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Fletcher R, Regan C, May C, Rennie A, Ludski K, George JS. Developing text-messaging support for fathers after perinatal loss. Women Birth 2024; 37:101594. [PMID: 38508068 DOI: 10.1016/j.wombi.2024.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Perinatal loss is a devastating occurrence for expecting parents. Although both parents are affected, research on fathers' grief has not resulted in effective support services for fathers. AIM To describe a multi-stage co-design process for developing text messaging support for fathers experiencing perinatal loss. METHODS Co-designed text messages were developed in collaboration with a perinatal bereavement organisation, mothers and fathers with lived experience of perinatal loss, and clinicians working with bereaved parents. Bereaved parents responded to a survey about bereaved fathers' information needs (stage 1). A qualitative descriptive data analysis created topics for the generation of text messages (stage 2). Parents with lived experience and clinicians evaluated the messages on importance and clinical fit (stage 3). Messages were revised (stage 4), followed by parent and clinician evaluation and final message revision (stage 5). FINDINGS There were 959 survey respondents; the majority agreed that support for fathers would have been useful; 539 provided comments. Qualitative analysis created twelve topics within three themes, leading to the generation of 64 text messages. Messages were evaluated by 27 lived experience parents and 19 clinicians as important (91.6%) and understandable (91.3%), and 92.5% of clinicians agreed the messages fitted clinical guidelines. Message revision resulted in 59 messages across three themes. The final evaluation by 12 parents and 14 clinicians led to a final revised set of 52 messages. CONCLUSION Text-based support for bereaved fathers can be developed in a co-design process to accord with clinical practice, from topics suggested parents with lived experience.
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Affiliation(s)
- Richard Fletcher
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia.
| | - Casey Regan
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Chris May
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | | | | | - Jennifer St George
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
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Pekyiğit A, Yildiz D, Deniz AÖ, Çalik Bağriyanik B. White Tears: A Phenomenological Study of Perinatal Loss. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241234381. [PMID: 38356333 DOI: 10.1177/00302228241234381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- Aylin Pekyiğit
- Faculty of Health Sciences, Department of Pediatric Nursing, Çankırı Karatekin University, Çankiri, Turkey
| | - Dilek Yildiz
- Gülhane Faculty of Nursing, Department of Pediatric Nursing, Health Sciences University, Ankara, Turkey
| | - Ayşe Özge Deniz
- Faculty of Health Sciences, Department of Pediatric Nursing, Çankırı Karatekin University, Çankiri, Turkey
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Fernández-Basanta S, Rodríguez-Pérez R, Coronado C, Movilla-Fernández MJ. Knight by force and wounded, protecting without a shield: A meta-ethnography of men's experiences after an involuntary pregnancy loss. Midwifery 2023; 126:103827. [PMID: 37741180 DOI: 10.1016/j.midw.2023.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/15/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
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.
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Affiliation(s)
- Sara Fernández-Basanta
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain.
| | - Rita Rodríguez-Pérez
- Nurse. University Hospital Complex of A Coruña, Galician Health Service (SERGAS), As Xubias, 84, A Coruña 15006, Spain
| | - Carmen Coronado
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
| | - María-Jesús Movilla-Fernández
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
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Kwesiga D, Wanduru P, Eriksson L, Malqvist M, Waiswa P, Blencowe H. Psychosocial effects of adverse pregnancy outcomes and their influence on reporting pregnancy loss during surveys and surveillance: narratives from Uganda. BMC Public Health 2023; 23:1581. [PMID: 37596665 PMCID: PMC10439567 DOI: 10.1186/s12889-023-16519-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In 2021, Uganda had an estimated 25,855 stillbirths and 32,037 newborn deaths. Many Adverse Pregnancy Outcomes (APOs) go unreported despite causing profound grief and other mental health effects. This study explored psychosocial effects of APOs and their influence on reporting these events during surveys and surveillance settings in Uganda. METHODS A qualitative cross-sectional study was conducted in September 2021 in Iganga Mayuge health and demographic surveillance system site, eastern Uganda. Narratives were held with 44 women who had experienced an APO (miscarriage, stillbirth or neonatal death) and 7 men whose spouses had undergone the same. Respondents were purposively selected and the sample size premised on the need for diverse respondents. Reflexive thematic analysis was undertaken, supported by NVivo software. RESULTS 60.8% of respondents had experienced neonatal deaths, 27.4% stillbirths, 11.8% miscarriages and almost half had multiple APOs. Theme one on psychosocial effects showed that both women and men suffered disbelief, depression, shame and thoughts of self-harm. In theme two on reactions to interviews, most respondents were reminded about their loss. Indeed, some women cried and a few requested termination of the interview. However, many said they eventually felt better, especially where interviewers comforted and advised them. In theme three about why people consent to such interviews, it was due to the respondents' need for sensitization on causes of pregnancy loss and danger signs, plus the expectation that the interview would lead to improved health services. Theme four on suggestions for improving interviews highlighted respondents' requests for a comforting and encouraging approach by interviewers. CONCLUSION Psychosocial effects of APOs may influence respondents' interest and ability to effectively engage in an interview. Findings suggest that a multi-pronged approach, including interviewer training in identifying and dealing responsively with grieving respondents, and meeting needs for health information and professional counselling could improve reporting of APOs in surveys and surveillance settings. More so, participants need to understand the purpose of the interview and have realistic expectations.
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Affiliation(s)
- Doris Kwesiga
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Phillip Wanduru
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Leif Eriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Abayneh M, Rent S, Ubuane PO, Carter BS, Deribessa SJ, Kassa BB, Tekleab AM, Kukora SK. Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development. Front Pediatr 2023; 11:1217209. [PMID: 37435165 PMCID: PMC10331424 DOI: 10.3389/fped.2023.1217209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.
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Affiliation(s)
- Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Duke Department of Pediatrics, Duke School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | - Brian S. Carter
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Solomie Jebessa Deribessa
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelehem B. Kassa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie K. Kukora
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Bilardi J, Webb A, Trieu VH, Sharp G, McIntosh J, Temple-Smith M. Miscarriage Australia: the use of a human centered design approach to design and develop a website for those affected by miscarriage. Front Public Health 2023; 11:1128768. [PMID: 37250069 PMCID: PMC10213628 DOI: 10.3389/fpubh.2023.1128768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Past research has shown that Australians affected by miscarriage want a website specific to both miscarriage and their local region that is accessible, comprehensive, evidence-based and informed by experts. The aim of this study was to design, develop and evaluate the Miscarriage Australia website using human centered design. Methods A four stage human centered design approach was used to develop the Miscarriage Australia website which aimed to: (1) Understand the issue and why users need a website; (2) Define users' specific needs; (3) Design solutions to meet those needs; and (4) Evaluate the design by testing with end users. Across the four stages, various types of data and data analysis were developed and utilized including interviews, desktop research, development of personas and tone of voice, followed by usability testing. Process and content were guided by designers, developers and an expert advisory committee of key stakeholders. Results Analysis and synthesis of user research across Stages 1 and Stage 2 found 11 key themes pertaining to user's miscarriage experiences and support needs. Using the themes, common experiences, goals, motivations and behaviors of users were identified and similar user types grouped and used to inform the development of two personas. Using the personas and user research findings, design elements (Stage 3) including the "tone of voice guidelines" were developed recommending the Miscarriage Australia website be calm, empathetic, hopeful and authoritative. The tone of voice guidelines guided branding and over 100 pages of content was informed by the research team and reviewed by a 13-member Expert Clinical Advisory Committee over two rounds to ensure it was evidence based and reflected best practice. Using a contextual inquiry approach, usability testing was undertaken with 8 end users to test a low fidelity mockup and high-fidelity prototype of the website. Overall, end users reported the website was highly acceptable in terms of the design, content, layout, language and terminology, describing it in line with the intended tone of voice. Users reported the website was easy to use and navigate and provided useful and appropriate content and resources. Minor areas for improvement included slight changes to specific images, improved links for navigating sections, and a title change to one section heading. Conclusion The Miscarriage Australia website was successfully implemented and commended by users as meeting their needs. As a result of using human centered design, the Miscarriage Australia website provides an ideal template or blueprint on how to develop a successful and useful digital resource for users, particularly around sensitive women's health issues.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Amy Webb
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Van-Hau Trieu
- Department of Information Systems and Business Analytics, Deakin University, Melbourne, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jennifer McIntosh
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- HumaniSE Lab, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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Burgess A, Murray C, Clancy A. Fathers' Relational Experiences of Stillbirth: Pre-natal Attachment, Loss and Continuing Bonds Through Use of Objects. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231162736. [PMID: 36927236 DOI: 10.1177/00302228231162736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study aimed to investigate fathers' lived experiences of stillbirth through the lens of continuing bonds and use of objects. Semi-structured interviews were conducted with six fathers who had experienced stillbirth from 20 weeks gestation. Interpretative phenomenological analysis revealed five themes: loss and continued bonds in a mother-mediated dynamic, objects as manifestations of relational and meaningful memories, exerting existence and continued connection to others, continued bond through physical presence and evolving expressions of love and fatherhood. Findings offer a novel understanding of the relationship between objects and continued bonds, where objects are seen to facilitate this bond through varying means, including physical manifestation of the deceased and representation of the father-infant relationship. The study places importance on fathers' involvement in creating objects permeated with meaning and memories, and of validating fathers' experiences of loss rather than considering these men merely as partners of a mother who lost their own baby.
