The Meanings and Experiences of Motherhood in Women Diagnosed With Severe Mental Illness: A Tidal Model-Informed Qualitative Study.

Abstract

Motherhood is a meaningful part of the life plans of many women diagnosed with severe mental illness, but they often experience motherhood or the desire for it in a context of vulnerability, stigma, and poorly coordinated care. The literature on the meaning of motherhood in this group is limited, especially research offering the perspective of humanistic models centred on the person. Identify how women diagnosed with severe mental illness give meaning to their desire to be mothers (or not) and their experience of motherhood (or not becoming a mother), using the Tidal Model as an interpretive framework. Descriptive qualitative study with intentional sampling. Eight women diagnosed with severe mental illness in Catalonia, Spain participated in semi-structured interviews. Data were analysed using thematic analysis guided by the Tidal Model. We report the findings using the COREQ criteria for qualitative rigour. We identified six themes structured in the three dimensions of the Tidal Model: (1) sharing the desire (or not) to become a mother; (2) stigma related to the decision to become a mother (or not to become one); (3) taking care of myself to become a mother; (4) self-stigma; (5) lack of specialised support and misinformation; and (6) barriers created by stigma. The narratives reveal the importance of validation, the impact of internal and external stigma, and the difficulties arising from the lack of service coordination. Participants faced multiple personal, relational, and structural barriers to their plans to become mothers. The findings indicate the need for interdisciplinary, empathetic, and person-centred care, as well as coordinated care circuits that integrate reproductive desire into clinical practice in mental health. Mental health nurses can play a pivotal role in validating women's reproductive desires, mitigating internal and external stigma, and providing nuanced, person-centred guidance regarding risks, care needs, and reproductive options. They are also essential in fostering coordinated care pathways that support informed decision-making and accompany women throughout their reproductive journeys.