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Vivekananda K, McDowell C, Knipe K, McMaster C, Rahimi F, Richards M, Salvini S. Professional bereavement photography for perinatal loss: A mixed-methods study. DEATH STUDIES 2024; 48:489-499. [PMID: 37489063 DOI: 10.1080/07481187.2023.2237440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
This study addresses research gaps regarding the impact of professional bereavement photography for perinatal loss. Utilizing a mixed-methods research design, 504 parents completed an online survey measuring their attitudes toward bereavement photography and its impact. Thirty-one parents participated in semi-structured interviews. The results indicate a high level of acceptability and satisfaction for professional bereavement photography by parents (including those from more diverse backgrounds). Data triangulation confirmed that photos are valuable in enfranchising grief, validating parental and babies' identities and facilitating connections with others. Significant correlations were found for sharing of photos with both positive attitudes toward photography and for continuing bonds. The expression of continuing bonds in public social media spaces suggests increased social acceptance and validation for grieving perinatal losses. The findings from this study further inform practice guidelines for supporting perinatal loss.
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Affiliation(s)
- Kitty Vivekananda
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Chiara McDowell
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Kayleigh Knipe
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Charlotte McMaster
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Fatima Rahimi
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Mia Richards
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
| | - Sarah Salvini
- School of Educational Psychology and Counselling, Monash University, Melbourne, Australia
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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 : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580231223763. [PMID: 38339829 PMCID: PMC10859064 DOI: 10.1177/00469580231223763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 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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Fernández-Basanta S, Rodríguez-Pérez R, Coronado C, Movilla-Fernández MJ. Knight by force and wounded, protecting without a shield: A meta-ethnography of men's experiences after an involuntary pregnancy loss. Midwifery 2023; 126:103827. [PMID: 37741180 DOI: 10.1016/j.midw.2023.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/15/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE To synthesize the available body of qualitative research regarding the experiences of men after an involuntary pregnancy loss. DESIGN Noblit and Hare's interpretive meta-ethnography of 13 original qualitative articles was carried out. RESULTS After reciprocal and refutational translations, the lines of argument synthesis were developed, together with the metaphor "Knight by force and wounded, protecting without a shield." This metaphor symbolizes the experience of men after an involuntary pregnancy loss. CERQual assessment showed that the results are a (highly) reasonable representation of the phenomenon of interest. CONCLUSIONS The men attempted to cope with the loss of fatherhood and suffering, while managing the lack of social recognition and social expectations of masculinity in terms of their behaviour and expression of suffering. They tended to be strong, although they did not always have the necessary support or knowledge. IMPLICATIONS FOR PRACTICE Comprehensive and individualized care that includes the man is required. This requires the theoretical-practical training of nurses and midwives, and the provision of tools that help the emotional management of emotionally demanding care.
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Affiliation(s)
- Sara Fernández-Basanta
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain.
| | - Rita Rodríguez-Pérez
- Nurse. University Hospital Complex of A Coruña, Galician Health Service (SERGAS), As Xubias, 84, A Coruña 15006, Spain
| | - Carmen Coronado
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
| | - María-Jesús Movilla-Fernández
- Research Group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
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Fernández-Basanta S, Dahl-Cortizo C, Coronado C, Movilla-Fernández MJ. Pregnancy after perinatal loss: A meta-ethnography from a women's perspective. Midwifery 2023; 124:103762. [PMID: 37399778 DOI: 10.1016/j.midw.2023.103762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/16/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE This study uses a meta-ethnography to synthesize qualitative research on the experiences of women during pregnancies after one or more perinatal losses. DESIGN This interpretive meta-ethnography followed the Noblit and Hare approach and the eMERGe Meta-ethnography Reporting Guidance. Manual searches and a comprehensive systematic search were conducted in Pubmed, Scopus, Cinahl, Web of Science, and Psycinfo. Eleven studies met the research objective and inclusion criteria. RESULTS After reciprocal and refutational translations, the metaphor "The rainbow in the storm" and the following three themes emerged: (i) Between ambivalent feelings; (ii) being careful in the new pregnancy; and (iii) leaning on others. CERQual assessment showed that the results are (highly) reasonable representations of the phenomenon of interest. CONCLUSIONS Most women experienced their subsequent pregnancy with ambivalent feelings and needed to reduce expectations, continuously monitor the pregnancy's viability, and eliminate risky behavior to protect themselves. Understanding and recognition by others is needed and appreciated. IMPLICATIONS FOR PRACTICE Nurses and midwives play a crucial role in subsequent pregnancies and need to establish a care communion and ethical care during their encounters with affected women whose specific needs need to be incorporated into the guidelines and training curricula of care professionals to equip them with the necessary gender and cultural competences.