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Affiliation(s)
- Amy Burgess
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Craig Murray
- Doctorate in Clinical Psychology, Lancaster University, UK
| | - Anna Clancy
- Doctorate in Clinical Psychology, Lancaster University, UK
- Aching Arms, Brentwood, UK
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Mota C, Sánchez C, Carreño J, Gómez ME. Paternal Experiences of Perinatal Loss-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4886. [PMID: 36981791 PMCID: PMC10049302 DOI: 10.3390/ijerph20064886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Perinatal grief is one of the most complex and devastating types of mourning for both mothers and fathers; however, there is still little research on the psychological impact on men who experience it. Therefore, the objective of this study was to summarize and synthetize the existing literature on the way men's grief is experienced. METHODS A search was carried out to examine three databases for articles published in the last four years; 56 articles were obtained, and 12 were retained for analysis. RESULTS Four common themes were found: the men's experience of grief, their role as fathers, the impact of the death, and their needs regarding grief and how to face it. CONCLUSIONS There is also a need for discussion of the importance of validating perinatal grief in men and studies that examine it without social gender stigmas in order to provide them with effective emotional support.
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Affiliation(s)
- Cecilia Mota
- Research Coordination in Psychology, National Institute of Perinatology, Mexico City 11000, Mexico
| | - Claudia Sánchez
- Research Coordination in Psychology, National Institute of Perinatology, Mexico City 11000, Mexico
| | - Jorge Carreño
- Research Coordination in Psychology, National Institute of Perinatology, Mexico City 11000, Mexico
| | - María Eugenia Gómez
- Department of Neurosciences, National Institute of Perinatology, Mexico City 11000, Mexico
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Delgado L, Cobo J, Giménez C, Fucho-Rius GF, Sammut S, Martí L, Lesmes C, Puig S, Obregón N, Canet Y, Palao DJ. Initial Impact of Perinatal Loss on Mothers and Their Partners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1304. [PMID: 36674059 PMCID: PMC9858910 DOI: 10.3390/ijerph20021304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.
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Affiliation(s)
- Laia Delgado
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Institut d’Investigació i Innovació Parc Taulí (I3PT), CERCA, 08208 Sabadell, Spain
| | - Cristina Giménez
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Genís Felip Fucho-Rius
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Stephanie Sammut
- Perinatal Mental Health Program, Cerdanyola-Ripollet Outpatient Department, Sant Joan de Dèu Serveis de Salut Mental, 08291 Ripollet, Spain
| | - Laia Martí
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Cristina Lesmes
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Salut Puig
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Noemí Obregón
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Yolanda Canet
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Diego J. Palao
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Institut d’Investigació i Innovació Parc Taulí (I3PT), CERCA, 08208 Sabadell, Spain
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Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Wischmann T, Kuon RJ. The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men. Geburtshilfe Frauenheilkd 2023; 83:88-96. [PMID: 36643876 PMCID: PMC9835763 DOI: 10.1055/a-1916-9180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.
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Affiliation(s)
- Emily Kuhlmann
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Scharli
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Ruben-J. Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Korrespondenzadresse Prof. Dr. Ruben-J. Kuon Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s HospitalIm Neuenheimer Feld 44069120 HeidelbergGermany
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11
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Gilbert SL, Dimoff JK, Brady JM, Macleod R, McPhee T. Pregnancy loss: A qualitative exploration of an experience stigmatized in the workplace. JOURNAL OF VOCATIONAL BEHAVIOR 2023. [DOI: 10.1016/j.jvb.2023.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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12
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Levy S, Avitsur R. Gender Differences in the Development of Posttraumatic Stress Symptoms Following Pregnancy Loss: Social Support and Causal Attributes. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Samman SK, Frick HA, Dansby Olufowote RA. Medical Family Therapy with Diverse Populations Part I: interracial Couples Navigating Infertility, Racialized Pregnancy, and Pregnancy Loss. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2022. [DOI: 10.1080/2692398x.2022.2128623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sarah K. Samman
- Couple and Family Therapy, Alliant International University, San Diego, California, USA
| | - Heather A. Frick
- Couple and Family Therapy, Alliant International University, San Diego, California, USA
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14
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Testoni I, Ronconi L, Iacona E, Trainini A, Tralli N, Nodari L, Limongelli G, Cena L. The impact of the COVID-19 pandemic on perinatal loss among Italian couples: A mixed-method study. Front Psychol 2022; 13:929350. [PMID: 36172232 PMCID: PMC9510916 DOI: 10.3389/fpsyg.2022.929350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPerinatal bereavement is an event that greatly impacts the emotional, psychological, and psychosocial aspects of those who want to have a child.ObjectivesSince there are few studies on the psychological impact of the COVID-19 pandemic on couples grieving for perinatal loss, this research aimed to survey this experience.ParticipantsBetween 2020 and 2021, in Italian provinces highly affected by the COVID-19 pandemic, 21 parents participated: 16 mothers (76%; mean age 36.2; SD: 3.1) and 5 fathers (24%; mean age 40.2; SD: 3.4), among which there were 4 couples.MethodsA mixed-method design was used through self-report questionnaires and in-depth interviews. Accompanied by a sociodemographic form, the following questionnaires were administered: Prolonged Grief-13, the Parental Assessment of Paternal Affectivity (PAPA) (to fathers), the Parental Assessment of Maternal Affectivity (PAMA) (to mothers), the Dyadic Adjustment Scale short version, the Daily Spiritual Experiences Scale, and the Impact of Event Scale-Revised. The texts obtained through the in-depth interviews underwent thematic analysis.ResultsFifty per cent of participants suffered from Post-Traumatic Stress Disorders (PTSD) symptoms and 20% suffered from relational dyadic stress. Four areas of thematic prevalence emerged: psychological complexity of bereavement, the impact of the COVID-19, disenfranchisement vs. support, and spirituality and contact with the lost child. Participants interpreted their distress as related to inadequate access to healthcare services, and perceiving the pandemic restrictions to be responsible for less support and lower quality of care. Furthermore, they needed psychological help, and most of them were unable to access this service. Spirituality/religiosity did not help, while contact with the fetus and burial did.ConclusionIt is important to implement psychological services in obstetrics departments to offer adequate support, even in pandemic situations.
