Women’s decisions to exercise in pregnancy: negotiating conflicting identities

Substantial benefits can be gained by participating in regular physical exercise, however only a minority of women meet current pregnancy exercise recommendations and there is limited understanding of women’s decision-making regarding exercise in pregnancy. The purpose of this constructivist grounded theory study was to develop a theoretical insight into the factors that influence women’s decisions regarding exercise in pregnancy and how they process the influences and multiple alternatives they encounter. The constructivist approach drew on the subjective researcher/participant interrelationship to co-construct meaning from the data and ultimately render the women’s experiences into theoretical interpretations. The theory presented was built inductively from the experiences of 10 pregnant women who exercised regularly, supplemented by insights from theoretical sampling of fitness experts, internet forums and extant literature. Longitudinal, audio-recorded semi-structured interviews occurred twice during each pregnancy and 6-8 weeks postnatal. Data generation and data analysis ran concurrently and iteratively using the constant comparative method of analysis. Theoretical constructs generated by the data were progressively amplified and clarified through a series of inductive-deductive cycles and theoretical sampling that drove the evolving interview schedules. Theorising ideas in the form of detailed memos was a fundamental part of the analysis and enabled a detailed audit trail to be established. The resultant substantive theory of ‘Accommodating the pregnant self’ conceptualises pregnancy as a transitional period during which women’s self-identity is modified. ‘The exercising self’ was a salient and valued facet of the women’s self-identity and continuing to exercise enabled women to maintain a degree of continuity and control that was integral to their sense of maintaining and to a degree regaining their past valued self. Decisions regarding exercise were influenced by a complex interplay of contextual factors that simultaneously encouraged exercise and rest. This consequently triggered a degree of identity conflict between two domains of their self-identity, ‘the exercising self’ and ‘the pregnant self’. The women reacted to the challenges to their identity through the process of self-identity regulation. Through this process they gradually re-constructed their self-identity to accommodate their pregnant self while contemplating possible future selves against various self and social normative standards. Negotiating conflicting identities was an integral component of the decision-making process, and ultimately resulted in many of the women modifying their activities to accommodate the pressures they faced to conform to social ideologies of ‘the pregnant self’. The theory explores a range of strategies that the women used to deal with identity conflict, particularly drawing on selective perception and self-justification to resolve cognitive dissonance. It also highlights a duality in the factors that influenced their decisions which suggests women’s identity characteristics resulted in a propensity for behaviour to be steered by either internal (personal) or external (relational and environmental) influences. The substantive theory underscores the significance of self-identity in steering the decisionmaking process. The findings provide insight into how women might be better supported to make informed and assured decisions regarding lifestyle choices. The theoretical potential to inform interventions to enhance activity levels in a wider population is highlighted.