1
|
Geusens F, Bogaerts A, Skalkidou A. 'I had to Educate Myself': A thematic analysis of online stillbirth stories to improve obstetric care. BJOG 2024; 131:1120-1128. [PMID: 38221506 DOI: 10.1111/1471-0528.17750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To examine which met and unmet needs are discussed in stillbirth stories shared on YouTube with the aim to improve obstetric care. DESIGN Inductive thematic analysis of 19 English-language stillbirth stories uploaded to YouTube. SETTING Online setting, YouTube video content. SAMPLE Women who experienced stillbirth and shared a video on YouTube talking about their experience. METHODS We conducted a thorough textual reading of the transcripts following Braun and Clarke's guidelines for thematic analysis. MAIN OUTCOME MEASURES Codes were developed and grouped into themes. RESULTS Although some women actively used their birth videos to call out shortcomings in their care, most others used their platform for other purposes such as destigmatisation, awareness and support, and rather unintentionally provided insight into their met and unmet needs. When analysing their birth stories, three major themes emerged: choice and decision-making, education and information, and behaviour of healthcare providers. CONCLUSIONS This study demonstrates the value of birth stories in research. We identified three major opportunities for improvement of obstetric care: being provided with options and being able to make choices in the decision-making process are clearly valued, but there are some caveats: women and other childbearing individuals need timely and continuous information, and more attention is needed for emotional intelligence training of healthcare providers.
Collapse
Affiliation(s)
- Femke Geusens
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
2
|
Brintow MB, Prinds C, O'Connor M, Möller S, Henriksen TB, Mørk S, Hvidtjørn D. Continuing bonds in parents after a loss in pregnancy, or a death at or shortly after birth: A population-based study. DEATH STUDIES 2023:1-13. [PMID: 38145415 DOI: 10.1080/07481187.2023.2297059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death.
Collapse
Affiliation(s)
| | - Christina Prinds
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark
| | - Tine Brink Henriksen
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sofie Mørk
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Hvidtjørn
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
3
|
Sun S, Qian J, Wang F, Tian Y, Sun Y, Zheng Q, Yu X. Impact of contact with the baby following stillbirth on parental mental health and well-being: A systematic review and meta-analysis. Int J Nurs Pract 2023; 29:e13146. [PMID: 36998112 DOI: 10.1111/ijn.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/20/2023] [Accepted: 02/19/2023] [Indexed: 04/01/2023]
Abstract
AIM This study aims to identify and synthesize available research reporting parental mental health outcomes related to contact with a stillborn baby. BACKGROUND Stillbirth is devastating events for parents. The effects of contact with the stillborn baby on parental mental health are uncertain. METHODS This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, EMBASE, Cochrane, Web of Science, PsycINFO and CNKI databases from inception to 15 January 2023. Review Manager software was used for data analysis. RESULTS Ten studies were included (n = 3974). Contact with a stillborn baby increased the risks of anxiety, depression and post-traumatic stress disorder in the short term and increased the risks of anxiety and post-traumatic stress disorder in the long term. Parents who had contact with a stillborn baby were more satisfied with their decision. Subgroup analysis showed that seeing a stillborn baby had no significant effect on anxiety or depression, but holding a stillborn baby increased the risks of anxiety. CONCLUSIONS Caregivers should respect the parents' decision on whether to have contact with the stillborn baby and provide parents with continuous information, emotional and behavioural support after they have contact with stillborn babies.
Collapse
Affiliation(s)
- Shiwen Sun
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jialu Qian
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fang Wang
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanping Tian
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yaping Sun
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiong Zheng
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
4
|
Oxlad MJ, Franke EF, Due C, Jaensch LH. Capturing parents' and health professionals' experiences of stillbirth bereavement photography: A systematic review and meta-synthesis. Women Birth 2023; 36:421-428. [PMID: 36878762 DOI: 10.1016/j.wombi.2023.03.001] [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: 11/30/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
PROBLEM Evidence-informed, best-practice recommendations concerning bereavement photography following stillbirth have yet to be proposed. BACKGROUND Previous research has highlighted the general importance of memory-making following pregnancy loss; however, scarce studies have specifically examined bereavement photography experiences. AIM To examine parents', healthcare professionals' and photographers' perspectives and experiences of stillbirth bereavement photography. METHODS Guided by JBI Collaboration methods, we conducted a systematic review and meta-synthesis (using a meta-aggregative approach) of 12 peer-reviewed studies conducted predominantly in high-income countries FINDINGS: Two overarching synthesised findings were generated: Bereavement photography as a helpful tool for the present and Bereavement photography as a helpful tool for the future. The proactive recommendation of memory-making influenced parents' decisions, and some parents not offered bereavement photography post-stillbirth expressed their desire for this opportunity retrospectively. Most parents who utilised bereavement photography were positive about their experiences. In the acute stages of loss, photographs supported meaningful introductions of the baby to their sibling(s) and validated parents' loss. Longer-term, the photographs validated the stillborn child's life, maintained memories and enabled parents to share their child's life with others. DISCUSSION Bereavement photography appeared beneficial, even though some parents felt conflicted about it. Parental views about photography appeared to fluctuate; many parents who rejected the offer of stillbirth photography described regret about their decision later. Conversely, parents who reluctantly accepted photographs were grateful. CONCLUSION Our review shows compelling evidence that bereavement photography should be normalised and offered to parents in the wake of stillbirth, with tactful, personalised approaches needed to assist with bereavement.
Collapse
Affiliation(s)
- Melissa J Oxlad
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Elisabeth F Franke
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren H Jaensch
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Bakhbakhi D, Siassakos D, Davies A, Merriel A, Barnard K, Stead E, Shakespeare C, Duffy JMN, Hinton L, McDowell K, Lyons A, Fraser A, Burden C. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set. BJOG 2023; 130:560-576. [PMID: 36655361 DOI: 10.1111/1471-0528.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. OBJECTIVES To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. SEARCH STRATEGY Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. SELECTION CRITERIA Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. DATA COLLECTION AND ANALYSIS Interventions, outcomes reported, definitions and outcome measurement tools were extracted. MAIN RESULTS Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome. CONCLUSIONS Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
Collapse
Affiliation(s)
| | | | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | | | - Emma Stead
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Anna Lyons
- Northern General Hospital, Sheffield, UK
| | | | | |
Collapse
|
7
|
Jones EE, Crawley R, Brierley-Jones L, Kenny C. Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation. J Reprod Infant Psychol 2023; 41:93-109. [PMID: 34510967 DOI: 10.1080/02646838.2021.1972951] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.
