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Wallis ELG, Heath J, Spong A. How do people story their experience of miscarriage? A systematic review of qualitative literature. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:100997. [PMID: 38901061 DOI: 10.1016/j.srhc.2024.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
Literature surrounding miscarriage is broad in scope, yet narrative constructions following miscarriage are significantly under-researched. Few studies have sought to understand sense-making processes following miscarriage, including how and why people story their experience. Consequently, the complexities and nuances of these processes have not been adequately explored. This review aimed to gain insight into what is already known about how people story their experience of miscarriage, as well as research gaps and limitations. A systematic literature review of qualitative literature was conducted across four databases to identify relevant research related to miscarriage narratives and sense-making. Eligibility criteria was applied to a staged screening process to identify the highest quality, peer-reviewed research. Ten studies were included in the review and presented as a narrative synthesis. The literature was divided into five collective themes: women's perspectives, male partner's perspectives, couples' perspectives, healthcare professional's perspectives, and cultural perspectives. The literature review summarises existing knowledge about narrative processes in relation to miscarriage, as well as highlighting research gaps, clinical implications, and directions for future research. When working with those who have experienced involuntary child loss and infertility, there is a need for professionals to have appropriate training to support the provision of compassionate, individualised care and decision-making. The role of language requires consideration as there is a need to address over-medicalised systems of knowledge, and it is important that there is understanding regarding the need for expression, and the various ways that individuals might express their feelings and loss.
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Affiliation(s)
- Emma L G Wallis
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
| | - Jennifer Heath
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK.
| | - Amanda Spong
- Ocean Service, John Bunyan House, 3 Kimbolton Road, Bedford MK40 2NT, UK
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Freeman N, Warland J, Cheney K, Bradfield Z. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review. JBI Evid Synth 2024:02174543-990000000-00312. [PMID: 38769931 DOI: 10.11124/jbies-23-00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia. INTRODUCTION In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. INCLUSION CRITERIA Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. METHODS A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. RESULTS The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. CONCLUSIONS This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. REVIEW REGISTRATION Open Science Framework osf.io/7zchu.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Jane Warland
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
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Filippa S, Jayaweera RT, Blanchard K, Grossman D. Do miscarriage care practice recommendations align with individuals' needs?: a scoping review. Contraception 2024:110448. [PMID: 38588848 DOI: 10.1016/j.contraception.2024.110448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Miscarriage is a common experience; yet individuals often have negative experiences when receiving miscarriage care, signaling a gap in the quality of miscarriage care. We explore the literature on individuals' experiences with miscarriage care across a variety of dimensions and assess how these experiences align with practice recommendations. METHODS We conducted a scoping review of peer-reviewed studies in PubMed published in English through April 30, 2022, and focused on individuals' experiences with miscarriage care in healthcare settings and on practice recommendations for providing care in a variety of countries. The search returned 1,812 studies; after screening, 41 studies were included in the analysis. RESULTS Included studies reported on individuals' experiences with miscarriage care settings and accessibility, information provision, emotional support, decision-making and follow-up. Overall, individuals are often dissatisfied with their miscarriage care experiences. Practice recommendations are generally responsive to these issues, but more research is needed to address some key gaps and improve the implementation of current practice recommendations. CONCLUSIONS Future research should focus on documenting the miscarriage experiences and developing relevant practice recommendations for communities that face the greatest barriers to care, generating evidence on the dimensions that constitute high-quality miscarriage care from patients' perspectives and assessing the barriers and facilitators to effectively implementing existing practice recommendations.
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Affiliation(s)
- Sofía Filippa
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA.
