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Basnet P, Skjærven R, Harmon QE, Sørbye LM, Morken NH, Singh A, Klungsøyr K, Kvalvik LG. Risk of adverse pregnancy outcomes in twin- and singleton-born women: An inter-generational cohort study. BJOG 2024; 131:750-758. [PMID: 37827857 PMCID: PMC10984801 DOI: 10.1111/1471-0528.17690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To compare the risk of adverse pregnancy outcomes between twin-born and singleton-born women. We also evaluated whether in utero exposure to pre-eclampsia or preterm delivery affected adverse pregnancy outcomes in women's own pregnancies. DESIGN Population-based cohort study. SETTING Medical Birth Registry of Norway 1967-2020. POPULATION 9184 twin-born and 492 894 singleton-born women during 1967-2005, with their later pregnancies registered during 1981-2020. METHODS Data from an individual's birth were linked to their later pregnancies. We used generalised linear models with log link binomial distribution to obtain exponentiated regression coefficients that estimated relative risks (RRs) with 95% confidence intervals (CIs) for associations between twin- or singleton-born women and later adverse pregnancy outcomes. MAIN OUTCOME MEASURES Pre-eclampsia, preterm delivery or perinatal loss in twin-born compared with singleton-born women. RESULTS There was no increased risk for adverse outcomes in twin-born compared with singleton-born women: adjusted RRs for pre-eclampsia were 1.00 (95% CI 0.93-1.09), for preterm delivery 0.96 (95% CI 0.90-1.02) and for perinatal loss 1.00 (95% CI 0.84-1.18). Compared with singleton-born women exposed to pre-eclampsia in utero, twin-born women exposed to pre-eclampsia had lower risk of adverse outcomes in their own pregnancies; the aRR for pre-eclampsia was 0.73 (95% CI 0.58-0.91) and for preterm delivery was 0.71 (95% CI 0.56-0.90). Compared with preterm singleton-born women, preterm twin-born women did not differ in terms of risk of pre-eclampsia (aRR 1.05, 95% CI 0.92-1.21) or perinatal loss (aRR 0.99, 95% CI 0.71-1.37) and had reduced risk of preterm delivery (RR 0.83, 95% CI 0.74-0.94). CONCLUSIONS Twin-born women did not differ from singleton-born women in terms of risk of adverse pregnancy outcomes. Twin-born women exposed to pre-eclampsia in utero, had a lower risk of pre-eclampsia and preterm delivery compared with singleton-born women exposed to pre-eclampsia.
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Affiliation(s)
- Prativa Basnet
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Quaker E. Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Linn Marie Sørbye
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Aditi Singh
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Liv Grimstvedt Kvalvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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De Vincenzo C, Cena L, Trainini A, Nieddu C, Iacona E, Ronconi L, Testoni I. Perinatal Loss and Parents' Grief Amidst the COVID-19 Pandemic: A Mixed-Method Research. Behav Sci (Basel) 2024; 14:339. [PMID: 38667135 PMCID: PMC11047657 DOI: 10.3390/bs14040339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Losing a child is a traumatic event, disrupting life's natural cycle, profoundly affecting the family system, and causing enduring grief. Perinatal death, including ectopic pregnancies, miscarriages, stillbirths, and neonatal deaths, exacerbates this distress. Additionally, the COVID-19 pandemic has challenged healthcare systems and supporting services available to individuals in need. Thus, this research explores experiences of parents facing perinatal loss in 2020-2021, further focusing on the pandemic's impact. Using a mixed-methods design with self-reports and qualitative interviews, this paper presents results from the quantitative protocol, involving an update and follow-up of a previous study. It compares measurements across scales: COVID-19: The Impact of Event Scale-Revised; The Prolonged Grief-13; The Parental Assessment of Paternal/Maternal Affectivity; The Dyadic Adjustment Scale (short version); The Daily Spiritual Experiences Scale; and The Inventory of Complicated Spiritual Grief. In the baseline measurement, 45 parents participated (37 mothers and 8 fathers), with 20 (13 mothers and 7 fathers) contributing to the follow-up and 9 engaging in interviews. Baseline results showed higher scores for mothers compared to fathers, with effect sizes ranging from small to medium (ranging from -0.02 to 0.29), though statistical significance was limited due to the small sample size. Multiple regression analysis for distress measures at baseline identified two significant predictors: maternal/paternal affectivity and gestational week. Additionally, positive support from healthcare professionals emerged as a mitigating factor, particularly in relation to Avoidance. A significant reduction in stress measures and parental affectivity was observed at the 6-month follow-up. Qualitative analysis revealed three themes: Shifts in Self-Perception and Post-Loss Growth; Conflicted Relationship with One's Body; and Negative Impact of COVID-19 vs. Unexpectedly Positive Aspects. In conclusion, the findings emphasize the significance of psychological and psychosocial interventions based on meaning-making processes, along with the importance of spiritual care and empowerment for those navigating perinatal loss.
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Affiliation(s)
- Ciro De Vincenzo
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35122 Padua, Italy; (C.D.V.); (C.N.); (E.I.)
| | - Loredana Cena
- Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, 25123 Brescia, Italy; (L.C.); (A.T.)
| | - Alice Trainini
- Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, 25123 Brescia, Italy; (L.C.); (A.T.)
| | - Chiara Nieddu
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35122 Padua, Italy; (C.D.V.); (C.N.); (E.I.)
| | - Erika Iacona
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35122 Padua, Italy; (C.D.V.); (C.N.); (E.I.)
| | - Lucia Ronconi
- Computer and Statistical Services, Multifunctional Pole of Psychology, University of Padua, 35122 Padua, Italy;
| | - Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35122 Padua, Italy; (C.D.V.); (C.N.); (E.I.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
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3
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Popoola T, Skinner J, Woods M. 'Every Woman Wants to Know What Came out of Her Body': Grief Experiences of Women After Stillbirth in Nigeria. Omega (Westport) 2024; 88:1275-1289. [PMID: 34996329 DOI: 10.1177/00302228211051823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stillbirth commonly affects women in Nigeria, but their experiences of grief following stillbirth is under explored. This study aimed to describe Nigerian women's experiences of grief after stillbirth. Face-to-face, semi-structured interviews were conducted with 20 women in Nigeria who experienced stillbirth. The results from the thematic analysis suggest that mothers had an unmet need to see their stillborn baby, and they experienced communication challenges such as being blindsided/misled about the baby during their interactions with health personnel. The participants experienced emotional and psychological reactions to grief that manifested in the form of emotional pain, sadness, blame and shock, but having a sense of gratitude helped them cope. The findings of this study highlight gaps in bereavement care and suggest the need for basic bereavement training for health personnel.
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Affiliation(s)
- Tosin Popoola
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington Regional Hospital, Wellington, New Zealand
| | - Joan Skinner
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington Regional Hospital, Wellington, New Zealand
| | - Martin Woods
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington Regional Hospital, Wellington, New Zealand
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4
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Pekyiğit A, Yildiz D, Deniz AÖ, Çalik Bağriyanik B. White Tears: A Phenomenological Study of Perinatal Loss. Omega (Westport) 2024:302228241234381. [PMID: 38356333 DOI: 10.1177/00302228241234381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Liu Y, Yang X, Zhu X, Tian X, Yang Z. Clinical Experiences of Perinatal Palliative Care After a Stillbirth: A Narrative Therapy for Grief. Am J Hosp Palliat Care 2024:10499091241228976. [PMID: 38242843 DOI: 10.1177/10499091241228976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Narrative care for families suffering from perinatal loss is rarely provided by medical institutions in China Mainland. However, with the advancement of the Chinese narrative medicine theory and practice, the clinical significance of narrative care has been increasingly recognized. Based on the principles of Chinese narrative medicine, this narrative case study described traumatic narrative foreclosures occuring in a family suffering from stillbirth, and highlighted the multidisciplinary collaboration for practising narrative care in the process of supporting the bereaved in our hospital. Meanwhile, we advocate the establishment of a narrative care ecology by training more obsteticians and nurses with good narrative competence in purpose of helping the family experiencing perinatal losses to overcome their tramatic narrative foreclosures, increasing the chances of another successful pregnancy and childbirth as well as enhancing their quality of life.
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Affiliation(s)
- Yanhua Liu
- Obstetrical Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaolin Yang
- Research Center of Narrative Medicine, Shunde Hospital, Southern Medical University, Shijiazhuang, China
| | - Xiaoxiong Zhu
- Obstetrical Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoling Tian
- Dean's office, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhifen Yang
- Obstetrical Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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6
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Giannatiempo F, Hollins Martin C, Patterson J, Welsh N. Exploring parents' experiences and holistic needs following late miscarriage: a narrative systematic review. J Reprod Infant Psychol 2024:1-26. [PMID: 38184816 DOI: 10.1080/02646838.2023.2297905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Up to 2% of all pregnancies result in pregnancy loss between 14 + 0 and 23 + 6 weeks' gestation, which is defined as 'late miscarriage'. Lack of consensus about definition of viability paired with existing multiple definitions of perinatal loss make it difficult to define the term 'late miscarriage'. Parents who experience late miscarriage often have had reassuring scan-milestones, which established their confidence in healthy pregnancy progression and identity formation, which socially integrates their baby into their family. The clinical lexicon alongside the lack of support offered to parents experiencing late miscarriage may disclaim their needs, which has potential to cause adverse psychological responses. AIM To review what primary research reports about parents' experiences and their perceived holistic needs following late miscarriage. METHODS A narrative systematic review was carried out. Papers were screened based on gestational age at time of loss (i.e. between 14 + 0 and 23 + 6 weeks' gestation). The focus was set on experience and holistic needs arising from the loss rather than its clinical care and pathophysiology. Studies were selected using PRISMA-S checklist, and quality assessed using the Critical Appraisal Skills Program (CASP) tool. Thematic analysis was used to guide the narrative synthesis of findings. RESULTS Six studies met the inclusion criteria. Three main themes emerged: communication and information-giving; feelings post-event; and impact of support provision. CONCLUSION Literature about the experience of late miscarriage is scarce, with what was found reporting a lack of compassionate and individually tailored psychological follow-up care for parents following late miscarriage. Hence, more research in this arena is required to inform and develop this area of maternity care provision.
