Transformation in self-identity amongst Taiwanese women in late pregnancy: A qualitative study

Background

In a culture transitioning between the traditions of old and modernity, the experience of pregnancy brings added challenges. Pregnant Taiwanese women in large cities are expected to modify their behavior in keeping with long-standing traditions that remain important to their families even if they themselves do not endorse the beliefs. To date, researchers have not examined the processes and the components of the transformation of self-identity during pregnancy under these cultural conditions.

Objectives

To examine the transformation of self during pregnancy by women living in urban Taiwan at a time when modern ideas of women's roles and health care practices co-exist with traditional cultural beliefs on these issues.

Methods

This was a qualitative study using in-depth, open-ended interviews. Eighteen pregnant women receiving prenatal examinations at clinics located in a medical center in Taipei, Taiwan, participated in this study. Interview responses were analyzed using a phenomenological approach.

Results

Cultural and family expectations clearly influenced women's activities and their sense of self during pregnancy. Two themes were central to these experiences. The first, “constructing a new self in the context of cultural values,” reflected the need for women to develop a response to the traditional beliefs, taboos, and public advice made very explicit in their lives during pregnancy. The second theme, “building a new body image from the past self,” addresses how women's reactions to the traditional beliefs and public advice influenced the ways in which the women viewed themselves as pregnant individuals.

Conclusions

Cultural factors and body image issues shape the transformation of self-identity during pregnancy for women living in a modernizing, yet culturally traditional, urban environment in Taiwan. Awareness of the impact that such cultural influences have on the psycho-social experience of pregnancy will help health professionals to better understand and respect the process of self-identity involved in moving toward motherhood, and thereby to provide a woman-centered model of care that is also culturally sensitive.     

Reading, writing, and having babies: a nurturing alternative school program.

This ethnographic study, a component of another study that examined the lived experiences of a small group of pregnant teenagers, focused on the social and learning environment of an alternative school program for pregnant and parenting female adolescents, aged 13 to 19. Field notes, participant observation, group discussion, and informal conversational data were gathered over a 16-week period. Analysis of the data revealed four major themes: nurture and positive regard, sisterhood and belonging, mentoring and sense of family, and proactive learning environment and academic pride. The girls who attended the program developed close relationships with their peers and teachers. Many of them experienced academic success for the first time and reported that pregnancy and impending motherhood motivated them to do better in school. Recommendations for a more comprehensive school-based approach to meeting the needs of pregnant and parenting teens are made, particularly after the babies are born.     

Balancing Risk: A Grounded Theory Study of Pregnant Women's Decisions to (Dis)Continue Antidepressant Therapy

This study explored how eight pregnant women diagnosed with depression managed the decision whether or not to take antidepressants during pregnancy. In total, 11 interviews were conducted and analysed by means of constructivist grounded theory. The major category constructed was Balancing risk, with two minor categories: Assessing depression and antidepressants and Evaluating the impact of significant others. The participants tried to make the safest decision, taking all aspects of their life into consideration. They described successful decision-making in the context of managing social norms that surround pregnancy, in a way that was acceptable to themselves, their significant others and healthcare professionals.     

Resisting,reproducing, resigned? Low‐income pregnant women's discursive constructions and experiences of health and weight gain

In this article, we use qualitative methodology to explore how 15 low‐income women of diverse sociocultural location construct and experience health and weight gain during pregnancy, as well as how they position themselves in relation to messages pertaining to weight gain, femininity and motherhood that they encounter in their lives. Discussing the findings through a feminist poststructuralist lens, we conclude that the participants are complex, fragmented subjects, interpellated by multiple and at times conflicting subject positions. While the discourse of maternal responsibility (i.e. managing personal behaviours for the baby's health) is very much in evidence in their narratives, embodied experiences of pregnancy, lived experiences of financial constraints and religious beliefs provided some with an alternative discourse and resistant subject position. Participants also had mixed emotions about weight gain; they recognized the need to gain weight in order to have a healthy pregnancy, but weight gain was also not welcome as participants reproduced the dominant discourse of obesity and the discourse of ‘feminine’ bodily norms. Based on our results, we advocate for change to recent clinical guidelines and social discourses around pregnancy and weight gain, as well as for policies that provide pregnant women with a range of health‐promoting resources.     

