“If You Were a Horse,You Would Have Been Shot”: A Thematic Analysis of Medical Professionals’ Communication with Mothers

Who is A “Good Mother”?

The “good mother” is a notion that has been constructed and reconstructed throughout history, shifting with times and cultures (Thurer, 1994). In ancient Rome, one mother was famous for her children's valiant service to the empire and for not wearing jewelry because, as she explained, her children were her jewels (Thurer, 1994). In Western medieval culture the good mother ideal was illustrated by the cult of Mary, the mother of Jesus, who embodied the concept of motherhood perfected (Thurer, 1994). The good mother ideal was also at the forefront of the cult of domesticity (sometimes known as “the true woman” movement), which gained popularity in the USA between 1820 and 1860 as a reactionary response to early industrialization (Welter, 1966). While life was chaotic at work outside of the home, the “true” woman maintained a haven of peace within the home by being sexually pure until she was married – at which point she would become submissive to her husband; the true woman was also pious, maintained Biblical learning in her home, and knew the best folk medicine to help her family (Welter, 1966).

Even though the proportion of women in the workforce rose dramatically in the 20th century thanks to cultural shifts and the advancement of equal employment opportunities, in the early 2000s one of the key markers of good motherhood was still a woman’s choice, or at least a desire, to stay at home with her children (Gorman & Fritzsche, 2002). Early-2000s popular discourses enforced this marker of “good” mother, as illustrated, for example, by news stories suggesting that “children of working mothers are more likely to perform badly at school” (Vincent et al., 2010, p. 133).

Goodwin and Huppatz (2010) identified several consistent themes in the definition of a good mother across time: (a) nurturing; (b) happy and calm; (c) responsible; (d) acting in socially acceptable ways; (e) extremely devoted to home and family; (f) reflective of a middle-class norm; (g) deeply interested in her child’s health and education; and (h) illustrative of a standard by which people judge mothers, and by which mothers judge themselves. Mothers who are incarcerated (Kennedy, 2011), first-generation immigrants (Vincent et al., 2010), HIV-positive (Nguyen et al., 2009), or poor (Connolly, 2000) may be judged especially harshly for circumstances outside their control and are therefore unlikely to meet “good” motherhood norms.

The “Good Mother” Stress

The literature described so far shows that the good mother is essentially an injunctive norm, a set of normative beliefs many mothers think they are required to meet. Injunctive norms routinely produce anxiety, psychological discomfort, and stress, which can be attributed to the perceived discrepancy between one’s perceived actual-self and the ought-self (Calogero & Watson, 2009; Higgins, 1987). This difference can drive chronic social self-consciousness, which is described as a maladaptive level of seeing oneself as a social object under the scrutiny of others—a phenomenon that happens more in women than in men (Calogero & Watson, 2009). A mother may feel a greater sense of stress over being “the good mother” if her perception of her parenting does not match lower her perception of what she ought to be like as a mother.

One way this stress can compound is when mothers feel too much embarrassment or fear to disclose when they may not be living up to the good mother standards; in keeping their secret, they go without needed care and support. For example, mothers report hesitancy to discuss their own depression and/or parental stresses with medical professionals because they fear being judged and/or referred to child protective services (Heneghan et al., 2004). The patriarchal model of motherhood, in which the medical institution acts as the ultimate arbiter of a child’s wellbeing, is reinforced, for example, in Dr. Spock’s 1992 edition of his famous book about child rearing: “the doctor knows your child, and is the only person in a position to advise you wisely” (Spock & Rothenberg, 1992, p. xiii). The Spock series fails to acknowledge the role of medical professionals in fostering mothers’ anxieties, even as the so-called Spockian Mother is routinely criticized as being overly anxious (Dobris et al., 2017).

