Grief and ruminative thought after perinatal loss among Turkish women: one-year cohort study

Abstract BACKGROUND: Among women who have suffered loss of pregnancy, the level of grief decreases gradually. Age, mental health status and childlessness are the factors known to mostly affect women's levels of grief. OBJECTIVES: To assess the levels of grief among women who experienced perinatal loss and the changes in their ruminative thought styles over the first year after their loss. DESIGN AND SETTING: One-year follow-up study carried out in a university hospital in Turkey. METHODS: The study population included 70 women who experienced loss of pregnancy in the hospital. The sample size was calculated using G*Power V3.1. Data were collected at 48 hours, at the third month, at the sixth month and at one year after pregnancy loss, between June 2018 and June 2019. A personal information form, the Perinatal Grief Scale and the Ruminative Thought Style Questionnaire were used for data collection. RESULTS: The women's highest levels of grief and ruminative thought style were in the first 48 hours. Their tendency towards grief and ruminative thought styles decreased over the repeated measurements during the follow-up. Women aged 20-29 years had the highest levels of grief at the third month after perinatal loss. CONCLUSIONS: Nursing assessments regarding grief and ruminative thought style over the first 48 hours after perinatal loss should be integrated into nursing care for these women. Grief follow-up programs for these women can be developed through nursing research.

Parto humanizado / Humanized delivery

Resumen Traer un nuevo ser al mundo es uno de los momentos más importantes en la vida de una mujer, y sin duda, una experiencia que marca el resto de sus días. Sin embargo, también es un momento de ansiedad y temor, no solo porque inicia una nueva etapa, sino que también sabemos que es una experiencia dolorosa y para muchas mujeres, traumática. La humanización del parto en las maternidades de nuestro país, tiene como objetivo brindar una atención calificada, adecuada, eficiente y oportuna, según los valores, costumbres y creencias de cada mujer, así como resguardarlos derechos de la familia gestante.

Abstract Bringing a new being into the world is one of the most important moments in a woman's life, and without doubt, an experience that marks the rest of her days. However it is also a time of anxiety and fear, not only because it starts a new stage but we also know that it is a painful and traumatic experience for many women. The humanization of childbirth in the maternity wards of our country, aims to provide qualified, adequate, efficient and timely care according to the values,customs and beliefs of each woman, as well as to protect the rights of the pregnant family.

Significado para las enfermeras de cuidar a las mujeres en duelo perinatal / Meaning for nurses of caring for women in perinatal bereavement

Objetivo: Describir el significado que tiene para las enfermeras cuidar a las mujeres en duelo perinatal, en los servicios de Ginecoobstetricia y Unidad de Cuidado Intensivo Neonatal, de una institución de cuarto nivel de la ciudad de Floridablanca. Metodología: una investigación de tipo cualitativo descriptivo con enfoque fenomenológico, mediante el abordaje Colaizzi; se realizaron 10 entrevistas a profundidad previo consentimiento informado que se grabaron y se trascribieron, en formato PDF se organizaron en el programa Atlas Ti 7.5. Resultados: la experiencia expresada por las enfermeras se codificó, para posteriormente organizarse en 22 subcategorías que se consolidaron en 12 categorías lo que permitió describir el significado así: la enfermera ante el duelo, percepciones de la enfermera, expectativas frente a capacidades de la enfermera, cuidados en duelo, experiencia, sentimientos de la enfermera, familia, interdisciplinariedad, formación académica, limitaciones, la mujer afronta el duelo y mujer adolescente en duelo. Análisis comparado: para las enfermeras cuidar a las mujeres en duelo perinatal está dado por la importancia que tiene para ellas brindar cuidados, pero hay ocasiones en que es difícil intervenir a la mujer, por el dolor que les genera la pérdida, reconociendo la necesidad de brindarle los cuidados y el interés de abordar, comunicar, ser amable, establecer una comunicación bidireccional, escuchar, guiar, apoyar, y colocarse en el lugar de la otra persona, que son características similares con los estudios encontrados, en el grupo de mujeres adolescentes se observó soledad y tristeza, quizá porque es un embarazo no deseado y la actitud tomada frente al cuerpo del feto o bebé fallecido, les generaba llanto y tristeza, distantes, desprendidas, y sin manifestaciones de afecto, aparentemente porque no alcanzan a ver la magnitud de la situación. Conclusión: el "significado para las enfermeras de cuidar a las mujeres en duelo perinatal" es un momento de gran tristeza para la mujer, por lo cual ella se involucra directamente en su cuidado brindando especialmente acompañamiento, escucha activa y empática, apoyándola a ella y su familia. La enfermera, reconoce que son importantes la experiencia profesional y la formación desde el pregrado en relación al duelo, pues fortalecen su desempeño, además, se necesita de todo el equipo interdisciplinario para intervenir a la mujer pero hay limitaciones de infraestructura y políticas de la clínica que interfieren en el cuidado.