Collapse
Affiliation(s)
- Emma E Jones
- School of Psychology, University of Sunderland, Sunderland, UK
| | | | | | - Catherine Kenny
- School of Psychology, University of Sunderland, Sunderland, UK
| |
Collapse
|
8
|
Lalande D, Desrosiers AA, Zeghiche S, Landry I, de Montigny F. L’expérience des parents endeuillés participant à des groupes de soutien après un deuil périnatal : une synthèse thématique. Rech Soins Infirm 2022; 149:31-50. [DOI: 10.3917/rsi.149.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
9
|
Hunt C, Josselin D. "What's Inside of You Now is Just Bones and Skin": The Tension between Restorative Meaning-Making and Deliberate Detachment in Maternal Experiences of Stillbirth. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221112255. [PMID: 36029020 DOI: 10.1177/00302228221112255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores the ways in which bereaved mothers framed experiences of continuing bonds with their stillborn child and aims to enrich an understanding of maternal sense-making. Four interviews were carried out with bereaved mothers and approached using Interpretative Phenomenological Analysis, so as to offer deeper insight into their individual experiences. Themes which arose from the analysis include: "Continuing bonds and the female body;" "Conflicted bonding with the shape-shifting baby;" and "Experiencing connection in the life beyond loss." These findings point to a tension between restorative meaning-making and detachment in maternal sense-making following stillbirth and have implications for clinicians working with bereaved mothers.
Collapse
Affiliation(s)
- Catharine Hunt
- Department of Psychology, City University of London, London, UK
| | - Daphne Josselin
- Department of Psychology, City University of London, London, UK
| |
Collapse
|
10
|
Comparing posttraumatic growth in mothers after stillbirth or early miscarriage. PLoS One 2022; 17:e0271314. [PMID: 35939433 PMCID: PMC9359608 DOI: 10.1371/journal.pone.0271314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
The possibility of posttraumatic growth in the aftermath of pregnancy loss has received limited attention to date. This study investigated posttraumatic growth in mothers following stillbirth compared to early miscarriage. It was hypothesised that mothers following stillbirth will demonstrate more posttraumatic growth, challenge to assumptive beliefs, and disclosure than mothers following early miscarriage. The study also sought to understand how theoretically-derived variables of the Model of Growth in Grief (challenge to assumptive beliefs and disclosure) explained unique variance in posttraumatic growth when key factors were controlled for. One-hundred and twenty women who had experienced a stillbirth (N = 57) or early miscarriage (N = 63) within the last two to six years completed validated questionnaires in an online survey relating to posttraumatic growth and key variables relevant to emotional adjustment post-bereavement. Participants who had experienced a stillbirth demonstrated significantly higher levels of posttraumatic growth, posttraumatic stress symptoms, perinatal grief, disclosure, challenge to assumptive beliefs and rumination than participants who had experienced an early miscarriage (Cohen’s d ranged .38-.94). In a hierarchical stepwise regression analysis, challenge to assumptive beliefs alone predicted 17.5% of the variance in posttraumatic growth. Intrusive and deliberate rumination predicted an additional 5.5% of variance, with urge to talk, reluctance to talk, and actual self-disclosure predicting a further 15.3%. A final model including these variables explained 47.9% of the variance in posttraumatic growth. Interventions targeting challenge to assumptive beliefs, disclosure, and rumination are likely to be clinically useful to promote psychological adjustment in mothers who have experienced stillbirth and early miscarriage.
Collapse
|
11
|
Holding a baby after stillbirth: the impact of fetal congenital and structural abnormalities. J Perinatol 2022:10.1038/s41372-022-01480-9. [PMID: 35931797 PMCID: PMC9362406 DOI: 10.1038/s41372-022-01480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Stillbirth can result in numerous adverse psychosocial sequelae. Recommendations vary with regard to holding the baby after a stillbirth. Few studies have addressed the impact of fetal abnormalities on these outcomes. STUDY DESIGN Analyses of singleton stillbirths within the Stillbirth Collaborative Research Network were conducted. Patient and stillbirth characteristics were compared between those who did and did not hold their baby. Results from psychometric surveys were compared between cases with and without visible fetal anomalies. RESULT There were no significant differences between those who held and those who did not hold in any patient or stillborn characteristics. Visible fetal abnormalities were not associated with adverse psychological outcomes. CONCLUSION Fetal abnormalities, including congenital and post-demise changes, do not differ between those who held and did not hold their baby after stillbirth. This suggests that patients should not be discouraged from holding their stillborn infant in the presence of visible abnormalities.
Collapse
|
12
|
Leinweber J, Fontein-Kuipers Y, Karlsdottir SI, Ekström-Bergström A, Nilsson C, Stramrood C, Thomson G. Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper. Birth 2022; 50:362-383. [PMID: 35790019 DOI: 10.1111/birt.12666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research. AIM To formulate an inclusive woman-centered definition of a positive childbirth experience. METHODS A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42). RESULTS The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman's psychosocial well-being." CONCLUSIONS This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.