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15
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Loughnan SA, Boyle FM, Ellwood D, Crocker S, Lancaster A, Astell C, Dean J, Horey D, Callander E, Jackson C, Shand A, Flenady V. Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death. Trials 2022; 23:464. [PMID: 35668502 PMCID: PMC9167910 DOI: 10.1186/s13063-022-06363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth and neonatal death are devastating pregnancy outcomes with long-lasting psychosocial consequences for parents and families, and wide-ranging economic impacts on health systems and society. It is essential that parents and families have access to appropriate support, yet services are often limited. Internet-based programs may provide another option of psychosocial support for parents following the death of a baby. We aim to evaluate the efficacy and acceptability of a self-guided internet-based perinatal bereavement support program "Living with Loss" (LWL) in reducing psychological distress and improving the wellbeing of parents following stillbirth or neonatal death. METHODS This trial is a two-arm parallel group randomized controlled trial comparing the intervention arm (LWL) with a care as usual control arm (CAU). We anticipate recruiting 150 women and men across Australia who have experienced a stillbirth or neonatal death in the past 2 years. Participants randomized to the LWL group will receive the six-module internet-based program over 8 weeks including automated email notifications and reminders. Baseline, post-intervention, and 3-month follow-up assessments will be conducted to assess primary and secondary outcomes for both arms. The primary outcome will be the change in Kessler Psychological Distress Scale (K10) scores from baseline to 3-month follow-up. Secondary outcomes include perinatal grief, anxiety, depression, quality of life, program satisfaction and acceptability, and cost-effectiveness. Analysis will use intention-to-treat linear mixed models to examine psychological distress symptom scores at 3-month follow-up. Subgroup analyses by severity of symptoms at baseline will be undertaken. DISCUSSION The LWL program aims to provide an evidence-based accessible and flexible support option for bereaved parents following stillbirth or neonatal death. This may be particularly useful for parents and healthcare professionals residing in rural regions where services and supports are limited. This RCT seeks to provide evidence of the efficacy, acceptability, and cost-effectiveness of the LWL program and contribute to our understanding of the role digital services may play in addressing the gap in the availability of specific bereavement support resources for parents following the death of a baby, particularly for men. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12621000631808 . Registered prospectively on 27 May 2021.
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Affiliation(s)
- Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,School of Medicine, Griffith University, Parklands Drive, Gold Coast, QLD, Australia.,Gold Coast University Hospital, 1 Hospital Drive, Southport, QLD, Australia
| | - Sara Crocker
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Ann Lancaster
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Chrissie Astell
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Julie Dean
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, Australia
| | - Dell Horey
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,La Trobe University, Plenty Rd &, Kingsbury Dr, Bundoora, VIC, Australia
| | - Emily Callander
- Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
| | | | - Antonia Shand
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
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16
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Davis CE, Lamson AL, Meier EM, Pratt GA. The Intersect of Pregnancy Loss, Trauma, and Spirituality: A Dyadic Perspective. Matern Child Health J 2022; 26:1709-1718. [PMID: 35654999 DOI: 10.1007/s10995-022-03452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Pregnancy loss and trauma are unexpected yet frequent occurrences for females in the United States, however little research exists on the role of pregnancy loss and trauma with both partners in couple relationships. The purpose of this study was to use dyadic analyses to better understand the role of trauma, spirituality, and pregnancy loss in the context of the couple relationship. METHOD Drawn from a secondary data set, the dyadic sample included survey responses from (n = 97) matched, pregnant heterosexual couples. Couples responded to questions related to traumatic experiences, previous pregnancy history, relationship satisfaction, and spirituality. Actor-partner independence models were conducted to explore pregnancy loss, trauma, and spirituality on relationship satisfaction. RESULTS Female partner's experience of trauma and loss predicted relationship satisfaction, but the male partner's experience did not. In addition, spirituality moderated the effects of loss and trauma for female partners but not for male partners. CONCLUSION The outcomes from this study punctuated the importance of learning about relational dynamics (e.g., pregnancy and interpersonal traumas) through dyadic samples and analyses. Implications include research and clinical recommendations to incorporate biopsychosocial-spiritual metrics into research designs with diverse samples and dyads.
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Affiliation(s)
- Corin E Davis
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA
| | - Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA.
| | - Emily M Meier
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA
| | - Grace A Pratt
- Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA
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17
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Heaney S, Tomlinson M, Aventin Á. Termination of pregnancy for fetal anomaly: a systematic review of the healthcare experiences and needs of parents. BMC Pregnancy Childbirth 2022; 22:441. [PMID: 35619067 PMCID: PMC9137204 DOI: 10.1186/s12884-022-04770-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/16/2022] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Improved technology and advances in clinical testing have resulted in increased detection rates of congenital anomalies during pregnancy, resulting in more parents being confronted with the possibility of terminating a pregnancy for this reason. There is a large body of research on the psychological experience and impact of terminating a pregnancy for fetal anomaly. However, there remains a lack of evidence on the holistic healthcare experience of parents in this situation. To develop a comprehensive understanding of the healthcare experiences and needs of parents, this systematic review sought to summarise and appraise the literature on parents' experiences following a termination of pregnancy for fetal anomaly. REVIEW QUESTION What are the healthcare experiences and needs of parents who undergo a termination of pregnancy following an antenatal diagnosis of a fetal anomaly? METHODS A systematic review was undertaken with searches completed across six multi-disciplinary electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane). Eligible articles were qualitative, quantitative or mixed methods studies, published between January 2010 and August 2021, reporting the results of primary data on the healthcare experiences or healthcare needs in relation to termination of pregnancy for fetal anomaly for either, or both parents. Findings were synthesised using Thematic Analysis. RESULTS A total of 30 articles were selected for inclusion in this review of which 24 were qualitative, five quantitative and one mixed-methods. Five overarching themes emerged from the synthesis of findings: (1) Contextual impact on access to and perception of care, (2) Organisation of care, (3) Information to inform decision making, (4) Compassionate care, and (5) Partner experience. CONCLUSION Compassionate healthcare professionals who provide non-judgemental and sensitive care can impact positively on parents' satisfaction with the care they receive. A well organised and co-ordinated healthcare system is needed to provide an effective and high-quality service. TRIAL REGISTRATION PROSPERO registration number: CRD42020175970 .
