This thesis examines how young, married, heterosexual Christian couples talk about and make sense of pregnancy loss, specifically loss before the twentieth week. Studies of pregnancy loss often focus on individual differences in response to pregnancy loss, but this research engages a shared, relational notion of pregnancy loss. Furthermore, this project focuses on Christianity as a tool for making sense of pregnancy loss, not simply a demographic characteristic. I conducted six open-ended interviews with two couples, with one interview together and an individual follow-up interview with each spouse. Following the interviews, I analyzed and interpreted the interview transcripts for symbols of identity and forms, which are communicative practices described by Carbaugh (1996) that construct social identity and cultural scenes, to examine how pregnancy loss is characterized as a "me," "you" and "we" experience. Through this analysis I observed how multiple agents (God, the couple, the community, family members and clinicians) continually construct what pregnancy loss means for the couple, but also for this cultural scene. This is a transformative experience for all entities as they continually interact with this notion of loss. Significantly, these couples see this experience continuing on past death and know that they will see their baby "in heaven."

This study aimed to address how fathers made sense of their experience of losing their baby due to stillbirth after receiving one-to-one counselling/therapy. An Interpretative Phenomenological Analysis was used to explore the unique lived experience of each father. Eight semi-structured interviews were carried out with fathers of a stillborn baby who had experienced some form of one-to-one counselling/therapy in the aftermath of their loss. The research found that fathers developed an embodied relationship and continued to experience an ongoing relationship with their stillborn child. The fathers were changed by their experience of having a stillborn baby in fundamental and complex ways. The fathers also re-addressed aspects of their ‘masculine selves’ in response to this profound loss. It was meaningful for the fathers when their relationship with their stillborn child was validated and legitimised in their one-to-one counselling/therapy. Moreover, some fathers were able to address the confusion and ambiguity around the nature of their loss and their experience as men. The fathers expressed the unique ways they were transformed by their experience emotionally, psychologically, and existentially. Some fathers could begin to make sense of this and find meaning in their experience when it was recognised in their individual therapy. Finally, a critique of the limitations of the research process and methodology was provided and suggestions for further research were offered.

This phenomenological study examined the experience of miscarriage from the couple's perspective. The study participants were six couples who had miscarried within four weeks of the initial interview. Data were collected in interviews and were analyzed concurrently. Themes were identified and validated by the couples as the interviews progressed. Findings from analysis confirmed that couples grieve following a miscarriage. This grief experience is represented by a composite of four interacting motifs called Discovery, Disclosure, Definition and Decision. Each motif is characterized by dominant emotions and behaviours. The composite interacts with the external theme of Health Care Interactions. Findings supported assertions that individuals within the couple relationship grieve incongruently. The grief experience is facilitated or hampered by the quality of health care interactions the couple experiences. Couples identified needs that were unmet during the experience particularly the need to talk through the experience at a later time and the need to have their losses acknowledged by their health care givers. Differences in Discovery were found between couples who had a prodromal phase of miscarriage and those who had a missed abortion. Couples who had a missed abortion experienced confusion in addition to the shock and disbelief encountered at this time. Findings also supported the assertion that grief following a miscarriage is generally resolved within twelve weeks. This description of the grief experience following a miscarriage will assist nurses to provide couple-centred care to facilitate resolution of their grief. Implications for practice, research and education are described to enhance the nurse's ability to provide more effective care to miscarrying couples. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

