International Journal of Nursing Studies 47 (2010) 6066

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International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

Transformation in self-identity amongst Taiwanese women in late

pregnancy: A qualitative study
Shiow-Ru Chang a,*, Nancy J. Kenney b, Yu-Mei Y. Chao a
a
b

Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan

Departments of Psychology and Women Studies, University of Washington, Seattle, WA, USA

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 29 January 2009
Received in revised form 16 May 2009
Accepted 14 June 2009

Background: In a culture transitioning between the traditions of old and modernity, the
experience of pregnancy brings added challenges. Pregnant Taiwanese women in large
cities are expected to modify their behavior in keeping with long-standing traditions that
remain important to their families even if they themselves do not endorse the beliefs. To
date, researchers have not examined the processes and the components of the
transformation of self-identity during pregnancy under these cultural conditions.
Objectives: To examine the transformation of self during pregnancy by women living in
urban Taiwan at a time when modern ideas of womens roles and health care practices coexist with traditional cultural beliefs on these issues.
Methods: This was a qualitative study using in-depth, open-ended interviews. Eighteen
pregnant women receiving prenatal examinations at clinics located in a medical center in
Taipei, Taiwan, participated in this study. Interview responses were analyzed using a
phenomenological approach.
Results: Cultural and family expectations clearly inuenced womens activities and their
sense of self during pregnancy. Two themes were central to these experiences. The rst,
constructing a new self in the context of cultural values, reected the need for women to
develop a response to the traditional beliefs, taboos, and public advice made very explicit
in their lives during pregnancy. The second theme, building a new body image from the
past self, addresses how womens reactions to the traditional beliefs and public advice
inuenced the ways in which the women viewed themselves as pregnant individuals.
Conclusions: Cultural factors and body image issues shape the transformation of selfidentity during pregnancy for women living in a modernizing, yet culturally traditional,
urban environment in Taiwan. Awareness of the impact that such cultural inuences have
on the psycho-social experience of pregnancy will help health professionals to better
understand and respect the process of self-identity involved in moving toward
motherhood, and thereby to provide a woman-centered model of care that is also
culturally sensitive.
2009 Elsevier Ltd. All rights reserved.

Keywords:
Self-identity
Culture
Body image
Qualitative study
Transition
Traditional belief
Maternal care
Womens body
Mothers body

What is already known about the topic?

* Corresponding author at: Department of Nursing, College of Medicine,

National Taiwan University, No. 1, Sec. 1, Jen-Ai Rd, 100 Taipei, Taiwan.
Tel.: +886 2 2312 3456x88425; fax: +886 2 2321 9913.
E-mail address: srchang@ntu.edu.tw (S.-R. Chang).
0020-7489/$ see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2009.06.007

 The meaning or perception of the transition entailed by

pregnancy can vary from individual to individual.
 A pregnant woman experiences a physical, emotional,
and social transition that can bring joy or stress.
 Pregnancy is not just a personal experience but one
meaningful to family and culture. To date, research has

S.-R. Chang et al. / International Journal of Nursing Studies 47 (2010) 6066

not examined the transformation of self-identity in a

culture that has both modern medical practice and
thought and traditional socio-cultural beliefs.
What this paper adds
 Acceptance or avoidance of traditional cultural beliefs
and practices inuence the transformation for pregnant
women.
 Cultural factors and body image issues shape the
transformation in self-identity during pregnancy.
 Traditional socio-cultural beliefs inuence the interaction between the self-as-a-woman and the self-as-amother, as well as the interaction between self-as-I and
self-as-me during pregnancy to forge a new sense of self.

61

Katabi, 2008). In contrast, changes related to technology are

quite rapid (Cortis, 2003). The culture of Taiwan is in the
midst of a transition in beliefs about gender roles and
modern medicine that began back in the early 1900s (Chang,
2008) and continues through the current day. While beliefs
and attitudes prevalent in developed (mostly Western)
nations gain prominence, traditional cultural practices and
beliefs remain strong. Little is known about the processes
and components of the transformation of self-identity
during a major life event such as pregnancy when it is
experienced within a culture that is also in the midst of
transformation. The purpose of this study was to examine
the transformation of self during pregnancy by urban
dwelling women in Taiwan who are negotiating this
transformation in a culture in which modern ideas of
womens roles and health care practices are strongly
intertwined with traditional cultural beliefs on these issues.