Objective: describe what taking care of women during perinatal grief means for nurses in Obstetrics and Neonatal Intensive Care Unit, in a fourth level institution of Floridablanca city. Methodology: a descriptive qualitative research with a phenomenological approach, using the Colaizzi's path; 10 profound interviews were done after getting informed consent. They were recorded and transcribed to PDF format and organized using Atlas Ti 7.5 program. Results: the experience expressed by the nurses was coded. Afterwards it was organized into 22 subcategories that were consolidated into 12 categories which allowed to describe the meaning as follows: the nurse before the grief, perceptions of the nurse, expectations regarding the capabilities of the nurse, grief care, experience, feelings of the nurse, family, interdisciplinarity, academic training, limitations, the woman faces the grief and the teenage woman in mourning. Comparative analysis: for nurses, taking care of women in perinatal grief is due to the importance of providing care for them. There are times when it is difficult to intervene those women, due to the pain generated by the loss, recognizing the need to provide care and interest to address, communicate, be friendly, establish a twoway communication, listen, guide, support, and put yourself in the place of another person, which are similar characteristics related to the studies found. In the group of adolescent women, loneliness and sadness were observed, perhaps due to an unwanted pregnancy and the attitude taken against the body of the deceased fetus or baby. This situation generated tears and sadness, remoteness, detachment, and affectionless manifestations, apparently because they can not see the magnitude of the situation. Conclusion: the "Meaning of taking care of women in perinatal grief, for nurses", is a moment of great sadness for the woman, so she gets involved directly in your care especially providing accompaniment, active and empathic listening, supporting her and her family . The nurse recognizes that are important professional experience and training from the undergraduate in relation to grief because strengthen their performance also needs all the interdisciplinary team to intervene women but there are infrastructure constraints and political clinic that interfere with care.

Escala de duelo perinatal: validación en mujeres mexicanas con pérdida gestacional / Perinatal Grief Scale: Validation in Mexican Women with Gestational Loss

La pérdida de un hijo al inicio de la vida constituye uno de los estresores emocionales más intensos que puede experimentar una mujer. La evaluación de este proceso de duelo requiere contar con instrumentos confiables y válidos. El objetivo del presente trabajo fue determinar las características psicométricas de la Perinatal Grief Scale (Escala de Duelo Perinatal, EDP) en una muestra de mujeres mexicanas que habían experimentado pérdidas perinatales. La escala fue traducida, retraducida, piloteada y adaptada, para finalmente aplicarla a 200 mujeres que habían experimentado una o más pérdidas perinatales y que asistían a una clínica especializada. Los datos fueron sometidos a los procedimientos estadísticos usuales de validación (análisis de distribución de frecuencias, comparación de grupos extremos, análisis factorial exploratorio y análisis factorial confirmatorio, así como correlación entre subescalas) y de evaluación de consistencia interna, obteniendo índices adecuados de confiabilidad y validez. La EDP quedó conformada por 27 reactivos, agrupados en cuatro subescalas: duelo activo, depresión, culpa y aceptación. Se discute su utilización en la investigación y en la práctica clínica.

Losing a child at the beginning of life is one of the most intense emotional stressors that may experience a woman. The evaluation of this mourning process requires reliable and valid instruments. This study aimed to determine the psychometric characteristics of the Perinatal Grief Scale (PGS) in a sample of Mexican women who had experienced perinatal loss. The scale was translated, retranslated, tested and adapted to finally be applied to 200 women who had experienced one or more perinatal loss and were attending a clinic. Data were subjected to the usual statistical procedures of validation (analysis of frequency distribution, comparison of extreme groups, exploratory factor analysis and factor analysis confirming, as well as correlation between scales) and evaluation of internal consistency, obtaining appropriate indexes of reliability and validity. The Perinatal Grief Scale (EDP) was formed by 27 items, grouped in four scales: active grief, depression, guilt, and acceptance. Its use in research and clinical practice is discussed.