The influence of prior perinatal loss on parents' psychological distress after the birth of a subsequent healthy infant

Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review

AIMS AND METHOD

Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up.

RESULTS

We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions.

CLINICAL IMPLICATIONS

Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.

White Tears: A Phenomenological Study of Perinatal Loss

Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An interpretative phenomenological study was carried out between January 2021 and July 2022 with 6 parental pairs (12 people in total, 6 mothers and 6 fathers) who experienced a perinatal loss. Participants were reached by snowball sampling method. Data were collected using semi-structured audio recording interviews that were transcribed and analyzed using thematic analysis. The themes of this study were determined as "attributing meaning to loss", "fragmented parenting roles and expectations", "changing relationships", "expectations from healthcare professionals", and "emotional responses". Five sub-themes were created from the emotional responses theme which included. These are sadness and pain, denial, anger, guilt and fear. In the study, it was concluded that the experience of perinatal loss may have negative consequences on the psychological health of the parents. Therefore, specific, professional, adequate nursing support and continuity of support are needed to help parents cope with perinatal losses.

A scoping review of therapies used to treat psychological trauma post perinatal bereavement

BACKGROUND

Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem.

AIM

To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package.

METHOD

A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement.

FINDINGS

Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth.

CONCLUSIONS

A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package.

A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss

BACKGROUND

Maternal identity, a mother's internalized view of self as mother, has not been studied in relation to perinatal loss. This study aimed to investigate how women construct a sense of maternal identity after the loss of a baby.

METHODS

We interviewed 10 mothers who had experienced perinatal loss. A Listening Guide framework for narrative analysis was used to identify patterns of giving voice to the mother's own story.

RESULTS

We identified 12 overarching voices which fell within three distinct groupings: voices of motherhood, voices of grief, and voices of growth. Although bereaved mothers grappled with constructing their maternal identity, they also demonstrated how maternal identity is individually and intuitively created through an honouring and remembering of the child that was lost, resulting in significant growth.

CONCLUSIONS

There is need for a broader definition of what constitutes motherhood to encapsulate diverse mothering experiences, including perinatal loss.

The association between history of prenatal loss and maternal psychological state in a subsequent pregnancy: an ecological momentary assessment (EMA) study

BACKGROUND

Prenatal loss which occurs in approximately 20% of pregnancies represents a well-established risk factor for anxiety and affective disorders. In the current study, we examined whether a history of prenatal loss is associated with a subsequent pregnancy with maternal psychological state using ecological momentary assessment (EMA)-based measures of pregnancy-specific distress and mood in everyday life.

METHOD

This study was conducted in a cohort of N = 155 healthy pregnant women, of which N = 40 had a history of prenatal loss. An EMA protocol was used in early and late pregnancy to collect repeated measures of maternal stress and mood, on average eight times per day over a consecutive 4-day period. The association between a history of prenatal loss and psychological state was estimated using linear mixed models.

RESULTS

Compared to women who had not experienced a prior prenatal loss, women with a history of prenatal loss reported higher levels of pregnancy-specific distress in early as well as late pregnancy and also were more nervous and tired. Furthermore, in the comparison group pregnancy-specific distress decreased and mood improved from early to late pregnancy, whereas these changes across pregnancy were not evident in women in the prenatal loss group.

CONCLUSION

Our findings suggest that prenatal loss in a prior pregnancy is associated with a subsequent pregnancy with significantly higher stress and impaired mood levels in everyday life across gestation. These findings have important implications for designing EMA-based ambulatory, personalized interventions to reduce stress during pregnancy in this high-risk group.

Nursing Care of Childbearing Families After Previous Perinatal Loss

Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.

Patterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort

BACKGROUND

Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns.

METHODS

A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns.

RESULTS

Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety).

LIMITATIONS

Generalizability may be compromised by attrition, under-reporting, and recall bias.

CONCLUSION

Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.

