Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents

The Integration of the Resolved Through Sharing Perinatal Bereavement Follow-up Model with Latinx Cultural Values: A Case Illustration

The Resolved Through Sharing (RTS) Perinatal bereavement model is an approach used for working with birthing people and their families who have experienced a perinatal loss. RTS is designed to help families cope with their grief and integrate the loss in their lives, meet the needs of the families during the initial crisis, and offer comprehensive care to each member of the family affected by the loss. This paper utilizes a case illustration to describe a year-long bereavement follow-up of an undocumented underinsured Latina woman who suffered a stillbirth during the beginning of the COVID-19 pandemic and the hostile anti-immigrant policy during the Trump presidency. The case illustration is based on a composite case of several Latina women who had pregnancy losses with similar outcomes, demonstrating how a perinatal palliative care (PPC) social worker provided ongoing bereavement support to a patient who experienced a stillbirth. The case illustrates how the PPC social worker utilized the RTS model, incorporated the patient’s cultural values, and acknowledged systemic challenges which resulted in the patient receiving comprehensive, holistic support that aided her emotional and spiritual recovery from her stillbirth. The author ends with a call to action for providers in the field of perinatal palliative care to incorporate practices that allow for greater access and equity for all birthing people.

Comparing posttraumatic growth in mothers after stillbirth or early miscarriage

The possibility of posttraumatic growth in the aftermath of pregnancy loss has received limited attention to date. This study investigated posttraumatic growth in mothers following stillbirth compared to early miscarriage. It was hypothesised that mothers following stillbirth will demonstrate more posttraumatic growth, challenge to assumptive beliefs, and disclosure than mothers following early miscarriage. The study also sought to understand how theoretically-derived variables of the Model of Growth in Grief (challenge to assumptive beliefs and disclosure) explained unique variance in posttraumatic growth when key factors were controlled for. One-hundred and twenty women who had experienced a stillbirth (N = 57) or early miscarriage (N = 63) within the last two to six years completed validated questionnaires in an online survey relating to posttraumatic growth and key variables relevant to emotional adjustment post-bereavement. Participants who had experienced a stillbirth demonstrated significantly higher levels of posttraumatic growth, posttraumatic stress symptoms, perinatal grief, disclosure, challenge to assumptive beliefs and rumination than participants who had experienced an early miscarriage (Cohen’s d ranged .38-.94). In a hierarchical stepwise regression analysis, challenge to assumptive beliefs alone predicted 17.5% of the variance in posttraumatic growth. Intrusive and deliberate rumination predicted an additional 5.5% of variance, with urge to talk, reluctance to talk, and actual self-disclosure predicting a further 15.3%. A final model including these variables explained 47.9% of the variance in posttraumatic growth. Interventions targeting challenge to assumptive beliefs, disclosure, and rumination are likely to be clinically useful to promote psychological adjustment in mothers who have experienced stillbirth and early miscarriage.

The Trauma of Perinatal Loss: A Scoping Review

Perinatal loss, the loss of a fetus or neonate between conception and 28 days after birth, is a worldwide phenomenon impacting millions of individuals annually. Whether due to miscarriage, stillbirth, life-limiting fetal diagnoses, or neonatal death, up to 60% of bereaved parents exhibit symptoms of depression, anxiety, and posttraumatic stress disorder. Despite the high prevalence of posttraumatic stress symptoms, perinatal loss is not framed using a trauma lens. The purpose of this scoping review is to gain insight into the trauma within the perinatal loss experience.