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Affiliation(s)
- Francesca Giannatiempo
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
| | - Caroline Hollins Martin
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
| | - Jenny Patterson
- School of Health and Social Care, Edinburgh Napier University (ENU), Edinburgh, Scotland, UK
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Li F, Shi Q, Xiong T, Li Y, Zheng Y, Jiang G, Duan DS, Wei X, Cui L, Chen Z. The effect of childbirth trauma on willingness to donate milk in women following perinatal loss: The mediating role of resilience. Matern Child Nutr 2024; 20:e13557. [PMID: 37583118 PMCID: PMC10750022 DOI: 10.1111/mcn.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
Limited studies have been conducted on Chinese women's willingness to donate milk following perinatal loss. In this study, we explore the relationship among childbirth trauma, willingness to donate milk, and resilience in women following perinatal loss, and the mediating effect of resilience between childbirth trauma and willingness to donate milk. A cross-sectional study was carried out throughout 4 months. We used convenience sampling methods and recruited 241 women following a perinatal loss from eight tertiary hospitals in Sichuan Province, China. Participants completed four questionnaires during a face-to-face individual interview: the general information questionnaire, the Willingness to Donate Milk Scale (WMDS), the City Birth Trauma Scale, and the Brief Resilience Scale. SPSS 20.0 was used to analyze the collected data. In our study, childbirth trauma was negatively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience was positively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience partially mediated the relationship between childbirth-related symptoms and willingness to donate milk (β = -0.38, 95% confidence interval [CI]: -0.50 to -0.26), which accounted for 69.03% of the total effect. Resilience partially mediated the relationship between general symptoms and willingness to donate milk (β = -0.31, 95% CI: -0.40 to -0.21), which accounted for 66.89% of the total effect. Resilience partially mediated the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. Our findings suggest that resilience can play a significant role in mediating the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. These results could help healthcare professionals design interventions for physical and mental recovery after perinatal loss.
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Affiliation(s)
- Fengling Li
- Obstetrics DepartmentHospital of North Sichuan Medical CollegeNanchongChina
- Department of Nursing, School of NursingNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Qi Shi
- Obstetrics DepartmentHospital of North Sichuan Medical CollegeNanchongChina
| | - Tao Xiong
- Department of Nursing, School of NursingNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Yang Li
- Department of Nursing, School of NursingNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Yuxi Zheng
- Department of Nursing, School of NursingNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Guolu Jiang
- Department of NursingAffiliated Hospital of North Sichuan Medical CollegeNanchongSichuanChina
| | - Diana S. Duan
- Department of Nursing, School of NursingNorth Sichuan Medical CollegeNanchongSichuanChina
| | - Xuemei Wei
- Department of NursingAffiliated Hospital of North Sichuan Medical CollegeNanchongSichuanChina
| | - Lijun Cui
- Department of NursingAffiliated Hospital of North Sichuan Medical CollegeNanchongSichuanChina
| | - Zhaoxia Chen
- Obstetrics DepartmentHospital of North Sichuan Medical CollegeNanchongChina
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Atashsokhan G, Farjamfar M, Khosravi A, Taher M, Keramat A. Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital-a Qualitative Study. Inquiry 2024; 61:469580231223763. [PMID: 38339829 PMCID: PMC10859064 DOI: 10.1177/00469580231223763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
This study aimed to investigate the understanding and experiences of mothers who have suffered perinatal loss regarding their needs after being discharged from the hospital. Data were collected through semi-structured face-to-face and telephone interviews using purposive sampling with maximum diversity. The sample included 15 mothers and 6 midwives who had experienced fetal loss and perinatal bereavement. The interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyze the data. Sampling was conducted from July 2022 to March 2023, continuing until data saturation was reached. The study identified 2 main categories of needs for mothers who have experienced perinatal loss: continuous healthcare (including the Comprehensive Mother Tracking System, provision of psychological welfare, and educational needs) and provision of a support network, including "spouse and family support" and "peer and colleague support." The primary theme of this study was "Deliberating Care for Grieving Mothers." The study results indicate that mothers who experience perinatal loss require continuity of care after being discharged. Psychological screening and counseling support are essential for both parents. Considering the significant impact of spousal, familial, and community support on an individual's life, it is crucial to prepare the community to comprehend and embrace grieving parents.
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Affiliation(s)
- Giti Atashsokhan
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Maryam Farjamfar
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahboobe Taher
- Department of Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran
| | - Afsaneh Keramat
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Rossen L, Opie JE, O'Dea G. A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss. Omega (Westport) 2023:302228231209769. [PMID: 37871980 DOI: 10.1177/00302228231209769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Maternal identity, a mother's internalized view of self as mother, has not been studied in relation to perinatal loss. This study aimed to investigate how women construct a sense of maternal identity after the loss of a baby. METHODS We interviewed 10 mothers who had experienced perinatal loss. A Listening Guide framework for narrative analysis was used to identify patterns of giving voice to the mother's own story. RESULTS We identified 12 overarching voices which fell within three distinct groupings: voices of motherhood, voices of grief, and voices of growth. Although bereaved mothers grappled with constructing their maternal identity, they also demonstrated how maternal identity is individually and intuitively created through an honouring and remembering of the child that was lost, resulting in significant growth. CONCLUSIONS There is need for a broader definition of what constitutes motherhood to encapsulate diverse mothering experiences, including perinatal loss.
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Affiliation(s)
- Larissa Rossen
- Department of Counselling Psychology, Trinity Western University, Langley, BC, Canada
| | - Jessica E Opie
- The Bouverie Centre, School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Gypsy O'Dea
- School of Psychology, Centre for Social and Emotional Early Development, Deakin University, Geelong, VIC, Australia
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McDonough MR, Leone-Sheehan D. "You're on a Rollercoaster, Just Hold On": The Lived Experience of the Dyad Following a Fetal Death. Res Theory Nurs Pract 2023:RTNP-2023-0037.R1. [PMID: 37848222 DOI: 10.1891/rtnp-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Purpose: Pregnancy and birth is often a joyous period for a dyad. In the instance of fetal death, however, dyads are met with a devastating loss of their child, the hope for the future, and the new reality of becoming a bereaved parent. The purpose of this qualitative study was to investigate the lived experience of the dyad following a fetal death and capture the essence of the grief journey. Study design and methods: A hermeneutic phenomenological study was performed using van Manen's method for data collection and analysis. Semi-structured interviews were conducted via Zoom. Participants were recruited from national and local agencies providing education and resources about perinatal loss. Data analysis utilized the Dedoose software platform to track qualitative coding. Results: Ten dyads (20 individuals) from the United States and Canada participated. The data revealed four major themes with several subthemes. The major themes were as follows: "The child I'll never really know": Pregnancy loss grief; "You're on a rollercoaster, just hold on": The emotional journey; Climbing uphill: Barriers to healing; and Resurfacing from grief: Healing after loss Clinical implications: The death of a fetus over 20 weeks gestation provides a unique experience of grief. The findings support the need for additional resources needed beyond the hospital by nurses or other providers to facilitate healing and minimize complicated grief. Furthermore, the findings support the need for increasing awareness among healthcare providers and peers about how to communicate and care for dyads experiencing fetal death.
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Affiliation(s)
- Mary Rose McDonough
- Community Nursing Department, UMASS Dartmouth College of Nursing and Health Sciences, Dartmouth, MA, USA
| | - Danielle Leone-Sheehan
- School of Nursing and Health Sciences, Merrimack College North Andover, North Andover, MA, USA
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Boutillier B, Embleton ND, Bélanger S, Bigras-Mercier A, Larone Juneau A, Barrington KJ, Janvier A. Butterflies and Ribbons: Supporting Families Experiencing Perinatal Loss in Multiple Gestation. Children (Basel) 2023; 10:1407. [PMID: 37628406 PMCID: PMC10453894 DOI: 10.3390/children10081407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Introduction: In neonatology, multiple pregnancies are common. Unfortunately, it is not rare for one baby to die. Communication with parents in these circumstances has been demonstrated to be sub-optimal. Methods: Two educational programs were evaluated with pre- and post-course surveys, questionnaires administered to participants, and audits. Results: In the online Butterfly project (UK; n = 734 participants), all participants reported that the training exceeded or met their expectations, 97% reported they learned new skills, and 48% had already applied them. Participants expressed gratitude in their open-ended answers: "I feel a lot more confident in supporting parents in this situation". In the Ribbon project (workshop for neonatal clinicians, Quebec; n = 242), 97% were satisfied with the training and reported feeling more comfortable caring for bereaved parents. Knowledge improved pre-post training. Audits revealed that 100% of cases were identified on the incubator and the baby's/babies' admission card, all changed rooms after the death of their co-twin/triplet, and all had the name of their co-twin/triplet on the discharge summary. All clinicians (55) knew what the ribbon symbol meant when asked during surprise audits at the bedside. Conclusion: Different educational strategies to optimize communication with families after the perinatal loss of a co-twin are appreciated and have a positive impact.
