1
|
Caldwell JM, Meredith PJ, Whittingham K, Ziviani J, Wilson T. Women pregnant after previous perinatal loss: relationships between adult attachment, shame, and prenatal psychological outcomes. J Reprod Infant Psychol 2024; 42:653-667. [PMID: 36800926 DOI: 10.1080/02646838.2023.2180142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/07/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women's psychological health in pregnancy subsequent to loss. OBJECTIVE This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. METHOD Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. RESULTS Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). CONCLUSIONS Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy - and in grief.
Collapse
Affiliation(s)
| | - Pamela J Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Trish Wilson
- Bereavement Support Service, Mater Mothers Hospital, South Brisbane, QLD, Australia
| |
Collapse
|
2
|
Chemouny M, Wendland J. The experience of miscarriage and its impact on prenatal attachment during the following pregnancy: A mixed-methods study. Midwifery 2024; 136:104072. [PMID: 38945103 DOI: 10.1016/j.midw.2024.104072] [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: 02/08/2024] [Revised: 05/01/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND In France, miscarriage affects nearly 200,000 women every year. This life event may generate negative effects on the mother-child relationship and the mother's mental health in the following pregnancy. OBJECTIVES To investigate the influence of body satisfaction, partner support, resilience and previous experience of a miscarriage on prenatal attachment in pregnant women. DESIGN This is a cross-sectional mixed-methods study. Women answered an online questionnaire in the period between November 2022 to April 2023. PARTICIPANTS 267 French pregnant women who had previously experienced a miscarriage were recruited for this study. MEASUREMENTS Study outcomes included prenatal attachment, resilience, partner support, history of previous pregnancies and miscarriages, the current pregnancy, and questions relating to body experience. FINDINGS Participants who reported a high investment in the current pregnancy, high partner support and a positive image of their body had higher levels of prenatal attachment. The experience of miscarriage also seems to influence prenatal attachment: pregnancy investment at the time of miscarriage had a positive influence, while medical experience had no significant impact. While the global resilience score was not related to prenatal attachment, sense of control was positively linked to prenatal attachment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results highlight the importance of considering miscarriage as a perinatal loss with potential for long-lasting impact on women, which deserves particular attention from professionals. Enhancing partner support and helping women build a positive image of their pregnant body can also have a role in fostering prenatal attachment to the foetus.
Collapse
Affiliation(s)
- Myriam Chemouny
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France
| | - Jaqueline Wendland
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France.
| |
Collapse
|
3
|
Kelmanson IA. Manifest anxiety and maternal-fetal attachment in pregnant women with previous fetal losses. J Reprod Infant Psychol 2024; 42:45-61. [PMID: 35412396 DOI: 10.1080/02646838.2022.2056882] [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: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
AIM To explore associations between manifest anxiety (Taylor's Manifest Anxiety Scale, TMAS), major obstetric and demographic features and maternal-fetal attachment (MFA) (Maternal Antenatal Attachment Scale, MAAS) in women with previous miscarriages. SUBJECTS AND METHODS One hundred pregnant women with previous miscarriages, having uncomplicated singleton pregnancy, not receiving any medications, and conceived in a natural manner . Ages ranged between 19 and 47 years, gestational age between 4 and 35 weeks. Hierarchical multiple linear regression, Kruskal-Wallis test, and ANCOVA were used in data analysis. RESULTS Maternal age, gestational age, previous abortions, parity, maternal education, and marital status in combination contributed significantly to the regression model in prediction of the MAAS quality and intensity scores. Adding the TMAS score accounted for an additional 17% of variation in the MAAS quality score, and the change in R2 was significant. There was a negative relationship between the TMAS and the MAAS quality scores. The TMAS score did not contribute to prediction of the MAAS intensity. The highest TMAS values were in the women having anxious, ambivalent or affectless preoccupation. CONCLUSION Prevention of negative consequences of poor quality of MFA in women with previous miscarriages should include early screening for manifest anxiety.