Collapse
Affiliation(s)
- Julia Leinweber
- Institute of Midwifery, Charité-University Medicine Berlin, Berlin, Germany
| | - Yvonne Fontein-Kuipers
- School of Midwifery, Health and Social Work, University College Antwerp, Antwerp, Belgium.,Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK
| | | | - Anette Ekström-Bergström
- Department of Health Sciences, University West, Trollhättan, Sweden.,Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Claire Stramrood
- Department of Obstetrics and Gynaecology, OLVG Hospital, Amsterdam, The Netherlands
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| |
Collapse
|
13
|
Sun S, Hao Y, Qian J, Wang F, Sun Y, Yu X. Incidence and predictors of paternal anxiety and depression following fetal abnormalities requiring pregnancy termination: a cross-sectional study in China. BMC Pregnancy Childbirth 2022; 22:440. [PMID: 35619057 PMCID: PMC9134591 DOI: 10.1186/s12884-022-04739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND China is a country with a high prevalence of fetal abnormalities. Termination of pregnancy for fetal abnormalities (TOPFA) is a devastating traumatic event for parents and families, resulting in serious and lasting psychological problems. The impact of TOPFA on mothers has been extensively explored, but little research has been conducted on the resulting paternal psychological problems. This study sought to determine the prevalence and predictors of paternal anxiety and depression following TOPFA. METHODS We analysed cross-sectional data from 169 Chinese couples (169 mothers and 169 fathers) who experienced TOPFA. Anxiety was assessed with the Self-Rating Anxiety Scale (SAS), and depression was measured with the Self-Rating Depression Scale (SDS) for fathers and the Edinburgh Postnatal Depression Scale (EPDS) for mothers. We used the Social Support Rating Scale (SSRS) to assess levels of social support. RESULTS Overall, 19.5% of fathers and 24.3% of mothers had symptoms of anxiety, but there was no significant difference in the incidence of anxiety between fathers and mothers. However, depression was more common in mothers (50.3%) than in fathers (24.9%). Level of income (β = -2.945, 95% CI: -5.448 to -0.442), worry about the pregnancy (β = 3.404, 95% CI: 1.210 to 5.599) and objective support (β = -0.668, 95% CI: -1.163 to -0.173) were predictors of anxiety in fathers. Worry about the pregnancy (β = 4.022, 95% CI: 1.630 to 6.414), objective support (β = -0.652, 95% CI: -1.229 to -0.075) and maternal depression (β = 0.497, 95% CI: 0.159 to 0.836) were predictors of paternal depression. CONCLUSION Anxiety and depression were prevalent among parents following TOPFA in China, and fathers had similar levels of anxiety as mothers. Strategies to support fathers should consider social support and psychological interaction and draw upon father-inclusive intervention recommendations.
Collapse
Affiliation(s)
- Shiwen Sun
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yuping Hao
- Emergency Department, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jialu Qian
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fang Wang
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yaping Sun
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Nursing, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
14
|
Lappeman M, Swartz L. Stillbirth in Khayelitsha Hospital, South Africa: Women's Experiences of Care. BRITISH JOURNAL OF PSYCHOTHERAPY 2022. [DOI: 10.1111/bjp.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Westby CL, Erlandsen AR, Nilsen SA, Visted E, Thimm JC. Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review. BMC Pregnancy Childbirth 2021; 21:782. [PMID: 34794395 PMCID: PMC8600867 DOI: 10.1186/s12884-021-04254-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This systematic review aimed to provide an updated summary of studies investigating depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) in parents after stillbirth (from 20 weeks gestational age until birth). METHODS A literature search was conducted in the databases Web of Science and PsychINFO. Main inclusion criteria were 1) peer-reviewed, quantitative, English-language articles published from 1980; (2) studies investigating depression, anxiety, PTSD, or OCD among parents following stillbirth; and (3) studies defining stillbirth as equal to or after 20 weeks of gestation. RESULTS Thirteen quantitative, peer-reviewed articles were eligible for inclusion. Selected articles investigated depression, anxiety, and PTSD, while no studies on OCD met our inclusion criteria. The majority of studies investigated women, while only two studies included men. The results indicated heightened short- and long-term levels of depression, anxiety, and PTSD in parents after stillbirth compared to those of parents with live birth. Studies investigating predictors found that social support, marital status, negative appraisals, and variables related to care and management after stillbirth affected levels of symptoms. CONCLUSIONS Parents who experience stillbirth have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births. More longitudinal studies are needed to increase our knowledge of how symptoms develop over time, and more research on fathers, transgender, non-binary and gender fluid individuals is needed. Research on the association between stillbirth and OCD is also warranted. Knowledge of the severity of anxiety, depression, and PTSD after stillbirth, and predictors associated with symptom severity could provide healthcare professionals with valuable information on how to provide beneficial postpartum care.
Collapse
Affiliation(s)
- Cèline Lossius Westby
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway
| | - Andrea Røsberg Erlandsen
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Jens C Thimm
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Bergen, Norway.
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| |
Collapse
|
16
|
Being a Parent: Findings from a Grounded Theory of Memory-Making in Neonatal End-of-Life Care. J Pediatr Nurs 2021; 61:51-58. [PMID: 33752063 DOI: 10.1016/j.pedn.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Neonatal palliative care guidelines increasingly recommend that parents be encouraged to provide care for their dying baby and to spend time with the before and after death. However, little is currently known about how parents perceive such memory-making interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of neonatal end-of-life care. DESIGN AND METHODS We conducted extended interviews with 18 parents who had experienced neonatal loss. Corbin and Strauss' grounded theory method was used throughout sampling, data collection and data analysis. A constant comparative approach was utilised throughout each stage of the data collection/data analysis process, resulting in the development of a grounded theory titled "Affirmed Parenthood". RESULTS The core category of "Affirmed parenthood" was underpinned by three primary categories: 'Creating Evidence', 'Needing Guidance' and 'Being a parent'. Opportunities to parent the baby by having contact with them, engaging with them, and providing care were central to parent's experiences of memory-making in the context of neonatal bereavement. CONCLUSIONS 'Being a Parent' provided important affirmation of the baby's identity and importance, and affirmed the role of the parents. 'Being a Parent' was a critical element of memory-making and had a significant impact on parents' experience of loss. PRACTICE IMPLICATIONS Parents should be supported to have unrestricted contact with their baby, to engage with them, and to provide care throughout the baby's brief life and after their baby's death.
Collapse
|
17
|
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] [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.
