The loss of self: The effect of miscarriage, stillbirth, and child death on maternal self-esteem

Transforming care for pregnancy loss: A qualitative study on advancing practices and addressing existing needs

Recent years have seen significant growth in the body of knowledge and the development of guidelines on pregnancy loss. This qualitative study analyses how these advancements have been implemented with a focus on health literacy, hospital protocols, and societal responses. Thematic analysis of semi-structured interviews from bereaved parents (n = 11) and healthcare professionals (n = 7) in Italy uncovers significant lapses in health literacy and societal reluctance to address pregnancy loss, which obstructs informed parental decision-making. The research indicates a movement toward more sensitive healthcare, yet disparities remain in the treatment of early versus later losses and uneven psychological support provision. The research underscores the need for standardized practices and combined psychological care for both parents and for reform in legal policies regarding bereavement and maternity leave. Despite progress in institutional and societal approaches to managing pregnancy loss, considerable challenges persist.

Perinatal Loss and Parents' Grief Amidst the COVID-19 Pandemic: A Mixed-Method Research

Losing a child is a traumatic event, disrupting life's natural cycle, profoundly affecting the family system, and causing enduring grief. Perinatal death, including ectopic pregnancies, miscarriages, stillbirths, and neonatal deaths, exacerbates this distress. Additionally, the COVID-19 pandemic has challenged healthcare systems and supporting services available to individuals in need. Thus, this research explores experiences of parents facing perinatal loss in 2020-2021, further focusing on the pandemic's impact. Using a mixed-methods design with self-reports and qualitative interviews, this paper presents results from the quantitative protocol, involving an update and follow-up of a previous study. It compares measurements across scales: COVID-19: The Impact of Event Scale-Revised; The Prolonged Grief-13; The Parental Assessment of Paternal/Maternal Affectivity; The Dyadic Adjustment Scale (short version); The Daily Spiritual Experiences Scale; and The Inventory of Complicated Spiritual Grief. In the baseline measurement, 45 parents participated (37 mothers and 8 fathers), with 20 (13 mothers and 7 fathers) contributing to the follow-up and 9 engaging in interviews. Baseline results showed higher scores for mothers compared to fathers, with effect sizes ranging from small to medium (ranging from -0.02 to 0.29), though statistical significance was limited due to the small sample size. Multiple regression analysis for distress measures at baseline identified two significant predictors: maternal/paternal affectivity and gestational week. Additionally, positive support from healthcare professionals emerged as a mitigating factor, particularly in relation to Avoidance. A significant reduction in stress measures and parental affectivity was observed at the 6-month follow-up. Qualitative analysis revealed three themes: Shifts in Self-Perception and Post-Loss Growth; Conflicted Relationship with One's Body; and Negative Impact of COVID-19 vs. Unexpectedly Positive Aspects. In conclusion, the findings emphasize the significance of psychological and psychosocial interventions based on meaning-making processes, along with the importance of spiritual care and empowerment for those navigating perinatal loss.

Nursing care for parents who have experienced fetal demise: integrative review

OBJECTIVES

to identify scientific evidence regarding nursing care for parents who have experienced grief following fetal demise.

METHODS

an integrative review of original studies was conducted across six databases. The studies were classified according to the level of evidence.

RESULTS

the qualitative analysis of the nine studies comprising the sample involved thematic categories, exploring the impact of perinatal loss on families, inadequate communication by healthcare professionals, and the importance of a holistic approach in care. The role of the nurse is highlighted in making a positive contribution to the team, emphasizing participation in training and the provision of essential information.

FINAL CONSIDERATIONS

grieving affects not only family dynamics but also the social environment, emphasizing the urgency of a more empathetic and comprehensive approach. Care should be holistic, going beyond technical nursing assistance, and addressing the biopsychosocial context of the parents.