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Affiliation(s)
- Béatrice Boutillier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada
| | | | - Sophie Bélanger
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
| | - Alexie Bigras-Mercier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
| | - Audrey Larone Juneau
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada
| | - Keith J. Barrington
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada
- Department of Medicine, University of Montreal, Montréal, QC H3T 1J4, Canada
| | - Annie Janvier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (B.B.); (S.B.); (A.B.-M.); (A.L.J.); (K.J.B.)
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada
- Department of Medicine, University of Montreal, Montréal, QC H3T 1J4, Canada
- Unité D’éthique Clinique, Unité de Soins Palliatifs, Bureau du Partenariat Patients—Familles-Soignants, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Clinical Ethics Unit and Palliative Care Unit, Department of Pediatrics and Clinical Ethics, University of Montreal Neonatologist, Sainte-Justine Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
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12
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Suarez A, Yakupova V. Past Traumatic Life Events, Postpartum PTSD, and the Role of Labor Support. Int J Environ Res Public Health 2023; 20:6048. [PMID: 37297652 PMCID: PMC10252538 DOI: 10.3390/ijerph20116048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
The aim of this study was to investigate the association of postpartum post-traumatic stress disorder (PP-PTSD) symptoms and subjective rates of traumatic birth experience with past traumatic life events (physical and sexual assault, child abuse, perinatal loss, previous traumatic birth experience, and the cumulative traumatic experience). A sample of Russian women (n = 2579) who gave birth within the previous 12 months, filled in a web-based survey, where they reported demographic and obstetric characteristics and past traumatic experiences, evaluated their birth experience (0 = not traumatic, 10 = extremely traumatic), and completed the City Birth Trauma Scale (CBiTS). We found that PP-PTSD symptoms were higher among women who previously experienced physical (F = 22.02, p < 0.001) and sexual (F = 15.98, p < 0.001) assault and child abuse (F = 69.25, p < 0.001), with only associations with child abuse (F = 21.14, p < 0.001) remaining significant for subjective rates of traumatic birth experience. Perinatal loss and previous traumatic birth showed moderate but inconsistent effects. Support during labor did not have a buffering effect for participants with past traumatic experiences but showed a universally protective effect against PP-PTSD. Trauma-informed practices and allowing women to have a supportive birth team of choice during childbirth are promising avenues to minimize the incidence of PP-PTSD and improve the childbirth experience for all women.
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Affiliation(s)
- Anna Suarez
- Department of Psychology, Lomonosov Moscow State University, Moscow 119991, Russia;
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13
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Amankwah B, Ani-Amponsah M, Mahama M, Gyepi-Garbrah A, Richardson D, Mensah ON, Acquah H, Kpikpitse D, Ofosu-Poku R. "The Health Caregivers Did Not Care about Me after the Loss": Maternal Experiences of Perinatal Loss in the Kumasi Metropolitan Area, Ghana. J Soc Work End Life Palliat Care 2023; 19:133-149. [PMID: 37334816 DOI: 10.1080/15524256.2023.2220078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
One of the common undesirable outcomes of pregnancy is perinatal loss. Healthcare systems strive to reduce the incidence of perinatal loss but typically little attention is on the experiences of bereaved mothers following perinatal loss, particularly in low and middle-income countries where such deaths are common. This research explored the lived experiences of mothers with perinatal loss in the Kumasi metropolis, Ghana. A qualitative design was used to explore the experiences of nine (9) bereaved mothers from the Komfo Anokye Teaching Hospital's postnatal ward and the Mother and Baby Unit. Data were collected through face-to-face interviews using a semi-structured interview guide, audio-recorded, and thematically analyzed. One major finding was that mothers restricted mourning their dead babies based on fear of recurrent perinatal loss and traditional beliefs on delayed return to fertility. Mothers blamed healthcare providers for their loss due to their concerns about care received. Gaps in communication flow from healthcare professionals to bereaved mothers were commonly identified as mothers struggled to make meaning of their loss and coped with cultural restrictions and beliefs. Healthcare professionals must explore mothers' concerns and "gut-feelings," and pay attention to their communication needs following perinatal loss.
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Affiliation(s)
- Bridget Amankwah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Ghana College of Nurses and Midwives, Accra, Ghana
| | - Mary Ani-Amponsah
- Ghana College of Nurses and Midwives, Accra, Ghana
- Maternal and Child Health Department, School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Mustapha Mahama
- Ghana College of Nurses and Midwives, Accra, Ghana
- Department of Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Alberta Gyepi-Garbrah
- Ghana College of Nurses and Midwives, Accra, Ghana
- Child Health Department, 37 Military Hospital, Accra, Ghana
| | | | - Olivia Nyarko Mensah
- Ghana College of Nurses and Midwives, Accra, Ghana
- Nursing and Midwifery Training College, Adum-Kumasi, Ghana
| | | | | | - Rasheed Ofosu-Poku
- Department of Family Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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14
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Bornemisza AY, Javor R, Erdos MB. Exploring Gender Differences in Adult Siblings' Recollections on Perinatal Loss. Omega (Westport) 2023:302228221131369. [PMID: 36914968 DOI: 10.1177/00302228221131369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This study is an exploration on potential gender differences in sibling grief over perinatal loss. 30 adult siblings' recollections were analysed to identify possible differences along the instrumental-intuitive continuum. A statistical analysis (ANOVA) on word frequencies indicated that the intensity of the emotional experiences did not differ between men and women, as there were not any significant differences in the function words reflecting such contents. Women referred to third persons, the delivery process, and the act of naming their deceased siblings more frequently. A subsequent qualitative context analysis revealed that these third persons were mainly family members and hospital staff. Men were more specific in their recollections, mentioning exact names and other types of data related to the loss while women focused more on the emotional significance of the experience. Our results may contribute to the development of personalized interventions for families struggling with disenfranchised grief.
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Affiliation(s)
- Agnes Y Bornemisza
- Department of Health Visiting and Prevention, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Rebeka Javor
- Department of Community and Social Studies, Faculty of Humanities, University of Pécs, Pécs, Hungary
| | - Marta B Erdos
- Department of Community and Social Studies, Faculty of Humanities, University of Pécs, Pécs, Hungary
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15
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Musodza W, Sheehan A, Nicholls D, Dahlen H. Experiences of Maternity Healthcare Professionals Returning to Work Following a Personal Perinatal Loss: A Scoping Review of the Literature. Omega (Westport) 2023; 86:744-768. [PMID: 33509046 DOI: 10.1177/0030222821991312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In Australia, midwives care closely for women during pregnancy and birth and the immediate postnatal period. This scoping review aimed to explore the experiences of female maternity healthcare professionals when they return to work following a personal pregnancy loss or neonatal death.Methodology: A scoping review was carried out on published and unpublished research and grey literature looking at how maternity healthcare professionals who have had a personal perinatal loss experience working in a maternity setting following the loss. A search of the literature was performed between October and December 2018, with no set limitations. A search for relevant references from included papers was also carried out. The literature was analysed thematically. The types of perinatal loss were defined as per Australian guidelines. RESULTS 10 articles were included in this scoping review. Four themes emerged from the literature and these were: 1) Impact of being asked, "have you got children?"; 2) Impact on professional practice; 3) Impact of pre-existing professional knowledge; 4) Importance of collegial support on return to work. CONCLUSIONS Return to work in a maternity setting following a personal perinatal loss is emotionally challenging and requires a range of supports. Further research is needed in this area.
