The paradox of awareness of death in parenthood transition—A qualitative study

Abstract

In the high-income countries of Scandinavia, there is a low statistical risk of death during childbirth. However, awareness of the possibility of death seems to have prevailed. In existential psychology and philosophy, awareness of death is a universal condition in life, and facing the anxiety this awareness might invoke has the potential of being life-invigorating. In a hermeneutic analysis of Qualitative data, generated in a study on new parents’ existential meaning-making, this study aimed to explore awareness of death as experienced in parenthood transition. The results found two overarching themes: Awareness of my own Finitude and Fragility of our loved ones. These were interpreted in existential philosophical and psychological theories, and concludes that awareness of death might signify an existential integration of ‘self’ in the new role of parenthood. Acknowledging these thoughts as healthcare professionals could support the meaning-making of parenthood transition, by normalizing their universal nature.

Background

In modern Scandinavian obstetric practice, guidelines and recommendations are primarily based on epidemiological evidence (Maimburg et al., 2023). In this natural scientific paradigm, maternal and perinatal mortality are the most heavily weighted outcome measures, and large numbers of otherwise healthy pregnancies needed to treat is accepted as necessary in order to avoid even one death (Heimstad et al., 2008). However, avoidance of death in childbirth is perhaps only one aspect parents consider in the process of birth, and this study explores other aspects of awareness of death during the transition to parenthood.

In Denmark, the mortality rate is low for mothers (0–5/100.000 live births) (Danmarks_Statistik, 2022) and neonates (3–4/1.000) (Sundhedsdatastyrelsen, 2022). However, evidence suggests that despite the low statistical risk of experiencing an actual loss, death still manifests itself in an awareness of the potential loss. In a survey among non-depressant mothers, many reported harboring thoughts either about how their baby could die (62,4%) or that someone in their family might die (52,2%) (Hall & Wittkowski, 2006). Sometimes, this fear can manifest in what seems to be irrational contexts, such as when a woman describes a sense of vulnerability in her pregnancy by “worrying that a car would mount the pavement and hit her as she was walking along the road” (Darvill et al., 2010). Also, an existential awareness seems to surface among parents experiencing birth, where they describe feelings of: “being between life and death” (Nges et al., 2022), or “I was in the middle of living and dying” (Hastings-Tolsma et al., 2018). The experience of childbirth is, by some, comparable to the spiritual aspects of witnessing a person’s death (Callister et al., 2007). There seems to be a global universality in this awareness of death related to birth, as it is recognized in multiple studies (Asadi et al., 2021; Callister et al., 2007; Carolan, 2003; Darvill et al., 2010; Gemayel et al., 2022; Hastings-Tolsma et al., 2018; Nges et al., 2022; Prinds et al., 2021), and some studies have even suggested that existential meaning-making and reorganization of values is considered, for some women, an inherent part of becoming a mother (Prinds et al., 2014).

In Denmark, as in many other high-income countries, mental health is a particular challenge for younger generations (Prinds et al., 2022), and there is increasing focus on the challenges of parenthood transition as a pathogenic stressor. One study reported that 5–15% of new parents experience postpartum depression (Rasmussen et al., 2017). National guidelines for pregnancy care recommend screening for postpartum depression utilizing the Edinburgh Postnatal Depression Scale (EPDS) (Sundhedsstyrelsen, 2022). Interestingly, even though the EPDS has been validated in Denmark (Smith-Nielsen et al., 2018), it is not tested for use during pregnancy, and there is a high rate of false-positive results (Eberhard-Gran et al., 2014). Considering that two out of ten questions on the EPDS scale are centered around “fear” or “worry without cause” (Cox et al., 1987), it could be argued that the mere thought of death as a possibility is considered a pathogenic stressor to be avoided. This implication could be problematic if EPDS categorizes fears or worries of death as pathogenic, especially if half or even two-thirds of new mothers report having these concerns. Interestingly, a systematic review reported that some women worried about answering the EPDS questionnaire truthfully, as they feared their child could be removed by social services, or that they would be shamed as “bad mothers” (Brealey et al., 2010).