Predictors of Individual and Interpersonal Adjustment Among Non-offending Partners of Individuals With Histories of Sexual Offenses

Recent research indicates that the consequences of sexual offenses extend beyond target victims, including to non-offending partners of individuals with sexual offense histories. However, little research has focused on non-offending partners' wellbeing and relationships with persons with sexual offense histories leading up to and following acts of sexual aggression. Non-offending partners may be secondary victims of their partners' offenses in managing psychological difficulties (e.g., guilt, shame), social stigma and isolation, fear for their safety, or difficulties in their romantic relationships resulting from their partners' sexual offenses, often with minimal supports. The current study examined key correlates of individual and interpersonal adjustment among 207 non-offending partners of individuals with histories of sexual offenses who were residing in Canada (n = 36) or the United States (n = 171). Findings indicate that positive changes due to the offense (i.e., improved finances), self-esteem, interpersonal adjustment, instrumental support, lower levels of acceptance, and humor positively predicted individual adjustment. Interpersonal adjustment was predicted by trust, intimacy, partner's stress communication, and problem-focused and emotion-focused common dyadic coping. Findings highlight the need for services for non-offending partners, including interventions that address self-esteem and practical difficulties resulting from the offense, and couples therapy to address trust issues, intimacy concerns, and shared coping with stressors related to the offense.

Competing aspects of the rural Arab mothers' bereavement experience

The study applied relational dialectics theory to explore competing discourses in bereaved Arab mothers' talk about their bereavement experience in a collective space in rural areas of Israel, and to understand how the interaction between these discourses gives meaning to their experience. Fifteen bereaved mothers were interviewed. The mothers, aged 28-46 years, had children (aged 1-6 years) who died between 2 and 7 years previously. Analysis of the interviews revealed three main discursive struggles that characterize mothers' bereavement experience: (a) moving closer versus keeping one's distance; (b) social harmony versus personal needs; and (c) criticism of ongoing grief versus criticism of returning to routine functioning. The advantage of being part of a close-knit social network is that it provides emotional cushioning to the bereaved. This cushioning, however, does not preclude the struggle to attain normalcy after the tragedy within the parameters of the contradictory societal expectations and needs of the mourner.

Religious Experience as a Predictor of the Meaning in Life and Life Satisfaction in the Lives of Polish Women after a Stillbirth

Many researchers have demonstrated the relationship of religiosity with dimensions of mental health such as searching for meaning in life, the presence of meaning in life, and life satisfaction. Hence, this study attempts to link such aspects of religiosity with the experience of the presence and/or absence of God with the search for and presence of meaning in life and satisfaction with life among a group of Polish women who have experienced a stillbirth in the past five years. The study included 64 women who lost a baby through stillbirth after the 22nd week of gestation. All the women were born into Christian families and declared themselves to be Christians and actively practicing their faith. Women's ages ranged from 29 to 47 years. The research results showed that the experience of God's presence and absence have a positive and significant relationship with the search for meaning in life and the presence of meaning in life, as well as with the satisfaction with life in the lives of women after stillbirth. The strongest relationship was between the presence of meaning in life and life satisfaction (r = .72; p < .01), God's presence and life satisfaction (r = .66; p < .01), as well as the presence of meaning in life and the search for meaning in life (r = .57; p < .01). The structural equation model showed that the experience of God's presence and God's absence have a significant, direct impact on the search for meaning in life and the presence of meaning in life, and the satisfaction with life. These also have an indirect impact on the satisfaction with life in the lives of women who have lost a child to stillbirth.

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.

"So, whose milk was it? … It became all of ours, together": A relational autoethnographic study of an interactional human milk donation process through bereavement

Most of the research on human milk donations after prenatal loss has focused on donations to milk banks in which donors and recipients are anonymous to each other. In contrast, in this Israel-based study, we focus on an ongoing, direct interaction between a bereaved donor and recipients who adopted a new baby. We conducted a relational autoethnography, wherein multiple researchers present their life experiences and interpersonal contexts and meanings. We suggest that directed, interactional bereaved milk donation allows both parties to assign symbolic meanings to the milk, which may help their grieving process and can create relational healing.

