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Felicity Agwu Kalu

AN EXPLORATION OF THE PSYCHOSOCIAL FACTORS THAT IMPACT ON MIDWIVES’ CONFIDENCE TO PROVIDE BEREAVEMENT SUPPORT TO PARENTS WHO HAVE EXPERIENCED A PERINATAL LOSS. Felicity Agwu Kalu . Introduction and Background to the problem.

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Felicity Agwu Kalu

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  1. AN EXPLORATION OF THE PSYCHOSOCIAL FACTORS THAT IMPACT ON MIDWIVES’ CONFIDENCE TO PROVIDE BEREAVEMENT SUPPORT TO PARENTS WHO HAVE EXPERIENCED A PERINATAL LOSS Felicity Agwu Kalu

  2. Introduction and Background to the problem • Perinatal loss is the loss of a baby at any stage of pregnancy (miscarriage, ectopic pregnancy and stillbirth) and the death of a liveborn baby in the first twenty eight days after birth (Armstrong 2002, Ewing 2005, John & Cooke 2006 Radestad et al. 2007). • Perinatal loss is one of the most painful, traumatic and devastating experiences for many parents (Kohner & Henley 2001, Abboud & Liamputtong 2005, Bennet et al. 2005, McCreight 2005, Simmons et al. 2006, Kean 2008).

  3. Introduction and Background to the problem • The outcomes for many parents depends on the midwives’ ability to provide effective bereavement support (Cote Arsenault & Donato 2007, Henley & Scott 2007). • Caring for, and supporting bereaved parents is demanding, difficult, stressful, and emotionally demanding, thus making the provision of effective bereavement support challenging (Kohner & Henley 2001, Mitchell 2005, Chan et al. 2007, 2008, 2009).

  4. Theoretical Context of Perinatal Bereavement Support

  5. Theoretical Context Grief theories • Freud (1915, 1917, 1933) • Klein (1940, 1955) • Bowlby (1969, 1973, 1980, 1988) • Ainsworth (1967, 1985). Socio-cultural perspectives on grief - Disenfranchised grief (Doka 2002) - Gender differences in grieving (Murkoff et al. 2002, O’Leary & Thorwick 2006, Serrano & Lima 2006).

  6. Empirical studies • Effects of perinatal bereavement on grieving parents -High levels of psychological distress around the time of loss and in subsequent pregnancies (Cote- Arsenault & Dombeck 2001, Corbett-Owen & Krueger 2001, Walker & Davidson 2001, Armstrong 2002, Cote- Arsenault & Donato 2007). • Some midwives have the ability to provide perinatal bereavement support while many others are unable to do so (Roehrs et al. 2008).

  7. Aim of the study • To explore the psychosocial factors that impact on midwives’ confidence to provide bereavement support to who have experienced a perinatal loss.

  8. Research Questions • What is the level of the confidence of midwives to provide perinatal bereavement support to grieving parents? • What are the psychosocial factors that predict confidence in midwives to provide bereavement support to bereaved parents? • What organisational support do midwives need to promote their confidence to provide perinatal bereavement support to parents in maternity hospitals and in the communities?

  9. Research Design • Mixed Method approach • Explanatory sequential design • Quantitative Qualitative Quan data Quan data Qual data Qual data Combined collection analysis collection analysis data (Creswell et al. 2003) Interpretation

  10. Rationale for Mixed Method approach • To gain a more comprehensive knowledge (breadth and depth) about the psychosocial factors that influence midwives’ confidence in providing perinatal bereavement support. - To provide more robust evidence to understand the complexity of this new and relatively unexplored area of research. • To draw on the complementary strengths of both quantitative and qualitative methods (Hunter & Brewer 2003, Bryman 2004Teddlie & Tashakkori 2010).

  11. Phase 1 Study design: The quantitative phase • Method: Cross sectional survey • Setting: Three maternity teaching hospitals in Ireland. • Population and Sample: An estimated sample size of 273 midwives and nurses will be required to achieve a 95% confidence level. With the addition of a 10% attrition rate to account for missing data the target sample required for this study will be 300 midwives and nurses. • Plan and procedure • Questionnaire development • Testing and piloting of the questionnaire • Main survey implementation • Data Analysis to include, descriptive statistics, a series of univariate and multivariate analysis

  12. Phase 2 Study design: The qualitative phase • Participants • Purposive sampling of 6 to 8 midwives and nurses • Data collection method: focus group discussions • Data analysis: Content analysis (Krippendorf, 2004)

  13. Interpretation of the Connected Results • Summary and interpretation of the quantitative results • Summary and interpretation of the qualitative results • Discussion of the extent and in what ways the qualitative research findings help to explain the quantitative results.

