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.

Bakgrund Perinatal förlust har en stor emotionell påverkan på föräldrar och familjer. Sjuksköterskan är utbildad i omvårdnad och ska ha ett etiskt förhållningssätt, kunna ge stöd, visa medkänsla och främja hälsa samt mänskliga rättigheter. Sjuksköterskan har en viktig roll i att lindra lidande och vårda patienter som upplever kris och/eller sorg. Syfte Syftet var att beskriva sjuksköterskors upplevelser av att vårda patienter som genomgår perinatal förlust. Metod Metoden var litteraturöversikt med kvalitativ ansats. Litteratursökningen gjordes i Cinahl Complete och MEDLINE och åtta kvalitativa och två kvantitativa artiklar inkluderades i resultatet. Resultat I resultatet framkom tre huvudteman. Första temat beskrev sjuksköterskors egna emotionella upplevelser av perinatal förlust. Andra temat handlade om olika hanteringsstrategier för att hantera känslor. Sista temat beskrev betydelsen av kunskap inom sorgevård och känslohantering för att kunna ge god omvårdnad och hantera sina känslor. Slutsats Slutsatsen i litteraturöversikten är att sjuksköterskor påverkas emotionellt vid vård av perinatal förlust, samt att utbildning är av stor vikt för god omvårdnad inom denna vård. Därav krävs mer utbildning i sorgeomvårdnad samt känslohantering och hanteringsstrategier för att kunna hantera dessa känslor, för att skapa ett öppet klimat bland kollegor och stöd från ledningen med rum för ventilation och reflektion, för att på så sätt kunna ge bättre omvårdnad med hög kvalité. / Background Perinatal loss has a great emotional impact on parents and families. ​The nurse is trained in nursing and must have an ethical approach, be able to provide support, show compassion and promote health and human rights. The nurse has an important role in alleviating suffering and caring for patients experiencing crisis and/or grief. Aim The aim was to describe nurses experiences of caring for patientes who have undergone perinatal loss. Method Systematic literature review with 8 qualitative and 2 quantitative articles using mixed methods. Results The results revealed three main themes. The first theme described the nurses' own emotional experiences of perinatal loss. The second theme was about different coping strategies for dealing with emotions. The last theme described the importance of knowledge in bereavement care and emotional management in order to provide good care and manage one's emotions. Conclusions The conclusion in the literature review is that nurses are emotionally affected when caring for perinatal loss, and that education is of great importance for good nursing in this care. As a result, more education is required in bereavement care as well as emotional management and coping strategies to be able to handle these emotions, to create an open climate among colleagues and support from management with room for ventilation and reflection, in order to be able to provide better care with high quality.

Nurses should play a key role in providing not only information on the physical aspect, but also the psychological/emotional aspects involved in having an abortion. The purpose of this review was to determine the appropriateness of nursing interventions to screen, counsel, and educate women pre- and post-abortion. The online databases used to conduct this integrative review of research included CINAHL, Medline, Psychinfo, and Psycharticles. Articles selected were published between 1997 and 2009 in the English language. Key search terms included "abortion," "counseling," "education," "guilt," "anxiety," "coping," "perinatal loss," and "support." Eighteen studies were reviewed, revealing the lack of screening, education, and counseling for women both before and after abortion. The current two-weeks postabortion follow-ups do not take into account the long-term emotional effects of abortion which may include anxiety, guilt, shame, isolation, stigmatization, substance abuse, and suicide. Support from nurses, family, and support groups have shown to be effective interventions.

The present study explored how emotional cushioning (EC) buffered the relationship between grief intensity of perinatal loss and relationship satisfaction among women who have experienced pregnancy after loss. It was hypothesized that higher levels of grief intensity would be negatively associated with relationship satisfaction among women. Additionally, it was hypothesized that higher levels of EC would lessen the negative relationship between grief intensity of perinatal loss and relationship satisfaction among women. Through the use of a hierarchical linear regression, it was determined that grief intensity was not significantly associated with relationship satisfaction and that EC did not serve as a buffer between grief intensity and relationship satisfaction. However, a significant correlation was found between EC and relationship satisfaction. The results of this study can help contribute to the literature by providing more discussion about utilizing systemic approaches for clients who have experienced perinatal loss and pregnancy-related anxiety.

