"Translation, cultural adaptation, and validation of perinatal grief scale in Urdu: Addressing a gap in the research of perinatal loss in Pakistan-Cross-sectional validation study"

Background and Aims

Perinatal grief have a significant influence on maternal mental health, hence appropriate tools for assessment are necessary. In this study, we translated and validated the Perinatal Grief Scale in Urdu (PGS-Urdu) for use in Pakistan, therefore filling the gap in validated tools.

Methods

Data was collected from 165 women using consecutive sampling. Initially, "forward/backward" translation was used. For validity, content validity index and confirmatory factor analysis (CFA) were used respectively, and "Cronbach's-Alpha" for reliability. In the validity stage, items 8, 11, 23, and 32 of the original scale were eliminated based on feedback from the target groups and the expert panel. For data-analysis, SPSS 26 and Amos 26 were used.

Results

In analyzing the "Confirmatory factor analysis", the "all-fitness indicators" validated the three-factor structure of 29-item main scale. Cronbach alpha value was 0.83 for the entire scale The CFA results showed that all fitness indicators, with the exception of four, had loadings greater than 0.20, supporting the main scale's three-factor structure. With a Cronbach's Alpha value of 0.83 for overall reliability, and varied from 0.81 to 0.87 for the PGS-U variables. the PGS-U exhibits an acceptable level of internal consistency.

Conclusion

The PGS-U identifies women in perinatal grief for medical and social care. This research supports using the Urdu perinatal grief scale in obstetrics and bereavement counseling to reduce maternal mental health issues.

Exploring parents' experiences and holistic needs following late miscarriage: a narrative systematic review

BACKGROUND

Up to 2% of all pregnancies result in pregnancy loss between 14 + 0 and 23 + 6 weeks' gestation, which is defined as 'late miscarriage'. Lack of consensus about definition of viability paired with existing multiple definitions of perinatal loss make it difficult to define the term 'late miscarriage'. Parents who experience late miscarriage often have had reassuring scan-milestones, which established their confidence in healthy pregnancy progression and identity formation, which socially integrates their baby into their family. The clinical lexicon alongside the lack of support offered to parents experiencing late miscarriage may disclaim their needs, which has potential to cause adverse psychological responses.

AIM

To review what primary research reports about parents' experiences and their perceived holistic needs following late miscarriage.

METHODS

A narrative systematic review was carried out. Papers were screened based on gestational age at time of loss (i.e. between 14 + 0 and 23 + 6 weeks' gestation). The focus was set on experience and holistic needs arising from the loss rather than its clinical care and pathophysiology. Studies were selected using PRISMA-S checklist, and quality assessed using the Critical Appraisal Skills Program (CASP) tool. Thematic analysis was used to guide the narrative synthesis of findings.

RESULTS

Six studies met the inclusion criteria. Three main themes emerged: communication and information-giving; feelings post-event; and impact of support provision.

CONCLUSION

Literature about the experience of late miscarriage is scarce, with what was found reporting a lack of compassionate and individually tailored psychological follow-up care for parents following late miscarriage. Hence, more research in this arena is required to inform and develop this area of maternity care provision.

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.

[From the cultural cradle to the empty cradle, accompanying perinatal mourning]

In all societies, births and deaths are important moments that call upon the intimate and collective representations of each person. When death occurs during the perinatal period, bereaved couples may feel the need to refer to the cultural representations they have internalized, and thus re-affiliate themselves with a group to which they belong, likely to accompany them in making sense of what they have experienced. A clinical situation allows us to understand the psychological support of couples from elsewhere who are confronted with perinatal mourning.

Are Mindfulness-Based Interventions as Effective as Cognitive Behavioral Therapy in Reducing Symptoms of Complicated Perinatal Grief? A Systematic Review

INTRODUCTION

Perinatal loss can be a devastating experience for parents that can result in complicated grief symptoms that include depression, anxiety, and posttraumatic stress. Perinatal bereavement care pathways have been developed internationally within health care services; however, there is an apparent lack of recommendations and guidance on grief-focused interventions specifically for complicated perinatal grief. Studies have analyzed the effectiveness of cognitive behavioral therapy (CBT) for perinatal grief, and more recent research has emerged on the use of mindfulness-based interventions (MBIs) for perinatal grief symptoms. The purpose of this study was to conduct a systematic review and present the effectiveness of CBT and MBIs for perinatal grief, to report patient experiences of the interventions, and to determine which intervention can be more effective in managing symptoms of complicated perinatal grief.

