The purpose of this study was to gain a better understanding of the paternal experience of perinatal loss. Perinatal loss is a significant life experience for childbearing families and this study helped to reveal the meaning of the paternal experience, how meaning was constructed and what factors both contributed and/or hindered coping following the loss. Although extensive research in grief and loss has been conducted there existed a significant knowledge gap related to the experience of perinatal loss and even more of a paucity concerning the understanding of the paternal experience. A qualitative study with a phenomenological approach was conducted with a purposeful sample of seven fathers who had experienced a perinatal loss. These fathers helped provide a basis for understanding through partaking in interviews conducted in a venue chosen by fathers. Data analysis involved procedures with roots in Heideggerian traditions of phenomenology, to allow for meaning interpretation of the father's narratives. The analysis resulted in four shared meanings 1) Perinatal Loss - Unexpected Reality, 2) Acknowledgment and Remembrance, 3) Significance and Strength and 4) Crisis, which consisted of 12 themes (World Falling Apart, Absolute Shock, Stoicism, Wishing for Answers, Silent Shelter, Concern for Wife, Communication, Time Heals - Though Never Forgotten, Continued Support and Understanding, Life Changing Moment, Opportunity of Growth and Avoidable Choice). Results indicated that fathers felt ill prepared for this unexpected life event and that they needed to remain strong or to live up to perceived expectations. Although the loss was never forgotten, through reflection, communication and continued support and understanding healing transpired over time and crisis was an avoidable choice. Further exploration of the paternal experience of perinatal loss with varying socio-cultural backgrounds, younger aged population group as well as different religious and cultural backgrounds is recommended. Research is also indicated to explore: 1) educational interventions focusing on both short and long term supportive care to bereaved families, 2) the impact of substantive bereavement programs on healing and meaning-making, 3) the impact of a perinatal loss experience on other members of the family unit, and 4) the impact of recurrent perinatal loss to a family.

The purpose of this dissertation was to explore the experience of long term grief following a perinatal loss. In particular, the processes of meaning reconstruction and self-changes stemming from perinatal loss were explored by listening to parents in-depth narratives of their experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that suggests that people are storytellers by nature and we attempt to organize and make sense of our life experiences by constructing coherent narratives. Participants were 4 couples and 8 individuals whose losses occurred 1 to 35 years before the interview. Interviews followed a reflexive-dyadic interview model. Analysis of the narratives was approached in two ways: First, a voice-centered relational approach was used for initial interpretation and identification of prevalent voices in the stories. Second, five of the stories were written as evocative narratives, which served as a way of incorporating the authors personal experience of perinatal loss, as well as to evoke an empathic understanding of the experience of perinatal loss. The interpretation and discussion of the stories focused on meaning-making that was evident on both an individual level as well as across the larger group of participants. In particular, meaning-making influences and strategies were identified, including influences of the medical establishment and social networks which either served to disenfranchise parents losses or to comfort and ease parents in their grief. The impact of meaning-making on long-term grief was considered, as well as parents reports of positive and negative self-changes that emerged from their struggle with grief. The unique contribution of this project lies in its elaboration of the meaning reconstruction process in the context of perinatal loss; its demonstration of both positive and negative self-changes in a group of perinatally-bereaved parents; its exploration of grief several years to decades following a perinatal loss; its inclusion of the researchers self as both an additional source of data and as a validity check on the presentation and interpretation of participants stories; and the use of evocative narratives to evoke an empathic understanding of a historically disenfranchised form of loss.

The purpose of this dissertation was to explore the experience of long term grief following a perinatal loss. In particular, the processes of meaning reconstruction and self-changes stemming from perinatal loss were explored by listening to parents in-depth narratives of their experiences of loss and grief. A narrative methodology was used, based on a constructivist epistemology that suggests that people are storytellers by nature and we attempt to organize and make sense of our life experiences by constructing coherent narratives. Participants were 4 couples and 8 individuals whose losses occurred 1 to 35 years before the interview. Interviews followed a reflexive-dyadic interview model. Analysis of the narratives was approached in two ways: First, a voice-centered relational approach was used for initial interpretation and identification of prevalent voices in the stories. Second, five of the stories were written as evocative narratives, which served as a way of incorporating the authors personal experience of perinatal loss, as well as to evoke an empathic understanding of the experience of perinatal loss. The interpretation and discussion of the stories focused on meaning-making that was evident on both an individual level as well as across the larger group of participants. In particular, meaning-making influences and strategies were identified, including influences of the medical establishment and social networks which either served to disenfranchise parents losses or to comfort and ease parents in their grief. The impact of meaning-making on long-term grief was considered, as well as parents reports of positive and negative self-changes that emerged from their struggle with grief. The unique contribution of this project lies in its elaboration of the meaning reconstruction process in the context of perinatal loss; its demonstration of both positive and negative self-changes in a group of perinatally-bereaved parents; its exploration of grief several years to decades following a perinatal loss; its inclusion of the researchers self as both an additional source of data and as a validity check on the presentation and interpretation of participants stories; and the use of evocative narratives to evoke an empathic understanding of a historically disenfranchised form of loss.

Magister Curationis - MCur / Perinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.