Mothers who ascribe to a Westernized medicinal approach have a plethora of opportunities to interact with medical professionals in prenatal visits, well-child visits, their own wellness visits, and specialist and emergency visits, resulting in communications that can either erode or boost a mother’s agency and self-esteem. For example, birth mothers are often provided with a lactation consultant and must negotiate their identity in the context of “good mother” standards as they learn to breastfeed (Marshall et al., 2007). Although some mothers embraced the process, others, who desired time to themselves, described themselves as feeling guilty and selfish. Sometimes, “good mother” stress also derives from a mother’s own medical challenges and the resulting additional encounters with the medical system. For example, mothers with multiple sclerosis, a degenerative condition affecting the nervous system, often judged themselves as “failing” in regard to mothering (Parton et al., 2019). In all of these situations, what medical professionals say or do is of significance. As Kantrowitz-Gordon (2013) notes, “because the biomedical discourse characterizes a mother’s distress as an illness, health care providers are privileged to make the diagnosis and legitimize or delegitimize the woman’s experiences” (p. 876).

Given medical professionals’ continued authority to judge mothers in the context of socially constructed norms of “good” motherhood, we ask two broad research questions. First, what are the main themes in what medical professionals say to mothers to either increase or decrease their belief that they meet “good mother” expectations? Second, how do mothers explain why specific communications from medical professionals either reduce or increase their “good mother” stress?

Participants

The mothers were sampled from all over the United States, and quotas were used to reflect U.S. census demographics in terms of race and ethnicity. About 11.4% of the participants self-identified as LatinX or Hispanic, 6.3% as Asian American or Pacific Islander, 11.4% as Black or African American, 0.4% as members of native/indigenous communities, 66.7% as White or Caucasian, and 3.5% as other. The highest educational attainment was high school/GED for 21.7% of the participants, some college for 26.8%, two-year degree for 13.8%, four-year degree for 25.6%, and master’s or higher degree for 9.4% of participants. This distribution mostly mirrored 2021 U.S. Census Bureau data showing the highest educational attainment was high school/GED for 26.6% of women, some college for 17.1%, two-year degree for 10.9%, four-year degree for 23%, and master’s or higher degree for 13.5% of women (U.S. Census Bureau, 2022).

The mothers’ ages also varied substantially. The 25–34 age group represented the largest number of participants (25.9%), followed by the 35–44 age group (22%), the 55-64 age group (20.8%), and the 45-54 age group (11.8%). The rest of the participants were younger than 25 or older than 64. In response to a question about working for pay, 38.2% of participants reported having no formal employment. 9.8% reported working less than 20 h a week, 34.2% reported working between 20 and 40 h a week, and 17.8% reported working over 40 h a week.

The average number of children was 2.42 (SD  =  1.48), and the ages of the participants’ youngest children ranged from “unborn” to 57 years. About 16.5% (42) of the participants reported their youngest child was an adult. Chi-square tests comparing the frequencies of themes between mothers with dependent/minor children and those with adult children showed no statistically significant differences. Furthermore, about 70% of all recalled communications were reported to have occurred within the last five years, and chi-square tests showed no significant differences in theme frequency between communications in the past five years and older communications, suggesting some contemporary relevance for all recollections in the narrative data.

Open-Ended Questions

There are various approaches to conducting a conversation analysis of medical communication events, including focusing on immediately preceding actions, stages of a medical consultation, and relative sequences of discussion (Robinson, 2011). Given the lack of access to the exact conversations that occurred during the relevant medical communication events, this study employed a meta-approach by focusing on the event’s overall experience through a participant’s salient recollection elicited by the open-ended questions. This approach emphasized understanding the participants as not simply receivers of messages during a medical communication event but rather as “embodied beings who experience communication” (Ucok-Sayrak, 2020, p. 54).

The participants were asked whether they (a) identified as a mother, and (b) had visited a medical setting since becoming a mother. If they responded in the affirmative to both screening questions, they were included in the sample. Next, mothers were asked whether they could recall a time when a medical professional communicated something that helped them to feel more relaxed about meeting the standards of “good motherhood.” The 138 participants who responded in the affirmative were redirected to an open-ended question asking them to recount what had been said. This question was followed by another open-ended question asking why the communication helped relieve stress related to the expectations of “good motherhood.”

The same approach was repeated in collecting data about medical communications that increased “good mother” stress. The participants were asked whether they could recall a time when a medical professional said something that increased their anxiety about meeting the standards of a “good mother.” The 72 mothers who responded in the affirmative answered an open-ended question asking them to recount what had been communicated, followed by another open-ended question asking why that communication increased their feelings of stress.

