos e técnicas contraceptivas e disciplinar condições para esterilização no âmbito do planejamento familiar. [Internet]. Brasília (DF): Presidência da República; 2022 [cited 2025 Sep 5]. Available from: https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2022/lei/L14443.htm
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ana Claudia Sierra Martins, Márcia Vieria dos Santos, Stephanie Vanessa Penafort Martins Cavalcante, Raquel Dias Botelho Borborema, Bianca Dargam Gomes Vieira, Diego Pereira Rodrigues, Valdecyr Herdy Alves
This work is licensed under a Creative Commons Attribution 4.0 International License.
Cogitare Enfermagem reserves the right to make normative, orthographic, and grammatical changes to the published article to maintain the cultured standard of the language, while respecting the authors' style.
The published study is the sole responsibility of the author(s), and Cogitare Enfermagem is exclusively responsible for evaluating the manuscript as a scientific publication vehicle. Revista Cogitare Enfermagem is not responsible for any violations of Law No. 9,610/1998, the Brazilian Copyright Law.
Cogitare Enfermagem allows the author to hold the copyright of articles accepted for publication, without restrictions.
The articles published are licensed under the Creative Commons license CC BY 4.0 Creative Commons - Attribution 4.0 International - CC BY 4.0 - The attribution adopted by Cogitare Enfermagem is permitted:
- Share - copy and redistribute the material in any media or format.
- Adapt - remix, transform and build upon the material for any purpose, even commercially.
- Attribution - You must give proper credit, provide a link to the license, and indicate if changes have been made. You may do this in any reasonable way, but not in a way that suggests that the licensor endorses it or approves of its use.
- No additional restrictions - You may not apply legal terms or technological measures that legally restrict others from doing something that the license allows.
