Developing Maternal Identity during Medically Complicated Pregnancy: Practicing Maternal Virtues Prematurely

Background and Purpose:  Medically complicated pregnancies (MCP) affect 10-15% of pregnant women leading to multiple biopsychosocial stressors.  This coincides with the development of maternal identity and maternal-fetal attachment. Little research exists concerning the phenomenology of maternal identity development in the context of MCP, despite its significance for the mother-baby relationship and long term outcomes for offspring as they grow. We explore women’s experiences during hospitalization for MCP and how MCP hospitalization shapes their prenatal experience of relationship with their fetus as well as their evolving identity as a mother.

Method: We drew data from a larger phenomenological study that included one interview during hospitalization and one several months postpartum; here we focus on Interview 1 findings. Using the tenets of phenomenology, we conducted sixteen semi-structured interviews with women hospitalized for MCP. Interviews were digitally recorded, transcribed verbatim, and coded using Atlas 6.0 qualitative software.  Phenomenological analysis focused on maternal identity development and relationship with the fetus.

Results: Women hospitalized for MCP enact an early maternal identity within the medical surveilling environment that forces an almost unitary focus on oneself as a mother. Women in our sample described high levels of anxiety, worry, and willingness to sacrifice their own comfort and well-being for the fetus.  Surveilling technologies of ultrasound and fetal monitoring intensified these experiences. Women embraced active parenting stances and discourses of motherhood (‘maternal virtues’ of sacrifice, nurture, and anxiety for the fetus) as they constructed maternal identity in the context of MCP. They developed cognitive and affective attributions about their fetus, in essence “babyfying’ them. They reported a sense that the hospitalization brought a unique, early “mom in me” identity into the present.

 Conclusions and Implications: MCP shapes women’s sense of a unique attachment to, and distinctive cognitive representations of, their fetus. This experience is facilitated by, and anxiety heightened through, the use of perinatal technologies such as ultrasound and fetal monitoring that also enhance maternal thoughts about the maternal-fetal bond and fetal attributes. Our analysis suggests that hospitalization simultaneously promotes and challenges women’s early maternal identifications and leads to thoughts and behaviors typical of women who have already given birth, an observation that indicates maternal virtues such as maternal sacrifice and worry are being practiced prematurely.

 Practice implications: Further research is necessary to explore how premature adoption of a (possibly) restricted maternal identity (whereby the woman focuses almost solely on fetal well-being to the disregard of balance with her own health and other facets of daily life) may impact the pregnant woman’s capacity for coping while hospitalized and the mother-child relationship after birth. Social workers have key roles in helping such women process their experience, their perceptions of their responsibilities to the fetus, and the ways they might balance life roles while hospitalized for MCP.