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.

The risk of opioid use disorder among women undergoing obstetric-related procedures: Results from the Cerner Real-World Database

Introduction

While the relationship between various obstetric procedures and the onset of opioid use disorder (OUD) remains ambiguous, this study aims to elucidate the immediate and prolonged risks of OUD in women who have undergone procedures such as vaginal and cesarean deliveries, induced abortions, and treatments related to miscarriages and ectopic pregnancies.

Methods

Retrospective data (n = 632,872) from the Cerner Real-World Data™ for pregnant females (age 15-44) between January 2010 and March 2020 were used. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to compare odds of OUD for each obstetric outcome to normal vaginal delivery using multivariable logistic regression. New opioid prescriptions and persistent opioid prescriptions were secondary outcomes for which modified Poisson regression models were used.

Results

Compared to patients with a vaginal delivery, those with an ectopic pregnancy, a cesarean delivery, miscarriage, and an induced abortion had 84%, 46%, 119%, and 131% significantly higher odds of OUD (aOR [95% CI]: 1.84 [1.36, 2.48], 1.46 [1.29, 1.65], 2.19 [1.94, 2.47], and 2.31 [1.80, 2.96]) respectively. Among opioid naïve patients, all other obstetric procedure groups (besides miscarriage) had significantly higher risk of being prescribed new opioids than those with a vaginal delivery. Among those newly prescribed opioids, patients from all other obstetric procedure groups demonstrated a significantly higher risk of persistent opioid prescription compared to those who had a vaginal delivery.

Conclusion

The association between specific obstetric outcomes, notably miscarriage and induced abortions, and opioid use patterns should inform safer and more effective pain management in a maternal population.

White Tears: A Phenomenological Study of Perinatal Loss

Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An interpretative phenomenological study was carried out between January 2021 and July 2022 with 6 parental pairs (12 people in total, 6 mothers and 6 fathers) who experienced a perinatal loss. Participants were reached by snowball sampling method. Data were collected using semi-structured audio recording interviews that were transcribed and analyzed using thematic analysis. The themes of this study were determined as "attributing meaning to loss", "fragmented parenting roles and expectations", "changing relationships", "expectations from healthcare professionals", and "emotional responses". Five sub-themes were created from the emotional responses theme which included. These are sadness and pain, denial, anger, guilt and fear. In the study, it was concluded that the experience of perinatal loss may have negative consequences on the psychological health of the parents. Therefore, specific, professional, adequate nursing support and continuity of support are needed to help parents cope with perinatal losses.

Lived Experience of the Dyad and Their Relationships Following a Fetal Death: A Hermeneutic Phenomenological Study

Little is known about the lived experience of the dyad following a fetal death and the impact on relationships. The purpose of this paper is to explore the dyadic relationship between partners, with health care providers, and with the baby's memory after birth. This qualitative study utilized hermeneutic phenomenology. The sample included 10 heterosexual dyads from the United States and Canada. All experienced a fetal death between 6 months and 7 years prior to their interviews. The data revealed three themes: (a) The Dyad Relationship: Moving Through the Experience Together; (b) Keeping the Memory Alive: Memorializing the Baby; and (c) Relationships With Health Care Providers: A Spectrum of Caring. The findings from this study provide the beginning knowledge needed to improve the care of dyads who have experienced a fetal death and for future studies to improve care delivery for dyads as their relationships change after fetal death.

Clinical Experiences of Perinatal Palliative Care After a Stillbirth: A Narrative Therapy for Grief

Narrative care for families suffering from perinatal loss is rarely provided by medical institutions in China Mainland. However, with the advancement of the Chinese narrative medicine theory and practice, the clinical significance of narrative care has been increasingly recognized. Based on the principles of Chinese narrative medicine, this narrative case study described traumatic narrative foreclosures occuring in a family suffering from stillbirth, and highlighted the multidisciplinary collaboration for practising narrative care in the process of supporting the bereaved in our hospital. Meanwhile, we advocate the establishment of a narrative care ecology by training more obsteticians and nurses with good narrative competence in purpose of helping the family experiencing perinatal losses to overcome their tramatic narrative foreclosures, increasing the chances of another successful pregnancy and childbirth as well as enhancing their quality of life.

Level of basic hope and symptoms of anxiety and depression in women after miscarriage

Introduction

The study aimed to determine the level of basic hope and symptoms of anxiety and depression in women after miscarriage.Methods: To evaluate the symptoms of anxiety and depression, and basic hope, the standardized questionnaires the Hospital Anxiety and Depression Scale (HADS) and the Basic Hope Inventory (BHI-12), respectively, were used. Patients hospitalized at the Department of Obstetrics and Gynaecology of the Provincial Combined Hospital in Kielce due to miscarriage in the period from September 2019 to August 2021 were included in the study.

Results

The sense of basic hope increased after 3 months (p < 0.001). The intensity of symptoms of anxiety and depression decreased (p < 0.001). The BHI-12 correlated significantly and negatively with the level of anxiety (r = -0.438, p < 0.001) and depression symptoms (r = -0.456, p < 0.001) during and after hospitalization (anxiety r = -0.649, p < 0.001; depression r = -0.643, p < 0.001).

Conclusions

It was found that the level of hope significantly increased after 3 months compared to this level during hospitalization. Hope was associated with lower levels of anxiety and depression symptoms.

Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital-a Qualitative Study

This study aimed to investigate the understanding and experiences of mothers who have suffered perinatal loss regarding their needs after being discharged from the hospital. Data were collected through semi-structured face-to-face and telephone interviews using purposive sampling with maximum diversity. The sample included 15 mothers and 6 midwives who had experienced fetal loss and perinatal bereavement. The interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyze the data. Sampling was conducted from July 2022 to March 2023, continuing until data saturation was reached. The study identified 2 main categories of needs for mothers who have experienced perinatal loss: continuous healthcare (including the Comprehensive Mother Tracking System, provision of psychological welfare, and educational needs) and provision of a support network, including "spouse and family support" and "peer and colleague support." The primary theme of this study was "Deliberating Care for Grieving Mothers." The study results indicate that mothers who experience perinatal loss require continuity of care after being discharged. Psychological screening and counseling support are essential for both parents. Considering the significant impact of spousal, familial, and community support on an individual's life, it is crucial to prepare the community to comprehend and embrace grieving parents.

