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1.
N Engl J Med ; 386(9): 811-813, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35213104
3.
J Clin Nurs ; 31(7-8): 860-868, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34227190

RESUMO

AIM: To explore parents' perspective on hospital's care and management of the remains of stillborn babies. BACKGROUND: Each year, 2.6 million of pregnancies end as stillbirth. Recent literature began to understand parents' traumatic experience in stillbirth and its profound impact on parents' mental health and psychosocial effect. But there is limited understanding on the actual care and management of the stillborn baby, nor is there an agreement on how hospitals should care for the stillborn baby to mitigate parents' profound loss. DESIGN: A descriptive phenomenological approach was applied to conduct this study. METHODS: A purposive sample of twenty couples (40 individuals) who had encountered how to care for the remains of their stillborn babies participated in the study. The data were collected through in-depth interviews, which involved semi-structured and open-ended questions. The phenomenological methods of Giorgi were applied to analyse the data. The COREQ checklist was used preparing the manuscript. RESULTS: Parents felt unprepared and lack of support when they had to handle their stillborn babies' remains. The research results revealed two major themes: (1) Handling stillborn babies remain ignorantly; (2) Pacifying the disturbed soul on both sides. CONCLUSIONS: It was found in the study that reflection and identification were the emerging themes, which can enable healthcare professionals to understand parents' concerns in a meaningful way, as they deal with the remains of stillborn babies. Moreover, it is hoped that hospital administration and health care personnel should consider stillborn parents' concerns and incorporate their needs into nursing assessment and treatment practices. RELEVANCE TO CLINICAL PRACTICE: Given stillbirth's profound implication for parents' identity and psychosocial role, hospitals need to be more sensitive and proactive to parents' cultural and religious needs when they care for stillborn baby and handle its body.


Assuntos
Pais , Natimorto , Emoções , Feminino , Pessoal de Saúde , Esperança , Humanos , Lactente , Pais/psicologia , Gravidez , Natimorto/psicologia
4.
BMC Pregnancy Childbirth ; 21(1): 818, 2021 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-34886815

RESUMO

BACKGROUND: The grief associated with the death of a baby is enduring, however most women embark on another pregnancy, many in less than a year following their loss. Symptoms of anxiety and depression are reported to be increased in pregnancies after perinatal death, although effect on maternal stress is less clear. Variation between individual studies may result from differences in gestation at sampling, the questionnaire used and the type of antecedent perinatal death. We aimed to describe quantitative measures of anxiety, depression, stress and quality of life at different timepoints in pregnancies after perinatal death and in the early postnatal period. METHODS: Women recruited from three sites in the North-West of England. Women were asked to participate if a previous pregnancy had ended in a perinatal death. Participants completed validated measures of psychological state (Cambridge Worry Score, Edinburgh Postnatal Depression Score (EPDS), Generalized Anxiety Disorder 7-item score) and health status (EQ-5D-5L™ and EQ5D-Visual Analogue Scale) at three time points, approximately 15 weeks' and 32 weeks' gestation and 6 weeks postnatally. A sample of hair was taken at approximately 36 weeks' gestation for measurement of hair cortisol in a subgroup of women. The hair sample was divided into samples from each trimester and cortisol measured by ELISA. RESULTS: In total 112 women participated in the study. Measures of anxiety and depressive symptoms decreased from the highest levels at 15 weeks' gestation to 6-weeks postnatal (for example mean GAD-7: 15 weeks 8.2 ± 5.5, 6 weeks postnatal 4.4 ± 5.0, p<0.001). Hair cortisol levels fell in a similar profile to anxiety and depression symptoms (p<0.05). In contrast, the median EQ-5D index, measuring health status was 0.768 at 15 weeks' gestation (Interquartile range (IQR) 0.684-0.879), 0.696 at 32 weeks' (IQR 0.637-0.768) and 0.89 (0.760-1.00) at 6 weeks postnatal. There was a negative relationship between EPDS and perceived health status. CONCLUSIONS: This study demonstrated heightened anxiety and depressive symptoms and elevated cortisol levels in women in pregnancies after a stillbirth or neonatal death which decrease as pregnancy progresses. Further studies are needed to determine optimal care for women to address these negative psychological consequences.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Morte Perinatal , Gestantes/psicologia , Qualidade de Vida , Natimorto/psicologia , Estresse Psicológico , Adulto , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Análise do Cabelo , Humanos , Hidrocortisona/análise , Pessoa de Meia-Idade , Gravidez , Trimestres da Gravidez , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
5.
BMC Pregnancy Childbirth ; 21(1): 840, 2021 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-34937548

