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Open Journal of Nursing, 2017, 7, 962-977

http://www.scirp.org/journal/ojn

ISSN Online: 2162-5344

ISSN Print: 2162-5336

DOI:

10.4236/ojn.2017.78071 Aug. 30, 2017 962 Open Journal of Nursing

Lost in a Nameless Chaos—Women’s

Experiences of Postpartum Depression:

A Meta-Ethnographic Study

Bente Dahl

, Marthe Sandvoll Hermansen, Elisabeth Severinsson

The Centre for Women’s, Family and Child Health, Department of Nursing and Health, Faculty of Health and Social Sciences,

University College of Southeast Norway, Kongsberg, Norway

Abstract

Postpartum depression is a common complication related to childbearing

with an estimated prevalence of 10% - 15%. The aim of the study was to e

plore and synthesize qualitative empirical studies

published between 2005 and

2016 that describe women’s experiences of postpartum depression. Ten qu

litative studies describing different perspectives on women’s experien

ces of

postpartum depression were

summarized and synthesized using Noblit and

Hare’s 7-step meta-ethnographical method. Four central

metaphors described

women’s experiences of postpartum depression: Feeling trapped by reality,

Experiencing a nameless chaos

, Struggling to find a way out and Being seen as

a normal but suffering person. The findings resulted in the following synth

sis: The women expected the transition to motherhood to be a joyous exp

rience. Instead, they found it painful, lonely and experienced

losing the

selves in a nameless chaos

. Motherhood is challenged when women exp

rience losing themselves due to depression rather than building a new identity

as a mother. Such a situation causes chaos, shame, anxiety and isolation.

When seeking profess

ional help, it is essential that the woman is encountered

with empathy and professional knowledge, rather than a pat on the back and

an underestimation of her problems.

Keywords

Postpartum Depression, Experience, Meta-Ethnography, Qualitative

1. Introduction

Postpartum depression (PPD) is a mental disorder and a common complication

How to cite this paper:

Dahl, B., Herman-

sen, M

. and Severinsson, E. (2017)

Lost in a

Nameless Chaos

—

Women’s Experiences of

Postpartum Depression: A M

eta-Ethnograph-

ic Study

Open Journal of Nursing

, 962-

977

https://doi.org/10.4236/ojn.2017.78071

Received:

July 17, 2017

Accepted:

August 27, 2017

Published:

August 30, 2017

7 by authors and

Scientific

Research Publishing Inc.

This work is licensed under the Creative

Commons Attribution International

License (CC BY

4.0).

http://creativecommons.org/licenses/by/4.0/

Open Access

B. Dahl et al.

DOI:

10.4236/ojn.2017.78071 963 Open Journal of Nursing

related to childbearing [1] [2]. The disorder is referred to as a major depressive

episode with a postpartum onset in the International Statistical Classification of

Diseases (ICD-10) [3] or with a peripartum onset in the Diagnostic and Statis-

tical manual of Mental Disorders, (DSM-5) [4]. However, studies have demon-

strated that this narrowly defined time frame should be broadened [5] [6] and

according to Munk-Olsen

et al

. [7], first-time mothers are at increased risk of

postpartum mental disorders for several months after the birth.

The estimated prevalence of postpartum depression ranges from 10% - 15%

[7]. Risk factors for developing the disorder include previous psychopathology,

lack of support from partner, low socio-economic status, domestic violence, his-

tory of abuse and life stress [6]. Pregnancy and birth related complications, such

as untreated depression and anxiety in pregnancy, have also been mentioned as

possible contributory factors [2] [6].

