Further Reading for Health Professionals - Early Pregnancy Loss

A. Recent articles with Australian content

1. Radford, E. J., & Hughes, M. (2015). Women’s experiences of early miscarriage: implications for nursing care. Journal of Clinical Nursing, 24(11-12), 1457–1465. doi: 10.1111/jocn.12781

Royal Sussex County Hospital, Brighton and Sussex Universities Hospital Trust, Brighton, UK

AIMS AND OBJECTIVES: To investigate women’s experience of early miscarriage (the first 16 weeks of pregnancy) by reviewing the literature since 1990, identifying and exploring critical themes. BACKGROUND: Early miscarriage loss accounts for 50,000 inpatient admissions per year in the UK reported in 2010. It can result in anxiety, depression, guilt, emptiness and other features of bereavement. DESIGN: A structured literature review of qualitative literature was undertaken to explore the evidence of women’s experience of early miscarriage, and elicit common themes emerging. METHODS: A systematic electronic database search was conducted using a range of search engines. Nine papers were identified; four from the UK and one paper each from the USA, Australia, Canada, Israel and Sweden. RESULTS: Four predominant themes were identified from the experiences of 211 women in the nine studies: ‘What I feel’, ‘Care for me and communicate with me’, ‘Me, my baby and others’ and ‘Help me to cope with the future’. CONCLUSIONS: Early miscarriage is a potentially devastating experience, and the diversity of experiences of women must be reflected in the provision of appropriate and sensitive nursing care. RELEVANCE TO CLINICAL PRACTICE: The study demonstrated a significant training need for nurses and midwives to provide women with individualised care.

2. Lee, C., & Rowlands, I. J. (2015). When mixed methods produce mixed results: integrating disparate findings about miscarriage and women’s wellbeing. British Journal of Health Psychology, 20(1), 36–44. doi: 10.1111/bjhp.12121

School of Psychology, University of Queensland, St Lucia, Queensland, Australia

PURPOSE:

To discuss an example of mixed methods in health psychology, involving separate quantitative and qualitative studies of women’s mental health in relation to miscarriage, in which the two methods produced different but complementary results, and to consider ways in which the findings can be integrated.

METHODS:

We describe two quantitative projects involving statistical analysis of data from 998 young women who had had miscarriages, and 8,083 who had not, across three waves of the Australian Longitudinal Study on Women’s Health. We also describe a qualitative project involving thematic analysis of interviews with nine Australian women who had had miscarriages.

RESULTS:

The quantitative analyses indicate that the main differences between young women who do and do not experience miscarriage relate to social disadvantage (and thus likelihood of relatively early pregnancy) and to a lifestyle that makes pregnancy likely: Once these factors are accounted for, there are no differences in mental health. Further, longitudinal modelling demonstrates that women who have had miscarriages show a gradual increase in mental health over time, with the exception of women with prior diagnoses of anxiety, depression, or both. By contrast, qualitative analysis of the interviews indicates that women who have had miscarriages experience deep emotional responses and a long and difficult process of coming to terms with their loss.

CONCLUSIONS:

A contextual model of resilience provides a possible framework for understanding these apparently disparate results. Considering positive mental health as including the ability to deal constructively with negative life events, and consequent emotional distress, offers a model that distinguishes between poor mental health and the processes of coping with major life events. In the context of miscarriage, women’s efforts to struggle with difficult emotions, and search for meaning, can be viewed as pathways to resilience rather than to psychological distress. Statement of contribution What is already known on this subject? Quantitative research shows that women who miscarry usually experience moderate depression and anxiety, which persists for around 6 months. Qualitative research shows that women who miscarry frequently experience deep grief, which can last for years. What does this study add? We consider ways in which these disparate findings might triangulate. The results suggest a need to distinguish between poor mental health and the experience of loss and grief. Adjusting to miscarriage is often emotionally challenging but not always associated with poor mental health.

3. St John, A., Cooke, M., & Goopy, S. (2006). Shrouds of silence: three women’s stories of prenatal loss. The Australian Journal of Advanced Nursing, 23(3), 8–12.

Sunnybank Hospital, Brisbane, Queensland, Australia

OBJECTIVE:

To give voice to the experiences of women who have suffered a prenatal loss prior to a full term pregnancy.

DESIGN:

A descriptive, exploratory qualitative study using mini-biographies was used. In-depth interviews were conducted with women to record their experiences and stories. Interviews were transcribed and the patterns that emerged from the data were identified and themes generated.

SUBJECTS:

The mini-biographical stories of three women were gathered. Interviews occurred in the women’s homes. The women were recruited through an advertisement in the Stillbirth and Neonatal Death Support (SANDS) newsletter.

RESULTS:

The stories revealed the tragedy, pain and silence endured by these women, as they live with loss and grief. Common themes emerged from their stories highlighting grief, isolation, anger and self-blame in the face of their loss and subsequent full term pregnancy.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:

The emergent theme suggests that further research needs to explore how society and the health care community may compound women’s grief and isolation and in-turn perpetuate their feelings of anger. In telling their stories, these women give voice to their current health care practices may be modified to better support the needs of women who have suffered a prenatal loss and also points to the need for further research. Specifically, the study identifies a need for nurses and midwives to offer sensitive care, acknowledgment of previous loss and supportive counseling strategies for women following prenatal loss and during antenatal care for subsequent pregnancies.

4. Conway, K., & Russell, G. (2000). Couples’ grief and experience of support in the aftermath of miscarriage. The British Journal of Medical Psychology, 73 Pt 4, 531–545.

Department of Psychology, Macquarie University, NSW, Australia

The aim of this prospective study involving 39 women and 32 partners was to investigate the grief response of both the woman and her partner to miscarriage and to ascertain if support received was adequate and appropriate to their needs. Previous research shows that partners’ grief can often be delayed and chronic. Special emphasis is placed on this area in this study. The miscarriage was found to be a significant event and the majority of women and partners still experienced feelings of loss up to 4 months afterwards, describing their reactions as sad or very sad. Scores on the first administration of the Perinatal Grief Scale showed that, in contrast with previous findings, partners scored significantly higher than the women on the three subscales and overall. Partners’ scores on the second administration were also higher than those for the women but the difference was not significant. The women tended to receive and welcome social support more than the partners. Support received from health professionals was not always optimal, particularly for partners. Pregnancy subsequent to miscarriage was often viewed with some anxiety. It is argued that the results of the study have important implications for health practice.

B. Search strategy to retrieve references to journal articles on early pregnancy loss bereavement

Click on the link for a search of:

• the US National Library of Medicine’s database: Pubmed. http://goo.gl/Qy5kF8

google scholar https://goo.gl/BLyjUQ


Last reviewed: 9/8/20