A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss

BACKGROUND

Maternal identity, a mother's internalized view of self as mother, has not been studied in relation to perinatal loss. This study aimed to investigate how women construct a sense of maternal identity after the loss of a baby.

METHODS

We interviewed 10 mothers who had experienced perinatal loss. A Listening Guide framework for narrative analysis was used to identify patterns of giving voice to the mother's own story.

RESULTS

We identified 12 overarching voices which fell within three distinct groupings: voices of motherhood, voices of grief, and voices of growth. Although bereaved mothers grappled with constructing their maternal identity, they also demonstrated how maternal identity is individually and intuitively created through an honouring and remembering of the child that was lost, resulting in significant growth.

CONCLUSIONS

There is need for a broader definition of what constitutes motherhood to encapsulate diverse mothering experiences, including perinatal loss.

Measuring Grief in the Context of Traumatic Loss: A Systematic Review of Assessment Instruments

Following traumatic loss, defined as the death of a loved one due to unexpected or violent circumstances, adults may experience a myriad of grief-related problems. Given the addition of Prolonged Grief Disorders into the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition, Text-Revision and influx of unexpected deaths due to the global Coronavirus pandemic, there is heightened interest in the measurement of grief-related processes. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify measures of grief used in studies of adults who experienced traumatic loss. Searches yielded 164 studies that used 31 unique measures of grief-related constructs. The most commonly used instrument was the Inventory of Complicated Grief-Revised. Half of the measures assessed constructs beyond diagnosable pathological grief responses. Given the wide variation and adaptations of measures reviewed, we recommend greater testing and uniformity of measurement across the field. Future research is needed to adapt and/or design measures to evaluate new criteria for Prolonged Grief Disorder.

The association between sexual function, quality of marital relationship and associated factors in women with a history of ectopic pregnancy: a cross-sectional study in Iran

BACKGROUND

Ectopic pregnancy (EP) has many adverse effects on the relationship between couples. The present study aims to assess the association between sexual function (SF), quality of marital relationship (QMR) and associated factors in women with a history of EP.

METHOD

This cross-sectional study was performed on 220 women with a history of EP in Kerman in 2022. Convenience sampling method was applied. Data were collected using the female sexual function index (FSFI) and the perceived relationship quality components scale (PRQC) questionnaires and were analyzed with descriptive and inferential statistics (median regression) in Stata software version 17. A P-value < 0.05 was considered statistically significant.

RESULTS

Of the female participants, 20.4% had sexual dysfunction (SD). Longer duration of marriage (P = 0.045) and increase in the number of EPs (P < 0.001) were associated with a decrease in SF. A quarter of women experienced poor QMR. Increase in spouse age (P = 0.047), longer duration of marriage (P = 0.028), and increase in the number of EPs (P < 0.001) were associated with a decrease in QMR. There was a significant direct relationship between SF and the QMR (r = 0.857; P < 0.001).

CONCLUSION

The present study showed a significant relationship between SF and the QMR in women with a history of EP. Therefore, SF and the QMR are necessary to be considered in future health promotion programs of these women.

Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain

OBJECTIVE

To assess the attitudes and care practices of midwives and nurses in the province of Granada in relation to death care and perinatal bereavement, to determine their degree of adaptation to international standards and to identify possible differences in personal factors among those who best adapt to international recommendations.

DESIGN

A local survey of 117 nurses and midwives from the five maternity hospitals in the province was conducted using the Lucina questionnaire developed to explore professionals' emotions, opinions, and knowledge during perinatal bereavement care. Adaptation of practices to international recommendations was assessed using the CiaoLapo Stillbirth Support (CLASS) checklist. Socio-demographic data were collected to establish their association with increased compliance with recommendations.

FINDINGS

The response rate was 75.4%, the majority were women (88.9%), with a mean age of 40.9 (SD=1.4) and 17.4 (SD= 10.58) years of work experience. Midwives were the most represented (67.5%) and reported having attended more cases of perinatal death (p = 0.010) and having more specific training (p<0.001.) Of these, 57.3% would recommend immediate delivery, 26.5% would recommend the use of pharmacological sedation during delivery and 47% would take the baby immediately if the parents expressed their wish not to watch them. On the other hand, only 58% would be in favour of taking photos for the creation of memories, 47% would bathe and dress the baby in all cases, and 33.3% would allow the company of other family members. The percentage that matched each recommendation on memory-making was 58%, 41.9% matched the recommendations on respect for the baby and parents, and 23% and 10.3% matched the appropriate delivery and follow-up options, respectively. The factors associated with 100% of the recommendations, according to the care sector, were being a woman, a midwife, having specific training and having personally experienced the situation.

KEY CONCLUSIONS

Although the levels of adaptation observed are more favourable than in other nearby contexts, serious deficiencies are identified in the province of Granada with respect to internationally agreed recommendations on perinatal bereavement care. More training and awareness-raising of midwives and nurses is needed, which also considers factors related to better compliance.

IMPLICATION FOR PRACTICE

This is the first study to quantify the degree of adaptation to international recommendations in Spain reported by midwives and nurses, as well as the individual factors associated with a higher level of compliance. Areas for improvement and explanatory variables of adaptation are identified, which allow support for possible training and awareness-raising programmes aimed at improving the quality of care provided to bereaved families.

Women's desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study

OBJECTIVE

We report on women's mental health care desires following a miscarriage, medical termination, or abortion.

METHOD

689 women completed a questionnaire on reproductive history, health care following miscarriage/medical termination/abortion, and current mental health. Descriptive statistics and logistic regression analyses examined: miscarriage/termination/abortion incidence, desires for mental health support following miscarriages/terminations/abortions, and current mental health.

RESULTS

Of 365 women with a pregnancy history, 37% reported ≥1 miscarriage, 9% ≥1 medical termination, 16% ≥1 abortion, and 3% endorsed all three. Current mental health did not differ between women with a history of miscarriage/termination/abortion and those with only live births (p = 0.82). Following miscarriage, 68% of women discussed options for the medical management of pregnancy loss with their provider, 32% discussed grief/loss, and 25% received mental health care recommendations. Engagement in mental health services was reported by 16% of women with a history of miscarriage, 38% after medical termination, and 19% following an abortion. Of women who became pregnant after their most recent miscarriage/termination/abortion and did not receive mental health care, 55% wished they had received services during the subsequent pregnancy.

CONCLUSIONS

Women desire mental health care after miscarriages, medical terminations, or abortions, warranting improved access to mental health care for these individuals.