Collapse
|
18
|
Thornton R, Nicholson P, Harms L. Creating Evidence: Findings from a Grounded Theory of Memory-Making in Neonatal Bereavement Care in Australia. J Pediatr Nurs 2020; 53:29-35. [PMID: 32344367 DOI: 10.1016/j.pedn.2020.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Perinatal and neonatal palliative care guidelines recommend the provision of photographs and other mementos as an element of care for parents bereaved by neonatal loss. However, little is known about parents' perceptions of such bereavement interventions. This study explored the significance of memory-making for bereaved parents and the impact of memory-making on parents' experience of loss following neonatal loss. DESIGN AND METHODS We conducted semi-structured interviews with 18 bereaved parents. A grounded theory approach informed by Corbin and Strauss was used to underpin data sampling, data collection and data analysis. A constant comparative approach was used to engage in open, axial and selective coding to distil parents' stories into categories supporting a core concept. RESULTS "Creating evidence" emerged as a key theme in the grounded theory of memory-making in bereavement care for parents following neonatal loss. Creating evidence involved taking photographs, creating mementos, as well as involving friends and family during the baby's time in the Neonatal Unit. CONCLUSIONS Creating evidence affirmed the life of the baby and the role of the parents. Creating evidence was a significant element of memory-making that had a positive impact on parents' experience of bereavement. PRACTICE IMPLICATIONS Parents should be supported to create evidence of their baby's life, through taking photos, creating mementos, and involving others in their baby's care. Such interventions provide affirmation of the baby's life and of the individual's role as a parent.
Collapse
Affiliation(s)
- Rebecca Thornton
- Department of Social Work, Alan Gilbert Building, The University of Melbourne, Victoria, Australia; Deakin University, Building W, 221 Burwood Hwy, Burwood, Victoria, Australia.
| | - Patricia Nicholson
- School of Nursing and Midwifery, Centre of Quality and Safe Patient Research, Deakin University, Geelong, Victoria, Australia
| | - Louise Harms
- Department of Social Work, Alan Gilbert Building, The University of Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Riegel M, Randall S, Buckley T. Memory making in end-of-life care in the adult intensive care unit: A scoping review of the research literature. Aust Crit Care 2019; 32:442-447. [DOI: 10.1016/j.aucc.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022] Open
|
20
|
Dekkers FHW, Go ATJI, Stapersma L, Eggink AJ, Utens EMWJ. Termination of pregnancy for fetal anomalies: Parents' preferences for psychosocial care. Prenat Diagn 2019; 39:575-587. [PMID: 30997678 PMCID: PMC6767557 DOI: 10.1002/pd.5464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 11/08/2022]
Abstract
Objective To investigate, from the perspective of women and partners, at what stage of a termination of pregnancy (TOP) for fetal anomalies psychosocial care (PSC) is most meaningful, what topics should be discussed, and who should provide PSC. Method A cross‐sectional retrospective cohort study was conducted with a consecutive series of 76 women and 36 partners, who completed a semi‐structured online questionnaire. Results Overall, women expressed a greater need for PSC than their partners. Parents expressed a preference for receiving support from a maternal‐fetal medicine specialist to help them understand the severity and consequences of the anomalies found and to counsel them in their decision regarding termination. Parents showed a preference for support from mental healthcare providers to help with their emotional responses. Forty‐one percent of the women visited a psychosocial professional outside of the hospital after the TOP, indicating a clear need for a well‐organised aftercare. Conclusion Different disciplines should work together in a complementary way during the diagnosis, decision making, TOP, and aftercare stages. Parents' need for PSC should be discussed at the beginning of the process. During aftercare, attention should be paid to grief counselling, acknowledgement of the lost baby's existence, and possible future pregnancies. What's already known about this topic?
Pregnancy termination for fetal anomalies has multiple psychological consequences for parents. Parents are mostly unaware of the need for psychosocial care during and after pregnancy termination. What does this study add?
Knowledge about which stage parents consider to be most meaningful for psychosocial care, the topics that should be discussed, and who should provide psychosocial care. Awareness that different disciplines should collaborate during and after the pregnancy termination.
Collapse
Affiliation(s)
- Frederike H W Dekkers
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Attie T J I Go
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alex J Eggink
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Unit of Psychosocial Care, Erasmus Medical Center and Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry, the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Ashley D Palmer
- a School of Social Work , Lakehead University , Thunder Bay , ON , Canada
| | | |
Collapse
|
22
|
Marwah S, Gaikwad HS, Mittal P. Psychosocial Implications of Stillborn Babies on Mother and Family: A Review from Tertiary Care Infirmary in India. J Obstet Gynaecol India 2018; 69:232-238. [PMID: 31178638 DOI: 10.1007/s13224-018-1173-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background When a mother loses a baby after the period of viability, there is no way to fathom her grief, neither any words, nor an explanation. It is an unexpected event. Stillbirth presents a situation where the early activation of the grief process primarily in mother is exacerbated by the circumstances surrounding the loss. It thus becomes imperative for the healthcare providers to evaluate the significance of parent's perception on the loss and the factors contributing to it before the initiation of therapy. Objective To evaluate the psychosocial impact of stillbirth among mothers and its contributing factors. Materials and Methods A WHO-funded prospective study was conducted in VMMC and Safdarjung Hospital from September 2015 to August 2016 on all women who gave birth to a stillborn baby, using a questionnaire based on EPDS, after taking their written informed consent. Data were entered on the predesigned proforma and analyzed after applying Chi-square test, keeping a null hypothesis value of 15% for all the variables. Results Out of the 709 women who delivered stillborn babies, 645 respondents, who willingly consented to participate, were included in the study. There was a significant relationship between psychosocial impact after perinatal loss and support from caregiver and family. Conclusion Mothers with stillborn fetuses should be screened for psychosocial impact and offered support when needed. Appropriate counseling by healthcare providers and continued psychosocial and emotional support by family members must be provided.
