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

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.

It is widely acknowledged in the literature that grief is most intense when it is experienced by parents whose children have died. However, as recently as 20 years ago, mothers whose children died at birth or before the pregnancy had reached full term were often dismissed as merely medical patients, and their psychological reactions were not considered or acknowledged by professionals, their friends, or their families. More recently fields such as psychology have recognized that women who have experienced pregnancy loss have complex psychological reactions to their loss. The present study examined the patterns of grief of women who have had a pregnancy end in spontaneous abortion or stillbirth and the ways in which these women gave meaning to their experiences. Participants were asked to complete several measures including the Perinatal Grief Scale (PGS), the Hogan Grief reaction Checklist (HGRC), the Perceived Social Support Scale (PSS), and the Inventory of Social Support (ISS). The participants also wrote a narrative account of their loss experience. These narratives were content analyzed to delineate common themes. The findings indicated several important factors which may be useful in understanding and assisting in post-loss adjustment.

Afrikaans: Die metodologiese model wat gevolg is het gepoog om deur die wisselwerking tussen teorie en praxis ‘n praktykteorie te lewer wat tot ‘n meer effektiewe bedizening in pastorale begeleiding van gesinne wat die trauma van ‘n miskraamsituasie beleef het, te kan dien. Indien hierdie praktykteorie geïmplementeer word, sal dit in die Prakties-Teologiese terugvra na die Woord daadwerklik daartoe bydra dat die beeld en bedoeling van die herdermotief in die pastoraat tot sy reg sal kom. Die ondersoek het van die hipotese uitgegaan dat daar ‘n leemte bestaan ten opsigte van die betrokkenheid van predikante by gesinne wat die trauma van ‘n miskraam beleef het. ‘n Empiriese ondersoek is gedoen en die resultate bevestig hierdie hipotese. In die literatuurstudie is daar gefokus op miskrame vanuit die perspektief van die rousmart-teorie en die gevolgtrekking is gemaak dat daar ‘n verband bestaan tussen ‘n miskraam en die rousmart wat daaruit voortspruit. Die status van die fetus, asook die vraag na die lewe ná die dood en die sin van lyding is vanuit verskillende perspektiewe ondersoek om as agtergrondskennis vir pastorale begeleiding te dien. Op grond van die resultate van die literatuurstudie en die empiriese ondersoekl is tot die slotsom gekom dat hierdie ‘n spesialiteitsgebied is, en dat ‘n toerustingskursus vir predikante kan lei tot ‘n beter begeleiding van mense in so ‘n situasie. Die raamwerk van so ‘n metodologiese model wat spesialiteitstoerusting vereis, sal moet fokus op die bemagtiging van predikante ten opsigte van die wêreld van die miskraamslagoffer, om sodoende daadwerklik hulpverlenend by die situasie betrokke te raak. ‘n Raamwerk vir so ‘n toerusting word as praktykteorie aangebied. English: The methodological model employed attempted to provide a practical theory through the interaction between theory and praxis to produce a more effective service in pastoral guidance to families who have experienced the trauma of a miscarriage situation. Should this practice theory be implemented, its Practical-Theological reference of the Word of God may actively contribute to the image and meaning of the pastoral motive in the pastorate being more clearly displayed. The study was based on the hypothesis that there is a need regarding the involvement of ministers with families who have experienced the trauma of a miscarriage. An empirical study was performed and the results confirm this hypothesis. In the literature study attention was focused on miscarriage from the perspective of the grief theory, and it was concluded that a causal relationship exists between miscarriage and the subsequent grief process. The status of the fetus, as well as the question regarding life after death and the purpose of suffering, were considered from various perspectives to provide background kwowledge for pastoral guidance. On the basis of the results of the literature study and empirical investigation, it was concluded that this is a speciality field, and that the appropriate preparation of ministers may equip them to better serve persons in a situation as this. The framework of such a methodological model requiring special preparation will have to focus on the empowerment of ministers with regard to the world of the victim of miscarriage, thus enabling them to become actively and supportively involved with the situation. A framework for the appropriate preparation of ministers is being offered as practice theory. / Thesis (PhD (Practical Theology))--University of Pretoria, 2006. / Practical Theology / unrestricted

D.Cur. / Although the general topic of death is receiving increasing attention by the medical community, little is known about the impact that pregnancy loss has on the lives experiencing it. Statistics show that the problem is widespread, but they tell nothing about the tears, the regrets, the feeling of guilt and the long process of rebuilding hope. And the medical community is not consistent in attitude or skill where caring for mothers with pregnancy loss. Mothers expect their physicians to be understanding and compassionate, especially when the worst fear has become a reality and the baby had died. Sadly, these expectations are too often unfulfilled, leaving the mother angry and confused, instead, death becomes the enemy to be avoided and opposed at all costs. The purpose of this study is to develop a conceptual framework of support to mothers with pregnancy loss to assist midwives and doctors in supporting these mothers

Grief and causal attribution are two of the most commonly observed reactions to early miscarriage, yet little is known about these reactions or whether a relationship exists between them. This exploratory and descriptive correlational study examined the maternal grief intensities, the causal attributions, and the relationship between them in a convenience sample of 15 women who spontaneously aborted at 16 weeks' or less gestation. Women responded to both a written questionnaire and a semi-structured Interview at 6 to 10 weeks post-miscarriage. Their responses Indicated both current and retrospective reactions to their miscarriages. Responses were analysed using nonparametric statistics and content analysis. Maternal grief Intensities were found to vary widely at the time of the miscarriage, but all decreased significantly 6 to 10 weeks later. All women reacted to their miscarriage with attribution-seeking behaviors. The explanations most women formed were comprised of more than one causal attribution. Attributions were observed to have four distinct characteristics. Causal attributions were found to be either philosophical or physically oriented; to be organic, non-specific or maternal/self-blaming In origin; to be either dominant or non-dominant, and/or to refer to causalities immediate or prior to the physical event. At the time of the miscarriage a positive correlation between grief Intensity and maternal/self-blaming attributions and between grief Intensity and philosophical attributions was found. These relationships were not observed 6 to 10 weeks later. A positive correlation was found between grief intensity and attributions to maternal emotions at both the time of the miscarriage and 6 to 10 weeks later. / Applied Science, Faculty of / Nursing, School of / Graduate