Evidence-based Intervention with Women Pregnant after Perinatal Loss

Abstract

Abstract:Purpose: To test the feasibility and acceptability of a caring-based nurse home visit intervention for women pregnant after perinatal loss (PAL), the goal of which was to provide a safe, supportive environment, normalize the pregnancy after loss, reduce anxiety and depression through stress reduction skills, and facilitate prenatal attachment.Study Design and Methods: This mixed methods study was conducted in two phases: Phase I, to determine the components of the intervention, and Phase II, a randomized trial that used the revised intervention components. Pregnant women with a history of at least one perinatal loss (9 in Phase I and 24 in Phase II) were recruited from obstetrical practices. Phase II sample size was adequate to detect group differences. Background measures of demographics, obstetrical history, and meaning of past losses were collected at baseline. Measured at three points across pregnancy were threat appraisal of pregnancy; and emotional states: anxiety (pregnancy, state, trait), depression, self mastery, prenatal attachment, and satisfaction with social support. The caringbased nurse home visit intervention included activities aimed to reduce anxiety and promote prenatal attachment. The control group were sent pregnancy information booklets that coincided with their gestational age. Qualitative and quantitative evaluations were obtained.Results: In Phase I, 8 women received the intervention; in Phase II, 13 received the intervention and 11 were in the control group. No baseline between-group differences were found. The intervention group had significantly higher satisfaction with social support over time. Women's evaluations were very positive; home visits were rated most liked and helpful. They appreciated a knowledgeable nurse who knew their story, listened, normalized the PAL experience, and was there with nonjudgmental support.Clinical Implications: The intervention is both feasible and acceptable. Most women felt that they could reduce their own anxiety using the tools and skills they were provided. Healthcare providers should consider past history's impact on current pregnancy experiences and incorporate process and content of the intervention into their practice. Many believe that becoming pregnant again after a perinatal loss from miscarriage, stillbirth, or neonatal death will ease a parent's grief, wipe away the sad memories of loss, and make a woman smile again. However, pregnancy after perinatal loss (PAL) is increasingly recognized as a psychologically stressful period of time (Gaudet, Sejourne, Camborieux, Rogers, & Chabrol, 2010;Hutti, Armstrong, & Myers, 2011). Specifically, in subsequent pregnancies, women with a history of loss report high levels of fear of losing another baby (Côté-Arsenault, Bidlack, & Humm, 2001), greater anxiety specific to pregnancy concerns (Armstrong, 2002;Bergner, Beyer, Klapp, & Rauchfuss, 2008;Côté-Arsenault, 2003), an increased sense of vulnerability, hypervigilance to their pregnancy symptoms (Côté-Arsenault, Donato, & Earl, 2006), and dou...