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland.
| | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, MBC Building, BT9 7BL, Belfast, Northern Ireland
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18
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Alcocer FED, Bignotto KB, Barbosa GDS. Abordagem psicossocial às perdas gestacionais na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: Perdas gestacionais são eventos comuns na vida reprodutiva. Tendo em vista a dificuldade individual e profissional de lidar com o sofrimento mental que ocasionam, indaga-se sobre a escolha da técnica, a periodicidade e o modo de execução das abordagens que melhor se adequariam ao enfrentamento dessa situação. Sendo assim, esta revisão clínica tem como objetivo avaliar a literatura recente acerca do tema e buscar as melhores evidências científicas em relação à abordagem psicossocial a essas perdas. Métodos: Foram utilizadas palavras-chave determinadas pelo Medical Subject Headings (MeSH) para selecionar títulos de estudos nas bases de dados: PubMed, ACCESSSS, British Medical Journal (BMJ), DYNAMED, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os critérios de inclusão foram: ano de publicação entre 2010 e 2020; tipo de estudo (metanálise, revisão sistemática, ensaio clínico randomizado, ensaio clínico não randomizado, coorte ou caso controle); não abordar abortamento induzido; estar em inglês, português ou espanhol; ser passível de ser encontrado na íntegra. Resultados: Foram encontrados 28 artigos, que tiveram seus resumos avaliados; 14 foram excluídos e 14 lidos na íntegra. No fim, nove estudos foram incluídos nesta revisão. Foi possível observar que sintomas psicológicos são frequentemente apresentados após perdas gestacionais, que há diversas maneiras de acessar esses dados e que não há consenso sobre qual a melhor intervenção a ser feita. Além disso, em homens e casais homossexuais, há maior chance de invisibilidade do sofrimento e menor abordagem de luto por profissionais de saúde. Conclusão: Na falta de consenso sobre quais intervenções apresentam melhores resultados, recomenda-se o rastreamento de sofrimento mental e o compartilhamento da decisão com as partes envolvidas.
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19
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Fernández-Basanta S, Coronado C, Movilla-Fernández MJ. Double-Layer Masking of Suffering After Pregnancy Loss: A Grounded Theory Study from a Male Perspective. J Midwifery Womens Health 2022; 67:470-477. [PMID: 35277916 PMCID: PMC9545819 DOI: 10.1111/jmwh.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Sara Fernández-Basanta
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
| | - Carmen Coronado
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
| | - María-Jesús Movilla-Fernández
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
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20
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Harty T, Trench M, Keegan O, O'Donoghue K, Nuzum D. The experiences of men following recurrent miscarriage in an Irish tertiary hospital: A qualitative analysis. Health Expect 2022; 25:1048-1057. [PMID: 35243718 PMCID: PMC9122424 DOI: 10.1111/hex.13452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Tommy Harty
- Department of Medicine, Cork University Hospital, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Maria Trench
- Graduate School of Healthcare Management, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Orla Keegan
- Graduate School of Healthcare Management, Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Education and Bereavement, Irish Hospice Foundation, Dublin, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.,The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Daniel Nuzum
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
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21
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Perceived Partner's Self-Control and Social Support Effects on Relationship Satisfaction in Couples Experiencing Infertility or Miscarriage: Dyadic Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041970. [PMID: 35206157 PMCID: PMC8872363 DOI: 10.3390/ijerph19041970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
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.
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22
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Azeez S, Obst KL, Due C, Oxlad M, Middleton P. Overwhelming and unjust: A qualitative study of fathers' experiences of grief following neonatal death. DEATH STUDIES 2022; 46:1443-1454. [PMID: 35107411 DOI: 10.1080/07481187.2022.2030431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research has examined the grief experiences of fathers following neonatal death. Using a qualitative research design, ten fathers were interviewed, and thematic analysis resulted in three overarching themes: 'A complicated grief experience: Neonatal death is highly emotional', 'Grief is multidimensional' and 'Sense of injustice'. Overall, results showed that grief was a multidimensional experience for fathers, with expressions of grief including strong feelings of anger and guilt and the manifestation of grief in physical symptoms. In addition, the findings also indicated a sense of injustice that contributed to the disenfranchisement of grief for fathers. The results of this study contribute to developing a better understanding of the grief that fathers experience following neonatal death, and can inform improvements in healthcare practices after the death of a baby in the neonatal period, including father-specific programs and adequate provision of information.
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Affiliation(s)
- Shazleen Azeez
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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23
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du Fossé NA, Lashley EELO, Treurniet TT, van Lith JMM, le Cessie S, Boosman H, van der Hoorn MLP. Exploring gender differences among couples with unexplained recurrent pregnancy loss regarding preferences for supportive care. BMC Pregnancy Childbirth 2021; 21:796. [PMID: 34847864 PMCID: PMC8630871 DOI: 10.1186/s12884-021-04277-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
Background International guidelines recommend to offer supportive care during a next pregnancy to couples affected by recurrent pregnancy loss (RPL). In previous research, several options for supportive care have been identified and women’s preferences have been quantified. Although it is known that RPL impacts the mental health of both partners, male preferences for supportive care have hardly been explored. Methods A cross-sectional study was conducted in couples who visited a specialized RPL clinic in the Netherlands between November 2018 and December 2019. Both members of the couples received a questionnaire that quantified their preferences for supportive care in a next pregnancy and they were asked to complete this independently from each other. Preferences for each supportive care option were analysed on a group level (by gender) and on a couple level, by comparing preferences of both partners. Results Ninety-two questionnaires (completed by 46 couples) were analysed. The overall need for supportive care indicated on a scale from 1 to 10 was 6.8 for men and 7.9 for women (P = 0.002). Both genders preferred to regularly see the same doctor with knowledge of their obstetric history, to make a plan for the first trimester and to have frequent ultrasound examinations. A lower proportion of men preferred a doctor that shows understanding (80% of men vs. 100% of women, P = 0.004) and a doctor that informs on wellbeing (72% vs. 100%, P = ≤0.000). Fewer men preferred support from friends (48% vs. 74%, P = 0.017). Thirty-seven percent of men requested more involvement of the male partner at the outpatient clinic, compared to 70% of women (P = 0.007). In 28% of couples, partners had opposing preferences regarding peer support. Conclusions While both women and men affected by RPL are in need of supportive care, their preferences may differ. Current supportive care services may not entirely address the needs of men. Health care professionals should focus on both partners and development of novel supportive care programs with specific attention for men should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04277-4.
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Affiliation(s)
- N A du Fossé
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.
| | - E E L O Lashley
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - T T Treurniet
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - J M M van Lith
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - H Boosman
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, 2333 ZA, the Netherlands
| | - M L P van der Hoorn
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
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24
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Westby CL, Erlandsen AR, Nilsen SA, Visted E, Thimm JC. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy Childbirth 2021; 21:782. [PMID: 34794395 PMCID: PMC8600867 DOI: 10.1186/s12884-021-04254-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This systematic review aimed to provide an updated summary of studies investigating depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) in parents after stillbirth (from 20 weeks gestational age until birth). METHODS A literature search was conducted in the databases Web of Science and PsychINFO. Main inclusion criteria were 1) peer-reviewed, quantitative, English-language articles published from 1980; (2) studies investigating depression, anxiety, PTSD, or OCD among parents following stillbirth; and (3) studies defining stillbirth as equal to or after 20 weeks of gestation. RESULTS Thirteen quantitative, peer-reviewed articles were eligible for inclusion. Selected articles investigated depression, anxiety, and PTSD, while no studies on OCD met our inclusion criteria. The majority of studies investigated women, while only two studies included men. The results indicated heightened short- and long-term levels of depression, anxiety, and PTSD in parents after stillbirth compared to those of parents with live birth. Studies investigating predictors found that social support, marital status, negative appraisals, and variables related to care and management after stillbirth affected levels of symptoms. CONCLUSIONS Parents who experience stillbirth have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births. More longitudinal studies are needed to increase our knowledge of how symptoms develop over time, and more research on fathers, transgender, non-binary and gender fluid individuals is needed. Research on the association between stillbirth and OCD is also warranted. Knowledge of the severity of anxiety, depression, and PTSD after stillbirth, and predictors associated with symptom severity could provide healthcare professionals with valuable information on how to provide beneficial postpartum care.
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Affiliation(s)
- Cèline Lossius Westby
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway
| | - Andrea Røsberg Erlandsen
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Jens C Thimm
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway.