Sudden Unexpected Death in Infancy [SUDI]: What the clinician, pathologist, coroner and researchers want to know

The loss of an apparently healthy infant is confronting for any family, puzzling for a clinician and challenging for the pathologist charged with the task of demonstrating a cause for death. The term "cot death" evolved to "sudden infant death syndrome" [SIDS] and now "sudden unexpected death in infancy [SUDI]" as the epidemiology and pathology of infant death changed. Community interventions were successful in changing sleep practices for young babies. The current research focus is on understanding genetic predispositions to unexpected death in early childhood. Whilst much has been achieved in reducing the infant mortality rate from SUDI by between 50%, and 80% in some countries, over the last 30 years, there remain challenges for improving rates of accurate diagnosis and reaching out to more vulnerable families with clearly modifiable risk factors for SUDI. These challenges directly involve the clinician through taking a systematic and detailed history and better standardised death scene evaluations with specifically accredited assessors. Better knowledge regarding circumstances of SUDI cases will help Coroners and researchers provide answers for grieving families now, and in the future contribute to further reductions in the rate of SUDI in communities across the world.

Miscarriage, Perceived Ostracism, and Trauma: A Preliminary Investigation

Miscarriage often is a traumatic experience with serious mental health implications. Friends and family members are often uncomfortable with and avoid discussing the topic with bereaved individuals, potentially making them feel ostracized (i.e., being ignored and excluded), contributing to their mental health concerns. We investigated the correlation between posttraumatic stress symptoms, perceived ostracism, and recalled grief intensity measures in a sample of cisgender women (N = 97) who have had a miscarriage. These participants were recruited using Qualtrics’s Panel Recruitment Services. Women’s perceived ostracism correlated positively with posttraumatic stress symptoms and negatively with grief congruence (i.e., the degree to which they felt that their miscarriage process was as satisfactory as possible, given they had to experience it). Perceived ostracism also explained additional variance in posttraumatic stress symptoms when considered alongside grief intensity measures (e.g., congruence).

Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

'I should have seen her face at least once': parent's and healthcare providers' experiences and practices of care after stillbirth in Kabul province, Afghanistan

OBJECTIVE

This study aimed to explore bereaved parents' and healthcare providers experiences of care after stillbirth.

STUDY DESIGN

Qualitative in-depth interviews with 55 women, men, female elders, healthcare providers and key informants in Kabul province, Afghanistan between October and November 2017.

RESULTS

Inadequate and insensitive communication and practices by healthcare providers, including avoiding or delaying disclosing the stillbirth were recurring concerns. There was a disconnect between parents' desires and healthcare provider's perceptions. The absence of shared decision-making on seeing and holding the baby and memory-making, manifested as profound regret. Health providers' reported hospitals were not equipped to separate women who had a stillbirth and acknowledged that psychological support would be beneficial. However, the absence of trained personnel and resource constraints prevented provision of such support.

CONCLUSION

Findings can inform future provision of perinatal bereavement care. Given resource constraints, communication training can be considered with longer term goals to develop context-appropriate bereavement care guidelines.

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.

History of perinatal loss: A study of psychological outcomes in mothers and fathers after subsequent healthy birth

BACKGROUND

The loss of an expected child is a psychologically difficult and potentially traumatic life event. While most women will become pregnant again within a year following the loss, data are limited regarding the mental health of parents with a history of perinatal loss, especially in the period following the birth of a subsequent healthy child. This study, therefore, investigated the relation between perinatal loss and mothers' and fathers' psychological symptoms and parenting stress 6-months after the birth of a healthy child.

METHODS

A community sample of 92 mother-father dyads living in a Canadian city and having a 6-month-old biological infant were asked to complete questionnaires measuring their history of perinatal losses (55 parents reporting at least one loss) and their psychological symptoms and parenting stress.

RESULTS

Mothers and fathers who have experienced a perinatal loss reported more psychological symptoms and parenting stress. Mothers were more likely to report psychological symptoms and parenting stress compared to fathers, but the magnitude of the relation between perinatal losses and psychological outcomes were comparable for mothers and fathers.

LIMITATIONS

Limitations of the study include the use of a small community sample with low generalizability and low levels of psychological symptoms and stress.

CONCLUSIONS

The results suggest that the experience of a perinatal loss might have negative consequences on the psychological wellbeing of parents even after the birth of a healthy child.