In The handbook of salutogenesis (2022), it has been argued that the salutogenic approach is the core of midwifery as it seeks to promote health and meaningfulness for parents-to-be (Muggleton & Davis, 2022). The essence of such an approach broadens the dichotomy of sickness and health to a continuum between health ease and dis-ease (Mittelmark et al., 2016). In such an understanding, thoughts on death could be considered salutary or pathogenic factors, depending on the integration and interpretation of them by a particular parent (Mittelmark et al., 2016). In a recent discussion, Prinds et al. (2022) argues that the parents’ sense of coherence could be augmented by open and explorative questioning about existential aspects, potentially strengthening an individual’s mental health (Prinds et al., 2022).

A better understanding of how existential reflections on death can impact parenthood transition is a prerequisite for exploring the parents meaning-making and thereby how their sense of coherence is affected through these reflections. Therefore, the aim of this study was to explore how awareness of death is experienced in parenthood transition.

Theoretical framework

The underpinning theoretical perspectives of this article lie within the realms of existential philosophy and psychology. Awareness of death has been a central philosophical theme, and in the tradition of Martin Heidegger it is our thrownness toward our own death (Sein-zum-Tode), that offers us the very foundation of an existential awareness of ourselves as Beings-in-the-world (Dasein) (Dastur, 1996; O’Byrne, 2010). The French philosopher Françoise Dastur argues that it is in recognition of our finitude; there will be a time-after-our-being, that we understand how “I”, as a unique being, exists in this world (Dastur, 1996). Finitude is, by these standards, a demarcation of our uniqueness, but also of our aloneness since, in death, no one can follow, as philosopher Anne O’Byrne writes (O’Byrne, 2010). In existential psychology, awareness of death is considered a universal condition in life, and the psychiatrist Irvin D. Yalom explains how our (sometimes suddenly awakened) awareness of our finitude can throw us into a deeper presence in life, an awakening toward Existential awareness (Yalom, 1980). In this state of being the acknowledgment of the fragility of life feeds into an awareness of how we (as unique beings) are responsible for grasping the full potential of living every moment of our lives (Yalom, 1980). However, awareness of death can also lead to existential anxiety, and according to Dastur, this anxiety stems from the paradox that the presence of death as a possibility demands an acknowledgment of the non-presence of our being after death (Dastur, 1996). In an attempt to make this anxiety manageable, Dastur argues, that we will try to translate the abstract possibility of death to a more tangible worry, because through worrying, the realization of death as a concept is shifted in time from a contemporary presence to a future possibility (Dastur, 1996). Thus, the true awareness that death is an ever-present possibility can only be grasped in these existential moments. According to Yalom, it is only in moments when we boldly meet the fear of death that we can lift our state of being from Existential forgetfulness (a state where our everyday lives are focused on daily chores, and the unique preciousness of life is forgotten) (Yalom, 2008).

The awareness of our finitude is viewed in relation to Hannah Arendt’s philosophical definition of our being-born (our natality) as the distinctive factor between our nonexistence and our coming into being (Arendt, 1958). In her interpretation, our understanding of birth gives a foundation for understanding our finitude, in the sense that there was a time when we were not yet here (Arendt, 1958; O’Byrne, 2010; Pahuus, 2006). When natality is seen as the essential part of understanding “self”, it is an important factor that natality is born in relations, since all of us are born-from-another (Arendt, 1958). Furthermore, as birth is seen as the beginning of something new, it is also understood as the philosophical foundation of the concept of beginning, since being born allows us to “act,” to bring something into the world, which was not there before (Arendt, 1958). In doing so, natality can transcend our endness because our actions can leave traces in the world beyond our own lifespan (Arendt, 1958). These existential philosophical and psychological interpretations of death and dying, as well as birth and being born, are chosen as the theoretical framework because they offer perspectives on awareness of death that as a concept may be life-invigorating and not merely something to avoid.

