Perinatal griefanalysis of the difficulties and facilitating elements of family coping (DPAFIS study)

Abstract

The pregnancy loss -involuntary pregnancy loss and termination of pregnancy for foetal anomaly- and neonatal death cause a varied, dynamic and highly individualized response in parents. Literature recognizes the special characteristics of these losses, due to the multiple losses that such a process entails for parents. However, the stigma surrounding these losses means that they are considered taboo losses and that they are silenced and made invisible in social and health settings. The care provided by health professionals, and especially nurses and midwives, is crucial to the short- and long-term well-being of parents. However, healthcare professionals report being poorly prepared and how stressful and emotional demanding it is to provide care for parents who have suffered these losses. This care is often superficial and based on the performance of procedures. Aims: This doctoral thesis is made up of two main axes. First, to know the experiences of parents in coping with pregnancy or perinatal losses and, later, to know the experiences of midwives and nurses in caring for parents who have suffered an involuntary loss of pregnancy. Methodology: This doctoral thesis is composed of 4 qualitative research studies, of which an empirical study and a meta-ethnography were developed for each objective. Regarding the first aim, 16 Spanish women who suffered an involuntary loss of pregnancy have been interviewed through a grounded theory study and a meta-ethnography of 14 qualitative studies has been carried out to XXVI Abstract synthesize the research results regarding the coping experiences of parents after pregnancy and neonatal losses. For the second objective, a metaethnography was also carried out, which included ten primary qualitative studies to discover the experiences of midwives and nurses in caring for parents who have suffered an involuntary pregnancy loss. In addition, an interpretive phenomenological study was conducted in which 11 primary care midwives were interviewed. Results: Regarding the experiences of parents, the coping strategies of parents were based on the experiences of connectedness/confrontation and disconnectedness/avoidance. These experiences were related through a dynamic process between the two. The use of these elements was conditioned by personal, social and cultural factors. On the other hand, the nurses and midwives who cared for parents who have suffered an involuntary pregnancy loss, faced difficulties that required leaving their comfort zone. This caused them not to get emotionally involved with parents and that, if they did, the care was based on their intuition. Conclusions: The coping strategies of parents were based on the experiences of connectedness/confrontation and disconnectedness/avoidance through a dynamic process between the two. For nurses and midwives, caring for parents who have suffered these losses involved leaving their comfort zone and dealing with difficulties, which caused them not to get emotionally involved with parents or, if they did, it was using their intuition.