Quality of life, social support and self-efficacy in women after a miscarriage

Background

Pregnancy loss is typically experienced as a traumatic, critical event, which may lead to secondary psychological health disorders. Its burden involves both the experience of loss and related medical issues, which are associated with pain, hospitalization, limitation in one’s social roles, decreased sense of security, and changes in one’s perceived quality of life. The purpose of the present study was to evaluate levels of quality of life (QoL), social support and self-efficacy among women who had suffered a miscarriage.

Methods

The study was performed using a diagnostic survey method with questionnaires administered to 610 patients hospitalized due to spontaneous pregnancy loss in hospitals in Lublin (Poland). The instruments used were: the Berlin Social Support Scales (BSSS), the Generalized Self-Efficacy Scale (GSES), the WHOQoL–BREF questionnaire, and a standardized interview questionnaire.

Results

Respondents rated their overall quality of life (3.90 points) higher than their overall perceived health (3.66). In terms of social support, the highest scores were noted for perceived available instrumental support (M = 3.78), perceived available emotional support (M = 3.68) and actually received support (M = 3.60). The mean generalized self-efficacy score among the women after pregnancy loss was 30.29. Respondents’ QoL was significantly correlated with multiple social support subscales and self-efficacy (p < 0.05).

Conclusions

Women after a miscarriage perceive their overall quality of life as better than their overall health, while reporting the poorest QoL in the psychological domain. They also have a high level of self-efficacy. Regarding the types of social support, perceived available support, both instrumental and emotional, and actually received support was rated highly. Social support and self-efficacy contributed to better perceived QoL among the respondents.

Death of an infant: Accessing the voices of bereaved mothers to create healing. A qualitative study

AIMS AND OBJECTIVES

To describe the health challenge for mothers whose infants have died and approaches and resources they used to manage the loss.

BACKGROUND

The death of an infant is a devastating experience for families. Bereaved mothers have higher rates of mental distress, loneliness and isolation. While some learn to cope, others remain consumed by grief, unable to function, with persistent affective, cognitive and physical symptoms.

DESIGN

Qualitative design guided by story theory.

METHODS

In-depth, semi-structured interviews were conducted with mothers 13-36 months after the death of their infant. Looking at the present, past and future, mothers were asked to describe the health challenge of losing an infant and approaches used to manage the loss. The COREQ checklist was used.

RESULTS

These mothers' experiences were captured in six main themes: 'Painful aloneness', 'Blemished identity', 'Burden of being misunderstood', 'Being with and being heard', 'Being present and building a future' and 'Finding meaning in the tragedy'. In sharing their stories, mothers identified positive and negative encounters with healthcare professionals following the death of their infant.

CONCLUSION

After losing an infant, mothers experience an array of challenges as they move forward. They describe their approaches used to manage the loss. This included a need to be heard, feel supported and find meaning in the loss as they try to build a new future. Their stories express a need for health care encounters to be healing, allowing mothers to feel cared for and supported on their unique journeys towards a new sense of well-being.

RELEVANCE TO CLINICAL PRACTICE

In sharing their stories what matters most to these mothers having lost an infant emerged. The study findings can be used to guide nursing practice, incorporated into healthcare providers bereavement training, increase knowledge and build effective communication skills.

The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis

BACKGROUND

Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown.

AIM

To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students.

METHODS

597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality.

RESULTS

28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes.

CONCLUSION

There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.

Creating Evidence: Findings from a Grounded Theory of Memory-Making in Neonatal Bereavement Care in Australia

PURPOSE

Perinatal and neonatal palliative care guidelines recommend the provision of photographs and other mementos as an element of care for parents bereaved by neonatal loss. However, little is known about parents' perceptions of such bereavement interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of loss following neonatal loss.

DESIGN AND METHODS

We conducted semi-structured interviews with 18 bereaved parents. A grounded theory approach informed by Corbin and Strauss was used to underpin data sampling, data collection and data analysis. A constant comparative approach was used to engage in open, axial and selective coding to distil parents' stories into categories supporting a core concept.

RESULTS

"Creating evidence" emerged as a key theme in the grounded theory of memory-making in bereavement care for parents following neonatal loss. Creating evidence involved taking photographs, creating mementos, as well as involving friends and family during the baby's time in the Neonatal Unit.

