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Bradford BF, Cronin RS, Popoola T, Bright N, Silverio SA. Care, connection, and social distancing: The challenges of baby loss during the COVID-19 pandemic in Aotearoa New Zealand. Women Birth 2024; 37:101622. [PMID: 38744163 DOI: 10.1016/j.wombi.2024.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
PROBLEM The COVID-19 pandemic hindered access to routine healthcare globally, prompting concerns about possible increases in pregnancy loss and perinatal death. BACKGROUND PUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand. AIM To explore parents' experiences of access to healthcare services and support following baby loss during the COVID-19 pandemic in Aotearoa New Zealand. METHODS We conducted in-depth, semi-structured interviews with 26 bereaved parents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and one neonatal death. Participant ethnicities were broadly representative of Aotearoa New Zealand's multi-ethnic society. Data were analysed using Template Analysis. FINDINGS Analysis revealed five themes relating to pandemic impact on bereaved parent's experiences. These were: 'Distanced and Impersonal care'; 'Navigating Hospital Rules'; Exclusion of Non-birthing Parents; 'Hindered Access to Social Support'; and 'Continuity of Relational Care'. DISCUSSION The COVID-19 pandemic exacerbated isolation of bereaved parents through perceived impersonal care by healthcare professionals and restrictions on movement hindered access to social and cultural support. Compassionate bending of the rules by healthcare professionals and community postnatal visits by continuity of care midwives following the bereavement appeared to be mitigating factors. CONCLUSION Social isolation is an added challenge for parents experiencing baby loss during a pandemic, which may be mitigated by flexible and compassionate care from healthcare professionals, especially continuity of care midwives.
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Affiliation(s)
- Billie F Bradford
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, New Zealand; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Health New Zealand, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Tosin Popoola
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, New Zealand; School of Nursing and Midwifery, University of Newcastle, Australia
| | | | - Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, United Kingdom
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Fernandez-Pineda M, Swift A, Dolbier C, Banasiewicz KG. Compounding stress: A mixed-methods study on the psychological experience of miscarriage amid the COVID-19 pandemic. BMC Pregnancy Childbirth 2024; 24:426. [PMID: 38872085 PMCID: PMC11170813 DOI: 10.1186/s12884-024-06610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Experiencing a miscarriage can have profound psychological implications, and the added strain of the COVID-19 pandemic may have compounded these effects. This study aimed to explore the psychological experiences, assess the levels of psychological distress (depression, anxiety, and post-traumatic stress disorder), and examine the relationships of personal significance of miscarriage and perceived stress with psychological distress of women in North Carolina who suffered a miscarriage of a desired pregnancy between March 30, 2020, and February 24, 2021, of the COVID-19 pandemic, at 14 to 31 months after the loss. METHODS We conducted a cross-sectional mixed-methods study using a convergent parallel design. A total of 71 participants from North Carolina completed the online survey and 18 completed in-depth interviews. The survey assessed demographics, mental health and reproductive history, personal significance of miscarriage, perceived stress, anxiety, depression, and PTSD. Interview questions asked about the psychological experience of the miscarriage and how the COVID-19 pandemic affected them and their experience. RESULTS Findings indicated moderate to severe levels of depression, anxiety, and PTSD, which persisted 14 to 31 months post-miscarriage. After conducting hierarchical binary logistic regressions, we found that perceived stress and prior trauma increased the odds of depression, perceived stress increased the odds of anxiety, and personal significance and prior trauma increased the odds of PTSD symptoms 14-31 months post-miscarriage. Notably, a subsequent successful childbirth emerged as a protective factor against depression, anxiety, and PTSD. Qualitative findings depicted emotions such as profound isolation, guilt, and grief. Women noted that additional pandemic-specific stressors exacerbated their distress. The categories identified via conventional content analysis fell under five broader thematic groups: mental health disorders, negative emotions/feelings, positive emotions/feelings, thoughts, and other experiences. CONCLUSIONS Miscarriage during the COVID-19 pandemic intensified and added complexity to the psychological distress experienced by affected women. The study underscores the need for comprehensive mental health screenings, specialized support for vulnerable groups, and the necessity of trauma-informed care. Providers are strongly encouraged to adopt a multifaceted, individualized approach to patient care that is cognizant of the unique stressors introduced by the pandemic.
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Affiliation(s)
- Madeline Fernandez-Pineda
- College of Nursing, Department of Nursing Science, East Carolina University, 2205 W 5th St, Greenville, NC, 27834, USA.
| | - Alison Swift
- College of Nursing, Department of Advanced Nursing Practice and Education, East Carolina University, 2205 W 5th St, Greenville, NC, 27834, USA
| | - Christyn Dolbier
- Department of Psychology, East Carolina University, Thomas Harriot College of Arts and Sciences, 104 Rawl Building, Greenville, NC, 27858, USA
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Sergi CM, Mullur T. Communication in reporting the autopsy results is utmost. Arch Gynecol Obstet 2023; 307:1655-1656. [PMID: 35699768 PMCID: PMC9194885 DOI: 10.1007/s00404-022-06667-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Consolato M Sergi
- Institute of Pathology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria.
