A quick reference table of interventions to assist families to cope with pregnancy loss or neonatal death

The Travesty of Choosing After Positive Prenatal Diagnosis

OBJECTIVE

To integrate the findings of qualitative studies of expectant parents receiving positive prenatal diagnosis.

DATA SOURCES

Seventeen published and unpublished reports appearing between 1984 and 2001 and retrieved between December of 2002 and March of 2003. The electronic databases searched include Academic Search Elite, AIDS Information Online (AIDSLINE), Anthropological Index Online, Anthropological Literature, Black Studies, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Digital Dissertations, Dissertation Abstracts Index (DAI), Educational Resource Information Center (ERIC), MEDLINE, PsycInfo, Public Affairs Information Service (PAIS), PubMed, Social Science Abstracts (SocSci Abstracts), Social Science Citation Index, Social Work Abstracts, Sociological Abstracts (Sociofile), Women's Resources International, and Women's Studies.

STUDY SELECTION

Qualitative studies involving expectant parents living in the United States of any race, ethnicity, nationality, or class who learned during any time in pregnancy of any fetal impairment by any means of diagnosis were eligible for inclusion.

DATA EXTRACTION

Metasummary techniques, including the calculation of frequency effect sizes, were used to aggregate the findings. Metasynthesis techniques, including constant comparison analysis and the reciprocal translation of concepts, were used to interpret the findings.

DATA SYNTHESIS

The topical emphasis in the findings is on the termination of pregnancy following positive diagnosis. The thematic emphasis is on the dilemmas of choice and decision making. Positive prenatal diagnosis was for couples an experience of chosen losses and lost choices. Couples managed information to minimize stigmatization and cognitive dissonance.

CONCLUSIONS

Existing guidelines for caring for couples after perinatal losses must accommodate the chosen loss experientially defining positive prenatal diagnosis.

Bereavement support for women and their families after stillbirth

OBJECTIVES

(1) To heighten awareness of the grieving process of the mother and her family experiencing the death of a baby; (2) to offer suggestions to health-care providers of the type of support that will achieve optimal grief resolution.

OPTIONS

Early, late, or no interventions for women and families who experienced stillbirths.

OUTCOME

Success of health-care providers in preventing, recognizing, and treating psychological problems in the bereaved parents and families, and also in helping these families to build meaningful experiences and positive memories from their loss.

EVIDENCE

English-language articles and their references on grief and bereavement after perinatal death, through a search of MEDLINE, the Cochrane Library, and publications of other national bodies including the Canadian Paediatric Society, and the American College of Obstetricians and Gynecologists.

Psychosocial needs of women during miscarriage or ectopic pregnancy

The woman who experiences a miscarriage or ectopic pregnancy may express her grief with many different responses. Perioperative nurses can enable the woman and her family members to adequately grieve the loss of pregnancy and the baby by using sensitive communication, therapeutic listening, and empathy skills and by coordinating follow up.

Professional bereavement photographs: one aspect of a perinatal bereavement program

Although professionals can do little to cushion the emotional trauma for parents and family when an infant dies, many institutions have implemented bereavement programs to offer counseling, support, and assistance. Included in such programs are photographs of the deceased infant. The value of such photographs has been documented in the literature. Some institutions provide parents with instantly developed photos of the deceased infant. Unfortunately, instant prints may blue and often fade with time. To improve services to bereaved families at a hospital in Massachusetts, a program was implemented to use the skills of the hospital's professional biomedical photographers and the nursing team. The perinatal clinical nurse specialist or her designee takes a 35-mm black-and-white photograph of the infant. The biomedical photographers process the negatives and use hand coloring techniques and matting to produce professional-quality photographs. The response by parents and families to the improved photographs has been positive. As the number of photographs taken has increased, the staff have continued to improve the service.

Perinatal loss. A critique of current hospital practices

Dramatic improvements in the hospital management of perinatal loss have taken place in the past 20 years. However, there has been no critical examination of current approaches. Four possible hazards of current hospital practice are described: 1) Institutionalization of bereavement: Instead of offering parents an empathic awareness of the unique dimensions of their perinatal loss, caregivers often interact according to detailed behavioral protocols. 2) Idealization of contact with the dead baby: This approach may equate actual physical contact with the dead child with the more complicated and variable process of mourning. 3) Homogenization of grief: Counselors tend to denigrate different grief responses by focusing on a preconceived grief reaction. Thus, they may mistakenly label many such reactions pathologic if they deviate from the rigidly prescribed "norm." 4) Lecturing the bereaved: Telling parents the "right" thing to do may deprive them of a crucial aspect of the process that empowers parents after they experience the helplessness associated with perinatal loss--that of making their own decisions. These problems are illustrated by a clinical vignette, and alternative approaches are explored.