Exploring maternal grief and shame in addiction recovery for pregnant and early parenting women using community-based participatory research: A qualitative descriptive study

Phyllis Raynor^1*April Hutto¹Khushi Patel¹Amber Goforth²Cynthia Corbett¹Delia West³Kacey Eichelberger⁴Constance Guille⁵Nichole Nidey⁶Lori Vick¹Alain Litwin⁴

• ¹Center for Advancing Chronic Care Outcomes through Research and Innovation, College of Nursing, University of South Carolina, Columbia, South Carolina, United States
• ²Phoenix Center, Greenville, Illinois, United States
• ³Technology Center to Promote Healthy Lifestyles, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
• ⁴Prisma Health Upstate, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina, United States
• ⁵College of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
• ⁶Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, United States

Introduction: Little research has explored the constructs of grief and shame-proneness for pregnant and early parenting women seeking recovery from substance use disorders (SUD) and the impact on parents' and children's well-being.Purpose: This study aimed to explore the contexts of reported guilt and shame and the associations with grief and loss among pregnant and early parenting women in SUD recovery. Methods: Using a community based participatory research (CBPR) approach, we conducted in-depth interviews with 30 pregnant and early parenting women with SUD who were recruited from a residential drug recovery facility in the Southeastern United States. A qualitative descriptive six-step thematic analysis established by Braun and Clarke (2006) was used to identify core themes surrounding loss events and feelings of grief, guilt, and shame.Results: There were 21 (70%) participants that reported at least one significant loss with a total of 56 loss events. Most participants who reported grief associated with a loss also experienced guilt and shame. Events surrounding grief and shame included: losing custody of children, adoption or child death, loss of romantic or familial relationships, guilt from using drugs while pregnant, loss of family support, and perceived loss of maternal attachment. Feelings of guilt and shame were mostly in the context of one's personal feelings of judgement or judgement from their family. Discussion: Our findings highlight multiple challenges and stigma surrounding maternal SUD, particularly during pregnancy and postpartum. We also attend to the critical need for relevant maternal support to adequately address complicated grief and shame-proneness in SUD treatment to facilitate positive parenting, recovery outcomes, and positive child health.We believe that the contents of our manuscript directly align with the scope of Frontiers Women's Health Journal. The results of our qualitative descriptive research findings highlight multiple challenges and stigma surrounding maternal substance use disorders, particularly during pregnancy and the postpartum period. We also attend to the critical need for relevant maternal support to adequately address complicated grief and shame-proneness in substance use disorder treatment to facilitate positive parenting and recovery outcomes.