Multiple miscarriage psychosocial implications
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Multiple miscarriage: Psychosocial implications. Uschi Van den Broeck Master in Psychology University Hospital of Leuven, Belgium Department of Gynaecology/Fertility Center. Overview. The psychology of pregnancy The psychology of pregnancy loss The grieving process

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Multiple miscarriage psychosocial implications

Multiple miscarriage:Psychosocial implications

Uschi Van den Broeck

Master in Psychology

University Hospital of Leuven, Belgium

Department of Gynaecology/Fertility Center


Overview

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


Overview1

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


1 psychology of pregnancy

1. Psychology of pregnancy

  • ‘Pregnancy begins psychologically, long before it occurs physically.’

  • Socialization: imaginative play  ‘playing house’

  • Society has certain expectations for women and men: motherhood is often placed on a ‘pedestal’


Psychology of pregnancy

Psychology of pregnancy

  • Sense of control:

    Women have multiple roles (career, family, social,…)

    • Birth control: freedom to decide when ‘not’ to get pregnant

    • Illusion of control

  • Couples talk about their plans for the future

    Pregnancy is ‘planned’, ‘timed’


1 psychology of pregnancy1

1. Psychology of pregnancy

  • Bonding and prenatal attachment starts sooner because of modern technology

    • Ultrasounds

    • 3D images


Psychology of pregnancy1

Psychology of pregnancy

  • Pregnancy = unique experience

  • Influenced by:

    • Cultural factors

    • Personal history: family of origin

    • Personality

    • Relationship: ‘early days’, ‘long term’, ‘single’, ..

    • Expectations and beliefs

    • Social environment


Psychology of pregnancy2

Psychology of pregnancy

  • Growing towards motherhood fatherhood

  • Fantasies and dreams about life with future child

  • Experiences with parenting in family of origin are evaluated

  • ‘New goal’


Psychology of pregnancy3

Psychology of pregnancy

  • Social event:

    • Grandparents and changing family structure: a new generation

    • Work-related issues: maternity leave, part-time work etc.


Psychology of pregnancy4

Psychology of pregnancy

PREGNANCY = POINT OF NO RETURN

= CRISIS


Overview2

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


1 psychology of pregnancy loss

1. Psychology of pregnancy loss

  • ‘A crisis within a crisis’

  • Conflicting emotions:

    • Sometimes first experience with death for couples

    • Elation of pregnancy followed by despair of pregnancy loss

    • Loss of a baby, a part of yourself, your health, control, potential, reproductive capacity etc. …


Psychology of pregnancy loss

Psychology of pregnancy loss

Loss is multi-layered

  • Individual loss

  • Family loss (parents, siblings, grandparents, etc.)

  • Impact on relationships

  • Impact on life conditions

  • Impact on future plans, goals

    GRIEVING


1 psychology of pregnancy loss1

1. Psychology of pregnancy loss

  • Expectations and beliefs about future life are destroyed

  • Idea of ‘controllable world’ challenged

  • Confrontation with ‘sterile’ medical world is often painful

    • ‘Unrecognized loss’

    • Miscarriage is ‘normal’


Between something and nothing

‘Between something

…and nothing’


Overview3

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


3 the grieving process

3. The grieving process

  • Grief is a normal, healthy, dynamic, universal and individual respons to loss

  • Kaleidoscope

  • Healing process: surviving and continuing to live


3 the grieving process1

3. The grieving process

Grief (Covington, 2000)

  • ‘Tidal wave’:

    growing and cresting with time

  • Intense feelings of shock, disbelief, anger, self-blame, rage, guilt, anxiety, depression  unpredictable and repetitive pattern

  • Expressions of grief: physical/somatic, psychological, social, emotional, cognitive

  • ‘Triggers’: reminders and rekindlers

  • ‘Shadow grief’: it’s always there


3 the grieving process2

3. The grieving process

Unique aspects of perinatal grief

  • Prospective: few memories

  • Multidimensional: individual’s unique experience

  • Little anticipatory grieving: sudden and without warning

  • No or little public acknowledgement

  • Absence of visible ‘object’ to mourn

  • Few socially acceptable avenues for mourning

  • Lack of social support

  • ‘Pain of not ever knowing’


3 the grieving process3

3. The grieving process

Mourning characteristics

  • Parents’ expectations and attitude towards the pregnancy: influences respons to the potential or actual loss

  • Personal beliefs: ideas, hopes, dreams and dreads about the pregnancy

  • Cultural background

  • Gestational age/postnatal age affects the grief process


3 the grieving process4

3. The grieving process

  • Attachment to the pregnancy and future baby or babies is formed prenatal

     time alone is not necessarily an indicator of the level or degree of attachment (Moulder, 1994)


Overview4

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


4 common feelings when confronted with multiple miscarriage

4. Common feelings when confronted with multiple miscarriage

Multiple miscarriage?

  • World Health Organization (WHO)

    • At least 3 or more consecutive pregnancy losses before the 22nd gestational week

    • 1% of couples (Bagchi & Friedman, 1999)

  • Recurrent pregnancy loss:

    • Traumatic event

    • Symptoms of depression, anxiety, lowered self-esteem, …


4 common feelings when confronted with multiple miscarriage1

4. Common feelings when confronted with multiple miscarriage

  • Every loss is followed by a new period of grieving

  • Increasing ambivalence about each consecutive pregnancy

  • Protective mechanism: distancing from a new pregnancy, beginning bereavementprocess and seperation before an actual loss occurs

  • Degree of attachment is a better predictor for severity of grief reactions than gestational age


4 common feelings when confronted with multiple miscarriage2

4. Common feelings when confronted with multiple miscarriage

Major life-event: individual differences

Longing Despair

Out of control

Sadness Regret

Shocked Confused Angry

Guilty Responsible

Emptiness Panicky

Loneliness Stressed

Lack of self-confidence


4 common feelings when confronted with multiple miscarriage3

4. Common feelings when confronted with multiple miscarriage

PHYSICAL SYMPTOMS

Headache Stomach achees

Shortness of breath constipated

Tightness in the chest

Problems with sleeping

Lack of appetite …….