Method

This study is grounded in hermeneutical ontology, where the knowledge explored is an interpretation of individual sense of meaning (Gadamer, 2004; Pahuus, 2014). In exploring awareness of death, hermeneutical ontology can generate knowledge of some parents’ understanding of this awareness and thereby how it can be interpreted in relation to their existential meaning-making. A hermeneutical analytical approach was chosen, and in this tradition, it is recognized that researcher preconceptions are inseparable from the analytical process (Gadamer, 2004). Instead, it is through transparent interpretation that this preconception can enter the hermeneutical spiral, seeking to merge horizons and make a deeper meaning visible (Dahlager & Fredslund, 2013)

Data generation

This article utilizes a dataset from the previously published study; Existential aspects in the transition to parenthood based on interviews and a theatre workshop by Prinds et al. (2021). The data for the original study was generated from a two-stage process (Figure 1), beginning with four focus-group interviews with new or expecting parents (n = 10). The participants included were 6 women and 4 men, with a proficiency in the Danish language. The objective of the original study was to explore medically uncomplicated parenthood transition, since this is what most parents experience, and therefore none of the included participants had a history of a traumatic birth-experience. For more details on the characteristics of the participants, see (Prinds et al., 2021). Using a moderator guide, Prinds functioned as the moderator in all focus groups. All interviews was initiated with a sharing of an article about a mother who always saved breastmilk in the freezer for her baby in case something were to happen to her. This story assisted in setting the narration tone in the interviews (Prinds et al., 2021). Two groups consisted of 2–4 expecting parents, with no knowledge of each other before the interview, but they were recruited from the same maternity hospital. The two remaining group interviews were performed with two couples expecting their second or third child. The hope was to gain insight into tacit knowledge and shared experiences of existential aspects of parenthood transition (Prinds et al., 2021).

Figure 1. The two-stage process of data generation (with permission from Prinds et al., 2021).

The interview data were transcribed and analyzed. For the second data generation stage, three case narratives were chosen to be dramatized and performed by professional actors in a theater workshop. The three narratives were used as the basis for group discussions inviting parents, healthcare workers, maternity care leaders and researchers (n = 40) to participate in open dialogue (Prinds et al., 2021). The results of Prinds et al. (2021) consisted of 5 themes, of which one was “Awareness of Death”. This was originally interpreted in the context of a broad understanding of existential reflections in parenthood transitions. The present study strived to delve deeper into an understanding of how and why these reflections on death can impact parenthood transition, and how parents can make meaning of them.

Analysis

The first author of the present study was given full access to the total dataset, consisting of unanalyzed transcriptions of the focus group interviews, four hours of video recording from the theater workshop and all notes of reflections during and after the workshop. The dataset was analyzed through four steps in a hermeneutical analytical approach inspired by Dahlager and Fredslund (2013), presented in Table 1.

Table 1. The process of analysis.

Phase	Description
1.	The transcriptions from the focus group interviews and CP’s fieldnotes were read, and video recordings from the theater workshop watched by the first author to get an overall impression of the whole dataset.
2.	Meaning-bearing units were identified from the dataset by going through it again, focusing on ensuring a continuous openness of mind. The meaning-bearing units were structured in categories and codes.
3.	The third phase consisted of an operationalization of the categories from Phase 2. Questions addressed in this phase were: Are there multiple themes within categories, so they should be divided? Are there overlapping themes between categories, so they should be merged? Is there congruency between a category and its meaning-bearing unit?
4.	The final phase of analysis was the recontextualization of themes in relation to each other and to the aim of the study. This phase attempted to move from specific statements to a more general understanding through hermeneutical circular integration of the results from step 1-3 with existing literature, the social and cultural context of birthing culture in Denmark, and existential philosophical and psychological theory.