RESUMO

BACKGROUND: The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic. METHODS: In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents' access to services, care, and networks of support, during the pandemic after their bereavement. RESULTS: All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents' experiences were notably affected by service reconfigurations. CONCLUSIONS: Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.


Assuntos
Aborto Espontâneo/psicologia , Luto , COVID-19/psicologia , Pesar , Pais/psicologia , Morte Perinatal , Natimorto/psicologia , Continuidade da Assistência ao Paciente/normas , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Recém-Nascido , Masculino , Gravidez , Dados Preliminares , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Quarentena/psicologia , SARS-CoV-2 , Reino Unido/epidemiologia
6.
BMC Pregnancy Childbirth ; 21(1): 830, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906118

RESUMO

OBJECTIVE: To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. DESIGN: Qualitative, interpretative. SETTING: Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. SAMPLE: Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. METHODS: Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. RESULTS: Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. CONCLUSIONS: As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths.


Assuntos
Mães/psicologia , Natimorto/psicologia , Relações Familiares/etnologia , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Nigéria/etnologia , Gravidez , Pesquisa Qualitativa , Valores Sociais/etnologia , Vulnerabilidade Social
7.
BMC Pregnancy Childbirth ; 21(1): 782, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794395

RESUMO

BACKGROUND: This systematic review aimed to provide an updated summary of studies investigating depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) in parents after stillbirth (from 20 weeks gestational age until birth). METHODS: A literature search was conducted in the databases Web of Science and PsychINFO. Main inclusion criteria were 1) peer-reviewed, quantitative, English-language articles published from 1980; (2) studies investigating depression, anxiety, PTSD, or OCD among parents following stillbirth; and (3) studies defining stillbirth as equal to or after 20 weeks of gestation. RESULTS: Thirteen quantitative, peer-reviewed articles were eligible for inclusion. Selected articles investigated depression, anxiety, and PTSD, while no studies on OCD met our inclusion criteria. The majority of studies investigated women, while only two studies included men. The results indicated heightened short- and long-term levels of depression, anxiety, and PTSD in parents after stillbirth compared to those of parents with live birth. Studies investigating predictors found that social support, marital status, negative appraisals, and variables related to care and management after stillbirth affected levels of symptoms. CONCLUSIONS: Parents who experience stillbirth have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births. More longitudinal studies are needed to increase our knowledge of how symptoms develop over time, and more research on fathers, transgender, non-binary and gender fluid individuals is needed. Research on the association between stillbirth and OCD is also warranted. Knowledge of the severity of anxiety, depression, and PTSD after stillbirth, and predictors associated with symptom severity could provide healthcare professionals with valuable information on how to provide beneficial postpartum care.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Pais/psicologia , Natimorto/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Feminino , Humanos , Masculino , Gravidez
9.
BMC Pregnancy Childbirth ; 21(1): 443, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172018