Perinatal loss (stillbirth or the death of a neonate) can result in considerable psycho-social disruption for mothers. As women grieve, they try to make meaning of the death of their baby. In contexts of social and economic deprivation, perinatal loss often occurs alongside other difficulties which may affect and limit women's ability to make meaning. A narrative approach was used to explore how meaning-making functions in such contexts. In-depth interviews were conducted with 15 women who had experienced perinatal loss while attending a state maternity hospital. Narratives which the mothers constructed of the event were examined in order to understand what meanings they derived from the loss, and how these were (or not) achieved. These narratives were often linked to other stories of pervasive life difficulties. Despite their difficult contexts, the bereaved mothers engaged in meaning-making in similar ways to those described in previous studies in more affluent settings: they attempted to integrate the loss with their identity and goals, they affirmed the baby as a real person to be mourned and they searched for reasons for the loss. The effect of their contexts on meaning-making was mediated by social support and personal agency. Where one or both of these were present, the bereaved mothers were able to find meaning in their loss; women who had neither seemed unable to do so. Those who portrayed themselves as agentic were able to reflect on their experience and make decisions to change their lives. Mothers with strong social support made meaning through conversations, social validation of the loss and social help which mitigated against the sense of helplessness engendered by their loss and circumstances. It is recommended that hospital and counselling services implement practices which help to build or consolidate personal agency and social support to facilitate successful meaning-making following perinatal loss.

Perinatal loss is a tragic event in a woman's life and is a time filled with much aguish and · grief. The care a women and her family receive during a perinatal loss experience can have an incredible impact on future subsequent pregnancies. Subsequent pregnancies have shown to be filled with apprehension and anxiety that can potentially lead to complications such as preterm labor or another loss. Depressive symptoms and decreased prenatal attachment are additional factors that play a role in the experience of a subsequent pregnancy. The purpose of this thesis was to complete a comprehensive review of research studies concerning the experiences of women and subsequent pregnancies after suffering a perinatal loss and develop strategies that can be used to promote effective coping in this population. A review of the literature was conducted using Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, PubMed, and Medline databases. Results found higher pregnancy anxiety, more depressive symptoms, and decreased prenatal attachment in couples with a history of perinatal loss, a lack of bereavement education for nurses and midwives, and emphasized the need for support for both families and health care providers. Coping strategies for women and their families were identified and specific nursing implications for practice were established in order to facilitate coping in women and families.

The thesis begins with an exploration of my experiences of caring for dying babies which considers the way in which the care given to dying babies differs according to the care environment. This sets the scene for an exploration of rituals surrounding their care. Critical Interpretive Synthesis was selected as a research design for the study because it offered the opportunity to take an interpretive approach to a range of data and allowed the creation of new arguments. Documentary data including professional literature, professional textbooks and professional guidelines were analysed and interpreted using methods which guideline analysis, critical appraisal and rhetorical analysis. The diverse range of analyses facilitated both the rigour and meaning of the data to interrogated. Performance Theory was used as the theoretical framework in the thesis to allow the rituals to be revealed and explored as dramatic performances. The thesis demonstrated that the origin of the rituals was rooted in the need for the baby to be treated with compassion and dignity and to provide parents with the opportunity to form meaningful attachments in the brief period between the previable baby’s birth and death. The rituals were devised by parents who had been bereaved and were incorporated into guidelines. The guidelines practised the rhetoric of choice but the data demonstrated that the rituals appear to have been adopted as routines which were then used indiscriminately, robbing them of their meaning.The findings reveal how care to meet the physical needs of the dying previable baby requires to be made more explicit to enable the ideology and of ‘comfort care’ to be realised in practice. The thesis also demonstrated a need for inclusiveness to represent the spectrum of parents affected by the death of a previable baby when researching perinatal loss and formulating policy.

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Spontaneous abortion, or miscarriage, is an event that affects approximately one in four women during their reproductive years. Despite the psychological and physiological trauma associated with the loss of pregnancy, few evidence-based practice recommendations exist to guide nursing care of women experiencing first trimester miscarriage. The purpose of this integrative review of literature was to examine research related to women's health care experiences of first trimester miscarriage and discuss common themes relating to nursing care. Inclusion criteria consisted of peer review research articles published after 2001 and available in the English language and women that experienced miscarriage during the first 12 weeks of pregnancy. Current literature was collected from Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost and PsycINFO databases using combinations of various key words. Six qualitative studies and one quasi-experimental study met the inclusion criteria and were reviewed. The results indicated that nursing care of women experiencing miscarriage should include therapeutic communication, psychological support, and provision of information and follow-up care. While there is little research reviewing nursing interventions related to first trimester miscarriage, these themes may help guide the development of further research reviewing the efficacy and effectiveness of specific nursing interventions.

PRENATAL AND PERINATAL LOSS ENTANGLED IN CZECH INSTITUTIONS Marie Hintnausová ABSTRACT An ethnographic research among women who experienced a loss of child during pregnancy or postpartum aims to expose contexts and backgrounds in which prenatal and perinatal loss emerges in the Czech Republic. This life event is delineated not only by unique biographies of affected mothers, but also by the societal understanding of prenatal life and institutional definitions of human reproduction. This thesis highlights various notions and meanings entangled in the event of prenatal and perinatal death and shows which trajectories women follow in the terrain of societal expectations and governmental and biomedical institutions when they lose a promised assurance of raising a new child.