Chapter 2 evaluates the effectiveness of two simple and widely applied self-report psychometric questionnaires: the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) in detecting psychological morbidity after miscarriage. Both GHQ-12 and BDI demonstrated satisfactory psychometric properties and both questionnaires were found to be effective in detecting general psychiatric disorders and depression respectively. / Chapter 3 reports the application of GHQ-12 and BDI in assessing the psychological well-being of 280 miscarrying women over a one-year longitudinal course after the loss. The psychometric outcomes were also compared with a community cohort unexposed to pregnancy loss. The study confirmed that although psychological distress reduces over time, the psychological impact following miscarriage is significant and could be enduring. Patients who were more distressed immediately after miscarriage continued to be at a higher risk of psychological morbidity at a later stage. / Chapter 4 assesses the possible underlying risk factors associated with psychological morbidity following miscarriage over a one-year longitudinal course. It has demonstrated that while a poor marital dyad and psychological distress experienced immediately after miscarriage are consistent predisposing factors, some obstetric variables such as the type of medical management, a history of abortion and prior ultrasound evidence of fetal viability contribute to the development of psychological morbidity at various time points along its evolutionary course. / Chapter 5 reports a randomised controlled trial involving 280 miscarrying women in assessing the effectiveness of a psychological counselling programme in reduction of psychological morbidity. A 30% reduction in the proportion of patients with psychological morbidity was found three months after miscarriage in the counselling group, suggesting a potential clinical beneficial effect, albeit not statistically significant. This potential effect was more profound for selected patients who were initially more distressed after miscarriage. / Chapter 6 reports our exploratory findings of the psychological reaction of 83 male partners after miscarriage and it reports the gender differences over a one-year longitudinal course. A significant proportion of men were found to report psychological distress and depressive symptoms immediately after miscarriage. When compared with their female partners, the psychological impact was less intense and less enduring. / Chapter 7 concludes the thesis and proposes directions for future research. / Miscarriage (spontaneous abortion) is the most common complication of pregnancy with 15-20% of clinically recognised pregnancies aborting spontaneously. It is also one of the commonest gynaecological conditions leading to hospitalisation, accounting for more than 10% of gynaecological admissions in Hong Kong. The common occurrence and the procedural simplicity involved in the medical management, however, may tend to obscure its psychological impact. While emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences, many questions remain unanswered, such as how to detect and screen for psychological morbidity after miscarriage; how long the symptoms last or when do they resolve; what are the underlying risk factors throughout its longitudinal course; what is the psychological impact on the male partner; and whether psychological intervention is helpful. In addition, nearly all studies have been conducted in Caucasian societies with the effect on other ethnic groups remaining largely unexplored. / This thesis specifically addresses the following aspects in assessing and managing psychological morbidity following miscarriage: Chapter 1 firstly introduces the clinical aspects of miscarriage, including the definition, incidence, risk factors, clinical manifestations and the current management options. It then discusses the current evidence available on the psychological aspects of miscarriage and outlines the deficiency in current knowledge. Finally, the hypotheses for this thesis are proposed. / Lok Hung Ingrid. / "May 2006." / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1567. / Thesis (M.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 248-276). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

