Main Article Content
Thai women grieving over perinatal death are usually judged and evaluated negatively due to a belief that sinfulness is attached to the spirit of mothering. Women suffer self-blame and stigmatization that disturbs the grieving process. This grounded theory study aimed to construct a descriptive theory to explain the process of overcoming grief in Thai women experiencing perinatal death. Twenty-five north-eastern Thai women experiencing perinatal death were recruited by purposive sampling to provide the initial data, then the researcher undertook theoretical sampling to develop codes, categories, and additional information. Each in-depth interview lasted 45-60 minutes and was conducted at the participants’ homes between September 2020 and March 2021 until data saturation. Constant comparative analysis with open, axial, and selective coding was applied. The results revealed four major processes: perception of loss and grief, cultural cognitive adaptation, acceptance, and overcoming grief. Importantly, cultural cognitive adaptation was the core category existing in the process of overcoming grief in Thai women experiencing perinatal death.
In conclusion, the results were conceptualized to explain the culture and context influencing women’s grieving process. This substantive theory emerged gradually through the passage of time in which women honed themselves through painful events caused by perinatal death resulting in women’s ability to reach their capacity to move through their grief. Based on the results, particular beliefs in religious doctrines, and supernatural powers can be applied to develop effective nursing and health interventions for women to work through grief smoothly and successfully.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
United Nations Inter-Agency Group for Child Mortality Estimation (UNIGME). Levels & Trends in Child Mortality:Report 2020, Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund;2020.
Smythe KL, Petersen I, Schartau P. Prevalence of perinatal depression and anxiety in both parents: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(6):e2218969.doi:10.1001/jamanetworkopen.2022.18969.
Taweevisit M, Thorner PS. Placental findings contributing to perinatal death: a 15-year retrospective review from a teaching hospital in Thailand. Fetal Pediatr Pathol.2022;41(1):18-28. doi:10.1080/15513815.2020.1747121.
Strategy & Planning Division. Public health statistics A.D. 2018. Nonthaburi: Ministry of Public Health;2019 (in Thai).
World Health Organization (WHO). Child health: health topics. Geneva: WHO; 2016.
Ayebare E, Lavender T, Mweteise J, Nabisere A, Nendela A, Mukhwana R, et al. The impact of cultural beliefs and practices on parents’ experiences of bereavement following stillbirth: a qualitative study in Uganda and Kenya. BMC Pregnancy Childbirth. 2021;21:443. doi:10.1186/s12884-021-03912-4.
Wattanagun K. The phenomenology of supernatural belief: the ravenous spirit (Phii Pob) belief tradition in contemporary Northeast Thailand. Asian Ethnol. 2018;77(1):79-97(in Thai).
Markin RD, Zilcha-Mano S. Cultural processes in psychotherapy for perinatal loss: breaking the cultural taboo against perinatal grief. Psychotherapy (Chic). 2018;55(1):20-6.doi:10.1037/pst0000122.
Doka KJ. Disenfranchised grief. Bereave Care.1999;18(3): 37-9. doi.org/10.1080/02682629908657467.
Cassidy PR. The disenfranchisement of perinatal grief: how silence, silencing and self-censorship complicate bereavement (a mixed methods study). Omega (Westport).2021 Oct 9;302228211050500. doi:10.1177/00302228211050500.
Obst KL, Due C, Oxlad M, Middleton P. Men’s grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model. BMC Pregnancy Childbirth.2020:20(11);1-17. doi:10.1186/s12884-019-2677-9.
Jooprempree K, Jongudomkarn D. Perceptions of elderly women in relation to the concept of family care: case studies in community at Laplae District, Uttaradit Province. Journal of Nursing and Health Care. 2019:37(2);73-82 (in Thai).
Chaisen U, Hinviman S. Myth construction of the motherhood of “deveined mother” and “parenting like mother” in Thai television dramas. DPU Comm Arts Journal. 2018:12(1);43-76 (in Thai).
Tanglakmankhong K, Thongphao P, Srisuwan J, Phuwongkrai O. The study of local wisdom of maternal and childcare using community classroom and research-based learning. J Prapokklao Hosp Clin Med Educat Center. 2016;33(4):288-99 (in Thai).
Rodsub N. Patriarchy: the reflection of the inequality between male and female in Asian society. Academic Journal of Humanities and Social Sciences Buriram Rajabhat University. 2012;4(2):30-46 (in Thai).