Stillbirth: prevention and supportive bereavement care

Around half of the two million stillbirths occurring worldwide each year are preventable. This review compiles the most up-to-date evidence to inform stillbirth prevention. Many general maternal health interventions also reduce the risk of stillbirth, for example, antenatal care attendance. This review focuses on specific aspects of care: glucose metabolism, targeted aspirin prophylaxis, clotting and immune disorders, sleep positions, fetal movement monitoring, and preconception and interconception health. In the past few years, covid-19 infection during pregnancy has emerged as a risk factor for stillbirth, particularly among women who were not vaccinated. Alongside prevention, efforts to address stillbirth must include provision of high quality, supportive, and compassionate bereavement care to improve parents' wellbeing. A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. Staff need support to be able to care for parents effectively, yet, studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. Action is urgently needed and is possible. Action must be taken with the evidence available now, in healthcare settings with high or low resources, to reduce stillbirths and improve training and care.

Subsequent pregnancy after stillbirth: a qualitative narrative analysis of Canadian families' experiences

BACKGROUND

In Canada, nearly nine pregnancies end in stillbirth daily. Most of these families will go on to have subsequent pregnancies, but research into how best to care for these parents is lacking. This study explores the lived experiences and the most important aspects of person-centred care for Canadian families experiencing a pregnancy after a stillbirth.

METHODS

This qualitative descriptive design used secondary data collected from an online, international survey for bereaved parents who reported having experienced a pregnancy subsequent to a stillbirth. Only parents who identified as Canadian were included in this study. Three open text questions were asked about parents' experiences in their subsequent pregnancy. An inductive thematic analysis approach was used with open coding and a constant comparative method.

RESULTS

Families' responses fell into six main themes that identified what they would have preferred for high quality, excellent care. These included: (1) recognizing anxiety throughout the subsequent pregnancy, (2) wanting one's voices and concerns to be heard and taken seriously, (3) needing additional and specific clinical care for reassurance, (4) desiring kindness and empathy from caregivers and others, (5) seeking support from others who had also experienced pregnancy after stillbirth; and (6) addressing mixed emotions including guilt, continuity of care and carer, positive thoughts versus more realistic ones, and poignant feelings of self-blame.

CONCLUSIONS

Participants' responses identified that pregnancy after stillbirth is an extremely stressful time requiring patient-oriented care and support, both physically and psychologically. Families were able to articulate specific areas that would have improved the experience of their subsequent pregnancy. Parents asked for high-quality clinical and psychosocial prenatal care that was specific to them having experienced a prior stillbirth. They also requested connections to others experiencing this similar scenario. Further research is needed to delineate what supports and resources would be needed to ensure this care would be available to all families experiencing pregnancy after stillbirth across Canada and their caregivers.

Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia

BACKGROUND

Perinatal loss can have long-lasting adverse effects on a woman's psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations.

AIMS

The primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss.

METHOD

This case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy.

RESULTS

Scandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49-1.95) and total depression score (β: 0.90, 95% CI: 0.06-1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating.

CONCLUSION

Women who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.

Pregnancy loss: Consequences for mental health

Pregnancy loss, in all its forms (miscarriage, abortion, and fetal death), is one of the most common adverse pregnancy outcomes, but the psychological impact of such loss is often underestimated. The individual response to this outcome may vary between women-and could be influenced by age, race, culture, or religious beliefs-but most experience anxiety, stress, and symptoms of depression. Because pregnancy loss is not uncommon, health providers are used to dealing with this diagnosis, however the correct management of the process of diagnosis, information-gathering, and treatment can greatly ameliorate the adverse mental consequences for these women. The aim of this review is to examine the different types of pregnancy loss, and consider how each can influence the mental health of the women affected and their partners-in both the short- and long-term; to review the risk factors with the aim of identifying the women who may be at risk of consequential mental health problems; and to provide some advice for health providers to help these women better cope with pregnancy loss. Finally, we provide some points for health providers to follow in order to aid the management of a pregnancy loss, particularly for spontaneous, induced, or recurrent miscarriage, or stillbirth.

Psychosocial Support within the Context of Perinatal Palliative Care: The "SORROWFUL" Model

Against the background of a society that tends to underrate the grief experienced by parents whose infants have died prematurely, the model "SORROWFUL" is presented here with the intent to highlight the significance of the death of a newborn for the affected family. It is a supportive tool in counseling for parents grieving the (impending) loss of an infant(s) during peri- or neonatal life and may be implemented within the parental psychosocial support setting beginning with the initial diagnosis until well after the death of the child. The model intentionally allows flexibility for cultural and individual adaptation, for the accommodation to the varying needs of the affected parents, as well as to available local resources.

Predictors of Women’s Childbirth Experience: A Prospective Longitudinal Study on Italian New Mothers

BACKGROUND

Women’s memories of their childbirth experience tend to remain unchanged over time. This experience can be influenced by obstetric factors as well as by sociodemographic and psychological variables.

OBJECTIVE

To examine whether women’s perceived childbirth experience changes over time; to identify the predictors (obstetric, sociodemographic, and psychological variables) of this experience immediately after delivery and after 3 months.

METHODS

This prospective longitudinal study comprised two hundred and twenty-one Italian women who completed a self-report questionnaire at two assessment points: immediately (1–3 days) after birth (Time 1) and 3 months postpartum (Time 2). At Time 1, the questionnaire included some questions on sociodemographic, psychological, and obstetric information, and the Wijma Delivery Experience Questionnaire (WDEQ(B); at Time 2 women compiled again the WDEQ(B).

RESULTS

Repeated measures ANOVA revealed that the childbirth experience did not change from Time 1 to Time 2. However, predictors of this experience were different between Time 1 and Time 2: at Time 1, the childbirth experience (WDEQ(B)_t1) was significantly predicted nly by type of cesarean section; at Time 2, the childbirth experience (WDEQ(B)_t2) was significantly predicted by WDEQ(B)_t1, history of psychological disorders, and type of conception.

DISCUSSIONS

Our findings enhance the understanding of the main predictors of a woman’s childbirth experience. Identifying areas of vulnerability is important for clinical practice, as well as for developing maternal health policies to improve women’s birth experiences, postpartum well-being, and the baby’s development.

Assessment of mental health issues in pregnant women with fetal complications: Relation to attachment and anxiety

PURPOSE

Pregnancy period is important for all women. The aim of this study was to evaluate mental status, antenatal depression, attachment, and anxiety in pregnant women with fetal complications.

