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

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.