The age range of participants was 28 to 42 years. The mean frequency of miscarriage of participants was 3.87 times, ranging from three to 10 times per participant (Table 1). In the final result of open coding, 107 concepts were grouped together with similar concepts, resulting in 47 subcategories. In the stage of selective coding, 15 categories identified. The relationship between loss and mother–fetal attachment is proposed as a core category with six properties of mastering internal growth and transformation following a miscarriage (Fig. 1).
General characteristics of participant (n = 23)
Level of education
College or university
Number of miscarriages
The causal condition of this study turned out to be a loss. The subcategories of loss were predicted miscarriage, spontaneous abortion. All participants experienced a very painful time due to loss.
I was married at the age of 39. The doctor recommended hospitalization at seven weeks of pregnancy, but I could not afford to be hospitalized… I went to the hospital a week later and my baby's heart was not running. I could not believe it and I was shocked (P 4, 40s).
The categories of contextual conditions herein were maternal instincts, conflict of self-actualization, and avoidance of pregnancy-related topics.
I went to the province from Seoul [great city] to find a doctor who was famous for trying to save my baby somehow, but I was told that the time to save the baby was too late… My husband’s family wanted a child too, and I also didn't want to be stressed anymore. (P 16, 40s).
The phenomenon is the primary experience of participants. The mother–fetal attachment was found to be the reoccurring phenomenon.
Basically, the child is to be buried in the chest. No matter how it was in the belly, the child is a child. Pregnancy tester and ultrasound pictures are still kept with me. (P 9, 30s)
The child I left is a child I should carry on forever. No matter how healthy the present children are now, I think of the one leaving me once and for all. I still remember. (P 23, 30s)
The intervening conditions in this study were reported spousal empathy, spirituality, and self-help support groups.
I saw my groom cry when I had an abortion. Oh, it's not hard and painful only for me, but it's hard for my husband too... (P 20, 30s)
There were a lot of cases like me when I saw an online social networking. I got information on how pregnant mothers have succeeded in pregnancy (P 18, 30s)
Action and Interaction strategies
Prayer for the lost fetus, the culture’s inherent shamanism, resilience formed through the prospect of future possibilities, and changes in lifestyle were revealed to be the action or interaction strategies of participants.
I went to the [Buddhist] temple for a baby who left me and gave a hundred-day prayer. I've been doing this type of ritual of leading the soul to heaven for three years. Even now, every time it is time to pray, I pray and make an offering… (P 1, 30s)
“Now put the photo of the three goddess of birth governing childbirth in the refrigerator.” I knew it, I wanted to buy a mother panty that gave birth to three sons in the hope of believing in superstitions. (P 17, 30s)
Through participants’ ability to cope and accomplish internal growth and transformation in the phases of loss, the consequences emerged as the ability to look back on the past, to feel gratitude for the things they have, and to find hope in not giving up. In other words, they experienced internal growth and change.
It was economically difficult and I had no good relationship with my husband. My husband got drunk and got home, told that his heart was so aching. And he cried sorry to me. My mom who was there with me also cried… I realized that they [family] are on my side… I already have enough. (P 3, 40s)
Process of analysis
We examined the meaning of the miscarriage experience for participants, as well as the processes that led participants to achieve internal growth and transformation following their loss due to miscarriage. Stages of denial, anger, depression, bargaining, acceptance, and accomplishing internal growth and transformation were revealed in this study.
Participants who had the joy of realizing pregnancy and expecting a baby tended to experience a stage of unbelievable denial upon experiencing a miscarriage. Participants reported undergoing other examinations by different means, or visiting other hospitals.
I do think... Pregnancy test is wrong...why am I? I still have a hyperemesis... (P 23, 30s)
Participants had greater feelings of anger as their expectations for a healthy baby increased with the pregnancy progression. Participants also experienced greater anger with repeated experiences of miscarriage.
Others easily have a good baby and even a baby that they do not want. I wonder why this is happening only to me who strongly craves a child, and I am so angry. (P 22, 30s)
As time progressed, participants reported that their degree of depression worsened. Most of the participants were feeling defeated or guilty in isolation. This heightened the feelings of depression.
I cried a lot and I thought that I was wrong and that it was my fault. I had a lot of self-defeats... I also got depression medication. (P 14, 40s)
I felt guilty. I got sorry that I got depressed whenever looking at women who were full-term pregnancy... (P 19, 30s)
Participants who experienced miscarriage were willing to bargain using habits or jobs that they had done in the past. However, the fear of miscarriage still remained.
After a third miscarriage, I was afraid that I would be miscarried again, so I was laid in my house quit my job. I decided to lie down on the bed for six months. Now, I went to the mother's classroom six months later and listened to my baby's heartbeat, but I was still very afraid. (P 13, 30s)
Participants reported that, after their experiences of miscarriage, they began to make changes in their attitude to find inner peace from the severe conflicts of mind and negative emotions following the loss. This evolution can be described as acceptance.
I thought it was my fault, it must be a divine intervention that this happened. I thought I couldn't meet baby because something was not good. (P 15, 30s)
Internal growth and transformation
Participants were able to shift their point of view to a new one that they had not considered in the past. They had a transformative perspective on life. They became grateful, satisfied in their relationships with family, and were able to grow and cope better with the present situation.
My age is over 40 now, but I think I got to be just an adult. The point is that I'm growing (P 11, 40s).
The experience of miscarriage is like mud in the water... I don't think it can be cured. But I think the experience of spontaneous abortion is meaningful. I knew the gratitude of my life and came to think about what I would do as a good person. (P 6, 40s)