Miscarriage at advanced maternal age and the search for meaning

How do people story their experience of miscarriage? A systematic review of qualitative literature

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.

Do miscarriage care practice recommendations align with individuals' needs?: A scoping review

OBJECTIVES

Miscarriage is a common occurrence; 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.

STUDY DESIGN

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 1812 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.

CONCLUSIONS

Individuals experiencing miscarriage are best served by care that is patient-centered, involves shared decision-making, and addresses individuals' informational and emotional needs. However, the prevalence of individuals' negative experiences with miscarriage care points to the need to address key gaps in and improve the implementation of practice recommendations.

IMPLICATIONS

Future research should focus on documenting the miscarriage experiences of 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.

Toward Optimal Emotional Care During the Experience of Miscarriage: An Integrative Review of the Perspectives of Women, Partners, and Health Care Providers

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.

Associations of Losing a Child With the Couple Relationship, Maternal Mental Health, and the Emotional Development of the Subsequent Baby

The loss of a child can impact maternal mental health and the emotional development of a subsequent baby. Couple relationship can help women to cope with this loss. This study investigates the association among child loss, maternal mental health (including prolonged grief), couple adjustment, and psycho-functional symptoms in the subsequent babies. 598 Brazilian mothers, recruited by convenience, took part in the study. Mothers with a baby loss (23%) presented greater age and religiosity, less income, a longer couple relationship, and better couple adjustment, and their baby presented a great number of symptoms. This population needs monitoring for early emotional assistance.

Construction of Meaning in Pregnancy Loss: Qualitative Study with Brazilian Couples

Abstract We investigated the process of meaning construction in pregnancy loss in 11 Brazilian couples. The reports were submitted to inductive and deductive thematic analysis using the categorization system from the integrative model of meaning construction in grief. Regarding the original dimensions of the model (Sense-making of death, benefit from the experience of loss, and identity change), there was a lack of meaning for death, perception of strengthened bonds within the couple as a benefit, and parenting as an identity project. We propose an additional dimension (Meaning-making process) that includes gender differences, lack of social recognition, and emotional intensity of the experience. As for coping strategies, spirituality and the search for peers were identified, especially in social media. After a pregnancy loss, the process of meaning construction proved similar to that of other types of loss, validating this experience. We discuss the implications of the category system used in this study.

Bereavement photography, volunteering, and posttraumatic growth: A mixed-methods investigation

Bereavement photography has been recognized as an important tool to create memories and as a support service for parents experiencing perinatal loss. This paper explores the impact of volunteering on posttraumatic growth among photographers working with parents impacted by stillbirth. Using a mixed-methods design, 141 Australian and New Zealand volunteer bereavement photographers were recruited. Higher number of losses experienced by photographers were correlated with a higher level of posttraumatic growth. Volunteering was associated with an enhanced understanding of loss, increased empathy for bereaved parents, developing effective coping skills and a renewed appreciation of photography. Implications of the findings are discussed.

Duration of estradiol supplementation in luteal phase support for frozen embryo transfer in hormone replacement treatment cycles: a randomized, controlled phase III trial

PURPOSE

In this study, we intend to evaluate pregnancy outcomes in women who undergo artificial frozen embryo transfer (FET) and stop estradiol (E2) after vaginal ultrasound observation of a gestational sac and heartbeat.

METHODS

In this randomized phase III clinical trial, we recruited 291 patients who underwent FET. We randomly assigned 64 pregnant women to a study or a control group after observation of a gestational sac and heartbeat at 6-week gestational age. E2 administration continued until week 12 of gestational age for the control group, but was discontinued for the study group. Progesterone-in-oil administration continued until week 12 of gestational age for both groups. Serum levels for E2 and progesterone were measured on the initial progesterone and embryo transfer (ET) days, and at weeks 6 and 12 of pregnancy in both groups.

RESULTS

The miscarriage rate was 1/32 (3.13%) in the study group and 6/32 (18.75%) in the control group after the intervention and confirmation of a fetal heartbeat. This difference was statistically significant. All patients who remained under intervention, which included 29 in the study group and 24 in the control group, had live births. Although the mean serum E2 and progesterone levels steadily increased from the initial day of progesterone administration to week 12 of gestational age, they were not significantly different between the two groups. Maternal complications were significantly more common in the control group.

CONCLUSION

Earlier discontinuation of E2 for luteal phase support of FET cycles may be taken into consideration. Additional clinical studies should be conducted to determine an accurate estimation of the time when E2 should be discontinued during FET luteal phase support.

TRIAL REGISTRATION

NCT04013438, registered 9 July 2019-Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT04013438?cond=NCT04013438&draw=2&rank=1.

Coping After Involuntary Pregnancy Loss: Perspectives of Spanish European Women

The purpose of this qualitative study was to discover the coping strategies used by Spanish (European) women to cope with a pregnancy loss. Sixteen women with miscarriages and stillbirths were interviewed. All of the women were Spanish European. The mean age of the women was 35 years, and most were university graduates, married, employed, and with living children. Audio-recorded interviews and field notes were transcribed and then subsequently coded and analyzed in individual or team sessions. Construction and confirmation of the categories and related themes derived from the data was a collaborative process. Two themes emerged regarding the coping strategies used by women: talking and avoiding. This study expands the theoretical model “Multicultural Model of Coping after Pregnancy Loss” and guides health providers regarding interventions used in practice.

Women’s Experiences of Utilizing Religious and Spiritual Beliefs as Coping Resources After Miscarriage

Religious and spiritual beliefs enable some bereaved women to cope better with the devastating effects of the loss of a baby through miscarriage. The aim of this study is to explore the experiences of women’s utilization of religious and spiritual beliefs as coping resources after miscarriage. Heideggerian interpretive phenomenological approach guided the study. Data were collected using audio-recorded, semi-structured interviews with 10 women and analyzed thematically using the method developed by van Manen. Data analysis revealed three themes: (a) feelings of grief (b) finding meaning in loss and the purpose of life and (c) religious and spiritual beliefs as coping resources. Religious and spiritual beliefs play a major role in the lives of many individuals, and act as coping resources for many women who have experienced a miscarriage. Bereavement care providers’ understanding of religious and spiritual values of women who have experienced a miscarriage is crucial to meeting their spiritual care needs.

Grief and Post-traumatic Growth Following Miscarriage: The Role of Meaning Reconstruction and Partner Supportive Communication

This study used the meaning reconstruction model of bereavement and the theory of conversationally induced reappraisals to investigate factors that influence the association between grief following a miscarriage and post-traumatic growth. Participants included 298 women who had experienced a miscarriage within the previous year. As predicted, a moderate level of grief corresponded with the most post-traumatic growth among bereaved mothers and meaning reconstruction and partner supportive communication moderated this association. The results clarify how grief is integral to post-traumatic growth in the aftermath of a miscarriage and how intrapersonal and interpersonal coping resources can foster post-traumatic growth in the face of grief.