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Clark OE, Fortney CA, Dunnells ZDO, Gerhardt CA, Baughcum AE. Parent Perceptions of Infant Symptoms and Suffering and Associations With Distress Among Bereaved Parents in the NICU. J Pain Symptom Manage 2021; 62:e20-e27. [PMID: 33631329 DOI: 10.1016/j.jpainsymman.2021.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Healthcare providers and parents face many challenges caring for infants at the end of life (EOL). Symptom assessment and management in critically ill infants can be especially difficult. However, the impact of the infant's EOL experience on bereaved parents is largely unknown. OBJECTIVE Explore associations between parental perceptions of infant symptoms and suffering at EOL in the neonatal intensive care unit (NICU) and parent adjustment following the death. METHODS Retrospective, cross-sectional pilot study involving parents of infants who died within the previous five years in a large, Midwestern, level IV NICU. Parents were recruited through mailed invitations, and 40 mothers and 27 fathers participated from 40 families. Parents retrospectively reported on infant symptom burden and suffering during the last week of life and the Impact of Events Scale-Revised (IES-R), and Prolonged Grief-13 (PG-13). Hierarchical regressions examined demographic/medical factors and parent perceptions at EOL in relation to post-traumatic stress symptoms (PTSS) and prolonged grief (PG). RESULTS Clinical levels of PTSS (Mothers = 18%; Fathers = 11%) and PG (Mothers and Fathers = 3%) were low. Maternal perception of higher symptom burden was associated with greater PTSS, R2 = 0.46, P= 0.001, and PG, R2 = 0.47, P < 0.01. Paternal perception of greater infant suffering was associated with greater PTSS, R2 = 0.48, P= 0.001, and PG, R2 = .38, P < 0.01. CONCLUSION Perceptions of symptoms and suffering were associated differently with mother and father adjustment after bereavement. While not necessarily causal, better symptom management at EOL could minimize distress for both infants and their parents.
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Affiliation(s)
- Olivia E Clark
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christine A Fortney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Zackery D O Dunnells
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Amy E Baughcum
- College of Nursing, The Ohio State University, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
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Abstract
Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.
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Meunier S, de Montigny F, Zeghiche S, Lalande D, Verdon C, Da Costa D, Feeley N. Workplace experience of parents coping with perinatal loss: A scoping review. Work 2021; 69:411-421. [PMID: 34092690 DOI: 10.3233/wor-213487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Perinatal loss affects many parents in the workforce. Yet, current knowledge about their workplace experience while facing this difficult event is sparse. OBJECTIVES The goal of this study was to review and synthesize the extent of scientific literature on the specific experiences of workers coping with perinatal loss and the resulting bereavement. METHODS A scoping review was carried out using eight different databases. A total of 15 references, all using a qualitative methodology, were identified. RESULTS Most of the references focused on the experience of mothers and on late perinatal loss (from the 20th week of pregnancy). All references highlighted the taboo and the non-recognition of perinatal grief and bereavement in both organizational practices and interpersonal relationships with colleagues and immediate supervisors. They also emphasized the difficulties associated with returning to work after the loss and the significant changes in the meaning attributed to work. CONCLUSIONS While the studies included in this review clearly indicate that perinatal loss can affect working life, larger, quantitative studies are needed to quantify this phenomenon and its impact on employees and their organizations.
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The unheard parental cry of a stillbirth: fathers and mothers. Arch Gynecol Obstet 2021; 305:313-322. [PMID: 34117899 DOI: 10.1007/s00404-021-06120-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Our objective was to compare the prevalence of depression, anxiety, stress, and domestic violence among parents after a stillbirth vs. livebirths and assessing of the need for psychological and pharmacological interventions for the affected individuals. METHODS This was a prospective cohort study conducted in a tertiary care public sector hospital Northern India. 150 consecutive couples with a recent stillbirth (group 1) and 150 couples with a recent live birth (group 2) were enrolled. They were screened for depression (EPDS scale), anxiety (GAD-7), stress (PSS). Apriori sample size was calculated. Screen positive mothers and fathers were compared for the presence of depression, anxiety and stress, domestic violence, and need for treatment interventions. RESULTS Depression was higher in group 1 mothers (39.3 vs 14.0%, p < 0.001) as well as fathers (18.1 vs 6.7%, p value = 0.022). Anxiety and moderate to severe stress were also significantly higher in stillborn than liveborn groups respectively. Characteristics associated with higher risk are analyzed. Domestic violence was found in 6.7% in group 1 and 2.7% in group 2 mothers (p value 0.169). Pharmacotherapy and counselling were required by 11.3 and 18.0% in stillbirth versus 3.3 and 18.7% in livebirth group, respectively. CONCLUSION Couples suffering stillbirths are at higher risk of depression, anxiety, and stress. We highlight this obstetrical public health issue, especially for the low middle income countries (LMIC) and advocate development of health policies for mental health screening of couples suffering stillbirths.
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Abstract
Importance Psychological reactions to perinatal loss, although often self-limited, may lead to significant psychological morbidities. Obstetrician-gynecologists and other maternal health providers play a key role in recognizing the range of psychological responses to perinatal loss and providing education, support, and treatment options to their patients. Objective This review aims to define psychological reactions associated with perinatal loss, examine psychotherapy and psychopharmacologic treatments for psychiatric morbidities, discuss interpregnancy interval following perinatal loss, and highlight brief, psychological interventions that can be implemented by maternal health providers. Evidence Acquisition Search terms "perinatal loss psychology," "reproductive loss grief," "perinatal psychopharmacology," "psychopharmacology grief," and "interpregnancy interval" were utilized to search PubMed, Google Scholar, and PsycINFO. Results Grief is an expected, normal response to perinatal loss. Psychological morbidities, including major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder, are also associated with perinatal loss. Risk factors for these conditions include history of a psychiatric illness, childlessness, unknown cause of perinatal loss, limited social support, and marital/relationship discord. Careful interviewing and brief screening measures can help identify patients who may suffer from depressive or anxiety disorders following reproductive loss. Patients with perinatal loss can benefit from psychological and possibly pharmacologic treatments. Recommended interpregnancy interval after perinatal loss should be customized by gestational age and cause of loss. Conclusions and Relevance Patients with perinatal loss emotionally benefit from their reproductive health care providers acknowledging the psychological aspects of reproductive loss, inquiring about their emotional needs, and providing information regarding grief and mental health referrals.
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Perinatal Grief and Post-Traumatic Stress Disorder in Pregnancy after Perinatal Loss: A Longitudinal Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062874. [PMID: 33799743 PMCID: PMC8001458 DOI: 10.3390/ijerph18062874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Background: Pregnancies that follow perinatal loss are often associated with mental health disorders, which are not usually treated or even identified. Objectives: The main study aim is to identify the prevalence of symptoms of post-traumatic stress disorder and complicated perinatal grief at different stages of pregnancy following a prior gestational loss. Methods: This descriptive longitudinal study will be conducted with a twelve-month follow-up. The study variables addressed will include sociodemographic data (age, sex, education, marital status, employment status and obstetric history) together with clinical data on complicated perinatal grief and post-traumatic stress disorder scores. Results: The results obtained are expected to provide a new perspective on the healthcare approach to perinatal loss and subsequent pregnancy. Conclusions: We seek to optimise comprehensive healthcare in cases of pregnancy following previous perinatal loss and to evaluate options to minimise possible risks.
