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Effect of a structured follow-up visit to a midwife on women with early miscarriage: a randomized study
Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. (Complications in the Reproductive Life of Women)ORCID iD: 0000-0002-2577-1632
Division of Nursing Science, Department of Medicine and Care, Faculty of Health Science, Linköping University, Linköping, Sweden. (Complications in the Reproductive Life of Women)
Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. (Complications in the Reproductive Life of Women)
2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 3, p. 330-335Article in journal (Refereed) Published
Abstract [en]

Background: Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2).

Methods: We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post.

Results: There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit.

Conclusions: A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

Place, publisher, year, edition, pages
Oslo, Norway: Taylor & Francis, 2006. Vol. 85, no 3, p. 330-335
Keywords [en]
Early miscarriage, grief, midwife, support, treatment
National Category
Obstetrics, Gynecology and Reproductive Medicine Nursing
Research subject
Caring sciences
Identifiers
URN: urn:nbn:se:oru:diva-25614ISI: 000236110500012PubMedID: 16553182OAI: oai:DiVA.org:oru-25614DiVA, id: diva2:548485
Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Miscarriage: women’s experience and its cumulative incidence
Open this publication in new window or tab >>Miscarriage: women’s experience and its cumulative incidence
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively.

Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss.

Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type.

We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage.

Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

Place, publisher, year, edition, pages
Linköping: LiU-Tryck, Linköping, Sweden, 2006. p. 68
Keywords
Miscarriage, Grief, Perinatal Grief Scale in Swedish, Follow-up visit to midwife, Medical Birth Register
National Category
Obstetrics, Gynecology and Reproductive Medicine Nursing
Research subject
Medicine; Nursing Science
Identifiers
urn:nbn:se:oru:diva-36196 (URN)91-85497-76-2 (ISBN)
Public defence
2006-04-07, Berzeliussalen Hälsouniversitet i Linköping, Linköping, 16:30 (Swedish)
Opponent
Supervisors
Available from: 2014-09-09 Created: 2014-08-28 Last updated: 2017-10-17Bibliographically approved

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Adolfsson, AnnsofieLarsson, Per-Göran

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