The responses varied greatly in length, from a few words to a long paragraph. Some answers lacked punctuation, making it impossible to count sentences, but we could still distinguish separate complete thoughts. The average response length was 123 characters. Even when responses were brief and simple, we were mindful of the potential potency of certain statements to increase or decrease a mother’s stress. A mother may be dramatically sleep-deprived and yet feeling it is morally abhorrent to take a nap. Or perhaps she fears someone would think her negligent and take away her baby if they knew she took a nap. When a medical professional, understood to be a legitimate legal and moral authority, says “it’s okay to take a nap sometimes,” the obviousness and simplicity of the statement does not take away its potential effect.

Theme Identification

A qualitative thematic analysis was used to determine four sets of themes: (a) the main themes in medical professionals’ messages that made mothers feel less and/or more stressed about the pressure to be “the good mother”; (b) the explanations the mothers gave for why these messages alleviated their stress; (c) the main themes in medical professionals’ messages that made mothers feel more stressed about the pressure to meet “good mother” norms; (d) the explanations the mothers gave for why these messages aggravated their stress. The thematic analysis process followed the stages described by Castleberry and Nolen (2018): (a) compiling data; (b) disassembling data (such as, for example, separating answers into complete thoughts and developing codes to describe the essence of each thought; and (c) reassembling the data by grouping compatible codes to identify subthemes, which are then further grouped to build higher-level themes.

We extracted themes by analyzing segments of the participants’ written recollections. Each segment expressing a complete thought (usually a sentence) about a specific memory of the communication experience. Such elements of one’s experience during a communication event can be understood as “slippages,” or communication-driven shifts in one’s construction of the self (Ucok-Sayrak, 2020). Some recollections referenced a single slippage relevant to the analysis, while others implied more than one. For example, the recollection “he told me i sic should meditate more” was analyzed as a single complete thought about a communication experience that was impactful enough to be remembered. By contrast, the following written recollection referenced multiple slippages through a series of complete thoughts:

There was a time when I was so tired I didn't no [sic] if I could go on because my baby had kept me up for several days crying endlessly. I just knew something had to be wrong. I took her to two different ER's and both said there was nothing wrong. The Doctor on duty looked at me as if he was saying “Lady don't bring her back here,” so I took her home and done everything I knew to do. That same night she started running a fever so we went back to the ER and they finally admitted something was wrong, a fever of 104F gave them that clue. They proceeded to take blood work, check her more closely, and ran some test. The nurse came into the room with a tub of icy water and a couple of towels and she told me to put the towel in the icy water and wring it out and put it on the baby. If looks could have killed I would have been dead as that nurse looked at me in such a way I felf [sic] like it was my fault she was sick—it wasn't. She had baby measles. They finally admitted her.

Each complete thought was rewritten as a shorter phrase capturing its essence. The rewritten phrases were examined to determine alignments allowing their collapse into a unifying theme. This process was repeated three times. The sub- and higher-leveled themes were regularly checked against the original raw data to make sure they accurately represented the original thoughts. Furthermore, the themes within a given set were checked for mutual exclusivity to ensure no overlap in descriptive components of the themes within a set. Overlap was allowed across sets because the concepts put forth in a communication can be reasonably expected to, at times, mirror explanations for why stress increased or decreased (e.g., a reassuring pat on the back can be both “kindness” communicated and “kindness” felt).

As qualitative thematic analysis “emphasize[s] an organic approach to coding and theme development and the active role of the researcher” (Clarke & Braun, 2017, p. 297), it was impossible to fully bracket our own motherhood experiences from the analytical process. Nonetheless, our goal was to establish the themes based on specific codes, each representing “an organizing concept—a shared core idea” (Clarke & Braun, 2017, p. 297). The final step was to interpret the data by discussing what the findings mean in the contemporary sociocultural context.

Affirmative Communication Themes

Responses about medical communications that reduced the mothers’ stress about meeting social expectations yielded five primary themes: (a) all is well; (b) “you are a good mother”; (c) absolution from guilt; (d) general kindness; and (e) useful instruction. Each of these themes is explicated in the paragraphs that follow.