Maternal adaptation during childbearing in Norway,Sweden and the United States

The purpose of the study of 147 healthy primiparous women is to investigate the relationship between maternal adaptation during pregnancy and postpartum. This report is part of a larger study of relationships between family dynamics and maternal adaptation during childbearing in Norway, Sweden and the US. Variables included maternal adaptation, age, social status, mother's employment, type of birth, length of hospitalization and mother infant time together in the hospital. Mothers reporting greater adaptation during pregnancy reported greater adaptation postpartum. Mothers who believed themselves adapted indicated that they were better prepared for labour, had more control over their birth experience, a better relationship with their partner, and perceived greater participation in child care from their partner. Few differences were found in maternal adaptation among all mothers, and few relationships were found among selected sociodemographic variables and maternal adaptation. Formation of maternal identity and mother's confidence in her ability to cope with the tasks of motherhood was affected by mothers' prenatal identification with the motherhood role, supporting the notion that knowing what to expect provides a sense of control. Mothers' prenatal identification with the motherhood role directly or indirectly affected her satisfaction with motherhood. Nurses may want to develop practice strategies to support these findings.     

How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again - a qualitative interview study

Scand J Caring Sci; 2012; 26; 262–270 How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again – a qualitative interview study Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again. Method: Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach. Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal. Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.     

Women's perceptions on risk pregnancy and family implications

This study aimed to identify the women's perceptions of risk pregnancies and to investigate its implications to the families. The data was collected through a qualitative approach, using semi-structured interviews during the months of March and April of 1999. Five pregnant women were interviewed at the Obstetric Clinic of the University Hospital Júlio Müller in Cuiabá/MT. It was found that the women sometimes experience confused and contradictory feelings, since the "myth of motherhood and maternal love" is still very strong in our society. It was observed that the involvement and support of the family during a risky pregnancy are very important to the pregnant woman.     

改进孕妇学校培训模式效果观察

目的提高孕产妇自我保健能力及孕期接受教育的普及率。方法在孕妇学校原有规范教育的基础上改进为多媒体专题讲座、座谈、示范互动、一对一个体针对性补充健康教育、设立网上健康生育论坛、开展孕产妇心理咨询、优生优育及高危妊娠咨询门诊及产后回访等多种形式；授课内容按孕早、中、晚期、分娩期、产褥期5个时期保健知识设12个专题讲座。并增加2个座谈会专题及示范互动活动。结果听课人数同比增加45．39％；听课人员由原来的单一孕妇增加到孕妇的丈夫、婆婆、母亲、准备怀孕的夫妇；满意度由原来的95．00％增加到98．87％；对孕期保健知识掌握明显优于改进前（P〈0．05或P〈0．01），从而促进了自然分娩；产科住院人数同比增加了13．25％，分娩人数同比增长11．01％。自然分娩率由45．05％（496／1101）增加到60．01%（728／1212）。结论孕妇学校培训方式的改进提高了办学的质量，深受广大孕产妇及家属的欢迎，取得了较好的社会效益及经济效益。     

Exercise during pregnancy

Routine exercise has become an accepted component of a healthy lifestyle, and many women want to continue exercising during pregnancy. In most cases, pregnant women can maintain previous levels of activity, while sedentary women can undertake new activities gradually.     

The externality of the inside: body images of pregnancy

This paper draws on literature, empirical data and a range of theoretical perspectives on the maternal body to examine understandings of the relationship between a pregnant woman and her foetus, with a particular focus on the body images used by women to represent this relationship. Psychoanalytic and nursing accounts of the relationship between mother and foetus have often described a symbiotic 'oneness' or unity during pregnancy. Such accounts, however, stress the temporary nature of this unity and identify a series of 'stages' of separation or 'polarisation' between mother and foetus during pregnancy. In contrast, many of the 25 women who participated in our interview study of new motherhood described a confusion of the boundary between self and foetus. For many women the experience of pregnancy and the relationship with the unborn baby was ambiguous and uncertain. Importantly, none of these women described her relationship with the foetus as a series of developmental stages, but rather saw it as fluctuating throughout pregnancy. These findings are more consistent with the work of feminist theorists who describe pregnancy as a dynamic and fluid merging of the inside and the outside of the body/self.     

Teenage pregnancy: "having a baby won't affect me that much"

This qualitative study explored the experience of pregnancy from the perspectives of female adolescents. Interviews were conducted over a 16-week period with eight pregnant students who attended an alternative school program for pregnant teens. The hermeneutic social science method based on the work of Kockelmans (1975) and Steeves and Kahn (1995) guided the analysis. Overall, participants expressed a sense of optimism and confidence in their abilities to manage single parenthood, achieve educational goals, and maintain supportive relationships with the fathers of their babies. The findings support previous research and raise questions that warrant further study, particularly in relation to fighting behaviors.     

