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Cope H, Garrett ME, Gregory S, Ashley-Koch A. Pregnancy continuation and organizational religious activity following prenatal diagnosis of a lethal fetal defect are associated with improved psychological outcome. Prenat Diagn 2015; 35:761-768. [PMID: 25872901 DOI: 10.1002/pd.4603] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of the article is to examine the psychological impact, specifically symptoms of grief, post-traumatic stress and depression, in women and men who either terminated or continued a pregnancy following prenatal diagnosis of a lethal fetal defect. METHOD This project investigated a diagnostically homogeneous group composed of 158 women and 109 men who lost a pregnancy to anencephaly, a lethal neural tube defect. Participants completed the Perinatal Grief Scale, Impact of Event Scale - Revised and Beck Depression Inventory-II, which measure symptoms of grief, post-traumatic stress and depression, respectively. Demographics, religiosity and pregnancy choices were also collected. Gender-specific analysis of variance was performed for instrument total scores and subscales. RESULTS Women who terminated reported significantly more despair (p = 0.02), avoidance (p = 0.008) and depression (p = 0.04) than women who continued the pregnancy. Organizational religious activity was associated with a reduction in grief (Perinatal Grief Scale subscales) in both women (p = 0.02, p = 0.04 and p = 0.03) and men (p = 0.047). CONCLUSION There appears to be a psychological benefit to women to continue the pregnancy following a lethal fetal diagnosis. Following a lethal fetal diagnosis, the risks and benefits, including psychological effects, of termination and continuation of pregnancy should be discussed in detail with an effort to be as nondirective as possible.
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Affiliation(s)
- Heidi Cope
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC, USA
| | - Melanie E Garrett
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC, USA
| | - Simon Gregory
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Allison Ashley-Koch
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC, USA
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Ramdaney A, Hashmi SS, Monga M, Carter R, Czerwinski J. Support Desired by Women Following Termination of Pregnancy for a Fetal Anomaly. J Genet Couns 2015; 24:952-60. [DOI: 10.1007/s10897-015-9832-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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Posttraumatic stress and posttraumatic stress disorder after termination of pregnancy and reproductive loss: a systematic review. J Pregnancy 2015; 2015:646345. [PMID: 25734016 PMCID: PMC4334933 DOI: 10.1155/2015/646345] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/20/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. The aims of this systematic review were to integrate the research on posttraumatic stress (PTS) and posttraumatic stress disorder (PTSD) after termination of pregnancy (TOP), miscarriage, perinatal death, stillbirth, neonatal death, and failed in vitro fertilisation (IVF). Methods. Electronic databases (AMED, British Nursing Index, CINAHL, MEDLINE, SPORTDiscus, PsycINFO, PubMEd, ScienceDirect) were searched for articles using PRISMA guidelines. Results. Data from 48 studies were included. Quality of the research was generally good. PTS/PTSD has been investigated in TOP and miscarriage more than perinatal loss, stillbirth, and neonatal death. In all reproductive losses and TOPs, the prevalence of PTS was greater than PTSD, both decreased over time, and longer gestational age is associated with higher levels of PTS/PTSD. Women have generally reported more PTS or PTSD than men. Sociodemographic characteristics (e.g., younger age, lower education, and history of previous traumas or mental health problems) and psychsocial factors influence PTS and PTSD after TOP and reproductive loss. Conclusions. This systematic review is the first to investigate PTS/PTSD after reproductive loss. Patients with advanced pregnancies, a history of previous traumas, mental health problems, and adverse psychosocial profiles should be considered as high risk for developing PTS or PTSD following reproductive loss.
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Lafarge C, Mitchell K, Fox P. Termination of pregnancy for fetal abnormality: a meta-ethnography of women’s experiences. REPRODUCTIVE HEALTH MATTERS 2014; 22:191-201. [DOI: 10.1016/s0968-8080(14)44799-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Maguire M, Light A, Kuppermann M, Dalton VK, Steinauer JE, Kerns JL. Grief after second-trimester termination for fetal anomaly: a qualitative study. Contraception 2014; 91:234-9. [PMID: 25499590 DOI: 10.1016/j.contraception.2014.11.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/23/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time. STUDY DESIGN We conducted a longitudinal qualitative study of decision satisfaction, grief and coping among women undergoing termination (dilation and evacuation or induction termination) for fetal anomalies and other complications. We conducted three post-procedure interviews at 1-3 weeks, 3 months and 1 year. We used a generative thematic approach to analyze themes related to grief using NVivo software program. RESULTS Of the 19 women in the overall study, 13 women's interviews were eligible for analysis of the grief experience. Eleven women completed all three interviews, and two completed only the first interview. Themes that contributed to grief include self-blame for the diagnosis, guilt around the termination decision, social isolation related to discomfort with abortion and grief triggered by reminders of pregnancy. Social support and time are mechanisms that serve to alleviate grief. CONCLUSIONS Pregnancy termination in this context is experienced as a significant loss similar to other types of pregnancy loss and is also associated with real and perceived stigma. Women choosing termination for fetal anomalies may benefit from tailored counseling that includes dispelling misconceptions about cause of the anomaly. In addition, efforts to decrease abortion stigma and increase social support may improve women's experiences and lessen their grief response. IMPLICATIONS The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients' suffering and offer tools to direct their grief toward positive coping.
