Healthcare Utilization in the Pregnancy Following a Perinatal Loss

Abstract

Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early postpartum with requests for additional healthcare resources. Nurses need to listen with compassion, providing appropriate education and information, and make referrals to mental healthcare providers and support groups as indicated. These nursing interventions during the subsequent pregnancy may be a better use of healthcare resources than providing extra, but medically unnecessary, laboratory and ultrasound testing for the sole purpose of fleeting reassurance.

Evidence-based Intervention with Women Pregnant after Perinatal Loss

“…Fear of further loss and grief, as well as disloyalty to babies who have died, often delay preparation for and attachment to the unborn baby (Côté-Arsenault & Donato, 2007; cautious optimism is common. It is somewhat logical then that women PAL have greater healthcare utilization, and thus higher costs, due to concerns about the baby than women without a perinatal loss history (Hutti et al, 2011).…”

“…Fear of further loss and grief, as well as disloyalty to babies who have died, often delay preparation for and attachment to the unborn baby (Côté-Arsenault & Donato, 2007; cautious optimism is common. It is somewhat logical then that women PAL have greater healthcare utilization, and thus higher costs, due to concerns about the baby than women without a perinatal loss history (Hutti et al, 2011).High-stress levels in pregnancy are associated with a host of negative outcomes for mother and child, including premature birth, low birthweight (Grote et al, 2010), and irritable infant temperament (Van den Bergh, Mulder, Mennes, & Glover, 2005;Wurmser et al, 2006). Studies have also linked stress in pregnancy with impaired cognitive, behavioral, urological, and neuroendocrine development in the child up to 6 years of age (Glover, O'Connor, Heron, Golding, & ALSPAC Study team, 2004; Huizink, Mulder, & Buitlaar, 2004;Huizink, Robles de Medina, Mulder, Visser, & Buitelaar, 2003; O'Connor, Heron, Golding, Glover, & ALSPAC Study Team, 2003).…”

“…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 doubt about their biological and psychological ability to successfully have and parent a baby.…”

Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study

“…[2][3][4][5][6][7] Attempts to cope may involve asking more questions, requesting additional tests and telephoning healthcare professionals between visits. It remains uncertain whether anxiety accounts for higher healthcare utilisation in women pregnant after stillbirth and if the type of support given is helpful.…”

“…1 In pregnancies subsequent to a miscarriage or stillbirth, many women sense a threat of an additional loss 2 and have increased generalised and pregnancy-specific anxiety. [2][3][4][5][6][7] Attempts to cope may involve asking more questions, requesting additional tests and telephoning healthcare professionals between visits. 4 In Norway, antenatal care is free and mainly carried out by midwives and general practitioners.…”