| | - Ruvani T Jayaweera
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Kelly Blanchard
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA
| | - Daniel Grossman
- Ibis Reproductive Health, 1736 Franklin St, Suite 600, Oakland, CA, 94612, USA; Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA. 94612, USA
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Tancioco V, Pancholi R, Schechter-Perkins E, Drainoni ML, White K. Emergency department staff perspectives on caring for patients experiencing early pregnancy loss (Boston, Massachusetts 2021). Contraception 2023; 125:110091. [PMID: 37331465 DOI: 10.1016/j.contraception.2023.110091] [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: 01/16/2023] [Revised: 05/28/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES A preimplementation study to examine the context of, and barriers and facilitators to, providing early pregnancy loss care in one emergency department (ED), to inform implementation strategies to improve ED-based early pregnancy loss care. STUDY DESIGN We recruited a purposive sample of participants and conducted semistructured individual qualitative interviews focused on caring for patients experiencing pregnancy loss in the ED until saturation was reached. For analysis, we used framework coding and directed content analysis. RESULTS Participant roles in the ED included administrators (N = 5), attending physicians (N = 5), resident physicians (N = 5), and registered nurses (N = 5). Most (70%, N = 14) participants identified as female. Primary themes included (1) caring for early pregnancy loss patients is challenging and uncomfortable, (2) inability to provide compassionate early pregnancy loss care causes moral injury, and (3) stigma influences early pregnancy loss care. Participants explained that early pregnancy loss is challenging due to added pressure, patient expectations, and gaps in knowledge. They reported barriers to providing compassionate care that are out of their control, such as systematic workflows, limited physical space, and insufficient time and expressed that these barriers lead to moral injury. Participants also reflected on how early pregnancy loss and abortion stigma affect patient care. CONCLUSIONS Caring for patients experiencing early pregnancy loss in the ED requires unique considerations. ED staff recognize this and desire more early pregnancy loss education, clearer early pregnancy loss tools and protocols, and early pregnancy loss-specific workflows. With concrete needs identified, an implementation plan to improve ED-based early pregnancy loss care can be created, which is important now more than ever, due to the impending influx in the ED for early pregnancy loss care after the Dobbs decision. IMPLICATIONS Since the Dobbs decision, patients are self-managing abortions and/or seeking out-of-state abortion care. Without access to follow-up, more patients are presenting to the ED with early pregnancy loss. By demonstrating the unique challenges emergency medicine clinicians face, this study can support initiatives to improve ED-based early pregnancy loss care.
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Affiliation(s)
- Virginia Tancioco
- Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
| | - Rushina Pancholi
- Obstetrics and Gynecology, Boston Medical Center, Boston, MA United States.
| | | | - Mari-Lynn Drainoni
- Sections of Infectious Diseases, Department of Medicine, Boston University/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
| | - Katharine White
- Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
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Freeman N, Bradfield Z, Cheney K, Warland J. Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services in Australia: a scoping review protocol. JBI Evid Synth 2023; 21:826-832. [PMID: 36415916 DOI: 10.11124/jbies-22-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this review is to review and synthesize what is documented on the role and scope of practice of midwives and registered nurses working in acute early pregnancy care settings in Australia. INTRODUCTION Women experiencing complications before 20 weeks of pregnancy may need to attend an acute care service, often a hospital emergency department. Midwives and registered nurses provide care for women with early pregnancy complications, and it is important that their role and scope of practice is documented. This review will explore the literature relating to acute early pregnancy care in Australia to better understand how midwives' and registered nurses' roles and scope are currently described in this setting. INCLUSION CRITERIA Any literature that explores the role and scope of practice of midwives and registered nurses who care for women who present to acute care services in Australia with early pregnancy complications will be considered for inclusion in the review. METHODS A 3-step review process will involve a preliminary search of MEDLINE and ProQuest, followed by a more detailed search of a larger selection of databases, using identified keywords and phrases from the initial search. Reference lists of retrieved literature will then be examined for relevant citations. Literature in English will be considered, including relevant gray literature. Search results will be imported into reference and review support software. Data that align with the inclusion criteria will be organized into tabulated and narrative formats for presentation. DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE AT Open Science Framework https://osf.io/5bnqz.
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Affiliation(s)
- Nicole Freeman
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Zoe Bradfield
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
| | - Kate Cheney
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jane Warland
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Women's and Newborn's Health Service, Perth, WA, Australia
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Jia L, Li W, Liu Y, Wang L. Psychologic Sequelae in Early Pregnancy Complications. Int J Womens Health 2023; 15:51-57. [PMID: 36643713 PMCID: PMC9838123 DOI: 10.2147/ijwh.s382677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Early pregnancy complications, including miscarriage, ectopic pregnancies, and hyperemesis gravidarum, are common discomforts accounting for about 15% to 20% of all pregnancies. A proportion of women with early pregnancy complications will experience short- and long-term psychologic sequelae in the aftermath of pregnancy complications, including anxiety, depression, and post-traumatic stress disorder (PTSD) which are the most commonly reported psychologic reactions. This review will focus on the course and impact of these psychologic sequelae in early pregnancy complications, and the noninvasive interventions to improve mental health are also briefly discussed.
