Pregnancy after perinatal loss: A meta-ethnography from a women's perspective

OBJECTIVE

This study uses a meta-ethnography to synthesize qualitative research on the experiences of women during pregnancies after one or more perinatal losses.

DESIGN

This interpretive meta-ethnography followed the Noblit and Hare approach and the eMERGe Meta-ethnography Reporting Guidance. Manual searches and a comprehensive systematic search were conducted in Pubmed, Scopus, Cinahl, Web of Science, and Psycinfo. Eleven studies met the research objective and inclusion criteria.

RESULTS

After reciprocal and refutational translations, the metaphor "The rainbow in the storm" and the following three themes emerged: (i) Between ambivalent feelings; (ii) being careful in the new pregnancy; and (iii) leaning on others. CERQual assessment showed that the results are (highly) reasonable representations of the phenomenon of interest.

CONCLUSIONS

Most women experienced their subsequent pregnancy with ambivalent feelings and needed to reduce expectations, continuously monitor the pregnancy's viability, and eliminate risky behavior to protect themselves. Understanding and recognition by others is needed and appreciated.

IMPLICATIONS FOR PRACTICE

Nurses and midwives play a crucial role in subsequent pregnancies and need to establish a care communion and ethical care during their encounters with affected women whose specific needs need to be incorporated into the guidelines and training curricula of care professionals to equip them with the necessary gender and cultural competences.

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.

A Legacy of Loss: Stories of Replacement Dynamics and the Subsequent Child

This article, a qualitative exploration of the experiences of subsequent children, endeavors to clarify common issues and experiences of this population. Subsequent children, also known as subsequent siblings, are children born after the death of a brother or sister. For this study, 25 adult subsequent siblings participated in semi-structured interviews. Few researchers have written about this population, and much of what has been documented was researched from single case studies, or from very small samples. This study aims to explore the commonalities of the unique experience of being a subsequent child. Themes which emerged include various replacement child dynamics, impaired bonding with parents or altered parenting as a result of the loss, family grief and its repercussions, meaning making and spiritual questioning, fantasies about the lost sibling, disenfranchised and unresolved grief, taking on a caregiver role, and survivor guilt. The implications for clinical practice are presented.

Interconception care for couples after perinatal loss: a comprehensive review of the literature

Perinatal loss can be emotionally devastating for couples who experience miscarriage, fetal or neonatal death. Nurses in a variety of settings can assist couples through their grief by providing emotional support, giving information about the grief process, and in planning for a future pregnancy or deciding to forego future childbearing. This article explicates the relationship between grief and perinatal loss and its effects on couples, specifically in the interconception period, when the initial grief and distress have begun to subside. Interconception care focuses on bridging the couple from the end of the postpartum period to the subsequent pregnancy or decision not to conceive again. Nurses assist couples in distinguishing between uncomplicated grief, complicated grief, and depression, and make appropriate referrals. Openness to expressions of grief, helping couples mobilize support, considering readiness for another pregnancy, and directing couples to useful Internet sites are essential nursing interventions.

Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss

BACKGROUND

Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally.

OBJECTIVES

To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss.

METHODS

In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70.

RESULTS

Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping.

DISCUSSION

Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.

Social and Professional Support Needs of Families After Perinatal Loss

Perinatal loss has been associated with depression, anxiety, obsessive-compulsive disorder, suicide, marital conflict, and post-traumatic stress disorder. Nurses may provide professional support through teaching, role modeling, encouragement, counseling, problem solving, and other interventions. Nurses also may encourage more effective social support by helping significant others to provide willing, well-intentioned action that will produce a positive response in the bereaved couple. Interventions to increase professional and social support after perinatal loss are described.

Interconceptional counseling after perinatal and infant loss

Historically, preconceptional health promotion has been recommended for all prospective parents to improve perinatal outcomes. Preconceptional health promotion and interconceptional counseling may be even more beneficial for parents who have had previous perinatal losses. Perinatal loss can be devastating, with long-term effects on subsequent pregnancies and children. A theoretical framework for interconceptional counseling after perinatal loss needs to be developed. Interconceptional counseling can give couples important information to improve outcomes, acknowledge fears and anxieties, evaluate genetic risks, facilitate grieving, and explore attachment and parenting issues.