Navigating an Uncertain Journey of Pregnancy After Perinatal Loss

Sunday, 29 October 2017: 2:45 PM

Sarah Moore, BSN, BA
Cone Health Alamance Regional Medical Center - Intensive Care Unit, Cone Health System, Burlington, NC, USA
Denise Cote-Arsenault, PhD
Family & Community Nursing, University of North Carolina Greensboro, Greensboro, NC, USA

Objective: This study aimed to gain insight into women’s experiences, anxiety, and prenatal attachment over the course of pregnancy subsequent to prior perinatal loss through written pregnancy diaries.
Background: Grief and bereavement are the most common responses to perinatal loss and may last for months or years (Cacciatore, 2013; Wojner, Swanson & Adolfsson, 2011). Loss at any gestational age is, for the mother, simultaneously the loss of part of self, of a unique child, and of the future with that child (Davis, 2014). Women with a perinatal loss history describe a desire to both get pregnant again to fill the void created by the death of their baby and to maintain a connection to their dead child (Lee, McKenzie-McHarg & Horsch, 2013).
Subjects: Diaries were from 19 pregnant women with a past history of miscarriage, stillbirth, or neonatal death. The participants were primarily Caucasian, 23 to 41 years old, had one to six prior losses, high school to graduate school education, and a wide range of incomes.
Methods: Qualitative design was used following Colaizzi’s steps for phenomenological analysis (Colaizzi, 1978) of diary entries written during an intervention study (Author, Schwartz, Krowchuk & McCoy, 2014).
Results: A metaphor emerged from the data of navigating a pregnancy journey that feels scary and uncertain, towards the goal of reaching their desired destination, a healthy infant, emerged from women’s personal accounts. Six themes were discovered: 1) Staying Alert: Noting Physical Symptoms, 2) Dealing with Uncertainty: Expressing Emotions, 3) Dreaming of the Destination: Evolving Thoughts of Baby, 4) Traveling Together: Connecting with Others, and 5) Moving Forward: Reflecting on Sense of Self. The interaction of several themes is described as 6) Staying on Track: Navigating through Pregnancy.
Conclusion: Women pregnant again after prior perinatal loss made diary entries that included their fears and hopes, ways they coped with their emotions, the evolution of their thoughts of baby, relationships with family and friends, and their own sense of who they were in this pregnancy. Women may find journaling helpful in dealing with the anxiety and fear that characterize pregnancy after loss. The metaphor of navigating an uncertain journey may improve care through greater understanding of the emotional, physical, and social challenges that women experience when they become pregnant again after a perinatal loss.