The Disenfranchisement of Perinatal Grief: How Silence, Silencing and Self-Censorship Complicate Bereavement (a Mixed Methods Study)

Based on an ethnographic and mixed-methods research design, the article explores the social and interactive processes of disenfranchisement of perinatal grief through the mechanisms of silence, silencing and self-censorship in encounters between bereaved women and the social milieu. The analysis finds that disenfranchisement results from the constriction of the social space of bereavement along various lines of discourse, cultural values, practice and materiality, that include: the passing of time (expectations of a quick ‘recovery’); competing discourses of loss (simplistic-dominant vs. complex-subordinate meaning-making); the biometrics of pregnancy (lower gestational age being equated with less intense grief); gendered ideas of reproduction and feeling rules; asymmetries in social power; social spheres (hospital, home, community, support groups); socio-materialities and performance/ritual; and structural aspects of social and familial organization (gender, age, intergenerational and kin v. non-kin relations). These processes are intimately linked to the complication of grief by undermining support, meaning-making and continuing bonds.

Conflicts Between Women's Religiosity and Sense of Free Will in the Context of Elective Abortion: A Qualitative Study in the Worst Period of Italy's COVID-19 Crisis

This qualitative study considers the relationship between abortion, bereavement, and the effects of the COVID-19 lockdown nine women who had undergone an elective abortion, which is voluntarily termination of a pregnancy at the woman's request. These women were interviewed in three time points (1 month, 6 months, and 1 year after the event) to consider the possible evolution of their experience. The third phase was concurrent with the COVID-19 pandemic and particularly with Pope Francis's Easter declaration against abortion. All the interviews were conducted and analysed through qualitative research in psychology. Results showed that the abortion experience led to physical, relational, and psychological suffering, similar to perinatal grief. Participants were non-practising Catholics and religiosity did not help them to overcome their sorrow. Though religiosity is a possible resilience factor in other stressful conditions, in this case it is a factor that aggravated suffering. Finally, we discuss the difficulties experienced by Catholic women who choose to have an abortion and assert the necessity of psychological and spiritual interventions to support these women.

Workplace experience of parents coping with perinatal loss: A scoping review

BACKGROUND: Perinatal loss affects many parents in the workforce. Yet, current knowledge about their workplace experience while facing this difficult event is sparse. OBJECTIVES: The goal of this study was to review and synthesize the extent of scientific literature on the specific experiences of workers coping with perinatal loss and the resulting bereavement. METHODS: A scoping review was carried out using eight different databases. A total of 15 references, all using a qualitative methodology, were identified. Most of the references focused on the experience of mothers and on late perinatal loss (from the 20th week of pregnancy). RESULTS: All references highlighted the taboo and the non-recognition of perinatal grief and bereavement in both organizational practices and interpersonal relationships with colleagues and immediate supervisors. They also emphasized the difficulties associated with returning to work after the loss and the significant changes in the meaning attributed to work. CONCLUSIONS: While the studies included in this review clearly indicate that perinatal loss can affect working life, larger, quantitative studies are needed to quantify this phenomenon and its impact on employees and their organizations.

Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review

Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions.

Los estilos de afrontamiento como predictores del duelo perinatal

La pérdida perinatal, genera problemas psicopatológicos en algunas mujeres. Para elaborar el duelo se activan recursos psicológicos, tales como los estilos de afrontamiento. El objetivo del estudio fue determinar la relación entre el tipo de afrontamiento y la intensidad del duelo, y conocer los estilos de afrontamiento que resultaron predictores confiables para la intensidad del duelo perinatal. Se realizó un estudio no experimental, transversal, correlacional con 100 mujeres mexicanas que tuvieron pérdida perinatal; se aplicó la Perinatal Grief Scale traducida al español y la Escala de Estilos de Afrontamiento de Lazarus y Folkman. Resultaron predictores confiables de la intensidad del duelo: la edad gestacional del bebé, el tiempo transcurrido desde la pérdida y los estilos de afrontamiento confrontativo, escape-evitación y resolución de problemas. Se concluye que los estilos de afrontamiento impactan en la intensidad del duelo, de ahí la importancia de centrar la intervención psicológica en ellos.

Stillbirth and infant death: mental health among low-income mothers in Mumbai

Background India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women’s mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae. Methods We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention. Conclusions Understanding factors contributing to women’s suffering related to reproductive challenges in this pronatalist context is critically important for women’s wellbeing.

Psychological Reactions in Women with Pregnancy Termination Due to Fetal Anomaly

OBJECTIVE: We aimed to determine and compare grief, depression, and post-traumatic stress scores in women who underwent termination of pregnancy due to fetal anomaly in the first vs. second-trimester of pregnancy. STUDY DESIGN: Forty-three women who underwent termination of pregnancy for fetal anomaly were subdivided into two categories in this prospective-cohort study: First-trimester group, which was defined as termination of pregnancy performed <14 weeks of gestation, and Second-trimester termination of pregnancy who underwent termination of pregnancy between 20 and 28 weeks of pregnancy. Eight weeks after the termination of pregnancy, the Beck Depression Inventory, Perinatal Grief Scale-short version, and Impact of Event Scale-Revised were performed with face-to-face interviews. RESULTS: Twenty-four women in the first-trimester group and 19 women in the second-trimester group were enrolled. The mean Beck Depression Inventory score was 7.3±4.2 in the first-trimester group and 11.1±4.6 in the second-trimester group (p=0.033). The mean Perinatal Grief Scale-short scores were 86.3±17.2 and 101.4±29.2 in the first and second-trimester groups, respectively (p=0.014). Impact of Event Scale-Revised scores of the first trimester and second-trimester groups were 22.5±8.6 and 35.3±17.1, respectively (p=0.022). Depression was detected in 29.1% of women in the first-trimester group and 57.8% in the second-trimester group (p=0.023). Perinatal grief was significantly higher in the second-trimester group (45.8% vs. 84.2% p<0.01). Post-traumatic stress was significantly higher in the second-trimester group (41.6% vs. 73.6%, p=0.031). CONCLUSION: Our study indicates that termination of pregnancy for fetal anomaly causes severe psychiatric problems in most women. Depression, grief, and post-traumatic stress are more prominent in women who underwent termination of pregnancy in the second trimester of pregnancy than in the first trimester.

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.