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Affiliation(s)
- Wimbayi Musodza
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Athena Sheehan
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Daniel Nicholls
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
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16
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D'Antonio F, Herrera M, Oronzii L, Khalil A. Solomon technique vs selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome: systematic review and meta-analysis of maternal and perinatal outcomes. Ultrasound Obstet Gynecol 2022; 60:731-738. [PMID: 36240516 DOI: 10.1002/uog.26095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To ascertain maternal and perinatal outcomes of monochorionic twin pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated with the Solomon technique compared with selective fetoscopic laser photocoagulation (SFLP) of placental anastomoses. METHODS MEDLINE, EMBASE and The Cochrane Library were searched to identify relevant studies. The outcomes observed were perinatal loss and survival, preterm prelabor rupture of membranes (PPROM), preterm birth (PTB), gestational age (GA) at delivery, interval between laser treatment and delivery, maternal bleeding, septostomy or chorioamniotic separation, placental abruption, twin anemia-polycythemia sequence (TAPS), recurrence of TTTS, neonatal morbidity and neurological morbidity. Random-effects head-to-head meta-analyses were used to analyze the data. Pooled odds ratios (OR) and mean differences (MD) and their 95% CIs were calculated. RESULTS Nine studies were included in the systematic review. There was generally no difference in the main maternal and pregnancy characteristics between pregnancies treated using the Solomon technique and those treated using SFLP of placental anastomoses. The risks of fetal loss (pooled OR, 0.69 (95% CI, 0.50-0.95); P = 0.023), neonatal death (pooled OR, 0.37 (95% CI, 0.16-0.84); P = 0.018) and perinatal loss (pooled OR, 0.56 (95% CI, 0.38-0.83); P = 0.004) were significantly lower in pregnancies treated using the Solomon technique than in those treated with SFLP. Likewise, pregnancies treated using the Solomon technique had a significantly higher chance of survival of at least one twin (pooled OR, 2.31 (95% CI, 1.03-5.19); P = 0.004) and double survival (pooled OR, 2.18 (95% CI, 1.29-3.70); P = 0.001). There was no difference in the risk of PPROM (P = 0.603), PPROM within 10 days from laser surgery (P = 0.982), PTB (P = 0.207), maternal bleeding (P = 0.219), septostomy or chorioamniotic separation (P = 0.224) or chorioamnionitis (P = 0.135) between the two groups, while the risk of placental abruption was higher in pregnancies treated using the Solomon technique (pooled OR, 2.90 (95% CI, 1.55-5.44); P = 0.001). In the Solomon technique group, pregnancies delivered at a significantly earlier GA than did those treated with SFLP (pooled MD, -0.625 weeks (95% CI, -0.90 to -0.35 weeks); P < 0.001), while there was no difference in the interval between laser treatment and delivery (P = 0.589). The rate of recurrence of TTTS was significantly lower in pregnancies undergoing the Solomon technique (pooled OR, 0.43 (95% CI, 0.22-0.81); P < 0.001), while there was no difference in the risk of TAPS between the two groups (P = 0.792). Finally, there was no difference in the overall risk of neonatal morbidity (P = 0.382) or neurological morbidity (P = 0.247) between the two groups. CONCLUSIONS Monochorionic twin pregnancies complicated by TTTS undergoing laser treatment using the Solomon technique had a significantly higher survival rate and lower recurrence rate of TTTS but were associated with an increased risk of placental abruption and earlier GA at delivery compared to those treated with SFLP. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - M Herrera
- Maternal Fetal Medicine Department, Colsanitas Clinic, Colombian University Clinic - Pediatric Clinic, Bogota, Colombia
- Maternal Fetal Medicine Foundation, Fetal Health Foundation, Bogota, Colombia
| | - L Oronzii
- Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
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17
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Chichester M, Tepner L, Côté-Arsenault D. Nursing Care of Childbearing Families After Previous Perinatal Loss. Nurs Womens Health 2022; 26:379-388. [PMID: 36065093 DOI: 10.1016/j.nwh.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.
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18
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Alaradi M, Hutti MH, Chaffin N. Arab Muslims' Perceptions of Perinatal Loss Care in the United States of America. Health Soc Care Community 2022; 30:1838-1846. [PMID: 34617365 DOI: 10.1111/hsc.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/10/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
One in four American women will experience a miscarriage, stillbirth or neonatal death each time she becomes pregnant. These perinatal losses occur even more frequently in women who are immigrants from developing countries. Care of Muslim families after perinatal loss is based primarily on expert opinion as opposed to research evidence, as few, if any, studies exist on this topic. It is critically important to know what parent's preferences for care actually are, since care that is incongruent with the desires of the bereaved parents may intensify their grief. The purpose of this study was to examine the perceptions and attitudes of immigrant Arab Muslims regarding psychosocial bereavement practices common in the United States after perinatal loss and to pilot test an investigator-developed instrument for collecting data regarding culturally relevant psychosocial bereavement practices of immigrant Arab Muslims after perinatal loss. The study employed a cross-sectional survey design using an investigator-developed instrument entitled the Arab Muslim Perceptions of Perinatal Loss Care (AMPPLC). The AMPPLC, available in both English and Arabic, was used to collect data on perinatal loss care from a convenience sample of 79 immigrant Arab Muslim adults (male n = 43 [54.4%]; female n = 36 [45.6%]). The study opened in June 2017 and closed in August 2019. The AMPPLC instrument demonstrated good reliability (α = 0.89) in measuring participants' responses. Responses by survey participants did not always agree with prior published literature on Muslim preferences after a loss. Optimal care for Arab Muslim immigrants involves offering all options that are typically part of Western bereavement care as well as options that may be more specifically associated with Islam. This information will enable healthcare providers to provide more culturally sensitive and compassionate care to Middle Eastern Muslim parents during this difficult and tragic experience.
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Affiliation(s)
- Maryam Alaradi
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
| | - Marianne H Hutti
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Women's Health Nurse Practitioner in Independent Practice, Louisville, Kentucky, USA
| | - Nikki Chaffin
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
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19
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Gold KJ, Boggs ME, Plegue MA, Andalibi N. Online Support Groups for Perinatal Loss: A Pilot Feasibility Study for Women of Color. Cyberpsychol Behav Soc Netw 2022; 25:534-539. [PMID: 35861706 DOI: 10.1089/cyber.2021.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We tested use of an online support group for women of color who had experienced stillbirth or early infant loss. We recruited recently bereaved mothers and asked them to participate in an existing online community for pregnancy and infant loss hosted on a commercial platform. Participants were asked to go online at least three times weekly for 6 weeks to read posts. Using a mixed-methods approach, we assessed attitudes toward online support, mental health, and experiences pre- and postintervention using written surveys and a brief phone interview. We used summary statistics for quantitative data and a deductive coding approach for qualitative data. Twenty participants completed the study. We found nonsignificant improvements in all four mental health domains (depression, post-traumatic stress disorder, moderate-severe generalized anxiety, and perinatal grief). Women reported the group allowed them to help others and feel less alone. They also reported that at times, posts could increase the intensity of their loss emotions. This study demonstrated feasibility to recruit, retain, and track participation in an online support group for perinatally-bereaved mothers of color. Although the study was not powered for outcome, all mental health measures showed nonsignificant improvements, suggesting value in further investigating online social support for improving women's mental health after perinatal loss. Clinical Trial Registration: Registered on clinicaltrials.gov [NCT04600076], October 19, 2020.
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Affiliation(s)
- Katherine J Gold
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha E Boggs
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nazanin Andalibi
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
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20
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Paraszczuk AM, Candelaria LM, Hylton-McGuire K, Spatz DL. The Voice of Mothers Who Continue to Express Milk After Their Infant's Death for Donation to a Milk Bank. Breastfeed Med 2022; 17:660-665. [PMID: 35549706 DOI: 10.1089/bfm.2021.0326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The second stage of lactation with copious milk production occurs after birth regardless of the infant's survival. Previous research indicates that milk donation following a perinatal loss may help some bereaved mothers come to terms with their loss. The purpose of this study was to explore the experience of women choosing to continue to express milk after a perinatal loss specifically for donation to a nonprofit milk bank governed by the Human Milk Banking Association of North America (HMBANA). Materials and Methods: Participants were recruited through HMBANA's milk bank directors' listserv, their bereavement committee, and through their website. Participants were eligible if they donated to an HMBANA milk bank and specifically continued to pump milk for the purpose of milk donation following a perinatal loss. Qualitative interviews were conducted with each participant using a secured web-based platform. Data collection and analysis occurred concurrently using qualitative content analysis until there was acknowledged informational redundancy. Participants' demographic and lactation data were collected and analyzed using descriptive statistics. Results: Over 10 months, 21 participants were interviewed. Donating after perinatal loss has been described as a positive, valuable, and nurturing experience. Diminished grieving, enhanced connection to the infant, establishment of legacy, and creation of a positive from a negative are highlighted in several themes that illuminate the phenomena of bereaved donation. Discussion: The findings of this research are consistent with published literature, but in this study, two subgroups were formed. This enabled the researchers to compare the experience of those with previous breastfeeding experience and those without, which adds to the knowledge about the phenomenon. It provides information for health care professionals (HCPs) to understand the experience of bereaved milk donors and serves as a call to action for HCPs to develop best practices and incorporate lactation management in enhanced, individualized bereavement care for these women.
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Affiliation(s)
- Ann Marie Paraszczuk
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York, USA
| | - Laura M Candelaria
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York, USA
| | | | - Diane L Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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21
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Lord S, Williams R, Pollard L, Ives-Baine L, Wilson C, Goodman K, Rapoport A. Reimagining Perinatal Palliative Care: A Broader Role for Support in the Face of Uncertainty. J Palliat Care 2022; 37:476-479. [PMID: 35657323 PMCID: PMC9465549 DOI: 10.1177/08258597221098496] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal medicine is confronted by a growing number of complex fetal conditions that can be diagnosed prenatally. The evolution of potentially life-prolonging interventions for the baby before and after birth contributes to prognostic uncertainty. For clinicians who counsel families in these circumstances, determining which ones might benefit from early palliative care referral can be challenging. We assert that all women carrying a fetus diagnosed with a life-threatening condition for which comfort-focused care at birth is one ethically reasonable option ought to be offered palliative care support prenatally, regardless of the chosen plan of care. Early palliative care support can contribute to informed decision making, enhance psychological and grief support, and provide opportunities for care planning that includes ways to respect and honor the life of the fetus or baby, however long it may be.
