Chinese culturally bound taboos against talking about perinatal loss related issues. The experience of pregnancy loss can be devastating and potentially traumatizing for women emotional and psychological health regardless of what kind indications for the perinatal loss and selective termination. However, maternal postpartum care still less concerning provide supportive bereaved care for parents. How to solve this clinical dilemma and to establish an appropriate compassionate bereavement support challenges care-givers in perinatal medicine.
The main purpose of this study were to explore the experience in Taiwanese women with perinatal loss due to non-elective indications (such as IUFD, spontaneous abortion and preterm premature rupture of membrane..) or elective termination due to fetal gene or chromosome defect. Thus, we examined (1) the trend changing in grieving adaptation, emotional depression and quality of life during six months after who had perinatal loss. (2) to compare the difference between the non-elective indication and elective indications two subgroups in grieving adaptation, emotional depression and quality of life. (3) to identify the influencing factors (maternal age, the indication of perinatal loss, gestational age), maternal self-efficacy and self-esteem, are related with the perinatal grieving, depression and quality of life.
Methods:
This study is a retrospective with cross-sectional research design. Data were collected at the Outpatient Department of a medical center in North Taiwan by consecutive samplings method. All participations were assessed by a trained interviewer with structure interview using several measurement scales, including (1) Background information form, (2) The perinatal grief scales (3) Becker depression scale (4) Self-esteem scale (5)self-efficacy scale and (6) Short form 12 heath survey (SF-12).
Results:
Total forty seven participations were recruited and divided into non-elective perinatal loss subgroup (53.2%) and elective termination subgroup (46.8%). Additionally, all participants were divided into three subgroups depended on the time since their experience perinatal loss/termination after hospital discharge with range from 6-8 months (40.4%), 3-4 months (38.3%) and 2 months (21.3%). The results presented that (1) both the time range and the indication in perinatal loss were not significant influencing factors of all of our measuring. But between the non-elective and elective subgroups there were significance differences existed in the perinatal grief subscale and Becker’s subscales. (2) The average total scores of mental component (MCN) in SF-12 of the non-elective and elective two subgroups were far below the norm. MCN score had significant positive association with the participant’s self-esteem and self-efficacy, but with significant negative association with perinatal grief score and Becker depression score. (3) No matter the participants had held their deceased infants /fetus or not, there were no statistic difference in the measuring tools.
Conclusion:
Although its grief reactions over time will gradually calm down, the participant still need medical professional assistance to provide continued support for identification the value of their deceased infants /fetus exist and to obtain export emotions. We anticipate these results will be benefit to construct the clinical educational programme for caregivers and practice care model for bereaved parents. Eventually, to promote the quality of care and to encourage the related health policy making in both gender friendly medical environment.