In the first phase of this study, the cluster analysis results of 208 WEM provided initial empirical support for this typology. Three subtypes of WEM were identified. They were "Adjusted Women" (AW, N = 54, 26%), "Dysphoric/Mixed Type Women" (DW, N = 57, 27%), and "Gender-Bound Women" (GW, N = 97, 47%). Partially supporting the hypothesis, GW experienced the worst adjustment as reflected in their high level of perinatal grief symptoms compared to AW and DW. Further examination of the demographic characteristics of each WEM subtype showed that while DW reported relatively stronger personality (i.e., trait anxiety, trait depression, and neurotic personality) and cultural vulnerabilities (i.e., traditional ideal personhood and self-sacrifice) compared to AW, GW's reports of personality and cultural vulnerabilities faked the worst among the 3 WEM subtypes. Cluster-constrained hierarchical regression analyses revealed a distinct set of predictors for immediate postloss adjustment of AW, DW, and GW. Instead of a complete nested model, the present data fitted a partially nested model where AW were nested within GW, and DW represented a mixed type of WEM. Specifically, AW's perinatal grief was affected by pregnancy factors whereas GW's was affected by pregnancy, personality, and cultural factors. DW's perinatal grief was not affected by pregnancy factors but by personality and cultural factors. / In the fourth phase of this study, pregnancy, personality, and cultural factors as well as spousal emotional social support were reexamined for their possible implications for WEM's and the pregnant controls' psychological distress, state anxiety symptoms, and state depressive symptoms at 6 months following the initial assessment. The results showed that spousal emotional support at a 6-month follow up was a salient predictor of psychological distress state anxiety symptoms, and state depressive symptoms at 6 months after the initial assessment for both WEM and the pregnant controls While spousal emotional support at the initial assessment did not have the same effect, this result suggested that to mitigate the longer term poor psychological adjustment of WEM and pregnant women, sustained spousal emotional support is needed. Trait anxiety at the initial assessment was also a strong predictor of WEM's psychological distress, state anxiety symptoms, and state depressive symptoms at 6 months post miscarriage. Pregnancy factors at the initial assessment were only moderately related to the psychological adjustment of WEM and the pregnant controls, and cultural factors at the initial assessment were not related to any of the adjustment indicators at the 6-month follow up. (Abstract shortened by UMI.) / In the second phase of this study, comparisons were made between the 3 WEM subtypes and women with healthy uncomplicated pregnancy (pregnant controls, N = 258). The results showed that the 3 WEM subtypes experienced varying levels of adjustment problems---that is, psychological distress, state anxiety symptoms, and depressive symptoms---compared to the pregnant controls. GW, in particular, were 8 times more likely to be classified as psychological distress caseness and 4 times more likely to be classified as state anxiety caseness and state depression caseness, even after controlling for pregnancy factors and spousal emotional social support. / In the third phase of this study, the author attempted to establish predictive validity of the proposed WEM typology using 6-month 2-wave longitudinal data A subsample from Phase One and Phase Two of this study, including 103 WEM (AW = 33, 32%; DW = 27, 26%; GW = 43, 42%) and 139 pregnant controls, provided information on their psychological distress, state anxiety symptoms and depressive symptoms, as well as on their motivation to reproduce at 6 months after the initial interview. Although GW were significantly more likely than AW and DW to report being pregnant or having the intention to conceive at 6 months post miscarriage, no significant differences were observed between the 3 WEM subtypes in their psychological distress, state anxiety symptoms, and state depressive symptoms. / The present 4-phase study was an attempt to propose an integrated conceptual model to advance understanding of Chinese women's adjustment to miscarriage; that is the perinatal grief symptoms, psychological distress, state anxiety symptoms, and depressive symptoms they experience in response to miscarriage. Through a comprehensive review of sociobiological theory, attachment theory, psychoanalytic theory and the feminist perspective, the author proposes a conceptual model involving 3 major pathways, namely pregnancy, cultural, and personality factors. It was hypothesized that 3 subtypes of women who experienced miscarriage (WEM) (Adjusted Women, AW; Dysphoric Women, DW; Gender Bound Women, GW) could be identified with each subtype being affected by a combination of different factors. Specifically, it was hypothesized that AW would be affected by pregnancy factors, DW by pregnancy and personality factors, and GW by pregnancy, personality, and cultural factors. / Yan Chau Wai Elsie. / "June 2007." / Adviser: Catherine So-Kum Tang. / Source: Dissertation Abstracts International, Volume: 69-01, Section: B, page: 0705. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 104-120). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