Infant Developmental Outcomes: Influence of Prenatal Maternal-Fetal Attachment, Adult Attachment, Maternal Well-Being, and Perinatal Loss

Identification of prenatal characteristics that predict later infant development may afford opportunities for early intervention, potentially optimizing childhood development outcomes. The aim of the present study was to examine the effects of selected prenatal factors (maternal–fetal attachment, maternal adult attachment, maternal well-being, and previous perinatal loss) on later infant development. Pregnant women were recruited from two antenatal clinics at one tertiary hospital and asked to complete self-report questionnaires. The Bayley’s Scales of Infant and Toddler Development were then completed one to two years after their baby’s birth. Independent samples t-tests, correlational analyses, and multivariate linear regression models were conducted. Results from 40 dyads revealed that more favorable maternal–fetal attachment, more secure/less anxious maternal attachment, and higher maternal well-being predicted maternal reports of infant adaptive behavior regardless of previous perinatal loss. Infants of women without perinatal loss scored higher in external observer-rated cognitive development compared to infants of women with previous perinatal loss. While further research is required, findings indicate that a mother’s well-being and her relationship with her baby during pregnancy contributes to positive perceptions of her infant’s daily living skills. Supporting the parenting of women with perinatal loss is required to, in turn, promote optimal cognitive development in infants.

Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilization

BACKGROUND

Stillbirth occurs in every 3.5 of 1000 pregnancies in Ireland and is a devastating event for a family. Women who have a pregnancy after stillbirth require increased antenatal support.

OBJECTIVE

This study aimed to determine maternal and fetal outcomes and to quantify health service utilization in pregnancy after stillbirth.

STUDY DESIGN

A retrospective cohort study of all pregnancies after stillbirth was conducted from 2011 to 2017 in a large tertiary referral university maternity teaching hospital with approximately 8000 births annually.

RESULTS

There were 222 stillbirths from 2011 to 2017. Two-thirds of women (145 of 222 [64.3%]) had a pregnancy after stillbirth. Almost one-fifth of these women (28 of 145 [19.3%]) had a miscarriage, but 16 of 28 women (57.1%) had a subsequent live birth, giving an overall live birth rate of 90.3% (131/145). The average interval from index loss to booking in the next pregnancy was 13 months, with almost half of the women (72 of 145 [49.7%]) booking within 1 year. The average number of antenatal appointments was twice than expected (10; range, 2-27), and the average number of ultrasound scans was 5 times higher than expected (5; range, 0-29). Rates of induction of labor (63 of 131 [48.1%]) and cesarean delivery (53 of 131 [40.5%]) were significantly higher than national rates for multiparous women. Almost two-thirds of women (40 of 63 [63.5%]) cited previous history of stillbirth as the indication for induction. There was a significantly higher rate of preterm delivery (30 of 131 [22.9%]). Moreover, 1 in 4 babies (35 of 137 [25.5%]) required admission to the neonatal intensive care unit, more than twice the number expected (median gestation, 37 0/7 weeks; range, 25 4/7 to 39 2/7 weeks).

CONCLUSION

Pregnancy after stillbirth was associated with increased surveillance and intervention. The women in this study had higher rates of cesarean delivery, induction of labor, and preterm delivery than the general multiparous population. Decision-making for intervention was often based on previous history of stillbirth. Clinicians should be cognizant of additional supports required for this population and focus on evidence-based interventions that improve maternal well-being and perinatal outcomes in pregnancy after stillbirth.

Perinatal Grief and Post-Traumatic Stress Disorder in Pregnancy after Perinatal Loss: A Longitudinal Study Protocol

Background: Pregnancies that follow perinatal loss are often associated with mental health disorders, which are not usually treated or even identified. Objectives: The main study aim is to identify the prevalence of symptoms of post-traumatic stress disorder and complicated perinatal grief at different stages of pregnancy following a prior gestational loss. Methods: This descriptive longitudinal study will be conducted with a twelve-month follow-up. The study variables addressed will include sociodemographic data (age, sex, education, marital status, employment status and obstetric history) together with clinical data on complicated perinatal grief and post-traumatic stress disorder scores. Results: The results obtained are expected to provide a new perspective on the healthcare approach to perinatal loss and subsequent pregnancy. Conclusions: We seek to optimise comprehensive healthcare in cases of pregnancy following previous perinatal loss and to evaluate options to minimise possible risks.