Communications that fell under the “all is well” theme often indicated that a child was healthy and well-behaved. As one respondent described it, “my child was right on track with growth and health and learning.” If the child was not entirely healthy, medical communications that fell in this thematic category would indicate that everything was still okay despite the impairment. For example, one mother reported that a medical professional told her that “my son’s medical problems would not stop him from achieving great things.” Sometimes, the medical professional would say that worries were unnecessary, or that having a specific concern was normal or temporary. For example: “It’s okay that kids rebel. It’s normal, and will pass, it’s only a phase,” or “it just takes time.”

Communications that fell under the “you are a good mother” theme directly indicated to the mother that she was doing a good job. For example, as some participants described in their responses, “[they] let me know I was doing a good job at being a momma,” or “that I was very attentive and protective the way a mom should be.” Other medical communications were a vote of confidence while the mother was still pregnant, such as “you’re going to be a great mom” or “you can do it.” One study participant wrote: “… she also mentioned that the fact that I was so worried about what I was worried about showed the fact that I was going to be a good mother.”

Other ways in which medical professionals reaffirmed the participants as good mothers were more indirect—for example, by praising specific actions. One mother wrote: “I explained to the doctor what I knew about the problem, and what I did to resolve it and the doctor agreed with me and told me I did the right thing.” Other medical professionals made statements that framed mothers as “good mothers” by emphasizing their importance in children’s lives. Examples of such statements included “You are the number one person in your daughter’s life” and “Our best is exactly what our kids need.” The latter statement suggests that a mother should always do her best but also that she does not need to do more than what is possible.

Communication that fell under the theme “absolution from guilt” occurred when mothers expressed concerns over having done something wrong, but the medical professional immediately relieved the concern. For example:

When my son was younger, he was constantly breaking bones. I felt like maybe I wasn’t doing something right and this was the reasoning. Maybe it was I didn’t give him enough vitamins, or milk growing up. The medical professionals reassured that this was nothing to do with how I raised him, but the fact that they were all sports related and his bones were brittle.

Communications categorized under the theme of “general kindness” were both verbal and nonverbal. Verbal expressions included ones that connected mothers to support. For example, this is how one mother described what a medical professional told her: “She recommended I join a group where we all talk about our struggles and find inner peace.” Another study participant reported being given a telephone number she could call for help. Other verbal expressions in this category involved defending the mother to others, as in the case of one doctor telling a third party “to leave his best patient mother alone.”

Many mothers appreciated medical professionals’ empathy and sympathy because such statements helped them know they were not alone. As one participant wrote about one visit, the medical professional “put my mind at ease a bit that I wasn't alone.” Sometimes, medical professionals who were parents themselves told mothers they had had similar experiences or experienced similar feelings. One mother reported that a medical professional “shared some of the things about what she had went [sic] through with some of her teenage children and it helped me feel a whole lot better.” Another wrote: “She completely related to my frantic disorganization while trying to make it to a doctor's appointment; we just added another child to the family.”

The nonverbal expressions in the “general kindness” category included out-of-the-way effort to reach the mother, such as sending a personal letter, as well as caring touch and/or facial expressions. One mother reported feeling her stress reduced when a medical professional “patted my arm and nodded and smiled.” Sometimes, the study participants could not recall the exact nature of the communication but reported leaving a medical office feeling uplifted. “I can’t remember the exact words that the doctor said,” wrote one mother, “but she really did help me out a lot!”

Finally, medical communication categorized as “useful instruction” consisted of medical advice, which was perceived as valuable rather than imposing. One mother reported she appreciated learning that she “needed to take the medicine on time.” Other participants had children with medical problems, and the stress resulting from these problems was partially alleviated when mothers learned from medical professionals “how to solve it.” Some participants received instruction that was directly focused on ways to reduce stress, such as “the doctor told me to slow down” and “reminded me to also make sure I am taking care of myself.” Another participant recalled a nurse “telling me as a new mom to take in the moments. She told me to forget about the dishes or clean house and snuggle and nurse that baby because time passes so quickly. She was so right!”