RESUMO

BACKGROUND: Stillbirth is an extremely traumatic and distressing experience for parents, with profound and long-lasting negative impacts. Cultural beliefs and practices surrounding death vary considerably across different contexts and groups, and are a key influence on individual experiences, impacting grief, adjustment, and support needs. Few studies have explored cultural influences surrounding stillbirth in an African context. This study explored the influence of cultural beliefs and practices on the experiences of bereaved parents and health workers after stillbirth in urban and rural settings in Kenya and Uganda. METHODS: A qualitative descriptive study design was employed. Face to face interviews were conducted with parents (N = 134) who experienced a stillbirth (≤ 1 year) and health workers (N = 61) at five facilities in Uganda and Kenya. Interviews were conducted in English or the participants' local language, audio-recorded and transcribed verbatim. Analysis was conducted using descriptive thematic analysis. RESULTS: Commonalities in cultural beliefs and practices existed across the two countries. Three main themes were identified: 1) Gathering round, describes the collective support parents received from family and friends after stillbirth. 2)'It is against our custom' addresses cultural constraints and prohibitions impacting parents' behaviour and coping in the immediate aftermath of the baby's death. 3) 'Maybe it's God's plan or witchcraft' summarises spiritual, supernatural, and social beliefs surrounding the causes of stillbirth. CONCLUSIONS: Kinship and social support helped parents to cope with the loss and grief. However, other practices and beliefs surrounding stillbirth were sometimes a source of stress, fear, stigma and anxiety especially to the women. Conforming to cultural practices meant that parents were prevented from: holding and seeing their baby, openly discussing the death, memory-making and attending the burial. The conflict between addressing their own needs and complying with community norms hindered parents' grief and adjustment. There is an urgent need to develop culturally sensitive community programmes geared towards demystifying stillbirths and providing an avenue for parents to grieve in their own way.


Assuntos
Luto , Cultura , Pais/psicologia , Natimorto/psicologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Quênia , Masculino , Gravidez , Pesquisa Qualitativa , População Rural , Estigma Social , Apoio Social , Uganda , População Urbana
10.
Sci Rep ; 11(1): 10818, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031497

RESUMO

Maternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11-0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.


Assuntos
Monitorização Fetal/métodos , Movimento Fetal , Relações Materno-Fetais/psicologia , Educação Pré-Natal/métodos , Natimorto/epidemiologia , Feminino , Monitorização Fetal/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Japão/epidemiologia , Análise Multivariada , Percepção , Gravidez , Estudos Prospectivos , Natimorto/psicologia
11.
BMC Pregnancy Childbirth ; 21(1): 394, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016084

RESUMO

BACKGROUND: Stillbirth is a global public health priority. Within the United Kingdom, perinatal mortality disproportionately impacts Black, Asian and minority ethnic women, and in particular migrant women. Although the explanation for this remains unclear, it is thought to be multidimensional. Improving perinatal mortality is reliant upon raising awareness of stillbirth and its associated risk factors, as well as improving maternity services. The aim of this study was to explore migrant women's awareness of health messages to reduce stillbirth risk, and how key public health messages can be made more accessible. METHOD: Two semi-structured focus groups and 13 one to one interviews were completed with a purposive sample of 30 migrant women from 18 countries and across 4 NHS Trusts. RESULTS: Participants provided an account of their general awareness of stillbirth and recollection of the advice they had been given to reduce the risk of stillbirth both before and during pregnancy. They also suggested approaches to how key messages might be more effectively communicated to migrant women. CONCLUSIONS: Our study highlights the complexity of discussing stillbirth during pregnancy. The women in this study were found to receive a wide range of advice from family and friends as well as health professionals about how to keep their baby safe in pregnancy, they recommended the development of a range of resources to provide clear and consistent messages. Health professionals, in particular midwives who have developed a trusting relationship with the women will be key to ensuring that public health messages relating to stillbirth reduction are accessible to culturally and linguistically diverse communities.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Natimorto/psicologia , Migrantes/psicologia , Adulto , Feminino , Grupos Focais , Promoção da Saúde/métodos , Humanos , Percepção , Gravidez , Saúde Pública , Pesquisa Qualitativa , Fatores de Risco , Apoio Social , Reino Unido , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 21(1): 292, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838663

RESUMO

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.


