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Entre honte et culpabilité, méandres de la maternalité chez la femme enceinte suite à une interruption médicale de grossesse

Abstract : The aim of this research is to explore the traces and updates of prenatal grief during a pregnancy subsequent to a Medical Termination of Pregnancy (MTP). The status of the fetus is triply complex: between human and non-human on a legal dimension ; perceptible object but that cannot directly be seen in the plan of material reality; both narcissistic extension and internal object - partial and potentially total - in psychic reality. This extreme paradox is the major challenge of the psychic work during prenatal bereavement. Depending on the cultural background and singular maternal and paternal choices among those possibilities, the practices surrounding the death of the baby will be different and lead to contrasting grieving processes. In the particular case of MTP, the clinical experience leads us to consider two fundamental aspects. On one hand, the decision taken by the mother with the choice that she has to make to interrupt the pregnancy or not - and thereby the fetus/baby's life - questions on possibles feelings of guilt. From the other hand, being pregnant with a fetus with a severe pathology represents a narcissistic injury referring to the concept of shame. Shame and guilt, because of their relationship with narcissistic and object-relation processes seem to be quite relevant to study the specificities of a pregnancy following a MTP. In this context, three main questions constitutes the problematic of this study : Is the investment of the dead fetus/baby updated by the investment of the current fetus/baby ? Is the pregnancy activating in a particular way feelings of shame and guilt ? What is the articulation of these feelings with the grieving process ? Methodology: This qualitative research refers to a hypothetical-deductive method and lays on a psychoanalytic background. Our population is composed with 11 women (primiparous and multiparous) pregnant after a MTP for fetal reasons occurred after 15 weeks of amenorrhea (WA). Semi-structured interviews were conducted on the three trimestre of the pregnancy. They also each time completed self-questionnaires (PAI, PGS, EPDS, STAI, DAS, PCLS). The analysis of the interviews, that were recorded, crosses a thorough observation of each case with a thematic content analysis, taking into account the subjective experience of each woman, in order to answer the research hypotheses. Results: The results highlight an updating of the grieving process during the following pregnancy. They are in line with the confirmation of the heuristic and clinical significance of the study of shame and guilt in a pregnancy following a MTP. For these women, shame is manifested by a feeling of unveiling and exclusion, loss of control, and an experience of failure and unworthiness. The elaboration of shame is a good marker for possible resolution of narcissistic and developmental dimensions of the grieving process. Guilt is very present, connected with fetal pathology, the decision to terminate the pregnancy and towards the baby of the current pregnancy. Shame and guilt can be understood as the two poles of a continuous gradient. Their study in the context of a pregnancy following a medically terminated one makes possible to offer pertinent semiological and psychopathological markers in the framework of primary and secondary prevention of troubles in parentality and in early relational dysharmonies.
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Jessica Shulz. Entre honte et culpabilité, méandres de la maternalité chez la femme enceinte suite à une interruption médicale de grossesse. Psychologie et comportements. Université Sorbonne Paris Cité, 2016. Français. ⟨NNT : 2016USPCB190⟩. ⟨tel-02001565⟩

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