Fall 2024 Issue

Motherless Mothering
By Brittany Nwachuku, DEd, LCSW, LISW-S
Social Work Today
Vol. 24 No. 4 P. 22

Implications for Social Work

Losing a parent is a deeply personal and challenging experience that can have a significant impact on individuals and their subsequent development. According to the 2021 Survey of Income and Program Participation, 26.4% of the US population has experienced the loss of both parents.1 Recent data sheds light on the impact of parental death according to the age at which individuals lose their parents. Among those who have lost a parent, 50.7% have lost their mother, and 69.2% have lost their father by the time they turn 50 years of age. Nearly 30.8% of people in the United States have lost their biological mother, 39.8% have lost their biological father, and 44.2% have lost at least one biological parent.1

The loss of a parent can negatively affect self-esteem, psychosocial wellbeing, sleep, stress levels, sadness, mental health, behavior, education, and physical health.2 Hence, the death of a parent is a complex life course event that requires attention, support, and care.

Scant research, however, has examined the impact of the loss on motherless mothers and its implications for the psychological and physical well-being of new mothers during the postpartum period. For a daughter who has experienced the loss of her mother, the grieving process is likely to be consistent as she matures, develops, and reaches certain milestones throughout life without the presence of her mother.3 Moreover, the grief experienced by daughters after becoming mothers can be intensified as they are then experiencing their grief from a different perspective.3

Definition of Terms
In the context of this article, a motherless mother is defined as a woman who has experienced the loss of her mother prior to bearing children.4 Maternal bereavement pertains specifically to the passing of a maternal relative of the mother.5 Conversely, parental loss encompasses the death of a parent or any other individual fulfilling that role.

Postpartum Depression
Following childbirth, new mothers may experience postpartum “baby blues,” which can also be influenced by motherlessness. Postpartum depression is commonly characterized by mood swings, tearfulness, anxiousness, and difficulties with sleeping. These symptoms usually emerge within the first two to three days after delivery and may persist for as long as two weeks.6 However, some new mothers may undergo a more intense and protracted version of these emotions, commonly referred to as postpartum depression. According to Oxford University Press,7 postpartum depression denotes depression experienced by a mother following childbirth, typically brought on by a combination of hormonal changes, psychological adaptation to motherhood, and exhaustion.

Mireault, Thomas, and Bearor8 examined how losing one’s mother during childhood affects future maternal functioning. Their study found that women who were motherless during childhood tend to feel less competent and self-assured in their maternal roles. They also experience more negative emotions, such as grief, a sense of loss, anger, anxiety, and sadness, compared with women who had a mother present during their upbringing. This lack of maternal support and guidance can result in a higher incidence of postpartum depression and anxiety for women whose mothers are no longer alive.9

Risk for Postpartum Depression
Depression symptoms can vary between individuals, with some mothers experiencing them more frequently or for more extended periods than others. The intensity of these symptoms may also differ from person to person. Women who have undergone stressful life events, such as the loss of a parent or who have limited social support, may be at greater risk of developing depression. Postpartum depression is a mental health condition that can affect women following childbirth and may arise due to a variety of stressors, such as inadequate support, the absence of maternal rituals, and the loss of a loved one. The CDC has revealed that nearly 1 in 10 women in the United States exhibit symptoms consistent with a major depressive episode in the previous year.10 The Pregnancy Risk Assessment Monitoring System has further found that one in eight women who have recently given birth experience symptoms of postpartum depression.10

Social workers play a vital role in providing evidence-based approaches to promote healing and well-being for grieving new mothers.

Case Example
When Elaine was just 16 years old, she experienced a tragic loss: Her mother died after an extended illness. As the only daughter in her family, Elaine was deeply affected by her mother’s death and relied heavily on the support of her grandmother, aunts, and mother’s friends. Even though she tried to be strong, Elaine often found herself struggling with overwhelming emotions as she went through the grieving process.

Years later, at age 34, Elaine and her husband were overjoyed to learn they were expecting their first child. However, as the pregnancy progressed, Elaine found herself struggling with feelings of grief once again. She longed for her mother’s presence, yearning for her support and maternal guidance as she embarked on this new journey. Despite her sadness, Elaine was determined to stay positive and focus on the arrival of her new baby.

After giving birth to a healthy baby boy, Elaine began to experience even more feelings of loss. Just three months postpartum, both her maternal grandmother and her paternal aunt died one day apart. These women had been a significant source of support for Elaine, and their deaths left her feeling lost and alone.

Elaine faced challenges relating to postpartum depression, which she associated with the absence of significant maternal figures in her life. She felt beleaguered and isolated, with few people to turn to for help. At times, she even had thoughts of suicide. Despite these challenges, Elaine did her best to press through her pain, determined to be present for her child and to find a way through her grief.