Assuntos
Depressão Pós-Parto/epidemiologia , Pesar , Morte do Lactente , Mães/psicologia , Natimorto/psicologia , Adolescente , Adulto , Estudos Transversais , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/prevenção & controle , Depressão Pós-Parto/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/organização & administração , Pobreza , Gravidez , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Pesquisa Qualitativa , Normas Sociais , Natimorto/epidemiologia , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 21(1): 29, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413199

RESUMO

BACKGROUND: Historically, men's experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men's perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. METHODS: Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men's grief intensity and style. RESULTS: Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men's total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of 'supporter' conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men's grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. CONCLUSIONS: Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.


Assuntos
Aborto Espontâneo/psicologia , Pesar , Homens/psicologia , Morte Perinatal , Aborto Induzido/psicologia , Adolescente , Adulto , Austrália , Família , Pai/psicologia , Feminino , Feto , Amigos , Papel de Gênero , Pessoal de Saúde , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Masculinidade , Pessoa de Meia-Idade , Apego ao Objeto , Gravidez , Apoio Social , Natimorto/psicologia , Adulto Jovem
14.
Reprod Health ; 18(1): 5, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407643

RESUMO

BACKGROUND: For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. Validating the grief of these losses has been a challenge to Brazilian society, which is evident considering the childbirth care offered to bereaved families in maternity wards. Positively assessed care that brings physical and emotional memories about the baby has a positive impact on the bereavement process that family undergoes. Therefore, this study aims to assess the effects supportive guidelines have on mental health. They were designed to assist grieving parents and their families while undergoing perinatal loss in public maternities in Ribeirão Preto, São Paulo state, Brazil. METHOD: A mixed-methods (qualitative/quantitative), quasi-experimental (before/after) study. The intervention is the implementation of bereavement supportive guidelines for women who experienced a stillbirth or a neonatal death. A total of forty women will be included. Twenty participants will be assessed before and twenty will be assessed after the implementation of the guidelines. A semi-structured questionnaire and three scales will be used to assess the effects of the guidelines. Health care professionals and managers of all childbirth facilities will be invited to participate in focus group. Data will be analyzed using statistical tests, as well as thematic analysis approach. DISCUSSION: The Perinatal Bereavement guidelines are a local adaptation of the Canadian and British corresponding guidelines. These guidelines have been developed based on the families' needs of baby memories during the bereavement process and include the following aspects: (1) Organization of care into periods, considering their respective needs along the process; (2) Creation of the Bereavement Professional figure in maternity wards; (3) Adequacy of the institutional environment; (4) Communication of the guidance; (5) Creation of baby memories. We expect that the current project generates additional evidence for improving the mental health of women and families that experience a perinatal loss. Trial registration RBR-3cpthr For many couples, getting pregnant does not only mean carrying a baby, but also having a child. Most of the time, the couple has already made many plans and has expectations towards the child. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. In Brazilian culture, validating this traumatic grief is very difficult, especially when it happens too soon. The barriers can be noticed not only by the way society deals with the parents' grief, but also when we see the care the grieving families receive from the health care establishment. Creating physical and emotional memories might bring the parents satisfaction regarding the care they receive when a baby dies. These memories can be built when there is good communication throughout the care received; shared decisions; the chance to see and hold the baby, as well as collect memories; privacy and continuous care during the whole process, including when there is a new pregnancy, childbirth and postnatal period. With this in mind, among the most important factors are the training of health staff and other professionals, the preparation of the maternity ward to support bereaved families and the continuous support to the professionals involved in the bereavement. This article proposes guidelines to support the families who are experiencing stillbirth and neonatal death. It may be followed by childbirth professionals (nurses, midwives, obstetricians and employees of a maternity ward), managers, researchers, policymakers or those interested in developing specific protocols for their maternity wards.