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Psychosocial interventions on psychological outcomes of parents with perinatal loss: A systematic review and meta-analysis. Int J Nurs Stud 2021; 117:103871. [PMID: 33548593 DOI: 10.1016/j.ijnurstu.2021.103871] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perinatal loss can occur due to miscarriages and ectopic pregnancies, among other circumstances. Psychological health of parents can deteriorate due to perinatal loss. Parent's negative psychological outcomes include depression, anxiety, and grief. OBJECTIVE To evaluate the effectiveness of psychosocial interventions in reducing depression, anxiety, and grief among parents after perinatal loss. DESIGN A systematic review and meta-analysis of randomized controlled trials DATA SOURCES: English language articles published from database inception to 19 November 2019 were systematically retrieved from eight electronic databases (CINAHL, Cochrane, EMBASE, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science). REVIEW METHODS The Cochrane Risk of Bias tool was used to conduct quality appraisal of each individual article and data was analyzed using Review Manager 5.3. A meta-analysis of randomized controlled trials was conducted using a random-effect model. RESULTS Among this review's 17 included studies, 15 studies' results were included in the meta-analyses. The remaining two studies were summarized narratively. Meta-analyses revealed that psychosocial interventions significantly reduced depression (95% CI: -0.64 to -0.29, Z = 5.17, p = <0.00001), anxiety (95% CI: -0.50 to -0.18, Z = 4.21, p < 0.0001) and grief (95% CI: -0.71 to -0.32, Z = 5.12, p < 0.0001). CONCLUSION Psychosocial interventions are effective in improving depression, anxiety, and grief amongst parents with perinatal loss. Psychosocial care can be provided by medical healthcare professionals and expanded with technology-assisted implementation. STUDY REGISTRATION NUMBER CRD42019145526.
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Obst KL, Oxlad M, Due C, Middleton P. Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample. BMC Pregnancy Childbirth 2021; 21:29. [PMID: 33413199 PMCID: PMC7792062 DOI: 10.1186/s12884-020-03514-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia.
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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Barratt O, Lee R, Curtin C. First trimester miscarriage: patient care considerations for the dental team. Br Dent J 2020; 229:527-531. [PMID: 33097886 DOI: 10.1038/s41415-020-2224-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023]
Abstract
First trimester miscarriage is common, occurring in approximately 6.4-12.0% of pregnancies. Women who experience first trimester miscarriage will often have no other significant health conditions and the healthcare professional they most frequently visit could be their dentist or dental care professional. For this reason, it is important that the dental team is aware of the management of first trimester miscarriage in order to allow for a better understanding of the patient's experience and situation. The choice of language used by healthcare professionals with patients who are grieving is also important to ensure effective and open communication.This article aims to provide the dental team with knowledge of first trimester miscarriage, how the effects of this can be relevant within the dental setting, and how to communicate effectively and appropriately with patients who have experienced this traumatic event.
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Affiliation(s)
- Olivia Barratt
- DCT 2 in Restorative Dentistry, University Dental Hospital, Cardiff & Vale University Health Board, Heath Park, Cardiff, CF14 4XY, UK.
| | - Rachel Lee
- ST5 Obstetrics and Gynaecology, Welsh Clinical Leadership Fellow, Health Education and Improvement Wales, UK
| | - Claire Curtin
- Consultant in Acute & Special Care Dentistry, University Dental Hospital, Cardiff & Vale University Health Board, Heath Park, Cardiff, CF14 4XY, UK
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Fernández-Basanta S, Coronado C, Bondas T, Movilla-Fernández MJ. Primary healthcare midwives' experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study. Midwifery 2020; 92:102863. [PMID: 33130341 DOI: 10.1016/j.midw.2020.102863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/20/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To illuminate the experiences of primary healthcare midwives who care for parents who have suffered an involuntary pregnancy loss. DESIGN The phenomenological hermeneutic approach developed by Lindseth and Norberg was used to carry out narrative interviews. SETTING AND PARTICIPANTS A purposive sample of 11 public primary healthcare midwives from a municipality in northern Spain, was selected. The participants' ages ranged between 26 and 62 years, and they were all women. FINDINGS Four main themes were identified: (1) handling adversity, (2) finding a motive to get involved, (3) providing care from the rear, and (4) avoiding emotional connections with the parents. For the midwives, caring for parents who had suffered an involuntary pregnancy loss meant leaving their own comfort zone and handling adversity. They described acting in different ways such as going beyond task-focused care, following their intuition or avoiding encounters with the parents. CONCLUSIONS More knowledge and preparation in terms of communication skills and bereavement is crucial for midwives in order to meet the needs of parents who have suffered an involuntary pregnancy loss. A caring organizational culture and supportive leadership will facilitate care continuity between specialized and primary healthcare and promote the welfare of midwives.
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Affiliation(s)
- Sara Fernández-Basanta
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain.
| | - Carmen Coronado
- Associate professor. Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain..
| | - Terese Bondas
- Professor (Full) and Leader of 'Childbearing - the Qualitative Research Network'. Faculty of Health Sciences, University of Stavanger, PO Box 8600, Forus, Stavanger, Norway..
| | - María-Jesús Movilla-Fernández
- Associate professor. Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, 15471 Ferrol, Spain..
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Experience of hope: An exploratory research with bereaved mothers following perinatal death. Women Birth 2020; 34:e426-e434. [PMID: 32950437 DOI: 10.1016/j.wombi.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
PROBLEM The negative implications of perinatal death on mothers' mental health are documented, however little is known about their experience of hope. BACKGROUND Within the broader literature, hope has contributed to better mental health and bereavement adjustment and often bereaved mothers report the importance of hope for the grieving process. AIM This study aims to explore bereaved mothers' experience of hope following perinatal death. METHODS Individual interviews were conducted with 33 mothers having experienced the death of an infant in the perinatal period. Data from the interviews were analysed using thematic analysis. FINDINGS The mothers' experience of hope following perinatal loss is organized into three themes: Hope disrupted by perinatal loss; Transformed hope: a new pregnancy challenged by the sense of foreboding of another loss; and Ways to restore and foster hope in life. DISCUSSION Although hope has been a motivating force for mothers to reconnect with their life plan and move on after a loss, it is also negatively affected by the experience of perinatal bereavement, social support, and health professionals' clinical practice. CONCLUSION Bereaved mothers have reported a disruption in their experience of hope. While some experience a loss of hope or a sense of hopelessness, others experience a transformation and restoration of hope, which is reinvested in the grieving process. Mothers' experience of hope highlights the need for the support of a healthcare professional and may contribute to enhanced clinical practice through the promotion of bereavement care, considering the aspects that instil, maintain, and interfere with hope.
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Williams HM, Jones LL, Coomarasamy A, Topping AE. Men living through multiple miscarriages: protocol for a qualitative exploration of experiences and support requirements. BMJ Open 2020; 10:e035967. [PMID: 32414830 PMCID: PMC7232625 DOI: 10.1136/bmjopen-2019-035967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Up to 1 in 4 pregnancies and 1 in 20 subsequent pregnancies end in miscarriage. Despite such prevalence the psychosocial effects are often unrecognised and unsupported. In the absence of any biomedical sequelae among men such marginalisation may be intensified. Men living through multiple miscarriages may also find any grief or anxiety intensified by loss of hope for future parenthood, but robust qualitative studies of these experiences are limited. We aim to rectify the deficiency. METHODS AND ANALYSIS Our qualitative study will adopt the sounds of silence framework designed by Serrant-Green to hear the voices of populations possibly marginalised. We will listen and learn from 30 to 50 men with a history of two or more miscarriages. The research participants will be recruited from a recurrent miscarriage clinic at a large tertiary hospital in England, and from advertisements to be disseminated by the project sponsor and miscarriage charities.Individual telephone interviews supported by a semistructured discussion guide will be audio-recorded, transcribed and anonymised. The transcriptions and any field notes will be interpreted by the framework method of Ritchie and Lewis embedded within the sounds of silence framework. Tentative findings will be presented to research participants in face-to-face focus group discussion, to enable member synthesis to enhance authenticity. The focus group discussion will be audio-recorded, transcribed, anonymised and similarly interpreted to contribute to our final synthesis. ETHICS AND DISSEMINATION The protocol of this project received a favourable opinion from the West Midlands South Birmingham Research Ethics Committee (16/WM/0423). Results will be submitted for publication in peer-reviewed journals and at conferences, and disseminated via newsletters and social media of our clinical collaborators and miscarriage charities. Outputs are anticipated to inform future policy and practice in the management of multiple miscarriages. TRIAL REGISTRATION NUMBER ISRCTN 21828561.
