Vera Villanueva

A team of Yale researchers examined how ambivalence manifests itself in different moments of women’s lives after confirmation of a new pregnancy. The researchers’ study, published in the September issue of the journal Women’s Health Issues, looked at how ambivalence could originate from any of myriad sources, such as relationship status, pregnancy timing and health issues.

“We let the women speak for themselves, and there is strength in using literal words to support a research’s findings,” said Abigail Cutler, first author of the research and a professor at the School of Medicine. “These women are both happy and sad, scared but excited — how would you categorize them in a quantitative analysis?”

The team’s sample included 84 women from the New Haven area who had just received positive pregnancy test results. Of these women, 55 percent expressed ambivalence when, during interviews conducted by the researchers, they were asked about pregnancy intentions, responses to realizing pregnancy and decision-making about future plans for the pregnancy. Researchers found these emotions were often interconnected and often conflicting.

One major issue to which Cutler’s team paid particular attention was how to define the concept of ambivalence, which is “often thrown around inaccurately in research,” she said. While previous studies have been centered on testing correlations between ambivalence about a pregnancy and a woman’s high-risk sexual behavior or pregnancy intention, Cutler said, her team did not find any of these correlations. She added that ambivalence about a pregnancy can occur whether or not a woman might forego   contraceptives in order to have children.

Cutler also emphasized the importance of appreciating the complexity of ambivalence as a signal of mixed, unformed feelings rather than concrete plans for pregnancy termination. She said hasty generalization that doesn’t take into account these different scenarios lead to real-life complications when health providers and policymakers try to provide relevant support for women.

Unlike most of its predecessors, the team’s study also eliminated recall bias — the influence of time on one’s perception of an event. Most other studies are retrospective assessments after completed or terminated pregnancies, which Cutler said cause inaccurate representations of women’s feelings.

“It’s difficult for participants to speak negatively of their pregnancies when they have already had a cute baby that they love very much,” she explained.

Instead, Cutler and her colleagues gathered responses from women “sometimes just minutes after discovering a positive pregnancy test,” she said. Such immediacy allowed researchers to more accurately evaluate ambivalence.

The team’s research was mainly qualitative, according to Cutler. Each study participant was interviewed face-to-face in semi-structured settings. Cutler stressed the role these interviews played in determining the course of the study.

According to the study, advancements in the scientific understanding of pregnancy are directly correlated with women’s welfare, since pregnancy influences diverse aspects of female lives. Newly gained insights on pregnancy ambivalence can contribute toward health care-related quality of life, Cutler said. For instance, when clinicians engage with their pregnant patients in reproductive life planning counseling, screening questions based on pregnancy intention may be less relevant and therefore less frequently employed.

Cutler speculated that future quantitative research could explore the tangible impact of ambivalence during pregnancy on maternal and fetal outcomes.

“In the end, it’s about how to best support women throughout their pregnancies, and how to reduce unwanted, unhealthy pregnancies,” Cutler said. “I hope this small study helped make our knowledge on the subject a little richer.”

Nicole Ahn | sebin.ahn@yale.edu