History of perinatal loss: A study of psychological outcomes in mothers and fathers after subsequent healthy birth

BACKGROUND

The loss of an expected child is a psychologically difficult and potentially traumatic life event. While most women will become pregnant again within a year following the loss, data are limited regarding the mental health of parents with a history of perinatal loss, especially in the period following the birth of a subsequent healthy child. This study, therefore, investigated the relation between perinatal loss and mothers' and fathers' psychological symptoms and parenting stress 6-months after the birth of a healthy child.

METHODS

A community sample of 92 mother-father dyads living in a Canadian city and having a 6-month-old biological infant were asked to complete questionnaires measuring their history of perinatal losses (55 parents reporting at least one loss) and their psychological symptoms and parenting stress.

RESULTS

Mothers and fathers who have experienced a perinatal loss reported more psychological symptoms and parenting stress. Mothers were more likely to report psychological symptoms and parenting stress compared to fathers, but the magnitude of the relation between perinatal losses and psychological outcomes were comparable for mothers and fathers.

LIMITATIONS

Limitations of the study include the use of a small community sample with low generalizability and low levels of psychological symptoms and stress.

CONCLUSIONS

The results suggest that the experience of a perinatal loss might have negative consequences on the psychological wellbeing of parents even after the birth of a healthy child.

Trying to conceive: An interpretive phenomenological analysis of couples' experiences of pregnancy after stillbirth

OBJECTIVE

Stillbirth affects 1:200 pregnancies in high income countries. Most women are pregnant again within 12 months. Little is known about how couples negotiate a subsequent pregnancy. This paper presents findings from a study exploring the experiences of couples' in pregnancy after stillbirth.

METHODS

Qualitative, interpretive phenomenological analysis was used to conduct in-depth interviews with eight heterosexual couples in the immediate pregnancy after stillbirth. Couples were interviewed together to explore their dyadic, lived experiences of stillbirth and the pregnancy that follows.

RESULTS

Hoping for a born alive baby was one superordinate theme and Trying to conceive one of its subordinate themes, is presented here. Couples jointly negotiated their decision to get pregnant again, varying upon their individual circumstances, including their experiences of stillbirth. Gender differences were apparent in a couple's agreement to pursue a pregnancy after stillbirth and may be explained by the desire of men to fully parent the baby who died before reaching a decision about a subsequent pregnancy. Sexual intercourse often became less about emotional connection and more about a means to achieve a pregnancy.

CONCLUSION

Couples spoke of the need for each partner to be in agreement with the decision for a pregnancy. The experiences of trying to conceive after stillbirth impacted the couple relationships. Couples who were able to discuss their feelings with one another appeared more cohesive than those who experienced communication challenges in the aftermath of loss. New insights into men's thinking about the decision to get pregnant after stillbirth were revealed.

The psychological implications of a subsequent pregnancy outcome in couples with a history of miscarriage

OBJECTIVES

The present study expands upon reproductive research by examining perinatal grief in couples following a miscarriage and throughout a subsequent pregnancy. The aim of the study was to address the question of whether the outcome of a successful live birth mitigates the negative impact of a previous miscarriage.

METHOD

Participants were recruited through 20 general practice surgeries that provided antenatal care in the United Kingdom. The study comprised 128 couples; 64 couples who experienced two consecutive miscarriages, and 64 couples who experienced a live birth following a miscarriage. Participants completed the Perinatal Grief Scale across four Time points (T1: Six weeks following the first pregnancy outcome; T2: Six weeks following the second pregnancy outcome; T3: Six months following the second pregnancy outcome and T4: Twelve months following the second pregnancy outcome).

RESULTS

The primary findings of the study demonstrated a significant mitigation effect with a decrease in perinatal grief over time. As predicted, couples who experienced a second miscarriage reported elevated perinatal grief; compared to couples who went on to have a successful live birth.

CONCLUSION

The present study's findings contribute to our knowledge of the long-term implications of miscarriage and its influence on psychological health in terms of perinatal grief.

