Men's grief and support following pregnancy loss: A qualitative investigation of service providers' perspectives

The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review

BACKGROUND

Perinatal loss is a traumatic event associated with a high risk of parents experiencing negative psychological outcomes. Despite most parents being in regular contact with midwives and nurses during the perinatal period, there is a lack of evidence which hampers these professionals from using effective psychosocial interventions with parents.

AIM

This study aims to synthesise the existing evidence on the types of psychosocial interventions delivered by midwives/nurses for parents with perinatal bereavement, their impacts on bereaved parents' mental health and the experiences of midwives and nurses in delivering psychosocial interventions for parents experiencing perinatal loss.

DESIGN

An integrative review of the literature.

METHODS

Whittemore and Knafl's five-stage integrative review framework guided this review. A systematic literature search of the Medline, PsycINFO, Embase, CINAHL and ASSIA, Cochrane Library and ProQuest databases was conducted from inception to January 2023, with no language or geographical limiters set due to the paucity of research published in this subject area. Two researchers independently screened and reviewed each study's data extraction and methodological quality using the Joanna Briggs Institute and Mixed Method Appraisal Tool. Results were analysed and synthesised using narrative synthesis.

RESULTS

A total of 21 studies met the inclusion criteria. From these, we identified nine types of psychosocial interventions for perinatal bereavement that can be delivered by midwives and nurses. The positive impacts of midwife/nurse-led psychosocial interventions on grief, anxiety, depression posttraumatic stress disorder and other psychosocial outcomes amongst parents experiencing perinatal loss have been demonstrated. In addition, we identified the useful components of these interventions and the experiences of midwives and nurses in delivering psychosocial interventions, thereby highlighting barriers such as lack of knowledge and skills, stressful working environments and inadequate emotional support.

CONCLUSION

Our findings demonstrate that midwife/nurse-led psychosocial interventions have the potential to improve grief, anxiety, depression, posttraumatic stress disorder symptoms and other psychosocial outcomes for parents experiencing perinatal loss. Thus, future research should consider training, workload, time cost and emotional support for midwives/nurses when developing midwife/nurse-led psychosocial interventions for parents with perinatal loss.

REGISTRATION NUMBER

CRD42022369032.

TWEETABLE ABSTRACT

Midwife/nurse-led psychosocial interventions have the potential to improve mental health amongst parents experiencing perinatal loss.

Continuing Bonds in grieving men: A comparative description of Costa Rica and Spain

Continuing Bonds among grieving men from Costa Rica and Spain were compared, with the primary hypothesis that there would be significant differences between the two groups. A descriptive, comparative, and cross-sectional research study was conducted. Non-probability and convenience sampling was employed, involving 227 grieving men who completed an online questionnaire comprising sociodemographic data, mediators of mourning, and the Continuing Bonds Scale. The results did not reveal significant differences in Continuing Bonds expressions. However, upon controlling for the interaction between degree of kinship with the deceased person, notable differences emerged in Continuing Bonds and internalized and externalized Continuing Bonds (p < 0.05). The influence of sociocultural factors in each country on Continuing Bonds expressions is considered. The findings could support the development of strategies centered on grieving men, Continuing Bonds, and their specific needs.

Parents' experiences and need for social support after pregnancy termination for fetal anomaly: a qualitative study in China

OBJECTIVE

The aim of this study was to explore the experiences and need for social support of Chinese parents after termination of pregnancy for fetal anomalies.

DESIGN

A qualitative study using semistructured, in-depth interviews combined with observations. Data were analysed by Claizzi's phenomenological procedure.

SETTING

A large, tertiary obstetrics and gynaecology hospital in China.

PARTICIPANTS

Using purposive sampling approach, we interviewed 12 couples and three additional women (whose spouses were not present).

RESULTS

Four themes were identified from the experiences of parents: the shock of facing reality, concerns surrounding termination of pregnancy, the embarrassment of the two-child policy and the urgent need for social support.

CONCLUSION

Parents experienced complicated and intense emotional reactions, had concerns surrounding the termination of pregnancy and an urgent need for social support. Paternal psychological reactions were often neglected by healthcare providers and the fathers, themselves. These findings suggest that both mothers and fathers should receive appropriate support from family, medical staff and peers to promote their physical and psychological rehabilitation.

Parents experiences of pregnancy following perinatal loss: An integrative review

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.