Identities of women who have an autoimmune rheumatic disease [ARD] during pregnancy planning, pregnancy and early parenting: A qualitative study

OBJECTIVE

Women of reproductive age who have autoimmune rheumatic diseases [ARDs] have expressed a need to be better supported with making decisions about pregnancy. Women with ARDs want their motherhood identities and associated preferences to be taken into account in decisions about their healthcare. The aim of this study was to explore the interplay between illness and motherhood identities of women with ARDs during preconception decision making.

METHODS

Timeline-facilitated qualitative interviews with women diagnosed with an ARD [18-49 years old]. Participants were purposively sampled based on the following three criteria: thinking about getting pregnant, currently pregnant, or had young children. Interviews were thematically analysed.

RESULTS

Twenty-two women were interviewed face-to-face [N = 6] or over the telephone [N = 16]. Interview length ranged from 20 minutes to 70 minutes, with a mean length of 48 minutes. Three main themes were identified: prioritisation, discrepancy, and trade-off. Difficulties in balancing multiple identities in healthcare encounters were reported. Women used 'self-guides' as a reference for priority setting in a dynamic process that shifted as their level of disease activity altered and as their motherhood identity became more or less of a focus at a given point in time. Women's illness and motherhood identities did not present in isolation but were intertwined.

CONCLUSIONS

Findings highlight the need for holistic person-centred care that supports women with the complex and emotive decisions relating to preconception decision-making. In practice, health professionals need to consider women's multiple and sometimes conflicting identities, and include both their condition and family associated goals and values within healthcare communication.

"Failed" Matches, Child Removals, and Disrupted Placements: Devastating and Invisible Losses During the Family-Building Journey for LGBTQ Adoptive Parents

Reproductive loss, which includes miscarriage and nongestational loss, such as adoption loss, is rarely recognized as part of the family-building journey. Such loss tends to be even more invisible among LGBTQ individuals. The current study examines the experiences of 80 LGBTQ individuals who experienced adoption-related losses (i.e., failed adoption matches, child removals, disrupted child placements), with attention to how these losses impacted them and what enabled them to move forward. Participants who pursued private domestic adoption experienced failed matches (i.e., birth parents deciding to parent or choosing another family) both before (n = 21) and/or after (n = 24) a child was born. Participants who pursued public domestic adoption experienced child removals involving reunification with birth parents (n = 14) and other birth relatives (n = 18), as well as disrupted placements initiated by parents (n = 10) and children (n = 7). Failed matches, child removals, and disrupted placements were typically experienced as "crushing" and invisible losses. They were often followed by a period of grieving, and sometimes prompted adjustments to the type of matches or placements participants would consider (e.g., to mitigate the likelihood of future similar losses). Moving forward from adoption losses was facilitated by support from partners and those who experienced similar losses, knowledge or hope regarding the children once in their care, and finally being placed with the child(ren) whom they ultimately legally adopted.

In good times and in bad: A longitudinal analysis of the impact of bereavement on self-esteem and life satisfaction in couples

This study examines the impact of bereavement on self-esteem and life satisfaction in both partners of a romantic couple. We investigate the moderating effects of the type of the lost relationship (close family, close friends/others) and romantic relationship characteristics (daily social support, responsiveness-closeness, self-disclosure). We examined 1238 individuals in 619 male–female couples from the ages 18 to 81 ( M [ SD] = 31.97 years [13.26]). Both partners completed questionnaires at two assessments that were 20 months ( SD = 2.02 months) apart, in between which n = 216 individuals were bereaved. Actor–partner interdependence models showed that bereavement did not predict later self-esteem or life satisfaction in either of the partners. The relationship characteristics and the type of lost relationship did not moderate the effects. The subjective meaning and distress of the loss predicted later self-esteem and life satisfaction. The self-esteem increase was larger for bereaved with a positive/neutral than for bereaved with a negative meaning of the bereavement. We found a partner effect on self-esteem for the group of bereaved who reported a negative meaning of the bereavement. The findings demonstrate that bereavement can impact romantic partners' self-esteem and that the subjective experience of bereavement helps understand individual differences in the effect of bereavement on self-esteem and life satisfaction.

