"I had no right to fall apart": Hope as a performative obligation following an adverse prenatal diagnosis.

PROBLEM: Hope is central to perinatal support, but encouragement may become a demand to appear positive after an adverse prenatal diagnosis.

BACKGROUND

Women can hold hope alongside fear and grief. Existing approaches rarely examine what happens when hope becomes socially required, or what its display is expected to prove.

AIM: To explain the conditions under which hope becomes a performative obligation for women who continue a pregnancy after an adverse prenatal diagnosis, and its consequences.

METHODS

Constructivist grounded theory. Sixteen women in Portugal were interviewed between 2024 and 2026, 14 during pregnancy and two postnatally. Data collection and analysis employed constant comparison, theoretical sampling, memo writing, and contrastive case analysis. This article reports an in-depth analysis of one conditional, bounded category from the wider study.

FINDINGS: Where pregnancy continuation was socially contestable, visible hope acquired a defensive function, signalling that the decision had been right and commitment to the baby remained intact. Distress could then be read as regret, irrationality or maternal failure. Women displayed acceptable hope and moved fear, grief and doubt into private spaces, at the cost of exhaustion, guilt and isolation. Contrastive cases showed that judgement, self-imposed strength and protective emotional work alone were insufficient; obligation required perceived accountability to others for displaying hope or adaptation.

DISCUSSION: The clinically relevant distinction concerns whether hope is self-directed or felt as socially required.

CONCLUSION

Where this conditional process is present, midwifery care may support women's own forms of hope while preserving space to express vulnerability.