Explanations of Positive Effects

The thematic analysis of the mothers’ explanations of how the above-described helpful communications from medical professionals reduced their stress related to motherhood norms yielded five primary themes: affirmation, functionality, positive affect, guilt reduction, and cognitive shift. Each of these themes is outlined below.

The “affirmation” theme included mothers’ recollections of feeling a tangible sense of their worth after a doctor’s appointment. Examples included “…made me know my worth” and “my efforts were materializing for the good. I was reaping what I sowed.” Other mothers felt affirmation as they were validated in knowing their decisions were correct (e.g., “I felt empowered and safe in my decisions”). Sometimes the explanations for why these communications reduced stress also included why the study participant perceived the medical worker as credible, therefore increasing the affirmation’s effect. For many, just having a professional or a doctor say something that alleviated the stress of motherhood norms was significant enough. Others saw as most credible the communications they received from medical professionals who were also women and mothers. For example, one respondent wrote: “Just hearing the feedback from a doctor, who was a woman and a mom as well, helped me out.”

The “functionality” theme included mentions of how following a medical professional’s advice produced positive effects that, in turn, reduced stress. Examples were “knowing how to be healthy makes me help my kids to be healthier” and “I needed to be shown again how to breastfeed.” Other explanations of why certain communications were helpful in a functional way included statements such as “it addressed the majority of my concerns” and “it helped relieve me so much.” Some participants did not directly describe the functional mechanism of stress reduction, but rather emphasized their preexisting need for stress reduction, implying that the communication met their need (e.g., “I was depressed at the moment”).

The “positive affect” theme included explanations of positive effects due to mothers’ perception that someone cared for them (e.g., “It just let me know that someone else cared”). Participants also reported experiencing a general sense of pleasure from being addressed with kindness (e.g., “it was said so nicely” and “the letter that was sent to me was very nice and brightened up my mood”). The “caring” theme of explanations also described instances when reciprocal talking-and-listening was the mechanism for the stress reduction. For example, one mother wrote: “The doctor just sitting there talking to me helped with the stress.”

Mothers also explained the positive effects of certain types of statements through the “guilt reduction” theme. The normative aspect of the “good mother” construction means that mothers are expected to judge their own worth in relation to their ability to rise to the standards of intensive mothering. One participant wrote: “Sometimes I feel guilty that I don’t do everything I have to do in a single day.” The guilt reduction theme in mothers’ explanations of positive effects emerged when they received some form of reassurance of their innocence. For example: “when the dentist assured me that there was nothing I could have done to change the outcome of my child’s dental problems, I felt comforted.” Another study participant reported that a medical professional “helped me when she said that my baby was crying due to colic and not like I was doing something wrong.” Mothers felt relieved because they found that imperfections are acceptable (e.g., “he understands that I am doing the best I can given the circumstances” and “it made me realize I’m human and it’s okay to make mistakes”).

The final theme, “cognitive shift,” in mothers’ explanations about what made certain medical communications alleviate the stress of motherhood as an injunctive norm included statements such as “it gave me insight and helped me understand.” Some reported that a medical visit helped them reframe their day-to-day lives (e.g., “it put my experience into perspective” and “it reminded me of reality”). One participant described how a medical professional helped her reconceptualize time: “I saw my child every day. So time stopped for me. I had to realize that time was really moving faster than I thought. Just take a breath and enjoy.” In all cases the cognitive shift was in a positive direction, challenging participants’ internalization of intensive motherhood norms.

Negative Communication Themes

The analysis of communications that increased mothers’ stress resulting from motherhood as an injunctive norm also yielded five primary themes: (a) “overwhelming responsibilities;” (b) “deal with it”; (c) “you are wrong”; (d) “general unpleasantness”; and (e) “child is not okay.” Each of the themes is explained in the following paragraphs.