DESIGN AND METHODS

Mothers who had been diagnosed with fetal complications during pregnancy were interviewed after the delivery of their babies.

FINDINGS

The results showed that anxiety and depression scores were significantly higher in the mothers who had received psychiatric support treatment. Maternal attachment scores were found low, depression scores were found high in mothers of children with congenital anomalies.

CONCLUSION

According to the results of the study, a maternal attachment was low and depression was high in mothers with congenital anomalies.

PRACTICE IMPLICATIONS

Possible psychological problems after birth can be prevented by psychotherapeutic nursing interventions during pregnancy to pregnant women who have babies with fetal anomalies.

Being PAL: Uncertainty and Coping in r/PregnancyAfterLoss

Women who become pregnant again following miscarriage or stillbirth are in a particularly vulnerable position as they grapple with uncertainty about the current pregnancy's viability and outcomes. In this study, we examine the types of uncertainty that emerge in pregnancy after loss (PAL) and how women manage that uncertainty. Framed by the theory of communication and uncertainty management, we thematically analyzed threads (N = 636) from the online discussion board Reddit, focusing on the specific subreddit community r/PregnancyAfterLoss. Themes of physiological, emotional, and social uncertainty dominated the PAL experiences of these online community members. Uncertainty management and coping strategies included direct information seeking, bracing, mantras, and accepting uncertainty as part of the PAL experience. Theoretical contributions of this study include an initial conceptualization of emotional uncertainty in health communication. In addition, we draw parallels between uncertainty in PAL and in illness and highlight the unique features of PAL that expand our understanding of uncertainty in health. Practical implications are drawn from members' expressed needs and uncertainty management practices, and provide direction for supporting women through the PAL experience.

Validity and reliability of the Greek version of Pregnancy Outcome Questionnaire (POQ)

BACKGROUND

During the last decades a considerable increase in biological and psychosocial approaches have occurred so as to enhance the study of prenatal period. This study aimed to investigate the validity and reliability of the Greek version of Pregnancy Outcome Questionnaire (POQ) in assessing pregnancy-related stress.

MATERIAL AND METHODS

The study group consisted of 135 first-time expectant women with good knowledge of the Greek language, low-risk pregnancies and a gestational age of ≥24 weeks. Questionnaires containing the POQ scale questions in addition to other questions and scaleswere distributed in printed and digital format at private gynecological clinics. The collected data were analysed using the SPSS software.

RESULTS

The POQ scale score showed satisfactory reliability (Cronbach's alpha = 0.8), while the factor analysis showed a major factor with an eigenvalue of 4.17 and an overall interpreted factor variance of 41%. The sample showed moderate intensity values on the scale. We observed that pregnancy-related characteristics affected the scale, while no significant correlations with demographic variables were recorded.

CONCLUSION

The results of the reliability and factor analyses evaluating the scale structure indicated that the tool performed well in Greek, had a compact structure with satisfying reliability, and is suitable for use in the Greek pregnant population. However, additional research is warranted to investigate the effect of various additional factors on the scale.

Perceived Partner's Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses

The process that infertile couples and those after a miscarriage go through is unpredictable and difficult to control; therefore, it is associated with a lowered sense of control for both partners. Uncontrolled stress creates a higher level of anxiety, which is associated not only with a lower quality of life but also with worse results from infertility treatment and higher risks of miscarriage. The aim of this study was to analyze the relationship between the partner’s perceived self-control and marital satisfaction in the context of the partners’ coping strategies. The actor-partner interdependence model was applied to 90 heterosexual married couples. Our results show that men who perceive their wives as being more self-controlled and women who are perceived by their husbands as being more self-controlled feel more satisfied in their relationships. The effect of a partner’s perceived self-control on satisfaction with the relationship was weaker when controlled for the length of marriage. It also appeared to be moderated through the spouses’ use of social support. We conclude that the effects of the partner’s perceived self-control and social support are strong for marital satisfaction in the context of infertility and miscarriage.

Adding a Facebook Support Group to an Online Yoga Randomized Trial for Women Who Have Experienced Stillbirth: A Feasibility Study

Objectives: Women who experience stillbirth are more likely to develop post-traumatic stress disorder (PTSD), and anxious and depressive symptoms than those who deliver live healthy babies. Participants in a recent study of online yoga (OY) reported a desire for more social support, which may help reduce PTSD related to grief and aid in coping. Facebook (FB) has been used successfully to deliver support for online interventions, but little is known about its use in conjunction with OY. The purpose of this study was to examine the feasibility of a FB support group in conjunction with an 8-week OY intervention. Design: Randomized parallel feasibility trial with a 1:1 study group allocation ratio. Setting/Location: Online. Subjects: Women (N = 60) who experienced stillbirth within the past 3 years. Interventions: Participants were recruited nationally to participate and randomized into one of two groups: OY only (n = 30) or online yoga with Facebook (OYFB) (n = 30). Both groups were asked to complete 60 min of OY per week. Women in the OY group were asked to log on to a FB page at least once per week. Outcome measures: Acceptability (i.e., satisfaction) and demand (i.e., attendance), PTSD, anxiety, depressive symptoms, social support. Results: Participants were satisfied with and enjoyed OY, and 8/13 FB acceptability benchmarks were met. There were no significant differences between groups in minutes of yoga per week. Conclusions: The addition of a FB group to an OY intervention for women who have experienced stillbirth is feasible, although more research is needed to increase its efficacy. Trial registration: NCT04077476. Registered September 4, 2019. Retrospectively registered (https://clinicaltrials.gov/ct2/show/NCT04077476).

A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care

Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.

The level of grief in women with pregnancy loss: a prospective evaluation of the first three months of perinatal loss

OBJECTIVE

To prospectively investigate perinatal grief in women with pregnancy loss.

METHODS

A total of 215 women (mean (SD) age: 30.7 (5.9) years) who experienced pregnancy loss were included. Data on sociodemographic, marital and obstetric characteristics and Perinatal Grief Scale (PGS) (first 48 h, 1 week, 1 month and 3 months after the loss) were recorded.

RESULTS

Active grief scores were lower (p ranged  < .05 to <.01), while difficulty coping (p < .05 for each) and despair (p < .05 for each) scores were higher in the 3rd month as compared with prior assessments. All PGS scores at the 48 h and 3rd month assessments were significantly higher in assisted and planned pregnancies (p < .01 for each). Maternal age was positively correlated with 48 h active grief (r = 0.19, p < .001), despair (r = 0.13, p < .05) and total PGS (r = 0.13, p < .05) scores. Parity and the number of children were negatively correlated (r ranged from -0.35 to -0.20, p < .01 for each) with all PGS scores.