RESUMO: CONTEXTO: Uma assistência avaliada positivamente por mães e pais que passaram pela perda perinatal permite a criação de memórias físicas e afetivas do bebê e possuem efeitos positivos no processo de luto da família. Este estudo avaliará os efeitos de uma diretriz de acolhimento na saúde mental de mulheres em processo de luto perinatal e neonatal em maternidades públicas do município de Ribeirão Preto (SP, Brasil). MéTODO: Estudo de métodos mistos (quantitativo e qualitativo), quase-experimental (antes e depois). A intervenção é a implementação de diretrizes de acolhimento ao luto de mulheres que tiveram um natimorto ou óbito neonatal. Um total de quarenta mulheres serão incluídas. Vinte participantes serão avaliadas antes, e vinte após a implementação da diretriz de acolhimento nas instituições. Serão aplicadas três escalas e uma entrevista semiestruturada para avaliar os efeitos da diretriz. Profissionais da saúde e gestores serão convidados a participar de grupos focais. Os dados serão analisados por meio de testes estatísticos, e sob a metodologia de análise temática. A diretriz de acolhimento contará com material baseado em diretrizes canadense e britânica. DISCUSSãO: As diretrizes brasileiras de luto perinatal propostas são uma adaptação local das diretrizes canadense e britânica. Baseamo-nos na necessidade da família por memórias físicas e afetivas da criança morta para facilitar a vivência do processo do luto. Elas incluem os seguintes aspectos: (1) organização dos períodos da assistência a partir de suas respectivas necessidades, (2) criação do papel do Profissional do Luto, (3) ambientação das instituições, (4) disseminação das diretrizes e (5) criação de memórias do bebê. Espera-se que o projeto gere evidências adicionais para melhorar a saúde mental de mulheres e famílias que vivenciam uma perda perinatal. Registro do estudo: RBR-3cpthr.


Assuntos
Luto , Pais/psicologia , Assistência Perinatal/normas , Morte Perinatal , Cuidado Pós-Natal/métodos , Guias de Prática Clínica como Assunto , Natimorto/psicologia , Brasil , Criança , Feminino , Pesar , Humanos , Recém-Nascido , Assistência Perinatal/métodos , Gravidez , Relações Profissional-Paciente , Apoio Social
15.
PLoS One ; 16(1): e0240270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503017

RESUMO

BACKGROUND: Grief following stillbirth and child death are one of the most traumatic experience for parents with psychosomatic, social and economic impacts. The grief profile, severity and its impacts in Indian context are not well documented. This study documented the grief and coping experiences of the Indian parents following stillbirth and child death. METHODS: This exploratory qualitative study in Delhi (India) included in-depth interviews with parents (50 mothers and 49 fathers), who had stillbirth or child death, their family members (n = 41) and community representatives (n = 12). Eight focus group discussions were done with community members (n = 72). Inductive data analysis included thematic content analysis. Perinatal Grief Scale was used to document the mother's grief severity after 6-9 months of loss. RESULTS: The four themes emerged were grief anticipation and expression, impact of the bereavement, coping mechanism, and sociocultural norms and practices. The parents suffered from disbelief, severe pain and helplessness. Mothers expressed severe grief openly and some fainted. Fathers also had severe grief, but didn't express openly. Some parents shared self-guilt and blamed the hospital/healthcare providers, themselves or family. Majority had no/positive change in couple relationship, but few faced marital disharmony. Majority experienced sleep, eating and psychological disturbances for several weeks. Mothers coped through engaging in household work, caring other child(ren) and spiritual activities. Fathers coped through avoiding discussion and work and professional engagement. Fathers resumed work after 5-20 days and mothers took 2-6 weeks to resume household chores. Unanticipated loss, limited family support and financial strain affected the severity and duration of grief. 57.5% of all mothers and 80% mothers with stillbirth had severe grief after 6-9 months. CONCLUSIONS: Stillbirth and child death have lasting psychosomatic, social and economic impacts on parents, which are usually ignored. Sociocultural and religion appropriate bereavement support for the parents are needed to reduce the impacts.