Grief
The grief experienced by the death of a family member can be devastating. Postpartum women who have experienced parental loss endure a particularly complicated blend of physical and emotional distress.3 Historically, the role of a mother has been to provide a range of financial, emotional, and instrumental support to their children across their adult years. Research indicates that mothers often remain a critical social resource to daughters through early adulthood into middle age.3 Forging a path in motherhood without a maternal guide can be challenging, as the absence of such a guide can cause grief to resurface at any moment. Grief is a natural response to loss or change, not indicative of a pathological condition or personality disorder. It occurs due to the conflicting emotions that arise when familiar behavior patterns end or change. One can experience grief when needing support from a person who has always provided it, only to find that person no longer available. Similarly, grief can occur when one reaches out to a person who has never been available to them and still fails to provide much-needed support. Persistent grief disrupts the body in diverse ways, with effects that can include a weakened immune system—a quandary for any new mother. While traumatic events can trigger grief, it is a normal emotional response to such events. However, in the case of motherless mothers, grief can persist and resurface over time, and the time and circumstance of their mother’s death can exacerbate the situation. It is important to note that grief is a stressor that can lead to depression or anxiety.11

Nuances of Motherhood
Becoming a mother is a dynamic, evolving process influenced by the individual’s environment, including their cultural, social, and subjective experiences.11 New mothers can experience a range of psychological and physical stressors in the postpartum period. New mothers may feel overwhelmed, confused by their new identity, exhausted, isolated, and unprepared. In addition, there may be the physical discomfort of childbirth, lack of sleep, anxiety about the baby, and the new responsibilities of caregiving. As a result, new mothers may draw heavily on their support network, resources, and resilience to tackle the transition of motherhood. Having a social support network effectively assists new mothers in coping with the stressors this period can bring. In addition, “Low levels or inconsistent social support are a strong predictor of postpartum depression, and dissatisfaction with social support may increase the risk for clinical and subclinical depression during the postpartum period.”5

Although a correlation exists between depression prevention and social support, little research has identified how social support is perceived and utilized by motherless mothers during the postpartum period.3 Although a new mother’s support network can vary, theoretical perspectives, such as the social learning theory and the psychoanalytic theory, address how new mothers often learn and identify the role of motherhood from the relationship formed with their mothers.12 For new mothers, the death of their mother is a defining moment in their life: one that marks the loss of their primary guide, role model, and source of identification.3 If this relationship has historically been positive, experiencing this physical loss can have implications for a new mother and their postpartum experience.

Absence of the Maternal Line
For women who have lost their mothers, navigating motherhood can be incredibly challenging due to the lack of this support. They often long for the guidance and encouragement of their mothers and must seek out alternative sources of support. Studies have shown that having additional support is critical for new mothers, and maternal figures such as grandmothers, aunts, and cousins can provide invaluable practical and emotional help.3,13 The importance of female kinship networks has been highlighted, emphasizing the support and communication between female family members. The strongest of these networks often exists between members of the mother’s relatives, known as the maternal line.3

The absence of a mother can leave new mothers feeling disconnected from their family histories. They may feel at a loss for the opportunity to ask questions of maternal relatives they would have normally asked their mother and subsequently feel that they lack knowledge and understanding of how to parent. In such cases, relying on the support of maternal grandmothers, aunts, cousins, and even their mother’s friends can be incredibly helpful. However, the generational knowledge, wisdom, secrets, and practices of motherhood often passed down through the maternal line can be lost, leading to a sense of bereavement and isolation for motherless mothers.

Implications for Social Work
Bereaved new mothers need people to remind them that there are no wrong feelings while grieving. Social workers must assess a new mother’s response to motherhood from an intersectional perspective to include their contextual, societal, cultural, and lived experiences to adequately prepare and support them in their mothering role. Social workers must identify the best intervention practices to effectively support motherless mothers during their postpartum journeys.

To gain a deeper understanding of the unique experience of motherless mothers, social workers must take the initiative to educate themselves and heighten their awareness of this topic. There’s a dearth of literature exploring the implications of parental loss, specifically from the perspective of mothers. Thus, it’s incumbent upon social work practitioners to approach this subject with the utmost sensitivity and empathy, keeping in mind the complex issues that surround both parental loss and motherhood. Compassion and empathy can be facilitated by seeking educational resources to enhance the practitioners’ understanding and empowering clients to share their experiences as the ultimate authorities on their grief journey.

Additionally, social workers can support women who have gone through the loss of a mother by encouraging them to share their feelings and thoughts concerning the loss and how it may affect their pregnancy and postpartum period. It’s critical to listen to their stories, understand the circumstances surrounding the losses, and grasp how their lives have been transformed since the deaths of their mothers. It’s important to acknowledge how the loss of their mothers may have caused feelings of parental incompetence as opposed to security in new mothers.