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Affiliation(s)
- Sara Fernández-Basanta
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain.
| | - Celtia Dahl-Cortizo
- University Hospital Complex of Ferrol, Galician Health Service (SERGAS), Av. da Residencia, S/N, 15405 Ferrol, Ferrol 15471, Spain
| | - Carmen Coronado
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
| | - María-Jesús Movilla-Fernández
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Naturalista López Seoane s/n, Ferrol 15471, Spain
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Suarez A, Yakupova V. Past Traumatic Life Events, Postpartum PTSD, and the Role of Labor Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND 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] [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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Martins MV, Valente VA, Silva AD, Ramalho C, Costa ME. "Death is a sensitive topic when you are surrounded by life": Nurses experiences with pregnancy loss. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100817. [PMID: 36764051 DOI: 10.1016/j.srhc.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Although there is increasing evidence on the psychosocial adjustment and experiencing pregnancy loss from the patient's perspective, few studies have investigated the nurses' experience perceptions. This study aimed to understand the experience of nurses involved in pregnancy loss care based on the self-fulfillment model of communication. METHODS A qualitative approach was developed through semi-structured interviews to 16 nurses working in an Obstetrics and Maternal-Fetal Department of a local hospital. Based on grounded theory approach, data was analyzed with NVivo 12 software. RESULTS The analysis revealed three major themes and 11 sub-themes: i) stressful work conditions, comprising care management and institutional practices; ii) personal characteristics, including discomfort with loss, communication skills, work experience and empathy; and iii) the patient's journey, containing the partner's ambiguous role, timing, respect for the patient's individuality, viewing the fetus and facilitating grief rituals. CONCLUSION Nurses daily involved in providing care to patients suffering pregnancy loses have a demanding challenge in trying to assure that patients get the appropriate and better care and ensuring they keep their level of engagement in their profession. Interventions to improve communications skills with patients and with other health professionals are needed to enhance professional realization.
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Affiliation(s)
- Mariana V Martins
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal.
| | - Vanessa A Valente
- Faculty of Psychology and Education Sciences - University of Porto, Portugal
| | - Ana D Silva
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal; Universidade de Brasília, Departamento de Psicologia Clínica, Brasil
| | - Carla Ramalho
- Universidade do Porto, Faculdade de Medicina, Portugal; I3S- Instituto de Investigação e Inovação em Saúde, Portugal; Centro Hospitalar Universitário São João, EPE, Portugal
| | - Maria E Costa
- Faculty of Psychology and Education Sciences - University of Porto, Portugal; Centre for Psychology at University of Porto, Portugal
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Alaradi M, Hutti MH, Chaffin N. Arab Muslims' Perceptions of Perinatal Loss Care in the United States of America. HEALTH & SOCIAL CARE IN THE 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] [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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The Trauma of Perinatal Loss: A Scoping Review. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perinatal loss, the loss of a fetus or neonate between conception and 28 days after birth, is a worldwide phenomenon impacting millions of individuals annually. Whether due to miscarriage, stillbirth, life-limiting fetal diagnoses, or neonatal death, up to 60% of bereaved parents exhibit symptoms of depression, anxiety, and posttraumatic stress disorder. Despite the high prevalence of posttraumatic stress symptoms, perinatal loss is not framed using a trauma lens. The purpose of this scoping review is to gain insight into the trauma within the perinatal loss experience.