Assuntos
Pai/psicologia , Pesar , Mães/psicologia , Natimorto/psicologia , Adulto , Criança , Mortalidade da Criança , Feminino , Humanos , Índia/epidemiologia , Masculino , Fatores Socioeconômicos
16.
BMC Pregnancy Childbirth ; 21(1): 58, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446124

RESUMO

BACKGROUND: Bereavement from a twin pregnancy can result in complex emotions as parents are often caring for a surviving sibling while mourning the loss of their infant. Health professionals have reported feeling ill-equipped to deal with the specific needs of parents in this situation. Our aim was to ascertain the current knowledge, training needs and self-rated confidence of health professionals in providing support to parents who have experienced a loss from a twin pregnancy. METHODS: We used an online survey, sent by email via professional organisations and clinical networks, to neonatal and fetal medicine doctors, neonatal nurses, and midwives. Respondents provided anonymous responses to questions on their experience of training and knowledge of existing guidelines, confidence in supporting parents and current practice in their hospital neonatal unit. RESULTS: We received 293 responses. Less than half (47.3%) of respondents had received training for supporting parents and 62% felt more training and further guidelines were required. Less than a third of respondents reported having no or some confidence when providing emotional support to parents. CONCLUSIONS: Current training and guidelines in the UK to support health professionals caring for parents who have experienced a loss from a twin pregnancy are inadequate. Guidelines for healthcare professionals who support parents experiencing the loss of a baby from a twin pregnancy are needed.


Assuntos
Luto , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Pais/psicologia , Gravidez de Gêmeos/psicologia , Natimorto/psicologia , Adulto , Feminino , Pesar , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Reino Unido
17.
Psychol Trauma ; 13(2): 157-164, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32881569

RESUMO

OBJECTIVE: Pregnancy loss is thought to impact women's perceptions of the world around them. Despite the growing recognition that this loss can have a differential impact on an individual's mental health, research focused on women's positive psychological change and factors contributing to it following pregnancy loss is scarce. This study explored relationships among core belief challenge, rumination, and women's experience of posttraumatic growth following miscarriage or stillbirth. Specifically, this study investigated whether deliberate rumination mediated the relationship between core belief challenge and posttraumatic growth. METHOD: Women who had experienced miscarriage or stillbirth (n = 476) were recruited via social media and completed an online survey that assessed core belief challenge, event-related rumination, and posttraumatic growth. Loss context factors and demographics were also collected. Hypotheses were tested via hierarchical multiple regression and the PROCESS macro. RESULTS: Change in beliefs about the world and rumination predicted posttraumatic growth. Moreover, deliberate, but not intrusive, rumination mediated the relationship between core belief challenge and posttraumatic growth. CONCLUSION: Findings suggest that core belief challenge and rumination play a significant role in positive posttrauma outcomes related to pregnancy loss. This study contributes to the literature by validating the applicability of posttraumatic growth theory to women who have experienced pregnancy loss. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Aborto Espontâneo/psicologia , Crescimento Psicológico Pós-Traumático , Trauma Psicológico/psicologia , Ruminação Cognitiva/fisiologia , Natimorto/psicologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
18.
BJOG ; 128(4): 704-713, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32992405

RESUMO

OBJECTIVE: To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. DESIGN: Case-control study. SETTING: 41 maternity units in the UK. POPULATION: Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). METHODS: Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. MAIN OUTCOME MEASURE: Late stillbirth. RESULTS: Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42). CONCLUSIONS: This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. TWEETABLE ABSTRACT: Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.


Assuntos
Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Violência Doméstica , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Natimorto/economia , Natimorto/psicologia , Estresse Psicológico/complicações , Adulto Jovem
19.
BJOG ; 128(1): 101-109, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32659031