Juggling identities of rheumatoid arthritis,motherhood and paid work – a grounded theory study

Purpose: To explore how women with rheumatoid arthritis manage their illness, motherhood, and work life.

Methods: A constructivist, grounded theory approach based on individual interviews and participant observations with 20 women with rheumatoid arthritis who participated in work life and had children living at home or were pregnant. After initial and focused coding Goffman’s concepts of social identity were applied.

Results: A core category: “Juggling meaningful identities” and three conceptual categories were developed: (1) Work life as the strongest identity marker; (2) Motherhood: a two-sided act; (3) Living with rheumatoid arthritis as an identity? Paid work, motherhood, and illness are linked to the women’s social identities. The women construct and change their identities in interactions with children, partners, other parents, colleagues, and employers.

Conclusion: The women attribute the highest priority to their professional identity, spending the majority of their time and energy in an effort to appear as “good stable workers”. The disease is seen as a hindrance in this regard, and the illness identity is almost completely rejected. In motherhood, the women prioritize close interaction with their children, and deprioritize external activities. Extended outbreaks of the disease and issues regarding the children force the women to deprioritize working life.

• Implications for rehabilitation

• Juggling meaningful identities of rheumatoid arthritis, motherhood, and paid work challenge women in managing their everyday lives. Therefore, rehabilitation professionals should support individuals to develop new strategies to manage the challenges they experience regarding juggling motherhood and work ability.

• Work is a dominant identity marker for women with rheumatoid arthritis therefore, rehabilitation professionals have an important role to play in investigating possible ways for the individual to maintain employment or return to work.

• Living with rheumatoid arthritis and being a paid worker challenge women’s role performance and thereby their identification as mothers. Therefore, rehabilitation professionals have to support the women and their families.

     

Factors related to the continuation of employment during pregnancy among Japanese women

Aim: To determine the relationship between the working situation (full‐time housewife, stopped working during pregnancy, or currently employed) and the lifestyle factors, reasons for stopping work during pregnancy, and effects of working conditions in order to identify the factors that are related to the continuation of employment among pregnant Japanese women. Methods: In a cross‐sectional study, a questionnaire was administered to pregnant women who visited an obstetrics clinic in a Tokyo suburb for an outpatient medical check‐up during July and August 2004. Results: The data of 530 healthy pregnant women were analyzed. The pregnant women who stopped working during their pregnancy had lower mental health scores than the full‐time housewives and employed pregnant women. In each trimester, the employed pregnant women reported a shorter daytime sleep duration than the pregnant women who stopped working during their pregnancy and the full‐time housewives. The reasons for stopping work during pregnancy were categorized as somatic symptoms due to pregnancy, working conditions, and a sense of values or social reasons. The employed women in the third trimester more often reported the availability of, and access to, a rest area in their company, compared to those in the first and second trimesters. Conclusion: The lifestyle factors of the pregnant women were different, based on their work situation. In particular, the employed pregnant women had a shorter daytime sleep duration. The pregnant women who stopped working during their pregnancy could have benefited from mental health support. In addition, the reasons for stopping work during pregnancy were different in the three trimesters. A flexible system is needed for working women that adapts to the physical changes that occur during pregnancy.     

Strength of motherhood: nonrecurrent breast cancer as experienced by mothers with dependent children

The experience of breast cancer in mothers of dependent children and the strategies these women use to handle their situation of illness in relation to the children was the focus of this study. Ten women with nonrecurrent breast cancer were interviewed using phenomenology as a theoretical framework. The findings reveal that the women needed to balance themselves from being needed and perhaps not existing, balancing between demands, a will to be strong and allowing herself to be sick, and balancing between telling the truth and protecting the children from the truth. The women had strategies to help them in this struggle. To carry on as usual and continue everyday life became very important to them. To do this they had to combine their own strength with support from others and try to turn things into a positive perspective. The essential meaning of living with breast cancer and having dependent children implied using the strength of motherhood to balance conflicting forces and thereby continuing everyday life. The clinical implications include awareness and support to maintain everyday routines and generate strength.     

Double binding, abusive intimate partner relationships, and pregnancy.