Culturally and Linguistically Diverse Men's Grief Experiences Following Perinatal Death in Australia

To explore the grief experiences of men from culturally and linguistically diverse (CALD) backgrounds following perinatal death in Australia. Qualitative analysis of interview data using thematic analysis. Participants were health service providers (n = 6), and CALD community members (n = 10) who were either community leaders with experience working with CALD men following perinatal death in Australia (n = 6), or were CALD men who had lived experience of perinatal death (n = 4). Thematic analysis identified four themes related to CALD men's grief. These included the role of religion and rituals, grief as stoic, the partner- and family-centred nature of men's grief, and finally grief as ensuring and changeable over time. This research points to the strong need for CALD men's specific needs to be included in the development of policy and practice surrounding perinatal death.

Initial Impact of Perinatal Loss on Mothers and Their Partners

(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.

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.

Culturally and linguistically diverse men's experiences of support following perinatal death: A qualitative study

AIMS AND OBJECTIVES

To explore culturally and linguistically diverse men's experiences of support after perinatal death, including barriers and facilitators to support and how healthcare providers, systems and policies can best support families.

BACKGROUND

Many groups of culturally and linguistically diverse families in Australia are at higher risk of experiencing perinatal death. Culturally sensitive bereavement services are essential; however, there has been no previous research specifically examining culturally and linguistically diverse men's experiences of support following perinatal death.

DESIGN

Individual semi-structured interviews were completed with healthcare providers, community leaders and culturally and linguistically diverse men who had experienced a perinatal death in Australia (n = 16). Data were analysed using Thematic Analysis and COREQ guidelines were followed.

RESULTS

Men's need for support following perinatal death was associated with stigma, and shaped by culturally-relevant religion and ritual, and connection to community and family. Significant barriers to men seeking and gaining support included challenges with self-advocacy and navigating the woman-centred nature of perinatal care in Australia.

CONCLUSIONS

Culturally and linguistically diverse men's specific needs should be included in the development of policy and practice surrounding perinatal death. While perinatal bereavement care guidelines acknowledge the importance of culturally informed care following perinatal death, there remains a lack of culturally specific supports available, particularly for culturally and linguistically diverse men.

RELEVANCE TO CLINICAL PRACTICE

Specific recommendations from this research include increasing community liaison officers or cultural consultants in hospitals and support organisations; providing culturally and linguistically diverse support groups; adopting family-centred and father-inclusive language in all perinatal death support services and ensuring clear communication and targeted assistance for culturally and linguistically diverse men to self-advocate for their baby and access to support.

PATIENT OR PUBLIC CONTRIBUTION

This study came out of consultation with community members and member checking of results was conducted to ensure adequate representation of participants' views.

Incidence and predictors of paternal anxiety and depression following fetal abnormalities requiring pregnancy termination: a cross-sectional study in China

BACKGROUND

China is a country with a high prevalence of fetal abnormalities. Termination of pregnancy for fetal abnormalities (TOPFA) is a devastating traumatic event for parents and families, resulting in serious and lasting psychological problems. The impact of TOPFA on mothers has been extensively explored, but little research has been conducted on the resulting paternal psychological problems. This study sought to determine the prevalence and predictors of paternal anxiety and depression following TOPFA.

METHODS

We analysed cross-sectional data from 169 Chinese couples (169 mothers and 169 fathers) who experienced TOPFA. Anxiety was assessed with the Self-Rating Anxiety Scale (SAS), and depression was measured with the Self-Rating Depression Scale (SDS) for fathers and the Edinburgh Postnatal Depression Scale (EPDS) for mothers. We used the Social Support Rating Scale (SSRS) to assess levels of social support.

RESULTS

Overall, 19.5% of fathers and 24.3% of mothers had symptoms of anxiety, but there was no significant difference in the incidence of anxiety between fathers and mothers. However, depression was more common in mothers (50.3%) than in fathers (24.9%). Level of income (β = -2.945, 95% CI: -5.448 to -0.442), worry about the pregnancy (β = 3.404, 95% CI: 1.210 to 5.599) and objective support (β = -0.668, 95% CI: -1.163 to -0.173) were predictors of anxiety in fathers. Worry about the pregnancy (β = 4.022, 95% CI: 1.630 to 6.414), objective support (β = -0.652, 95% CI: -1.229 to -0.075) and maternal depression (β = 0.497, 95% CI: 0.159 to 0.836) were predictors of paternal depression.

CONCLUSION

Anxiety and depression were prevalent among parents following TOPFA in China, and fathers had similar levels of anxiety as mothers. Strategies to support fathers should consider social support and psychological interaction and draw upon father-inclusive intervention recommendations.

Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: a scoping review

BACKGROUND

Miscarriage can be a devastating event for women and men that can lead to short- and long-term emotional distress. Studies have reported associations between miscarriage and depression, anxiety, and post-traumatic stress disorder in women. Men can also experience intense grief and sadness following their partner's miscarriage. While numerous studies have reported hospital-related factors impacting the emotional wellbeing of parents experiencing miscarriage, there is a lack of review evidence which synthesises the findings of current research.