Collapse
Affiliation(s)
- Igor A Kelmanson
- Department of Children's Diseases, Institute for Medical Education of the V.A. Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Clinical Psychology, St. Petersburg State Institute for Psychology and Social Work, St Petersburg, Russia
| |
Collapse
|
4
|
Shorey S, Lalor J, Pereira TLB, Jarašiūnaitė-Fedosejeva G, Downe S. Decision-making and future pregnancies after a positive fetal anomaly screen: A scoping review. J Clin Nurs 2023; 32:5534-5549. [PMID: 36707923 DOI: 10.1111/jocn.16628] [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: 07/13/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis of an actual anomaly in a previous pregnancy. BACKGROUND Prenatal screening consists of any diagnostic modality that is aimed at acquiring information about a fetus or an embryo; however, the entire process is highly stressful for parents, especially if there was a previous screen positive result, but no abnormality was detected in the final result. METHODS Eight electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Theses and Dissertations and ClinicalTrials.gov) were searched from each database's inception until February 2022. This scoping review was guided by Arksey and O'Malley's framework and was reported in accordance with the PRISMA-ScR checklist. Braun and Clarke's thematic analysis framework was utilised. RESULTS Thirty-one studies were eligible for inclusion. Two main themes (reliving the fear while maintaining hope, and bridging the past and future pregnancies) and six subthemes were identified. CONCLUSIONS A fetal anomaly diagnosis in pregnancy had a mixed impact on the attitudes of parents toward a future pregnancy. Some parents were fearful of reliving a traumatic experience, while others were determined to have a healthy child and grow their family. Parents generally expressed a greater preference for non-invasive over invasive prenatal testing due to the procedural risks involved. RELEVANCE TO CLINICAL PRACTICE There is a need for healthcare professionals to provide psychosocial and emotional support to parents so that they can achieve resolution for their previous pregnancy. Healthcare professionals' ability to provide informational support also enables these parents to make informed decision and understand their reproductive outcomes. Additionally, healthcare administration and policymakers should reconsider current neonatal or pregnancy loss bereavement guidelines to improve the inclusivity of fathers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Travis Lanz-Brian Pereira
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Soo Downe
- THRIVE Centre, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| |
Collapse
|
5
|
Donegan G, Noonan M, Bradshaw C. Parents experiences of pregnancy following perinatal loss: An integrative review. Midwifery 2023; 121:103673. [PMID: 37037073 DOI: 10.1016/j.midw.2023.103673] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/23/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pregnancy following perinatal loss has a profound effect on parents and may contribute to intense psychological distress including grief, post-traumatic stress disorder, anxiety and depression. The subsequent pregnancy may also be perceived as more stressful due to the fear of recurrent loss. Midwives and other health care professionals need to be sensitive and empathetic to the needs of these parents when providing care in a pregnancy subsequent to a loss. METHODOLOGY The aim of this integrated literature review was to explore parents' experiences of pregnancy following a previous perinatal loss using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A systematic search of seven electronic databases was conducted (Jan 2009 -Jan 2023) to identify relevant primary research which addressed parents' experiences of pregnancy following a previous perinatal loss. Seven papers met the eligibility criteria and were assessed for quality using Crowe's Critical Appraisal Tool (CCAT). Thematic analysis identified two themes. FINDINGS The key themes identified from the literature were; the psychosocial needs and challenges faced by previously bereaved parents in subsequent pregnancies; and the need for specialist care and support in a subsequent pregnancy. Psychological needs and challenges included continued grief, depression, anxiety, and disparities in the grief process between men and women. The importance of specialist care with an increased level of support from competent, confident and compassionate health care providers was highlighted. CONCLUSION The experience of pregnancy following a perinatal loss can be a complex emotional experience for parents. The review identifies the need for post pregnancy loss debriefing and counselling and care pathways specific to caring for women and their partners in a pregnancy subsequent to a perinatal loss. Care in pregnancy subsequent to loss should be provided by empathetic, competent health care providers and include additional antenatal clinic appointments, pregnancy monitoring and psychological support in order to meet the needs of these expectant parents.
Collapse
Affiliation(s)
- Gemma Donegan
- University of Limerick and University Maternity Hospital, Limerick, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, Health Research Institute (HRI) Affiliated, University of Limerick, Limerick, Ireland
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, Health Research Institute (HRI) Affiliated, University of Limerick, Limerick, Ireland.
| |
Collapse
|
6
|
Chichester M, Tepner L, Côté-Arsenault D. Nursing Care of Childbearing Families After Previous Perinatal Loss. Nurs Womens Health 2022; 26:379-388. [PMID: 36065093 DOI: 10.1016/j.nwh.2022.07.011] [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: 05/17/2021] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.
Collapse
|
7
|
Anderson CM, Brunton RJ, Dryer R. Pregnancy‐related anxiety: Re‐examining its distinctiveness†. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Carla M. Anderson
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Robyn J. Brunton
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Rachel Dryer
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| |
Collapse
|
8
|
Cortezzo DE, Ellis K, Schlegel A. Perinatal Palliative Care Birth Planning as Advance Care Planning. Front Pediatr 2020; 8:556. [PMID: 33014940 PMCID: PMC7505922 DOI: 10.3389/fped.2020.00556] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose of Review: A significant number of pregnancies are complicated by a fetus with a life-limiting diagnosis. As diagnoses are made earlier in the pregnancy, families experience anticipatory grief and are faced with navigating goals of care for a baby that has yet to be born. With the support of the care team, families can begin to grieve, plan, and make meaningful memories during the duration of the pregnancy, the birth of their baby, and life of the child. Creating a palliative care birth plan, which expands beyond the traditional concept for delivery planning to include prenatal, perinatal, and neonatal care has become an important method for parents to process the diagnosis, for parents to document their wishes, and for members of the care team to communicate with the goal of supporting and enhancing the experience of the family. This articles reviews recent and relevant literature on the importance of birth planning and the role of perinatal palliative care when a life-limiting fetal diagnosis is made. Recent Findings: The process of birth planning is an important component of perinatal palliative care. Through this process, families can express their fears, values, hopes, and wishes. It also offers an opportunity for providers to communicate these wishes for the remainder of the pregnancy, the delivery, birth, and time afterwards. This has been demonstrated to decrease maternal stress and promote family centered care. Summary: Perinatal birth planning is an important component of perinatal palliative care when a fetus has a life-limiting diagnosis. The process of birth planning can be supportive and therapeutic as well as an important communication tool. With multiple practices and designs of perinatal palliative care programs, there are no standard tools even though important components have been identified. Ultimately, the strategies outlined here can be used as advance care planning tools.
