Date Presented 4/1/2017
A phenomenological approach and heuristic design were used in this preliminary research study to examine the lived experience of miscarriage. Understanding the significance of occupation in the context of bereavement provides opportunities for program development, advocacy, and further research.
Primary Author and Speaker: Marit Watson
Contributing Authors: Vanessa D. Jewell, Sarah L. Smith
PURPOSE: Miscarriage is often incorrectly believed to be a solitary moment of loss. However, the physical, emotional, and psychological ramifications of miscarriage may extend across a lifetime (Cahill, 2015). This phenomenological study sought to understand the lived experience of women coping with unexpected loss in order to fill gaps in current insights and studies related to the influence of miscarriage on relationships, perceptions of motherhood, and the meaning of occupation in the context of grief. Therefore, this study addressed the following research questions: What is the lived experience of women who are coping with miscarriage? In what ways does miscarriage impact relationships with friends and family? How does miscarriage impact perceptions of motherhood? In what ways does miscarriage influence occupational roles and routines?
DESIGN: This study used a phenomenological approach and a heuristic design. Four women participated in this study. Inclusion criteria were women ages 25–45 who were proficient in English and had a personal history of at least one miscarriage within the past 5 yr. Women whose miscarriage occurred while under a physician’s care after an assisted reproductive procedure such as intrauterine insemination or in vitro fertilization and women who were diagnosed with a chronic mental health disorder or chronic illness prior to miscarriage were excluded from the study.
METHOD: Interviews with all consented participants were conducted via telephone, digitally recorded, and transcribed verbatim. Questions examined the lived experience of miscarriage and the subsequent impact on relationships, perceptions of motherhood, and the evolving role of occupation after loss. The interview guide was created with critical review by a panel of women with a history of miscarriage. Participants also completed a brief demographic questionnaire. Due to the intimate nature and heuristic design of this research study, a single data analyst with a personal history of miscarriage was used to conduct, transcribe, and code participant interviews. In addition, the first author engaged in Moustakas’s five basic phases of heuristic inquiry throughout the study and merged tacit knowledge, personal reflections, and data from participant interviews. Interview transcripts were coded line by line by the first author with consideration of four present categories: miscarriage experience, relationships, perceptions of motherhood, and occupation. Next, the data were further analyzed with consideration of emergent categories such as trauma, self-identity, and validation of loss. Central themes emerged as the preset and emergent categories were merged. Participants were contacted to ensure both accuracy of interview transcripts and credibility of the findings.
RESULTS: The following four themes emerged during data analysis: (1) The Journey: Ambiguity, Vulnerability, and Trauma of Miscarriage; (2) Desensitized and Disconnected: Implications for Medical Practice; (3) Seeking Acknowledgment and Validation of Loss: Impact on Relationships; and (4) Occupational Engagement: Evolving Roles and Routines.
CONCLUSION: The findings of this study indicate that the phenomenon of miscarriage is a life-changing experience that influences relationships and self-identity and shapes perspectives of life roles and occupational engagement on a lifetime continuum.
IMPACT STATEMENT: The findings of this study inform occupational therapy practice by providing practitioners with an intimate perspective of the evolving role of occupation in the context of bereavement. With this knowledge, occupational therapists may be better equipped to work with people grieving the loss of a loved one or occupation.
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68, S1–S48. https://doi.org/10.5014/ajot.2014.682006
Cahill, A. J. (2015). Miscarriage and intercorporeality. Journal of Social Philosophy, 46, 44–58. https://doi.org/10.1111/josp.12082
Forhan, M. (2010). Doing, being, and becoming: A family’s journey through perinatal loss. American Journal of Occupational Therapy, 64, 142–151. https://doi.org/10.5014/ajot.64.1.142
Hoppes, S. (2005). When a child dies the world should stop spinning: An autoethnography exploring the impact of family loss on occupation. American Journal of Occupational Therapy, 59, 78–87. https://doi.org/10.5014/ajot.59.1.78
Wilcock, A. A. (1999). Reflections on doing, being, and becoming. Australian Occupational Therapy Journal, 46, 1–11. https://doi.org/10.1046/j.1440-1630.1999.00174.x