CONCLUSION

Our findings revealed decrease in active grief levels, whereas gradual increase in difficulty coping and despair in women with pregnancy loss within the first 3 months of losing a child. Our finding indicate association of older maternal age, primiparity, assisted and planned pregnancies with regular antenatal follow up with higher total PGS scores as well as active grief, difficulty coping and despair scores in women regardless of the time of assessment within 3 months after the pregnancy loss.

Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilization

BACKGROUND

Stillbirth occurs in every 3.5 of 1000 pregnancies in Ireland and is a devastating event for a family. Women who have a pregnancy after stillbirth require increased antenatal support.

OBJECTIVE

This study aimed to determine maternal and fetal outcomes and to quantify health service utilization in pregnancy after stillbirth.

STUDY DESIGN

A retrospective cohort study of all pregnancies after stillbirth was conducted from 2011 to 2017 in a large tertiary referral university maternity teaching hospital with approximately 8000 births annually.

RESULTS

There were 222 stillbirths from 2011 to 2017. Two-thirds of women (145 of 222 [64.3%]) had a pregnancy after stillbirth. Almost one-fifth of these women (28 of 145 [19.3%]) had a miscarriage, but 16 of 28 women (57.1%) had a subsequent live birth, giving an overall live birth rate of 90.3% (131/145). The average interval from index loss to booking in the next pregnancy was 13 months, with almost half of the women (72 of 145 [49.7%]) booking within 1 year. The average number of antenatal appointments was twice than expected (10; range, 2-27), and the average number of ultrasound scans was 5 times higher than expected (5; range, 0-29). Rates of induction of labor (63 of 131 [48.1%]) and cesarean delivery (53 of 131 [40.5%]) were significantly higher than national rates for multiparous women. Almost two-thirds of women (40 of 63 [63.5%]) cited previous history of stillbirth as the indication for induction. There was a significantly higher rate of preterm delivery (30 of 131 [22.9%]). Moreover, 1 in 4 babies (35 of 137 [25.5%]) required admission to the neonatal intensive care unit, more than twice the number expected (median gestation, 37 0/7 weeks; range, 25 4/7 to 39 2/7 weeks).

CONCLUSION

Pregnancy after stillbirth was associated with increased surveillance and intervention. The women in this study had higher rates of cesarean delivery, induction of labor, and preterm delivery than the general multiparous population. Decision-making for intervention was often based on previous history of stillbirth. Clinicians should be cognizant of additional supports required for this population and focus on evidence-based interventions that improve maternal well-being and perinatal outcomes in pregnancy after stillbirth.

Perinatal Grief and Related Factors After Termination of Pregnancy for Fetal Anomaly: One-Year Follow-up Study

Introduction:

Many people grieve in a resilient manner, often having a sense of equilibrium restored within six months. The most devastating type of loss is usually considered to be the death of the child. For such a loss, bereavement may take a period of distressing years with signs and symptoms that are related to grief. There have been different phases identified in the grieving process, and this process encompasses various difficulties with different levels of psychological effects. Women with perinatal losses can suffer long periods of grief. The purpose of this study was to monitor the grief in women who had undergone a termination of pregnancy due to fetal anomaly.

Methods:

Forty-six women who applied to the Gynaecology Clinic of Istanbul University Cerrahpaşa Faculty of Medicine and who decided to terminate their pregnancy due to fetal anomaly were included in the study. The Perinatal Grief Scale (PGS), the Impact of Event Scale-Revised (IES-R), Beck Anxiety Inventory (BAI), the Edinburgh Postnatal Depression Scale (EPDS), the Multidimensional Relationship Questionnaire (MRQ) and the Adult Attachment Scale (AAS) were administered to the participants six weeks after termination. Participants’ grief signs were re-evaluated with the PGS at the sixth and 12th months.

Results:

There was no relationship between severity of grief symptoms and socio-demographic and clinical characteristics of the patients. The perinatal grief symptoms can decrease gradually from termination of pregnancy to six months and can persist for a period of six months up to a year. There was positive correlation between the scores of PGS and BAI, IES-R hyper-arousal. The mean score of PGS changed significantly from sixth week to sixth month and from sixth week to 12th months. IES-R hyper-arousal and MRQ relational satisfaction were found to be the predictors for PGS total score at the first year.

Conclusion:

The diagnosis of fetal anomaly and especially the termination of pregnancy itself may be traumatic and disruptive. In women with perinatal loss, grief may become persistent after the first six months. It would be helpful to examine how the women resolve this experience. Especially the anxiety and the hyper-arousal signs following the termination should not be ignored. Perinatal grief is a unique bereavement experience; specific interventions should be performed for detecting and treating severe perinatal grief.

Factors affecting the grieving process after perinatal loss

Background

Factors associated with the grief process in response to perinatal loss have been investigated. However, few studies focused on the intrapersonal factors, such as developmental and personality traits. Hence, this study aimed to investigate medical and psychosocial risk factors, including inter- and intrapersonal factors for the development of complicated grief following perinatal loss, while considering emotional support.

Methods

A total of 50 patients who were treated for grief due to perinatal loss at the National Center for Child Health and Development were divided into two groups according to the treatment period (< 6 months: n = 28; ≥ 6 months: n = 22). We compared medical and psychosocial variables between the two groups using the χ² test and t test. All data were further analyzed using a logistic regression model to adjust for confounding effects.

Results

Patients who had traits of developmental/personality disorders (adjusted odds ratio [OR]: 7.21, 95% confidence interval (CI): 1.21–42.9, P = .030), and those treated with psychoactive drugs (adjusted OR: 5.77, 95% CI 1.09–30.5, P = .039) required a longer treatment period (≥ 6 months).

Conclusions

Patients with personality/developmental traits and those with active psychiatric symptoms required a more extended treatment period in response to loss, suggesting the accumulation of negative factors in these patients; thus, more intensive and specialized care is necessary for these patients. Precise analysis of the coping style, attachment style, communication skills, and life history including relationship with the original family of the patients may have implications on the approach toward patients with complicated grief after perinatal loss. Studies with larger sample size are required to increase the reliability of the present findings, and future research should address the effects of the differential attachment and coping styles of patients with developmental/personality traits on the grief process.