Collapse
Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kelstan Ellis
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, United States.,Section on Palliative Care, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Amy Schlegel
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, Ohio State University of Medicine, Columbus, OH, United States
| |
Collapse
|
9
|
Catlin A. Pregnancy Loss, Bereavement, and Conscientious Objection in Perioperative Services. J Perianesth Nurs 2019; 33:553-559. [PMID: 30077300 DOI: 10.1016/j.jopan.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
|
10
|
Andipatin MG, Naidoo AD, Roomaney R. The hegemonic role of biomedical discourses in the construction of pregnancy loss. Women Birth 2019; 32:e552-e559. [DOI: 10.1016/j.wombi.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
|
11
|
Bailey SL, Boivin J, Cheong YC, Kitson-Reynolds E, Bailey C, Macklon N. Hope for the best …but expect the worst: a qualitative study to explore how women with recurrent miscarriage experience the early waiting period of a new pregnancy. BMJ Open 2019; 9:e029354. [PMID: 31154315 PMCID: PMC6549705 DOI: 10.1136/bmjopen-2019-029354] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate how women experience the initial period of a new pregnancy after suffering recurrent miscarriage (RM). DESIGN A qualitative study, nested within a randomised controlled feasibility study of a coping intervention for RM, used semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic network approach. SETTING Participants were recruited from the Recurrent Miscarriage Clinic and Early Pregnancy Unit in two tertiary referral hospitals in the UK. PARTICIPANTS 14 women with RMs and who had previously participated in the randomised controlled trial (RCT) feasibility component of the study were recruited. RESULTS Seven organising themes emerged from the data: (1) turmoil of emotions, (2) preparing for the worst, (3) setting of personal milestones, (4) hypervigilance, (5) social isolation, (6) adoption of pragmatic approaches, (7) need for professional affirmation. CONCLUSIONS The study established that for women with a history of RM, the waiting period of a new pregnancy is a traumatic time of great uncertainty and emotional turmoil and one in which they express a need for emotional support. Consideration should be given to the manner in which supportive care is best delivered within the constraints of current health service provision. TRIAL REGISTRATION NUMBER ISRCTN43571276.
Collapse
Affiliation(s)
- Sarah Louise Bailey
- Health Sciences, University of Southampton, Southampton, Hants, UK
- Women and Newborn and Research and Development, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, UK
| | - Ying C Cheong
- Obstetrics and Gynaecology, University of Southampton, Southampton, UK
- Princess Anne Hospital, Complete Fertility Centre, Southampton, UK
| | | | - Christopher Bailey
- Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Nick Macklon
- Medical Director, London Womens Clinic, London, UK
- Obstetrics and Gynaecology, Zealand University Hospital, Copenhagen, Denmark
| |
Collapse
|
12
|
Murphy S. “I'd failed to produce a baby and I'd failed to notice when the baby was in distress”: The social construction of bereaved motherhood. WOMENS STUDIES INTERNATIONAL FORUM 2019. [DOI: 10.1016/j.wsif.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Brunton R, Dryer R, Saliba A, Kohlhoff J. Re-examining pregnancy-related anxiety: A replication study. Women Birth 2019; 32:e131-e137. [DOI: 10.1016/j.wombi.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
|
14
|
Psychological Impact of Pregnancy Loss: Best Practice for Obstetric Providers. Clin Obstet Gynecol 2018; 61:628-636. [DOI: 10.1097/grf.0000000000000369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Jansson C, Volgsten H, Huffman C, Skoog Svanberg A, Swanson KM, Stavreus-Evers A. Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples’ experiences after miscarriage. EUR J CONTRACEP REPR 2017; 22:412-417. [DOI: 10.1080/13625187.2017.1409346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Caroline Jansson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Helena Volgsten
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Carolyn Huffman
- College of Health Sciences, Appalachian State University USA
| | | | | | | |
Collapse
|
16
|
Abstract
Compassionate clinical practice guidelines for healthcare providers for respectful disposition after miscarriage are presented. When woven into the whole of a clinician's practice, these guidelines provide the framework for giving women and their families the care they want and deserve when experiencing miscarriage. Relying on theoretical concepts of personhood, place, and protection, care providers can assess the unique meaning a woman assigns to her early pregnancy loss and offer interventions that embrace the concept of respectful disposition. Respectful methods of disposition involve a continuum of care that shows respect for remains and relies on person-, family-, and culture-centered nursing care. Policies, practices, and perspectives that flow from respectful disposition have women and families at their core and flexibility to cocreate care. This involves courage and competence. Several states have enacted fetal disposition laws, but these mandates are of questionable benefit because the expertise of healthcare leaders, nurses, physicians, chaplains, and other stakeholders must be involved in this sensitive and important area of care. Compassionate care cannot be legislated. We offer a practical approach to respectful disposition, including how to handle and prepare remains and examples of burial and memorial services, which will give clinicians the ability to respond empathetically and respectfully to the heart-rending plea of a woman who asks, "Where is my baby?"