1. Introduction
2. Methods
Transitional experiences are complex and multidimensional (Kralik, 2002; Meleis and Trangenstein, 1994;
Schumacher and Meleis, 1994). Transition may be facilitated or inhibited by ones personal conditions, cultural
beliefs and attitudes, socioeconomic status, preparation
and knowledge, and community and societal conditions
(Meleis et al., 2000). For women, one of the most dramatic
transitions in self-identity occurs during pregnancy.
Pregnancy challenges the womans view of herself as a
woman and as a mother.
During pregnancy, a womans body undergoes extensive and rapid physical change. As Bailey (1999) pointed
out, pregnancy affects the womans sense of relationship
with her body. Women are aware that the extensive
physical changes they are experiencing both assist their
fetus to grow and develop adequately and prepare the
womans body for birth and mothering. These changes and
the ways in which she interprets them greatly affect a
womans body image and have a considerable impact on
her self-image (Chang et al., 2006; Ussher, 1989).
Many psychological factors contribute to the experience of maternal transition (Darvill et al., 2008). During
pregnancy, women undergo changes in the psychological
self and the self-concept; identities and relationships are
transformed (Darvill et al., 2008; Hilnger Messias and
DeJoseph, 2007; Metastasio et al., 1995).
All self-transformations encompass both losses and
growth in the self (Carpenter et al., 1999). Goals, behaviors,
and responsibilities are re-structured to achieve a new
conception of self (Barba and Selder, 1995). The meaning or
perception of transitions can vary considerably from
individual to individual (McCubbin, 1999). Such differential perceptions may inuence both the way in which
pregnancy is experienced and the outcome of the
transition in identity (Chick and Meleis, 1986).
Transformation of self-identity during a major life event
like pregnancy does not occur in a vacuum. Culture (Cooley,
1902; McIntyre, 2006) and interpersonal relationships
(Surrey, 1991) affect how such a transition takes place.
But cultures are not static; they undergo transitions as well.
Culture is an active concept that changes gradually as it is
transmitted from generation to generation (Ozsoy and

The Research Ethics Committee of the hospital involved

reviewed and approved this research project. We recruited a
purposive sample of research participants from amongst
pregnant women who were receiving prenatal examinations at clinics located at a medical center in Taipei, Taiwan.
To be included in this study, a woman coming to the clinic
had to (1) be in the 29th to 39th weeks of pregnancy, (2) be at
least 20 years of age, (3) have lived in Taiwan most of her life,
(4) speak Taiwanese or Chinese uently, and (5) be willing to
share her personal story with the interviewer. A potential
participant was excluded if she was (1) seeking medical
treatment on that particular clinic visit; (2) experiencing
problems such as heart disease, hypertension, thalassemia,
or any other serious complication of pregnancy; or (3)
unwilling to share her personal story.
We developed the interview guide through a series of
pilot interviews with 10 women whom we asked to discuss
the physical and emotional changes they experienced
during pregnancy. None of these women was a subject in
the study reported here. Interview questions were revised
and rened after each pilot interview. The resulting study
interview guide began with broad opening questions: Tell
me about your pregnancy experience. How did you feel
when you rst learned you were pregnant? How about
now? and How do you feel about your current appearance
and body shape?. The inuence of cultural traditions was
assessed through such questions as: Talk about your daily
activities or social activities., Which activities did you stop
doing or keep doing?, During pregnancy, are there any
taboos you have to follow?, Have you been attending
parties or celebrations?. The rst author, a nurse with 10
years of clinical nursing experience, conducted all interviews in Chinese or Taiwanese.
With the permission of the unit chief, pregnant women
in the waiting room of the hospital clinic were approached
and asked if they would be willing to participate in a
research project involving an audiotaped interview concerning their experiences of pregnancy. Women who
consented completed a demographic questionnaire. We
then interviewed them in a private room in the clinic. We
conducted interviews face to face in a conversational style.