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Fernández-Basanta S, Coronado C, Movilla-Fernández MJ. Double-Layer Masking of Suffering After Pregnancy Loss: A Grounded Theory Study from a Male Perspective. J Midwifery Womens Health 2022; 67:470-477. [PMID: 35277916 PMCID: PMC9545819 DOI: 10.1111/jmwh.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Men can express different responses after pregnancy loss. This loss can interfere with their expectation of parenthood, new life, and future hopes. Expectations from the social construction of gender can encourage them to maintain an image that contradicts their actual feelings. This can lead to isolation, distancing, and difficulties in seeking support. The scarcity and low representation of men in previous studies makes research that captures the complexity of their experience necessary. The aim of this study was to explore how men confront the suffering caused by pregnancy loss. METHODS This study is part of a larger research project focusing on the experiences of parents and midwives following pregnancy loss. In this study, 22 cisgender and white heterosexual men who experienced pregnancy losses participated in semistructured interviews. Data were analyzed iteratively using constructivist grounded theory methods. RESULTS The substantive theory of double-layer masking of suffering emerged as way to explain the confrontation of suffering after pregnancy loss from the male perspective. The themes, (1) suffering beyond physical loss, (2) rationalization in the search for meaning, and (3) keeping a façade with others, show the impact that this loss had on men, which was masked by the meaning they gave to the situation and by its social expression. DISCUSSION The findings provide a theoretical conceptualization of the masking these men use to deal with the suffering they experienced from this situation. These aspects provide reasons for including these individuals in the assistance given by midwives after a pregnancy loss. Collaboration between specialized and primary care, along with staff training and support, is necessary for the provision of couple-centered care after pregnancy loss.
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Affiliation(s)
- Sara Fernández-Basanta
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
| | - Carmen Coronado
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
| | - María-Jesús Movilla-Fernández
- Research group GRINCAR, Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Industrial of Ferrol, University of A Coruña, Ferrol, 15403, Spain
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Liu CH, Hyun S, Mittal L, Erdei C. Psychological risks to mother-infant bonding during the COVID-19 pandemic. Pediatr Res 2022; 91:853-861. [PMID: 34645943 PMCID: PMC9008072 DOI: 10.1038/s41390-021-01751-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to examine the association between mental health symptoms, along with psychological experiences and coronavirus disease 2019 (COVID-19) related concerns, and self-reported maternal-infant bonding experiences of postpartum women. METHODS Using data collected from May 19 to August 17, 2020, this cross-sectional online study assessed 429 women to better understand the impact of the COVID-19 pandemic on women during the postpartum period. Enrolled respondents were asked to participate in a 30-45-min online survey about COVID-19-related experiences, pregnancy, stress, and well-being. RESULTS Postpartum women's depressive symptoms were related to lower quality maternal-infant bonding, but the anxiety symptoms were not associated with bonding. Maternal self-efficacy, but not social support, was associated with mothers' higher quality of maternal-infant bonding. COVID-19-related grief was significantly associated with lower quality bonding. On the other hand, COVID-19-related health worries were associated with higher quality of maternal-infant bonding. CONCLUSIONS We describe potential psychological risk factors to maternal-infant bonding among postpartum women during the pandemic period. To best support the medical and psychological well-being of the mothers and infants, enhanced interdisciplinary partnerships among perinatal healthcare professionals involved in primary and/or specialty care is needed. IMPACT Unique COVID-19-related health and grief concerns exist, with implications for maternal-infant bonding. Depression but not anxiety is associated with lower maternal-infant bonding. Caregiving confidence, but not social support, is associated with higher maternal-infant bonding. It is critical to screen for postpartum depression and COVID-19-related grief during maternal follow-up and pediatric visits. Study findings inform and prioritize pediatric interventions toward enhancing maternal-infant bonding during the COVID-19 era.