Collapse
|
17
|
Hutti MH, Myers J, Hall LA, Polivka BJ, White S, Hill J, Kloenne E, Hayden J, Grisanti MM. Predicting grief intensity after recent perinatal loss. J Psychosom Res 2017; 101:128-134. [PMID: 28867418 DOI: 10.1016/j.jpsychores.2017.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/17/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Perinatal Grief Intensity Scale (PGIS) was developed for clinical use to identify and predict intense grief and need for follow-up after perinatal loss. This study evaluates the validity of the PGIS via its ability to predict future intense grief based on a PGIS score obtained early after a loss. METHODS A prospective observational study was conducted with 103 international, English-speaking women recruited at hospital discharge or via the internet who experienced a miscarriage, stillbirth, or neonatal death within the previous 8weeks. Survey data were collected at baseline using the PGIS and the Perinatal Grief Scale (PGS). Follow-up data on the PGS were obtained 3months later. Data analysis included descriptive statistics, Cronbach's alpha, receiver operating characteristic curve analysis, and confirmatory factor analysis. RESULTS Cronbach's alphas were ≥0.70 for both instruments. PGIS factor analysis yielded three factors as predicted, explaining 57.7% of the variance. The optimal cutoff identified for the PGIS was 3.535. No difference was found when the ability of the PGIS to identify intense grief was compared to the PGS (p=0.754). The PGIS was not inferior to the PGS (AUC=0.78, 95% CI 0.68-0.88, p<0.001) in predicting intense grief at the follow-up. A PGIS score≥3.53 at baseline was associated with increased grief intensity at Time 2 (PGS: OR=1.97, 95% CI 1.59-2.34, p<0.001). CONCLUSIONS The PGIS is comparable to the PGS, has a lower response burden, and can reliably and validly predict women who may experience future intense grief associated with perinatal loss.
Collapse
Affiliation(s)
- Marianne H Hutti
- University of Louisville, School of Nursing, 555 S. Floyd Street, Louisville, KY 40202, USA.
| | - John Myers
- University of Louisville, School of Medicine, USA
| | - Lynne A Hall
- University of Louisville, School of Nursing, 555 S. Floyd Street, Louisville, KY 40202, USA
| | - Barbara J Polivka
- University of Louisville, School of Nursing, 555 S. Floyd Street, Louisville, KY 40202, USA
| | - Susan White
- University of Louisville, School of Nursing, Norton Healthcare, USA
| | - Janice Hill
- University of Louisville, School of Nursing, Norton Healthcare, USA
| | - Elizabeth Kloenne
- University of Louisville, School of Nursing, 555 S. Floyd Street, Louisville, KY 40202, USA
| | - Jaclyn Hayden
- University of Louisville, School of Nursing, 555 S. Floyd Street, Louisville, KY 40202, USA
| | | |
Collapse
|
18
|
San Lazaro Campillo I, Meaney S, McNamara K, O'Donoghue K. Psychological and support interventions to reduce levels of stress, anxiety or depression on women's subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open 2017; 7:e017802. [PMID: 28882928 PMCID: PMC5595175 DOI: 10.1136/bmjopen-2017-017802] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage. DESIGN A systematic review of randomised controlled trials (RCTs). DATA SOURCE A total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE. ELIGIBILITY CRITERIA This review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention. RESULTS This systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found. CONCLUSION Cohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women's psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.