The first three steps were not theoretically bound but were conducted with an inductive approach by the first author, and each phase was brought to conclusion throughout the whole dataset before moving on to the next. Coding and categories were guided by identifying thoughts and statements about awareness of death as a concrete phenomenon as well as an aspect with more existential meaning. Meaning-bearing units were identified using colorcoding and the overarching themes of phase three were extracted by the manufacturing of a mind-map showing the interrelation between meaning-bearing units. These results were discussed with all authors, and discussions of researchers’ preconceptions concerning the impact on the analytical process were included.

Ethical considerations

The Danish Data Protection Agency approved the original study by Prinds et al. via SDU RIO (Journal no.18/4619), and the Regional Committee for Health Research was notified (no. 20182000-95). The informants gave written consent for the data to be used for other studies such as this one, and complete anonymity was accomplished by removing all real names and characteristics from the data. The data was shared according to the rules of GDPR, and approval for this specific study was given from SDU RIO.

Results

The themes of phase three are presented in Table 2 and elaborated below. These themes were used as a foundation for choosing the theoretical framework, which was utilized in phase four of the analysis, and this will be presented in the discussion section.

Table 2. Overarching themes, meaning-bearing units, and subthemes.

Awareness of my own Finitude	The significance of our lives	The importance of their survival
	Aloneness of the Responsibility	Responsible beyond our lifespan
		The world we leave them in
Fragility of our loved ones	The Fragile Pregnant Body
	A birth of worry	Growing love and fear
		Frightening What-If’s
	The violence of birth

Awareness of my own finitude

The significance of our lives

During the interviews, several parents ascribe more meaning to the significance of their own lives, because of its meaning to their children’s lives. Some of the parents describe an awareness of the irreplaceability of their existence as a parent for their children and awareness that the uniqueness of this role invokes a fear of their own death that had not been experienced before. The fear of dying is, for some, provoked by the thought that if both parents were to die, who would take care of the child? As one mother, Millie says, “…but if we are driving both of us. What would happen to our children if we were to crash? Who should our children … go to… if we weren’t there?”

For others, anxiety about the death of one parent is experienced through the lens of the child’s life. As Michael, a father-to-be says, “[I have] generally developed a fear, that something would happen to me or my partner, Siobhan… and not for either of our sakes, but because it would be a major bummer for him, if he were to miss a parent.” And Samuel even interprets dying as a failure to his children. He says, “I don’t know if you could have a guilty conscience about dying, but you know…” At the same time, some of the parents refer to their own finitude as secondary to the importance of their children’s survival, and that their own life is expendable if it could protect their children. As Millie says, “I don’t have a moment of doubt, that if someone wanted to… shoot us now, I would use myself as a human shield to protect my children.”

Aloneness of the responsibility

The sense of irreplaceability for some of the parents feed into a heightened awareness of responsibility. This heightened awareness creates feelings of aloneness concerning the responsibility for creating an environment which is good for the child. A mother Sienna explains, “This feeling, that [GASP]: It is me, that is responsible for them. It is me, that must take care of them, and…. Yeah, this vulnerability. I have this vulnerability a lot.” Some parents seem to relate their finitude to this sense of lone responsibility when they extend the role of parenthood beyond their lifespan. The worry about who should care for the children if they were to die is an example of this.

The sense of responsibility that reaches beyond their own lifespan can be seen as an outwards direction of what we send into the world, as Millie explains, “…and now we are responsible for raising them… well enough… to be able to take care of themselves… in society, with others. And that is a huge weight to carry on my shoulders.” Nevertheless, there is also an inwards reflection of how parental choices and actions influence the childhood and life of our children, as Sienna acknowledges, “I think that it is our children, that kind of created this complete awareness of “Oh God,” it is actually important, what we do.” This reflection is also seen when some parents describe making choices in life, based on the world their children will live in, once they are gone. The mother, Emily, explains that the decision to have a second child was partly based on a wish for her older son to have a sibling. She summarizes a conversation between herself and her husband, “Okay, we need to have another child. It was the argument of: What happens after we die? Would you have wanted to be alone when your mother died? Well. Who is going to… just the practical stuff and the emotional stuff. No matter how close or distant you are with your siblings. At least there will always be someone to fight with [laughs] or to lean on.”