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Affiliation(s)
- Marguerite Maguire
- University of Rochester School of Medicine, 601 Elmwood Ave, Rochester, NY 14642.
| | - Alexis Light
- Washington Hospital Center Department of Obstetrics and Gynecology, 110 Irving Street, NW Suite 5B-63, Washington, DC 20010.
| | - Miriam Kuppermann
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
| | - Vanessa K Dalton
- University of Michigan Department of Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109.
| | - Jody E Steinauer
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
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Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother–infant interaction: The case of preterm birth. Infant Behav Dev 2014; 37:624-31. [DOI: 10.1016/j.infbeh.2014.08.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/18/2014] [Accepted: 08/26/2014] [Indexed: 11/21/2022]
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Roux SL, van Rensburg E. South African Mothers' Perceptions and Experiences of an Unplanned Caesarean Section. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2011.10820477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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van Reenen SL, van Rensburg E. The Influence of an Unplanned Caesarean Section on Initial Mother-Infant Bonding: Mothers' Subjective Experiences. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2013.10820623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kersting A, Dölemeyer R, Steinig J, Walter F, Kroker K, Baust K, Wagner B. Brief Internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:372-81. [PMID: 24061387 DOI: 10.1159/000348713] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 02/05/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC). METHODS The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing. RESULTS The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low. CONCLUSIONS The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.
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Affiliation(s)
- Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany
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Nazaré B, Fonseca A, Canavarro MC. Trauma Following Termination of Pregnancy for Fetal Abnormality: Is This the Path From Guilt to Grief? JOURNAL OF LOSS & TRAUMA 2014. [DOI: 10.1080/15325024.2012.743335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ayers S. Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care. Midwifery 2014; 30:145-8. [DOI: 10.1016/j.midw.2013.12.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Helbig A, Kaasen A, Malt UF, Haugen G. Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation. PLoS One 2014; 9:e86597. [PMID: 24475155 PMCID: PMC3903559 DOI: 10.1371/journal.pone.0086597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/13/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction Antenatal maternal psychological distress may be associated with reduced placental circulation, which could lead to lower birthweight. Studies investigating this in humans show mixed results, which may be partially due to type, strength and timing of distress. In addition, the arterial vascular resistance measures often used as outcome measures do not detect smaller changes in placental volume blood flow. We aimed to investigate the effect of a specific stressor, with increased levels of stress early in pregnancy, on the fetoplacental volume blood flow in third trimester. Methods This was a prospective observational study of 74 pregnant women with a congenital malformation in a previous fetus or child. Psychological distress was assessed twice, around 16 and 30 weeks' gestation. Psychometric measures were the General Health Questionnaire-28 (subscales anxiety and depression), Edinburgh Postnatal Depression Scale, and Impact of Event Scale-22 (subscales intrusion, avoidance, and arousal). Placental circulation was examined at 30 weeks, using Doppler ultrasonography, primarily as fetoplacental volume blood flow in the umbilical vein, normalized for abdominal circumference; secondarily as vascular resistance measures, obtained from the umbilical and the uterine arteries. Results Maternal distress in second but not third trimester was associated with increased normalized fetoplacental blood flow (P-values 0.006 and 0.013 for score > mean for depression and intrusion, respectively). Post-hoc explorations suggested that a reduced birthweight/placental weight ratio may mediate this association. Psychological distress did not affect vascular resistance measures in the umbilical and uterine arteries, regardless of adjustment for confounders. Conclusions In pregnant women with a previous fetus or child with a congenital malformation, higher distress levels in second trimester were associated with third trimester fetoplacental blood flow that was higher than expected for the size of the fetus. The results do not support placental blood flow reduction as a pathway between maternal distress and reduced birthweight.