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Affiliation(s)
- Sarah Lord
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Rebecca Williams
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | - Lindsay Pollard
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Lori Ives-Baine
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | | | - Kira Goodman
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | - Adam Rapoport
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Emily's House Children's Hospice, Toronto, Canada
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22
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Fernández-Medina IM, Jiménez-Lasserrotte MDM, Ruíz-Fernández MD, Granero-Molina J, Fernández-Sola C, Hernández-Padilla JM. Milk Donation Following A Perinatal Loss: A Phenomenological Study. J Midwifery Womens Health 2022; 67:463-469. [PMID: 35166428 DOI: 10.1111/jmwh.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perinatal loss is a traumatic event for women with negative consequences for their well-being and mental health. After perinatal loss, some women choose to not suppress lactation and to donate their breast milk. Donating milk can be a grief ritual to cope with the loss. The aim of this study was to explore women's experiences of donating their breast milk following a perinatal loss. METHODS A hermeneutic phenomenology was carried out. Thirteen semistructured interviews were conducted. Data was recorded, transcribed, and categorized into themes and subthemes. RESULTS Two main themes emerged from the data: (1) lactation after loss: a forgotten aspect of the care, with the subthemes "the silence surrounding grieving lactation" and "experiencing lactation amidst a sea of tears"; and (2) milk donation: a resource to alleviate pain and offer hope, with the subthemes "expressing and donating breast milk: a healing ritual" and "breaking the taboo of the grieving lactation." DISCUSSION Information about lactation options is not typically included in participants' care plan. Women's experiences highlight the need for the support of health care professionals. Donating milk helps some women to cope with the loss and accept and integrate it into their daily lives. Milk donation is also an opportunity to educate society about options following a perinatal loss.
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Affiliation(s)
| | | | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, London, United Kingdom
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23
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Hiefner AR, Villareal A. A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care. Front Public Health 2021; 9:725762. [PMID: 34917568 PMCID: PMC8669268 DOI: 10.3389/fpubh.2021.725762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.
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Affiliation(s)
- Angela R Hiefner
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Astrud Villareal
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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24
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Popoola T, Skinner J, Woods M. Exploring the Social Networks of Women Bereaved by Stillbirth: A Descriptive Qualitative Study. J Pers Med 2021; 11:1056. [PMID: 34834407 PMCID: PMC8624714 DOI: 10.3390/jpm11111056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
The loss of a baby to stillbirth is a traumatic experience and can lead to secondary losses, such as the loss of social relationships. In Nigeria, stillbirths are a common public health problem. However, limited attention has been given to the social ramifications of stillbirths. This study describes the social networks of women who have experienced a stillbirth and the factors influencing their social networks. Interviews and social network diagrams were used to collect data from 20 women about their social networks before and after stillbirth. Findings suggest that the experience of shame, unmet expectation of support, and a lack of trust led to relationship changes after stillbirth. Most participants met bereavement needs with their existing social networks before stillbirth, but many participants also experienced relationship losses (even among family networks). Information from social network analysis can reveal the risks and strengths inherent in social networks, which can be helpful for the provision of tailored/personalized bereavement care.
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Affiliation(s)
- Tosin Popoola
- School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington 6012, New Zealand; (J.S.); (M.W.)
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Hvidtjørn D, Mørk S, Eklund M, Maimburg RD, Henriksen TB. Women's Length of Stay in a Danish Specialized Unit for Perinatally Bereaved Parents. J Obstet Gynecol Neonatal Nurs 2021; 50:714-723. [PMID: 34384770 DOI: 10.1016/j.jogn.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe the clinical characteristics of women admitted to a specialized unit for bereaved parents and to identify the characteristics of women who stayed more than 2 days. DESIGN A population-based descriptive study. SETTING A midwifery-led specialized unit for bereaved parents at Aarhus University Hospital, Denmark. PARTICIPANTS Women with miscarriage (>14 weeks), missed abortion (>14 weeks), termination of pregnancy (>14 weeks), stillbirth, or death of their neonate during the first 48 hours after birth. METHODS We collected information from the electronic health care records for women admitted to the unit from January 2012 through December 2018, including parity, type of loss, gestational age, mode and duration of birth, pain relief, and duration of stay. RESULTS From January 1, 2012. to December 31, 2018, 579 women were admitted to the unit. Hospitalization varied from 1 day to 1 week. More women with a loss after 22 gestational weeks stayed for more than 2 days. In multivariate analyses, the hazard ratio (HR) of staying longer than 2 days was 1.3 times greater for primiparous women than for multiparous women (HR = 1.3, 95% confidence interval [1.0, 1.7]) and 2.4 times greater for women with near-term loss compared to women with perinatal loss before gestational week 22 (HR = 2.4, 95% confidence interval [1.7, 3.6]). CONCLUSION Providing unlimited stay at a specialized unit for perinatal loss resulted in variation in length of stay. Primiparous women and women who lost neonates or fetuses closer to term gestation were more likely to stay in the unit for up to 8 days. This may indicate a need for individual support not available in standard care.
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Yenal K, Tektaş P, Dönmez A, Okumuş H. Perinatal Loss: Experiences of Midwives and Nurses. Omega (Westport) 2021:302228211029143. [PMID: 34324400 DOI: 10.1177/00302228211029143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim was to determine the experiences of Turkish midwives and nurses when caring for families with perinatal loss. It was a descriptive and qualitative study. One-to-one interviews were conducted with ten midwives and five nurses using a semi-structured interview form. It was found that the nurses and midwives experienced pain and grief during caring for women who had perinatal losses, and they tried to relieve these feelings by using positive thinking and prayer. The nurses and midwives stated that they were unsure how to approach women or family experiencing perinatal loss, and they needed mentoring and training. The results showed that it would be beneficial to plan training for nurses and midwives and to conduct mentoring for those experiencing difficulties. For nurses and midwives frequently facing perinatal loss, there will be benefit in planning grief care training at regular intervals and mentoring for those experiencing difficulties.
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Affiliation(s)
- Kerziban Yenal
- Nursing Department, School of Health, European University of Lefke, Turkish Republic of Northern Cyprus
| | - Pınar Tektaş
- Nursing Department, School of Health, European University of Lefke, Turkish Republic of Northern Cyprus
| | - Ayşegül Dönmez
- Midwifery Department, Faculty of Health Sciences, Tınaztepe University, Izmir, Turkey
| | - Hülya Okumuş
- Nursing Faculty, Dokuz Eylül University, Izmir, Turkey
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Fernández-Férez A, Ventura-Miranda MI, Camacho-Ávila M, Fernández-Caballero A, Granero-Molina J, Fernández-Medina IM, Requena-Mullor MDM. Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18115587. [PMID: 34073728 PMCID: PMC8197264 DOI: 10.3390/ijerph18115587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions.
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Affiliation(s)
- Alba Fernández-Férez
- Faculty of Health Sciences, University of Granada, Distrito Sanitario Almería, 04009 Almería, Spain;
| | - Maria Isabel Ventura-Miranda
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.M.F.-M.); (M.d.M.R.-M.)
- Correspondence:
| | | | - Antonio Fernández-Caballero
- Faculty of Nursing, Univesity of Cádiz, 11207 Algeciras, Spain;
- Gynecology, Obstetrics and Delivery Service of the Hospital Punta Europa, 11207 Algeciras, Spain
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.M.F.-M.); (M.d.M.R.-M.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.M.F.-M.); (M.d.M.R.-M.)
| | - María del Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (J.G.-M.); (I.M.F.-M.); (M.d.M.R.-M.)
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Abstract
The loss of a child comes with trauma, which affects parents and the entire family. Yet, there is limited support for parents who lose their child and little empirical research has been devoted to the experiences of parents who lose a child in the Ghanaian context. Based on interviews with 20 participants purposively sampled from the Accra Metropolis, this study explored parents' psychosocial experiences of child loss using a qualitative approach. The study's findings indicated that bereaved parents showed signs of complicated grief and experienced spousal neglect, self-blame, and emotional pain. Bereaved parents may become sensitive to child comments years after child loss. The quality of interaction after child loss influences how parents experience the loss. Findings underscore the need for a joint effort by government and other stakeholders in the health sector to address issues related to child loss and provide improved services to those who suffer child loss.
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Affiliation(s)
| | - Francis Annor
- Department of Psychology, University of Ghana, Accra, Ghana
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Berry SN, Marko T, Oneal G. Qualitative Interpretive Metasynthesis of Parents' Experiences of Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2020; 50:20-29. [PMID: 33212051 DOI: 10.1016/j.jogn.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss. DATA SOURCES We searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents' experiences of perinatal loss. STUDY SELECTION We included research on parents' experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature. DATA EXTRACTION We used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents' perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis. DATA SYNTHESIS We used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding-Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere. CONCLUSION Our findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents' overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.
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Abstract
OBJECTIVE To examine the interactions and social processes involved when nurses care for women who experience fetal demise and subsequent stillbirth. DESIGN Qualitative design using grounded theory. SETTING Single-site urban medical center in New York City. PARTICIPANTS Twenty registered nurses who worked in the labor and delivery department. METHODS I collected data via in-depth interviews and recorded, transcribed, and analyzed the data using constant comparative analysis. RESULTS Managing Ambiguity emerged as the overarching preliminary theory to describe how nurses cared for women who experienced stillbirth. This preliminary theory included three themes: Experiencing a Spectrum of Emotions, Managing Patient Care in an Ambiguous Context, and Managing Institutional Ambiguity. These themes provided an overview of the creative/protective and avoidant/conflicted behaviors that nurses brought to their work with women whose fetuses died in utero and were stillborn. These interactions were complicated by institutional policies and additional factors, such as workload, that often denied nurses the resources needed to engage in the patient care processes required to address the trauma experienced by women and their families. CONCLUSION The preliminary theory Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for women who experience stillbirth. The absence of preparatory education, effective protocols, and institutional support contributed to the ambiguity inherent in caring for these women.