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S.-R. Chang et al. / International Journal of Nursing Studies 47 (2010) 6066

Interviews lasted from 40 min to 2.5 h. Interviews took

place between August 2003 and July 2004, with additional
interviews in December 2004. (While data collection for
this study was completed some time ago, the cultural
conditions of coexistence and conict between traditional
cultural beliefs and modern technology are no less
apparent today than they were at the time the interviews
took place.) Data resulting from questions about attitudes
toward body changes during late pregnancy included in
these interviews were reported earlier (Chang et al., 2006).
2.1. Data analysis
As noted in our earlier work, interview audiotapes were
transcribed within 2 weeks of the interview, producing a
narrative description that served as the data for analysis.
We used a modication of Giorgis (1985) phenomenological method of data analysis to analyze the transcripts.
Following procedures detailed in Chang et al. (2006),
respondents statements were organized into clusters
reecting similar issues or experiences. Continued analysis
and synthesis resulted in our grouping the clusters into
two overarching themes that encompassed the varied
experiences reported by the subjects and their adjustment
of their self-identity amid traditional cultural pressures.
3. Results
The mean age of the 18 pregnant women was 30.5 years
and the median was 30.0 years. The mean week of
pregnancy was 33.6 and the median was 34.0 weeks. The
mean prepregnancy body mass index (BMI) was 21.0 and
the median was 21.2. The mean and median BMIs upon
entering the study were both 26.2. Interview participants
were 15 primiparas and 3 multiparas; each multipara had
one older child. Ten participants were employed full-time;
four were part-time workers; four were homemakers. All
women had completed high school and most had received
either additional technical training (n = 5) or a university
degree (n = 11). All were in apparently heterosexual
relationships; one was engaged and 17 were married.
The sample characteristics can be found in Chang et al.
(2006).
3.1. Constructing a new self in the context of cultural values
The rst major theme reected in the responses of the
participants related to their experience with and response
to the culturally relevant social values, traditional beliefs,
taboos, and public advice they encountered during
pregnancy. Four sub-themes emerged illustrating the
different degrees to which the participants identied with
traditional cultural ideas and different ways they reacted
to traditional restrictions and expectations. These were
Identifying with Traditional Cultural Taboos, Disagreeing but Complying, Achieving a Compromise between
Public Advice and Autonomy, and Asserting Oneself.
3.1.1. Identifying with traditional cultural taboos
Many participants had internalized traditional cultural
beliefs and expected themselves to act in accordance with

traditional taboos and public advice. For example, the wellentrenched cultural taboo banning pregnant women from
certain settings limited the social activity of some
participants. This is clearly emphasized by one participant
who noted:
Since I got pregnant, I havent attended any weddings.
My mothers generation regards pregnancy as a sign of
good luck, so I wont put myself in a position of
competing with the bride, who is the star of her
wedding and is also regarded as another sign of good
luck. It is said that two different kinds of good luck will
be ruined if they occur together. . .. I do not know, but I
think it is a belief. Anyway, I tell myself not to attend
any weddings if I really care. (B4, 31 wks)
3.1.2. Disagreeing but complying
Some women disagreed with cultural norms but abided
by them nonetheless. When cultural warnings are
commonly held a woman who challenges the warning
might be regarded as a bad mother who will not make
sacrices in order to protect her children. She will face
blame and ridicule if her baby has health problems. In
Taiwan, traditional beliefs about proper dietary habits
during pregnancy are conveyed to a pregnant woman by
the people around her, who often pressure her to abide by
culturally endorsed dietary restrictions. This pressure may
challenge the autonomy of pregnant women.
I like to eat shaved ice, but now I cant. My husband and
family say that it will hurt the baby, especially the
breath organs, although I dont think it has any effect.
Sometimes, I try to get shaved ice, but it is quickly taken
away by my husband. He does not allow me to eat it.
(B17, 35 wks)
Is it true that [a pregnant womans] having cold or iced
food is not good for the babys lungs? At this moment, I
am craving shaved ice, but my husband wont allow me
to have it. . . Everything that goes into the stomach will
become warm, so why cant I have shaved ice on these
hot days? Its so tiring; I just cant stand it. . . Shaved ice
is still not for me. Ill just set the iced drink aside at room
temperature for ten or twenty minutes before I can
drink it. The most disgusting part is sitting beside my
husband and watching him eat shaved ice while I can
eat nothing cold. (B5, 36 wks)
3.1.3. Achieving a compromise between public advice and
autonomy
Family members, friends, and even strangers sometimes offer comments and advice telling pregnant women
what they should or should not do. The women often
struggle to maintain control over their behavior in spite of
the pressure. Sometimes elaborate compromises are
reached:
He (my husband) asks me more often to do this or
follow that, because he says the baby is now in my body
and I have to eat, keep eating, he would love to buy
special food for me. . . he is just worried that the
baby might be too small or what. . . Not long ago, the