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Affiliation(s)
- Anne Helbig
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Anne Kaasen
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
| | - Guttorm Haugen
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway
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Lafarge C, Mitchell K, Fox P. Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies. Prenat Diagn 2013; 33:1173-82. [PMID: 23943597 DOI: 10.1002/pd.4218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/23/2013] [Accepted: 08/10/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Caroline Lafarge
- School of Psychology, Social Work & Human Sciences; University of West London; Brentford UK
| | - Kathryn Mitchell
- Office of the Vice-Chancellor; University of West London; London UK
| | - Pauline Fox
- School of Psychology, Social Work & Human Sciences; University of West London; Brentford UK
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Delahaije DHJ, Dirksen CD, Peeters LL, Smits LJ. Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. A systematic review. Acta Obstet Gynecol Scand 2013; 92:746-61. [PMID: 23679343 DOI: 10.1111/aogs.12175] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 05/12/2013] [Indexed: 11/27/2022]
Abstract
Women who suffered from pregnancy complications are at increased risk for anxiety and depression. The aim of this study was to evaluate whether having suffered from preeclampsia (PE) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is associated with anxiety and depression, and whether PE/HELLP is an independent risk factor for developing anxiety and depression. Systematic search on PubMed and PsycInfo with no time limit. Studies presenting original data, including women with a history of PE/HELLP and at least one comparison group of women without PE/HELLP, reporting the results for each group separately or in a multivariate regression analysis with PE/HELLP as an independent variable. Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed. The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (six studies) showed generally positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (two studies) did not show significant associations between PE/HELLP and anxiety scores. Associations between post-traumatic stress and PE/HELLP, investigated in four studies, were often nonsignificant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor. Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous PE/HELLP. Causality of the associations can, however, not be judged adequately.
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Affiliation(s)
- Denise H J Delahaije
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands.
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66
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Bellieni CV, Buonocore G. Abortion and subsequent mental health: Review of the literature. Psychiatry Clin Neurosci 2013; 67:301-10. [PMID: 23859662 DOI: 10.1111/pcn.12067] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 03/28/2013] [Accepted: 05/26/2013] [Indexed: 02/03/2023]
Abstract
The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. Depression, anxiety disorders (e.g. post-traumatic stress disorder) and substance abuse disorders were the most studied outcome. Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. In conclusion, fetal loss seems to expose women to a higher risk for mental disorders than childbirth; some studies show that abortion can be considered a more relevant risk factor than miscarriage; more research is needed in this field.
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Affiliation(s)
- Carlo V Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.
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67
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Effectiveness of psychological intervention for treating symptoms of anxiety and depression among pregnant women diagnosed with fetal malformation. Int J Gynaecol Obstet 2013; 121:123-6. [DOI: 10.1016/j.ijgo.2012.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/10/2012] [Accepted: 01/25/2013] [Indexed: 01/25/2023]
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Mashiach R, Anter D, Melamed N, Ben-Ezra M, Meizner I, Hamama-Raz Y. Psychological response to multifetal reduction and pregnancy termination due to fetal abnormality. J Matern Fetal Neonatal Med 2012; 26:32-5. [DOI: 10.3109/14767058.2012.722714] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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69
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Kerns J, Vanjani R, Freedman L, Meckstroth K, Drey EA, Steinauer J. Women's decision making regarding choice of second trimester termination method for pregnancy complications. Int J Gynaecol Obstet 2011; 116:244-8. [DOI: 10.1016/j.ijgo.2011.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/12/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
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Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: pilot data from a randomized controlled trial. Arch Womens Ment Health 2011; 14:465-77. [PMID: 22006106 DOI: 10.1007/s00737-011-0240-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 09/25/2011] [Indexed: 12/17/2022]
Abstract
The loss of a child during pregnancy can be a traumatic event associated with long-lasting grief and psychological distress. This study examined the efficacy of an internet-based cognitive behavioral therapy program for mothers after pregnancy loss. In a randomized controlled trial with a waiting list control group, 83 participants who had lost a child during pregnancy were randomly allocated either to 5 weeks of internet therapy or to a 5-week waiting condition. Within a manualized cognitive behavioral treatment program, participants wrote ten essays on loss-specific topics. Posttraumatic stress, grief, and general psychopathology, especially depression, were assessed pretreatment, posttreatment, and at 3-month follow-up. Intention-to-treat analyses and completer analyses were performed. Relative to controls, participants in the treatment group showed significant improvements in posttraumatic stress, grief, depression, and overall mental health, but not in anxiety or somatization. Medium to large effect sizes were observed, and the improvement was maintained at 3-month follow-up. This internet-based cognitive behavioral therapy program represents an effective treatment approach with stable effects for women after pregnancy loss. Implementation of the program can thus help to improve the health care provision for mothers in this traumatic loss situation.