Collapse
Affiliation(s)
- Indra San Lazaro Campillo
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- National Perinatal Epidemiology Centre (NPEC), University College Cork - National University of Ireland, Cork, Ireland
| | - Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork - National University of Ireland, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork - National University of Ireland, Cork, Ireland
| |
Collapse
|
19
|
Lee L, McKenzie-McHarg K, Horsch A. The impact of miscarriage and stillbirth on maternal–fetal relationships: an integrative review. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2016.1239249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Al-Maharma DY, Abujaradeh H, Mahmoud KF, Jarrad RA. MATERNAL GRIEVING AND THE PERCEPTION OF AND ATTACHMENT TO CHILDREN BORN SUBSEQUENT TO A PERINATAL LOSS. Infant Ment Health J 2016; 37:411-23. [DOI: 10.1002/imhj.21570] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/09/2016] [Accepted: 03/17/2016] [Indexed: 11/06/2022]
|
21
|
Brunton RJ, Dryer R, Saliba A, Kohlhoff J. Pregnancy anxiety: A systematic review of current scales. J Affect Disord 2015; 176:24-34. [PMID: 25687280 DOI: 10.1016/j.jad.2015.01.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. METHODS Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. RESULTS Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed. LIMITATIONS Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. CONCLUSIONS Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.
Collapse
Affiliation(s)
- Robyn J Brunton
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia.
| | - Rachel Dryer
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Anthony Saliba
- School of Psychology, Charles Sturt University, Bathurst, NSW 2795, Australia
| | | |
Collapse
|
22
|
Brooten D, Youngblut JM, Hannan J, Caicedo C, Roche R, Malkawi F. Infant and child deaths: Parent concerns about subsequent pregnancies. J Am Assoc Nurse Pract 2015; 27:690-7. [PMID: 25761229 DOI: 10.1002/2327-6924.12243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/22/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE Examine parents' concerns about subsequent pregnancies after experiencing an infant or child death (newborn to 18 years). DATA SOURCES Thirty-nine semistructured parent (white, black, Hispanic) interviews 7 and 13 months post infant/child death conducted in English and/or Spanish, audio-recorded, transcribed, and content analyzed. Mothers' mean age was 31.8 years, fathers' was 39 years; 11 parents were white, 16 black, and 12 Hispanic. CONCLUSIONS Themes common at 7 and 13 months: wanting more children; fear, anxiety, scared; praying to God/God's will; thinking about/keeping the infant's/child's memory and at 7 months importance of becoming pregnant for family members; and at 13 months happy about a new baby. Parents who lost a child in neonatal intensive care unit (NICU) commented more than those who lost a child in pediatric intensive care unit (PICU). Black and Hispanic parents commented more on praying to God and subsequent pregnancies being God's will than white parents. IMPLICATIONS FOR PRACTICE Loss of an infant/child is a significant stressor on parents with documented negative physical and mental health outcomes. Assessing parents' subsequent pregnancy plans, recognizing the legitimacy of their fears about another pregnancy, discussing a plan should they encounter problems, and carefully monitoring the health of all parents who lost an infant/child is an essential practitioner role.
Collapse
Affiliation(s)
- Dorothy Brooten
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - JoAnne M Youngblut
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - Jean Hannan
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - Carmen Caicedo
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - Rosa Roche
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| | - Fatima Malkawi
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida
| |
Collapse
|
23
|
Hutti MH, Armstrong DS, Myers JA, Hall LA. Grief Intensity, Psychological Well‐Being, and the Intimate Partner Relationship in the Subsequent Pregnancy after a Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2015; 44:42-50. [DOI: 10.1111/1552-6909.12539] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
24
|
van Rensburg EJ, Poggenpoel M, Myburgh C, Du Plessis D. Experience of Women after a Spontaneous Abortion. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2009.10820306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
25
|
Blood C, Cacciatore J. Parental grief and memento mori photography: narrative, meaning, culture, and context. DEATH STUDIES 2014; 38:224-233. [PMID: 24524585 DOI: 10.1080/07481187.2013.788584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Postmortem photography is a widespread practice in perinatal bereavement care, yet few studies have explored how it affects bereaved parents, or how it might be received by parents of older children. This study is an examination of the meaning, utility, and social context of postmortem photography in a sample of 181 bereaved parents. Data were subjected to both quantitative and qualitative analysis. Photographs were positively regarded by most parents after perinatal death and several parents of older children. Other parents rejected postmortem photography for aesthetic, personal, or cultural reasons. Brief recommendations are offered for healthcare providers.
Collapse
Affiliation(s)
- Cybele Blood
- a School of Social Work , Arizona State University , Phoenix , Arizona , USA
| | | |
Collapse
|
26
|
Hutti MH, Armstrong DS, Myers J. Evaluation of the Perinatal Grief Intensity Scale in the Subsequent Pregnancy After Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2013; 42:697-706. [DOI: 10.1111/1552-6909.12249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
27
|
Lee L, McKenzie-McHarg K, Horsch A. Women's decision making and experience of subsequent pregnancy following stillbirth. J Midwifery Womens Health 2013; 58:431-9. [PMID: 23855388 DOI: 10.1111/jmwh.12011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study sought to increase understanding of women's thoughts and feelings about decision making and the experience of subsequent pregnancy following stillbirth (intrauterine death after 24 weeks' gestation). METHODS Eleven women were interviewed, 8 of whom were pregnant at the time of the interview. Modified grounded theory was used to guide the research methodology and to analyze the data. RESULTS A model was developed to illustrate women's experiences of decision making in relation to subsequent pregnancy and of subsequent pregnancy itself. DISCUSSION The results of the current study have significant implications for women who have experienced stillbirth and the health professionals who work with them. Based on the model, women may find it helpful to discuss their beliefs in relation to healing and health professionals to provide support with this in mind. Women and their partners may also benefit from explanations and support about the potentially conflicting emotions they may experience during this time.