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Affiliation(s)
- Lili Jia
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Wenfei Li
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Yue Liu
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Longqin Wang
- Department of Emergency, Binhai County People’s Hospital, Yancheng City, People’s Republic of China,Correspondence: Longqin Wang, Department of Emergency, Binhai County People’s Hospital, 248 Fudong Middle Road, Yancheng City, 224599, People’s Republic of China, Email
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Gilbert SL, Dimoff JK, Brady JM, Macleod R, McPhee T. Pregnancy loss: A qualitative exploration of an experience stigmatized in the workplace. JOURNAL OF VOCATIONAL BEHAVIOR 2023. [DOI: 10.1016/j.jvb.2023.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Lee L, Ma W, Davies S, Kammers M. Toward Optimal Emotional Care During the Experience of Miscarriage: An Integrative Review of the Perspectives of Women, Partners, and Health Care Providers. J Midwifery Womens Health 2023; 68:52-61. [PMID: 36370053 PMCID: PMC10098777 DOI: 10.1111/jmwh.13414] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/18/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Miscarriage is frequently associated with significant emotional impact, causing psychological distress, trauma, and grief. Unfortunately, women and partners frequently report dissatisfaction with care around miscarriage, and health care providers report feeling ill-prepared and underequipped to provide emotional support. This integrative review synthesizes the individual perspectives of the woman experiencing the miscarriage, the partner, and the different health care provider roles involved in the care to better understand what future research is necessary to improve the experiences of bereaved parents and their health care providers. METHODS Electronic databases were searched for studies that covered emotional care around miscarriage from the perspective of women, partners, or health care providers. The review included studies published in English between 2015 and 2022, using either quantitative or qualitative methods. Thematic analysis was carried out, and conclusions from these articles were integrated into themes and subthemes. RESULTS A total of 60 studies met the inclusion criteria. Two main themes were identified for women: (1) a need for more information and (2) a need for acknowledgment of their loss. Two main themes were likewise identified for partners: (1) a need for more information and (2) a need for recognition. Three main themes were identified for health care providers: (1) a need for additional training, (2) components of quality care, and (3) perceived barriers to providing care. DISCUSSION There is broad overlap in the needs identified by bereaved parents and their health care providers, as well as general agreement regarding the barriers to providing effective care. Five areas of future research priority were identified to understand how best to meet these needs: empirical evaluation of strategies to meet identified needs, investigation of setting-specific needs, integrated consideration of all relevant roles, investigation of the care needs of diverse groups, and an investigation of the predictors of emotional impact.
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Affiliation(s)
- Lysha Lee
- Melbourne School of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Winn Ma
- Melbourne School of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Sidney Davies
- Melbourne School of Psychological Science, University of Melbourne, Melbourne, Australia
| | - Marjolein Kammers
- Melbourne School of Psychological Science, University of Melbourne, Melbourne, Australia
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Levitan F, Frei-Landau R, Sabar-Ben-Yehoshua N. "I Just Needed a Hug": Culturally-Based Disenfranchised Grief of Jewish Ultraorthodox Women Following Pregnancy Loss. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133864. [PMID: 36227857 DOI: 10.1177/00302228221133864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pregnancy loss (PL) often results in disenfranchised grief. Although much is known about women's experience of PL in general, less is known about PL among women from different backgrounds, particularly the Ultraorthodox community, where the woman's role is often defined by childbearing, but fertility is not openly discussed. The study's goal was to explore PL experiences among this unique sociocultural group: Jewish Ultraorthodox women. Employing a qualitative approach, we interviewed 14 women about their PL. Analysis revealed five themes denoting Ultraorthodox women's struggles post-PL, within two arenas: religiously-based marital struggle (restricted physical support, challenged emotional support) and social struggle/conflict regarding sharing (due to PL as a taboo, perceived failure to fulfill the woman's fertility role, and yearning for "room to grieve"). The findings highlight that PL-grief may be disenfranchised for religious reasons, underscoring the need for a culturally-sensitive inquiry of PL and disenfranchised grief. Therapeutically, clinicians' additional awareness is required.
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Affiliation(s)
- Fayga Levitan
- The Culturally-Sensitive Clinical Psychology Program, School of Advance Studies, Achva Academic College, Shikmim, Israel
| | - Rivi Frei-Landau
- The Culturally-Sensitive Clinical Psychology Program, School of Advance Studies, Achva Academic College, Shikmim, Israel
| | - Na'ama Sabar-Ben-Yehoshua
- The Israel's Culture and Instruction Program, School of Advance Studies, Achva Academic College, Shikmim, Israel
- School of Advance Studies, Tel-Aviv University, Israel
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Strumpf E, Austin N, Lang A, Derksen S, Bolton J, Brownell M, Gregory P, Chateau D, Heaman M. The effects of early pregnancy loss on health outcomes and health care utilization and costs. Health Serv Res 2022; 57:786-795. [PMID: 35076944 PMCID: PMC9264463 DOI: 10.1111/1475-6773.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/21/2021] [Accepted: 12/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate the effects of early pregnancy loss on subsequent health care use and costs. Data Sources Linked administrative health databases from Manitoba, Canada. Study Design This was a population‐based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications. Data Collection/Extraction Methods We identified women who experienced their first recorded loss (EPM) from 2003–2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators. Principal Findings EPM was associated with a short‐term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician‐gynecologists (OB‐GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls. Conclusion Pregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post‐EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss.