S.-R. Chang et al. / International Journal of Nursing Studies 47 (2010) 6066

check-up showed the baby was a little too small. . . then

he (my husband) heard people say Chicken Essence [a
dietary supplement] was great, very good for babies to
grow faster. But I dont like its smell. I said Id rather
drink chicken soup, I dont want Chicken Essence. Then
he said, ask your baby and see if he (she) likes it or not.
Yeah, he just wanted to pressure me. Or he would say,
The doctor said the baby wasnt big enough, you eat or
not? He did say that. . . actually it made me feel
stressed, but I know what he did is for me. So, I told him
I would like to make a deal with him, that is, drink milk
one day and then Chicken Essence the other day. I dont
want to drink Chicken Essence everyday. Originally he
asked me to drink every single day. I said I would rather
drink fresh soup. Chicken Essence makes me feel sick.
Sometimes, he just takes the baby as an excuse to give
me pressure. (B8, 30 wks)
In other cases, the opinions of others result in a
complete change in the womans behavior even to the
point of giving up a favored activity:
When I went swimming, people around me kept
reminding me to be careful. I became very careful
but also very nervous, so I decided not to go swimming
any more. Those people who cared so much about me
included my husband, my parents-in-law, and some
other swimmers. They were just afraid that I might slip
on the oor. Even the lifeguards gave me advice. (B1, 34
wks)
Situations such as these challenge the womans selfidentity and sense of self-efcacy.
3.1.4. Asserting oneself
Some women, faced with social attempts to restrict
their behavior, act autonomously. This response may
require special conditions. The woman quoted below had
just returned from study abroad and her husband
supported her behavior in spite of opposition from other
family members.
My parents-in-law said the water wasnt clean, but my
husband said it was OK. I went for a swim at the spa,
where saunas are also provided. My husband just said
not to stay in the water too long; otherwise I might get
infected. He always gives me a ride and encourages me
to go swimming. . . because I used to do so during my
rst pregnancy (experienced in Belgium). I think the
delivery process would become more difcult without
proper exercise. Especially since I am now staying home
taking care of my child and rarely have other activities. I
certainly will go swimming without hesitation. . . I dont
care, because my only goal is to get a workout and I
dont care what people say to me. (B16, 30 wks)
3.2. Building a new body image from the past self
For a woman in late pregnancy, the experience of
change in body shape, the appearance of stretch marks,
and the decline in physical mobility are related to changes
in the self.

63

3.2.1. Changing body shape and self-condence

In our earlier work, we concentrated on womens
attitudes toward the physical changes they experienced
(Chang et al., 2006). Here we assess how those changes
translate into womens evaluation of themselves as
competent and condent individuals. These changes seem
to reect a relatively universal experience of pregnancy
and not one imposed by traditional Taiwanese beliefs.
In late pregnancy, the increase in body girth becomes
burdensome and restricts motor and social activity. One
woman interviewed 39 weeks into her pregnancy felt
very uncomfortable and dissatised with her body shape.
She pointedly talked about how the change was so
dramatic that she could not maintain the appearance she
wanted, and she felt she had lost her self-condence.
Furthermore, her experience of her body refuted the
common social discourse extolling pregnant women as
beautiful women:
I used to be a slim girl, but my body shape changed after
I got pregnant. Because of this change, I no longer feel
self-condent when I am walking down the street.
Although people always say that pregnant mothers are
the most beautiful women in the world. I dont get it.
Just look at me! See what I look like now!
In the hospital waiting room I paid more attention to
the pregnant women who dressed themselves up. They
looked much prettier than others and easily stood out in
the waiting room. Of course, I wanted to be one of them.
So I started to choose carefully and dress in my favorite
clothes, which made me feel pretty and condent when
I needed to go to hospital for check-ups. Now I cant nd
the right dress because my belly has grown too big to t
my clothes. I think I look ugly no matter how I dress.
(B13, 39 wks)
3.2.2. Skin changes and the evaluation of normality
Unexpected changes cause concern as women worry
whether they are normal or if they are experiencing
something unusual unique to them. Both of these aspects
of identity formation are apparent in the following quote:
Im surprised that a dark line appeared above my
umbilicus. At rst, a light colored line appeared on my
lower belly and I thought it looked OK. Later the line not
only got darker but it also spread to my upper belly as if
it were climbing up a tree. . . During the late stage of
pregnancy, the line climbed higher and higher and the
area around my umbilicus got dark. I asked my husband
why the area was getting dark. Then I asked my sisterin-law the same question. She said she had the same
problem and showed me her line. Her line also climbed
up, and the circle around the umbilicus was very dark,
too. I feel better knowing we both are the same and Im
sure its normal. (B5, 35 wks)
3.2.3. Changing physical and social competence
Participants spoke of how weight gain and altered body
shape affected their faith in their own skills, a belief that is
often reinforced by concerns expressed by others.