Variation in self-identified most stressful life event by outcome of previous pregnancy in a population-based sample interviewed 6-36 months following delivery

The majority of health research uses a deductive approach to measure stressful life events, despite evidence that perception of what is stressful varies. The goal of this project was to 1) describe the distribution of self-identified most stressful life events in a cohort of women who experienced a perinatal loss (stillbirth or neonatal death) or live birth in the previous three years and 2) test how childhood adversity influences participant selection of their most stressful life event. We used data from 987 women (282 with stillbirth, 657 without loss, and 48 with a neonatal death in the first 28 days) in the Stillbirth Collaborative Research Network - OASIS (Outcomes after Study Index Stillbirth) follow-up study, a population-based sample set in five U.S. states in 2009. We applied an inductive coding process to open-ended responses to a question about the most stressful event or major crisis that participants had ever experienced, resulting in a set of 15 categories. We compare psychologic wellbeing across self-identified most stressful life event, accounting for sampling and loss-to-follow-up weights. Overall, stillbirth was most commonly identified as the most stressful event (18.3% [95% CI: 15.6, 21.5]), followed by loss by death of someone other than a child (17.25% [95% CI: 13.9, 20.3]). For participants who experienced a perinatal loss, we fit multivariable logistic regression models to quantify the association between report of childhood maltreatment and identifying the perinatal loss as the most stressful life event, calculating risk ratios (RRs). Reporting any moderate or severe childhood maltreatment was associated with 24% lower risk of identifying the perinatal loss as the most stressful life event (adjusted RR: 0.76 [95% CI: 0.58, 1.01]), after adjusting for race/ethnicity, age, and education. These results demonstrate the value of combining standardized measures with open-ended, inductive approaches to measuring stress in large, population-based studies.

Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider

Introduction

There is a paucity of clinical guidelines for the routine assessment of maladaptive reproductive grief reactions in outpatient primary care and OB-GYN settings in the United States. Because of the disenfranchised nature of perinatal grief reactions, many clinicians may be apt to miss or dismiss a grief reaction that was not identified in the perinatal period. A significant number of those experiencing a reproductive loss exhibit signs of anxiety, depression, or post-traumatic stress disorder. Reproductive losses are typically screened for and recorded numerically as part of a woman’s well-visit intake, yet this process often fails to identify patients emotionally troubled by a prior pregnancy loss.

Materials and Methods

A summative content analysis of 164 recent website blogs from female participants who self-reported having experienced a miscarriage or abortion in their lifetime was conducted. The narratives were reviewed for details regarding the time span between the pregnancy loss and the composition of the blog post. The stories were analyzed for subsequent relationship problems and detrimental mental health conditions. Maladaptive reactions were contrasted for those that indicated a greater than 12 months’ time-lapse and those who had not.

Results

More than a third (39.6%) of the women reported in the narrative that at least one year or more had passed since experiencing the miscarriage or abortion. For those women, the median time span between the loss and composing the blog was 4 years with a range of 47 years. Mental health conditions attributed to the reproductive loss by those who reported longer bereavement times included subsequent relationship problems, substance misuse, depression, suicidal ideation, and PTSD. The percent of reported maladaptive issues was more than double (136.9% vs. 63.6%) for those who reported that a year or more had passed since the loss of the pregnancy.

Discussion

Grief reactions following the loss of a pregnancy may be prolonged or delayed for several months which can contribute to adverse biopsychosocial outcomes. Recognition and treatment of maladaptive grief reactions following a pregnancy loss are critical. Screening methods should be enhanced for clinicians in medical office settings to help identify and expedite the appropriate mental health assistance.

The impact of anencephaly on parents: A mixed-methods study

This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.

Chronic histiocytic intervillositis (CHI): an under-recognised condition with potential serious sequelae in pregnancy

Chronic histiocytic intervillositis (CHI) is a rare placental disorder associated with adverse pregnancy outcomes and high recurrence rates in subsequent pregnancies. We discuss a case of CHI diagnosed incidentally in a young primigravida who presented with a first trimester miscarriage. CHI is usually diagnosed after an adverse pregnancy outcome by microscopic placental histopathology. Currently, CHI is a poorly understood condition by clinicians in many aspects, including its aetiology and subsequent management of patients in their future pregnancies. This is due to the lack of awareness and underdiagnosis of CHI among general pathologists and obstetricians. The authors would like to highlight this interesting case to encourage more research on CHI to understand its pathophysiology and optimal management better. Clinicians should also focus on providing holistic care to this group of patients by considering the impact of adverse pregnancy outcomes on their emotional well-being.

Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial

AIM

The purpose of this study was to investigate the effectiveness of empathic caring on sleep quality, depression, stress, and social support in women with recurrent miscarriage.

MATERIALS AND METHODS

Sixty-two eligible women were randomly assigned to either the experimental group (n = 31), which received three face-to-face nursing counseling sessions, or the control group (n = 31). Outcome measures included the Pittsburgh Sleep Quality Index, Edinburgh Prenatal Depression Scale, Perceived Stress Scale, and Interpersonal Support Evaluation List.

RESULTS

Paired-sample t-tests revealed that, after receiving nursing counseling, the participants in the experimental group showed significant decreases in stress and depression. However, no significant mean differences were found in the control group between the pretest and the 12-week posttest for any of the four outcome measures.

CONCLUSION

Clinical healthcare professionals may incorporate empathic caring into health-promotion protocols to assist women with recurrent miscarriage to improve their psychosocial health.

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.

Protective and risk factors for women's mental health after a spontaneous abortion

Objective:

to examine personal and contextual protective and risk factors associated with women’s mental health after a spontaneous abortion.

Method:

a cross-sectional study was carried out where 231 women who had experienced spontaneous abortions in the past 4 years answered a self-reporting online questionnaire to assess their mental health (symptoms of depression, anxiety, perinatal grief) and to collect personal as well as contextual characteristics.

Results:

women who had experienced spontaneous abortions within the past 6 months had higher scores for depressive symptoms than those who had experienced spontaneous abortions between 7 and 12 months ago, while anxiety level and perinatal grief did not vary according to the time since the loss. Moreover, low socioeconomic status, immigrant status, and childlessness were associated with worse mental health after a spontaneous abortion. In contrast, the quality of the conjugal relationship and the level of satisfaction with health care were positively associated with women’s mental health.