My experience of baby loss was an isolated learning experience and the main objective of my research was to help better resource other women who may find themselves lost in the system caring for women when their babies die. Particularly, I wanted to highlight and possibly remedy the invisibility of women and their babies that die between 12 and 20 weeks gestation. Loss Before Life Begins was written as four journalistic articles with one of the goals to be that all or some of the articles achieve publication in a mainstream New Zealand magazine. I focussed all the research on the last 20 years, beginning in 1985. Firstly, because it coincides with the establishment of Miscarriage Support Auckland, the first group of its kind in New Zealand. Secondly, because it ensured that the participants' stories would be relevant in the current context of how baby loss is treated by society, the media and the health system. Each article had a specific purpose and aim. Firstly, The Language of Loss investigated the background of our popular understanding of baby loss, including the legal categorisations of baby loss in different gestational periods. It also included research into the language commonly used by health professionals working with women whose babies have died. Quotes from the five women who were participants in the thesis were interwoven in the article. Their stories illustrated the effects of insensitive language on a woman's experience, and the perception of care and treatment received by health professionals. Then I reviewed all mainstream media articles published in New Zealand from 1985. This disclosed the lack of articles about baby loss, and the general dearth of practical information provided when stories did appear. Secondly, And Mother Makes Me was the narrative of the five women's stories interviewed about their babies' deaths between 12 and 20 weeks gestation. I discovered that this timeframe is 'invisible' because women under 20 weeks are not part of the obstetric system, and are cared for by nurses instead of midwives. These mothers are invisible, as are their babies' deaths. Article three, The 'System' and the People Working In It encompasses the sometimes conflicting views of four leading health professionals. Possible explanations for why women whose babies die under 20 weeks are treated differently to women whose babies are considered stillborn were included. Conflicting views about the importance of the media's role emerged. Small changes in the use of medical language by health professionals were outlined. Finally, possible reasons for society's difficulty with the concept of death, and specifically the difficulties when a woman's baby dies before its life has begun were uncovered. The fourth and final article, The Way It Is and The Way It Could Be summarised the background reading; media analysis from the last 20 years; the themes from the five women's stories; and the array of health professionals' views. Included are a number of specific meaningful ways that health professionals, media outlets and society can better support the invisible women when their babies die. These include updating medical language printed in brochures; including fact boxes in editorials; giving women and their families an opportunity to talk about their losses; and reviewing 'the system' that allows women who lose babies between 12 and 20 weeks to be cared for by nurses instead of midwives.

Thesis (Ph.D.)--York University, 2007. Graduate Programme in Sociology. / Typescript. Includes bibliographical references (leaves 217-233). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR39000

My experience of baby loss was an isolated learning experience and the main objective of my research was to help better resource other women who may find themselves lost in the system caring for women when their babies die. Particularly, I wanted to highlight and possibly remedy the invisibility of women and their babies that die between 12 and 20 weeks gestation. Loss Before Life Begins was written as four journalistic articles with one of the goals to be that all or some of the articles achieve publication in a mainstream New Zealand magazine. I focussed all the research on the last 20 years, beginning in 1985. Firstly, because it coincides with the establishment of Miscarriage Support Auckland, the first group of its kind in New Zealand. Secondly, because it ensured that the participants' stories would be relevant in the current context of how baby loss is treated by society, the media and the health system. Each article had a specific purpose and aim. Firstly, The Language of Loss investigated the background of our popular understanding of baby loss, including the legal categorisations of baby loss in different gestational periods. It also included research into the language commonly used by health professionals working with women whose babies have died. Quotes from the five women who were participants in the thesis were interwoven in the article. Their stories illustrated the effects of insensitive language on a woman's experience, and the perception of care and treatment received by health professionals. Then I reviewed all mainstream media articles published in New Zealand from 1985. This disclosed the lack of articles about baby loss, and the general dearth of practical information provided when stories did appear. Secondly, And Mother Makes Me was the narrative of the five women's stories interviewed about their babies' deaths between 12 and 20 weeks gestation. I discovered that this timeframe is 'invisible' because women under 20 weeks are not part of the obstetric system, and are cared for by nurses instead of midwives. These mothers are invisible, as are their babies' deaths. Article three, The 'System' and the People Working In It encompasses the sometimes conflicting views of four leading health professionals. Possible explanations for why women whose babies die under 20 weeks are treated differently to women whose babies are considered stillborn were included. Conflicting views about the importance of the media's role emerged. Small changes in the use of medical language by health professionals were outlined. Finally, possible reasons for society's difficulty with the concept of death, and specifically the difficulties when a woman's baby dies before its life has begun were uncovered. The fourth and final article, The Way It Is and The Way It Could Be summarised the background reading; media analysis from the last 20 years; the themes from the five women's stories; and the array of health professionals' views. Included are a number of specific meaningful ways that health professionals, media outlets and society can better support the invisible women when their babies die. These include updating medical language printed in brochures; including fact boxes in editorials; giving women and their families an opportunity to talk about their losses; and reviewing 'the system' that allows women who lose babies between 12 and 20 weeks to be cared for by nurses instead of midwives.

Thesis (Ph.D.(Practical Theology))--University of Pretoria, 2008. / Includes bibliographical references (leaves 306-337)