The “overwhelming responsibilities” theme included medical communications emphasizing mother’s duties, such as “mom’s [sic] have the responsibility to do everything for their children.” In the same category were communications that emphasized the difficulty of meeting the expectations. As one study participant wrote, “I was told being a new mother will make you tired, overwhelmed, and stressed.” Sometimes, these communications were delivered as to-do lists, creating in the participants a sense of being overwhelmed. Examples that illustrated such communications included “she made me feel like there was a lot to remember,” “the feedings and how many times I have to change them,” and “telling me all the things I needed to do to ensure my son’s dental health.” One mother wrote that after giving birth and leaving the hospital, she was given “all the warnings of how things could go wrong.”

The “deal with it” theme included communications that emphasized the importance of mothers’ mental strength, implying that the patient present at the visit lacked such strength. Examples included “take it like a woman” (an interesting reversal of the masculinity-enforcing saying, “take it like a man”) and “we have to be strong to get through it.” Some participants were told to relax, but they perceived the communication as condescending rather than caring (e.g., “you need to relax a little”). Participants also reported being expected to deal with situations for which the medical professional provided no useful advice. For example:

My baby took bad temper spells, throwing herself on the floor, holding her breath, the whole nine yards. When I asked her doctor what to do he said in a rough voice “walk over her and let her throw her fit.”

The theme titled “you are wrong” included communications that pointed out mothers’ mistakes and directed blame. For example, one medical professional told a mother that she “needed to regulate her food intake better.” Some of the communications in this category were phrased as harsh disapprovals of specific parenting actions. For example, one study participant wrote that when she was trying to potty train her daughter, “her doctor said I should not be asking my daughter if she has to go potty. She said I should just be telling her it’s time to go potty.” Some medical professionals laid blame on mothers, such as “the dentist blamed me for not getting enough fluoride when I was pregnant” or “they told me that I was overwhelmed and anxious which caused the kids to act out.” Some participants even recalled medical communications directly indicating that the mothers are not enough and had failed to meet the “good mother” standards, such as “are you sure you can do this?” One mother wrote: “I had several medical complications during pregnancy. On my third trimester, my OBGYN said ‘if you were a horse, you would have been shot.’”

The “general unpleasantness” theme included participants’ recollections of communications that were rude in words and/or manner. For example, one mother wrote that “they told me to ‘shut up’’’ and “the doctor’s bedside manner was very gruff and mean.” Another participant recalled a time when she was anxious to hear about the medical condition of her child and faced a medical professional who “was unwilling to give the possible bad news and asked me to come back in a week.” This theme also included communications that could not be specifically recalled but resulted in an overall sense of negative affect. One participant reported that such experiences are routine: “I can’t think of one instance, but I always feel pressure for me and my kids to act a certain way or be judged when we are at medical appointments.”

Finally, the “child is not okay” theme included recollections of medical professionals’ statements that a child was unhealthy or maladapted (e.g., “telling me that my daughter was too underweight” or “that my child was struggling behaviorally”). In these cases, mothers felt that the child’s condition reflected on them as (not) “good mothers,” even when no blame was laid directly. Sometimes, the children’s medical conditions were life-threatening (e.g., “your child has a heart murmur and will need to stay in the NICU longer” and “they weren’t sure if my baby would survive”). In these cases, the negativity felt by the study participants likely reflected the lack of additional statements that could have expressed situation-appropriate support or sympathy.

Explanations of Negative Effects

Five themes emerged in the study participants’ explanations of the reasons specific medical communications affected them negatively and overtly or indirectly upheld the oppressiveness of the “good mother” norm. The themes included judgment, reduced sense of self, overwhelming burden, negative affect, and frustration with unhelpful advice.

The “judgment” theme included participants’ explanations such as “it felt as if she was scolding me” and “I was shamed for rushing to my nearest hospital.” These experiences, however, were not necessarily internalized. For example, one mother asserted her self-worth and challenged the “good mother” norm by writing that something a medical professional said “was meant to make me feel like I messed up as a parent, even though it was something completely out of my control.” Recognizing what was out of her control indicated that she accepted reality-based limitations on her parenting rather than embracing an ideologically driven, unrealistic perspective. Another participant also challenged a medical professional’s attempt to enforce “good mother” norms by describing the situation as somewhat illusory: “It seemed I fit into neither of the two acceptable patterns.”