CONCLUSIONS

Creating evidence affirmed the life of the baby and the role of the parents. Creating evidence was a significant element of memory-making that had a positive impact on parents' experience of bereavement.

PRACTICE IMPLICATIONS

Parents should be supported to create evidence of their baby's life, through taking photos, creating mementos, and involving others in their baby's care. Such interventions provide affirmation of the baby's life and of the individual's role as a parent.

The Relationship between Posttraumatic Stress Disorder, Interpersonal Sensitivity and Specific Distress Symptoms: the Role of Cognitive Emotion Regulation

This study examined 1) the relationship between posttraumatic stress disorder (PTSD) from past trauma, interpersonal sensitivity and psychiatric co-morbidity, and 2) whether cognitive emotion regulation strategies would mediate the impact of PTSD on specific distress outcomes. Four hundred seventy-five Kazakh students (F = 336, M = 139) participated in the study and completed a demographic page, Posttraumatic Stress Diagnostic Scale for DSM-5, General Health Questionnaire-28, Interpersonal Sensitivity Measure and Cognitive Emotion Regulation Questionnaire. The results showed that 71% reported that they had experienced at least one trauma throughout their lifespan, of whom 39% met the criteria for full-PTSD. Controlling for age and university majors, PTSD was associated with interpersonal sensitivity and psychiatric co-morbidity. Cognitive emotion regulation strategies were correlated with specific distress outcomes. Whilst positive reappraisal and refocusing on planning were associated with interpersonal sensitivity, self-blame and putting the trauma into perspective were associated with psychiatric co-morbidity. Self-blame mediated the impact of PTSD on psychiatric co-morbidity. To conclude, trauma can heighten levels of sensitivity in interpersonal interaction and psychological symptoms. Having specific thoughts about the trauma can impact on specific psychological reactions. Blaming oneself for the trauma can influence its impact on the severity of psychological symptoms.

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

This study explores service providers' experiences of supporting men following a miscarriage or stillbirth in Australia. In-depth, semi-structured interviews were completed with seven service providers including midwives, grief counselors and social workers. Participants highlighted that, despite the individual nature of men's grief, there is a need to recognize and address the additional expectations and responsibilities that may compound their experience. Within an environment focused on woman-centered care, participants described creative strategies and inclusive language to promote engagement of men. Further research exploring men's grief is needed to inform training and guidelines for healthcare professionals who work with bereaved families.

Posttraumatic Stress and Interpersonal Sensitivity: Alexithymia as Mediator and Emotional Expressivity as Moderator

This study examined 1) the link between PTSD from past trauma, interpersonal sensitivity and psychiatric co-morbidity, 2) mediational effects of alexithymia on 1), and 3) moderated mediational effects with emotional expressivity as the moderator. Five hundred and fifteen Kazakh students completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Toronto Alexithymia Scale-20, Berkeley Expressivity Questionnaire and Interpersonal Sensitivity Measure. The results showed that 28% met the criteria for full-PTSD. Controlling for academic year, age and university major, PTSD from past trauma was significantly correlated with interpersonal sensitivity and psychiatric co-morbidity. Alexithymia mediated the impact of PTSD on interpersonal sensitivity and psychiatric co-morbidity. Alexithymia, however, did not interact with type of emotional expressivity to influence outcomes. Moderated mediational effects were not found. To conclude, following trauma, Kazakh students can experience heightened levels of interpersonal sensitivity and psychological symptoms. These problems are particularly severe for those who have difficulty getting in touch with their emotions.

Is partners' mental health and well-being affected by holding the baby after stillbirth? Mothers' accounts from a national survey

Objective: This study aimed to assess the effects on partners’ health and well-being of holding a stillborn baby.

Background: Findings from quantitative and qualitative studies have produced inconsistent results concerning the effects of holding a stillborn baby on parents.