Pregnancy after miscarriage in primiparae and multiparae: implications for women's psychological well-being

Introduction: Miscarriage is a stressful life event with negative consequences that can last into the subsequent gestation, increasing women's risk for psychological symptoms. Less clear in literature is whether having a living child may buffer the psychological impact of miscarriage on subsequent pregnancies.Objective: explore levels of depression, anxiety and fear of delivery in women with and without a previous miscarriage, taking into consideration the presence of a living child.Method: 208 women (M = 34.68) were recruited during the third trimester of gestation. The sample was composed of 159 women without a previous miscarriage (72.3% primiparae and 27.7% multiparae) and 49 women with a history of miscarriage (53.1% primiparae and 46.9% multiparae). Participants filled out a battery of questionnaires aimed at assessing anxiety, depression, and fear of delivery.Results: Primiparae reported higher levels of fear of childbirth than multiparae. Moreover, women without a history of previous perinatal loss showed lower levels of depression and fear of childbirth than women with a previous perinatal loss.Conclusions: Data highlight the importance of developing specific support groups, for primiparae, due to their great emotional vulnerability, and for women with past miscarriage, to help them cope in adaptive ways with a new pregnancy.

Factors Influencing Stress in Spouses of Hospitalized Women Diagnosed with Preterm Labor

PURPOSE

The purpose of the study was to identify to identify the nursing needs and stress levels among spouses of women hospitalized with preterm labor, and to determine factors influencing spousal stress.

METHODS

Data were collected from 95 spouses of hospitalized pregnant women due to preterm labor at a hospital in Gyeonggi province from June to December of 2016. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression.

RESULTS

The mean score of spouses' nursing needs was 3.06±0.42 and stress was 1.85±0.44 out of 4.00. The highest score of nursing needs was 3.37±0.51 in assurance and the highest score for stress was 2.26±0.72 for patient's illness and prognosis. There was a significant positive correlation between stress in spouse and nursing needs (p=.004). Stress was explained by nursing needs (β=.28) and hospitalization days (β=.21). CONCLUSIONS: The results of this study suggest that appropriate nursing interventions are required to address the nursing needs at the beginning of hospitalization and to reduce the stress among spouses of hospitalized pregnant women diagnosed with preterm labor.

Anxiety in fathers in the perinatal period: A systematic review

BACKGROUND

fatherhood in the perinatal period can be a time of great excitement, happiness and joy. However, a growing body of literature indicates that fathers are at risk for elevated levels of anxiety symptoms during the perinatal period.

PURPOSE

the purpose of this systematic review is to determine the prevalence and levels of anxiety in fathers during the perinatal period, identify the risk factors and impact of anxiety, and establish if there are effective interventions that reduce father's anxiety.

DESIGN

Systematic review.

METHODS

A systematic review protocol was developed and registered with PROSPERO (reference number: CRD42017073760). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, Embase, the Cochrane Library, PsycARTICLES, PsycINFO, and Psychology were searched to identify eligible studies. Studies that researched fathers during the perinatal period were included if anxiety was the primary focus of the research or was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures.

FINDINGS

Thirty-four studies met the inclusion criteria. Findings from these studies indicate that fathers experience anxiety in the perinatal period, particularly at the time of birth. Anxiety increased from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. The prevalence of anxiety ranged between 3.4% and 25.0% during the antenatal period and 2.4% and 51.0% during the postnatal period. Factors contributing to anxiety included lower education levels, lower income levels, lower co-parenting support, lower social support, work-family conflict, a partner' anxiety and depression, and being present during a previous birth. Anxiety had a negative impact on fathers' mental health, physical health, social relationships and parenting skills. Anxiety contributed to stress, depression, fatigue and lower paternal self-efficacy. Five studies reported on interventions to reduce anxiety and all the studies found that anxiety significantly decreased following the intervention.

KEY CONCLUSION

Fathers experience increased anxiety from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. Anxiety during the perinatal period that can impact negatively on fathers physical and mental health, and social relationships.

Nurses' Perspective on Caring for Women Experiencing Perinatal Loss

PURPOSE

The purpose of this study was to describe the experience of caring for women with a perinatal loss from the perspective of the nurse and to determine the extent to which the response to perinatal loss reflects a process.

STUDY DESIGN AND METHODS

A purposive study was conducted with nine labor and birth nurses with experience in caring for women with a perinatal loss. The nurses were from two acute care hospitals within one healthcare system in Southeastern Massachusetts. A qualitative descriptive design with in-depth interviewing based on was used to gather and analyze data.

