Contributor: Cheryl Beck
August 29, 2018
Updated December 9, 2023
View FITNE Video of Cheryl Beck Interviewed by Martha Alligood

Author – Cheryl Tatano Beck, DNSc, CNM, FAAN

Year First Published – Postpartum Depression, 1993; Traumatic Childbirth, 2015

Traumatic Childbirth Major Concepts

Typology –

• Postpartum Depression – Substantive Grounded Theory
• Traumatic Childbirth – Middle Range Theory

Postpartum Depression “Teetering on the Edge” Concepts

• Stage 1: Encountering terror
  • Emotional lability
  • Horrifying anxiety
  • Relentless obsessive thinking
  • Emotional fogginess
  • Somatic expressions
• Stage 2: Dying of self
  • Alarming unrealness
  • Isolating oneself
  • Contemplating and attempting self-destruction
• Stage 3: Struggling to survive
  • Battling self and culture
  • Battling the system
  • Praying for relief
  • Seeking multiple sources of support
  • Barriers to sources of support

Postpartum Depression Description

“Once a substantive grounded theory is completed, that should not be the end of it. Glaser stressed that in grounded theory, modification never stops. Built into a classic Glaserian grounded theory study is constant verification by continually modifying it through the constant comparative method of new literature. As new literature is published, it can be compared as additional data. The grounded theory can be modified to weave in varying conditions to increase the theory’s power. Grounded theorists can increase and control the scope of their theory by deciding which groups to use for comparison. By maximizing the differences and similarities among comparative groups, the theoretical properties of a substantive theory can be extended.” (Beck, 2022, p.16)

I conducted the original grounded theory of postpartum depression, “Teetering on the Edge”, with a sample of Caucasian women living in the United States (Beck, 1993). I have modified my theory three times to increase its scope by including data from transcultural qualitative studies of women from other countries and of varying ethnicities. In the first grounded theory modification (Beck, 2007) I included 10 transcultural qualitative studies that had been conducted since I had published by original teetering on the edge theory. Five years later I conducted a second modification that included 17 more qualitative transcultural studies of women with postpartum depression (Beck, 2012). The third grounded theory modification of “Teetering on the Edge” (Beck, 2022) included 13 qualitative studies that specifically focused on the experiences of immigrant and refugee women with postpartum depression. With each modification the postpartum depression theory increased its applicability due to expanding categories and properties from data shared by women with varying cultural perspectives and vulnerability. Teetering on the edge with its three modifications provides a framework for assisting women with postpartum depression in resolving their main problem of loss of control.

Traumatic Childbirth Description

“A middle range theory of traumatic childbirth was developed using Morse’s method of theoretical coalescence. The scope of this qualitative theory was increased by formalizing the connections between 14 individual studies all conducted by the same researcher on the same topic, with different groups, using different research designs and different types of analyses. Axioms were derived from this research program along with attributes of traumatic childbirth, posttraumatic stress, and secondary traumatic stress. This middle range theory addresses the long-term chronic consequences of a traumatic birth for mothers including its impact on breastfeeding, subsequent childbirth, and the anniversary of birth trauma. The impact on fathers and clinicians present at the traumatic birth is highlighted as secondary traumatic stress comes into play. Troubling glimpses of difficulties in mother–infant bonding are revealed.” (p. 1)

Primary Sources – Postpartum Depression

Beck, C. T. (1993).  Teetering on the Edge:  A Substantive Theory of Postpartum Depression.  Nursing Research, 42, 42-48.

Beck, C.T. (2007). Exemplar: Teetering on the Edge: A Continually Emerging Theory of Postpartum Depression (pp. 273-292). In P.L. Munhall (Ed.) Nursing Research: A Qualitative Perspective (4^th edition). Sudbury, MA: Jones & Bartlett.

Beck, C.T. (2012). Exemplar: Teetering on the Edge: A second Grounded Theory Modification ( pp.257-284). In P.L. Munhall (Ed.). Nursing Research: A Qualitative Perspective (5^th Ed) Sudbury, MA: Jones & Bartlett Publishers.

Beck, C. T. (2023). Teetering on the Edge: A Third Grounded Theory Modification. Advances in Nursing Science, 46(1), 14-27. DOI: 10.1097/ANS.0000000000000432

Postpartum Depression Additional resources

Beck, C.T. (2023). Experiences of postpartum depression in women of color. MCN: The American Journal of Maternal Child Nursing, 48(2), 88-95.

Beck, C. T. (2023). Postpartum mood and anxiety disorders: A lexicon of metaphors. Journal of Holistic Nursing, 41(3), 246-255.

