Alleviating stress among racial minorities during pregnancy with VR

Two years ago, Wilmar Mondestin left Haiti amid rising violence. She found herself in the United States, in new surroundings, getting used to a new way of life — and pregnant. During this vulnerable time, Mondestin found support from the burgeoning world of healthcare-related virtual reality (VR) technologies.

Pregnancy is a period of stress, with research showing that 17 percent of pregnant people are psychologically stressed, with clinically significant levels of depression, anxiety, and perceived stress, and another 16 percent are physically stressed, with relatively higher daily blood pressure and greater caloric intake compared to healthy pregnant people.

Stress during pregnancy disproportionately affects people of color. One 2020 study revealed that Black birthing people had more risk factors for chronic stress than their White counterparts. According to the Policy Center for Maternal Mental Health, chronic stress tied to racism is a risk factor for maternal mental health disorders. In fact, Black women are at risk of the ‘weathering hypothesis’ defined as “a chain of biological processes that undermine Black women’s physical and mental health.”

Though racial minorities face these elevated risks during pregnancy, they often do not get the help they need.

Judite Blanc, PhD, an assistant professor of psychiatry and behavioral science at the University of Miami Miller School of Medicine, pointed to research showing significant disparities in the perinatal experiences of birthing people from racial and ethnic minority and low-income groups compared to their White peers.

“Within the perinatal care landscape, racial and ethnic minority mothers encounter systemic barriers that impede their access to high-quality services,” Blanc said in an interview with mHealthIntelligence. “These barriers include inadequate pain management, insufficient mental health screening and treatment, and a lack of essential perinatal services.”

Stress and anxiety during pregnancy not only affect the birthing person’s health but have also been linked to increases in the number and variety of infant illnesses during the first year of life and psychiatric and cardiovascular diseases decades later.

Thus, strategies to combat these challenges and alleviate the stress pregnant people of color face are essential. Blanc and a team of researchers from the University of Miami Miller School of Medicine and the University of Pittsburgh conducted a study exploring the complexities of pregnancy and motherhood among racially diverse perinatal women and examining whether new VR technology is effective in helping this population manage their stress. The study was published in Frontiers in Psychiatry last month.

The research team analyzed qualitative data from two focus groups, comprising perinatal women, primarily identifying as Black or Latina, and enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. They assessed the efficacy of the Nurture VR program, which provides mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and the postpartum period through a VR headset.

“The results yielded narrative insights across five primary themes: navigating motherhood, maternal mental wellness, resilience, embodied therapy, and postpartum,” said Blanc.

Within these themes, participants shared challenges related to time management, caregiver burden, financial stress, societal pressures to conceal emotions, and professional responsibilities.

However, they expressed positive sentiments regarding embodied therapy and provided favorable feedback on the VR program. The participants engaged in the Nurture VR program for five weeks, completing modules tailored to different pregnancy and postpartum stages.

According to the study, the women noted that the immersive experience allowed them to “escape” into guided imagery and relaxation techniques.

Mondestin, one of the women participating in the study, echoed this in an interview with mHealthIntelligence.

“Utilizing the VR technology offered me a sense of solace, providing a space to unwind and connect with the developing baby within me,” she said. “It facilitated a weekly overview of fetal development, fostering a deeper emotional and physical connection.”

Mondestin experienced high levels of anxiety during her pregnancy, primarily due to a lack of information and not having a close rapport with her OB-GYN. Mondestin had to quickly find a new OB-GYN after the unexpected departure of her original physician four months into her pregnancy.

VR helped Mondestin during this challenging period by providing information and relaxation through diversion.

“It serves as a tool for distraction, enabling women to divert their attention from immediate challenges,” Blanc said. “This aspect of distraction is especially crucial when considering the unique and cumulative stressors faced by perinatal women from marginalized backgrounds.”

Not only that, but VR tools are also portable and provide on-demand care, making them valuable assets for low-income communities that face transportation and other social determinants of health (SDOH) barriers.

“Whether grappling with concerns related to pregnancy, social support, healthcare accessibility, discrimination, or socio-economic obstacles, VR can offer a valuable reprieve from these stressors during this critical period,” Blanc noted.

However, there are some limitations to VR use in maternal mental healthcare. First, some study participants were concerned about their inability to multitask while using the VR headset. The study stated that this underscores “the essential nature of multitasking in their roles as mothers” and “the broader challenge of finding precious moments for self-care within their demanding schedules.”

Further, stigma related to digital health tool use remains a trenchant hurdle to VR adoption.

“This stigma manifests in various forms, such as concerns about escapism, apprehensions regarding technology dependence, and the enduring stigma surrounding mental health issues,” Blanc said.

Some participants also noted that the lack of human presence and real-time answers in the VR program were the primary barriers to its usage.

Blanc highlighted several strategies that can help mitigate challenges to VR adoption. First, more research needs to be focused on developing virtual care programs that enhance accessibility and engagement, particularly for socioeconomically disadvantaged groups. Second, digital health companies should develop customized interventions that address the needs of diverse populations with a human-centered approach. Finally, health insurance companies should facilitate patient access and engagement by integrating VR therapy into covered healthcare services.

For first-time mothers without a support system like Mondestin, the VR tool was accessible and valuable.

“I would recommend it to others, as it gave me a beneficial means of relaxation and bonding throughout pregnancy,” she said.

As VR becomes increasingly embedded into healthcare delivery, Blanc hopes her study can help “lay the groundwork for future research to delve deeper into these themes and refine digital interventions to better meet the diverse needs of perinatal women and mental health providers.”