Capstone Project on "Perinatal Loss Support at Time of Diagnosis"

Capstone Project 15 pages (5174 words) Sources: 15 Style: APA

[EXCERPT] . . . .

Perinatal Loss Support at Time of Diagnosis

The magnitude of perinatal loss measured by statistics is significant. The magnitude of the impact and consequences of perinatal loss on the parents who experience it is an area which merits more detailed investigation. Adaptation to the loss of a pregnancy at any gestational age is a crisis to any parent, many of whom have had little experience coping with death. Approximately 25% of all pregnancies end in some type of loss (i.e., miscarriage, ectopic pregnancy, stillbirth, or neonatal death) (Woods & Esposito, 1987).

The interventions by health care professionals provided to bereaved parents must be delineated and defined from the beginning of suspected or actual diagnosis to best meet the individual needs of grieving couples. An understanding of both the ubiquity and individuality of the grief process, especially as related to perinatal loss, is a precursor to the formulation of specific nursing strategies designed to meet the unique need of bereaved parents. When implemented, these strategies may assist the couple in their adaptation to the loss as they progress through the bereavement process.

While many couples today are waiting longer until their lives are settled to conceive, few woman and even men anticipate or even acknowledge a pregnancy outcome that is less than optimal. Despite all the latest medical advances and technology, not all pregnancy outcomes produce a healthy child; and unfortunately they occur for many reasons from cardiac genetic defects to idiopathic cases. When they do, the emotional responsibility of caring for the grieving couple and family will depend on how the nurses react and handle the situation. How can the nurse's best be prepared for these challenging situations and tasks? The health care system and care providers need to be knowledgeable in the bereavement care so they are able to counsel and educate parents through this journey and provide hospice holistic care to meet the unique needs of them and their unborn baby. Palliative Bereavement Care Services can begin as soon as the poor outcome of the news is delivered to the parents. The overall goal is to provide medical and ethical care meeting the needs of the grieving parents as well as providing them with emotional support with empathetic care and this will therefore decrease complicated grief outcomes, resentment, and progression of depression to the mother and family because the patient will realize that they are not traveling this journey of a crisis alone.

Statement of Problem

Perinatal loss encompasses many negative pregnancy outcomes including miscarriage, stillbirth, therapeutic abortion, and neonatal death. One in five women suffers a perinatal loss.

Literature Review

Armstrong (2007) states that perinatal loss '...includes fetal death (early or late) or neonatal death within the first 28 days of life. The incidence of early fetal death (before 20 weeks' gestation) is conservatively estimated at 1 in 6 pregnancies.1 in 2002, fetal death after 20 weeks' gestation and neonatal death was reported at 11.1 per 1000 live births." The work of Armstrong (2007) entitled: "Perinatal Loss and Parental Distress After the Birth of a Healthy Infant" reports a study with the purpose of determining "...whether levels of depressive symptoms and current stress related to prior perinatal loss differ from similar prenatal evaluations after the birth of a subsequent healthy full-term infant and investigate differences in depressive symptoms in the postpartum period among parents with and without a history of perinatal loss." (Armstrong, 2007)

According to the study of Armstrong of the original 206 parents participating in an earlier prenatal study 74 participated at follow up and these were divided into two groups, one group with a history of perinatal loss and one group with no prior losses. The study was conducted through telephone surveys and interviews and data analyzed through use of descriptive statistics, chi-square tests, t-tests and Pearson correlations. Primary outcome measures used were the Impact of the Event Scale (IES), which is an instrument used in evaluating the ongoing influence of a live event in the past of great stress. Armstrong reports the results of the study to include a "significant overall decrease in depressive symptoms after the birth of a healthy infant for fathers but not for mothers with prior perinatal losses." (2007)