AIMS

The aim of this review was to synthesise the findings of studies of emotional distress and wellbeing among women and men experiencing miscarriage in hospital settings.

METHODS

A systematic search of the literature was conducted in October 2020 across three different databases (CINAHL, MEDLINE and PsycInfo) and relevant charity organisation websites, Google, and OpenGrey. A Mixed Methods appraisal tool (MMAT) and AACODS checklist were used to assess the quality of primary studies.

RESULTS

Thirty studies were included in this review representing qualitative (N = 21), quantitative (N = 7), and mixed-methods (N = 2) research from eleven countries. Findings indicated that women and men's emotional wellbeing is influenced by interactions with health professionals, provision of information, and the hospital environment. Parents' experiences in hospitals were characterised by a perceived lack of understanding among healthcare professionals of the significance of their loss and emotional support required. Parents reported that their distress was exacerbated by a lack of information, support, and feelings of isolation in the aftermath of miscarriage. Further, concerns were expressed about the hospital environment, in particular the lack of privacy.

CONCLUSION

Women and men are dissatisfied with the emotional support received in hospital settings and describe a number of hospital-related factors as exacerbators of emotional distress.

IMPLICATIONS FOR PRACTICE

This review highlights the need for hospitals to take evidence-informed action to improve emotional support services for people experiencing miscarriage within their services.

Pregnancy loss experiences of couples in a phenomenological study: Gender differences within the Turkish sociocultural context

Despite the high prevalence of miscarriage and stillbirth, prenatally bereaved couples tend to experience a sense of isolation or loneliness after their loss. The purpose of this study was to describe the prenatal loss experiences of partners from a sociocultural perspective. Data were gathered via semi-structured interviews with 10 couples (n = 20). The findings of the study reflected the inner experiences of partners, how sociocultural context has impacted their grief experiences, and how women's and men's grief reactions differ within this sociocultural context.

Men's experiences and need for targeted support after termination of pregnancy for foetal anomaly: A qualitative study

AIMS AND OBJECTIVES

To explore men's experiences of termination of pregnancy for life-limiting foetal anomaly, including how healthcare providers, systems and policies can best support men and their families.

BACKGROUND

While there is a sizable body of research and recommendations relating to women's experiences of grief and support needs following a termination of pregnancy for foetal anomaly, very few studies specifically examine men's experiences.

METHODS

Semi-structured interviews were completed with ten Australian men who had experienced termination of pregnancy for life-limiting foetal anomalies with a female partner between six months and 11 years ago. Interviews were completed over the telephone, and data were analysed using thematic analysis. COREQ guidelines were followed.

RESULTS

Thematic analysis resulted in the identification of three over-arching themes, each with two sub-themes. First, participants described the decision to terminate their pregnancy as The most difficult choice, with two sub-themes detailing 'Challenges of decision-making' and 'Stigma surrounding TOPFA'. Second, participants described that they were Neither patient, nor visitor in the hospital setting, with sub-themes 'Where do men fit?' and 'Dual need to support and be supported'. Finally, Meet me where I am described men's need for specific supports, including the sub-themes 'Contact men directly' and 'Tailor support and services'.

CONCLUSIONS

Findings indicated that termination of pregnancy for life-limiting foetal anomaly (TOPFA) is an extremely difficult experience for men, characterised by challenges in decision-making and perceived stigma. Men felt overlooked by current services and indicated that they need specific support to assist with their grief. Expansion of existing infrastructure and future research should acknowledge the central role of fathers and support them in addressing their grief following TOPFA.

RELEVANCE TO CLINICAL PRACTICE

Nursing/midwifery professionals are well situated to provide men with tailored information and to promote genuine inclusion, acknowledgement of their grief, and facilitate referrals to community supports.

Impact of Perinatal Death on the Social and Family Context of the Parents

BACKGROUND

Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand the impact of perinatal death on parents' social and family life.

METHODS

A qualitative study based on Gadamer's hermeneutic phenomenology was used. In-depth interviews were conducted with 13 mothers and eight fathers who had suffered a perinatal death. Inductive analysis was used to find themes based on the data.

RESULTS

Seven sub-themes emerged, and they were grouped into two main themes: 1) perinatal death affects family dynamics, and 2) the social environment of the parents is severely affected after perinatal death.

CONCLUSIONS

PD impacts the family dynamics of the parents and their family, social and work environments. Parents perceive that society trivializes their loss and disallows or delegitimizes their grief.

IMPLICATIONS

Social care, health and education providers should pay attention to all family members who have suffered a PD. The recognition of the loss within the social and family environment would help the families to cope with their grief.