Academic journal article Family Relations

Pregnancy Loss and Distress among U.S. Women

Academic journal article Family Relations

Pregnancy Loss and Distress among U.S. Women

Article excerpt

Although pregnancy loss-especially miscarriage-is a relatively common experience among reproductive-aged women, much of our understanding about the experience has come from small clinic-based or other nonrepresentative samples. We compared fertility-specific distress among a national sample of 1,284 women who have ever experienced a stillbirth or miscarriage. We found that commitment/attachment to pregnancy that ended in loss as well as current childbearing contexts and attitudes were associated with distress following pregnancy loss. Practitioners working with women or couples who have experienced pregnancy loss should be aware of the importance of characteristics associated with higher distress, such as whether the pregnancy had been planned, recency of the loss, no subsequent live births, having a medical explanation for the loss, a history of infertility, current childbearing desires, importance of motherhood, and locus of control over fertility.

Key Words: attachment, commitment, distress, fertility, miscarriage, pregnancy loss, stillbirth.

Approximately 14% of all clinically recognized pregnancies in the United States result in miscarriage, defined as a loss during the first 20 weeks of pregnancy, another 0.5% result in stillbirth, a loss after the 20th week (Saraiya, Berg, Shulman, Green, & Atrash, 1999). Pregnancy loss is often a devastating experience for parents. Research suggests that women experience a variety of psychological distress outcomes following miscarriage, including grief, anxiety, depression, and guilt (Lok, Yip, Lee, Sahota, & Chung, 20 1 0; Thapar & Thapar, 1992), and that- although effects usually diminish within 6 months (Brier, 2008) - these outcomes are often sustained over years (Janssen, Cuisinier, & Hoogduin, 1996; Stinson, Lasker, Lohmann, & Toedter, 1992). Less is known about stillbirths than early pregnancy loss; however, research on stillbirth indicates that bereaved mothers, as a group, manifest significantly higher rates of psychological distress than mothers of living infants for at least 30 months after their loss (Boyle, Vance, Najman, & Thearle, 1 996). There is some evidence that the adverse effects of stillbirth on mental health persist throughout the life course (Bernazzani & Bifulco, 2003).

Although pregnancy loss, especially miscarriage, is a relatively common experience among reproductive-aged women, much of our understanding about the experience of pregnancy loss has come from small clinic-based or other nonrepresentative samples. Furthermore, the various factors (individual, familial, economic, medical, and cultural) that affect the psychological response to pregnancy loss are not well understood (Bennett, Litz, Lee, & Maguen, 2005), possibly limiting the effectiveness that family professionals could have with regard to reducing psychological distress. We therefore advance understanding of the responses to pregnancy loss by examining factors associated with distress using a population-based sample of women who had stillbirths or miscarriages or both. Making use of the concepts of commitment and attachment, we endeavored to enhance understanding of the effect of pregnancy loss on fertility-specific distress (FSD) using data from the National Survey of Fertility Barriers (NSFB), a probability-based study of 4,796 American women of reproductive age. We assessed differences in distress by pregnancy commitment and attachment (e.g., gestation length and whether the pregnancy had been planned); experiences since the loss (e.g., recency of loss, having a medical explanation for the loss, giving birth after the loss, and having experienced multiple losses); current fertility context (e.g., infertility history, currently wanting a baby, importance of motherhood, and pregnancy locus of control); and background characteristics (e.g., education level, age, relationship status, and race/ethnicity).

INVESTMENT IN PREGNANCY AND THE RELEVANCE OF PREGNANCY LOSS

There is a good deal of variability in how women respond to pregnancy loss. …

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