RESULTS

Several themes depicting nurses' experience were identified: struggling with emotions, carrying on in the moment, being present for the patient, expressing conflict, and taking care of self. A process was identified by nurses describing their response to perinatal loss. The process began with recognition of the loss and progressed through phases including the recognition of their emotional impact, connecting with the mother, dealing with emotions, acting professionally, preparing to return to work, and never forgetting the woman.

CLINICAL IMPLICATIONS

Nurses identified a need for more education and managerial support for excellence in care of women with a perinatal loss. Education to prepare nurses to meet the physical, psychological, and spiritual needs of women is recommended. Debriefing after caring for a woman with a loss was suggested by the nurses. When nurses' needs are met, they are better prepared to care for women experiencing a perinatal loss.

Traumatic events: exploring associations with maternal depression, infant bonding, and oxytocin in Latina mothers

Background

Childhood and adulthood traumatic experiences negatively impact maternal-infant bonding and increase risk of postpartum depression (PPD). Lower oxytocin levels have also been associated with PPD and compromised mother-infant bonding. Despite advances in these areas of investigation, much of the research has not included Latinas, who are important because they have high rates of fertility, traumatic events, and PPD.

Methods

To address gaps identified in the literature, we explored associations between traumatic life events, PPD, and bonding subscale scores (e.g., Impaired Bonding, Rejection and Anger, Anxiety about Care) in a sample of 28 Latinas. We also examined associations between these factors and oxytocin (OT). Wilcoxon signed-rank tests were employed to examine differences in subscale scores over time. Kruskal–Wallis one-way analysis of variance was used to examine differences in bonding subscale scores and OT by maternal depression status and traumatic events. We also explored interaction effects of traumatic events and OT AUC on bonding subscale scores.

Results

Women with PPD at 8 weeks had significantly higher Rejection and Anger subscale scores (p = 0.054) than non-PPD women, where higher scores represent more compromised bonding. Significant differences in Rejection and Anger (p = 0.042) and Anxiety about Care (p = 0.005) by adulthood traumatic histories were observed at 8 weeks postpartum. There was also a significant difference in Anxiety about Care scores at 4 weeks postpartum (p = 0.024) and Impaired Bonding at 8 weeks postpartum (p = 0.041) by trauma events involving an infant. There was a significant interaction between OT and childhood sexual abuse on Impaired Bonding (p = 0.038).

Conclusion

We observed differential responses in bonding subscale scores by traumatic histories. Women who experienced a trauma involving an infant had higher compromised bonding scores, whereas those with adulthood traumatic histories, such as intimate partner violence, had lower scores. We also found an interaction between childhood trauma and oxytocin levels on bonding scores, suggesting a physiological response to early abuse that can have implications on mothers’ bonding perceptions. These preliminary results suggest the need for additional research on the long-term emotional and physiological effects of traumatic events occurring prior to parturition.

Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study

Background

Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women’s relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth.

Methods

This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors.

Results

Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90–10.32 and aOR 1.91, 95% CI 1.11–3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68–9.24 and aOR 1.91, 95% CI 1.08–3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval <  12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups.

Conclusion

Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.

Predicting grief intensity after recent perinatal loss

OBJECTIVE

The Perinatal Grief Intensity Scale (PGIS) was developed for clinical use to identify and predict intense grief and need for follow-up after perinatal loss. This study evaluates the validity of the PGIS via its ability to predict future intense grief based on a PGIS score obtained early after a loss.

METHODS

A prospective observational study was conducted with 103 international, English-speaking women recruited at hospital discharge or via the internet who experienced a miscarriage, stillbirth, or neonatal death within the previous 8weeks. Survey data were collected at baseline using the PGIS and the Perinatal Grief Scale (PGS). Follow-up data on the PGS were obtained 3months later. Data analysis included descriptive statistics, Cronbach's alpha, receiver operating characteristic curve analysis, and confirmatory factor analysis.

RESULTS

Cronbach's alphas were ≥0.70 for both instruments. PGIS factor analysis yielded three factors as predicted, explaining 57.7% of the variance. The optimal cutoff identified for the PGIS was 3.535. No difference was found when the ability of the PGIS to identify intense grief was compared to the PGS (p=0.754). The PGIS was not inferior to the PGS (AUC=0.78, 95% CI 0.68-0.88, p<0.001) in predicting intense grief at the follow-up. A PGIS score≥3.53 at baseline was associated with increased grief intensity at Time 2 (PGS: OR=1.97, 95% CI 1.59-2.34, p<0.001).

