Experience of hope: An exploratory research with bereaved mothers following perinatal death

Finding Hope in Finnish Parents Following the Traumatic Death of Their Child

Hope is a complex and ever-evolving personal phenomenon that plays a vital role in individuals' abilities to cope with stressful events. This is particularly true for parents who are coping with the traumatic loss of a child. However, the topic of hope in this context is often inadequately addressed. The primary objective of this paper is to gain insight into the hope held by Finnish parents following the traumatic loss of a child. This qualitative study unfolded in two phases. A total of 117 participants took part in the study, including 108 females, 5 males, and 4 individuals who chose not to disclose their sex. Subsequently, 17 parents participated in in-depth phone interviews. Thematic analysis was conducted to identify key themes. Several themes emerged from the analysis, including the endurance of hope amidst uncertainty, the hope for a reunion based on faith, hope directed towards family members, and moments of hopelessness regarding the future. The findings of this research are pivotal in enhancing our comprehension of the challenges faced by grieving parents in the aftermath of a child's traumatic death. Moreover, this study holds significant relevance for professionals who work with bereaved parents following the traumatic loss of a child.

Maternal Perception of Pregnancy Loss: Protocol for a Thematic Synthesis

Introduction

The number of women who present this perineal loss is high. Identifying the existing knowledge about the women's experiences and perceptions of pregnancy loss is essential to understand the impact of the phenomenon on women. This identification is also crucial to adapt and improve the healthcare provided.

Subjects and Methods

A systematic literature review, meta-synthesis, of qualitative studies will be developed with the goal of obtaining a comprehensive understanding of mothers' perception of pregnancy loss and identifying their specific support needs.

Inclusion Criteria

This review will consider qualitative investigations that study the perceptions or experiences of adult women who have suffered prenatal loss. All studies published in English, Spanish or Portuguese between January 1, 2012, and December 31, 2022 will be considered. This systematic review will follow the Joanna Briggs Institute statement for systematic reviews of qualitative design. The Psychology and Behavioral Sciences Collection, Scopus, CINAHL®, MEDLINE® and Cochrane Database of Systematic Reviews (CDRS) databases will be utilized for research. Data extraction will be performed in-peers by the researchers, using the Joanna Briggs Institute model. Finally, the available data will be analysed using a meta-aggregation approach.

Conclusion

A better understanding of this phenomenon will be useful, identifying, on the one hand, the support needs of women who have suffered fetal loss and, on the other hand, also identifying the support and interventions that can be implemented by health professionals.

Systematic Review Registration Number

PROSPERO® (CRD42023407314).

Network analysis of posttraumatic stress and posttraumatic growth symptoms among women in subsequent pregnancies following pregnancy loss

BACKGROUND

Pregnant women who have undergone pregnancy loss often display both posttraumatic stress (PTS) and posttraumatic growth (PTG). However, the precise relationship and structure of symptomatic levels of PTS and PTG have not been well understood. This study aimed to assess the associations between PTS and PTG symptoms in women during subsequent pregnancies following a previous pregnancy loss.

METHODS

A total of 406 pregnant women with a history of pregnancy loss were included in this study. The Impact of Events Scale-6 (IES-6) and the Posttraumatic Growth Inventory Short Form (PTGI-SF) were used to assess symptoms of PTS and PTG, respectively. The Graphical Gaussian Model was employed to estimate the network model. Central symptoms and bridge symptoms were identified based on "expected influence" and "bridge expected influence" indices, respectively. The stability and accuracy of the network were examined using the case-dropping procedure and nonparametric bootstrapped procedure.

RESULTS

The network analysis identified PTG3 ("Ability to do better things") as the most central symptom, followed by PTS3 ("Avoidance of thoughts") and PTG6 ("New path for life") in the sample. Additionally, PTS3 ("Avoidance of thoughts") and PTG9 ("Perception of greater personal strength") were bridge symptoms linking PTS and PTG clusters. The network structure was robust in stability and accuracy tests.

CONCLUSIONS

Interventions targeting the central symptoms identified, along with key bridge symptoms, have the potential to alleviate the severity of PTS experienced by women with a history of pregnancy loss and promote their personal growth.

Care in pregnancy after stillbirth

Pregnancy after stillbirth is associated with increased risk of stillbirth and other adverse pregnancy outcomes including fetal growth restriction, preeclampsia, and preterm birth in subsequent pregnancies. In addition, pregnancy after stillbirth is associated with emotional and psychological challenges for women and their families. This manuscript summarizes information available to guide clinicians for how to manage a pregnancy after stillbirth by appreciating the nature of the increased risk in future pregnancies, and that these are not affected by interpregnancy interval. Qualitative studies have identified clinician behaviors that women find helpful during subsequent pregnancies after loss which can be implemented into practice. The role of peer support and need for professional input from the antenatal period through to after the birth of a live baby is discussed. Finally, areas for research are highlighted to develop care further for this group of women at increased risk of medical and psychological complications.

Psychological distress in subsequent pregnancy among women with a history of pregnancy loss: A latent profile analysis

BACKGROUND

Women who have undergone pregnancy loss can experience a range of psychological distress during subsequent pregnancies; however, the outcomes may vary based on individual circumstances.