In contrast, the “reduced sense of self” theme incorporated explanations showing the effects of internalizing the negative communication, which resulted in self-doubt and feeling like a failure or at fault. One participant’s recollection directly invoked the good-bad mother dichotomy: “I felt like a bad mom for not being able to produce enough milk.” Another mother reported that what a medical professional said “made me feel like I was almost being neglectful.” Similar examples included “I felt I was failing at guiding him [my son] correctly” and “made me feel like I was … doing it wrong.”

The “overwhelming burden” theme in mothers’ explanations of the effects of negative communications was sometimes directly stated (e.g., “sometimes you just get overwhelmed”). Participants reported that some visits with medical professionals added to the normativity of motherhood they had already been negotiating in their lives (e.g., “it just sounded like another long to-do list on top of all the things I already have to manage”). Similar explanations for why certain conversations induced anxiety focused on circumstances over which most people have relatively limited control, such as poverty and children’s potential for developing mental illness (e.g., “it made me stress over money” and “it made me worry for my child's mental health”).

The “negative affect” theme in mothers’ explanations of the effects of negative medical communication on their stress levels included general statements about psychological discomfort, such as “it made me feel really bad” and “because it was my first baby I was terrified.” Other study participants attributed the effects of negative communication on their state of mind as “just negative energy thrown at me” and as “it’s not a fun feeling. It’s a depressing one.” Even when participants were certain that a medical professional’s statement was inaccurate, unsupported by evidence, or situationally inappropriate, they still had to manage some negative emotional effects (e.g., “I knew it was irrational so mostly it was just annoying”).

Finally, the “frustration with unhelpful advice” theme in mothers’ explanations included recollections of dashed hopes of being helped by medical professionals. One study participant, who reported having been told to “hang in there,” reported: “I’ve been hanging in there for years… Still hanging.” One mother, who was told to make her child lose weight by increasing exercise, wrote: “My daughter never stopped moving until she fell asleep. How much more exercise could she get?” Another mother was told to talk to her kids, even though “kids are hard to talk to.” One participant even reported that she had been actively prevented from acting as a “good mother” by being forced to wait outside a room in which her child was undergoing a medical procedure: “I needed to help her handle the situation.”

Theoretical and Practical Implications

This analysis contributes to the literature about the role of the “good mother” ideology in continually upholding ever-evolving forms of oppression (Dobris et al., 2017; Green, 2004) and the mother-blame/ mother-valor dichotomy (Blum, 2007; Sousa, 2011). It also extends previous research about actual versus ought-selves discrepancies (Calogero & Watson, 2009; Higgins, 1987) to a new context involving medical communication about the “good mother” ideal.

This study also has some practical implications for medical practitioners. Some of the communications that were reported to have increased mothers’ stress are unavoidable for doctors and nurses fulfilling the duties of their employment. A doctor, for example, should communicate a health concern, even if doing so increases the mother’s stress. However, assuring a mother that she is not at fault and/or that a health concern represents a temporary phase can and should become standard elements of medical professionals’ approach to delivering bad news whenever doing so is reasonably accurate. Medical professionals may also wish to refrain from adding to mothers’ already long “to-do” lists unless doing so is necessary and justified.

Limitations and Directions for Future Research

This study had several limitations. First, the analysis was based on written recollections rather than on ethnographic observations. Although the literature suggests that memories are essentially reliable, exact precision should not be expected (Brewin et al., 2020). Future research could employ ethnographic observations of mothers’ experiences in medical settings; however, it is worth noting that such a study would be extraordinarily difficult to arrange due to privacy limitations.

Second, the sample included only mothers who identified as women and only adults over 18, omitting potential insights from nonbinary or young mothers, who are known to face higher standards for achieving “good motherhood.” Future research should seek more diverse motherhood experiences within medical settings. Third, the study did not seek any insights from medical professionals about what they communicate to mothers and why. Future research could examine the same questions through in-depth interviews with medical professionals. Finally, future research should continue to track trends in defining good fatherhood, as fathers are increasingly playing a larger role in nurturing their children (Sarfaraz et al., 2021), and may, in time, also come to share strong societal expectations about ensuring their children’s health and well-being.