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Disenfranchised Grief in Postpartum Women: a Heuristic Inquiry Into Women's Lived Experience of Loss of the Dreamed-Of Birth

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Disenfranchised Grief in Postpartum Women: a Heuristic Inquiry Into Women's Lived Experience of Loss of the Dreamed-Of Birth University of Pennsylvania ScholarlyCommons Doctorate in Social Work (DSW) Dissertations School of Social Policy and Practice Fall 10-9-2015 Disenfranchised Grief In Postpartum Women: A Heuristic Inquiry Into Women's Lived Experience Of Loss Of The Dreamed-of Birth Rumyana P. Kudeva University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations_sp2 Part of the Maternal and Child Health Commons, Maternal, Child Health and Neonatal Nursing Commons, Other Mental and Social Health Commons, Social Work Commons, and the Women's Studies Commons Recommended Citation Kudeva, Rumyana P., "Disenfranchised Grief In Postpartum Women: A Heuristic Inquiry Into Women's Lived Experience Of Loss Of The Dreamed-of Birth" (2015). Doctorate in Social Work (DSW) Dissertations. 72. https://repository.upenn.edu/edissertations_sp2/72 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations_sp2/72 For more information, please contact [email protected]. Disenfranchised Grief In Postpartum Women: A Heuristic Inquiry Into Women's Lived Experience Of Loss Of The Dreamed-of Birth Abstract Abstract DISENFRANCHISED GRIEF IN POSTPARTUM WOMEN: A HEURISTIC INQUIRY INTO WOMEN’S LIVED EXPERIENCE OF LOSS OF THE DREAMED-OF BIRTH Rumyana P. Kudeva, MSW, LCSW Jeffrey Applegate, PhD The childbearing year is of upmost significance in a woman’s life, carrying inherent possibilities of empowerment and self-actualization. Most women create a vision of their “dreamed-of birth” that represents their beliefs about birth and their role in the process. However women’s expectations about birth are often subverted by the authoritative knowledge and practices of the Western maternity care system or by the unpredictable nature of the birth itself. The pregnant woman repeatedly becomes the object of the “medicalized gaze” of a technocratic medical system that places her in the passive role of “compliant patient,” being “delivered” by professionals and robbed of her inner power and embodied knowledge of giving birth. Coming out of the childbirth experience with feelings of being uncared for, silenced, and even abused can cause serious long term psychological reactions in postpartum women. Many of these women are left unacknowledged and unsupported by professionals who unwittingly contribute to the disenfranchisement of their grief. Furthermore their grief remains invisible if they continue to appear capable and productive in their lives. This phenomenological study explores how a sample of nine women whose actual birth experience violated their “dreamed-of” birth coped with associated feelings of loss and unacknowledged grief. Employing Kenneth Doka’s concept of disenfranchised loss and grief as the theoretical framework, I conducted informal conversational in-depth interviews and employed a heuristic approach in order to explore women’s lived experience of postpartum grief. From my findings, I draw specific implications for clinical social work knowledge building and practice. Degree Type Dissertation Degree Name Doctor of Social Work (DSW) First Advisor Jeffrey Applegate, PhD Second Advisor Carolyn Walter, PhD Third Advisor Robbie Davis-Floyd, PhD Keywords loss of the dreamed-of birth, disenfranchised grief, women's mental health, negative childbirth experiences, feminist theory and childbirth, heuristic inquiry Subject Categories Maternal and Child Health | Maternal, Child Health and Neonatal Nursing | Other Mental and Social Health | Social and Behavioral Sciences | Social Work | Women's Studies This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations_sp2/72 DISENFRANCHISED GRIEF IN POSTPARTUM WOMEN: A HEURISTIC INQUIRY INTO WOMEN’S LIVED EXPERIENCE OF LOSS OF THE DREAMED-OF BIRTH Rumyana Petrova Kudeva, MSW, LCSW A DISSERTATION In Social Work Presented to the Faculties of the University of Pennsylvania In Partial Fulfillment of the Requirements for the Degree of Doctor of Social Work 2015 Jeffrey Applegate, PhD Dissertation Chair John L. Jackson, Jr., PhD Dean, School of Social Policy and Practice Dissertation Committee Carolyn Walter, PhD Robbie Davis-Floyd, PhD Copyright 2015 By Kudeva, Rumyana P. All rights reserved. Abstract DISENFRANCHISED GRIEF IN POSTPARTUM WOMEN: A HEURISTIC INQUIRY INTO WOMEN’S LIVED EXPERIENCE OF LOSS OF THE DREAMED-OF BIRTH Rumyana P. Kudeva, MSW, LCSW Jeffrey Applegate, PhD The childbearing year is of upmost significance in a woman’s life, carrying inherent possibilities of empowerment and self-actualization. Most women create a vision of their “dreamed-of birth” that represents their beliefs about birth and their role in