METHODS

A systematic search was conducted of 5 academic databases: PsycINFO, CINAHL, MEDLINE, Social Science, and ASSIA. No limits on publication date, language, or geographic location were set because of the paucity of research published on this subject. Quality appraisal was conducted for each included study. Findings are reported in accordance with the PRISMA statement.

RESULTS

This systematic review identified 8 eligible studies with a total of 681 bereaved participants. The results were examined for effectiveness of CBT and MBIs for grief; effectiveness of CBT and MBIs for depression, anxiety, and posttraumatic stress; and participant experiences. Both interventions produced favorable reductions of perinatal grief symptoms, depression, and posttraumatic stress. However, a true comparison between the 2 interventions' effect on complicated perinatal grief symptoms could not be made because of the limited studies in this area and the heterogeneity of the included studies' methods and outcomes.

DISCUSSION

Both MBIs and CBT interventions can be effective in reducing symptoms of complicated perinatal grief. The findings of this review are heavily weighted in quantitative outcome measurements. More qualitative research and randomized controlled trials with larger sample sizes are needed in this area of perinatal bereavement care.

Une journée pour honorer les tout-petits partis trop tôt

La perte d’un tout-petit pendant la grossesse ou autour de la naissance provoque un état de détresse incommensurable. Cette souffrance est accentuée par l’incompréhension de l’entourage, par la solitude et par le silence qui règnent autour de ce drame, par le manque de reconnaissance de ces enfants et, pour les couples, par la difficulté de vivre le statut ambigu de parents sans enfants. Depuis 2013, un collectif associatif organise chaque année la journée “Une fleur, une vie”. Née d’une envie commune de créer un événement artistique et public, cette initiative permet à des centaines de personnes, en France et depuis l’étranger, d’honorer leur tout-petit et d’avancer à leur rythme dans leur deuil.

[Perinatal bereavement and support for siblings]

When the premature death of a baby occurs in a family, brothers and sisters need support. Their silence, their absence of questions or reactions must set off alarm bells. The parents, beyond their own bereavement, have a key role to play in enabling their children to integrate this loss into their lives.

[Supporting families experiencing perinatal bereavement]

Parents hit by perinatal bereavement are often confronted with misunderstanding and awkwardness on the part of those around them. However, they need to talk, to be listened to and respected in their grief from the moment the death is announced. Support from Agapa association enables them to talk about their child, to break the isolation in which they find themselves, and thereby move forward along the path of bereavement and reconstruction.

[The care of stillborn babies and their family]

Practices around the care of stillborn babies have evolved considerably over the last 15 years. Perinatal bereavement care requires a team approach to support the parents experiencing this ordeal. The place of rituals is important as is the personalisation of the care. The humanity which surrounds such moments constitutes the foundation on which the future equilibrium of these bereaved families will be based.

[A pregnancy after perinatal bereavement]

A pregnancy following a perinatal bereavement has a rather particular dimension to it. It requires attentive support and monitoring in order to enable the future baby to take its place within the family. An interview with Marie-José Soubieux, child psychiatrist and psychoanalyst.

[The caregiver faced with perinatal bereavement]

Being a caregiver in perinatal care means working with others' intimate feelings as well as one's own. Issues surrounding life and death coexist in delivery rooms, causing all those involved to consider the meaning of life and origins. When perinatal bereavement becomes part of the idealised picture of birth, the caregiver becomes the buoy to whom the parents hold on in order not to founder.

[The specificities of perinatal bereavement]

Parents can be faced with a situation of bereavement during pregnancy or birth. It is often during a later pregnancy, an ultrasound scan or a subsequent birth, that some will talk about the loss of a child. These situations resulting in bereavement during pregnancy or perinatal bereavement are specific and all perinatal caregivers must be aware of them.