One third of the mothers with a history of loss are reported to have "continued to report CES-D scores that placed them at a high risk for depression." (Armstrong, 2007) Perinatal losses are "traumatic events in the lives of parents and may have long-term consequences for the psychological health of families." (Armstrong, 2007) Following a perinatal loss depressive symptoms, anxiety, guilt, prolonged grieving and feelings of loss are experienced by parents. Perinatal losses are "traumatic events in the lives of parents and may have long-term consequences for the psychological health of families. The incidence of depressive symptoms, anxiety, guilt, prolonged grieving, and feelings of loss of control experienced by parents increases after perinatal loss." (Armstrong, 2007)

Pregnancies following perinatal loss tend to be stressful for both mothers and fathers. In fact mothers and fathers expecting a child and who have had an experience of perinatal loss often experience increased anxiety and symptoms of depression and for some women "perinatal loss is described as a life-changing event. Moreover these women reported a lack of confidence in the outcome of subsequent pregnancies which continues after the birth" of a healthy child and express feelings of fear that they also would lose the healthy child. While it is unclear as to whether perinatal loss results in depression even after the birth of a healthy child there is evidence that increased psychological stress affects the woman in terms of postpartum depression and results in an affect on the woman's ability to function "as well as on the cognitive and behavioral development of infants whose mothers were diagnosed with this psychopathology. While "Maternal postpartum depression presents substantial adverse consequences for family functioning, partnered relationships, and maternal-infant interactions, depression is stated to be "...recognized and treated in as few as 10% of those affected." (Armstrong, 2007)

Maternal prenatal depression is stated to increase "the risk for the negative effects of this condition the mothers' newborns as early as the neonatal period. In addition, depressive symptoms during pregnancy can increase the risk for depression during the postpartum period." (Armstrong, 2007) in addition, it is related that "neonates of mothers with high depressive symptoms displayed physiological and biochemical mechanisms associated with depression compared with newborns of nondepressed mothers as early as the first postpartum week." (Armstrong, 2007)

Another problem that has been noted in research is that there is a link between "maternal unresolved loss or trauma as a result of perinatal loss and the development of disordered attachment relationships between infants and mothers. In a study of 19 mother and their infants born 12 to 19 months after a perinatal loss, the risk for disturbed attachment relationships were evaluated." (Armstrong, 2007) Findings reveal that 45% of infants "had disorganized attachment relationships with their mothers at 12 months of age. This is stated to have been substantially higher than the expected prevalence of 15% for disordered attachment relationships found in other middle-class samples." (Armstrong, 2007)

Armstrong relates that it is not clear as to 'what level increased psychological distress observed during subsequent pregnancies" is ongoing following the birth of a healthy child. It is important to understand the path that the psychological stress of parents takes following perinatal loss and the nurse is in a unique position to assist with this acquisition of knowledge in their position of "working with expectant parents" and in indentifying those parents that would be at the most risk for ongoing psychological stress.

Armstrong (2007) reports that the aim of the study she reports was two-fold:

1) Determine whether levels of depressive symptoms and continued stress related to the previous loss differ from similar prenatal evaluations; and 2) Investigate differences in depressive symptoms in the postpartum period among parents with and without a history of perinatal loss.

Research questions posed by Armstrong include the following questions:

1) Does the level of depressive symptoms and current stress related to their previous loss differ after the birth of a subsequent healthy infant compared to prenatal assessments for mothers and fathers with a history of prior perinatal loss?

2) Do depressive symptoms differ after birth when comparing mothers and fathers who have experienced prior perinatal loss with those mothers and fathers without such a history? (Armstrong, 2007)

Armstrong reports in her results that while there was only a small sampling in this followup study and issues a caution in terms of generalization of the findings due to interpretation variation that there is a suggestion in the study findings that there is a need for followup on parents who have experienced perinatal loss and then follow with the birth of a healthy child in order to avoid psychological harm for both parents and the healthy newborn child that follows a perinatal loss. Developmental harm is also suggested as an outcome for the healthy newborn child following parent's… READ MORE

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