Bakgrund: Missfall är ett ofrivilligt avslutande av en graviditet som kan medföra känslor av chock, sorg och skuld. Vårdtiden vid missfall är ofta kortvarig och vårdpersonal har en betydande roll för kvinnornas upplevelse och återhämtning. Syfte: Syftet var att genom en litteraturstudie beskriva kvinnors upplevelser av missfall och den vård som ges i samband med missfall. Metod: Allmän litteraturstudie baserad på tio vetenskapliga artiklar med en kvalitativ design. Resultat: Resultatet bestod av tre huvudteman med tillhörande subteman. Det första huvudtemat var Kvinnors egna subjektiva tankar och känslor i samband med missfall med subteman Förlust av en graviditet, Skuldkänslor, Oro och förväntningar vid framtida graviditeter. Det andra huvudtemat var Kvinnors erfarenheter av bemötande från vårdpersonal vid missfall, med subteman Attityder och bemötande, Brist på information. Det sista huvudtemat var Kvinnors behov av stöd i samband med missfall med subteman Familj och närståendes betydelse, Vårdpersonalens betydelse. Slutsats: Missfall var en chockartad upplevelse, ofta präglad av existentiell smärta och sorg. Kvinnors erfarenheter av vården var oftast negativa. Kvinnorna hade ett behov av tillräcklig och adekvat information, delaktighet, stöd utifrån den individuella upplevelsen och bekräftelse vilket är faktorer som kännetecknar personcentrerad omvårdnad. Klinisk betydelse: Beskrivning av kvinnors upplevelser av missfall och den vård som ges i samband med missfall kan öka medvetenheten hos vårdgivare om hur kvinnors individuella behov tillgodoses genom personcentrerad omvårdnad. / Background: Miscarriage is an involuntary termination of pregnancy which may cause feelings of shock, sadness and guilt. The hospital stay for miscarriage is often brief and health professionals have an important role in women's experience and recovery. Objective: The objective was to provide a literature review of women's experience of miscarriage and the care associated with miscarriage. Method: Literature review based on ten scientific articles with a qualitative design. Results: The result consisted of three main themes and associated subthemes. The first main theme was Women's own subjective thoughts and feelings associated with miscarriage with subthemes Loss of a pregnancy, feelings of guilt, anxiety and expectations in future pregnancies. The second main theme was Women's experience of how they were treated by healthcare professionals during miscarriage, with subthemes attitudes and treatment, lack of information. The last main theme was Women need of support in association with miscarriage with subthemes significance of family and kindred, professionals importance. Conclusion: Miscarriage was a shocking experience, often marked by existential pain and grief. Women's experiences of care were often negative. The women had a need for sufficient and adequate information, participation, support based on the individual experience and confirmation, which are factors that characterizes person-centered care. Clinical significance: Description of women's experiences of miscarriage and the care associated with miscarriage can increase awareness among health care providers on how women's individual needs are met through person-centered care.

Professional ethics and legal competencies require midwives practising in New Zealand to provide care for childbearing women in a partnership characterised by continuity, equality, mutual respect, trust, shared responsibility and decision making. New Zealand is culturally and legislatively a bi-cultural environment and the cultural safety of Maori (indigenous peoples) are prioritised within health legislation. The midwifery philosophy of partnership and bi-cultural legislation, have provided a foundation for developing a research methodology for the profession. This thesis stories the interweaving of multiple epistemologies, theoretical tenets, philosophical concepts, indigenous and Western European world views as well as women’s narratives in creating and implementing a contextually relevant qualitative research methodology, ‘Te Whakamaramtanga’. The methodology was trialled in the field of miscarriage; a practice issue for midwives in New Zealand. Research participants were recruited through ‘word of mouth’ and snowballing methods. Twenty women participated in the research project and of these nine identified as midwives. Twelve participants were of Non Maori descent, including four women who were immigrants to New Zealand, and eight participants identified as Maori. Participants’ stories were gathered through dialogical interviews, which recognised the co-construction and exploration of knowledge. Ethical tenets outlined in the methodology involved the use of extensive, ongoing consultation with Maori, midwifery and local communities. Maori, women, and midwives share an oral culture that values narratives as facilitating the constitution of identities, creation and transmission of knowledge, and the development of social relationships. Whole narrative, thematic and narrative elements analyses of participants’ miscarriage-related talk have been developed through drawing on kaupapa Maori philosophy, the social theories of Pierre Bourdieu, Michel Foucault, Bruno Latour, Paul Ricouer, and Rom Harre as well as the narrative concepts of Arthur Frank and Margaret Somers. Substantive chapters explore whakapapa, corporeal temporalities, narrative silences and women’s desires for recognition and relationships. A new theory is advanced that methodologies, narratives, genealogies, temporalities, silences and women voices are simultaneously co-constituted metaphysical and material technologies. These heterogeneous and relational entities are collectively perceived as actants, hybrid actors, actor networks as well as technologies, which exist within a range of dynamic and hierarchical networks and/or fields in which this thesis is also embedded. My development of a multicultural midwifery research methodology informed by multidisciplinary theoretical approaches is innovative for midwifery research and theory, and potentially other health disciplines. My research also addresses gaps in midwifery, miscarriage–related, professional development, Maori health and health research literature.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