The father, Jacob sums it up, “The second you become a parent, your life is no longer about yourself but about becoming a good memory for your child.”

Fragility of our loved ones

The fragile pregnant body

Experiencing the pregnant body can, for some parents, result in feelings of fragility, where a growing number of everyday activities are now perceived as threats to the pregnancy or child. Some women report worrying about what is allowed in pregnancy, like the mother Millie who states, “that it feels like you just have to sit inside a plastic bubble, and not move, and not eat anything other than what is recommended”. Some of the partners also feel an intensified need to protect the woman in her pregnancy and describe a change in perspectives of what she can and cannot do. The father, Michael, says, “things like, eh…reaching for something on a shelf that she can’t reach, standing on a chair. I don’t really like it when she does that.”

A birth of worry

For some parents, the transition to parenthood invokes a constant sense of worry that was previously absent. They describe that the fear of losing a loved one is connected with emotional attachment, and therefore, the fear grows simultaneously with a growing love. The mother Joanna describes, “And it just becomes stronger and stronger, the more you get to know your child, well… yeah I remember six months after [the birth], I thought: Okay losing a child now would be much more painful, than if it had been during birth. And now a year ago Anna had fever cramps, where I thought I would lose her… and then I thought again: Okay losing a two-year-old. That would just be so much worse, than losing one at six months.

Interestingly, for some parents, it seems that consideration of the possibility of the child dying in the womb enhanced the attachment to the coming life. The father, Michael describes how the fear of something being wrong with the baby grew in the last 20 minutes before a scan, until it almost seemed like the most likely scenario. It was a presence of the possibility of their baby being so severely ill that a termination of the pregnancy would come into question. And then after the scan, where everything is confirmed to be fine with the baby, the mother Siobhan remembers feeling, “I mean, we were so… I was so completely happy when we came out from the hospital. I felt like we had gotten an A or something.”

Perhaps it is the same mechanism at play when some parents describe how they emotionally visit the frightening “What-ifs” of death in their own family. When the mother, Sienna, heard a story of a high-school friend who died, the possibility of death became personal, and she instantly thought, “What if that happened to me?” Or the mother, Emily, who has an almost physical response to the thought of losing her son, “Well, I even get tears in my eyes about: What if I were to lose him. Or what if something were to happen, or… OH, you get so [GASPS] I can’t even stand to think about it.” Nevertheless, she DOES think about it, and so do several of the other parents, when they hear stories of death. Thus, it seems that for some of the parents, the possibility of death is real, and life is not to be taken for granted, like the mother, Sienna, who exclaims, “Could we really be so lucky as to have three healthy children?”

The violence of birth

The experience of birth itself pushed some parents to feel the limits between life and death. For Joanna, it was the pain of birth which provoked this feeling, “…and afterwards I thought to myself: it is crazy, that you can experience that intense kind of pain, and not die from it. I mean, I can’t even understand, that something that doesn’t kill you, can be that painful.” But standing as a witness to a birth, can also trigger surprisingly fearful emotions as described by several fathers. For some, this emotion was triggered by the emotional exhaustion, like when Jacob describes, “I thought to myself: Okay now Molly will die. And now the little baby will die. And I almost fainted, and I … I was SO emotionally pushed, that I was completely paralyzed.” For others, it was the unfamiliar sounds and reactions of the birthing woman that functioned as a trigger of fear. Joanna describes that her husband asked if she was unconscious because “He was so very… very afraid on my behalf because he… It felt unsafe for him, that I was completely not present. There was no contact.”

Discussion

Overall, participants seemed to acquaint themselves with various aspects of awareness of death in parenthood transition. There seemed to be a continuum ranging from the very concrete fear of losing your own, or your partner’s life or losing the child to a more existential awareness of our lives as finite and reflections about the lives our loved ones will lead after our death. These results will be discussed through the lens of existential philosophy and psychology and related to other findings on awareness of death.

