WOMEN OF ADVANCED MATERNAL AGE AND MISCARRIAGE: AN EXAMINATION OF THE ESSENCE OF THE EXPERIENCE By Rebecca Jean Wright A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Human Development and Family Studies – Doctor of Philosophy 2013 ABSTRACT WOMEN OF ADVANCED MATERNAL AGE AND MISCARRIAGE: AN EXAMINATION OF THE ESSENCE OF THE EXPERIENCE By Rebecca Jean Wright It is estimated that one in four of all clinically recognized pregnancies will end in miscarriage (Lerner, 2003; Rai & Regan, 2006). The medical community considers miscarriage to be the most common complication of pregnancy (Rai & Regan, 2006). Today, more women are choosing to delay childbearing (Mathews & Hamilton, 2009) and the risk of miscarriage increases with maternal age (Balasch & Gratacos, 2011; Garmel, 2002). Although it has been well documented that miscarriage is a relatively common pregnancy outcome and more likely to happen among women aged 35 years and older, very little research has been conducted on the quality of such a lived experience. Given that, this qualitative study explores the essence of the experience of miscarriage among women aged 35 years and older. Concepts from Ambiguous Loss Theory and Feminist Theory guide this study, with the Human Ecological Model situating the experience within various levels of context. A Transcendental Phenomenological approach, as specified by Moustakas (1994) is utilized to analyze the content of 10 in-depth participant interviews. The salient themes identified suggest that women experience miscarriage from a physical, emotional, temporal and social context. From these themes of experience, the essence of miscarriage for the participants in this study were found to be 1) physically experiencing intense loss and grief, 2) having a sense of otherness, 3) a continuous search for meaning and 4) feelings of regret and self-blame. Clinical implications are provided, as well as future research directions as pertaining to the phenomena and limitations to this study. Copyright by REBECCA JEAN WRIGHT 2013 DEDICATION This dissertation is dedicated to my two sons, Elliott and Phillip, and to my husband, Jason. iv ACKNOWLEDGEMENTS Leaving a successful career in the biotech industry to pursue a career in family science and family therapy, while at that same time starting my own family, has been the biggest challenge of my life. Coming from the east coast, Michigan State University seemed the most unlikely of options, yet proved to be the best choice. The Human Development and Family Studies department provided me an exemplary academic environment and a strong system of support, for which I am very grateful. I would like to acknowledge and to thank all of those who have influenced me and my challenging academic journey. I especially want to thank my dissertation advisor, Dr. Marsha Carolan. Without her support, encouragement and guidance, this research would not have been possible. Her influence, both personally and academically, has played a significant role in my development as a scholar, a therapist, and as a mother. Special thanks go to my other committee members, Dr. Barbara Ames, Dr. Deborah Johnson and Dr. Elaine Yakura. Each has contributed positively to my overall experience. Dr. Ames, thank you for extensively editing my work. Your attention to detail and editing expertise is something to admire. You have made me a much better writer. Dr. Johnson, thank you for always bringing the humor, while simultaneously demanding research rigor. You have made me a better researcher. Dr. Yakura, thank you for bringing an outsider and global perspective to my work. Your endless encouragement of me and my work has made me a stronger student and has allowed me to believe in the value of my future contributions to the field. I must thank my sister, Michelle Auffarth, for her sustained influence for all my life. She served as my grief therapist during my own miscarriage experience. I can sometimes get mired v down in the grim realities of my research and clinical interests, but my sister and her family of six wonderful children is the face of hope. My sister has modeled for me family resilience and cohesion, the meaning of “good mothering,” and together we have set the highest standard of sibling love and friendship. Her encouragement of my academic pursuits has meant the world to me. I also want to thank my mother-in-law, Ruth Anderson for her endless encouragement and tireless efforts to support me by providing the best quality childcare available! Without her provision of care for my children when I had to be away, none of this would have been possible. To Amy Maffeo and Dr. Kayla Katterman, thanks for the years of friendship and for all the spirit lifting. Few words can describe the love and appreciation that I feel for my husband, Jason. He has provided so much love, support, and encouragement throughout our time together. He is an amazing husband and a loving father to our two sons, and for that, I am so very thankful. To my sons, Elliott and Phillip, you both are my inspiration. You each have served as little reminders to me that I could not give up. You boys are the essence of my life story. Being your mother has been my greatest honor and achievement. And to the baby in between, the one who was, and then suddenly was not, you broke my heart and opened it up to be filled with the love of my rainbow baby Phillip, who would not be if you had not been. Finally, I would like to thank the 10 women who participated in this study and shared their story of miscarriage with me. Your unique contributions to this work make it as much yours as it is mine. I hope that I have done well in attempting to capture your voice and to tell your story. Each of you has an important narrative to share with the social and academic world. vi TABLE OF CONTENTS LIST OF TABLES ................................................................................................................................ xi LIST OF FIGURES ............................................................................................................................. xii Chapter One: Introduction .............................................................................................................. 1 Significance .................................................................................................................................. 1 Miscarriage and Women 35+ .................................................................................................. 1 Purpose of Study ......................................................................................................................... 3 Background of Theoretical Constructs Regarding Motherhood and Miscarriage ...................... 3 Clarifying Motherhood ............................................................................................................ 3 Motherhood as a Developmental Stage and Social Role ........................................................ 4 Delayed Motherhood .................................................................................................................. 5 Pregnancy and Miscarriage ......................................................................................................... 7 Pregnancy Rates ...................................................................................................................... 8 Miscarriage Types .................................................................................................................... 9 Miscarriage Rates and Risks .................................................................................................. 11 Theoretical Frameworks ............................................................................................................ 14 Ambiguous Loss Theory ......................................................................................................... 14 Feminist Theory ..................................................................................................................... 15 Human Ecological Theory ...................................................................................................... 16 Combined Conceptual and Theoretical Map ............................................................................ 18 Research Questions ................................................................................................................... 20 Chapter Two: Literature Review ................................................................................................... 23 Ambiguous Losses with Miscarriage ......................................................................................... 23 Cultural Context ........................................................................................................................ 24 Unresolved Social Role ........................................................................................................... 24 Social Context ............................................................................................................................ 25 Loss of Social and Personal Status of Mother-to-Be.............................................................. 25 Relational Context ..................................................................................................................... 26 Ambivalence Towards Pregnant Others ...............................................................................