CONCLUSIONS

The PGIS is comparable to the PGS, has a lower response burden, and can reliably and validly predict women who may experience future intense grief associated with perinatal loss.

A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study)

BACKGROUND

In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

METHODS

The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

DISCUSSION

This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

TRIAL REGISTRATION

NCT02925481.

Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort

INTRODUCTION

Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy.

METHODS

Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits.

RESULTS

Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester.

DISCUSSION

Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety.

The psychological, social, and economic impact of stillbirth on families

This article reviews the current state of psychological, social, and economic research into the impact of stillbirth on families. We argue that whereas the knowledge we have of the experiential aspects of stillbirth is increasing, there is still much that remains to be uncovered especially in respect of the impact that seeing the baby may have on mental health. Moreover, the experience of particular social groups merits further work, most notably regarding same-sex couples and surrogates, mothers and fathers drawn from Black and Minority Ethnic groups as well as those from lower socio-economic groups. Particular attention needs to be paid to the economic impact of stillbirth on families, whether this is from a perspective that focuses on the family or the wider society in which they live.

Posttraumatic stress disorder in parents following infant death: A systematic review

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.

Relation between quality of life and mental health in pregnant women with prior pregnancy loss

AIM

This paper intends to compare quality of life (QoL) and mental health among pregnant women with and without previous pregnancy loss.

METHODS

An analytical cross-sectional study was conducted on 409 women between the 16th and 30th weeks of gestation in health centers in Ahvaz, Iran, including 145 women with prior pregnancy loss (group 1) and 264 women without such history (group 2). Data were collected using the QoL Short Form-36 questionnaire, the Mental Health Questionnaire 25 and a questionnaire for assessing sociodemographic variables. Data were analyzed using spss version 22. Results were analyzed using the χ² -test, the Student's t-test and logistic regression. P < 0.05 was defined as statistically significant.

RESULTS

There was a significant difference between the two groups in respect to QoL and mental health. Women with previous pregnancy loss had lower scores in total and in all subscales of the QoL Short Form-36 (P < 0.001) and higher scores in total and in six out of the nine subscales of the Mental Health Questionnaire 25 compared to women without these histories.

CONCLUSION

Women with history of spontaneous abortion and stillbirth seem to have poorer QoL and mental health during their subsequent pregnancy than those without such experience.

From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth

Background

Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide.

Methods

Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included.

Results

Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature.

Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8).

They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9).

Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7).

In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent.

Conclusion

Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0800-8) contains supplementary material, which is available to authorized users.

Effect of previous miscarriage on depressive symptoms during subsequent pregnancy and postpartum in the first baby study

Our objective was to test the hypothesis that nulliparous women with a history of miscarriage have an increased risk of depression during late pregnancy, and at 1, 6, and 12 months postpartum compared to women without a history of miscarriage. We conducted secondary analysis of a longitudinal cohort study, the First Baby Study, and compared 448 pregnant women with a history of miscarriage to 2,343 pregnant women without a history of miscarriage on risk of probable depression (score >12 on the Edinburgh Postnatal Depression Scale). Logistic regression models were used to estimate odds ratios at each time point and generalized estimating equations were used to obtain estimates in longitudinal analysis. Women with a history of miscarriage were not more likely than woman without a history of miscarriage to score in the probable depression range during the third trimester or at 6 or 12 months postpartum but were more likely at 1 month postpartum, after adjustment for sociodemographic factors (OR 1.66, 95% CI 1.03-2.69). Women with a history of miscarriage may be more vulnerable to depression during the first month postpartum than women without prior miscarriage, but this effect does not appear to persist beyond this time period. We support the promotion of awareness surrounding this issue and recommend that research is planned to identify risk factors that may position a woman with a history of miscarriage to be at higher risk for depression.

Cognitive predictors and risk factors of PTSD following stillbirth: a short-term longitudinal study

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.