This thesis combines quantitative and qualitative methods to examine both women’s psychological wellbeing after miscarriage and the specific coping strategies that are associated with coping well with this event. Chapter 1 reviews the ways in which miscarriage has been defined and its estimated prevalence. As definitions of miscarriage tend to vary across Western countries, the research implications of this are discussed. Chapter 2 reviews the literature related to women’s psychological responses following miscarriage, discussing the main outcomes which have been examined, including depression, anxiety, stress and grief. As the literature is relatively small, and current research is limited by small and non-representative samples, Chapter 3 takes an epidemiological approach by cross-sectionally investigating the psychological correlates, and relevant sociodemographic, reproductive and health-related variables associated with miscarriage using a large population sample of young Australian women. Sociodemographic and reproductive variables most strongly predicted membership of the Miscarriage and No Miscarriage groups, while psychological wellbeing did not distinguish the two groups in the stepwise logistic regression. Using the same data but applying longitudinal methods, Chapter 4 examined whether trajectories of Mental Health, Stress and Optimism varied over time and according to women’s miscarriage status. Relevant sociodemographic and reproductive variables identified in Chapter 3 as possible confounding variables were controlled in these analyses. Miscarriage was found to affect trajectories of Mental Health, Stress and Optimism, with poorer outcomes on all variables for women reporting miscarriage by comparison to women who had never miscarried over a seven-year period. Because miscarriage has significant effects on women’s mental health and wellbeing, the next part of the thesis was dedicated to examining the predictors of, and coping strategies related to, coping well after miscarriage. Since the term coping well is not easily defined, Chapter 5 is a critical review of the theoretical frameworks of coping, with an emphasis on identifying the conceptualisation and measurement problems which have limited advancements in the field. Chapter 6 is a review of the psychological, reproductive and sociodemographic predictors of adjustment to miscarriage, highlighting the conflicting evidence and the need for multivariate methods when analysing these relationships. Using the Australian Longitudinal Study on Women’s Health data, Chapter 7 uses longitudinal methods to investigate predictors of Mental Health among young women reporting miscarriage. Optimism, social support and the number of miscarriages were strong predictors of Mental Health among women reporting miscarriage. Chapter 8 is a review of the research which has examined the coping styles and strategies that women use to cope with miscarriage. The majority of this research tends to be of a qualitative nature, and therefore the next step was to complete interviews with nine women to gain a more in-depth understanding of the specific coping strategies related to positive outcomes after miscarriage. Social support was reported as facilitating adjustment to miscarriage, consistent with the quantitative analyses. Acknowledgement and support from health professionals was also described as facilitating adjustment. While the quantitative analyses had also initially suggested that satisfaction with the general practitioner was an important predictor of adjustment, this variable did not reach significance when other reproductive and psychological variables were controlled for. Taking all the results into consideration, it appears that changes to social norms and attitudes regarding miscarriage may help women to cope with this challenging and distressing experience. Interventions to help women cope with miscarriage need to be grounded in an understanding of women’s need for social and family support, and understanding from health professionals. However, it is essential that interventions should be comprehensively evaluated, and future research in this area is warranted.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (MA (SW Play Therapy))--University of Pretoria, 2003. / Includes bibliographical references.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (D. Min.)--New Orleans Baptist Theological Seminary, 2007. / Abstract and vita. Includes final project proposal. Description based on Print version record. Includes bibliographical references (leaves 139-142, 56-57).

Objetivos: O objetivo do nosso estudo foi verificar se a umidificação dos comprimidos com formulação brasileira de misoprostol vaginal aumenta a dilatação cervical antes da aspiração manual por vácuo (AMIU), em comparação com o uso de misoprostol seco nos abortos espontâneos no primeiro trimestre. O objetivo secundário foi verificar se houve correlação entre o pH vaginal e o grau de dilatação cervical usando um comprimido de misoprostol umedecido ou seco. Métodos: Estudo unicêntrico, duplo cego e randomizado, com 46 pacientes com aborto espontâneo de primeiro trimestre foram alocados aleatoriamente para o tratamento com 400 μg de misoprostol seco ou umedecido (com 200 μl de água destilada). Resultados: A dilatação cervical mediana (intervalo) nos grupos úmido e seco foi de 8 mm (6-12 mm) e 7 mm (5-10 mm), respectivamente ( p = 0,06). O tempo médio entre a inserção de misoprostol e a realização do procedimento não diferiu entre os grupos seco (406 min, intervalo 180-550 min) e molhado (448 min, intervalo 180-526 min) ( p = 0,1). Não foi encontrada correlação entre o pH vaginal e a dilatação cervical usando dados continuos ( p = 0.57; r = 0.08; intervalo de confiança de 95% -0.02, 0.3) ou dados dicotômicos (pH ≤5 /> 5, dilatação cervical ≥8 mm ou <8 mm; p = 0,8). Conclusão: Não foi observada diferença na dilatação cervical entre o uso de misoprostol umedecido e não umedecido antes do AMIU. / Objectives: The aim of our study was to ascertain whether moistening the Brazilian formulation of vaginal misoprostol tablets increases cervical dilation before manual vacuum aspiration (MVA), compared with use of dry misoprostol, in first-trimester miscarriage. The secondary objective was to ascertain whether there was any correlation between vaginal pH and the degree of cervical dilation using a moistened or dry misoprostol tablet. Methods: In a single-centre, double-blind, randomised trial, 46 patients with first-trimester miscarriage were randomly allocated to treatment with dry or moistened (with 200 μl distilled water) 400μg of misoprostol. Results: The median (range) cervical dilation in the wet and dry groups was 8 mm (6–12 mm) and 7 mm (5–10 mm), respectively (p=0.06). The median time between misoprostol insertion and carrying out the procedure did not differ between the dry (406 min, range 180–550 min) and wet (448 min, range 180–526 min) groups (p=0.1). No correlation was found between vaginal pH and cervical dilation using continuous data (p=0.57; r=0.08; 95% confidence interval -0.02, 0.3) or dichotomous data (pH ≤5/>5; cervical dilation ≥8 mm or <8 mm; p=0.8). Conclusion: No difference was observed in cervical dilation between moistened and non-moistened misoprostol use prior to MVA.