O tempo do luto materno pelo filho que morreu na infância

Resumo Objetivo desvelar o movimento existencial da mãe após a morte do filho por acidente doméstico na infância. Método pesquisa embasada no referencial teórico-filosófico-metodológico da fenomenologia de Martin Heidegger, com dados coletados entre maio e junho de 2017, mediante entrevista fenomenológica com 10 mães cujos filhos morreram em decorrência de acidentes domésticos na infância. Resultados da compreensão dos relatos, emergiram três temáticas: Lembrando o sofrimento profundo diante da morte do filho e os primeiros dias/meses sem ele; Revivendo a dor no presente, por meio da falta diária e das datas importantes e objetos/símbolos da criança; e Antecipando que a dor e a falta que sentem dos filhos nunca irão passar. Conclusão e implicações para a prática o tempo não é preditor da elaboração do luto materno. Neste contexto, o vivido da mãe é composto por um conjunto de significados, que envolvem multiplicidade de fatores e geram importantes repercussões ao longo da vida. Na perspectiva para promoção do cuidado, emergem, assim, a necessidade de ampliar a compreensão e as ações de acolhimento à mãe enlutada, refletindo sobre a temporalidade como constituinte do enlutamento materno.

Exploring the Social Networks of Women Bereaved by Stillbirth: A Descriptive Qualitative Study

The loss of a baby to stillbirth is a traumatic experience and can lead to secondary losses, such as the loss of social relationships. In Nigeria, stillbirths are a common public health problem. However, limited attention has been given to the social ramifications of stillbirths. This study describes the social networks of women who have experienced a stillbirth and the factors influencing their social networks. Interviews and social network diagrams were used to collect data from 20 women about their social networks before and after stillbirth. Findings suggest that the experience of shame, unmet expectation of support, and a lack of trust led to relationship changes after stillbirth. Most participants met bereavement needs with their existing social networks before stillbirth, but many participants also experienced relationship losses (even among family networks). Information from social network analysis can reveal the risks and strengths inherent in social networks, which can be helpful for the provision of tailored/personalized bereavement care.

Low self-esteem is related to depression and anxiety during recovery from an ectopic pregnancy

BACKGROUND

Considering the increasing incidence of ectopic pregnancy and the negative effects of pregnancy loss on mental health, this study aimed to determine the status of mental health in women with ectopic pregnancy and examine its relationship with their self-esteem.

METHODS

This was a cross-sectional study on 150 women (with a 100% response rate) hospitalized for ectopic pregnancy et al.-Zahra hospital in Tabriz, Iran, during 2018-2019, and recruited via convenience sampling. Data were collected using the General Health Questionnaire-28, which has four subscales (overall score range: 0 to 84; subscale score range: 0 to 21 with a lower score indicating a better mental state), and Rosenberg Self-Esteem Scale (score range: - 10 to + 10 with a higher score indicating higher self-esteem). To determine the association between self-esteem and mental health, independent t-tests, and multivariable logistic regression were used.

RESULTS

The response rate was 100%. The mean score (SD) of participants' mental health was 31.4 (8.5), and that of self-esteem was 4.5 (3.80). The percentage of participants who were considered as having mental distress (i.e., overall GHQ-28 score ≥ 24) was 76%. Among the subscales of mental health, social dysfunction was the most prevalent (observed in 100% of the participants), followed by somatic symptoms (79.3%). Lower self-esteem was significantly associated with overall mental distress (odds ratio (OR): 0.74; 95% confidence interval (95% CI): 0.64-0.87; P < 0.001), depression (OR: 0.70; 95% CI: 0.60-0.80; P < 0.001) and anxiety/insomnia (OR: 0.76; 95% CI: 0.66-0.87; P < 0.001).

DISCUSSION

Mental distress was common among women with ectopic pregnancy. This study is the first to examine the relationship between self-esteem and mental health among women with ectopic pregnancy and highlights the important role of self-esteem in mental wellbeing among those women.