Collapse
Affiliation(s)
- Louise Lee
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Unité de Recherche, 25A Rue du Bugnon, Lausanne, Switzerland
| | | | | |
Collapse
|
28
|
Thorp JM. Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later. SCIENTIFICA 2012; 2012:980812. [PMID: 24278765 PMCID: PMC3820464 DOI: 10.6064/2012/980812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/15/2012] [Indexed: 06/02/2023]
Abstract
During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.
Collapse
Affiliation(s)
- John M. Thorp
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
29
|
O'Leary J, Warland J, Parker L. Bereaved parents' perception of the grandparents' reactions to perinatal loss and the pregnancy that follows. JOURNAL OF FAMILY NURSING 2011; 17:330-356. [PMID: 21813814 DOI: 10.1177/1074840711414908] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article presents bereaved parents' perceptions of their parents' (the grandparents) reactions at the time of loss and in the pregnancy that follows. Data originated from two phenomenological studies conducted to understand bereaved parents' experiences during their loss and subsequent pregnancy. However, this article reports a secondary thematic analysis focused on bereaved parents perceptions of the grandparents' support (or lack of) at the time of loss and during the pregnancy following loss. Our findings illustrate some families found the means to share their grief at the time of loss in a constructive manner, while in others the intergenerational relationship was strained. Most important to parents was intergenerational acknowledgment of the ongoing relationship to the deceased child as an important, though absent family member, especially during the pregnancy that followed. Those supporting bereaved families can play an important role in helping intergenerational communication around perinatal loss and the subsequent pregnancy.
Collapse
Affiliation(s)
- Joann O'Leary
- Center for Early Education and Development, University of Minnesota, 3208 Rankin Rd. NE, Minneapolis, MN 55418, USA.
| | | | | |
Collapse
|
30
|
Abstract
PURPOSE To evaluate the influence of previous perinatal loss, anxiety, depressive symptoms, impact of the previous loss, and maternal investment in the baby on mothers' healthcare utilization (HCU) during the subsequent pregnancy and postpartum periods. STUDY DESIGN AND METHODS A longitudinal, cohort study design gathered telephone interview data from 36 mothers with a history of prior perinatal loss, 32 mothers with no loss history, and 38 first-time mothers. These data were collected during the third trimester of pregnancy until 8 months postpartum. MEASURES Centers for Epidemiologic Studies-Depression Scale, Spielberger State-Trait Anxiety Scale, Pregnancy Outcome Questionnaire, Impact of Events Scale, Maternal Attitude Questionnaire, and a questionnaire regarding HCU. RESULTS Mothers with a history of prior perinatal loss utilized more healthcare resources in the subsequent pregnancy when compared with non-loss controls. Increased HCU during pregnancy was associated with increased maternal anxiety and depressive symptoms after birth. CLINICAL IMPLICATIONS Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early postpartum with requests for additional healthcare resources. Nurses need to listen with compassion, providing appropriate education and information, and make referrals to mental healthcare providers and support groups as indicated. These nursing interventions during the subsequent pregnancy may be a better use of healthcare resources than providing extra, but medically unnecessary, laboratory and ultrasound testing for the sole purpose of fleeting reassurance.
Collapse
|
31
|
|
32
|
Abstract
This article discusses an issue rarely seen in the professional literature: the tangible ways nurses can respect a woman's needs following miscarriage by ensuring the safe handling and disposition of fetal tissue or remains. Concepts of personhood, place, and protection are important for nurses to understand within the context of a woman's response to miscarriage. Hospitals or clinics that foster a culture of respectful fetal disposition should have a system in place to bury tissue or fetal remains in a designated area; in fact, several states have enacted laws that regulate what hospitals and clinics must do, or what women must be offered, after a miscarriage or ectopic pregnancy. Barriers may exist to creating a culture of respectful disposition, including staff attitudes, perceived time and financial constraints, lack of knowledge, and inefficient communication between departments. Nurses can begin implementing change in this regard through conducting a needs assessment using guiding questions contained in this article. In addition, through communication, education, and implementation of respectful disposition, nurses can promote safe processes that will honor women's preferences and wishes for care following a miscarriage.