Collapse
Affiliation(s)
- Sheeba Marwah
- Department of Obstetrics and Gynecoclogy, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Harsha Shailesh Gaikwad
- Department of Obstetrics and Gynecoclogy, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Pratima Mittal
- Department of Obstetrics and Gynecoclogy, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| |
Collapse
|
23
|
Keeble CJ, Loi NM, Thorsteinsson EB. Empathy and the Public Perception of Stillbirth and Memory Sharing: An Australian Case. Front Psychol 2018; 9:1629. [PMID: 30233465 PMCID: PMC6127839 DOI: 10.3389/fpsyg.2018.01629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: Stillbirth devastates families and leaves them struggling to grieve the death of their baby in a society that expects grief symptoms to decrease over time. Previous research has suggested that increased memory sharing opportunities can lead to positive mental health outcomes. The aim of the current study was to examine people’s perceptions of stillbirth as well as the perceived appropriateness of affected parents sharing memories of their child. In addition, we examined whether manipulating empathy would have an effect on people’s perceptions of stillbirth. Method: Participants included 200 Australian men and women 18 to 74 years of age (M = 36.76, SD = 12.59) randomly allocated to one of three experimental conditions (i.e., low empathy, high empathy, and control). The high empathy group watched a video about stillbirth and was instructed to imagine how the people portrayed felt; the low empathy group watched the same video but was instructed to remain detached; and the control group watched an unrelated video. Participants were then asked how much money they would be willing to donate to a fictional stillbirth organization, followed by the completion of questionnaires measuring (a) perceptions of stillbirth, (b) empathy, and (c) the appropriateness of parents sharing memories of a stillborn child with different groups of people over time. Results: The empathy manipulation had an effect on empathy and the willingness to help effected parents (high empathy vs. control). However, empathy did not have an effect on participants’ perceptions toward stillbirth nor appropriateness of sharing memories. The appropriateness of sharing memories decreased as time passed and social distance increased. Discussion: Individuals who have experienced stillbirth need to be aware that societal expectations and their own expectations in relation to sharing memories may not correspond to each other and that they may need to educate their social group about their need to share memories. Removing the taboo surrounding stillbirth is vital for both parents and those to whom they would wish to communicate.
Collapse
Affiliation(s)
- Christina J Keeble
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Natasha M Loi
- School of Psychology, University of New England, Armidale, NSW, Australia
| | | |
Collapse
|
24
|
Brierley-Jones L, Crawley R, Jones E, Gordon I, Knight J, Hinshaw K. Supporting parents through stillbirth: A qualitative study exploring the views of health professionals and health care staff in three hospitals in England. Eur J Obstet Gynecol Reprod Biol 2018; 222:45-51. [PMID: 29353132 DOI: 10.1016/j.ejogrb.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the views of a range of hospital based health professionals and health care staff involved in the management of stillbirth. STUDY DESIGN A qualitative pilot study informed by grounded theory conducted in three hospital trusts in the North East of England. In total, 21 consultant obstetricians, 3 trainees (including 1 senior trainee), 29 midwives, 3 midwife sonographers and 4 chaplains took part in six focus groups and two semi-structured interviews. RESULTS Two different approaches in stillbirth management could be detected in our study. One approach emphasised the existing evidence-base and patient directed choice whilst the other emphasised tradition and profession-directed care. These differences were particularly apparent in choices over mode of delivery, and the location of women as well as the time interval between diagnosis of an IUD and delivery. The existence of these two approaches was underscored by a lack of high quality evidence. CONCLUSION Robust, high quality evidence is needed regarding the longer term psychological and emotional sequelae of different modes of delivery and varying time intervals and locations of women between diagnosis and delivery in stillbirth. If the competing discourses demonstrated here are found elsewhere then such need to be considered in any future policy development, evidence implementation and training programmes.
Collapse
Affiliation(s)
- Lyn Brierley-Jones
- Department of Sociology, Wentworth College, University of York, Heslington, York, YO10 5DD, United Kingdom.
| | - Rosalind Crawley
- School of Psychology, Faculty of Health Sciences and Well-being, Shackleton House, Sunderland, SR1 3SD, United Kingdom
| | - Emma Jones
- School of Psychology, Faculty of Health Sciences and Well-being, Shackleton House, Sunderland, SR1 3SD, United Kingdom
| | - Isabel Gordon
- Nursing, Health and Wellbeing, Sciences Complex, Wharncliffe Street, Sunderland, SR1 3SD, United Kingdom
| | - Joanne Knight
- Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom
| | - Kim Hinshaw
- Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, United Kingdom
| |
Collapse
|
25
|
Chung MC, Reed J. Posttraumatic Stress Disorder Following Stillbirth: Trauma Characteristics, Locus of Control, Posttraumatic Cognitions. Psychiatr Q 2017; 88:307-321. [PMID: 27338722 DOI: 10.1007/s11126-016-9446-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined the incidence of PTSD and psychiatric co-morbidity among women who experienced stillbirth and investigated the relationship between locus of control, trauma characteristics of stillbirth, posttraumatic cognitions, PTSD and co-morbid psychiatric symptoms following stillbirth. Fifty women recorded information on stillbirth experiences, and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Edinburgh Post-natal Depression Scale, Rotter's Locus of Control Scale and the Posttraumatic Cognitions Inventory. 60, 28 and 12 % met the diagnostic criteria for probable full-PTSD, partial and no-PTSD respectively. Sixty-two percent and 54 % scored at or above the cutoff of the General Health Questionnaire-28 and postnatal depression respectively. Women who experienced stillbirth reported significantly more psychiatric co-morbid and post-natal depressive symptoms than the comparison group. Both groups were similar in locus of control. Women who experienced stillbirth reported negative cognitions about the self the most. After adjusting for postnatal depression, trauma characteristics were significantly correlated with Posttraumatic cognitions which, in turn, were significantly correlated with PTSD and psychiatric co-morbidity. Locus of control was not significantly correlated with psychological outcomes. Mediational analyses showed that negative cognitions about self mediated the relationship between trauma characteristics and psychiatric co-morbidity only. Women reported a high incidence of probable PTSD and co-morbid psychiatric symptoms following stillbirth. Stillbirth trauma characteristics influenced how they negatively perceived themselves. This then specifically influenced general psychological problems rather than PTSD symptoms.