Changes Over Time in Parental Self-identity After the Loss of an Adolescent Child

This study explored bereaved parents' responses to their child's death in the 2014 Sewol Ferry sinking incident, focusing on identifying changes in parental self-identity two and five years after their loss. To understand the unique meaning of their loss and its impact on their self-perception, in-depth interviews were conducted with eight mothers and four fathers at two timepoints. Three patterns of parental self-identity: reintegration, disintegration, and coexistence emerged. Patterns emerged in five domains: (a) relational identity, (b) physical identity, (c) financial identity, (d) professional identity and (e) spiritual identity. Each of these domain-associated themes provided insights into the patterns and characteristics of the changes in bereaved parents' self-identity following their loss. Recommendations for future research and potential implications are discussed.

ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care

INTRODUCTION

The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition.

AIM

To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition.

METHODS

A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches.

PARTICIPANTS

A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland.

DATA COLLECTION

Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted.

FINDINGS

Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group.

CONCLUSION

A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement.

RECOMMENDATIONS FOR PRACTICE

Routine assessment of ICD-11 CPTSD is recommended in this population group.

Breaking the silence: Determining Prevalence and Understanding Stillbirth Stigma

BACKGROUND

The 2011 and 2016 Stillbirth Lancet series made a call to action to identify mechanisms to reduce stillbirth stigma. This research answers that call, investigating the extent and dimensions of stillbirth stigma experienced by an international sample of mothers bereaved by stillbirth.

OBJECTIVE

To determine the prevalence and type as well as explore explanatory variables associated with higher levels of stillbirth stigma with bereaved mothers in high-income countries (Australia, United Kingdom, The United States of America and New Zealand).

METHOD

An international survey of 889 bereaved mothers was conducted utilising the recently developed Stillbirth Stigma Scale to explore the extent and types of stigma experienced, as well as the association between stigma and self-esteem (Rosenberg Self- Esteem Scales), perinatal grief (Perinatal Grief Scale), and perceived social support (Perceived Social Support Scale). Demographic information (e.g. age, education, stillbirth history, sexual orientation and mental health) were collected to determine the association between individual demographic factors and stillbirth stigma.

RESULTS

Results of the Stillbirth Stigma Scale indicated that a majority (54%) of bereaved mothers experienced stigma. Self-stigma was the predominant type of stigma experienced (80%), followed by perceived devaluation (64.9%). Bereaved mothers also experienced discrimination (29.1%) and issues with disclosing their stillbirth to their community (36.7%). Stillbirth stigma scores were higher in bereaved mothers who had experienced the loss of their first child. High scores were associated with the mother's mental health status (diagnoses prior to stillbirth, and/or after stillbirth (p<.05)).The other scales used indicated that higher stillbirth stigma scores were also associated with lower self-esteem (r (877) =-.304, p<.001), lower perceived social support (r (871) =-.448, p<.001) and higher levels of grief (r (829) =.609, p<.001).

CONCLUSION

The current research was the first to identify that 54% of bereaved mothers experienced stigma, with self-stigma being the most prominent. Bereaved mothers endured discriminating experiences and had trouble disclosing their stillbirth to others within their community. The first-time mother with a self- reported history of mental illnesses appears to be the most at-risk of higher levels of stigma. Future longitudinal research needs to be conducted to determine the direction of the explanatory variables i.e. mental health, self-esteem and social support and develop interventions, which support the bereaved mother and reduce stillbirth stigma.

RELEVANCE

This study is the first to demonstrate the prevalence, extent, type and explanatory variables of stigma reported by bereaved mothers and the association between this and poorer outcomes including increased grief and decreased self-esteem. This study begins a dialogue about prevalence and explanatory variables of stillbirth stigma and its impact, to inform future prevention and support potential stigma reduction programs for community and bereaved mothers.

