Cheryl Tatano Beck, DNSc, CNM, FAAN, and Board of Trustees Distinguished Professor, University of Connecticut School of Nursing has published the majority of qualitative research regarding postpartum depression, PTSD following childbirth offering unparalleled data regarding the lived experience of these phenomena (Beck, 1993; 1995; 1996a; 1996b; 1996c; 1998; 2001; 2002; 2004a; 2004b). She continues today to pioneer the application of qualitative methodology to this crucial issue (Beck, 2011). The foundation of Beck's work in phenomenological inquiry demonstrates the efficacy and power of qualitative research in the following ways.

Phenomenological Themes
Beck (1993) published a landmark phenomenological inquiry 'Teetering on the edge: A substantive theory of postpartum depression' from which she theorized a four-stage process for the consequences of PPD: (1) encountering terror, (2) dying of the self, (3) struggling to survive, and (4) regaining control.

Encountering Terror.
According to Beck (1993), women were initially 'hit suddenly and unexpectedly by the postpartum depression' (p. 44); and when it did happen, they were blindsided. One of Beck's (1993) participants described:

I was on cloud nine through my whole pregnancy'¦then it hit me when my baby was 14 days old. One night I had my first severe panic attack. I felt like everything was closing in on me. Something just snapped in me and there was no going back. (p. 44)

The conditions of the experience of terror manifested in (a) panic attacks as one participant recounted: 'It came out of the blue. I just felt numb all over and I started to hyperventilate. I felt this pain in my chest so I started to think, Oh my God, I'm having a heart attack. I'm dying!'(Beck, 1993, p. 45); (b) obsessive thinking: 'My thoughts were extremely obsessive. They would never stop. I thought, Oh my God, am I going crazy? What if I have to be admitted to the hospital? and so on. It was just nonstop' (Beck, 1993, p. 45); and (c) enveloping fogginess described by one participant as: 'Oh, I tried to do something'go out for a run, visit a friend, or take the baby to the mall'but it didn't work. The fogginess would set in' (Beck, 1993, p. 45).

Dying of the Self.
Due to the conditions of the encountering terror stage, the dying of mothers' normal selves in the second stage occurred (Beck, 1993). As a result of the sense of pronounced sense of incongruity between past definition of self, and present reality of life as a new mother, mothers feared others perceptions that they were bad mothers and withdrew into increased sense of isolation, loneliness and desperation. Within the dying-of-the-self stage, there occurred an 'alarming unrealness' where mothers experienced the normal self as gone: 'It's very scary.You feel as though you are not the same person' (p. 45), and resorted to extreme isolation from family, social support, and even the baby, 'I couldn't be around him' (p. 45).Ultimately, the stage resulted in contemplating, if not attempting self-destruction 'I just wanted to get out of this world. It was like everything was black' (Beck, 1993, p. 46).

Struggling to Survive.
Beck (1993) theorized the conditions created for stage three where women engaged in three strategies to cope: (a) battling the system, (b) praying for relief, and (c) seeking solace in support groups. Once women had decided to reach out for help, Beck (1993) related that their experience of navigating the health care system as a 'torturous' (p.46) process of primary provider patronizing, minimizing their symptoms, frequent referral to other physicians, lack of knowledgeable providers, limited treatment options, and financial hardship. Interestingly, Beck (1993) found that along with battling the system, women frequently used prayer to strategize surviving PPD. One participant offered, 'I used to go to church and pray for hours. My God, how much ore can I endure?', and another, 'The Lord was what really got me through a lot. It was just a lot of prayer and crying to the Lord that helped me get through it' (p. 46). In addition to prayer, women struggled to survive by seeking solace in postpartum depression support groups (Beck, 1993).

Regaining Control.
As a consequence of struggling to survive Beck (1993) theorized the final stage, regaining control, as a 'slow process consisting of three consequences: unpredictable transitioning, mourning lost time, and guarded recovering' (p. 47). Recovery was not overnight, and the nature of recovery, unpredictable. As the recovery was experienced, Beck (1993) found that mothers experienced mourning for the time with their babies that they perceived as lost due to PPD. Finally, the experience of recovery was experienced with high levels of concern that PPD would return, as a participant offered:

Postpartum depression makes you very, very vulnerable. You still feel like you're on a fine line between sanity and insanity because when it first happened it came out of nowhere. You're normal and then the next thing you know you're crazy. (Beck, 1993, p. 47)

Conclusion
Clearly the Beck (1993) exploration of the thematic content sheds invaluable qualitative light on the understanding of the complexities of the phenomenon of postpartum depression. Qualitative research methods provide essential evidence of maternal experience. In coming weeks, I am honored to bring an exclusive interview with Cheryl Beck to Lamaze and Science and Sensibility.

References

Beck, A., & Alford, B. (2009). Depression: Causes and treatment (2nd ed.). Philadelphia, PA: University of Pennsylvania Press.Beck, C., & Driscoll, J. (2006). Postpartum mood and anxiety disorders: A clinician's guide. Sudbury, MA: Jones and Bartlett.

Beck, C. T. (1992). The lived experience of postpartum depression: A phenomenological study. Nursing Research 41, 166-170.

Beck, C. T. (1993). Teetering on the edge: A substantive theory of postpartum depression. Nursing Research 42, 42-48.

Beck, C. T. (1995). The effects of postpartum depression on maternal-infant interaction: A meta-analysis. Nursing Research 44, 298-304.

Beck, C. T. (1996a). A meta-analysis of predictors of postpartum depression. Nursing Research 45, 297-303.

Beck, C. T. (1996b). A meta-analysis of the relationship between postpartum depression and infant temperament. Nursing Research 45, 225-230.

Beck, C. T. (1996c). Postpartum depressed mothers' experiences interacting with their children. Nursing Research,45, 98-104.

Beck, C. T. (1998). The effects of postpartum depression on child development: A meta-analysis. Archives of Psychiatric Nursing, 45, 12-20.

Beck, C. T. (1999). Maternal depression and child behaviour problems: a meta-analysis. Journal of Advanced Nursing, 29(3), 623-629.

Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50, 275-285.

Beck, C. T. (2002). Postpartum depression: A meta synthesis. Qualitative Health Research, 12, 453-472.

Beck, C. T. (2003). Recognizing and screening for postpartum depression in mothers of NICU infants. Advances in Neonatal Care, 31, 37-46.

Beck, C. T. (2004a). Birth trauma: In the eye of the beholder. Nursing Research 53(1), 28-35.

Beck, C. T. (2004b). Posttraumatic stress disorder due to childbirth: The aftermath. Nursing Research, 53, 216-224.

Beck, C. T. (2011). Meta-ethnography of traumatic childbirth and its aftermath: Amplifying causal looping. Qualitative Health Research, 21(3), 301-311.

Published: January 19, 2012

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