Collapse
Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin NT, Hong Kong.
| | | |
Collapse
|
26
|
Christiansen DM. Posttraumatic stress disorder in parents following infant death: A systematic review. Clin Psychol Rev 2016; 51:60-74. [PMID: 27838460 DOI: 10.1016/j.cpr.2016.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Abstract
Parents who have lost an infant prior to, during, or following birth often interpret the event as highly traumatic. The present systematic review included 46 articles based on 31 different studies of posttraumatic stress disorder (PTSD) in parents bereaved by infant death. The PTSD prevalence in mothers differed widely across studies with estimated rates at 0.6-39%. PTSD in fathers following infant loss has been less extensively studied but PTSD levels were generally much lower than in mothers with reported prevalence rates at 0-15.6% across studies. PTSD symptoms were not found to differ much depending on whether the death occurred prior to, during, or following birth and nor was gestational age consistently associated with PTSD severity. A number of risk and protective factors have been found to be associated with PTSD severity. Relevant focus areas for future research are presented along with considerations for future pregnancies and children. The suffering associated with PTSD following infant loss is overwhelming because of the rates at which such losses occur around the world. For this reason, it is problematic that not all types of infant loss resulting in sufficient symptoms of re-experiencing, avoidance, and arousal can elicit a DSM-5 PTSD diagnosis.
Collapse
Affiliation(s)
- Dorte M Christiansen
- Institute of Psychology, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark; National Center for Psychotraumatology, Institute of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| |
Collapse
|
27
|
Huberty JL, Matthews J, Leiferman J, Hermer J, Cacciatore J. When a Baby Dies: A Systematic Review of Experimental Interventions for Women After Stillbirth. Reprod Sci 2016; 24:967-975. [DOI: 10.1177/1933719116670518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jennifer L. Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Jeni Matthews
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Jenn Leiferman
- Colorado School of Public Health, University of Colorado at DenverAnschutz Medical Campus, Aurora, CO, USA
| | - Janice Hermer
- ASU library, Arizona State University, Phoenix, AZ, USA
| | | |
Collapse
|
28
|
O’Connell O, Meaney S, O’Donoghue K. Caring for parents at the time of stillbirth: How can we do better? Women Birth 2016; 29:345-9. [DOI: 10.1016/j.wombi.2016.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/27/2015] [Accepted: 01/12/2016] [Indexed: 11/26/2022]
|
29
|
Heazell AEP, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, Dang N, Das J, Flenady V, Gold KJ, Mensah OK, Millum J, Nuzum D, O'Donoghue K, Redshaw M, Rizvi A, Roberts T, Toyin Saraki HE, Storey C, Wojcieszek AM, Downe S. Stillbirths: economic and psychosocial consequences. Lancet 2016; 387:604-616. [PMID: 26794073 DOI: 10.1016/s0140-6736(15)00836-3] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.
Collapse
Affiliation(s)
- Alexander E P Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; International Stillbirth Alliance, New York, NY, USA.
| | - Dimitrios Siassakos
- International Stillbirth Alliance, New York, NY, USA; Academic Centre for Women's Health, University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK
| | - Hannah Blencowe
- Centre for Maternal Reproductive and Child Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christy Burden
- Academic Centre for Women's Health, University of Bristol, Bristol, UK; Southmead Hospital, Bristol, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Nghia Dang
- Institute for Reproductive and Family Health, Hanoi Vinmec International General Hospital, Hanoi, Vietnam
| | - Jai Das
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Vicki Flenady
- International Stillbirth Alliance, New York, NY, USA; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Katherine J Gold
- International Stillbirth Alliance, New York, NY, USA; Department of Family Medicine and Department of Obstetrics, University of Michigan, Ann Arbor, MI, USA
| | | | - Joseph Millum
- Clinical Center Department of Bioethics, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Maggie Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tracy Roberts
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | - Claire Storey
- International Stillbirth Alliance, New York, NY, USA
| | - Aleena M Wojcieszek
- International Stillbirth Alliance, New York, NY, USA; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Soo Downe
- ReaCH group, University of Central Lancashire, Preston, UK
| |
Collapse
|
30
|
Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, Heazell A, Siassakos D. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16:16. [PMID: 26810220 PMCID: PMC4727309 DOI: 10.1186/s12884-016-0806-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and clear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0806-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alison Ellis
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Caroline Chebsey
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | | | | | - Vicki Flenady
- Mater Research Institute -The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Alexander Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Dimitrios Siassakos
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.,University of Bristol, School of Social & Community Medicine, Bristol, UK
| |
Collapse
|
31
|
Hennegan JM, Henderson J, Redshaw M. Contact with the baby following stillbirth and parental mental health and well-being: a systematic review. BMJ Open 2015; 5:e008616. [PMID: 26614620 PMCID: PMC4663431 DOI: 10.1136/bmjopen-2015-008616] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To collate and critically appraise extant evidence for the impact of contact with the stillborn infant on parental mental health, well-being and satisfaction. DESIGN Systematic review. DATA SOURCES A structured systematic search was conducted in 13 databases, complemented by hand-searching. STUDY ELIGIBILITY CRITERIA English language studies providing quantitative comparison of outcomes for parents who held their baby or engaged in other memory-making activities, such as having photos and handprints, compared to those who did not, were eligible for inclusion. OUTCOME MEASURES Primary outcomes included clinically diagnosed mental health issues, standardised assessment of mental health issues or self-reported psychological distress. Secondary outcomes included poor health, relationship difficulties and satisfaction with the decision to have contact with the baby. RESULTS Two authors independently screened abstracts, selected potentially eligible studies, extracted data and evaluated the quality of included papers. 11 eligible studies, reported in 18 papers, were included. Studies were heterogeneous, precluding quantitative synthesis, thus a narrative synthesis is presented. Studies presented high risks of bias, particularly in regard to sample representativeness, and confounder identification and adjustment. Results were mixed concerning the impact of holding the stillborn baby on mental health and well-being. One study found no significant effects, and two studies reported no impact on depression. Conflicting effects were found for anxiety and post-traumatic stress. Other memory-making activities were not found to have a significant association with mental health or well-being outcomes. Across studies, mothers were satisfied with their decision to hold their baby or engage in other memory making. CONCLUSIONS Evidence for the impact of holding the stillborn baby on mental health and well-being is sparse, and of poor quality. High-quality research guided by a priori hypotheses, with attention to potential confounders and moderating effects, is needed to provide more rigorous evidence to guide practitioners' and parents' decision-making for care following stillbirth. REVIEW PROTOCOL NUMBER PROSPERO CRD42014013890.