Conclusion:

women in vulnerable situations, such as immigrants, women with a low socioeconomic status, or childless women are particularly vulnerable to mental health problems after a spontaneous abortion. However, beyond those personal and contextual factors, the quality of the conjugal relationship and the level of satisfaction with health care could be important protective factors.

A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions

OBJECTIVE

Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions.

METHOD

Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms.

RESULTS

A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles.

SIGNIFICANCE OF RESULTS

The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.

The need for improved emotional support: A pilot online survey of Australian women's access to healthcare services and support at the time of miscarriage

PROBLEM

Women need improved emotional support from healthcare professionals following miscarriage.

BACKGROUND

Significant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.

AIM

This study was developed to pilot a survey aimed at exploring women's access to healthcare services and support at the time of miscarriage.

METHODS

Women over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.

FINDINGS

A total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.

CONCLUSION

There is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals' usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.

The Grief of Parents After the Death of a Young Child

Research demonstrates that severe forms of grief and grief-related pathology exist in the general population. Less attention, however, has been paid to the grief of parents following the death of a young, dependent child. In this review, we summarize a search of Pubmed, PsycINFO and Web of Science from 1995 to 2017, using the terms 'parental complicated grief', 'parental traumatic grief', and 'parent Prolonged Grief Disorder', specifically addressing parental grief and identified risk factors for complicated or prolonged grief. Forty-two studies met criteria and indicate a significant burden of complicated or prolonged grief in parents of children dying from virtually any cause. It appears that the empiric literature is undermined by great variability, including the composition of samples, the causes of death studied, the psychometric measures used, and post-loss intervals. We conclude that the uniform severity of grief experiences following the death of a young child is potentially a distinct subtype of grief, deserving of attention in its own right in future research and diagnostic formulations.

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial

BACKGROUND

About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a "stretch and tone" control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health.

METHODS

Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable.

RESULTS

Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control).

CONCLUSIONS

This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT02925481. Registered 10-04-16.

Effectiveness and feasibility of internet-based and mobile-based interventions for individuals experiencing bereavement: a systematic review protocol

INTRODUCTION

Internet-based and mobile-based interventions (IMIs) provide an innovative and efficient self-management tool for mental health problems. This systematic review aims to summarise and critically evaluate studies addressing the effectiveness and feasibility of IMIs for normal and complicated grief in bereaved adults.

METHODS AND ANALYSIS

The databases MEDLINE, Cochrane Library, PsycINFO, Embase and Web of Science and Google Scholar (for 'grey' literature) will be systematically searched for feasibility studies or randomised controlled trials of IMIs for bereaved adults who were experiencing normal/complicated grief. Data will be extracted and evaluated independently by two reviewers from studies eligible for inclusion. Quality of evidence will be assessed, and results will be synthesised qualitatively and pooled meta-analytically, if sufficient outcome data are available. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and Grades of Recommendation, Assessment, Development and Evaluation methodology will be used.

ETHICS AND DISSEMINATION

No primary data will be collected; thus, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations.

TRIAL REGISTRATION NUMBER

CRD42019131428.

'In the hospital there are no care guidelines': experiences and practices in perinatal loss in Spain

BACKGROUND AND OBJECTIVES

Healthcare professionals play an important role in supporting and attending to families that experience a perinatal loss. Previous research has identified the existence of obstacles that professionals may encounter during their practices. The main objective of the current research was to identify and examine the subjective experiences and practices of experienced professionals attending to perinatal loss in the hospital context in Spain.

DESIGN

Qualitative descriptive design.

SETTING

Three different hospitals in Spain.

PARTICIPANTS

Sixteen professionals were interviewed, including doctors, nurses, midwives, nursing assistants, a psychologist and a funeral home manager.

METHODS

Individual semi-structured interviews focusing on three areas were carried out: practices with the baby-foetus, practices with parents and interaction with the team. A thematic analysis was performed using the three main focuses of the semi-structured interview (deductive approach) and the codes that emerged from the data (inductive approach).

RESULTS

Regarding guideline-based care for the baby/foetus, participants made a distinction between the initial process of care for the baby and the decision-making process with parents. Where support for families was concerned, participants identified considerable variability in the practices used and lack of organisational and care guidelines, psychological support and follow-up. Finally, interactions with other team members were perceived as a source of support, although participants identified a significant lack of coordination.

CONCLUSION

Participants reported variability of practices in care for the baby and parents, lack of continuity-of-care guidelines and the importance of support from a coordinated healthcare team.

The Severity of Post-abortion Stress in Spontaneous, Induced and Forensic Medical Center Permitted Abortion in Shiraz, Iran, in 2018

Background:

Abortion and loss of pregnancy in the first trimester may affect maternal mortality and morbidity. This study aimed to determine the severity of post-abortion stress in spontaneous abortion, induced abortion, and Forensic Medical Center (FMC) referral abortions immediately after abortion and after 1 month of follow-up in Shiraz, Iran, in 2018.

Materials and Methods:

This cross-sectional study was conducted on 104 mothers selected through convenience sampling method in 2018. The data collection tools included a demographic characteristics questionnaire and the Mississippi Post-Traumatic Stress Disorder (M-PTSD) Scale that were filled out by mothers immediately and 1 month after the abortion. Data were analyzed using one-way ANOVA and post-hoc LSD test in SPSS software. Moreover, p < 0.05 was considered as statistically significant.

Results:

The mean (SD) of post-traumatic stress scores was 83.87 (18.35) and 77.40 (9.88) in spontaneous abortion, 82.28 (13.27) and 75.71 (14.73) in FMC permitted abortions, and 86.66 (10.10) and 74.98 (12.99) in induced abortions immediately and 1 month after abortion, respectively. Stress was reduced in the three groups of mothers, after one month of severe value. The score for frequency of stress was 3.10% in FMC-permitted abortions and 5.10% in induced abortions; moreover, no stress was observed in the spontaneous abortion cases.

Conclusions:

Stress was gradually reduced over time. The level of PTSD was lower after 1 month in women who had experienced spontaneous abortion. Given that 1 month after abortion, women are still often moderately stressed, follow-up care, and appropriate counseling for these women are necessary.

Pregnancy happiness: implications of prior loss and pregnancy intendedness

Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.

Pregnancy happiness: implications of prior loss and pregnancy intendedness

Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.

The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study

AIM

To explore the experience of both the mothers and the fathers regarding the care received during delivery in cases of stillbirth.