Posttraumatic stress and posttraumatic stress disorder after termination of pregnancy and reproductive loss: a systematic review

Objective. The aims of this systematic review were to integrate the research on posttraumatic stress (PTS) and posttraumatic stress disorder (PTSD) after termination of pregnancy (TOP), miscarriage, perinatal death, stillbirth, neonatal death, and failed in vitro fertilisation (IVF). Methods. Electronic databases (AMED, British Nursing Index, CINAHL, MEDLINE, SPORTDiscus, PsycINFO, PubMEd, ScienceDirect) were searched for articles using PRISMA guidelines. Results. Data from 48 studies were included. Quality of the research was generally good. PTS/PTSD has been investigated in TOP and miscarriage more than perinatal loss, stillbirth, and neonatal death. In all reproductive losses and TOPs, the prevalence of PTS was greater than PTSD, both decreased over time, and longer gestational age is associated with higher levels of PTS/PTSD. Women have generally reported more PTS or PTSD than men. Sociodemographic characteristics (e.g., younger age, lower education, and history of previous traumas or mental health problems) and psychsocial factors influence PTS and PTSD after TOP and reproductive loss. Conclusions. This systematic review is the first to investigate PTS/PTSD after reproductive loss. Patients with advanced pregnancies, a history of previous traumas, mental health problems, and adverse psychosocial profiles should be considered as high risk for developing PTS or PTSD following reproductive loss.

Parents bereaved by infant death: sex differences and moderation in PTSD, attachment, coping and social support

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.

History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum

While grief, emotional distress and other mental health conditions have been associated with pregnancy loss, less is known about the mental health impact of these events during subsequent pregnancies and births. This paper examined the impact of any type of pregnancy loss on mental health in a subsequent pregnancy and postpartum. Data were obtained from a sub-sample (N = 584) of the 1973-78 cohort of the Australian Longitudinal Study on Women's Health, a prospective cohort study that has been collecting data since 1996. Pregnancy loss was defined as miscarriage, termination due to medical reasons, ectopic pregnancy and stillbirth. Mental health outcomes included depression, anxiety, stress or distress, sadness or low mood, excessive worry, lack of enjoyment, and feelings of guilt. Demographic factors and mental health history were controlled for in the analysis. Women with a previous pregnancy loss were more likely to experience sadness or low mood (AOR = 1.75, 95% CI: 1.11 to 2.76, p = 0.0162), and excessive worry (AOR = 2.01, 95% CI: 1.24 to 3.24, p = 0.0043) during a subsequent pregnancy, but not during the postpartum phase following a subsequent birth. These results indicate that while women who have experienced a pregnancy loss are a more vulnerable population during a subsequent pregnancy, these deficits are not evident in the postpartum.

Effect of previous miscarriage on the maternal birth experience in the First Baby Study

OBJECTIVE

To determine whether a history of miscarriage is related to birth experience and/or maternal fear of an adverse birth outcome for self or infant during a subsequent delivery.

DESIGN

Secondary analysis of a prospective cohort study, the First Baby Study.

SAMPLE

Women age 18 to 35 who were expecting to deliver their first live-born infants in Pennsylvania between January 2009 and April 2011.

PARTICIPANTS

Four hundred fifty-three pregnant women who reported perinatal loss prior to 20 weeks gestation (miscarriage) in a previous pregnancy and 2401 pregnant women without a history of miscarriage were interviewed during pregnancy and again one month after their first live birth.

METHODS

Maternal birth experience and fear of an adverse birth outcome measured via telephone interview were compared across groups.

RESULTS

Maternal birth experience scores did not significantly differ between women with and without previous miscarriage. Women with a history of miscarriage reported that they feared an adverse birth outcome for themselves or their infants more frequently than women without a history of miscarriage (52.1% vs. 46.6%; p = .033), however, this relationship was not significant after adjustment for confounders.

CONCLUSION

Our findings indicate that there is no association between miscarriage history and birth experience. Additional research on this topic would be beneficial including an in-depth examination of fear of adverse outcome during birth. However, nurses and midwives may consider using therapeutic communication techniques to ensure that women with a history of miscarriage receive strong emotional support and reassurance during birth.

Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study

OBJECTIVE

Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies.

STUDY DESIGN

In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies-Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearson's χ(2) test and binary logistic regression were used for statistical analyses.

RESULTS

Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p<0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p<0.05) and depression symptoms (p<0.05) during the first trimester. Women with an interpregnancy interval of 7-12 months had a 2.511-fold higher risk of depression (p<0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index.

