The impact of miscarriage and stillbirth on maternal-fetal relationships: an integrative review.

OBJECTIVE: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal-fetal relationships subsequent to miscarriage and stillbirth. BACKGROUND: Although now widely accepted that the relationship between mother and child develops in utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy. METHODS: An integrative review methodology was chosen for the review. RESULTS: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal-fetal relationship, and coping following perinatal loss and the subsequent maternal-fetal relationship. CONCLUSIONS: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal-fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother-fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal-fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.

¿Siente dolor el feto?

Objetivo: Analizar una variedad de estudios publicados sobre el dolor fetal. Desde hace más de un siglo, investigadores clínicos y básicos han estudiado la posibilidad de que el feto sienta dolor. Este tema ha aumentado en relevancia debido al uso creciente de técnicas invasivas para diagnóstico y tratamiento fetal, y además por ser sustrato social de confrontación entre partidarios y adversarios del aborto. La pregunta fundamental es si el sistema nociceptivo del feto adquiere un desarrollo neurobiológico suficiente como para generar la experiencia mental que llamamos dolor. En el presente artículo, comenzamos con las etapas del desarrollo del sistema nociceptivo humano. Luego abordamos los aspectos éticos. Seguidamente discutimos si las manifestaciones conductuales, hormonales, hemodinámicas y electroencefalográficas del feto son evidencia de que ya tiene una mente y es capaz de sentir dolor. Conclusiones: No parece probable que el feto sienta dolor antes de la semana 20 de gestación; quizás pueda comenzar a sentir dolor entre las semanas 22 y 26. Sea cual sea la respuesta definitiva a la pregunta fundamental planteada más arriba, ante abordajes invasivos del feto, es recomendable usar analgesia o anestesia.

Objective: To analyze a variety of published studies on fetal pain. For a long time now, clinical and basic researchers have dealt with the question of whether the fetus is able to feel pain. The relevance of this subject has augmented in view of the increasing use of invasive techniques for fetal diagnosis and treatment, and also because of social strife between advocates and adversaries of abortion. The fundamental question here is whether the fetal nociceptive system has reached sufficient development for generating the mental experience that we call pain. We start with the developmental stages of the human nociceptive system. Then we approach the ethics of the problem. We further discuss whether the behavioral, hormonal, hemodynamic and electroencephalographic manifestations of a fetus are evidence for a mind capable of feeling pain. Conclusions: It seems unlikely that a fetus feels pain before week 20 of gestation; the fetus might be able to start feeling pain at weeks 22-26. We finally conclude that, whatever the answer to the fundamental question posed above, upon invasive approaches to the fetus the use of analgesia or anesthesia is recommended.

Etude comparative du vécu psychique de femmes vivant une grossesse gémellaire ou unique / Comparative study of the psychological experience of women carrying a twin or a singleton pregnancy / Estudo comparativo da experiência psicológica de mulheres grávidas de gêmeos ou de um único bebê

Quelle incidence de porter deux enfants sur l'expérience psychique des femmes ? Dans cette étude qualitative et comparative, nous avons rencontré dix femmes enceintes: trois de jumeaux de même sexe, trois de jumeaux de sexe différent et quatre d'un enfant unique. Elles ont répondu à un entretien semi-directif, à une échelle de représentations sémantique-différentielle et réalisé deux dessins. Les résultats montrent l'intérêt de favoriser les échanges entre les femmes enceintes de jumeaux, afin de faciliter leurs identifications et de les rassurer sur leurs compétences maternelles. Ils soulignent aussi la nécessité de proposer un espace pour que les femmes enceintes de jumeaux de même sexe, notamment, puissent verbaliser leurs peurs et leurs fantasmes concernant leurs enfants et la relation gémellaire qu'ils pourraient entretenir.

What is the impact of carrying two fetuses on the psychological experience of women? In this qualitative comparative study, ten women have been met: three were expecting samesex twins, three were expecting sex-different twins, and four women were carrying a singleton pregnancy. They responded to a semi-structured interview and to a semantic-differential maternal representations scale, and have drawn two pictures. The results underscore the need of encourage women expecting twins to discuss with other women experiencing the same situation in order to facilitate their identification processes and to support their maternal sense of competence. In particular, it's important to offer women expecting same-sex twins the opportunity to verbalize their fears and projections regarding their fetuses and their future twin relationship.

Qual é o impacto de esperar gêmeos para a experiência psicológica da mulher grávida? Neste estudo qualitativo e comparativo, dez mulheres grávidas foram encontradas: 3 grávidas de gêmeos do mesmo sexo, 3 de gêmeos de sexo diferente e 4 esperando um único bebê. As mulheres responderam a uma entrevista semidiretiva e a uma escala semântica-diferencial de representações maternas, e realizaram dois desenhos. Os resultados mostram a importância de se favorecer as trocas entre mulheres grávidas de gêmeos para facilitar seus processos de identificação e tranquilizá-las quanto às suas competências maternas. Afirmam também a necessidade de proporcionar um espaço, sobretudo para mulheres esperando gêmeos do mesmo sexo, para que possam verbalizar seus medos e fantasias com respeito aos seus filhos e à relação gemelar que poderão estabelecer.

A ultrassonografia obstrética e suas implicações para a relação materno-fetal / The obstetric ultrasound and its implications on mother-fetus relationship

O objetivo desta pesquisa foi investigar as implicações emocionais da ultrassonografia obstétrica para a relação materno-fetal, no contexto de normalidade fetal. Participaram 11 gestantes primíparas, com idades entre 18 e 35 anos e idades gestacional entre 11 e 24 semanas, que estavam sendo submetidas pela primeira vez à ultrassonografia. Elas responderam a uma entrevista semiestruturada e à Escala de Apego Materno-Fetal, antes e depois do exame. Análise de conteúdo qualitativa das entrevistas mostrou que a ultrassonografia, além de modificar a visão da mãe sobre o bebê, que passou a vê-lo de uma forma mais real e concreta, intensificou os comportamentos de interação mãe-bebê, ou seja, ampliou as diferentes maneiras de interagir e fortificou os sentimentos maternos, fazendo com que a mãe se sentisse mais apropriada de seu papel. Análise estatística revelou um aumento significativo na média dos escores da escala de apego após o exame. Juntos, os resultados indicam que a ultrassonografia parece ter exercido um impacto importante nas gestantes influenciando a relação mãe-bebê.

This study aimed to investigate the emotional implications of obstetric ultrasound for the maternal- -fetal relationship, in the context of fetal normality. Eleven primiparous pregnant women, aged 18 to 35, with gestational ages between 11 and 24 weeks, who were being submitted to ultrasound for the first time, took part in the study. They answered a semi-structured interview and the Mother-Fetus Attachment Scale, before and after the examination. Qualitative content analysis of the interviews revealed that ultrasound, in addition to modifying the mother’s view about the baby, now seen as more real and concrete, has intensified mother-baby interaction behaviors, expanding the different ways of contact, and strengthening maternal feelings, making the mother feel more appropriate in its role. Wilcoxon Test revealed a significant increase in mother-fetus attachment after the examination. Taken as a whole, the results indicate that ultrasound had an important emotional impact on pregnant women, influencing mother-baby relationship.