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Affiliation(s)
- Helen Marie Williams
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Annie E Topping
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Obst KL, Due C, Oxlad M, Middleton P. Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model. BMC Pregnancy Childbirth 2020; 20:11. [PMID: 31918681 PMCID: PMC6953275 DOI: 10.1186/s12884-019-2677-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men's grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men's grief, this systematic review sought to summarise and appraise the literature focusing on men's grief following pregnancy loss and neonatal loss. METHODS A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men's experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men's grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men's grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth. RESULTS A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men's grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience. CONCLUSION There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men's grief. TRIALS REGISTRATION PROSPERO registration number: CRD42018103981.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Williams HM, Topping A, Coomarasamy A, Jones LL. Men and Miscarriage: A Systematic Review and Thematic Synthesis. QUALITATIVE HEALTH RESEARCH 2020; 30:133-145. [PMID: 31526062 PMCID: PMC7322941 DOI: 10.1177/1049732319870270] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Miscarriage is common, affecting one in five pregnancies, but the psychosocial effects often go unrecognized and unsupported. The effects on men may be subject to unintentional neglect by health care practitioners, who typically focus on biological symptoms, confined to women. Therefore, we set out to systematically review the evidence of lived experiences of male partners in high-income countries. Our search and thematic synthesis of the relevant literature identified 27 manuscripts reporting 22 studies with qualitative methods. The studies collected data from 231 male participants, and revealed the powerful effect of identities assumed and performed by men or constructed for them in the context of miscarriage. We identified perceptions of female precedence, uncertain transition to parenthood, gendered coping responses, and ambiguous relations with health care practitioners. Men were often cast into roles that seemed secondary to others, with limited opportunities to articulate and address any emotions and uncertainties engendered by loss.
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Affiliation(s)
| | - Annie Topping
- University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Göbel A, Arck P, Hecher K, Schulte-Markwort M, Diemert A, Mudra S. Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers. Front Psychiatry 2020; 11:575845. [PMID: 33362598 PMCID: PMC7759496 DOI: 10.3389/fpsyt.2020.575845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mackie FL, Pattison H, Jankovic J, Morris RK, Kilby MD. Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study. BMC Pregnancy Childbirth 2019; 20:4. [PMID: 31892359 PMCID: PMC6938629 DOI: 10.1186/s12884-019-2679-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 12/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background Twin-twin transfusion syndrome (TTTS) is a highly morbid condition in which treatment exists, but the pregnancy remains high-risk until delivery. It may have serious sequelae, including fetal death, and in the longer term, neurodevelopmental problems. The aim of this study is to assess antenatal and postnatal parental attachment and depressive symptoms in those with pregnancies affected by TTTS. Methods Couples attending for fetoscopic laser ablation treatment of TTTS were asked to complete Condon’s Maternal/Paternal Antenatal/Postnatal Attachment Scale as appropriate, and the Edinburgh Depression Scale the day before ablation, 4 weeks post-ablation, and 6–10 weeks postnatally. Results 25/27 couples completed the pre-ablation questionnaire (median gestational age 19 + 3 weeks [interquartile range 18 + 2–20 + 6]). 8/18 eligible couples returned the post-ablation questionnaire. 5/17 eligible couples returned the postnatal questionnaire. There was no significant difference in parento-fetal attachment when mothers were compared to fathers at each time point, however parento-fetal attachment did increase over time in mothers (p = 0.004), but not fathers. Mothers reported more depressive symptoms antenatally compared to fathers (p < 0.02), but there was no difference postnatally. 50% women reported Edinburgh Depression Scale scores above the cut-off (≥15) 4 weeks post-ablation. Over time maternal depressive symptoms decreased (p = 0.006), however paternal depressive symptoms remained the same. Conclusions This is the first attachment and depression study in a UK cohort of parents with pregnancies affected by TTTS. Although this was a small cohort and the questionnaires used had not been validated in these circumstances, the results suggest that centres caring for these couples should be aware of the risk of maternal and paternal antenatal depression, and screen and refer for additional psychological support. Further work is needed in larger cohorts. Trial registration ISRCTN 13114861 (retrospectively registered).
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Affiliation(s)
- Fiona L Mackie
- Centre for Women's & Children's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK. .,Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TG, UK.
| | - Helen Pattison
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Jelena Jankovic
- Mother and Baby Unit, Barberry, Birmingham and Solihull Mental Health NHS Foundation Trust, 25 Vincent Drive, Edgbaston, Birmingham, B15 2FG, UK
| | - R Katie Morris
- Centre for Women's & Children's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TG, UK
| | - Mark D Kilby
- Centre for Women's & Children's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Edgbaston, B15 2TG, UK
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Nguyen V, Temple-Smith M, Bilardi J. Men's lived experiences of perinatal loss: A review of the literature. Aust N Z J Obstet Gynaecol 2019; 59:757-766. [PMID: 31414479 DOI: 10.1111/ajo.13041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Perinatal loss is often considered an emotionally and physically traumatic event for expectant parents. While there is strong evidence of its impact on women, limited research has independently explored men's lived experiences. AIM This scoping review will examine current literature on the lived experiences of men whose partner has experienced a still-birth or miscarriage. MATERIAL AND METHODS The scoping review identified relevant articles by systematically searching through four electronic databases utilising a PRISMA search strategy. Strict inclusion and exclusion criteria were applied to articles. The articles' reference lists were further scrutinised until no further articles that met the criteria were located. Fifteen articles were located including 14 qualitative studies and one non-peer reviewed academic article. Articles were thematically analysed. RESULTS The review identified three major themes that are particularly pertinent to shaping the lived experiences of men whose partner has suffered a perinatal loss: (1) pregnancy attachment and the aftermath; (2) supporting their partner and being supported; and (3) impacts upon future pregnancies. CONCLUSION Perinatal loss can have negative implications for men's psychological and social well-being. Across the studies men had different levels of attachments to the pregnancy, influencing their emotional responses to the loss. Men perceived their primary role as being a supporter to their partners but received limited support themselves. Men often reported that their safe and trusting attitudes toward pregnancy had forever changed. Further areas of research are recommended in hopes of enhancing support for men, and consequently their partners and families, who experience perinatal loss.