Bowlby J. Attachment and loss: loss, sadness, and depression. New York: Basic Books;1980.
Klass D, Silverman PR, Nickman SL. Continuing bonds: new understandings of grief. Washington, DC: Taylor &Francis;1996.
Kübler-Ross E. On death and dying. New York: Macmillan;1969.
Parkes CM. Bereavement: studies of grief in adult life. New York: Routledge;1972.
Worden JW. Grief counseling and grief therapy: a handbook for the mental health Practitioner (4th ed.). New York:Springer;2009.
Stroebe MS, Schut HAW. Meaning making in the Dual Process Model. 2001. In: Neimeyer R, editor. Meaning reconstruction and the experience of loss. Washington,DC: American Psychological Association; 2001. pp.55-73.
Kain VJ. Perinatal palliative care: cultural, spiritual, and religious considerations for parents—what clinicians need to know. Front Pediatr. 2021;9:597519. doi:10.3389/fped.2021.597519.
Phra Promkhunaporn (Prayut Payutto). Buddhadham.Bangkok: Phli-Dharma Publishing; 2014 (in Thai).
Glaser BG, Strauss AL. The discovery of grounded theory:strategies for qualitative research. Chicago: Aldine;1967.
O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-51.doi:10.1097/ACM.0000000000000388.
Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory (3rd ed.). Thousand Oaks, CA: Sage; 2008.
Lincoln YS, Guba EG. Naturalistic inquiry. Thousand Oaks: Sage; 1985.
Marrone R. Dying, mourning, and spirituality: a psychological perspective. Death Stud.1999:23(6);495-519. doi:10.1080/074811899200858.
Reed PG. Toward a nursing theory of self-transcendence: deductive reformulation using developmental theories. ANS Adv Nurs Sci.1991:13(4);64-77. doi:10.1097/0001 2272-199106000-00008.
Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et al. Advancing the science of symptom management. J Adv Nurs.2001:33(5);668-76. doi:10.1046/j.1365-2648.2001.01697.x.
Boyden JY, Kavanaugh K, Issel LM, Eldeirawi K, Meert KL. Experiences of African American parents following perinatal or pediatric death: a literature review. Death Stud.2014;38(6-10):374-80. doi:10.1080/07481187.2013.766656.
Fisher SD, Cobo J, Figueiredo B, Fletcher R, Garfield CF, Hanley J, et al. Expanding the international conversation with fathers’ mental health: toward an era of inclusion in perinatal research and practice. Arch Womens Ment Health.2021;24(5):841-8. doi:10.1007/s00737-021-
Aphisak Somin. Isan worldview. Maha Sarakham: Apichart Printing; 1994 (in Thai).
Cheng FK. Buddhist insights into life and death: overcoming death anxiety. Athens J Soc Sci (online). 2017;4(1):67-88.doi:10.30958/ajss.4-1-4.
Rando TA. Treatment of complicated mourning. Champaign, Illinois: Research Press; 1993.
Lindemann E. Symptomatology and management of acute grief. Am J Psychiatry.1994:101(3);141-8. doi:10. 1176/ajp.101.2.141.
Engel GL. Is grief a disease? a challenge for medical research. Psychosom Med.1961:23(1);18-22. doi:10.1097/00006842-196101000-00002.
Dalai Lama HH, Cutler H. The art of happiness: a handbook for living. New York: Riverhead Books;1998.
Wright PM. Perinatal loss and spirituality: a metasynthesis of qualitative research. Illn Crisis Loss. 2020;28(2):99-118. doi:10.1177/1054137317698660.
Tedeschi RG, Shakespeare-Finch J, Taku K, Calhoun LG. Posttraumatic growth: theory, research, and applications. New York: Routledge; 2018.
Waugh A, Kiemle G, Slade P. Understanding mothers’ experiences of positive changes after neonatal death. Eur J Psychotraumatol. 2018: 22;9(1):1528124. doi:10.1080/20008198.2018.1528124.
Currie ER, Christian BJ, Hinds PS, Perna SJ, Robinson C, Day S, et al. Life after loss: parent bereavement and coping experiences after infant death in the neonatal intensive care unit. Death Stud. 2019;43(5):333-42. doi: 10.1080/07481187.2018.1474285.