Collapse
Affiliation(s)
- Julie M Hennegan
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Jane Henderson
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Maggie Redshaw
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| |
Collapse
|
32
|
Kingdon C, Givens JL, O'Donnell E, Turner M. Seeing and Holding Baby: Systematic Review of Clinical Management and Parental Outcomes After Stillbirth. Birth 2015; 42:206-18. [PMID: 26111120 DOI: 10.1111/birt.12176] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2009 there were an estimated 2.6 million stillbirths worldwide. In the United States, a 2007 systematic review found little consensus about professional behaviors perceived by parents to be most helpful or most distressing. In the United Kingdom, a bereaved parents' organization has highlighted discordance between parental views and clinical guidelines that recommend clinicians do not encourage parents to see and hold their baby. The objective of this review was to identify and synthesize available research reporting parental outcomes relating to seeing and holding. METHODS We undertook a systematic review. We included studies of any design, reporting parental experiences and outcomes. Electronic searches (PubMed and PsychINFO) were conducted in January 2014. Three authors independently screened and assessed the quality of the studies before abstracting data and undertaking thematic analysis. RESULTS We reviewed 741 records and included 23 studies (10 quantitative, 12 qualitative, and 1 mixed-method). Twenty-one studies suggested positive outcomes for parents who saw or held their baby. Increased psychological morbidity was associated with current pregnancy, choice not to see their baby, lack of time with their baby and/or insufficient mementos. Three themes were formulated "positive effects of contact within a traumatic life event," "importance of role of health professionals," and "impact on mothers and fathers: similarities and differences." CONCLUSIONS Stillbirth is a risk factor for increased psychological morbidity. Parents seeing and holding their stillborn baby can be beneficial to their future well-being. Since 2007, there has been a proliferation of studies that challenge clinical guidelines recommending that clinicians do not encourage parental contact.
Collapse
Affiliation(s)
- Carol Kingdon
- School of Health, University of Central Lancashire, Preston, Lancashire, UK
| | - Jennifer L Givens
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Emer O'Donnell
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mark Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
33
|
Kingdon C, O’Donnell E, Givens J, Turner M. The Role of Healthcare Professionals in Encouraging Parents to See and Hold Their Stillborn Baby: A Meta-Synthesis of Qualitative Studies. PLoS One 2015; 10:e0130059. [PMID: 26154302 PMCID: PMC4495992 DOI: 10.1371/journal.pone.0130059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final.
Collapse
Affiliation(s)
- Carol Kingdon
- School of Health, University of Central Lancashire, Preston, Lancashire, United Kingdom
- * E-mail:
| | - Emer O’Donnell
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jennifer Givens
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mark Turner
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
34
|
Basile ML, Thorsteinsson EB. Parents' evaluation of support in Australian hospitals following stillbirth. PeerJ 2015; 3:e1049. [PMID: 26137430 PMCID: PMC4485727 DOI: 10.7717/peerj.1049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/03/2015] [Indexed: 11/20/2022] Open
Abstract
The present study evaluated the level of support and satisfaction among parents of stillborn babies in Australian hospitals. One-hundred and eighty-nine mothers and fathers completed an online survey designed by the researcher based on the guidelines designed by the Perinatal Society of Australia and New Zealand. Support was inconsistent with guidelines implemented on average only 55% of the time. Areas of support regarding creating memories, birth options and autopsy were most problematic. A significant positive correlation was found between support and satisfaction and there is indication that there has been some increase in support and satisfaction over time. There has been a significant increase in both support and satisfaction since the release of the guidelines in 2009. Creating memories was regarded by parents as the most influential to their grief. It is recommended that health professionals review guidelines and seek feedback from parents as to how they can improve the support they provide.
Collapse
Affiliation(s)
- Melanie L. Basile
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| | - Einar B. Thorsteinsson
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, Australia
| |
Collapse
|
35
|
Crispus Jones H, McKenzie-McHarg K, Horsch A. Standard care practices and psychosocial interventions aimed at reducing parental distress following stillbirth: A systematic narrative review. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1035234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
36
|
McKenzie-McHarg K, Ayers S, Ford E, Horsch A, Jomeen J, Sawyer A, Stramrood C, Thomson G, Slade P. Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1031646] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
37
|
Horsch A, Jacobs I, McKenzie-McHarg K. Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study. J Trauma Stress 2015; 28:110-7. [PMID: 25820435 DOI: 10.1002/jts.21997] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This short-term longitudinal study investigated cognitive predictors and risk factors of posttraumatic stress disorder (PTSD) in mothers following stillbirth. After a stillbirth at ≥ 24 weeks gestational age, 65 women completed structured clinical interviews and questionnaires assessing PTSD symptoms, cognitive predictors (appraisals, dysfunctional strategies), and risk factors (perceived social support, trauma history, obstetric history) at 3 and 6 months. PTSD symptoms decreased between 3 and 6 months (Cohen's d ranged .34-.52). Regression analyses also revealed a specific positive relationship between Rumination and concurrent frequency of PTSD symptoms (β = .45). Negative Self-View and Negative World-View related positively and Self-Blame related negatively to concurrent number of PTSD symptoms (β = .48, .44, -.45, respectively). Suppression and Distraction predicted a decrease and Numbing predicted an increase in time-lagged number of PTSD symptoms (β = -.33, -.28, .30, respectively). Risk factors for PTSD symptoms were younger age (β = -.25), lower income (β = -.29), fewer previous pregnancies (β = -.31), and poorer perceived social support (β = -.26). Interventions addressing negative appraisals, dysfunctional strategies, and social support are recommended for mothers with PTSD following stillbirth. Knowledge of cognitive predictors and risk factors of PTSD may inform the development of a screening instrument.