Made available in DSpace on 2016-04-28T20:39:17Z (GMT). No. of bitstreams: 1 Tese.pdf: 2686264 bytes, checksum: 6bde964fff23e8b3a35c4e9643f2b0d8 (MD5) Previous issue date: 2006-06-20 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present study is about the familiar grief process for stillbirth. Vast is the literature about physical, psychological and social aspects of pregnancy, but insufficient is the reference to cases where the pregnancy goes well, but the baby bourns dead. The World Health Organization defines a stillbirth as a pregnancy product with more than 500g that doesn t show life signs . According to IBGE, in 2003, 16.909 was the number of stillbirths in Brazil. Beyond the analysis of the construction of death and childhood concept, of the pregnancy process, familiar grief and perinatal grief, we pursue the following objectives: recognize the existence of a grief process after a stillbirth and its impact under the familiar system; identify ways of reaction and adaptation of the family; and identify ways to help the family in your grief for stillbirth. The data were collected in Boa Viagem CE. Through the study of four cases and based on Systemic Family Approach, we arrive to the following points: the impact of a stillbirth in the family is undeniable e its consequences reach all members. The four families made reference to the difference between fulfillment at the pregnancy versus the emptiness after the loss. In respect to the marital relation, it seems that, instead to dissolve (as the literature sometimes suggests) the way they use to be gets more intense. The extreme importance of the social support became manifest. Two things were very frequent: the distress caused by the lack of evidence of the baby s existence and the guilt, sometimes self inflicted, sometimes direct to the doctor or to health staff. Give patients sedative were a very common practice in theses cases, considered negative by the families. In opposition to the literature, none of the families wanted a subsequent pregnancy. However, only longitudinal researches e and with a larger sample could give more consistency to our conclusions / O presente trabalho trata do processo de luto familiar por um natimorto. Vasta literatura é dedicada aos aspectos físicos, psicológicos e sociais da gravidez, mas escassa é a referência aos casos onde a gravidez segue seu curso normal, mas não tem êxito, ou seja, em que a criança nasce morta. A OMS define o natimorto como sendo o produto de gestação com mais de 500g que não apresente sinais de vida ao nascer . Segundo dados do IBGE, em 2003, o número de natimortos no Brasil chegou a 16.909. Através da análise da construção do conceito de morte e de infância, do processo de gravidez, luto familiar e luto perinatal, perseguimos os seguintes objetivos: reconhecer a existência de um processo de luto subseqüente á ocorrência de natimorto e seu impacto sobre o sistema familiar como um todo; identificar padrões de reação e adaptação ante a tal ocorrência por parte da família; e identificar maneiras de auxiliar a família em seu processo de luto por natimorto. A coleta de dados se deu no município de Boa Viagem CE. Por meio do estudo de quatro casos e baseados na Abordagem Familiar Sistêmica, chegamos aos seguintes pontos: o impacto de um natimorto na família é inegável e suas conseqüências chegam a atingir todos os membros. As quatro famílias fizeram referência à disparidade do sentimento de completude experimentado na gravidez e do vazio depois da morte. Quanto à relação conjugal, nos parece que, ao invés de se dissolver (como às vezes sugere a literatura) há uma intensificação do padrão anterior. A rede de apoio revelou-se de extrema importância. Dois fenômenos foram muito freqüentes: o desconforto causado pela falta de provas da existência do bebê e a culpa, ora auto dirigida, ora dirigida ao médico ou à equipe hospitalar. Ministrar calmantes às pacientes foi prática comum nesses casos, tendo sido vista como negativa pelas famílias. Contrariando a tendência da literatura, nenhuma família desejava uma gravidez subseqüente. No entanto, apenas pesquisas longitudinais e com maior número de casos poderão tornar nossas conclusões mais consistentes

This dissertation is focused on mapping the needs and development of experiencing the prenatal loss integration process in mothers, whose child died during the second or the third pregnancy trimester or suffered stillbirth. The goal of this dissertation is to suggest optimal intervention, which would prevent the progress of complications in terms of psychological disorders (PTSD, PAS). The theoretical part describes prenatal loss from the aspect of incidence and etiology and the loss of a close relative in general. It also focuses on the specifics of prenatal loss, the topic of crisis and its experience, phases of crisis, definition of the term "psychosocial intervention" and demarcation of its existing forms. This part also offers several perspectives and attitudes to the topic of grief as a process of hard life experience integration. It also describes several phases and problems connected with their fulfillment. The empirical part focuses on surveying the experiences and needs of women, who have suffered with prenatal loss. It also follows the approaches and circumstances, means of support, which helped women to cope with such an experience. It also tries to identify such aspects, which hindered this acceptation or made it more complicated. Research inquiry involves 13 depth interviews, which...