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Affiliation(s)
- Cindy H. Liu
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Corresponding Author: Cindy H. Liu, PhD, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA, Tel: 617-525-4131, Fax: 617-582-6026,
| | - Sunah Hyun
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
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Wesselmann ED, Parris L. Miscarriage, Perceived Ostracism, and Trauma: A Preliminary Investigation. Front Psychol 2022; 12:747860. [PMID: 35153890 PMCID: PMC8828504 DOI: 10.3389/fpsyg.2021.747860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
Miscarriage often is a traumatic experience with serious mental health implications. Friends and family members are often uncomfortable with and avoid discussing the topic with bereaved individuals, potentially making them feel ostracized (i.e., being ignored and excluded), contributing to their mental health concerns. We investigated the correlation between posttraumatic stress symptoms, perceived ostracism, and recalled grief intensity measures in a sample of cisgender women (N = 97) who have had a miscarriage. These participants were recruited using Qualtrics’s Panel Recruitment Services. Women’s perceived ostracism correlated positively with posttraumatic stress symptoms and negatively with grief congruence (i.e., the degree to which they felt that their miscarriage process was as satisfactory as possible, given they had to experience it). Perceived ostracism also explained additional variance in posttraumatic stress symptoms when considered alongside grief intensity measures (e.g., congruence).
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Affiliation(s)
- Eric D Wesselmann
- Department of Psychology, Illinois State University, Normal, IL, United States
| | - Leandra Parris
- College of William & Mary, Williamsburg, VA, United States
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Aggarwal N, Moatti Z. "Getting it right when it goes wrong - Effective bereavement care requires training of the whole maternity team". Best Pract Res Clin Obstet Gynaecol 2021; 80:92-104. [PMID: 34866003 DOI: 10.1016/j.bpobgyn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Stillbirth or neonatal death is one of the most traumatic and distressing life experiences with negative psychosocial effects. Perinatal grief is natural and understandable, and, if not recognized and well supported, may lead to long-term harmful effects. Harm may also be caused to the other surviving siblings, families, and next generation. This can be helped by effective bereavement care. Bereavement care is an area of enormous needs, relatively untraveled road. Though the loss cannot be undone, but a negative impact can be minimized by compassionate supportive care. This chapter will focus on the need of a trained team for effective bereavement care. Principles of evidence-based best practices from the literature will be reviewed and translated into key practice implications. An emphasis is laid on a structured training involving the whole team. We hope this will help in day-to-day situation handling so as to prevent the harm associated with unaddressed grief. Areas of gap with the further need of research are highlighted.
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Affiliation(s)
- Neelam Aggarwal
- Department of Obstetrics. & Gynecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Zoe Moatti
- Department of Obstetrics and Gynaecology, Royal London Hospital, Whitechapel Rd, London, E1 1FR, United Kingdom
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Abstract
Parents who choose to carry a pregnancy complicated by a life-limiting congenital anomaly such as anencephaly may give birth to a live neonate and be discharged home. Very little guidance is available to health care professionals providing palliative care in the home setting to this population. This article is a secondary analysis that discusses the concerns and complications that parents experienced after bringing home a neonate with anencephaly. Each parental experience is a qualitative descriptive summary extracted from a larger study on the impact of anencephaly on parents. Parents reported feeling alone in their grief and struggled with their partners' differing style of grief. Parents' primary concerns after hospital discharge included transporting their neonate home, feeding their neonate, changing cranial defect dressings, managing pain and seizures, addressing uncertainty, and facilitating a good death. All parents received hospice services from health care professionals without perinatal bereavement training or experience. Only 1 woman received follow-up care after the death of her son. Preparing and educating health care professionals providing hospice and palliative services with perinatal bereavement training may be beneficial. Identifying and allocating local and online perinatal bereavement resources may provide parents with the tools and support necessary to facilitate healing after perinatal loss.
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Affiliation(s)
- Shandeigh N Berry
- Shandeigh N. Berry, PhD, RN, CNOR, is assistant professor, College of Arts & Sciences, Saint Martin's University, Lacey, Washington
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Abstract
When caring for women experiencing preterm labor and birth, nurses play a significant role as bedside experts, advocates, patient educators, and key members of the maternity care team. Enhanced expertise on clinical and professional knowledge of preterm labor and birth is crucial in prevention and treatment. As preterm birth rates continue to rise, perinatal nurses as well-informed clinical experts have the opportunity to offer innovative education, holistic assessments, and communication through shared decision-making models. Educating pregnant women about early recognition of preterm labor warning signs and symptoms allows for timely diagnosis, interventions, and treatment. Informed and collaborative nursing practice improves quality of clinical care based on individualized interactions. A clinical review of preterm labor and preterm birth is presented for perinatal nurses.