Relational Sequelae of Fetal Death During the First Pregnancy: A Qualitative Study on the Subjective Perceptions of the Relationship Between Mothers and Their Adult Subsequent Firstborn Children

Perinatal loss may deeply affect the attachment relationships of mothers and their next-born children. The aim was to explore the subjective perceptions of mothers, who had fetal death during the first pregnancy, and their adult subsequent firstborn children regarding the impact of the perinatal loss on the mother-child relationship and children's self-perception. Fifteen mothers who experienced a fetal death during the first pregnancy and their adult subsequent firstborn children were interviewed. A Grounded Theory approach was used. Five main themes were identified: fetal death as a real loss producing prolonged grief; the importance of the communication about the dead sibling; creating and maintaining a relationship with the lost sibling; the mother-subsequent child relationship: between detachment and overprotection; significant effects of fetal death on adult subsequent children's self-perception. Results highlighted a deep impact of fetal death on the subsequent mother-child relationship, as perceived by both mothers and adult children.

Events surrounding stillbirth and their effect on symptoms of depression among mothers

Women who experience stillbirth often report anxiety, depression, and loss of self-esteem afterward, but aspects of the pregnancy, such as length of pregnancy, seeing the baby after delivery, and seeing the baby as long as they wished might be associated with symptoms of depression. So, we sent an online, detailed questionnaire about their stillbirth experience and their current depression to two Facebook child loss support groups. A total of 66 women answered anonymously through SurveyMonkey. The women delivered their babies at about seven months gestation, on average 2.5 years earlier. The women reported moderately severe depression symptoms, which was related to being single, length of time between diagnosis and delivery, seeing the baby immediately after delivery and as long as they wished and secondary infertility after the stillbirth. Although this sample may have been unique, these women report long-term negative ramifications of their experience. An implication is that the specific details surrounding their stillbirth experience in the hospital can have long-term implications for depression.

The effect of counseling based on health promotion awareness on mental health and self-esteem in women with ectopic pregnancy: a randomized controlled clinical trial

OBJECTIVES

In all types of pregnancies women experienced changes in their mental health and self-esteem condition. The aim of this study was to determine the effect of counseling on mental health and self-esteem following an ectopic pregnancy (EP).

STUDY DESIGN

This was a randomized controlled clinical trial on 68 pregnant women with EP referring to Al-Zahra hospital in Tabriz, Iran in 2018. The participants randomly allocated to counseling and control groups. Intervention group received four sessions of counseling including 1) providing medical information about EP and its physical and psychological complications; 2) explaining the syndrome of sadness after losing a pregnancy; 3) mental health and ways to improve it after pregnancy loss; and 4) self-esteem and how to increase it after losing a pregnancy and control group received only routine care. Before and 2 weeks after the end of the intervention, data were collected by the General Health Questionnaire-28 and Rosenberg self-esteem questionnaires. Data were analyzed using SPSS software. The registration number was IRCT20100109003027N41.

RESULTS

There was no significant difference between the two groups in terms of sociodemographic characteristics and the scores of mental health and self-esteem before the intervention. Two weeks after the end of the intervention, the mean (SD) total score of mental health of women in counseling and control groups were 20.1 (5.0) and 32.9 (9.8), respectively. When compared with the control group, a significant reduction in the total score of mental health (adjusted difference = -11.27; 95% confidence interval: -15.19 to -7.34; p < .001) was observed in the counseling group. In counseling group compared with the control group, a significant increase in the total score of self-esteem (adjusted difference = 4.79; 95% confidence interval: 3.07-6.51; p < .001) was observed.

CONCLUSIONS

Providing counseling based on health promotion awareness by the midwife can help reduce mental health problems and increase self-esteem. For this reason, counseling should be considered as part of care after losing a pregnancy.

Life after the loss: protocol for a Danish longitudinal follow-up study unfolding life and grief after the death of a child during pregnancy from gestational week 14, during birth or in the first 4 weeks of life

INTRODUCTION

After the death of a child during pregnancy, birth or in the neonatal period, parents often experience feelings of guilt, disenfranchisement, feelings of betrayal by one's own body and envy of others. Such bereavement results in high rates of distress: psychologically, emotionally, physiologically and existentially. These data are collected using a national, longitudinal cohort to assess grief in mothers and their partners after the death of a child during pregnancy, birth or in the neonatal period. Our aim is to achieve a general description of grief, emotional health, and existential values after pregnancy or perinatal death in a Danish population.

