A psychoanalytic study of recurrent miscarriage: Brief psychotherapeutic work with pregnant women

This thesis describes qualitative research using a post-kleinian, psychoanalytic clinical approach, into the emotional experience of pregnant women who have experienced previous miscarriages. Despite a growing interest in matters regarding pregnancy and infertility; the impact of a woman's emotional response to the traumatic event of her previous miscarriages during a current pregnancy has received little research attention, although a wider category of stillbirth has been the subject of many studies. The existing literature identified various emotional states associated with the interruption of pregnancy but seemed to lack a deeper understanding or a meaningful connection between these states. My interest was aimed principally at an investigation of the mental state and what is associated with the emotional experience connected to the loss and how the way in which the loss itself was confronted had an impact on the experience and on the new pregnancy. The pivotal basis for the research question aimed to examine what features characterise the state of mind of pregnant women with a history of miscarriage and what contribution can be made by a brief psychoanalytic intervention. The design of the research project was based on psychoanalytically-oriented, monthly sessions which took place at the hospital during the pregnancy, with one session after the birth and two other follow-up sessions. The research group included 8 mothers between the ages of 32 and 39 each of whom had a history of at least two miscarriages prior to their current pregnancy.. A number of research methods were considered, and grounded theory was chosen as the most appropriate for the analysis of the data. Analysis of the material, using this approach, generated concepts and categories which proved useful in shedding light on the mass of complex material. What emerged from the research is that the experience of recurrent miscarriage had destabilised the sense of identity of these mothers and seriously undermined their trust in the creative process. In particular, in this group of women, it raised persecutory feelings in relation to internal figures who it was felt would not give permission to become a parent and made the women feel dominated by an inexorable destiny. The concepts developed here have significance not only for clinical work but also constitute a useful tool for any professional working with children and parents-to-be, helping them to understand the emotional reactions of these women in order to deal with the anxiety resulting from the risk of losing their baby once again. The study was carried out within a hospital environment within which, for various reasons, it was difficult to adhere to the original objectives and this imposed certain constraints which will be the subject of further reflection in the final chapter. Brief psychotherapeutic intervention for pregnant women with a history of miscarriage seems to be a justifiable course of action. This is supported not only by the fact that all the women in the study successfully brought their pregnancies to term but also by their responses to the questionnaire, by the follow-up sessions, and by my own assessment of the work undertaken together. Moreover, the preventive function of this intervention was particularly important: it activated in these mothers an ability to ask for help after our sessions had concluded and helped them to develop trust in someone who would be able to support and assist them in their relationship with the child. Additionally, the understanding reached through this study will inform preventive and consultation work while suggesting further research questions