The purpose of this study was to extend and integrate the process theories of abuse and becoming a mother in order to provide a contextually appropriate perspective for understanding women's behavioural responses to intimate partner abuse during pregnancy. Double binding is proposed as a construct for understanding intimate partner abuse during pregnancy. Double binding refers to the simultaneous and often conflicting psychological and social processes of binding-in to the unborn child and to the abusive intimate partner that women engage in as they perform the developmental tasks associated with becoming a mother while living with an abusive partner.This construct was developed through an inductive-deductive process using clinical experience, a literature review, and qualitative data from 2 studies of abuse during pregnancy. The authors conclude that double binding is a suitable lens through which to interpret pregnant women's behavioural responses to abuse.They offer suggestions regarding clinical practice and research to further develop appropriate interventions incorporating this construct.     

Parenting an infant during alcohol recovery

This qualitative study explored women's concurrent experiences of alcohol/drug recovery while parenting an infant. The study explored women's experiences of recovery from alcohol/drug dependence during the first year after their infant's birth. Balancing emerged as the process that explained how women successfully integrated the recovery and motherhood processes into their identity. Understanding the balancing process will increase sensitivity of care.     

Women's voices: the lived experience of pregnancy and motherhood after diagnosis with HIV.

The objective of this study was to explore the meaning of pregnancy after diagnosis with HIV. Study design was a qualitative analysis of individual informant interviews conducted in two academic health centers in metropolitan New York. Participants were a purposive sampling of 9 women, 34 to 53 years old, who had been diagnosed with HIV and were currently pregnant or who had become mothers postdiagnosis. The result of the study included themes of extreme emotional distress after HIV diagnosis, feeling stigmatized, emotions related to the pregnancy and baby, experiences with health care providers, and motherhood for women with a diagnosis of HIV. The author concluded that the experience of pregnancy for a woman with HIV is one fraught with isolation, anxiety, and distrust, but it is also one of hope for the normalcy that motherhood may bring. Further research is needed to determine best practice for care delivery as women with HIV enter the health care system, especially for perinatal services.     

Beyond biomedicine: health through social and cultural understanding

This article argues that traditional approaches to reproductive health are concerned with safe motherhood. In the discourse of reproductive health, safe motherhood is defined as the ability to bear and raise children, and to plan and space births for safe pregnancy, focusing strictly on the biological abilities of women [Reproductive Health Matters, 2005, 13: 34]. This fails to account for how women construct, negotiate and maintain their health within their own cultural context. To understand how social context influences meanings of health, in-depth interviews were conducted with young Nepalese women living in poverty. Centralizing women's voices not only creates opportunities for exploring how local context shapes meanings of health but also allows alternative health meanings of the cultural participants to emerge. In particular, by highlighting narratives we are able to understand how women actively (re)construct dominant meanings of reproductive health and in turn act upon meanings that are socially and culturally relevant.     

Towards understanding the concept of risk for pregnant women: some nursing and midwifery implications

Aims and objectives. This paper aims to explore the concept of risk in pregnancy. Background. Notions of risk and ‘not knowing’ have always surrounded pregnant women, although in the last two decades trends of increased consumer confidence and midwifery activism have together promoted a greater appreciation of pregnancy as a normal life event. At the same time, advances in pregnancy‐related technologies have contributed new levels of concern related to an increasing ability to detect minor abnormalities by ultrasound. This, in turn, causes a concordant rise in the number of women referred to high‐risk pregnancy care to monitor suspect findings. Overall, it seems likely that this increasing emphasis on abnormality detection and risk may have serious implications for women. Design. Concept analysis. Method. In this paper, I undertake an exploration of the concept of risk as understood by health professionals and pregnant women. Then, using Deborah Lupton’s understanding of a ‘discourse of risk’, I discuss the ways pregnant women both contribute to and are enmeshed in, this discourse. In the final section, I consider how nurses act informally to shield vulnerable women. Conclusions. Health professionals and pregnant women understand risk differently. Women employ a subjective appraisal of risk, measuring it against their personal values and prior experience, while health professionals evaluate risk in an objective manner. Relevance to clinical practice. As increasing numbers of women are referred to ‘at risk’ care, it is important that health professionals understand and respond to maternal understandings of risk. Nurses and midwives particularly, have a role to play in assisting women to make sense of risk calculations. In this way, they can act to ameliorate the growing concept of risk for pregnant women.