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Gambina I, Soldera G, Benevento B, Trivellato P, Visentin S, Cavallin F, Trevisanuto D, Zanardo V. Postpartum psychosocial distress and late preterm delivery. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.653962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mirlesse V, Perrotte F, Kieffer F, Ville I. Women's experience of termination of pregnancy for fetal anomaly: effects of socio-political evolutions in France. Prenat Diagn 2011; 31:1021-8. [DOI: 10.1002/pd.2825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/30/2011] [Accepted: 06/06/2011] [Indexed: 11/09/2022]
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Kersting A, Kroker K, Schlicht S, Wagner B. Internet-based treatment after pregnancy loss: concept and case study. J Psychosom Obstet Gynaecol 2011; 32:72-8. [PMID: 21329485 DOI: 10.3109/0167482x.2011.553974] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The loss of a child during pregnancy results in significant psychological stress for many women, and may lead to long-lasting grief and psychological illnesses. However, only a small percentage of those affected seek or receive traditional forms of psychological treatment, and therefore novel treatment approaches and methods are required. This article introduces an Internet-based psychotherapy programme for patients after pregnancy loss. The five-week intervention comprises two components: structured writing disclosure and cognitive-behavioural therapy. Communication between the therapist and patient is text-based and asynchronous. The writing protocol consists of three treatment phases: self-confrontation, cognitive reappraisal and social sharing. A case report is presented to illustrate the course of the treatment and clinical considerations associated with delivering Internet-based interventions to patients after pregnancy loss.
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Affiliation(s)
- Anette Kersting
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.
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74
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Systematic review of the literature: parental outcomes after diagnosis of fetal anomaly. Adv Neonatal Care 2011; 11:182-92. [PMID: 21730912 DOI: 10.1097/anc.0b013e31821bd92d] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Advancing technology has made detecting fetal abnormalities in the first and second trimesters a reality. Few families are prepared for the difficult decisions that must be made if their unborn children are diagnosed with a life-limiting condition. Expectant parents are compelled to make decisions on the basis of limited options. A systematic review of the literature is presented with an aim to inform clinicians of parental experiences and outcomes after diagnosis of a fetal anomaly. The review focused on patients given a diagnosis for fetal anomalies for the 40-year period from 1970 to 2010 by using the key words such as fetal anomaly, congenital malformations, pregnancy termination, perinatal palliative care, and perinatal hospice. Regardless of the option taken, women often experienced intense grief reactions. Both giving birth to a child with a life-limiting condition and termination of pregnancy for fetal anomaly can be emotionally traumatic life events, both associated with psychological morbidity. Nonaggressive obstetric management, allowing natural birth without life-sustaining therapeutics, is an option for families. Couples presented with a coordinated perinatal palliative care model may opt to continue their pregnancy. Families who experienced perinatal hospice/palliative care report positive feedback, but more research is needed to explore the psychological outcomes of this choice.
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75
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Steinberg JR. Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research. Womens Health Issues 2011; 21:S44-8. [PMID: 21530839 DOI: 10.1016/j.whi.2011.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Some abortion policies in the U.S. are based on the notion that abortion harms women's mental health. The American Psychological Association (APA) Task Force on Abortion and Mental Health concluded that first-trimester abortions do not harm women's mental health. However, the APA task force does not make conclusions regarding later abortions (second trimester or beyond) and mental health. This paper critically evaluates studies on later abortion and mental health in order to inform both policy and practice. METHOD Using guidelines outlined by Steinberg and Russo (2009), post 1989 quantitative studies on later abortion and mental health were evaluated on the following qualities: 1) composition of comparison groups, 2) how prior mental health was assessed, and 3) whether common risk factors were controlled for in analyses if a significant relationship between abortion and mental health was found. Studies were evaluated with respect to the claim that later abortions harm women's mental health. RESULTS Eleven quantitative studies that compared the mental health of women having later abortions (for reasons of fetal anomaly) with other groups were evaluated. Findings differed depending on the comparison group. No studies considered the role of prepregnancy mental health, and one study considered whether factors common among women having later abortions and mental health problems drove the association between later abortion and mental health. CONCLUSION Policies based on the notion that later abortions (because of fetal anomaly) harm women's mental health are unwarranted. Because research suggests that most women who have later abortions do so for reasons other than fetal anomaly, future investigations should examine women's psychological experiences around later abortions.
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Affiliation(s)
- Julia R Steinberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California 94143, USA.
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Meijssen D, Wolf MJ, van Bakel H, Koldewijn K, Kok J, van Baar A. Maternal attachment representations after very preterm birth and the effect of early intervention. Infant Behav Dev 2011; 34:72-80. [DOI: 10.1016/j.infbeh.2010.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 08/02/2010] [Accepted: 09/24/2010] [Indexed: 11/27/2022]
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78
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Kersting A, Kroker K, Steinhard J. Psychiatric morbidity after termination of pregnancy for fetal anomaly. Am J Obstet Gynecol 2010; 202:e6; author reply e6-7. [PMID: 20350638 DOI: 10.1016/j.ajog.2009.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/23/2009] [Indexed: 11/24/2022]
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79
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Chen CH, Chen TH, Kuo SJ, Chen CD, Yang YS, Chen M. Late Termination of Pregnancy: Experience From an East Asian Population and Report of a Novel Technique for Feticide. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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