In addition to maternal suffering and diminished functioning, studies have

shown that PPD is associated with poor mother-infant attachment. Further-

more, infants whose mothers suffered from postnatal depression are at increased

risk of developing emotional problems as well as problems related to social be-

havior [8]. The association between postnatal depression and cognitive out-

comes in the child is also described and includes learning abilities and language

development [8]. Two meta-studies present women’s experiences of PPD [9]

[10]. Beck’s meta-synthesis on PPD published in 2002 includes 18 qualitative

papers on the subject [9], while Knudson-Martin and Silverstein’s [10] me-

ta-data-analysis published in 2009 includes nine qualitative papers. These papers

contain a total of 27 empirical studies published between 1990 and 2005 that de-

scribe women’s experiences of PPD as related to lack of congruity between ex-

pectations and experiences of motherhood, loss of identity and role as well as

feelings of “losing oneself”. Feelings of anxiety, despair and sadness were also

referred to in the studies. According to the mothers, the responsibility of mo-

therhood was overwhelming and they were afraid that they would be unable to

deal with their new role. They described feelings of shame and guilt connected to

the disorder and in order to avoid being regarded as a failure, they isolated

themselves or refrained from talking about their feelings with friends and

healthcare providers.

Aim

Beck and Knudson-Martin’s meta-studies [9] [10] include empirical studies that

provide a limited but important snapshot of knowledge about women’s expe-

riences of PPD from 1990 to 2005. However, we ask whether women described

similar experiences in studies published after 2005 and if the information con-

tributed by recent empirical studies is likely to change our understanding of the

experience of suffering from PPD. We therefore conducted a study to explore

and synthesize qualitative empirical studies published between 2005 and 2016

that describe women’s experiences of postpartum depression.

B. Dahl et al.

DOI:

10.4236/ojn.2017.78071 964 Open Journal of Nursing

2. Methods

2.1. Design

In order to synthesize qualitative research findings we conducted a meta-synthesis,

using a meta-ethnographic approach [11]. The use of meta-synthesis has become

increasingly popular in health-related research [12] as it is supposed to provide a

new, integrated and more complete interpretation of the findings, offering an

in-depth understanding that transcends the sum of the individual studies and

facilitates theory development [13]. Several ways of conducting a qualitative

meta-synthesis have been described [14]. In this study, our aim was not to sum-

marize or aggregate data, but to conduct an interpretive integration of the em-

pirical data from the included studies [14]. Thus, due to its interpretive orienta-

tion we decided to use meta-ethnography, a method developed by Noblit and

Hare [11] comprising seven overlapping and sometimes parallel steps, as de-

scribed in

Table 1.

2.2. Data Collection and Participants

2.2.1. Search Strategy and Outcome

We started by defining the aim of the study and deciding on inclusion and ex-

clusion criteria. We continued by performing a scope search to gain a prelimi-

nary overview of the research area and to identify relevant search terms. The

scope search was followed by a systematic literature search in March 2016. An

experienced librarian guided the literature search, which included the PsycIN-

FO, Cinahl, Pubmed and Maternity & Infant Care databases. We applied the

following search terms as MESH terms or text words, entered individually or in

combination: postpartum depression, experience and emotions.

The literature search resulted in 962 hits. We started by excluding duplicates

and studies that did not meet the inclusion criteria in terms of publication

year, language and methods, after which 128 papers remained. We continued

by manually examining all papers, excluding those that were thematically or

methodologically irrelevant. We also identified and excluded another 11 duplicates.

Table 1. The seven steps in meta-ethnography [11].

Getting started

—identifying the topic of the study and defining the aim.

Deciding what is relevant to the initial interest

—including relevant studies, describing search

strategy and criteria for inclusion and exclusion.

Reading the studies

—repeated reading of studies noting their interpretative metaphors.

Determining how the studies are related

—determining the relationship between the studies.

This phase starts with the creation of a list of key metaphors (themes, concepts, phrases, ideas)

and ends with an initial assumption that their relationship is reciprocal (findings across studies

are comparable), refutational (findings stand in opposition to each other) or representative of a

line of argument.

Translating the studies into one another

—comparing metaphors and their interactions within

single studies and across studies, while at the same time protecting uniqueness and holism.

Synthesizing translations

—creating a new whole from the sum of the parts, enabling a second

level of synthesis.

Expressing the synthesis

—finding the appropriate form to effectively communicate the

synthesis to the audience.

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