On Being Mother and Patient: Dialectical Struggles During Medically High‐risk Pregnancy

Abstract

Medically high‐risk pregnancy (MHRP) affects 3 to 10% (diagnosis‐dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well‐being. Although mothers’ prenatal distress and mother–infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient–provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy‐depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother–infant relationship is considered, and strategies for psychosocial support are identified.

Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory

“…The mother-fetus dyad is characterized by the symbiotic relationship and maternal-fetal bond ( 1 ) . When this relationship or bond is interrupted, pregnant women are classified as high-risk and may experience pregnancy complications such as hemorrhage, placental abruption, uterine atrophy, premature membrane rupture, and others, which can lead to unfavorable outcomes ( 2 - 3 ) .…”

“…O binômio mãe-feto é caracterizado pela relação simbiótica e pelo vínculo materno-fetal ( 1 ) . Quando essa relação ou vínculo são interrompidos, as gestantes são classificadas como de alto risco e podem apresentar complicações gestacionais, como hemorragia, descolamento de placenta, atrofia uterina, ruptura prematura de membranas, entre outras, que podem resultar em desfechos desfavoráveis ( 2 - 3 ) .…”

Midwives’, obstetricians’, and nurses’ perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review

“…This may be attributed to the woman’s inability to anticipate unplanned pregnancy complications and/or not having an anticipatory roadmap of knowing what to expect [ 18 ]. Furthermore, women’s transition to motherhood is also combined with a transition to ‘patient’, an additional adjustment that women who are not classified as high risk may not experience [ 20 ]. The label ‘patient’ may also be an unwelcome adjustment for some women who may consider childbirth to be a normal physiological process [ 20 ].…”

“…Furthermore, women’s transition to motherhood is also combined with a transition to ‘patient’, an additional adjustment that women who are not classified as high risk may not experience [ 20 ]. The label ‘patient’ may also be an unwelcome adjustment for some women who may consider childbirth to be a normal physiological process [ 20 ].…”