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Berry SN, Severtsen B, Davis A, Nelson L, Hutti MH, Oneal G. The impact of anencephaly on parents: A mixed-methods study. DEATH STUDIES 2021; 46:2198-2207. [PMID: 33866956 DOI: 10.1080/07481187.2021.1909669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.
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Affiliation(s)
- Shandeigh N Berry
- College of Arts & Sciences, Saint Martin's University, Olympia, Washington, USA
| | - Billie Severtsen
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Andra Davis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Lonnie Nelson
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Marianne H Hutti
- College of Nursing, University of Kentucky, Louisville, Kentucky, USA
| | - Gail Oneal
- College of Nursing, Washington State University, Spokane, Washington, USA
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16
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Perinatal Grief and Post-Traumatic Stress Disorder in Pregnancy after Perinatal Loss: A Longitudinal Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062874. [PMID: 33799743 PMCID: PMC8001458 DOI: 10.3390/ijerph18062874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Background: Pregnancies that follow perinatal loss are often associated with mental health disorders, which are not usually treated or even identified. Objectives: The main study aim is to identify the prevalence of symptoms of post-traumatic stress disorder and complicated perinatal grief at different stages of pregnancy following a prior gestational loss. Methods: This descriptive longitudinal study will be conducted with a twelve-month follow-up. The study variables addressed will include sociodemographic data (age, sex, education, marital status, employment status and obstetric history) together with clinical data on complicated perinatal grief and post-traumatic stress disorder scores. Results: The results obtained are expected to provide a new perspective on the healthcare approach to perinatal loss and subsequent pregnancy. Conclusions: We seek to optimise comprehensive healthcare in cases of pregnancy following previous perinatal loss and to evaluate options to minimise possible risks.
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Paraíso Pueyo E, González Alonso AV, Botigué T, Masot O, Escobar-Bravo MÁ, Lavedán Santamaría A. Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review. Int Nurs Rev 2021; 68:122-137. [PMID: 33686660 DOI: 10.1111/inr.12659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. AIM Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. METHODS A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. RESULTS A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. CONCLUSION In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. IMPLICATIONS FOR NURSING PRACTICE AND POLICY This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.
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Affiliation(s)
- Elena Paraíso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | | | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Miguel Ángel Escobar-Bravo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
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18
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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] [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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Iheduru-Anderson K. Reflections on the lived experience of working with limited personal protective equipment during the COVID-19 crisis. Nurs Inq 2020; 28:e12382. [PMID: 33010197 PMCID: PMC7646033 DOI: 10.1111/nin.12382] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 12/01/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) has placed significant strain on United States’ health care and health care providers. While most Americans were sheltering in place, nurses headed to work. Many lacked adequate personal protective equipment (PPE), increasing the risk of becoming infected or infecting others. Some health care organizations were not transparent with their nurses; many nurses were gagged from speaking up about the conditions in their workplaces. This study used a descriptive phenomenological design to describe the lived experience of acute care nurses working with limited access to PPE during the COVID‐19 pandemic. Unstructured interviews were conducted with 28 acute care nurses via telephone, WebEx, and Zoom. Data were analyzed using thematic analysis. The major theme, emotional roller coaster, describes the varied intense emotions the nurses experienced during the early weeks of the pandemic, encompassing eight subthemes: scared and afraid, sense of isolation, anger, betrayal, overwhelmed and exhausted, grief, helpless and at a loss, and denial. Other themes include: self‐care, ‘hoping for the best’, ‘nurses are not invincible’, and ‘I feel lucky’. The high levels of stress and mental assault resulting from the COVID‐19 crisis call for early stress assessment of nurses and provision of psychological intervention to mitigate lasting psychological trauma.
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Affiliation(s)
- Kechi Iheduru-Anderson
- School of Rehabilitation and Medical Sciences, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
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20
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A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions. Palliat Support Care 2020; 19:246-256. [PMID: 32867873 DOI: 10.1017/s1478951520000826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. METHOD Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. RESULTS A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. SIGNIFICANCE OF RESULTS The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
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Abstract
BACKGROUND Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.