- Anatomic Pathology Division, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Tomy Mullur
- Tiroler Landeskrankenanstalten GmbH (TILAK), Pastoral Care, Innsbruck, Austria
- Department of Pastoral and Spiritual Care, Medical University of Innsbruck, Innsbruck, Austria
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Sun S, Hao Y, Qian J, Wang F, Sun Y, Yu X. Incidence and predictors of paternal anxiety and depression following fetal abnormalities requiring pregnancy termination: a cross-sectional study in China. BMC Pregnancy Childbirth 2022; 22:440. [PMID: 35619057 PMCID: PMC9134591 DOI: 10.1186/s12884-022-04739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND China is a country with a high prevalence of fetal abnormalities. Termination of pregnancy for fetal abnormalities (TOPFA) is a devastating traumatic event for parents and families, resulting in serious and lasting psychological problems. The impact of TOPFA on mothers has been extensively explored, but little research has been conducted on the resulting paternal psychological problems. This study sought to determine the prevalence and predictors of paternal anxiety and depression following TOPFA. METHODS We analysed cross-sectional data from 169 Chinese couples (169 mothers and 169 fathers) who experienced TOPFA. Anxiety was assessed with the Self-Rating Anxiety Scale (SAS), and depression was measured with the Self-Rating Depression Scale (SDS) for fathers and the Edinburgh Postnatal Depression Scale (EPDS) for mothers. We used the Social Support Rating Scale (SSRS) to assess levels of social support. RESULTS Overall, 19.5% of fathers and 24.3% of mothers had symptoms of anxiety, but there was no significant difference in the incidence of anxiety between fathers and mothers. However, depression was more common in mothers (50.3%) than in fathers (24.9%). Level of income (β = -2.945, 95% CI: -5.448 to -0.442), worry about the pregnancy (β = 3.404, 95% CI: 1.210 to 5.599) and objective support (β = -0.668, 95% CI: -1.163 to -0.173) were predictors of anxiety in fathers. Worry about the pregnancy (β = 4.022, 95% CI: 1.630 to 6.414), objective support (β = -0.652, 95% CI: -1.229 to -0.075) and maternal depression (β = 0.497, 95% CI: 0.159 to 0.836) were predictors of paternal depression. CONCLUSION Anxiety and depression were prevalent among parents following TOPFA in China, and fathers had similar levels of anxiety as mothers. Strategies to support fathers should consider social support and psychological interaction and draw upon father-inclusive intervention recommendations.
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Affiliation(s)
- Shiwen Sun
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yuping Hao
- Emergency Department, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jialu Qian
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fang Wang
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yaping Sun
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Bakhbakhi D, Fraser A, Siasakos D, Hinton L, Davies A, Merriel A, Duffy JMN, Redshaw M, Lynch M, Timlin L, Flenady V, Heazell AE, Downe S, Slade P, Brookes S, Wojcieszek A, Murphy M, de Oliveira Salgado H, Pollock D, Aggarwal N, Attachie I, Leisher S, Kihusa W, Mulley K, Wimmer L, Burden C. Protocol for the development of a core outcome set for stillbirth care research (iCHOOSE Study). BMJ Open 2022; 12:e056629. [PMID: 35140161 PMCID: PMC8830254 DOI: 10.1136/bmjopen-2021-056629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stillbirth is associated with significant physical, psychosocial and economic consequences for parents, families, wider society and the healthcare system. There is emerging momentum to design and evaluate interventions for care after stillbirth and in subsequent pregnancies. However, there is insufficient evidence to inform clinical practice compounded by inconsistent outcome reporting in research studies. To address this paucity of evidence, we plan to develop a core outcome set for stillbirth care research, through an international consensus process with key stakeholders including parents, healthcare professionals and researchers. METHODS AND ANALYSIS The development of this core outcome set will be divided into five distinct phases: (1) Identifying potential outcomes from a mixed-methods systematic review and analysis of interviews with parents who have experienced stillbirth; (2) Creating a comprehensive outcome long-list and piloting of a Delphi questionnaire using think-aloud interviews; (3) Choosing the most important outcomes by conducting an international two-round Delphi survey including high-income, middle-income and low-income countries; (4) Deciding the core outcome set by consensus meetings with key stakeholders and (5) Dissemination and promotion of the core outcome set. A parent and public involvement panel and international steering committee has been convened to coproduce every stage of the development of this core outcome set. ETHICS AND DISSEMINATION Ethical approval for the qualitative interviews has been approved by Berkshire Ethics Committee REC Reference 12/SC/0495. Ethical approval for the think-aloud interviews, Delphi survey and consensus meetings has been awarded from the University of Bristol Faculty of Health Sciences Research Ethics Committee (Reference number: 116535). The dissemination strategy is being developed with the parent and public involvement panel and steering committee. Results will be published in peer-reviewed specialty journals, shared at national and international conferences and promoted through parent organisations and charities. PROSPERO REGISTRATION NUMBER CRD42018087748.
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Affiliation(s)
- Danya Bakhbakhi
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Abigail Fraser
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | | | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Abi Merriel
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - James M N Duffy
- Obstetrics and Gynaecology Department, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Mary Lynch
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Laura Timlin
- Women & Children's Health Department, North Bristol NHS Trust, Bristol, UK
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | | | - Soo Downe
- Research in Childbirth and Health, University of Central Lancashire, Preston, UK
| | - Pauline Slade
- Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Sara Brookes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Aleena Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Margaret Murphy
- Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | | | - Danielle Pollock
- Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Neelam Aggarwal
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Irene Attachie
- Department of Nursing and Midwifery, University of Health and Allied Sciences School of Public Health, Hohoe, Ghana
| | | | | | | | | | - Christy Burden
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
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Letter to the editor on: “The unheard parental cry of a stillbirth: fathers and mothers”. Arch Gynecol Obstet 2021; 306:563. [PMID: 34727224 PMCID: PMC8562375 DOI: 10.1007/s00404-021-06249-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
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