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The following quote reects one participants loss of

condence that she could perform certain physical
activities. She also reports that her activities were
restricted by others who were concerned that she might
harm herself or the baby.
I used to enjoy going out, but now I dont. Since Im a
clumsy person, Im quite worried that some accident
might happen while Im out. For example, Im not
steady on my feet and it would be easy for me to fall
down if I werent careful. . . I used to have a lot of fun
driving to visit my friends, but now I mostly stay at
home. My social activities are severely restricted. Ive
been forced to stop many activities that I used to do.
Most signicantly, I rarely drive my car because Im
afraid that my belly, which is so close to the steering
wheel, might get hurt if I step on the brake suddenly.
My mother-in-law asked me not to drive. (B3, 30 wks)

4. Discussion
Pregnancy is a special life situation. During pregnancy, a
woman experiences major changes in her physiology and
in her psychology. These changes, in turn, lead to
alterations in her self-concept (Chao, 1977). In the present
study, womens descriptions of their experiences of
pregnancy clearly revealed the interaction of the body
and the self, as well as the interaction between sociocultural values and traditions and the self during late
pregnancy. The results of this study support the notion that
the self-image arises from action in and interaction with
the physical and social world (Rubin, 1984) and points to
additional complications that arise when the social world
has strong, and even conicting, traditional and modern
views of the requirements for a healthy pregnancy.
Stets and Burke (2003) proposed that the responses of
the self as an object to itself comes from the point of view
of others with whom one interacts. . . The meaning of the
self is formed on the basis of interaction with others and,
ultimately, the social structure (p. 130). When these
interactions with others occur in a context of changing
cultural beliefs, another layer of meaning must be
negotiated in developing a new self-identity.
Mead (1934) argued that the I and the me are
essential elements of the self in its full expression. In
Meads view, the me involves taking on the attitudes of
others in a group in order to belong to a community. The I
entails the individuals continuing reactions to social
circumstances that, in a dialectic process, change the very
community to which she or he belongs. For a pregnant
woman, the interaction of I and me may lead to a struggle.
This struggle between the changing self of the pregnant
women and her work to maintain or change cultural
traditions regarding pregnancy (the changing I) is very
apparent in the words of the women who participated in
this study. Rubin (1976) identied a number of elements
that characterize the content and substance of pregnancy.
One of these is the pregnant womans act of seeking a safe
passage for herself and her child through pregnancy, labor,
and delivery. The women in this study were clearly focused