[pt] O luto vivenciado a partir de uma perda gestacional ou neonatal apresenta características e reações semelhantes a outros tipos de luto, entretanto, muitas vezes é não-reconhecido (Doka, 1989). Espera-se que a chegada de um novo bebê seja capaz de resolver o luto. O vínculo entre cuidador primário e a criança é fundamental para a sobrevivência física e emocional e, por isso, essa relação inicial é tão importante para o desenvolvimento de todos os indivíduos. O objetivo da pesquisa foi investigar as repercussões da perda gestacional ou neonatal prévia no processo de construção do vínculo da mãe com o bebê que nasce durante o processo de luto. O estudo de cunho qualitativo entrevistou 17 mulheres que tiveram ao menos uma perda gestacional ou neonatal e tiveram um novo bebê após a perda. Os resultados demonstraram a necessidade das mães explicarem detalhadamente a experiência de perda, em uma possível busca de construção de sentido. A tristeza e a culpa foram identificadas como principais reações frente ao luto que foi vivenciado de maneira silenciosa. A maioria das mães referiu medo relacionado à gravidez subsequente e à vinculação com o bebê durante o período gestacional. O contato corporal foi o principal sistema parental identificado nas interações. O trabalho concluiu que apesar de serem comuns e frequentes e, muitas vezes não- reconhecidas, perdas perinatais são vividas de maneira singular, repercutem nas interações e não são resolvidas com o nascimento de um novo bebê. Acredita-se que esse estudo possa contribuir para a legitimação e o reconhecimento do luto por perda gestacional e neonatal e para a maior atenção às interações iniciais nesse contexto. / [en] The grief experienced after a miscarriage, stillbirth, or neonatal loss presents characteristics and reactions similar to other types of bereavement although it is often unrecognized (Doka, 1989). It is expected that the arrival of a new baby should be able to resolve the grief. The bond between the primary caregiver and the child is fundamental for physical and emotional survival and that is why this initial relationship is so important for the development of all individuals. The objective of this research was to investigate the repercussions of a previous perinatal loss in the process of building the mother s bond with the baby born during the grieving process. The qualitative study interviewed 17 women who had at least one perinatal loss and had a new baby after such loss. The results demonstrated the need for mothers to explain the loss experience in detail, possibly searching for the meaning reconstruction. Sadness and guilt were identified as the main reactions to the grief, which was experienced silently. Most mothers reported fear related to the subsequent pregnancy and to bonding with the baby during the gestational period. Body contact was the main parental system identified in the interactions. The study concluded that, although common and frequent and, many times, unrecognized, perinatal losses are experienced in a unique way, impact on interactions, and are not necessarily resolved with the birth of a new baby. We believe that this study may contribute to the legitimacy and recognition of mourning from perinatal loss and to greater attention to the initial interactions in this context.

The dissertation discusses theis sues of psycho-socio-spiritual care of midwives for a woman after perinatal loss and is mainly focused on interventions that help building an attitude towards perinatal loss (farewell rituals with a baby, collection of mementos) and their influence on grieving process of women after perinatal loss. The objective of the empirical part of the study was to thoroughly describe the experiences of Czech women with parting with a child after perinatal death and investigate the impact of this experience on the grieving process after the perinatal loss. Thesub-objective of the thesis was to validate the Czech version of the Perinatal Grief Scale. We used a mixed methods research design to fulfill the dissertation's objectives. The analyses of qualitative and quantitative data were performed separately and integrated during the interpretation of research findings. The study sample comprised of total 102 women who experienced perinatal loss. The detailed description of experience of Czech women with interventions related to parting with the deceased child was dominated by the decision making process of women about farewell rituals (seeing and holding the baby, receive mementos of it). The key factors that influenced the decision making process were classified as internal (the need of the woman to get to know her child, doubt and fear of contact) and external (emotional support, information provided and a relationship with the midwife/ attending doctor) during our research. The research proved a significant influence of the independent decision of the woman about the contact with her deceased child on the intensity of grief. Grief of women who decided on their own and were confident about their decision was statistically less severe than grief of women whose decision was made by the medical personnel instead. We were checking the intensity of grief of women after perinatal loss using the newly validated Perinatal Grief Scale instrument that can be used as a single factor scale in the Czech Republic. Reliability of the research instrument was established using Cronbach alpha coefficient (? = 0.9545) and indicated high reliability. The outcomes of the mixed research point towards necessary changes in the psycho-social care of midwives for women after perinatal loss.