[Perinatal bereavement, legal and social aspects]

Since 2008, upon presentation of a medical certificate attesting to birth, parents are able to request a stillbirth certificate and the registration of their baby in the family record book, and to choose his or her funeral. In addition to the acknowledgement of the memory of this stillborn baby, certain rights are granted, subject to conditions, to the parents, such as maternity and paternity leave, pension entitlements and the birth allowance.

[Palliative care in maternity units]

Over recent years, palliative care in maternity units has developed considerably. This is due to the evolution of legislation, medicine and requests from many parents, faced with a fatal prenatal diagnosis, to continue with the pregnancy and support their baby at birth. In parallel, the neonatal intensive care of extremely premature babies has improved significantly. Different situations can be concerned by the setting up of palliative care in maternity units. This specific support comprises significant challenges.

Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss

OBJECTIVE

To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss.

DESIGN

A qualitative, descriptive design with secondary data analysis.

SETTING

The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States.

PARTICIPANTS

Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review.

METHODS

We used thematic analysis to analyze interview data.

RESULTS

Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death.

CONCLUSION

Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.

Enduring to gain new perspective: a grounded theory study of the experience of perinatal bereavement in Black adolescents

Black adolescents in the US experience perinatal loss at a higher rate than other races and ethnicities. The experience of eight Black urban adolescents through the first 3 months after perinatal loss was studied using grounded theory. The process of "enduring to gain new perspective" began with "denying and hesitating" when surprised by unplanned pregnancy but led to "getting ready for this whole new life," followed by shock of "suffering through the loss," "all that pain for nothing," and "mixed emotions going everywhere." Over time, the adolescents began "reaching out for support" and eventually "preserving the memory and maintaining relationship," "searching for meaning and asking why," and "gaining new perspective on life." Parallels are noted to extant bereavement theory.

Perinatal bereavement: a principle-based concept analysis

AIM

To report an analysis of the concept of perinatal bereavement.

BACKGROUND

The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice-based concept, although it is not well-defined in the scientific literature and is often intermingled with the concepts of mourning and grief.

DESIGN

Concept Analysis.

DATA SOURCES

Using the term 'perinatal bereavement' and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974-2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles.

REVIEW METHODS

The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement.

RESULTS

The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions).

CONCLUSIONS

Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development.

Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis

BACKGROUND

In the United States, an estimated 70 stillbirths occur each day, on average 25,000 each year. Research into the prevalence and causes of stillbirth is ongoing, but meanwhile, many parents suffer this devastating loss, largely in silence, due to persistent stigma and taboo; and many health providers report feeling ill equipped to support grieving parents. Interventions to address bereavement after neonatal death are increasingly common in U.S. hospitals, and there is growing data on the nature of parent bereavement after a stillbirth. However, further research is needed to evaluate supportive interventions and to investigate the parent-clinician encounter during hospitalization following a stillbirth. Qualitative inquiry offers opportunities to better understand the lived experience of parents against the backdrop of clinicians' beliefs, intentions, and well-meaning efforts to support grieving parents.

METHODS

We present a secondary qualitative analysis of transcript data from 3 semi-structured focus groups conducted with parents who had experienced a stillbirth and delivered in a hospital, and 2 focus groups with obstetrician-gynecologists. Participants were drawn from the greater Seattle region in Washington State. We examine parents' and physicians' experiences and beliefs surrounding stillbirth during the clinical encounter using iterative discourse analysis.

RESULTS

Women reported that the cheery, bustling environment of the labor and delivery setting was a painful place for parents who had had a stillbirth, and that the well-meaning attempts of physicians to offer comfort often had the opposite effect. Parents also reported that their grief is deeply felt but not socially recognized. While physicians recognized patients' grief, they did not grasp its depth or duration. Physicians viewed stillbirth as an unexpected clinical tragedy, though several considered stillbirth less traumatic than the death of a neonate. In the months and years following a stillbirth, these parents continue to memorialize their children as part of their family.

CONCLUSIONS

Hospitals need to examine the physical environment for deliveries and, wherever possible, offer designated private areas with staff trained in stillbirth care. Training programs in obstetrics need to better address the bereavement needs of parents following a stillbirth, and research is needed to evaluate effective bereavement interventions, accounting for cultural variation. Critical improvements are also needed for mental health support beyond hospitalization. Finally, medical professionals and parents can play an important role in reversing the stigma that surrounds stillbirth.