Objectives: The purposes were to (1) inductively content analyze women’s appraisals of how miscarriage affected their couple and sexual relationships during the first year after loss and (2) at a year post loss examine the differences in contexts, meanings, resources, and emotional responses amongst women who claimed their couple and sexual relationships had become closer, ‘as it was’, or more distant since miscarrying.
Design: This prospective longitudinal study involved inductive content analysis followed by quantitative analysis for differences amongst qualitatively derived comparison groups. Data were collected via mailed surveys at 1, 6, 16, and 52 weeks post miscarriage.
Population, Sample, Setting, Years: Between 1990 and 1994, 242 women were non-randomly selected through healthcare provider referral. Selection criteria included: miscarriage at less than 20 weeks; enrollment within five weeks of loss; and able to speak and write in English. Surveys were completed in subjects’ homes. Data from 171 women were available for these analyses.
Variables: Lazarus’ theory of emotions and adaptation guided the project. Written responses to the following questions were analyzed “How has your miscarriage affected your relationship with your partner? How has your miscarriage affected your sexual relationship? Dependent variables for the quantitative analysis included couple and sexual relationship appraisals (closer, as it was, more distant) at 12 months. Independent variables included: context (obstetrical history, demographics, events since loss), meaning (miscarriage impact), resources (emotional strength, coping, partner caring), and emotions (anger, depression, anxiety).
Methods: Written responses were content analyzed for self-defined effects on sexual and couple relationships. Responses were first inductively coded and counted. Similar codes were then collapsed and nominally categorized into three relationship appraisals: closer (c), as it was (w), and more distant (d). ANOVA followed by Scheffe procedures were used to determine differences amongst couple and sexual relationship appraisals.
Findings: At one year 23% described their couple relationship as closer (strengthened relationship or shared loss), 44% as it was, and 32% more distant (not as close, her loss only, afraid of trying again, and anxiety between us). Sexually, 6% claimed to be closer (choosing contraception, sex is a loving reassurance, pleasure), 55% as it was, and 39% more distant (avoiding intercourse, sex is less than it used to be, a functional necessity, fearful reminder of loss, source of anxiety). Variables that significantly differentiated (p < .05) amongst appraisals of couple relationships included: having children (c < w), gestational age at loss (c < d), being pregnant again (c&w < d), negative life events since loss (w < d), partner caring by doing helpful things (c&w < d) and sharing feelings (c > w&d), miscarriage impact (w < c&d), passive coping (w < c&d), emotional strength (c&w > d), depression (c&w < d), anger (w < d), and anxiety (w < d). Variables that significantly differentiated (p < .05) amongst appraisals of sexual relationships included: gestational age at loss (w < d), being pregnant again (w > c&d), negative life events since loss (w < d), partner caring by doing helpful things (w > d) and sharing feelings (w > d), miscarriage impact (w < d), passive coping (w < d), emotional strength (w > d), depression (w < d), and anger (w < d).
Conclusions: Close to 1/3 of women claimed that miscarriage took a negative toll on their couple and sexual relationships. Significant differences in contexts, meanings, resources, and emotional responses were identified.
Implications: Interventions are needed to assist women and their partners to anticipate and manage the potential deleterious effects of miscarriage on their couple and sexual relationships.
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