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Paloma-Castro O, Pastor-Montero SM, Carnicer Fuentes C, Jesús Albar-Marín M, Bas-Sarmiento P, Moreno-Corral LJ, Romero-Sánchez JM. Nursing Diagnosis of Grieving in Cases of Perinatal Loss: A Preliminary Clinical Validation. Int J Nurs Knowl 2020; 32:157-165. [PMID: 33009885 DOI: 10.1111/2047-3095.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a preliminary clinical validation the NANDA-I nursing diagnosis "Grieving" in cases of perinatal loss. METHODS Descriptive cross-sectional study using the Fehring model. FINDINGS The overall clinical validity index for the diagnosis was 0.15. Only four defining characteristics and five manifestations identified in the literature were validated. CONCLUSIONS The variability of manifestations identified in the study participants is considered to be detrimental to the overall clinical validity index. IMPLICATIONS FOR NURSING PRACTICE The clinical validity of the diagnosis could not be substantiated by the preliminary results of this study and, therefore, additional research is necessary to determine the ability of the diagnosis to adapt to perinatal loss situations in real contexts. Some manifestations have been proposed to NANDA-I for inclusion as defining characteristics in the nursing diagnosis of grieving. OBJETIVO Validar clínicamente de forma preliminar el diagnóstico enfermero NANDA-I duelo en caso de pérdida perinatal. MÉTODOS: Estudio descriptivo transversal usando el modelo de Fehring. RESULTADOS El índice de validez clínica global del diagnóstico fue de 0.15. Se validaron únicamente cuatro características definitorias y cinco manifestaciones identificadas en la literatura. CONCLUSIONES Se considera que la variabilidad de las manifestaciones presentadas por los participantes actuó en detrimento del índice de validación clínica global. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: La validez clínica del diagnóstico no pudo ser corroborada por los resultados preliminares de este estudio y, por tanto, se necesita investigación adicional para terminar la capacidad de este diagnóstico para adaptarse a las situaciones de pérdidas perinatales en contexto reales. Se han propuesto a NANDA-I algunas manifestaciones para que sean incluidas como Características Definitorias del diagnóstico enfermero Duelo.
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Affiliation(s)
- Olga Paloma-Castro
- Professor at Nursing School, University of Cádiz, Cádiz, Spain.,Head of the Research Group under the Andalusian Research, Development and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
| | | | - Concepción Carnicer Fuentes
- Professor at Nursing School, University of Cádiz, Cádiz, Spain.,Researcher at Research Group under the Andalusian Research, Development and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
| | | | - Pilar Bas-Sarmiento
- Professor at Nursing School, University of Cádiz, Cádiz, Spain.,Researcher at Research Group under the Andalusian Research, Development and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
| | - Luis Javier Moreno-Corral
- Professor at Nursing School, University of Cádiz, Cádiz, Spain.,Researcher at Research Group under the Andalusian Research, Development and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
| | - José Manuel Romero-Sánchez
- Researcher at Research Group under the Andalusian Research, Development and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
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Abstract
Emotional care is an important part of the holistic labor and should be considered when providing care to people affected by perinatal losses. To synthesize the findings from recently published scientific evidence on the emotional care needed following perinatal loss, a search in PubMed, CINAHL, SCOPUS, and Web of Science was carried out in January 2020 yielding 22 studies which met the inclusion criteria and were analyzed following Whittemore and Knafl's (2005) methodology. One category on "offering emotional care" was identified: "Aspects influencing the psychosocial well-being of women after perinatal loss," comprising eight themes: risk of complicated grief, cultural values, perinatal losses in multiple pregnancies, experience of subsequent pregnancies, need of information, contact with the deceased baby, impact on relatives, and strategies for emotional care. In conclusion, the evidence highlights the need of specific emotional grief care.
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Affiliation(s)
- Sara Furtado-Eraso
- Department of Health Sciences, Public University of Navarre, Pamplona, Navarre, Spain
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Barrett PM, McCarthy FP, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS, Kublickiene K. Stillbirth is associated with increased risk of long-term maternal renal disease: a nationwide cohort study. Am J Obstet Gynecol 2020; 223:427.e1-427.e14. [PMID: 32112729 PMCID: PMC7479504 DOI: 10.1016/j.ajog.2020.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/30/2023]
Abstract
Background Stillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth. Objective To identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities. Study Design/Methods We conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately. Results There were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9–30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09–1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55–3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13–1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86–4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73–1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78–2.85). Conclusion Women who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.
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Abstract
The purpose of this research was to ascertain the availability and depth of services of bereavement care for mothers who live rurally. The specific focus is on those who experienced early losses including pregnancy, stillbirth, neonatal, and young children who were born with fetal anomalies or neonatal disease that resulted in death. The convenience (nonprobability) sample originated from a population of mothers who lived in rural east central Minnesota. Participants were interviewed in a 60-minute interval. All data were coded confidential. Common themes, incidence of resources, or lack of bereavement resources for the participants' lived experiences were considered using a descriptive phenomenological approach. Our appreciation of the continuing bond between mother and child compels us to believe that there is an ethical obligation to reduce and remove these barriers and inequalities in bereavement support services for those who live rurally and have experienced perinatal and infant loss. Results of this study indicate the need for further study and establishment of bereavement resources in rural outreach for perinatal and early childhood loss.
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Affiliation(s)
- Julie S Domogalla
- Department of Thanatology, Marian University, Fond du Lac, Wisconsin, United States
| | - Janet McCord
- Department of Thanatology, Marian University, Fond du Lac, Wisconsin, United States
| | - Rebecca Morse
- Department of Thanatology, Marian University, Fond du Lac, Wisconsin, United States
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Zsák É, Hegedűs K. [Possibilities and challenges of perinatal hospice-palliative care]. Orv Hetil 2020; 161:452-457. [PMID: 32172586 DOI: 10.1556/650.2020.31636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Perinatal hospice care is a special form of paediatric palliative care, with a focus on prenatally diagnosed malformation, providing physical, psychological and mental support with a holistic approach for the families. Our aim was to analyse how perinatal hospice-palliative care can be implemented and what opportunities it may provide on the basis of available professional guidelines. We introduce study and analysis of the professional guidelines and protocols, mainly from Anglo-Saxon countries, and describe some examples of best practices. Perinatal hospice is a specially demanding care regarding professional and personal challenges. Standardised guidelines based on consensus can serve as starting points, describing proper care and its conditions. Moreover, they can facilitate communication and coordinative processes between the collaborating specialists. Challenging conditions and possible solutions to them can be identified during supportive formative courses. Continuous formation means competency development in palliative care as well as in adequate communication. Orv Hetil. 2020; 161(12): 452-457.
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Affiliation(s)
- Éva Zsák
- Általános Orvostudományi Kar, Magatartástudományi Intézet,Semmelweis EgyetemBudapest, Nagyvárad tér 4., 1089
| | - Katalin Hegedűs
- Általános Orvostudományi Kar, Magatartástudományi Intézet,Semmelweis EgyetemBudapest, Nagyvárad tér 4., 1089
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Fernández-Basanta S, Movilla-Fernández MJ, Coronado C, Llorente-García H, Bondas T. Involuntary Pregnancy Loss and Nursing Care: A Meta-Ethnography. Int J Environ Res Public Health 2020; 17:E1486. [PMID: 32106591 DOI: 10.3390/ijerph17051486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/15/2020] [Accepted: 02/22/2020] [Indexed: 11/16/2022]
Abstract
Healthcare professionals find the care of parents following an involuntary pregnancy loss stressful and challenging. They also feel unprepared to support bereaved parents. The challenging nature of this support may have a personal impact on health professionals and the care provided to parents. The aim of this meta-ethnography is to synthesise nurses’ and midwives’ experiences of caring for parents following an involuntary pregnancy loss. A meta-ethnography of ten studies from five countries was carried out. GRADE CERQual was assessed to show the degree of confidence in the review findings. An overarching metaphor, caring in darkness, accompanied by five major themes provided interpretive explanations about the experiences of nurses and midwives in caring for involuntary pregnancy losses: (1) Forces that turn off the light, (2) strength to go into darkness, (3) avoiding stumbling, (4) groping in darkness, and (5) wounded after dealing with darkness. Nursing staff dealt with organizational difficulties, which encouraged task-focused care and avoidance of encounters and emotional connection with parents. However, nurses and midwives might go beyond in their care when they had competencies, support, and a strong value base, despite the personal cost involved.
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Baransel ES, Uçar T. Posttraumatic stress and affecting factors in couples after perinatal loss: A Turkish sample. Perspect Psychiatr Care 2020; 56:112-120. [PMID: 31020674 DOI: 10.1111/ppc.12390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE We aimed to determine the posttraumatic stress levels and the factors affecting them in couples (154 women and 154 men) after a perinatal loss in Turkey. CONCLUSIONS In women, an ending of the pregnancy between gestational weeks 30 and 37 and being employed reduced the posttraumatic stress level. In men, seeing the baby after birth, having no alcohol, and having high education and income levels decreased the posttraumatic stress level. PRACTICE IMPLICATIONS Knowledge of the factors affecting posttraumatic stress may help identify those couples in whom the probability of this disorder occurring is increased.
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Affiliation(s)
- Esra Sabancı Baransel
- Department of Midwifery, Faculty of Health Sciences, İnönü University, Malatya, Turkey
| | - Tuba Uçar
- Department of Midwifery, Faculty of Health Sciences, İnönü University, Malatya, Turkey
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Abstract
This study was conducted to evaluate the efficiency of a nursing support program developed in accordance with the Roy adaptation model that was applied in addition to routine nursing care during the treatment process of pregnant women for whom the medical termination decision. This study, which was conducted using a pretest-posttest design, was a prospective, single-blind, and randomized-controlled empirical study. In the experimental group, although the first and last assessment State Anxiety Inventory scores were higher than those in the control group after the medical termination nursing support program, there was no significant difference. Compared with the control group, there were positive differences in the Scale of Ways of Coping with Stress, Adaptation Assessment Form for Role Function Area, and physical complaints in the experimental group. At the follow-up assessment, the total Perinatal Grief Scale score was significantly higher than that in the control group.