Collapse
|
33
|
Woods-Giscombé CL, Lobel M, Crandell JL. The impact of miscarriage and parity on patterns of maternal distress in pregnancy. Res Nurs Health 2010; 33:316-28. [PMID: 20544819 PMCID: PMC3070408 DOI: 10.1002/nur.20389] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of the current study was to examine patterns of state anxiety and pregnancy-specific distress across pregnancy in a diverse sample of women with (n = 113) and without (n = 250) prior miscarriage. For both groups, state anxiety and pregnancy-specific distress were highest in the first trimester and decreased significantly over the course of pregnancy. Compared to women without prior miscarriage, women with prior miscarriage experienced greater state anxiety in the second and third trimesters. Having a living child did not buffer state anxiety in women with a prior miscarriage. Attention to patterns of distress can contribute to delivery of appropriate support resources to women experiencing pregnancy after miscarriage and may help reduce risk for stress-related outcomes.
Collapse
Affiliation(s)
- Cheryl L Woods-Giscombé
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA
| | | | | |
Collapse
|
34
|
Gaudet C, Séjourné N, Camborieux L, Rogers R, Chabrol H. Pregnancy after perinatal loss: association of grief, anxiety and attachment. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903487342] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
35
|
Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res 2009; 43:770-6. [PMID: 19046750 DOI: 10.1016/j.jpsychires.2008.10.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 10/19/2008] [Accepted: 10/21/2008] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.
Collapse
Affiliation(s)
- Priscilla K Coleman
- Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.
| | | | | | | |
Collapse
|
36
|
Kempson D, Conley VM, Murdock V. Unearthing the Construct of Transgenerational Grief: The “Ghost” of the Sibling Never Known. ACTA ACUST UNITED AC 2008. [DOI: 10.2190/il.16.4.aa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A child's death profoundly affects family dynamics, stories, and even other siblings' perceived reasons for being. This influence is often sustained over time to affect not only the lost child's parents and siblings, but also future generations. Health care and mental health care workers frequently encounter such stories, but little is known about the actual phenomenon, which may be a form of disenfranchised grief. This conceptual article explores the construct of transgenerational grief as it pertains to adults' lifelong grief responses to a sibling whom they did not know, but whose “ghost” has been important in the family. The authors consider this construct within its historical family context, proposing that miscarriages and infant losses that a family experienced even a century ago may have resembled unresolved grief, due in part to brief, unresolved mourning. Bereavement theory, Bowenian family theory, and constructionist theory of grief are woven together to create speculative theoretical underpinnings to support transgenerational grief and its impact as uncovered in the authors' study of personal stories of sibling loss.
Collapse
|
37
|
DeBackere KJ, Hill PD, Kavanaugh KL. The parental experience of pregnancy after perinatal loss. J Obstet Gynecol Neonatal Nurs 2008; 37:525-37. [PMID: 18811772 PMCID: PMC2923205 DOI: 10.1111/j.1552-6909.2008.00275.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To review the research literature on the parental experience of pregnancy, primarily maternal, subsequent to perinatal loss. DATA SOURCES Computerized searches on CINAHL and PubMed databases. STUDY SELECTION Articles from indexed journals relevant to the objective were reviewed from January 1997 to December 2007. Only research-based studies in English were included. DATA EXTRACTION The review was performed using the methodology of Whittemore and Knafl (2005). Data were extracted and organized under headings: author/year/setting; purpose; sample; design/instruments; results; and nursing implications for parents during a pregnancy following a perinatal loss. DATA SYNTHESIS Depression and anxiety are frequently seen in pregnant women subsequent to a perinatal loss. The parental experience is filled with intense and conflicting emotions as parents balance being hopeful while worrying about another potential loss. CONCLUSIONS It is important for health care providers to evaluate the woman's obstetric history, acknowledge and validate previous perinatal loss, and discuss with her what would be helpful during the prenatal period with respect to the previous perinatal loss.
Collapse
|
38
|
Levels of Personhood: A Model for Dementia Care. Geriatr Nurs 2008; 29:324-32. [DOI: 10.1016/j.gerinurse.2007.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/05/2007] [Accepted: 11/11/2007] [Indexed: 11/19/2022]
|
39
|
Abstract
BACKGROUND Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally. OBJECTIVES To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss. METHODS In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70. RESULTS Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping. DISCUSSION Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.
Collapse
|
40
|
Abstract
Perinatal loss is a profound experience for childbearing families. Examples of perinatal loss include miscarriage, ectopic pregnancy, stillbirth, neonatal death, and other losses. Perinatal loss engenders a unique kind of mourning since the child is so much a part of the parental identity. Societal expectations for mourning associated with perinatal loss are noticeably absent. Gender differences in response to such loss, as well as sibling and grandparent grief have been identified in the literature. Descriptive studies provide information on cultural responses to perinatal loss. Nursing interventions have been refined over the past two decades as research studies have been performed, in order to more fully promote health and healing in the face of perinatal loss. These include helping to create meaning through the sharing of the story of parental loss, the facilitation of sociocultural rituals associated with loss, the provision of tangible mementos, sensitive presence, and the validation of the loss. Outcome evaluations of such interventions are recommended.