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Affiliation(s)
- Van Nguyen
- Department of Social Work, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jade Bilardi
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Monash University, Melbourne, Victoria, Australia
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Martínez-Serrano P, Pedraz-Marcos A, Solís-Muñoz M, Palmar-Santos AM. The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study. Midwifery 2019; 77:37-44. [PMID: 31254962 DOI: 10.1016/j.midw.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Paloma Martínez-Serrano
- Obstetric and Ginecology Service, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2. 28222 Majadahonda (Madrid), Madrid, Spain.
| | - Azucena Pedraz-Marcos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
| | - Montserrat Solís-Muñoz
- Nursing and Healthcare, Research Area, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2, Majadahonda (Madrid) 28222, Spain.
| | - Ana María Palmar-Santos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
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Miller EJ, Temple-Smith MJ, Bilardi JE. 'There was just no-one there to acknowledge that it happened to me as well': A qualitative study of male partner's experience of miscarriage. PLoS One 2019; 14:e0217395. [PMID: 31136597 PMCID: PMC6538154 DOI: 10.1371/journal.pone.0217395] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/11/2019] [Indexed: 11/29/2022] Open
Abstract
Miscarriage occurs in up to one in four pregnancies and can be a devastating event affecting both men and women. Unfortunately, the male partner’s experience of miscarriage is seldom researched, particularly within Australia. This qualitative study involved semi-structured telephone interviews with 10 Australian men, whose partners miscarried between three months and ten years ago. Participants were recruited through professional networks and support organisations. Interviews explored men’s general miscarriage experience and the support received or lacking from both healthcare providers and social networks. Online health seeking behaviour and opinions on online support were also discussed. Data was transcribed verbatim and analysed thematically. Most men described feeling significant grief following miscarriage and felt that there was little acknowledgment of their loss, both from healthcare providers and within their social networks. Feelings of sadness, devastation, powerlessness, fear, shock and a loss of identity were common. All men felt their primary role at the time of miscarriage was to support their partner. Most men did not want to burden their partner with their emotions or grief, and struggled to find people within their social networks to talk to about their loss, leading to feelings of isolation. Overall participants felt there was inadequate support offered to men affected by miscarriage. Men wanted information, informed professionals to talk to and male-orientated support networks. A website was one mechanism suggested by men which could adequately contribute to information and support needs during this time. Men are often greatly affected by miscarriage and yet there is all too often little acknowledgement or support available to them at this time. Men affected by miscarriage want and need further support, including reputable, Australian based information and resources tailored their needs.
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Affiliation(s)
- Ellena J. Miller
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Meredith J. Temple-Smith
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jade E. Bilardi
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- * E-mail:
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Story Chavez M, Handley V, Lucero Jones R, Eddy B, Poll V. Men’s Experiences of Miscarriage: A Passive Phenomenological Analysis of Online Data. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/23802359.2019.1611230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Megan Story Chavez
- Couple and Family Therapy Program, Texas Tech University, Lubbock, Texas, USA
| | - Valerie Handley
- Marriage and Family Therapy, Texas Tech University, Lubbock, Texas, USA
| | | | - Brandon Eddy
- Couple and Family Therapy Program, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Von Poll
- Couple and Family Therapy Program, Texas Tech University, Lubbock, Texas, USA
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Obst KL, Due C. Australian men's experiences of support following pregnancy loss: A qualitative study. Midwifery 2019; 70:1-6. [DOI: 10.1016/j.midw.2018.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
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Riggs DW, Due C, Tape N. Australian Heterosexual Men's Experiences of Pregnancy Loss: The Relationships Between Grief, Psychological Distress, Stigma, Help-Seeking, and Support. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:409-423. [PMID: 30558482 DOI: 10.1177/0030222818819339] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores experiences of pregnancy loss via a questionnaire completed by a convenience sample of 48 Australian cisgender heterosexual men. The questionnaire included measures of support following pregnancy loss, recognition of loss, perceived utility of help-seeking, perceived stigma attached to help-seeking, perinatal grief, and depression and anxiety. The questionnaire also included open-ended questions focused on help-seeking and support. Higher levels of grief were related to higher levels of both depression and anxiety. Perceptions about stigma were related to the perceived utility of help-seeking. While a majority of participants had accessed formal support services, feeling supported was unrelated to either grief or depression. Participants emphasized the utility of men's groups where members have experienced pregnancy loss, though barriers to support were also identified in terms of the unavailability of support or the perceived need to focus on a partner's loss.
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Affiliation(s)
- Damien W Riggs
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, South Australia, Australia
| | - Nicole Tape
- School of Psychology, The University of Adelaide, South Australia, Australia
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Shurie S, Were E, Orang'o O, Keter A. Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study. Pan Afr Med J 2018; 31:214. [PMID: 31447973 PMCID: PMC6691316 DOI: 10.11604/pamj.2018.31.214.17484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION ectopic pregnancy is one of the causes of maternal morbidity and mortality in sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy. METHODS case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy and LNG-EC was assessed using Pearson chi-square test. The relationship between outcome and exposure (while adjusting for confounders) was assessed using logistic regression model. RESULTS The mean age was 27.15 years. Both cases and controls were similar by age (p = 0.990), educational level (p = 0.850), marital status (p = 0.559), employment status (p = 0.186) and parity (p = 0.999). Seventy-eight (24.7%) participants had a history of miscarriage. A higher proportion of the cases had history of using LNG-EC compared to the controls (32.9% vs. 7.2%, p < 0.001). The use of LNG-EC portended more than nine times increased odds of ectopic pregnancy compared to other contraceptive methods {OR = 9.34 (95% CI: 3.9 - 16.0)}. CONCLUSION levonorgestrel only emergency contraceptive use was associated with ectopic pregnancy. One of the limitations of this study is that we could not control for all confounders of ectopic pregnancy.
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Affiliation(s)
- Sahara Shurie
- Department of Reproductive Health, College of Health Sciences Moi University, Eldoret, Kenya
| | - Edwin Were
- Department of Reproductive Health, College of Health Sciences Moi University, Eldoret, Kenya
| | - Omenge Orang'o
- Department of Reproductive Health, College of Health Sciences Moi University, Eldoret, Kenya
| | - Alfred Keter
- Department of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Kopp DM, Bula A, Maman S, Chinula L, Tsidya M, Mwale M, Tang JH. Influences on birth spacing intentions and desired interventions among women who have experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study. BMC Pregnancy Childbirth 2018; 18:197. [PMID: 29855296 PMCID: PMC5984328 DOI: 10.1186/s12884-018-1835-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth and neonatal mortality are very high in many low-income countries, including Malawi. Use of family planning to encourage birth spacing may optimize outcomes for subsequent pregnancies. However, reproductive desires and influences on birth spacing preferences of women who have experienced a stillbirth or neonatal death in low-resource settings are not well understood. METHODS We conducted a qualitative study using 20 in-depth interviews and four focus group discussions with women who had experienced a stillborn baby or early neonatal death to explore attitudes surrounding birth spacing and potential interventions to promote family planning in this population. Qualitative data were analyzed for recurrent patterns and themes and central ideas were extracted to identify their core meanings. RESULTS Forty-six women participated in the study. After experiencing a stillbirth or neonatal death, most women wanted to wait to become pregnant again but women with living children wished to wait for longer periods of time than those with no living children. Most women preferred birth spacing interventions led by clinical providers and inclusion of their spouses. CONCLUSIONS Many influences on family size and birth spacing were noted in this population, with the most significant influencing factor being the spouse. Interventions to promote birth spacing and improve maternal and neonatal health in this population need to involve male partners and knowledgeable health care providers to be effective. TRIAL REGISTRATION Clinicaltrials.gov NCT02674542 Registered February 1, 2016 (retrospectively registered).
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Affiliation(s)
- Dawn M Kopp
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi. .,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA. .,Kamuzu Central Hospital, Lilongwe, Malawi.
| | - Agatha Bula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Suzanne Maman
- UNC Department of Health Behavior, Chapel Hill, NC, USA
| | - Lameck Chinula
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
| | - Mercy Tsidya
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi
| | - Mwawi Mwale
- Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi
| | - Jennifer H Tang
- UNC Project-Malawi, Private Bag, A-104, Lilongwe, Malawi.,UNC Department of Obstetrics & Gynecology, Chapel Hill, NC, USA.,Kamuzu Central Hospital, Lilongwe, Malawi.,Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi
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