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Affiliation(s)
- Meltem Mecdi Kaydirak
- Department of Obstetrics and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Turkey
| | - Ergül Aslan
- Department of Obstetrics and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Turkey
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Druguet M, Nuño L, Rodó C, Arévalo S, Carreras E, Gómez-Benito J. Maternal Satisfaction with Healthcare after Perinatal Loss in Monochorionic Twin Pregnancy. J Clin Med 2019; 8:E1213. [PMID: 31416177 DOI: 10.3390/jcm8081213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The analysis of patients' satisfaction with healthcare is recognised as being useful in the evaluation of health outcomes and perceived quality of care. Little is known, however, about how the psychological status of women who experience perinatal complications may affect their perceived satisfaction with care. METHODS We assessed healthcare satisfaction in 52 women who had undergone intrauterine surgery during a complicated monochorionic twin pregnancy and examined the influence that fetal loss and sociodemographic, clinical, and psychological factors had on the degree of satisfaction. Data were gathered in an individual interview and through the administration of the Medical Patient Satisfaction Questionnaire, Beck Depression Inventory, and State-Trait Anxiety Inventory. Relationships between variables were analysed using a chi-square test, Spearman's rho, Student's t test, and the Mann-Whitney U test, in accordance with the metric nature of the variables and the assumptions fulfilled. RESULTS Age and level of education were not associated with the degree of healthcare satisfaction. Negative but non-significant correlations were observed between the level of satisfaction and symptoms of anxiety and depression. Satisfaction with healthcare was high in the sample as a whole, although it was significantly higher among women who had not experienced fetal loss. There were no differences in satisfaction with services involving direct contact with medical staff, whereas satisfaction with indirect services was lower among women who had experienced perinatal loss. CONCLUSIONS Due to the unique characteristics of this population, specialised care teams of both professional healthcare and indirect services are needed. Although administrative aspects of healthcare are regarded as being of secondary importance, this may not be the case with more vulnerable populations.
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Ramirez FD, Bogetz JF, Kufeld M, Yee LM. Professional Bereavement Photography in the Setting of Perinatal Loss: A Qualitative Analysis. Glob Pediatr Health 2019; 6:2333794X19854941. [PMID: 31236429 PMCID: PMC6572886 DOI: 10.1177/2333794x19854941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 11/22/2022] Open
Abstract
Perinatal loss, including fetal and infant death, is a devastating experience for parents, resulting in long-term adverse physical and psychosocial outcomes. However, little is known about what services might best support grieving parents. We aimed to understand the role of professional bereavement photography in assisting the grieving process of parents who have lost a fetus or infant, by examining the perspectives of bereaved parents, professional photographers, and health care professionals. Twenty semistructured interviews were conducted, and interview transcripts were analyzed using modified grounded theory. Twenty-three individuals participated, including 6 bereaved parents, 8 photographers, and 9 health care professionals. Analyses generated 5 major themes describing ways in which the photographs were valuable to parents: validation of the experience, permission to share, creation of a permanent and tangible legacy, creation of positive memories, and moving forward after the loss. Hospitals should consider incorporation of professional bereavement photography services into palliative care and bereavement programs.
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Affiliation(s)
| | - Jori F Bogetz
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | - Lynn M Yee
- Northwestern University, Chicago, IL, USA
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Abstract
Death, disease and disaster can inflict anyone, anywhere and at any time. While occurrence of such an event could be absolved of any selective strike, the outcome reflects otherwise. Historical deprivations experienced by certain populations have caused more bereavement and sorrow to them than those who have experienced lesser or no deprivation. Therefore, the process which shapes the factors to yield such a result is important and needs to be understood for any policy suggestions and programmatic inputs. Loss of pregnancy and newborn inflicts sorrow and bereavement across space, time and social labyrinth. The degree of bereavement is likely to reduce with time, but space and social context govern the response to it. Therefore, factors contributing to the differentials vary in their demographic, social and economic characteristics. The loss of pregnancy and newborn remains inadequately addressed. Family and community play a significant role in coping. While the developed countries have institutional structure to address coping with the loss, the South Asian countries rely heavily on the family and the community for such support. The present review examines these trajectories across social groups.
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Affiliation(s)
- Sanghmitra S Acharya
- Centre of Social Medicine & Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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Cohen K, Leibovich L, Markin R, Zilcha-Mano S. The process of change in psychotherapy with a pregnant patient following perinatal losses: An analysis of a case study. J Clin Psychol 2019; 75:874-885. [PMID: 30768793 DOI: 10.1002/jclp.22763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM Despite research suggesting increased anxiety and depressive symptoms after a perinatal loss and during future pregnancies, little knowledge exists to guide clinicians treating pregnant women after perinatal loss. This case study explores processes that facilitated therapeutic change for a pregnant patient with major depressive disorder (MDD) and posttraumatic stress disorder after perinatal losses. METHOD The study integrated quantitative and narrative analyses in a single case derived from the pilot phase of a randomized controlled trial on supportive-expressive therapy for MDD. RESULTS The quantitative and narrative analyses suggest that an improvement in maladaptive interpersonal patterns toward the therapist, in the form of attachment avoidance, made it possible to form a strong alliance, which in turn led to a successful outcome. CONCLUSIONS The findings highlight the importance of improving maladaptive interpersonal patterns as a prerequisite to enable patients after pregnancy losses to develop and maintain a corrective therapeutic experience.
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Affiliation(s)
- Keren Cohen
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Liat Leibovich
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Rayna Markin
- The Department of Education and Counseling, Villanova University, Villanova, Pennsylvania
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Pirnat A, DeRoo LA, Skjaerven R, Morken NH. Risk of having one lifetime pregnancy and modification by outcome of pregnancy and perinatal loss. Acta Obstet Gynecol Scand 2019; 98:753-760. [PMID: 30648732 DOI: 10.1111/aogs.13534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With increasing cesarean section rates, adverse pregnancy outcomes such as preterm delivery and small-for-gestational-age continue to be public health challenges. Besides having high co-occurrence and interrelation, it is suggested that these outcomes, along with preeclampsia, are associated with reduced subsequent fertility. On the other hand, the loss of a child during the perinatal period is associated with increased reproduction. Failure to consider this factor when estimating the effects of pregnancy outcomes on future reproduction may lead to erroneous conclusions. However, few studies have explored to what degree a perinatal loss contributes to having a next pregnancy in various adverse pregnancy outcomes. MATERIAL AND METHODS This was a population-based study of mothers giving birth to their first singleton infant (≥22 gestational weeks) during 1967-2007 who were followed for the occurrence of a second birth in the Medical Birth Registry of Norway until 2014. Relative risks with 95% confidence intervals for having one lifetime pregnancy by preterm delivery, small-for-gestational-age, preeclampsia and cesarean section were obtained by generalized linear models for the binary family and adjusted for maternal age at first birth, education and year of first childbirth. Main outcome measure was having one lifetime pregnancy. RESULTS Nearly 900 000 women gave birth to their first singleton infant in 1967-2007, of which 16% had only one lifetime pregnancy. These women were older at first delivery, had less education and there was a higher proportion of unmarried women than women with two or more births. In women with pregnancy complications where the infant survived the perinatal period, there were the following relative risks for one lifetime pregnancy: increased preterm delivery: 1.21 (1.19-1.22)], small-for-gestational-age: 1.13 (1.12-1.15), preeclampsia: 1.09 (1.07-1.11), cesarean section: 1.24 (1.23-1.25). The risk was significantly reduced if the child was lost (preterm delivery: 0.63 [0.59-0.68], small-for-gestational-age: 0.57 [0.51-0.63], preeclampsia: 0.69 [0.59-0.80], cesarean section: 0.67 [0.56-0.79]), compared with women with no perinatal loss and no adverse outcome. CONCLUSIONS The associations between adverse outcomes of pregnancy and the risk of having one lifetime pregnancy were strongly modified by child survival in the perinatal period.
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Affiliation(s)
- Aleksandra Pirnat
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lisa A DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolv Skjaerven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Fertility Center, Norwegian Institute of Public Health, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Wimmer L. Star Legacy Foundation: The Power of Hope for Families Living With Stillbirth. Creat Nurs 2018; 24:258-262. [PMID: 30567969 DOI: 10.1891/1078-4535.24.4.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The stillbirth of her son prompted this nurse to look inside herself for the tools needed to move forward both personally and professionally. The first tasks were to learn how to trust herself again and find hope for the future. This journey prompted her to create a nonprofit organization, Star Legacy Foundation, that utilizes what she learned, and to expand her definition of what it means to be a health-care professional.