METHODS AND ANALYSIS

The cohort comprises mothers and their partners in Denmark who lost a child during pregnancy from gestational week 14, during birth or in the neonatal period (4 weeks post partum). We began data collection in 2015 and plan to continue until 2024. The aim is to include 5000 participants by 2024, generating the largest cohort in the field to date. Parents are invited to participate at the time of hospital discharge or via the Patient Associations homepage. Data are collected using web-based questionnaires distributed at 1-2, 7 and 13 months after the loss. Sociodemographic and obstetric variables are collected. Validated psychometric measures covering attachment, continuing bonds, post-traumatic stress, prolonged grief, perinatal grief and existential values were chosen to reach our aim.

ETHICS AND DISSEMINATION

The study was approved by The Danish National Data Protection Agency (no. 18/15684, 7 October 2014). The results will be disseminated in peer-reviewed and professional journals as well as in layman magazines, lectures and radio broadcasts.

Relationship Between Mindfulness and Posttraumatic Stress in Women Who Experienced Stillbirth

OBJECTIVE

To explore the potential factors that mediate the relationship between mindfulness and symptoms of posttraumatic stress (PTS) in women who experienced stillbirth.

DESIGN

A cross-sectional analysis of baseline data before women's participation in an online mindfulness intervention (i.e., online yoga).

SETTING

This was a national study, and women participated in their own homes.

PARTICIPANTS

Women who experienced stillbirth (N = 74) within the past 2 years and resided in the United States.

METHODS

Women were recruited nationally, primarily through social media. Participants (N = 74) completed baseline assessments (self-report mental and physical health surveys) via a Web-based survey tool. We conducted an exploratory factor analysis of the COPE Inventory subscales to reduce the number of variables before entry into a mediation model. We then tested the mediation effects of sleep quality, self-esteem, resilience, and maladaptive coping on the relationship between mindfulness and PTS symptoms.

RESULTS

Through the exploratory factor analysis we identified a two-factor solution. The first factor included nine subscales that represented adaptive coping strategies, and the second factor included five subscales that represented maladaptive coping strategies. Results from multiple mediation analysis suggested that mindfulness had a significant inverse relationship to PTS symptoms mediated by sleep quality.

CONCLUSION

Mindfulness practices may have potential benefits for grieving women after stillbirth. Evidence-based approaches to improve sleep quality also may be important to reduce PTS symptoms in women after stillbirth.

Empathy and the Public Perception of Stillbirth and Memory Sharing: An Australian Case

Objective: Stillbirth devastates families and leaves them struggling to grieve the death of their baby in a society that expects grief symptoms to decrease over time. Previous research has suggested that increased memory sharing opportunities can lead to positive mental health outcomes. The aim of the current study was to examine people’s perceptions of stillbirth as well as the perceived appropriateness of affected parents sharing memories of their child. In addition, we examined whether manipulating empathy would have an effect on people’s perceptions of stillbirth.

Method: Participants included 200 Australian men and women 18 to 74 years of age (M = 36.76, SD = 12.59) randomly allocated to one of three experimental conditions (i.e., low empathy, high empathy, and control). The high empathy group watched a video about stillbirth and was instructed to imagine how the people portrayed felt; the low empathy group watched the same video but was instructed to remain detached; and the control group watched an unrelated video. Participants were then asked how much money they would be willing to donate to a fictional stillbirth organization, followed by the completion of questionnaires measuring (a) perceptions of stillbirth, (b) empathy, and (c) the appropriateness of parents sharing memories of a stillborn child with different groups of people over time.

Results: The empathy manipulation had an effect on empathy and the willingness to help effected parents (high empathy vs. control). However, empathy did not have an effect on participants’ perceptions toward stillbirth nor appropriateness of sharing memories. The appropriateness of sharing memories decreased as time passed and social distance increased.

Discussion: Individuals who have experienced stillbirth need to be aware that societal expectations and their own expectations in relation to sharing memories may not correspond to each other and that they may need to educate their social group about their need to share memories. Removing the taboo surrounding stillbirth is vital for both parents and those to whom they would wish to communicate.