Men’s Experiences of Miscarriage: A Passive Phenomenological Analysis of Online Data

Knight by force and wounded, protecting without a shield: A meta-ethnography of men's experiences after an involuntary pregnancy loss

OBJECTIVE

To synthesize the available body of qualitative research regarding the experiences of men after an involuntary pregnancy loss.

DESIGN

Noblit and Hare's interpretive meta-ethnography of 13 original qualitative articles was carried out.

RESULTS

After reciprocal and refutational translations, the lines of argument synthesis were developed, together with the metaphor "Knight by force and wounded, protecting without a shield." This metaphor symbolizes the experience of men after an involuntary pregnancy loss. CERQual assessment showed that the results are a (highly) reasonable representation of the phenomenon of interest.

CONCLUSIONS

The men attempted to cope with the loss of fatherhood and suffering, while managing the lack of social recognition and social expectations of masculinity in terms of their behaviour and expression of suffering. They tended to be strong, although they did not always have the necessary support or knowledge.

IMPLICATIONS FOR PRACTICE

Comprehensive and individualized care that includes the man is required. This requires the theoretical-practical training of nurses and midwives, and the provision of tools that help the emotional management of emotionally demanding care.

Interpretative Phenomenology of Grief following Reproductive Loss: A Narrative Review and Considerations on Improving Support

The loss of pregnancy through miscarriage or stillbirth is typically an unexpected and highly distressing event for parents. While death in any form may be overwhelming to those bereaved, pregnancy and newborn loss are unique in several ways because they involve the added loss of parental identity and the idealized baby and family. In this study, the authors performed a narrative review of the literature regarding the phenomenon of grief following reproductive loss in bereaved parents, focusing on heteronormative mothers and fathers and on nontraditional families. One of the main highlighted aspects is the disenfranchisement of grief, which refers to a loss that is not or cannot be acknowledged, publicly mourned, or socially supported. This feeling is elicited by family, society, and healthcare providers. Although the literature has consistently documented the negative impact of this type of experience on parents and families, it is still largely unrecognized by healthcare providers. As most studies demonstrate, there are significant gaps in the psychosocial components of miscarriage and stillbirth care, including a lack of clarity in communication about the loss and subsequent steps, a lack of empathy, an invalidation of grief, and a failure to attend to emotional needs. Since healthcare providers are most often the first point of contact as they experience the loss, it is imperative to act so that patients' needs are more adequately met. To this purpose, the authors propose a set of measures aimed at improving the quality of care and support.

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.

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.

Double-Layer Masking of Suffering After Pregnancy Loss: A Grounded Theory Study from a Male Perspective

INTRODUCTION

Men can express different responses after pregnancy loss. This loss can interfere with their expectation of parenthood, new life, and future hopes. Expectations from the social construction of gender can encourage them to maintain an image that contradicts their actual feelings. This can lead to isolation, distancing, and difficulties in seeking support. The scarcity and low representation of men in previous studies makes research that captures the complexity of their experience necessary. The aim of this study was to explore how men confront the suffering caused by pregnancy loss.

METHODS

This study is part of a larger research project focusing on the experiences of parents and midwives following pregnancy loss. In this study, 22 cisgender and white heterosexual men who experienced pregnancy losses participated in semistructured interviews. Data were analyzed iteratively using constructivist grounded theory methods.

RESULTS

The substantive theory of double-layer masking of suffering emerged as way to explain the confrontation of suffering after pregnancy loss from the male perspective. The themes, (1) suffering beyond physical loss, (2) rationalization in the search for meaning, and (3) keeping a façade with others, show the impact that this loss had on men, which was masked by the meaning they gave to the situation and by its social expression.

DISCUSSION

The findings provide a theoretical conceptualization of the masking these men use to deal with the suffering they experienced from this situation. These aspects provide reasons for including these individuals in the assistance given by midwives after a pregnancy loss. Collaboration between specialized and primary care, along with staff training and support, is necessary for the provision of couple-centered care after pregnancy loss.

The experiences of men following recurrent miscarriage in an Irish tertiary hospital: A qualitative analysis

Introduction

Miscarriage is one of the most common complications of pregnancy, and recurrent miscarriage affects approximately 1% of couples. The psychological impact of early pregnancy loss on women has been well documented in the literature; however, the burden of miscarriage on men remains largely unexplored.

Methods

This qualitative research involved semi‐structured interviews with five men whose partners had experienced at least two consecutive miscarriages. Participants were recruited through an early pregnancy loss clinic in a large, tertiary maternity hospital. Interviews were recorded and transcribed verbatim and analysed thematically.

Results

Recurrent miscarriage had a pronounced psychological impact on all the men interviewed, which worsened with each successive miscarriage. Three primary themes were developed from the data: (1) the deeply emotional experiences of men following recurrent miscarriage; (2) frustrations experienced during the provision of support following recurrent miscarriage; and (3) a sense of feeling unimportant. Lack of timely provision of information about miscarriage as well as lack of access to services were highlighted as deficiencies in the quality of care provided after recurrent miscarriage.

Conclusion

The experiences of men after recurrent miscarriage are based largely on their assumed role as the protector and supporter of their partner, which often results in neglect of their own psychological needs. The support required by men is similar to that required by women, and greater access to information and services is needed to improve the experiences of men following recurrent miscarriage.

Patient Contribution

Participants were recruited through the Pregnancy Loss Clinic at Cork University Maternity Hospital and were identified by specialist midwives. Participants were approached and interviewed by one of the researchers. Participation was voluntary and the men received no financial contribution for their time.

Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample

Background

Historically, men’s experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men’s perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men.

Methods

Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men’s grief intensity and style.

Results

Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men’s total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of ‘supporter’ conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men’s grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance.

Conclusions

Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03514-6.