Video clip 1 tori amos

Video Clip 1: Tori Amos


4 common feelings when confronted with multiple miscarriage4

4. Common feelings when confronted with multiple miscarriage

  • Physical and emotional loss

    different for women and men

  • Self-blaming possibilities

  • ‘Injustice’: Why is this happening to me?

    • Feelings of helplessness

    • Need to blame someone

    • Desire to bring a sense of control to the event

    • Hope that if a cause can be identified, a recurrence can be prevented


4 common feelings when confronted with multiple miscarriage5

4. Common feelings when confronted with multiple miscarriage

  • Feeling that they’ve disappointed their partners, their family

  • Doubts about reproductive competence

  • Marital strain: differences can be misinterpreted


4 common feelings when confronted with multiple miscarriage6

4. Common feelings when confronted with multiple miscarriage

Gender differences: mothers and fathers:

  • Loss is equally important

    but the experience can be very different

  • Different ways of experiencing feelings + at different times

  • It’s a journey, not a destination

  • Dance of closeness and distance (Rosenblatt, 2006)

  • Fathers are often overlooked, feel ignored or excluded: have to deal with organisational tasks

  • Sexual relationship can be difficult for a while

     physical reminder of the pregnancy


4 common feelings when confronted with multiple miscarriage7

4. Common feelings when confronted with multiple miscarriage

  • Risk of more intense or longer lasting destress:

    • Pregnancy strongly desired

    • Waited a long time to conceive

    • No living children

    • Elective abortions

    • Other losses in history

    • Few warning signs that a loss might occur

    • Experienced the loss relatively late in pregnancy

    • Little social support

    • History of coping poorly


4 common feelings when confronted with multiple miscarriage cuisinier 1996

4. Common feelings when confronted with multiple miscarriage (Cuisinier, 1996)

  • Recurrent miscarriage = recurrent disappointment

  • In general couples cope fairly well

  • Already having children >< no live children

    • Thoughts about a future pregnancy

    • Will I ever conceive?

    • Will I be able to keep the pregnancy?

    • Need for a succesful pregnancy becomes overwhelming

    • Secondary childwish: often incomprehension of environment  ‘Why do you need another child?’


4 common feelings when confronted with multiple miscarriage8

4. Common feelings when confronted with multiple miscarriage

  • ‘How long will I feel like this?’

  • Expectations from environment

  • Bad times even when you feel better (process of grief!!)

  • ‘Shadow’ grief


4 common feelings when confronted with multiple miscarriage9

4. Common feelings when confronted with multiple miscarriage

  • Social environment

    • Many different expectations

    • Confrontation with pregnancy: painful, often avoidance or trying to be brave

    • People often don’t know how to respond: minimalizing

    • Reactions can be hurtful

    • Seek out supporting contacts

    • No matter what people ‘recommend’, seek what is right for you and feels right for you.

    • Grandparents and other relatives have lost a ‘family member’ too.


Overview5

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


5 coping with grief and loss

5. Coping with grief and loss

  • There is no right or wrong.

  • ‘There are no rules.’

    • ‘I think I should be over it by now.’

    • ‘Some people go through worse things.’

      There is only one way,

      and that is your way.


Video clip 2 grey s anatomy

Video Clip 2: Grey’s Anatomy


5 coping with grief and loss1

5. Coping with grief and loss

  • Accepting the reality of the loss

  • Experiencing the pain and the loss in your life

  • Adjusting to a life without the pregnancy and without your babies

  • Trying to make sense of it and give life meaning again


Overview6

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


6 infertility and recurrent pregnancy loss

6. Infertility and recurrent pregnancy loss

  • Infertility and miscarriage are both devastating experiences

  • Together: larger impact

  • Physical component of treatment can become more invasive and traumatic with each repeated reproductive failure

  • Impact on partner relationship

  • Impact on social relationships

  • ‘Invisible loss’


Overview7

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


7 trying again

7. Trying again…

  • Timing?

    • Too soon

    • Not soon enough

  • Sexual relationship can become pressured

  • ‘Careless’ pregnancy is gone

  • Rituals and superstition

  • Sharing the good news with friends and family

  • Extra check-up and honest reassurance from the medical team can help reduce anxieties


Overview8

Overview

  • The psychology of pregnancy

  • The psychology of pregnancy loss

  • The grieving process

  • Common feelings when confronted with multiple miscarriage

  • Coping with grief and loss

  • Infertility and pregnancy loss

  • Trying again…

  • Helpful interventions


8 helpful interventions

8. Helpful interventions

  • Reality reinforcing interventions

  • Decision making is up to the couple but ‘informed’ choice

  • ‘Joining’ the couple

  • Creating a safe ‘holding environment’

  • Listening without judging


8 helpful interventions1

8. Helpful interventions

  • Creating mementos

  • Memorial activities

  • Self care

  • Keeping a journal: writing things down

  • Reaching out: talking with friends, support groups, etc.


Multiple miscarriage psychosocial implications1

Multiple miscarriage:Psychosocial implications

Thank you for listening

Uschi Van den Broeck

Master in Psychology

University Hospital of Leuven, Belgium

Department of Gynaecology/Fertility Center

Contact:


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