DESIGN

A hermeneutic phenomenological study based on semi-structured interviews with eleven mothers and fathers who experienced stillbirth.

PARTICIPANTS

A purposive sample was recruited in Hospital XXX of XX and through a local pregnancy loss support organization.

METHODS

Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis.

FINDINGS

Four main categories identified: 1) denial of grief, 2) the life and death paradox, 3) guilt, and 4) go through and overcome the loss. The parents manifested a lack of recognition of their loss and their parenthood. Although the midwife was the highest valued professional, not all the experiences were positive and the parents would have appreciated being accompanied by trained people with good communication skills. They also referred to in-hospital logistic barriers that complicated the process, as well as the fact that these births occurred in the same place where healthy deliveries were attended.

CONCLUSION

Findings highlight the importance of tailoring support systems according to mothers' and fathers' needs. Promoting social and institutional recognition of this kind of loss and training healthcare professionals in the accompaniment of this type of mourning is useful to plan comprehensive care to facilitate the initiation and subsequent evolution of healthy mourning.

Hope for the best …but expect the worst: a qualitative study to explore how women with recurrent miscarriage experience the early waiting period of a new pregnancy

OBJECTIVE

To investigate how women experience the initial period of a new pregnancy after suffering recurrent miscarriage (RM).

DESIGN

A qualitative study, nested within a randomised controlled feasibility study of a coping intervention for RM, used semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic network approach.

SETTING

Participants were recruited from the Recurrent Miscarriage Clinic and Early Pregnancy Unit in two tertiary referral hospitals in the UK.

PARTICIPANTS

14 women with RMs and who had previously participated in the randomised controlled trial (RCT) feasibility component of the study were recruited.

RESULTS

Seven organising themes emerged from the data: (1) turmoil of emotions, (2) preparing for the worst, (3) setting of personal milestones, (4) hypervigilance, (5) social isolation, (6) adoption of pragmatic approaches, (7) need for professional affirmation.

CONCLUSIONS

The study established that for women with a history of RM, the waiting period of a new pregnancy is a traumatic time of great uncertainty and emotional turmoil and one in which they express a need for emotional support. Consideration should be given to the manner in which supportive care is best delivered within the constraints of current health service provision.

TRIAL REGISTRATION NUMBER

ISRCTN43571276.

Coping After Involuntary Pregnancy Loss: Perspectives of Spanish European Women

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

Socio-economic correlates of bereavement among women - Examining the differentials on social axes

Death, disease and disaster can inflict anyone, anywhere and at any time. While occurrence of such an event could be absolved of any selective strike, the outcome reflects otherwise. Historical deprivations experienced by certain populations have caused more bereavement and sorrow to them than those who have experienced lesser or no deprivation. Therefore, the process which shapes the factors to yield such a result is important and needs to be understood for any policy suggestions and programmatic inputs. Loss of pregnancy and newborn inflicts sorrow and bereavement across space, time and social labyrinth. The degree of bereavement is likely to reduce with time, but space and social context govern the response to it. Therefore, factors contributing to the differentials vary in their demographic, social and economic characteristics. The loss of pregnancy and newborn remains inadequately addressed. Family and community play a significant role in coping. While the developed countries have institutional structure to address coping with the loss, the South Asian countries rely heavily on the family and the community for such support. The present review examines these trajectories across social groups.

Individual Differences in Maternal, Marital, Parenting and Child Outcomes Following Perinatal Loss: A Longitudinal Study

Objective: To examine the impact of past perinatal loss on mothers and children in a community sample and to consider maternal race and adult attachment status as moderators.Background: Prior perinatal loss has been shown to impact subsequent maternal parenting and child outcomes, but findings have been inconsistent particularly in minority mothers and samples not chosen due to perinatal loss history.Methods: Participants were 204 first-time mothers from a longitudinal study about predictors of sensitivity. Mothers completed the Adult Attachment Interview prenatally and reported on depressive symptoms and marital satisfaction prenatally and at 6 months and 1 year postpartum. Maternal sensitivity was observed at 6 months and 1 year, and infant-mother attachment security was assessed via the Strange Situation when children were 1 year old. Mothers reported on their reproductive history and current attitudes about the target child during the preschool period.Results: Fifty-eight (28.43%) mothers had a history of prior perinatal loss. Between group analysis revealed no differences based on perinatal loss and no moderation by maternal race or adult attachment. However, within the loss group, mothers who experienced losses later in the gestational period had less positive feelings about parenting and their children had less secure attachments to them; and mothers who had more perinatal losses had higher depressive symptoms at 1 year postpartum and less positive attitudes about parenting independent of race and SES.Conclusion: In the circumstance of multiple and later perinatal losses maternal well-being and child outcomes may be negatively impacted.

The Impact of Communication Surrounding Intrauterine Congenital Anomaly Diagnoses: An Integrative Review

Congenital anomalies are the leading cause of infant death in the United States, accounting for 20% of the annual infant mortality. Advancements in ultrasound diagnostic technology allow practitioners to diagnose fetal anomalies as early as 11 weeks' gestational age, 75% of which are detected in low-risk pregnancies. Communicating a fetal anomaly diagnosis to parents and initiating perinatal end-of-life discussions are difficult for healthcare providers and parents alike. Furthermore, poorly communicated diagnoses have had long-term negative impacts on perinatal grief intensity, which can manifest into lifelong symptoms of adverse psychosocial outcomes such as anxiety, depression, substance abuse, and suicidal ideation. The purpose of this integrative review is to examine the impact of communication in discussing an intrauterine diagnosis of a fetal congenital anomaly on perinatal grief. An integrative review was conducted following the distinct 5-stage process of problem identification, searching the literature, evaluating data, analyzing, and presenting findings. A systematic literature review using the PICO model (Population, Intervention, Comparison, Outcome) and structured after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). This framework was completed between November 2017 and May 2018 using PubMed, CINAHL, and PsycINFO databases. Of the 931 article results, 15 satisfied search criteria. Emerging themes included parental need for appropriate time to assimilate and understand the diagnosis, freedom to explore options and alternatives, and the need for clinicians with expert communication skills. The initial conversation communicating the diagnosis of a congenital anomaly impacts expectant parents for the remainder of their lives. Healthcare professionals are in a unique position to either positively or negatively impact the intensity of perinatal grieving reactions. The application of empathetic, sensitive communication may offer solace and promote healing surrounding perinatal end-of-life discussions.