The circle of natality and finitude

When moving through parenthood transition, several parents in this study seemed to experience a new sense of fragility when reflecting on how their own death would impact the life of their child. In the lens of existential philosophy, this can be interpreted as an awakening to their thrownness toward their own death, whereby they acknowledge the being-there or Dasein of their own being (Dastur, 1996). Seemingly, it is the birth of the child, or the coming-into-being of the baby, which sets these reflections of death in motion. Thus, it appears that the emergence of a new life simultaneously awakens some of the parents’ awareness of the finitude or endness of their own life. In this way, the “awareness of my finitude” is deeply related to the natality of the child for some parents. At the same time it circles back to embracing their own natality, in the definition by Hannah Arendt, as our ability to act or to bring something new into the world (Arendt, 1958). When the parents seem to extend the responsibilities of parenthood, and make plans based on the life their child will have beyond the lifespan of themselves as parents, they can be said to embody their natality, in the sense that they take actions that transcend their own endness (O’Byrne, 2010; Pahuus, 2006). These parents seem to relate themselves as generational beings, where their own place in life is now to generate the settings and boundaries of their child’s life. In other studies, transcendence is also found that reaches backwards in time before our own birth, when some mothers describe feeling a special connection to their own parents (Prinds et al., 2021), or that “In giving birth, I had become a link in the eternal chain of mothers” (Callister et al., 2007). This aligns with the interpretation by Anne O’Byrne that natality as a concept is essentially being-with-others, since we are all of us born-from-another being, and to add to that we are born as helpless creatures, dependent on others for our survival (O’Byrne, 2010). This relational aspect of natality, according to Arendt, is also essential in the existential realization of our individual sense of self, because it is only through the community of others we can recognize how our actions are unique to us (Arendt, 1958). Perhaps this need for community is the underlying longing seen in more modern fictional literature on motherhood, describing ambivalent feelings of anger at the aloneness of motherhood, or even the disappearance of the individual in the mother-role (Lind, 2019; Ravn, 2020).

It has been suggested that there is a circular similarity in the existential reflections on awareness of death in both end-of-life experiences as well as giving-birth-to-new-life transitions (Prinds et al., 2019; Wojtkowiak & Crowther, 2018). However, where the Danish national policy documents for palliative care recognizes, that existential care is needed to support a possible transition of life values and what it means to be a human being (Sundhedsstyrelsen, 2017), there does not seem to be a similar focus in the policies for maternity care (Sundhedsstyrelsen, 2022). An interesting question for further research would be if and how the parents manage to integrate these thoughts on awareness of death to an enrichment of their understanding of self, and how the maternity care system, and we as healthcare professionals, can support this salutogenic process.

The connection between fear of death and joy of life

The experience of the birth event is a pivotal point for some parents in this study, where they are pushed to experience the limits between life and death. There is joy at the emergence of the new life, but also fear of death for the birthing mother and child equally. In existential philosophy, awareness of death is not something to be avoided, it is essential to understanding one’s place in the world (Dastur, 1996; O’Byrne, 2010). The question is, why some parents experience such a heightened awareness of death during a birth, that in Scandinavian countries has a very high probability of a healthy outcome (Danmarks_Statistik, 2022; Sundhedsdatastyrelsen, 2022). The definition of natality by Hannah Arendt offers an explanation of this. In this understanding the awareness of our being-born is seen as the foundation of acknowledging that as unique beings, we are mortals; there is an end to our being (Arendt, 1958). Through this light, birth could be seen as a melting pot of potent existential realizations, where the natality, the acknowledgment of the child as a unique and irreplaceable being also highlights the uniqueness of our role as parents for them, and through this proxy, we understand our own endness. In this interpretation, awareness of death could be a potential for existential growth and should not be seen as a mere symptom of possible postpartum depression, as implied by the weighting of questions in the Edinburgh Postpartum Depression Scale (Brealey et al., 2010; Cox et al., 1987). An important implication for clinical practice is how we identify and address these aspects among the narratives of pregnant, birthing, and postpartum parents, in order to invite a realization of such a potential, without neglecting the minority of about 5–15%, who are at actual risk of a postpartum depression (Rasmussen et al., 2017).