CONCLUSIONS

Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health.

Posttraumatic Growth and Transformation as Outcomes of Perinatal Loss

Perinatal loss in its many forms results in profound grief and distress for women, their partners, and families. The possibility of personal growth in the aftermath of perinatal loss has been suggested through early research; however, systematic research on posttraumatic growth after perinatal loss has not been well-developed. Posttraumatic growth is positive psychological change as a result of confronting a challenging life experience. After a short description of perinatal loss, this article presents the conceptual development of posttraumatic growth, its measurement, and early research suggesting that posttraumatic growth occurs after perinatal loss. Finally, future avenues for research are recommended, and suggestions are made as to how clinicians may acknowledge the positive transformative work of bereavement in order to enhance posttraumatic growth in their patients who have experienced the painful loss of their expected children.

A study of psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy

INTRODUCTION

Pregnancy plays a unique role in the transformation of women towards completeness. For those women who have had a previous unsuccessful outcome, pregnancy may bring a lot of inevitable negative emotions. We studied psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy.

METHODS

The study was carried out in Dayanand Medical College and Hospital, Ludhiana, India. A total of 120 patients were divided into 4 groups depending on their pregnancy status. All the groups were compared with each other regarding their psychiatric morbidities, which were measured using various rating scales such as Hamilton Depression rating scale, Hamilton Anxiety Rating Scale, State Trait Anxiety Inventory, Presumptive Stressful Life events Scale, and Brief Psychotic Rating Scale.

RESULTS

We found that subjects with history of previous abortion, whether single or more had significantly higher mean depression and anxiety score than primigravida or subjects with history of previous successful pregnancy; depression and anxiety scores decreased with increase in time gap between abortion and current pregnancy. High anxiety was found in 36.67%(11) of females with history of previous abortion. We also found that 36.67%(11) of subjects with previous single abortion and 30%(9) of subjects with previous 2 or more abortions were suffering from depressive episode. None of the female suffered from psychotic disorder.

CONCLUSIONS

The incidence of depression and anxiety is high in pregnancy after previous abortion and more in subjects who conceive earlier after previous abortion. These results warrant the need for screening all pregnancies for psychiatric morbidity after a previous abortion.

Previous prenatal loss as a predictor of perinatal depression and anxiety

BACKGROUND

Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy.

AIMS

This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy.

METHOD

Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13,133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks' gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included.

RESULTS

Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P<0.01) and anxiety (β = 0.14, s.e. = 0.05, P<0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child.

CONCLUSIONS

Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

Perinatal grief in Latino parents

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Interconception care for couples after perinatal loss: a comprehensive review of the literature

Perinatal loss can be emotionally devastating for couples who experience miscarriage, fetal or neonatal death. Nurses in a variety of settings can assist couples through their grief by providing emotional support, giving information about the grief process, and in planning for a future pregnancy or deciding to forego future childbearing. This article explicates the relationship between grief and perinatal loss and its effects on couples, specifically in the interconception period, when the initial grief and distress have begun to subside. Interconception care focuses on bridging the couple from the end of the postpartum period to the subsequent pregnancy or decision not to conceive again. Nurses assist couples in distinguishing between uncomplicated grief, complicated grief, and depression, and make appropriate referrals. Openness to expressions of grief, helping couples mobilize support, considering readiness for another pregnancy, and directing couples to useful Internet sites are essential nursing interventions.

Personal Growth After Severe Fetal Diagnosis

The traumatic aspects of positive diagnosis of a severe fetal anomaly have garnered the most attention, but the personal growth in the aftermath of this event remains relatively unexplored. We used the five dimensions of growth and change from Posttraumatic Growth Inventory (PTGI) to analyze data generated from ethnographic interviews conducted with 15 women and 10 of their male partners in the aftermath of a severe fetal diagnosis. Eighteen (12 women and 6 men) of these 25 participants experienced positive change across these dimensions. Relating to others was the dimension that showed the most consistent early and prolonged change. Six of the 10 couples had congruent profiles of change. Negative change was evident in 2 women and 2 men. Recognizing the potential for growth allows nurses opportunities to promote it in the aftermath of severe fetal diagnosis.