the process. However women’s expectations about birth are often subverted by the authoritative knowledge and practices of the Western maternity care system or by the unpredictable nature of the birth itself. The pregnant woman repeatedly becomes the object of the “medicalized gaze” of a technocratic medical system that places her in the passive role of “compliant patient,” being “delivered” by professionals and robbed of her inner power and embodied knowledge of giving birth. Coming out of the childbirth experience with feelings of being uncared for, silenced, and even abused can cause serious long term psychological reactions in postpartum women. Many of these women are left unacknowledged and unsupported by professionals who unwittingly contribute to the disenfranchisement of their grief. Furthermore their grief remains invisible if they continue to appear capable and productive in their lives. iii This phenomenological study explores how a sample of nine women whose actual birth experience violated their “dreamed-of” birth coped with associated feelings of loss and unacknowledged grief. Employing Kenneth Doka’s concept of disenfranchised loss and grief as the theoretical framework, I conducted informal conversational in-depth interviews and employed a heuristic approach in order to explore women’s lived experience of postpartum grief. From my findings, I draw specific implications for clinical social work knowledge building and practice. iv Table of Contents Abstract…………………………………………………………………………….…...iii Table of Contents ……………………………………………………………………….v I. Introduction……………………………...……………………………………………...1 Problem statement…………………………….…………………………………………..1 Purpose of study ……………………………..…………..……………...………..……...5 Research question …………………………………………...……………….…………...6 Significance of the study…………………………………………………………………7 Theoretical framework……………………………...……………………………………8 II. Literature review……………………...……………………………………............…10 1. Dreaming about birth – women’s expectations and beliefs about childbirth in contemporary America ……………………………………………………………..……11 1.1. Authoritative knowledge about birth and its influence over women’s expectations and beliefs about childbirth ……………………..……………….....……………………11 1.2. The internalized gender technologies of power and their influence over women’s expectations about childbirth …………..………………………………………………..14 1.3. Fear of pain and the promise of painless childbirth…………………………………16 1.4. Intergenerational transmission of birth expectations ……………………………….18 2. Birth expectations vs. lived experience of childbirth……………………………….…20 3. Shattered dreams – adverse psycho-social outcomes of women’s unmet expectations of childbirth ………………………………………………………………………………...24 3.1. Loss of control and disempowerment during childbirth…………………………….25 v 3.2. Lost relationships……………………………………………………………….......29 3.3. Possible feelings after losing the dreamed-of birth…………………………………34 3.4. The impact of negative childbirth experience on reproductive decisions and adaptation to motherhood and parenting………………………………………………....36 4. Disenfranchised grief and the lost dreamed-of birth…………………………………..40 5. Disenfranchised grief after a loss of the dreamed-of birth and the creation of new self- narrative………………………………………………………………………………….47 III. Methodology…………………………………………………………………………50 Research design………………………………………………………………………….50 Sampling and recruitment………………………………………………………………..54 Setting……………………………………………………………………………………58 Methods of data collection………………………………………………….…...............58 Methods of data analysis…………………………………………………………………59 Ethical considerations and human subject protection……………………………………64 Discussion of rigor of heuristic research………………………………..………….……65 Limitations of the study………………………………………………………………….66 Reflexivity statement…………………………………………………………………….67 IV. Findings ………………………………………………………………………….….71 Individual depictions………………………………………………………………….…71 Table I…………………………………………………………………………………....72 Andrea……………………………………………………………………………………76 Elizabeth………………………………………………………………...……………….79 Kaya……………………………………………………………………………………..82 vi Kelly……………………………………………………………………………………...88 Liz…………………………………………………………………………………...…...93 Lynn……………………………………………………………………………………...97 Maggie………………………………………………………………………………….101 Mary…………………………………………………………………………………….107 Sarah……………………………………………………………………………………113 Composite depictions…………………………………………………………………...117 Summary………………………………………………………………………………..137 V. Discussion …………………………………………………………………………..138 Study findings and existing literature…………………………………………………..139 Clinical implications……………………………………………………………………148 Implications for clinical social work……………………………………………………151 Future research questions……………………………………………………………….153 Creative synthesis………………………………………………………………………154 References………………………………………………………………………………157 Appendix A……………………………………………………………………………..186 Appendix B……………………………………………………………………………..190
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