on a safe transition through pregnancy, for themselves and

for their babies. The conict between some traditional
beliefs and modern ideas often made the route of safe
passage unclear for the women in this study. Women
responded to this conict by accepting the traditional
outright, capitulating to the traditional social pressure
reluctantly, compromising between their own desires and
cultural demands they do not uphold, or even refuting
cultural demands entirely. Rejection of traditional requirements or compromise between traditional demands and
the womans own desire added layers of negotiation and
potential stress as the women took on the role of good
mother and independent self.
Upton and Han (2003) noted . . .[T]he pregnant body is
subjected to increased social control and scrutiny. Moral and
value judgments [are] implied based upon what pregnant
women chose to eat, wear, and say, and highlight the idea for
some that the individual is now lost. . . (p. 680). Pregnant
women in many cultures receive advise, both public and
private, about appropriate nutrition and healthful behaviors
(Longhurst, 2001). Pregnant bodies are public bodies and are
often regarded as public property (Longhurst, 1999; Upton
and Han, 2003). Pregnancy is often constructed as a special
condition requiring extra guidance or surveillance to
protect the fetus (Longhurst, 1999; Young, 1990). A
contemporary example might be the pressure applied to
prevent pregnant women from consuming alcohol in many
modern societies. This campaign is in structure similar to the
taboo on consumption of iced products by pregnant women
in Taiwan. While the sanction against excessive alcohol
consumption rests in a strong bed of modern scientic
research, this evidence is not without challenge. Many
pregnant women accept the evidence and avoid alcohol
consumption. In a scientically based society, following this
taboo is easily justied. Avoiding shaved ice is based on
traditional beliefs but has no modern scientic foundation.
Following this taboo can induce a conict between the need
to maintain tradition (or at least not challenge others who
maintain tradition) and the modern educated womens
knowledge of biology and fetal safety. Both situations limit
the pregnant womens autonomy but the latter may induce
more stress if the woman truly does not believe the
tradition. It should be noted that the same degree of added
distress would result if a woman who strongly holds to
traditional beliefs is made to act in a way that contradicts
those beliefs by others who prize modern perspectives.
The Taiwanese women interviewed here experience
transformations in their sense of self during pregnancy that
were both common to all womens experience of the
responsibility of gestation and unique to the culture in
which the women were experiencing this life event.
Participants in this study emphasized concerns about the
normality of their physical changes, needing assurance that
their experiences were not unique or unacceptable.
Awareness of both the uniqueness of their experiences
and the similarities between themselves and other pregnant
women help women maintain self-identity during pregnancy (Earle, 2000). Mead (1934) contended that the body,
or the biologic individual, and the self, or the socially selfconscious individual, (p. 347) are mutually inuential in
the ones sense of self. Both are constantly emerging relative

S.-R. Chang et al. / International Journal of Nursing Studies 47 (2010) 6066

to the changes in ones body. Some of the women

interviewed here clearly noted a loss of self-condence.
Physical abilities were questioned as bodies changed and
loss of pre-pregnant physical characteristics was greeted
with concern and dismay. These seem rather universal
adjustments to the individuals sense of self. Participants
reported that their activities had moved during late
pregnancy from public spaces to the home. Their bodies
had come to be limited to private spaces (Longhurst, 2001).
Weight gain and altered body shape result in decreased
mobility and problems with balance (Rubin, 1984). Restrictions on the womens physical activity and social functioning might have reected or even induced a heightened sense
of vulnerability, resulting in even further constriction of
personal and interpersonal space (Rubin, 1984).
Cultural inuences on the womens sense of self clearly
reected the demands of Taiwanese tradition and the
womans own attitude toward the cultural beliefs. Dietary
and social engagement traditions both affected womens
attitudes toward their pregnant condition. Following rules,
when unsure or even rejecting of their value, had the
positive effect of keeping peace in families or reducing the
risk of blame if something went wrong. But, adherence also
bred resentment and anger in the women. Direct
confrontation of rm cultural or societal demands is
possible but may require special circumstances. The
clearest example of such deance in our work came from
a woman who had lived in the Europe for a period of time
and had experienced her rst pregnancy outside of Taiwan.
Even in this case, the added support of the husband for the
womans behavior no doubt eased her ability to act in
contradiction to social rules.
Identity is physically situated and shaped by the
capabilities, limitations, and activities of the body, as well
as by dominant cultural meanings pertaining to female
beauty, femininity, and womens social value (Clarke,
2001). Thoits (1983) has suggested that life events related
to identities are more likely than other life events to cause
difculty. The work of Higgins has shown that discrepancies between reected appraisals and ones ideal self, the
person one feels one ought to be, lead to anxiety and
distress (Higgins, 1987). Some have suggested that a loss of
mastery results in a loss of self-esteem and, perhaps, a rise
in depression (Burke, 1991). The ndings of this study
suggest that pregnant women experience their identities
as engaged in a process of transition. These participants
searched for a state of being that balanced the identities of
the new body and the old body, the new role and the old
role, the new self and the old self. Some of these pregnant
women were able to achieve a state of equilibrium within
their changing body image and changing self-image, but
some of them were not. Pregnancy may represent the onset
of a critical point for women, where the self is in transition
and self-concept is reconstructed. This critical transition
may present a potential mental health crisis for women.
When individuals feel good about themselves, they are
able to take on more identities. The core of an identity is
the categorization of the self as an occupant of a role that
can be fully integrated into the self (Stets and Burke, 2003).
In this period of transition to motherhood, a womans
identity has to shift and become re-embodied through