OBJECTIVE

To explore the potential patterns of psychological distress for pregnant women with a history of pregnancy loss, and to investigate the impact of factors related to pregnancy loss on these patterns.

METHODS

From October 2022 to August 2023, the participants were recruited from four medical centers in Guangdong Province, China. They completed a questionnaire survey comprising sociodemographic and obstetric characteristics, the Perceived Stress Scale-4 (PSS-4), the Impact of Event Scale-Revised (IES-R), the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2), and the Patient Health Questionnaire-9 (PHQ-9). Latent profile analysis was used to determine optimal patterns of psychological distress. The logistic regression was conducted to assess the associations between the number of pregnancy loss, types of pregnancy loss, inter-pregnancy interval, and distinct psychological distress patterns.

RESULTS

A total of 446 pregnant women with a history of pregnancy loss were included for formal analysis. Three distinct profiles were identified, namely the "mild psychological distress" (34.1 %), "moderate psychological distress" (57.8 %), and "severe psychological distress" (8.1 %). Recurrent pregnancy loss was associated with increased risks of both moderate (adjusted odds ratio [aOR] 2.45, 95 % confidence interval [CI]: 1.42-4.24; P = 0.001) and severe psychological distress (aOR 2.93, 95 %CI: 1.25-6.83; P = 0.013). Furthermore, compared to women who conceived after 6 months of pregnancy loss, those who conceived within 6 months of pregnancy loss were more likely to be categorized into the group of moderate psychological distress (aOR 2.00, 95 % CI: 1.21-3.30; P = 0.007).

CONCLUSIONS

Approximately two-thirds of pregnant women with a history of pregnancy loss exhibit moderate to severe psychological distress. Such individuals could benefit from early screening and targeted psychological interventions, particularly those who have encountered recurrent pregnancy loss and those who conceive shortly after a pregnancy loss.

A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss

BACKGROUND

Maternal identity, a mother's internalized view of self as mother, has not been studied in relation to perinatal loss. This study aimed to investigate how women construct a sense of maternal identity after the loss of a baby.

METHODS

We interviewed 10 mothers who had experienced perinatal loss. A Listening Guide framework for narrative analysis was used to identify patterns of giving voice to the mother's own story.

RESULTS

We identified 12 overarching voices which fell within three distinct groupings: voices of motherhood, voices of grief, and voices of growth. Although bereaved mothers grappled with constructing their maternal identity, they also demonstrated how maternal identity is individually and intuitively created through an honouring and remembering of the child that was lost, resulting in significant growth.

CONCLUSIONS

There is need for a broader definition of what constitutes motherhood to encapsulate diverse mothering experiences, including perinatal loss.

Self-management experiences of youth following the unexpected loss of a family member to HIV

Background

Death of a close family member is one of the most traumatic events in a person’s life. The way, in which this loss unfolds, varies from person to person and depends on how close you were with the deceased. It was unclear how youths experienced it to manage themselves during different stages of the bereavement process, after losing a near-family member to human immunodeficiency virus (HIV).

Aim

The aim of this study was to understand the self-management of youth following the unexpected loss of a family member to HIV.

Setting

Khayelitsha, Western Cape province, South Africa.

Methods

A descriptive phenomenological design was followed, with an accessible population of youth who lost a family member to HIV. Individual semi-structured interviews were conducted with 11 purposively selected participants after obtaining written informed consent. The sessions, held with an interview schedule, did not take longer than 45 min to conduct until data saturation was reached. A digital recorder was used and field notes held. Open coding was followed after transcribing interviews.

Results

Individuals had different experiences during different stages of the bereavement process, not necessarily similar or following the same sequence. Individuals had to manage their guilt of being unable to do more before the family member passed away, struggling to realise that they have a future purpose, and hardship having fond memories.

Conclusion

Youth find it difficult to view death as a natural loss of life and to manage themselves after the loss of their loved one to HIV.

Contribution

The context-based information in this study confirms the importance of youth and self-coping and self-continuation to plan, organise and direct their future after the loss of a family member.

Risk factors for stillbirth after 28 complete weeks of gestation

PURPOSE

To identify the risk factors for stillbirth (SB).

MATERIAL AND METHODS

This case-control study was carried out between 1 December 2019 and 30 April 2020. Women whose fetuses died after the 28^th week of gestation, but before delivery and women whose newborns were alive and healthy after delivery were examined. The main variables recorded included maternal age, educational level, medical and obstetrical past histories, number of antenatal visits, whether the woman was referred or not, body mass index (BMI), and sex of newborn. Fisher exact test, t-test and logistic regression were used for comparison. p < .05 was considered statistically significant.

RESULTS

Our frequency of SB was 54/1000 births (63 SB out of 1167 deliveries). Significant risk factors for SB were referred parturient (aOR = 7.76, 95%CI = 2.84-21.20), past-history of SB (aOR = 6.54, 95%CI = 1.27-33.63), primary school educational level (aOR = 5.60, 95%CI = 3.63-9.06), pregnancy followed up by a general practitioner (aOR = 5.38, 95%CI = 1.13-25.65 and BMI ≥30kg/m² (aOR = 3.51, 95%CI = 1.32-9.38).

CONCLUSION

When the above-identified risk factors are present, pregnancy and delivery should be well followed up, if we want to reduce the frequency of SB.