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22
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Palmer AD, Murphy-Oikonen J. Social work intervention for women experiencing early pregnancy loss in the emergency department. SOCIAL WORK IN HEALTH CARE 2019; 58:392-411. [PMID: 30776979 DOI: 10.1080/00981389.2019.1580237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Often referred to as miscarriage, Early Pregnancy Loss (EPL) is the spontaneous death of a fetus experienced within the first 20 weeks of gestation and is the most common complication in pregnancy. Symptoms of an impending EPL are routinely managed in the Emergency Department (ED). EPL can have a substantial impact on women, potentially leading to psychological and emotional health issues and risks to future pregnancies. Despite the high prevalence of EPL, many women suffer in silence due to the common societal belief that EPL are insignificant. Many women experience EPL as an ambiguous loss and are at risk for disenfranchised grief. Compassionate, patient-centred care has been identified by women as an essential and often missing aspect of ED care and can have a profound impact on the overall well-being of women after EPL. Social workers play a critical role in the ED given that they prioritize the psychosocial well-being of patients in a system that is structured to primarily address trauma care. In an effort to reduce the psychological impact and complicated grief reactions of women experiencing EPL, specific recommendations for social work intervention to address the individual needs of women experiencing EPL in the ED are presented. These include acknowledging the loss, providing psychoeducation, honouring the loss, assessing resources, referral and additional information, and building capacity in the ED.
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Affiliation(s)
- Ashley D Palmer
- a School of Social Work , Lakehead University , Thunder Bay , ON , Canada
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The Impact of Communication Surrounding Intrauterine Congenital Anomaly Diagnoses: An Integrative Review. J Perinat Neonatal Nurs 2019; 33:301-311. [PMID: 30741752 DOI: 10.1097/jpn.0000000000000390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital anomalies are the leading cause of infant death in the United States, accounting for 20% of the annual infant mortality. Advancements in ultrasound diagnostic technology allow practitioners to diagnose fetal anomalies as early as 11 weeks' gestational age, 75% of which are detected in low-risk pregnancies. Communicating a fetal anomaly diagnosis to parents and initiating perinatal end-of-life discussions are difficult for healthcare providers and parents alike. Furthermore, poorly communicated diagnoses have had long-term negative impacts on perinatal grief intensity, which can manifest into lifelong symptoms of adverse psychosocial outcomes such as anxiety, depression, substance abuse, and suicidal ideation. The purpose of this integrative review is to examine the impact of communication in discussing an intrauterine diagnosis of a fetal congenital anomaly on perinatal grief. An integrative review was conducted following the distinct 5-stage process of problem identification, searching the literature, evaluating data, analyzing, and presenting findings. A systematic literature review using the PICO model (Population, Intervention, Comparison, Outcome) and structured after the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). This framework was completed between November 2017 and May 2018 using PubMed, CINAHL, and PsycINFO databases. Of the 931 article results, 15 satisfied search criteria. Emerging themes included parental need for appropriate time to assimilate and understand the diagnosis, freedom to explore options and alternatives, and the need for clinicians with expert communication skills. The initial conversation communicating the diagnosis of a congenital anomaly impacts expectant parents for the remainder of their lives. Healthcare professionals are in a unique position to either positively or negatively impact the intensity of perinatal grieving reactions. The application of empathetic, sensitive communication may offer solace and promote healing surrounding perinatal end-of-life discussions.
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Emotional Effect of the Loss of One or Both Fetuses in a Monochorionic Twin Pregnancy. J Obstet Gynecol Neonatal Nurs 2018; 47:137-145. [DOI: 10.1016/j.jogn.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/18/2022] Open
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Hutti MH, Myers JA, Hall LA, Polivka BJ, White S, Hill J, Grisanti M, Hayden J, Kloenne E. Predicting Need for Follow-Up Due to Severe Anxiety and Depression Symptoms After Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2018; 47:125-136. [DOI: 10.1016/j.jogn.2018.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/17/2022] Open
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