RESUMO

OBJECTIVE: To explore parents' lived experiences of care and support following stillbirth in urban and rural health facilities. DESIGN: Qualitative, interpretative, guided by Heideggerian phenomenology. SETTING: Nairobi and Western Kenya, Kampala and Central Uganda. SAMPLE: A purposive sample of 75 women and 59 men who had experienced the stillbirth of their baby (≤1 year previously) and received care in the included facilities. METHODS: In-depth interviews, analysed using Van Manen's reflexive approach. RESULTS: Three main themes were identified; parents described devastating impacts and profound responses to their baby's death. Interactions with health workers were a key influence, but poor communication, environmental barriers and unsupportive facility policies/practices meant that needs were often unmet. After discharge, women and partners sought support in communities to help them cope with the death of their baby but frequently encountered stigma engendering feelings of blame and increasing isolation. CONCLUSIONS: Parents in Kenya and Uganda were not always treated with compassion and lacked the care or support they needed after the death of their baby. Health workers in Kenya and Uganda, in common with other settings, have a key role in supporting bereaved parents. There is an urgent need for context and culturally appropriate interventions to improve communication, health system and community support for African parents. TWEETABLE ABSTRACT: Health-system response and community support for parents after stillbirth in Kenya and Uganda are inadequate.


Assuntos
Adaptação Psicológica , Pais , Cuidado Pré-Natal , Apoio Social , Natimorto/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Quênia , Pessoa de Meia-Idade , Gravidez , População Rural , Uganda , População Urbana , Adulto Jovem
20.
Midwifery ; 93: 102884, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33246144

RESUMO

BACKGROUND: The 2011 and 2016 Stillbirth Lancet series made a call to action to identify mechanisms to reduce stillbirth stigma. This research answers that call, investigating the extent and dimensions of stillbirth stigma experienced by an international sample of mothers bereaved by stillbirth. OBJECTIVE: To determine the prevalence and type as well as explore explanatory variables associated with higher levels of stillbirth stigma with bereaved mothers in high-income countries (Australia, United Kingdom, The United States of America and New Zealand). METHOD: An international survey of 889 bereaved mothers was conducted utilising the recently developed Stillbirth Stigma Scale to explore the extent and types of stigma experienced, as well as the association between stigma and self-esteem (Rosenberg Self- Esteem Scales), perinatal grief (Perinatal Grief Scale), and perceived social support (Perceived Social Support Scale). Demographic information (e.g. age, education, stillbirth history, sexual orientation and mental health) were collected to determine the association between individual demographic factors and stillbirth stigma. RESULTS: Results of the Stillbirth Stigma Scale indicated that a majority (54%) of bereaved mothers experienced stigma. Self-stigma was the predominant type of stigma experienced (80%), followed by perceived devaluation (64.9%). Bereaved mothers also experienced discrimination (29.1%) and issues with disclosing their stillbirth to their community (36.7%). Stillbirth stigma scores were higher in bereaved mothers who had experienced the loss of their first child. High scores were associated with the mother's mental health status (diagnoses prior to stillbirth, and/or after stillbirth (p<.05)).The other scales used indicated that higher stillbirth stigma scores were also associated with lower self-esteem (r (877) =-.304, p<.001), lower perceived social support (r (871) =-.448, p<.001) and higher levels of grief (r (829) =.609, p<.001). CONCLUSION: The current research was the first to identify that 54% of bereaved mothers experienced stigma, with self-stigma being the most prominent. Bereaved mothers endured discriminating experiences and had trouble disclosing their stillbirth to others within their community. The first-time mother with a self- reported history of mental illnesses appears to be the most at-risk of higher levels of stigma. Future longitudinal research needs to be conducted to determine the direction of the explanatory variables i.e. mental health, self-esteem and social support and develop interventions, which support the bereaved mother and reduce stillbirth stigma. RELEVANCE: This study is the first to demonstrate the prevalence, extent, type and explanatory variables of stigma reported by bereaved mothers and the association between this and poorer outcomes including increased grief and decreased self-esteem. This study begins a dialogue about prevalence and explanatory variables of stillbirth stigma and its impact, to inform future prevention and support potential stigma reduction programs for community and bereaved mothers.


Assuntos
Mães/psicologia , Estigma Social , Natimorto/psicologia , Adulto , Austrália , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Prevalência , Psicometria/instrumentação , Psicometria/métodos , Apoio Social , Inquéritos e Questionários , Reino Unido , Estados Unidos
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