Bittersweet: a qualitative exploration of mothers' experiences of raising a single surviving twin.

Loss of a child from a multiple birth pregnancy is not uncommon yet the idiographic experience of parents who have lost a single twin from a multiple birth pregnancy is underexplored. This novel study sought to explore the experiences of mothers bereaved after loss of a twin from a multiple birth pregnancy, focusing on the dual challenges of parenting and grieving. Eighteen mothers at least 12 months post loss were recruited from a private UK based Facebook page dedicated to supporting parents after loss from a multiple birth. Eligible mothers completed an independent qualitative open-ended survey to explore maternal experiences of loss. Data were analysed using Thematic Analysis. Findings represented a sense of duality for participants, with mothers experiencing conflict between roles and identities as well as the nature of their loss. Key themes identified include 'Narrating a story of family and loss', 'Finding a place for the twins within the family' and 'A changing sense of self'. Findings fit with theoretical conceptualisations of bereavement that acknowledge retaining relationships with the deceased. Practically, suggestions for supporting mothers to identify stock answers to often asked questions about family make up were suggested.

"They Say I Should not Think About It:": A Qualitative Study Exploring the Experience of Infant Loss for Bereaved Mothers in Kumasi, Ghana.

Despite the high rate of infant mortality in Ghana, few studies have explored the maternal experience of infant loss and the perinatal grieving process. As part of a larger study that interviewed 153 mothers with a sick infant, this 1-year follow-up study reinterviewed eight mothers from the original cohort whose infant died since the study began. Mothers were queried about mental health, coping, and cultural issues related to the loss. Mothers were often discouraged from speaking or thinking about the death due to fear of psychological harm and impact on fertility. Primary coping mechanisms involved seeking support within the community and accepting the loss as God's will. Mothers desired more communication from health-care providers at the time of death. Despite the cultural norm of silent acceptance in the face of perinatal loss, intense maternal grief and desire to mourn may allow more opportunities for health-care workers to support bereaved mothers.

Drawing Close to the Brokenhearted: Pastoral Responses to Parents Grieving Stillbirth.

Despite its prevalence worldwide, stillbirth is poorly understood and rarely discussed. Accordingly, ministers and other pastoral caregivers are seldom prepared to counsel and console parents suffering from this type of infant loss and to effectively design, propose, and lead ministries within their faith communities for this grieving population. This article addresses the immediate pastoral needs of bereaved parents and proposes first and second order responses that ministers and faith communities can employ to compassionately and effectively care for parents suffering from the trauma of stillbirth.

Untold stories of infant loss: the importance of contact with the baby for bereaved parents.

This article presents secondary analysis of data from parents who, 50 to 70 years ago, birthed stillborn babies or babies with lethal anomalies and from adult children born after these losses. The stories reflect a time in history when parents were "protected" from seeing or holding their babies and mothers were unable to attend the funeral. There was no understanding by society or caregivers for parents' need to process the loss or resources to build memories. They provide a strong argument for health care providers to offer such resources to parents today and offer grief support.

Racial and ethnic differences in the relationship between infant loss after prior live birth and hypertensive disorders in pregnancy.

BACKGROUND: Race and ethnicity influence the distribution and severity of hypertensive disorders of pregnancy (HDP) in the U.S. population, although the impact of prior infant loss on this relationship requires further investigation. OBJECTIVES: The aim of this study was to assess the relationship between history of infant loss and the risk of HDP by maternal race and ethnicity. METHODS: For this large cross-sectional study, data were analyzed from the National Center for Health Statistics Vital Statistics Natality Birth Data, 2014-2017. The primary outcome was HDP, and the primary predictor was infant loss after prior live birth. Maternal race/ethnicity was the secondary predictor categorized as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Asian, or Other. Multiple logistic regression was used to assess the association between history of infant loss and HDP by race and ethnicity. RESULTS: The 9,439,520 women included in this sample were 51% NHW, 15% NHB, 25% Hispanic, 6% Asian, and 3% Other with a mean age of 29.8 ± 5.3 years. In adjusted analyses, infant loss after prior live birth was significantly associated with an 11% odds of HDP (OR 1.11, 95% CI 1.08, 1.13). Stratified by race, NHB (OR 1.28; 95% CI 1.21, 1.36) women had significantly higher odds of HDP, and Hispanic (OR 0.84, 95% CI 0.79, 0.90) and Asian (OR 0.85, 95% CI 0.75, 0.97) women had significantly lower odds compared to NHW women. Within races, all women with infant loss after prior live birth had significantly higher odds of HDP (p < .001), except Other women (p = .632). CONCLUSIONS: Infant loss after prior live birth was significantly associated with higher odds of HDP among NHB women after adjusting for covariates. Further research is warranted to assess underlying mechanisms associated with higher odds of HDP in NHB women.

The brain oxytocin and corticotropin-releasing factor systems in grieving mothers: What we know and what we need to learn.

The bond between a mother and her child is the strongest bond in nature. Consequently, the loss of a child is one of the most stressful and traumatic life events that causes Prolonged Grief Disorder in up to 94 % of bereaved parents. While both parents are affected, mothers are of higher risk to develop mental health complications; yet, very little research has been done to understand the impact of the loss of a child, stillbirth and pregnancy loss on key neurobiological systems. The emotional impact of losing a child, e.g., Prolonged Grief Disorder, is likely accompanied by dysregulations in neural systems important for mental health. Among those are the neuropeptides contributing to attachment and stress processing. In this review, we present evidence for the involvement of the brain oxytocin (OXT) and corticotropin-releasing factor (CRF) systems, which both play a role in maternal behavior and the stress response, in the neurobiology of grief in mothers from a behavioral and molecular point of view. We will draw conclusions from reviewing relevant animal and human studies. However, the paucity of research on the tragic end to an integral bond in a female's life calls for the need and responsibility to conduct further studies on mothers experiencing the loss of a child both in the clinic and in appropriate animal models.

Texting Condolences: Adapting mHealth Programs After Unexpected Pregnancy and Infant Outcomes.

Mobile health (mHealth) short message system (SMS) interventions for maternal and child health (MCH) are being implemented globally. In many low- and middle-income settings in which these mHealth interventions are being rolled out, stillbirths and neonatal and infant deaths are common. It is important that mHealth solutions do not exacerbate emotional stress and pain by continuing with routine messaging for pregnancy or infant care when someone has experienced loss. In this brief viewpoint paper, we argue that SMS programs for maternal and child health need to adapt and make available messaging for miscarriage, stillbirth, and infant loss.

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.