To appreciate their grief, social workers must pose vital questions and employ social work skills to unravel the new mothers’ stories. They can play a critical role in motivating women to discuss their encounters with loss by organizing support groups or educational sessions for those transitioning into motherhood or experiencing it. In addition, this can be done by completing a comprehensive assessment of clients’ grief.

Further, Murray14 outlines 10 questions social workers can ask clients about their grief to facilitate the assessment process.

Among these are the following:

• What was the importance of the loss in the person’s life?

• What stage of the grieving process has the individual attained?

• How is the person coping with the shift from the world “that was” to the world “that is”?

Finally, the advantages of adopting a trauma-informed, person-centered, or strengths-based approach must be considered.15-17 These evidence-based perspectives provide practitioners with distinct lenses through which to view different facets of a new mother’s journey. For instance, a trauma-informed perspective fosters a supportive environment that aids individuals in their recovery from trauma while also preventing retraumatization.15 A person-centered approach enhances assertiveness skills to enable better decision-making.16 Lastly, a strengths-based approach can help identify the areas of resilience and persistence in one’s lived experiences.17

— Brittany Nwachuku, DEd, LCSW, LISW-S, is a board-certified oncology social worker and a qualified administrator of the Intercultural Development Inventory. She received her Doctor of Education degree from the University of Pittsburgh and her Bachelor of Social Work and Master of Social Work degrees from the University of Louisville’s Raymond A. Kent School of Social Work. She also holds a certificate in women’s leadership from Yale University. With numerous years of experience in medical and mental health settings, Nwachuku has clinical experience working with diverse populations, including juvenile probation, foster care youth, school social work, private practice, and oncology health care settings. She’s an assistant professor of social work at Alliant International University and a member of the Ethics Committee for the Ohio Chapter of the National Association of Social Workers. In addition, she’s on the executive committee for the Council on the Role and Status of Women at the Council on Social Work Education. Her research specialties include equity and inclusion, psychosocial oncology care, grief and bereavement, and  women’s health disparities.

References
1. Hayward GM. New 2021 data visualization shows parent mortality: 44.2% had lost at least one parent. United States Census Bureau website. https://www.census.gov/library/stories/2023/03/losing-our-parents.html. Published March 21, 2023. Accessed March 17, 2023.

2. Marks N, Jun H, Song J. Death of parents and adult psychological and physical well-being: a prospective U.S. national study. J Fam Issues. 2007;28(12):1611-1638.

3. Harman B. Motherless mothers: maternally bereaved women in their everyday roles as mothers. J Fam Stud. 2014;20(1):28.

4. Edelman H. Motherless Mothers: How Mother Loss Shapes the Parents We Become. Sydney, NSW: Hodder; 2006.

5. Class QA, Mortensen PB, Henriksen TB, Dalman C, DʼOnofrio BM, Khashan AS. Preconception maternal bereavement and infant and childhood mortality: a Danish population-based study. Psychosomc Med. 2015;77(8):863-869.

6. Negron R, Martin A, Almog M, Balbierz A, Howell E. Social support during the postpartum period: mothers' views on needs, expectations, and mobilization of support. Matern Child Health J. 2013;17(4):616-623.

7. Oxford University Press. Postpartum depression. Oxford English Dictionary website. https://www.oed.com/dictionary/postpartum-depression_n. Accessed May 9, 2024.

8. Mireault G C, Thomas T, Bearor K. Maternal identity among motherless mothers and psychological symptoms in their firstborn children. J Child Fam Stud. 2002;11(3):287-297.

9. Rowe B, Harman BA. Motherless mothers: maternally bereaved women in their everyday roles as mothers. J Fam Stud. 2014;20(1):28-38.

10. Bauman BL, Ko JY, Cox S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581.

11. Copeland D, Harbaugh B. "It is hard being a mama": validation of the maternal distress concept in becoming a mother. J Perinat Educ. 2019;28(1):28-42.

12. Walsh A, Tiernan B, Thompson B, McCormack D, Adair P. ‘Nobody taught her how to be a mother’: the lived experience of mothering without a mother. Infant Ment Health J. 2023;44(4):554-571.

13. Brown L H, DeRycke S B. The kinkeeping connection: continuity, crisis and consensus. J Intergener Relatsh. 2010;8:338-353.

14. Murray J. Grief and loss. In: Common Client Issues in Counselling: An Australian Perspective. University of Southern Queensland; 2023. https://usq.pressbooks.pub/counselling/chapter/grief-and-loss/

15. Boss P. Loss, Trauma, and Resilience. WW Norton & Company; 2006.

16. Larson DG. A person-centered approach to grief counseling. In: Cooper M, O'Hara M, Schmid PF, Bohart AC, eds. The Handbook of Person-Centered Psychotherapy and Counseling. Palgrave Macmillan/Springer Nature; 2013:313-326.

17. Garcia RB, Pomeroy EC. Trauma and Grief Assessment and Intervention: Building on Strengths. New York: Routledge; 2021.