Collapse
|
41
|
Wright PM. Childbirth education for parents experiencing pregnancy after perinatal loss. J Perinat Educ 2005; 14:9-15. [PMID: 17273448 PMCID: PMC1595261 DOI: 10.1624/105812405x72285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Expectant parents who have experienced previous perinatal loss have special concerns, which can be partially addressed by modifying prepared childbirth education courses. This article presents a review of current literature, highlighting the unique needs of expectant parents who have experienced previous pregnancy loss. Modifications to traditional childbirth education courses are suggested, which include addressing parents' grief, managing anxiety, and facilitating communication with health-care providers and others.
Collapse
Affiliation(s)
- Patricia Moyle Wright
- PATRICIA MOYLE WRIGHT is employed as a childbirth educator for the Wyoming Valley Health Care System in Pennsylvania and is pursuing a PhD in Nursing at Loyola University Chicago in Illinois
| |
Collapse
|
42
|
Burkhammer MD, Anderson GC, Chiu SH. Grief, Anxiety, Stillbirth, and Perinatal Problems: Healing With Kangaroo Care. J Obstet Gynecol Neonatal Nurs 2004; 33:774-82. [PMID: 15561666 DOI: 10.1177/0884217504270594] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A young, anxious mother's first pregnancy was eclamptic, her placenta was underperfused, and her son was stillborn. She carried grief, guilt, anxiety, and hypervigilance into her next preeclamptic pregnancy, birth (of her small-for-dates son), and early postpartum period. When breastfeeding difficulties developed, the authors intervened with three consecutive (skin-to-skin) breastfeedings. During the first skin-to-skin breastfeeding, the mother stopped crying, shared self-disparaging emotions, and then began relaxing and "taking-in" her new baby. Breastfeeding continues at 1 year.
Collapse
Affiliation(s)
- Maria D Burkhammer
- Edward J. and Louise Mellen Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA
| | | | | |
Collapse
|
43
|
Fielding SL, Schaff EA. Social context and the experience of a sample of U.S. women taking RU-486 (mifepristone) for early abortion. QUALITATIVE HEALTH RESEARCH 2004; 14:612-27. [PMID: 15107166 DOI: 10.1177/1049732304263677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Of 50 women seeking an abortion in Rochester, New York, between November 1999 and January 2001, 35 went on to complete an in-depth interview from 1 to 6 weeks after their follow-up clinical visit. A higher proportion of women who defined their pregnancy as a baby indicated emotional distress during their in-depth interview compared to those who saw their pregnancy as only having the potential to become a baby. The authors conclude that abortion might be made less difficult through public education about the different views of pregnancy and abortion throughout U.S. history. It might be important for abortion counselors to first ask a woman how she defines her pregnancy. A larger study is warranted.
Collapse
|
44
|
Holcomb MB. Perinatal loss. J Obstet Gynecol Neonatal Nurs 2004; 33:154; author reply 155. [PMID: 15095793 DOI: 10.1111/j.1552-6909.2004.tb00295.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
45
|
Côté-Arsenault D. The Influence of Perinatal Loss on Anxiety in Multigravidas. J Obstet Gynecol Neonatal Nurs 2003; 32:623-9. [PMID: 14565741 DOI: 10.1177/0884217503257140] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare multigravid women with and without a history of perinatal loss on state anxiety, pregnancy anxiety, and optimism. DESIGN Comparative descriptive; cross-sectional. SETTING Private obstetric offices in a small northeastern city in the United States. PARTICIPANTS The sample included 160 women who were between 17 and 28 weeks gestation: 96 multigravidas with no history of loss and 74 women with a history of one or two losses. MAIN OUTCOME MEASURES State anxiety, pregnancy anxiety, optimism, and perinatal loss history. RESULTS No group differences were found on demographic variables, state anxiety, or optimism. However, pregnancy anxiety was higher in women with a history of perinatal loss. Pregnancy anxiety was also correlated with desire to see care provider more often and number of phone calls between visits, and was not correlated with the number of living children. CONCLUSION Women experiencing pregnancy subsequent to perinatal loss have greater pregnancy anxiety: That is, they are more concerned about their pregnancies and their babies than women without a history of perinatal loss. State anxiety and optimism do not differentiate these two groups. This heightened anxiety should be acknowledged and more frequent contact with the care provider should be offered.
Collapse
Affiliation(s)
- Denise Côté-Arsenault
- School of Nursing, College of Human Services and Health Professions, Syracuse University, NY 13244, USA.
| |
Collapse
|