65

both physical change and role change. The pregnant

woman embodies the identity of woman through the
reshaping of her body image, a process that results in a
reconceptualization of the self. In the meantime, the
embodiment of her identity as mother enables the
conceptualization of the self-as-mother. The interaction
between self-as-woman and self-as-mother, as well as the
interaction between I and me, creates a new self for the
woman during pregnancy. Moreover, the reshaped body
image along with the incorporation of the role and identity
of a pregnant woman reect a transition from past self to
present self.
4.1. Implications
The words of the women interviewed for this study
clearly articulate the challenges they face in re-dening
the self during pregnancy. These challenges are more
complex because they are taking place in a cultural milieu
that is, itself, in transition. The women are negotiating all
the changes of pregnancy while immersed in conicting
views of women and of pregnancy reected in contemporary urban Taiwan where modern technological culture
is establishing its foothold along side well-ingrained and
still very strong beliefs of arising from centuries of
tradition. How this complexity is negotiated varies from
woman to woman. Risks to self-identity and self-condence arise no matter how the woman handles the
situation. It is important for health care providers to assess
womens risk related to this conict on an individual basis
neither assuming her belief and adherence to tradition nor
assuming that she rejects such tradition outright. It is
critical for professional nurses to remain sensitive to the
varied meanings of transformation process of pregnancy
within a transcultural milieu.
In a more general context, this study suggests that care
providers and researchers need pay more attention to the
complex individual experience of pregnancy. The ndings
show that some women are conicted or stressed in the
transitional process of pregnancy. Care providers should
recognize the impact of self-change on the womans
personal experience of pregnancy. The provision of
effective emotional support from health professionals
such as attentive listening is needed. The emphasis should
be on being with pregnant woman as she struggles with
conict. Furthermore, awareness of the complex and
possibly conicting reactions pregnant women have to
their bodies and self may help health professionals be more
open to hearing and respecting what pregnant women
have to say, help them provide a nondirective environment
in which women can feel free to talk any feeling they may
have thus providing greater social and psychological
support for their clients. The interaction process between
care providers could help pregnant women improve the
accuracy of the self-reection underlying the transition in
self-identity during pregnancy.
Finally, the nding of this study indicates the importance
of educating the pregnant womens family, relatives, friends
or strangers about the potential impacts of providing too
much directive advice or protection to pregnant women.
People should respect pregnant womens feeling, embodi-

66

S.-R. Chang et al. / International Journal of Nursing Studies 47 (2010) 6066

ment and eliminate the universal control to enhance their

autonomy, self-condence and mental health.
5. Conclusions
This study clearly shows that experiencing pregnancy
in a transitional culture can add a layer of conict and
stress over and above that experienced by all women
undergoing this massive physical and psychological
transition. Both cultural factors and body image issues
shape the transformation in self-identity during pregnancy. Traditional socio-cultural beliefs inuence the
interaction between the self-as-a-woman and the selfas-a-mother, as well as the interaction between self-as-I
and self-as-me during pregnancy to forge a new sense of
self. Health professionals need to understand the cultural
factors that are inuencing the womens self-identity and
self-concept during pregnancy and take the time to
understand the womans unique position in negotiating
the space between traditional and modern social beliefs.
Conicts of interest
We do not have any conicts of interest.
Funding
We do not have any sources of funding for our research.
Ethical approval
This research project was reviewed and approved by
Research Ethics Committee of National Taiwan University
Hospital (Number: 9461701115).
Acknowledgments
We thank all participants in this study for their time.
We also like to thank Sandy Chuang for her review of the
English translation of interview excerpts.
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