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Zwiers C, van der Bom JG, van Kamp IL, van Geloven N, Lopriore E, Smoleniec J, Devlieger R, Sim PE, Ledingham MA, Tiblad E, Moise KJ, Gloning KP, Kilby MD, Overton TG, Jørgensen DS, Schou KV, Paek B, Walker M, Parry E, Oepkes D, de Haas M. Postponing Early intrauterine Transfusion with Intravenous immunoglobulin Treatment; the PETIT study on severe hemolytic disease of the fetus and newborn. Am J Obstet Gynecol 2018; 219:291.e1-291.e9. [PMID: 29902448 DOI: 10.1016/j.ajog.2018.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/18/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrauterine transfusion for severe alloimmunization in pregnancy performed <20 weeks' gestation is associated with a higher fetal death rate. Intravenous immunoglobulins may prevent hemolysis and could therefore be a noninvasive alternative for early transfusions. OBJECTIVE We evaluated whether maternal treatment with intravenous immunoglobulins defers the development of severe fetal anemia and its consequences in a retrospective cohort to which 12 fetal therapy centers contributed. STUDY DESIGN We included consecutive pregnancies of alloimmunized women with a history of severe hemolytic disease and by propensity analysis compared index pregnancies treated with intravenous immunoglobulins (n = 24) with pregnancies managed without intravenous immunoglobulins (n = 28). RESULTS In index pregnancies with intravenous immunoglobulin treatment, fetal anemia developed on average 15 days later compared to previous pregnancies (8% less often <20 weeks' gestation). In pregnancies without intravenous immunoglobulin treatment anemia developed 9 days earlier compared to previous pregnancies (10% more <20 weeks), an adjusted 4-day between-group difference in favor of the immunoglobulin group (95% confidence interval, -10 to +18; P = .564). In the subcohort in which immunoglobulin treatment was started <13 weeks, anemia developed 25 days later and 31% less <20 weeks' gestation (54% compared to 23%) than in the previous pregnancy. Fetal hydrops occurred in 4% of immunoglobulin-treated pregnancies and in 24% of those without intravenous immunoglobulin treatment (odds ratio, 0.03; 95% confidence interval, 0-0.5; P = .011). Exchange transfusions were given to 9% of neonates born from pregnancies with and in 37% without immunoglobulin treatment (odds ratio, 0.1; 95% confidence interval, 0-0.5; P = .009). CONCLUSION Intravenous immunoglobulin treatment in mothers pregnant with a fetus at risk for hemolytic disease seems to have a potential clinically relevant, beneficial effect on the course and severity of the disease. Confirmation in a multicenter randomized trial is needed.
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Affiliation(s)
- Carolien Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - John Smoleniec
- Feto-Maternal Unit, Liverpool Hospital, Liverpool, Australia
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Pauline E Sim
- Ian Donald Fetal Medicine Unit, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - Marie Anne Ledingham
- Ian Donald Fetal Medicine Unit, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kenneth J Moise
- McGovern Medical School, UT Health; Fetal Center, Children's Memorial Hermann Hospital, Houston, TX
| | | | - Mark D Kilby
- Fetal Medicine Center, Birmingham Women's and Children's Foundation Trust, and Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | | | - Ditte S Jørgensen
- Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Katrine V Schou
- Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bettina Paek
- Evergreen Fetal Therapy Program, Evergreen Health Medical Center, Kirkland, WA
| | - Martin Walker
- Evergreen Fetal Therapy Program, Evergreen Health Medical Center, Kirkland, WA
| | - Emma Parry
- Maternal-Fetal Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands; Immunohematology Diagnostic Services, Sanquin Blood Supply, Amsterdam, The Netherlands
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Druguet M, Nuño L, Rodó C, Arévalo S, Carreras Moratonas E, Gómez-Benito J. Influence of farewell rituals and psychological vulnerability on grief following perinatal loss in monochorionic twin pregnancy. J Matern Fetal Neonatal Med 2017; 32:1033-1035. [PMID: 29046073 DOI: 10.1080/14767058.2017.1395013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to analyze whether the absence of farewell rituals and previous psychological vulnerability are associated with the intensity of grief following perinatal loss in monochorionic twin pregnancy. METHOD The sample comprised 28 women who experienced perinatal loss following fetal surgery. Sociodemographic and clinical data and information about farewell rituals were collected through interview. The women also completed a questionnaire about perinatal grief. RESULTS A history of psychological and/or psychopharmacological treatment was associated with more intense grief following perinatal loss. CONCLUSION Women with a history of psychological difficulties are particularly vulnerable to a complicated grief reaction after experiencing perinatal loss. However, the intensity of grief did not differ significantly according to whether or not the women performed some kind of farewell ritual. Further studies are needed to investigate these relationships and to encourage and facilitate the development of specific interventions for this population.
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Affiliation(s)
- Mònica Druguet
- a Quantitative Psychology Unit, Faculty of Psychology , University of Barcelona , Barcelona , Spain
| | - Laura Nuño
- a Quantitative Psychology Unit, Faculty of Psychology , University of Barcelona , Barcelona , Spain.,b Clinical Institute of Neuroscience (ICN) , Hospital Clinic , Barcelona , Spain
| | - Carlota Rodó
- c Maternal Fetal Medicine Unit, Department of Obstetrics , Hospital Vall d'Hebron , Barcelona , Spain
| | - Silvia Arévalo
- c Maternal Fetal Medicine Unit, Department of Obstetrics , Hospital Vall d'Hebron , Barcelona , Spain
| | - Elena Carreras Moratonas
- c Maternal Fetal Medicine Unit, Department of Obstetrics , Hospital Vall d'Hebron , Barcelona , Spain
| | - Juana Gómez-Benito
- a Quantitative Psychology Unit, Faculty of Psychology , University of Barcelona , Barcelona , Spain.,d Group on Measurement Invariance and Analysis of Change (GEIMAC) , Institute of Neurosciences (NeuroUB), University of Barcelona , Barcelona , Spain
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Gandino G, Di Fini G, Bernaudo A, Paltrinieri M, Castiglioni M, Veglia F. The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals' reactions. J Health Psychol 2017; 25:640-651. [PMID: 28854811 DOI: 10.1177/1359105317727841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals' language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed.
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Affiliation(s)
| | | | | | | | - Marco Castiglioni
- Riccardo Massa Department of Human Sciences and Education, University of Milano-Bicocca, Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin, Italy
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Abstract
Healthcare professionals' psychological involvement in perinatal loss is a largely overlooked subject by healthcare systems, scientific research and prevention policies. A systematic scientific review has been carried out about emotional experiences, attributed meanings and needs conveyed by healthcare professionals in relation to perinatal loss. We identified 213 studies between 1985 and 2015, 20 of which were included in the present study for qualitative analysis. Our results point out the need for a targeted vocational training in perinatal loss, enabling healthcare professionals to achieve a proper management of their own internal states.
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Affiliation(s)
| | | | | | - Ilaria Vanni
- Department of Psychology, University of Turin, Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin, Italy
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Zwiers C, Lindenburg ITM, Klumper FJ, de Haas M, Oepkes D, Van Kamp IL. Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol 2017; 50:180-186. [PMID: 27706858 PMCID: PMC5601196 DOI: 10.1002/uog.17319] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/19/2016] [Accepted: 09/22/2016] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Maternal alloimmunization to fetal red-blood-cell antigens is a major cause of fetal anemia, which can lead to hydrops and perinatal death if untreated. The cornerstone of management during pregnancy is intrauterine intravascular blood transfusion (IUT). Although this procedure is considered relatively safe, complications continue to occur. The aim of this study was to evaluate rates of procedure-related complications and perinatal loss following IUT, and their change over time, in order to identify factors leading to improved outcome. METHODS This was a retrospective analysis of all IUTs for red-cell alloimmunization performed at the national referral center for fetal therapy in The Netherlands, from 1988 to 2015. Differences in complication rates and their associations with alterations in transfusion technique after 2001 were assessed. RESULTS Between 1988 and 2015, 1678 IUTs were performed in 589 fetuses. For IUTs performed in 2001 and onwards, there was significant improvement in survival (88.6% vs 97.0%, P < 0.001) and a decline in procedure-related complications per fetus (9.8% vs 3.3%, P = 0.001) and per procedure (3.4% vs 1.2%, P = 0.003) compared with those performed before 2001. Procedure-related perinatal loss declined from 4.7% to 1.8% per fetus (P = 0.053). Beneficial changes in transfusion technique were routine use of fetal paralysis, increased use of intrahepatic transfusion and avoidance of arterial puncture. CONCLUSIONS IUT has become an increasingly safe procedure in recent years when performed by experienced hands. The chosen technique should be fine-tuned according to the patient's individual situation. The declining complication rates are most likely related to center volume: this rare procedure is best performed in experienced fetal therapy centers. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Zwiers
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - I. T. M. Lindenburg
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - F. J. Klumper
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - M. de Haas
- Department of Red Blood Cell Serology, Sanquin DiagnosticsAmsterdamThe Netherlands
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenThe Netherlands
| | - D. Oepkes
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - I. L. Van Kamp
- Department of ObstetricsLeiden University Medical CenterLeidenThe Netherlands
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Shapiro GD, Séguin JR, Muckle G, Monnier P, Fraser WD. Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort. J Psychosom Obstet Gynaecol 2017; 38:121-132. [PMID: 28079434 PMCID: PMC5383417 DOI: 10.1080/0167482x.2016.1271979] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy. METHODS Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits. RESULTS Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester. DISCUSSION Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety.
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Affiliation(s)
- Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada,CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada
| | - Jean R. Séguin
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Gina Muckle
- Centre de Recherche du Centre hospitalier universitaire de Québec, Quebec, Canada,École de psychologie, Université Laval, Quebec, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Canada
| | - William D. Fraser
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada,Department of Obstetrics and Gynaecology, Université de Sherbrooke, and Centre de recherche du CHUS, Sherbrooke, Canada
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