Collapse
Affiliation(s)
- Antje Horsch
- Department of Child and Adolescent Psychiatry, Research Unit, University Hospital Lausanne, Lausanne, Switzerland; Department of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, Lausanne, Switzerland
| | | | | |
Collapse
|
38
|
Brierley-Jones L, Crawley R, Lomax S, Ayers S. Stillbirth and stigma: the spoiling and repair of multiple social identities. OMEGA-JOURNAL OF DEATH AND DYING 2015; 70:143-68. [PMID: 25628022 DOI: 10.2190/om.70.2.a] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated mothers' experiences surrounding stillbirth in the United Kingdom, their memory making and sharing opportunities, and the effect these opportunities had on them. Qualitative data were generated from free text responses to open-ended questions. Thematic content analysis revealed that "stigma" was experienced by most women and Goffman's (1963) work on stigma was subsequently used as an analytical framework. Results suggest that stillbirth can spoil the identities of "patient," "mother," and "full citizen." Stigma was reported as arising from interactions with professionals, family, friends, work colleagues, and even casual acquaintances. Stillbirth produces common learning experiences often requiring "identity work" (Murphy, 2012). Memory making and sharing may be important in this work and further research is needed. Stigma can reduce the memory sharing opportunities for women after stillbirth and this may explain some of the differential mental health effects of memory making after stillbirth that is documented in the literature.
Collapse
|
39
|
Christiansen DM, Olff M, Elklit A. Parents bereaved by infant death: sex differences and moderation in PTSD, attachment, coping and social support. Gen Hosp Psychiatry 2014; 36:655-61. [PMID: 25218784 DOI: 10.1016/j.genhosppsych.2014.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Parents bereaved by infant death experience a wide range of symptomatology, including posttraumatic stress disorder (PTSD) that may persist for years after the loss. Little research has been conducted on PTSD in fathers who have lost an infant. Mothers report most symptoms to a greater extent than fathers, but not much is known about other sex differences following infant death. METHOD The present cross-sectional study examined sex differences in PTSD and sex differences in the relationship between PTSD severity and related variables. Subjects were 361 mothers and 273 fathers who had lost an infant either late in pregnancy, during birth or in the first year of life. Participants filled out questionnaires between 1.2 months and 18 years after the loss (M = 3.4 years). RESULTS Mothers reported significantly more PTSD symptoms, attachment anxiety, emotion-focused coping and feeling let down, but significantly lower levels of attachment avoidance than fathers. Attachment anxiety, attachment avoidance and emotion-focused coping were significantly more strongly associated with PTSD severity in mothers than fathers, but only when examined alone. When all variables and time since the loss were examined together, there were no longer any significant moderation effects of sex. CONCLUSIONS Persistent posttraumatic symptomatology exists in both mothers and fathers long after the loss. There are several sex differences in severity and correlates of PTSD, and a few moderation effects were identified for attachment and emotion-focused coping. Overall, more similarities than differences were found between mothers and fathers in the associations between PTSD and covariates.
Collapse
Affiliation(s)
- Dorte M Christiansen
- Department of Psychology, University of Aarhus, Bartholins Allé 9, 8000 Aarhus C, Denmark; National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, the Netherlands.
| | - Ask Elklit
- National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Psychology Research Institute, School of Psychology, Faculty of Life and Health Sciences, University of Ulster, Londonderry, United Kingdom.
| |
Collapse
|
40
|
Ryninks K, Roberts-Collins C, McKenzie-McHarg K, Horsch A. Mothers' experience of their contact with their stillborn infant: an interpretative phenomenological analysis. BMC Pregnancy Childbirth 2014; 14:203. [PMID: 24923242 PMCID: PMC4062775 DOI: 10.1186/1471-2393-14-203] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines surrounding maternal contact with the stillborn infant have been contradictory over the past thirty years. Most studies have reported that seeing and holding the stillborn baby is associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so. In contrast, others studies suggest that contact with the stillborn infant can lead to poorer maternal mental health outcomes. There is a lack of research focusing on the maternal experience of this contact. The present study aimed to investigate how mothers describe their experience of spending time with their stillborn baby and how they felt retrospectively about the decision they made to see and hold their baby or not. Method In depth interviews were conducted with twenty-one mothers three months after stillbirth. All mothers had decided to see and the majority to hold their baby. Qualitative analysis of the interview data was performed using Interpretive Phenomenological Analysis. Results Six superordinate themes were identified: Characteristics of Contact, Physicality; Emotional Experience; Surreal Experience; Finality; and Decision. Having contact with their stillborn infant provided mothers with time to process what had happened, to build memories, and to ‘say goodbye’, often sharing the experience with partners and other family members. The majority of mothers felt satisfied with their decision to spend time with their stillborn baby. Several mothers talked about their fear of seeing a damaged or dead body. Some mothers experienced strong disbelief and dissociation during the contact. Conclusions Results indicate that preparation before contact with the baby, professional support during the contact, and professional follow-up are crucial in order to prevent the development of maternal mental health problems. Fears of seeing a damaged or dead body should be sensitively explored and ways of coping discussed. Even in cases where mothers experienced intense distress during the contact with their stillborn baby, they still described that having had this contact was important and that they had taken the right decision. This indicates a need for giving parents an informed choice by engaging in discussions about the possible benefits and risks of seeing their stillborn baby.
Collapse
Affiliation(s)
| | | | | | - Antje Horsch
- Department of Child and Adolescent Psychiatry, Research Unit, University Hospital Lausanne, Rue du Bugnon 25 A, Lausanne CH-1011 Lausanne, Switzerland.
| |
Collapse
|