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Affiliation(s)
- E. Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health & Department of Economics. Leacock Building McGill University Montreal QC Canada
| | - N. Austin
- School of Health Administration Dalhousie University Halifax Nova Scotia Canada
| | - A. Lang
- School of Nursing McGill University Quebec Canada
| | - S. Derksen
- University of Manitoba, Manitoba Centre for Health Policy Manitoba Canada
| | - J. Bolton
- Department of Psychiatry and Manitoba Centre for Health Policy University of Manitoba Winnipeg Manitoba Canada
| | - M. Brownell
- Department of Community Health Sciences & Manitoba Centre for Health Policy, Max Rady College of Medicine, Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - P. Gregory
- Red River College, Nursing Department School of Health Sciences and Community Services Winnipeg Manitoba Canada
| | - D. Chateau
- Department of Community Health Sciences & Manitoba Centre for Health Policy University of Manitoba Manitoba Canada
| | - M. Heaman
- College of Nursing & Department of Obstetrics, Gynecology and Reproductive Sciences, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba University of Manitoba Winnipeg Manitoba Canada
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Hiefner AR, Villareal A. A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care. Front Public Health 2021; 9:725762. [PMID: 34917568 PMCID: PMC8669268 DOI: 10.3389/fpubh.2021.725762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.
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Affiliation(s)
- Angela R Hiefner
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Astrud Villareal
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Rzońca E, Bień A, Bączek G, Rzońca P, Filip M, Gałązkowski R. Suspected Miscarriage in the Experience of Emergency Medical Services Teams-Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12305. [PMID: 34886025 PMCID: PMC8657126 DOI: 10.3390/ijerph182312305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of suspected miscarriage. The study involved a retrospective analysis of EMS team interventions in cases of suspected miscarriage carried out between January 2018 and December 2019 in Poland. Data obtained from Poland's National Monitoring Center of Emergency Medical Services included emergency medical procedure records and EMS team dispatch records in electronic format. The mean patient age was 30.53 years. Most were primiparous (48.90%) and up to the 13th gestational week (76.65%). The most commonly reported symptom was vaginal bleeding (80.71%). EMS teams were most commonly dispatched in the winter (27.03%), between 7 A.M. and 6:59 P.M. (51.87%), in urban areas (69.23%), with urgency code 2 (55.60%), and in most cases, they transferred the patient to a hospital (97.53%). The present study addresses very important issues concerning the characteristics of Polish suspected miscarriage cases handled by different EMS team types, in different locations (urban vs. rural areas), and concerning patients in a different obstetric situation (gestational week, gravidity, parity). Our findings suggest a need for further studies in this field and for gestational health promotion activities to be implemented, specifically including actions to reduce the risk of vaginal bleeding during pregnancy.
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Affiliation(s)
- Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica St., 20-081 Lublin, Poland;
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 5 Chałubińskiego St., 02-004 Warsaw, Poland;
| | - Michał Filip
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 16 Staszica St., 20-081 Lublin, Poland;
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
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Zhang X, Liu J, Han N, Yin J. Social Media Use, Unhealthy Lifestyles, and the Risk of Miscarriage Among Pregnant Women During the COVID-19 Pandemic: Prospective Observational Study. JMIR Public Health Surveill 2021; 7:e25241. [PMID: 33293263 PMCID: PMC7787689 DOI: 10.2196/25241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023] Open
Abstract
Background The COVID-19 pandemic has resulted in changes to normal life and disrupted social and economic function worldwide. However, little is known about the impact of social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women during the COVID-19 pandemic. Objective This study aims to assess the association between social media use, unhealthy lifestyles, and the risk of miscarriage among pregnant women in the early stage of the COVID-19 pandemic in China. Methods In this prospective cohort study, 456 singleton pregnant women in mainland China were recruited during January and February 2020. Sociodemographic characteristics, history of previous health, social media use, and current lifestyles were collected at baseline, and we followed up about the occurrence of miscarriage. Log-binomial regression models were used to estimate the risk ratios (RRs) of miscarriage for women with different exposures to COVID-19–specific information. Results Among all the 456 pregnant women, there were 82 (18.0%) who did no physical activities, 82 (18.0%) with inadequate dietary diversity, 174 (38.2%) with poor sleep quality, and 54 (11.8%) spending >3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. Conclusions Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic.
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Affiliation(s)
- Xiaotong Zhang
- School of Medicine, Macau University of Science and Technology, Macau, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Na Han
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Jing Yin
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Tongzhou District, Beijing, China
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