Methods: Secondary analyses were conducted on postal questionnaire data relating to 455 partners of women who had a stillbirth. Women answered questions about their partners’ behaviour, perceptions of care, mental health and well-being at three and nine months after the stillbirth. Demographic, clinical and care characteristics were compared between partners who, according to the mothers, did and did not hold their baby. Sub-group analyses assessed hypothesised moderating effects.

Results: Mothers reported that most partners saw (92%) and held (82%) their stillborn baby. However, partners born outside the UK were less likely to have held their baby. Higher gestational age, shorter time interval between antepartum death and delivery, and mother’s holding the baby all predicted a higher rate of partner’s holding. There was a consistent negative effect of holding the baby across mental health and well-being outcomes, although after adjustment only higher odds of depression (OR 2.72, 95% CI 1.35–5.50) and post-traumatic stress type symptoms (OR 1.95, 95% CI 1.01–3.78) at 3 months were significantly associated with having held the baby following stillbirth.

Conclusions: This study is the first to assess the impact of holding the baby on partners’ mental health and well-being. The prevalence of depression and anxiety were high, and the negative effects of holding the baby were significant 3 months later.

Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss

OBJECTIVE

To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss.

DESIGN

A qualitative, descriptive design with secondary data analysis.

SETTING

The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States.

PARTICIPANTS

Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review.

METHODS

We used thematic analysis to analyze interview data.

RESULTS

Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death.

CONCLUSION

Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.

Divorce and parity progression following the death of a child: A register-based study from Finland

Most studies that have examined whether a child's death influences parental relationship stability have used small-scale data sets and their results are inconclusive. A likely reason is that child loss affects not only the risk of parental separation, but also the risk of having another child. Hence parity progression and separation must be treated as two competing events in relation to child loss. The analysis in this paper used Finnish register data from 1971 to 2003, covering over 100,000 married couples whose durations of both first marriage and parenthood could be observed. We ran parity-specific Cox regressions in which process time started from the birth of each additional child. All marriages included women of childbearing age, none of whom had experienced any child death on entering the analysis. We find that child loss only modestly influences the divorce risk, whereas its effect on the risk of parity progression is considerable.

"Not just a normal mum": a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss

BACKGROUND

Following previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers' Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services.

METHOD

A qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers' PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process.

RESULTS

Seven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother.

CONCLUSIONS

Participants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss.

Posttraumatic growth in aging individuals who have lost their only child in China

This article examined the extent of posttraumatic growth (PTG) and factors related to PTG in aging individuals who have lost their only child in China. The sample included 201 bereaved parents from different families residing in Chongqing, China. They were between 49-80 years old (M = 61) and had lost their only child. Personal interviews were conducted in their homes. PTG was assessed with a revised Posttraumatic Growth Inventory (PTGI-R). Descriptive and multiple linear regression analyses were conducted. Overall, the sample showed a positive tendency toward PTG. The older the child was at death, the less PTG the parent experienced. Time since the child's death was negatively correlated with PTG, and parents whose children died by accident/suicide had lower PTG than those whose children died of illness. Lower education and poor parental health were significantly associated with lower levels of PTG. Community support was significantly and positively associated with PTG. A majority of aging parents who have lost their only child in China experience PTG. Characteristics related to the loss (child's age at death, time since the death, and cause of death), personal resources (parent's education and health), and community support are associated with the degree of growth.

When Baby Stops Breathing

Sudden unexplained infant death is responsible for 14% of Indiana’s infant mortality. The purpose of this qualitative research study was to describe mothers’ experiences when death of an infant occurred suddenly and unexpectedly. Field deputies or social workers interviewed mothers from central Indiana during the child-death team investigations. The Thematic Analysis Program from the Joanna Briggs Institute was used to analyze interview data. Sixteen de-identified interview cases were extracted, and a meta-aggregate method was conducted. The three synthesized themes were Extreme Emotional Shock, We Feel Like We’re to Blame, and Working Toward Moving On. Understanding these phenomena from mothers’ experience may assist in eliminating risks associated with infant deaths and inform nursing practice and policy.