Several parents in the interviews related feelings of fear of death for themselves, their children or their partner. This is also found in the literature on pregnancy (Darvill et al., 2010; Gemayel et al., 2022; Larsson et al., 2016), childbirth (Gemayel et al., 2022; Klobučar, 2016; Nges et al., 2022), and the postnatal period (Asadi et al., 2021; Carolan, 2003). The theory of Françoise Dastur offers an alternative explanation to such reflections, and describes how concrete worries of death are a coping mechanism that masks the realization of the unpredictable possibility of death (Dastur, 1996). In a psychological interpretation, it is only through truly embracing this ever-present possibility, that we can reach a more profound and authentic presence in our lives (Yalom, 1980). Perhaps it is in attempting to improve this presence, that parents visit the “frightening what-ifs” of death happening in their family. If so, then exploring existential feelings behind such fears has the potential of a salutogenic approach (Prinds et al., 2022). Furthermore, Dastur argues that fear of death for a loved one can be said to be the epitome of love for that person because life without them cannot be imagined (Dastur, 1996). This is reflected in the results of this study, when some parents said they would sacrifice their own lives if it would save the life of their child. The fear of death could be viewed as a sign of moving toward healthy attachment patterns, and instead of stigmatizing awareness of death and avoiding it, reflection on this fear has the potential to enhance the lives of parents. This is supported in other studies, where experiencing birth changes some parents’ outlook on life (Callister et al., 2007), relationships (Nges et al., 2022) or even to “…love life more since I have become a mother.” (Asadi et al., 2021).

Strengths and limitations

The first author was not part of the data generation process of Prinds et al. (2021), which can be seen as a strength since there was no relation between the analyst and participants that could have influenced any assumptions of meaning before the analysis. At the same time, it could be considered a limitation of the present study, that a re-analysis of data already given, leaves no room for further elaboration of meaning from informants. This gives the steps one through three of analysis a descriptive characteristic, and it could be argued that a deeper meaning could have emerged, through an original datageneration process of interviews or focus-groups directly addressing thoughts on awareness of death in parenthood transition.

The choice of hermeneutical analysis was a pragmatic one since the data was already given. In a hermeneutical study such as this, generalizability is not the scientific objective since every finding is interpreted, and another interpreter could have reached other conclusions (Green & Thorogood, 2014). The validity of the results was assessed through the transparency of the analytical process (Dahlager & Fredslund, 2013) and the clear relation of the results section to the empirical data (Tong et al., 2007). This allows the reader to assess the logical route from data to results, enabling critical evaluation of the truthfulness of the analysis (Tanggaard & Brinkmann, 2020).

Conclusion

This study offers an existential philosophical interpretation of experiences of awareness of death in parenthood transition. This interpretation expands our understanding of the paradox of death in childbirth and offers a framework for understanding awareness of death from a salutogenic stance. Introducing the concept of natality explains how birth can trigger an awareness of death because understanding our own birth is understanding that there was a time before us, and there will be a time after us. In this sense, the birth of new life highlights the endness of parental individuality. Simultaneously, the embodied relationality of the child transcends this endness, because natality, in its essence, signifies the beginning or creation of something new. It seems crucial to acknowledge the deep existential aspects of awareness of death and the dialectic relationship between feelings of community and aloneness in becoming a parent to support making sense of the parenthood transition.

Acknowledgments

The authors wish to acknowledge the generosity of the informants of this study.

Disclosure statement

We declare no conflicting financial interests or personal relationships which could have appeared to have influenced the work of this study.

Data availability statement

The data supporting the findings of this study are available from Prinds, but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Prinds.

Additional information

Funding

The University of Southern Denmark (SDU) funded this study.