Beck, C.T. (2022). Postpartum depression: A metaphorical analysis. Journal of the American Psychiatric Nurses Association, 28(5), 382-390.

Beck, C. T. (2020). Mother-Infant Interaction during Postpartum Depression: A Metaphor Analysis. Canadian Journal of Nursing Research, 52(2), 108-116.

Primary Source – Traumatic Childbirth

Beck, C. T. (2015). Middle range theory of traumatic childbirth: The ever –widening ripple effect. Global Qualitative Nursing Research, 1-13, DOI: 10.1177/2333393615575313. Also see Open Access PDF

Traumatic Childbirth Additional Resources

Beck, C. T. (2023). Lexicon of metaphors: An Innovative Approach to detect the aftermath of traumatic childbirth. Issues in Mental Health Nursing, 44(5), 366-372.

Beck, C. T. (2022). The impact of traumatic childbirth on women’s breastfeeding experiences: A metaphor analysis. Clinical Lactation, 13(1), 54-59.

Beck, C. T. (2021). Subsequent Childbirth after a Previous Birth Trauma: A Metaphor Analysis. Issues in Mental Health Nursing, 42(10), 909-916.

Beck, C.B., & Watson, S. (2019). Mothers’ Experiences Interacting with Their Infants after Traumatic Childbirth. MCN: American Journal of Maternal Child Nursing, 44(6), 338-344.

Beck, C. T. & Casavant, S. (2019). Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 48, 385-397.

Beck, C. T., Watson, S., & Gable, R. K. (2018). Traumatic Childbirth and Its Aftermath: Is There Anything Positive? Journal of Perinatal Education, 27, 175-184.

Beck, C.T., & Anderson, B. A. (2017). ‘Being with Woman’ Is There a Cost for Midwives and Students Attending Traumatic Births? International Journal of Childbirth, 7, 181-191.

Beck, C. T., & Woynar, J. (2017). Posttraumatic stress in mothers while their infants are in the NICU: A mixed research synthesis. Advances in Nursing Science, 40, 337-355.

Beck, C.T., & Harrison, L. (2017). Posttraumatic stress in mothers related to giving birth prematurely: A mixed research synthesis. Journal of the American Psychiatric Nurses Association, 23, 241-257.

Beck, C. T. (2017). The anniversary of birth trauma: A metaphor analysis. Journal of Perinatal Education, 26, 219-228.

Beck, C. T. (2016). Posttraumatic stress disorder after birth: A metaphor analysis. MCN: The  American Journal of Maternal Child Nursing, 41, 76-83.

Author

Cheryl Tatano Beck (1948 – )

Dr. Beck is a Distinguished Professor at the University of Connecticut, School of Nursing. She also has a joint appointment in the Department of Obstetrics and Gynecology at the School of Medicine. She received her Master’s degree in maternal-newborn nursing and also her certificate in nurse-midwifery from Yale University. Her Doctor of Nursing Science degree is from Boston University. She is a fellow in the American Academy of Nursing. Over the past 30 years Cheryl has focused her research efforts on developing a research program on postpartum mood and anxiety disorders. She is a prolific writer who has published over 200 journal articles. She also has published multiple American Journal of Nursing Books of the Year such as Nursing Research: Generating and Assessing Evidence for Nursing Practice of which is a co-author with Dr. Denise Polit.

Other notable works:

Beck, C. T. (2016). Developing a Program of Research in Nursing. New York: Springer Publishing Company.

Long, T. & Beck CT (2017). Writing in nursing: A brief guide. New York: Oxford University Press.

Beck, C. T., Driscoll, J. W., & Watson, S. (2013). Traumatic childbirth. New York: Routledge. Beck, C.T. (Ed.) (2013). Routledge International Handbook of Qualitative Nursing Research. New York: Routledge.

Beck, C.T. & Driscoll, J.W. (2006). Postpartum mood and anxiety disorders: A clinician’s guide. Sudbury, Ma.: Jones & Bartlett Publishers.

Beck, C. T. (Ed.). (2013). Routledge International Handbook of Qualitative Nursing Research. Routledge Publications.

Polit, D. F., & Beck, C.T. (2018). Essentials of Nursing Research: Appraising Evidence for Nursing Practice. (9th Ed). Philadelphia: Lippincott Williams, & Wilkins. Polit, D. F., &

Beck, C.T. (2017). Nursing Research: Generating and assessing evidence for nursing practice (10th Ed). Philadelphia: Lippincott Williams and Wilkins.

Beck, C. T. (2019). Secondary Qualitative Data Analysis in the Health and Social Sciences. Routledge Publications.

Beck, C.T. (2021). Phenomenology: Focus on Method. Sage Publications.

2016 Interview of Cheryl Beck by Martha Alligood