Understanding the role of stigma in women’s help-seeking behaviours for postpartum emotional difficulties : a grounded theory study

Smallwood, Susannah (2017) Understanding the role of stigma in women’s help-seeking behaviours for postpartum emotional difficulties : a grounded theory study. Doctoral thesis, London Metropolitan University.


The reported incidence of postpartum depression and anxiety for women in the first year after birth in the UK ranges from 15 to 20 per cent. Research suggests that as many as 58 per cent of women with symptoms of postpartum depression do not seek professional help, indicating that the incidence of postpartum emotional difficulties may be much higher. Attempts to understand the help-seeking behaviours of women with symptoms of postnatal depression have identified stigma as one of the reasons for avoiding treatment. Although the relationship between stigma and help-seeking has been explored in the context of mental health in general, at the time of writing it does not appear to have been a primary research question for the specific population of women in the postpartum period.

This thesis seeks to examine how women understand the role of stigma in the context of seeking help for postpartum emotional difficulties.

Constructivist grounded theory was selected due to its ability to accommodate a heterogeneous sample of women, representing a spectrum of emotional well-being and help-seeking behaviours. Initially, four first-time mothers were interviewed. Purposive sampling followed, recruiting two additional participants as well as conducting a follow-up interview with one of the original interviewees as part of data validation. In total, seven interviews were conducted with six women.

Analysis highlighted five emergent themes: experiencing a difference between expectations and reality; re-evaluating a sense of self; seeking and trusting the help available; “saying it how it is” and the role of breastfeeding in stigma and help-seeking. A Grounded Theory Model was created to demonstrate the relationship between these themes. It appears that the absence and avoidance of ‘open and honest’ conversations about the difficult elements of mothering at a public, inter- and intra-personal level might perpetuate the stigmatisation of postpartum emotional difficulties. In addition, aspects of the way that professional support services are designed, which may indirectly amplify stigma and inhibit help-seeking, are explored. Implications for further research and the role that Counselling Psychologists can play in advancing multi-disciplinary practice to reduce stigma related to postpartum emotional difficulties are proposed.

Susannah Smallwood - DProf - Final Thesis.pdf - Published Version

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