  14. References • Abboud L. and Liamputtong P. (2005) When pregnancy fails: coping strategies, support networks and experiences with health care of ethnic women and their partners. Journal of Reproductive and Infant Psychology 23(1), 3-18. • Ainsworth M. (1967) Infancy in Uganda: Infant Care and the growth of Attachment. The Johns Hopkins Press, Baltimore. • Ainsworth M. D. S. (1985) Attachments across the lifespan. Bulletin of New York Academy 61(9), 792-812. • Armstrong D. (2002) Emotional distress and prenatal attachment in pregnanacy after perinatal loss. Journal of Nursing Scholarship34(4), 339-345. • Bennett S. M., Litz B.T., Lee B.S. and Maguen S. (2005) The scope and impact of perinatal loss: current status and future directions. • Bowlby J. (1969) Attachment and Loss: Attachment (Volume I),The Hogarth Press, London. • Bowlby J. (1973) Attachment and Loss: Separation Anxiety and Anger (Volume II), The Hogarth Press, London.

  15. References • Bowlby J. (1980) Attachment and Loss: Loss, Sadness and Depression (Volume III), The Hogarth Press, London. • Bowlby J. (1988) A Secure Base: Clinical Applications of Attachment Theory. Routledge, London. • Bryman A. (2004) Social Research Methods. Oxford University Press, Oxford. • Chan M. F., Lou F., Zang Y., Chung Y. F., Wu L. H., Feng C. and Ping L. (2007) Attitudes of midwives towards perinatal bereavement in Hong Kong. Midwifery23, 309-321. • Chan M. F., Lou F., Arthur D. E., Cao F., Wu L. G., Li P., Sagara-Rosemeyer M., Chung L. Y. F. & Lui L. (2008) Investigating factorsassociated to nurses’ attitudes towards perinatal bereavement care. Journal of Clinical Nursing17, 509-518. • Chan M. F., Lou F., Cao F., Ping L., Lui L. and Wu L. H. (2009) Investigating factors associated to nurses’ attitudes towards perinatal bereavement care: a study in Shandon and Hong Kong. Journal of Clinical Nursing 18, 2344-2354.

  16. References • Central Statistics Office (2010) Statistical Yearbook of Ireland. The Stationery Office, Dublin. • Corbet-Owen C. and Kroger L. (2001) The health system and emotional care: Validating the many meanings of spontaneous pregnancy loss. Families, Systems and Health19(4), 411-427. • Cote-Arsenault D. and Dombeck M. T. B. (2001) Maternal assignment of fetal personhood to a previous pregnancy loss: relationship to anxiety in the current pregnancy. Health Care for Women International22, 649-665. • Cote-Arsenault D. and Donato K. L. (2007) Restrained expectations in late pregnancy following loss. Journal of Obstetric, Gyneacologic, and Neonatal Nursing 36,550-557. • Creswell J. W., Plano Clark V. L., Gutmann M. L. & Hanson W. E. (2003) Advanced mixed methods research designs sociology In Handbook of Mixed Methods in Social and Behavioural Research 1st edn. (Tashakkori A & Teddlie C. eds), Sage Publications, Thousand Oaks p. 209-240.

  17. References • Doka K. J. (2002) Disenfranchised grief: New Directions, Challenges, and Strategies for Practice. Taylor and Francis Publishers, Washington DC. • Ewing S. (2005) Losing a Baby. Sheldon Press, London. • Freud S. (1915) Repression. (Volume 2). Penguin Freud Library. • Freud S. (1917) Mourning and melancholia. In The International psycho-analytic library: collected papers (Volume 5) (Riviere J. ed), Hogarth Press, London, p.152-170. • Freud S.(1933) New introductory lectures on psychoanalyis (Volume 2). Penguin Freud Library. Cited in Jacobs M (1992) Sigmund Freud. Sage Publications, London. • Henley A. and Scott J. (2008) The death of a baby before, during or shortly after birth: good practice from parents’ perspectives. Seminare in Fetal and Neonatal Medicine13, 325-328. • Hunter A. & Brewer J. (2003) Multimethod research in sociology In Handbook of Mixed Methods in Social and Behavioural Research 1st edn. (Tashakkori A & Teddlie C. eds), Sage Publications, Thousand Oaks p. 577-594.

  18. Refernces • John A. and Cooke M. (2006) Shrouds of silence: three women’s stories of prenatal loss. Australian Journal of Advanced Nursing23(3),1-5. • Kean L. (2008) Intrauterine Death. Obstetrics, Gynaecology and Reproductive Medicine19(1), 1-6. • Klein M. (1940) Mourning and its relation to Manic-Depressive States In Contributions to Psychoanalysis 1921-1948. Hogarth Press, London. • Klein M. (1955) On Identification In New Directions for Psycho-analysis 1st edn. (Klein M., Heimann P. and Money-Kyrle R. E. eds), Tavistock Publications Limited, London p.309-345. • Kohner N. and Henley A. (2001) When a Baby Dies: The Experience of Miscarriage, Stillbirth and Neonatal Death. Routledge. • Krippendorf K. (2004) Content Analysis: An introduction to its methodology. 2nd edn. Sage Publications Ltd, Thousand Oaks. • McCreight B.S (2005) Perinatal grief and emotional labour: a study of nurses’ experiences in gynae wards. International Journal of Nursing Studies42(4), 439-448.

  19. References • Mitchell M. (2005) Preparing student midwives to care for bereaved parents. Nurse Education in Practice5, 78-83. • Murkoff H., Eisenberg A. and Hathaway S. (2002) What to expect when you are expecting. 3rd edn. Simon and Schuster Publishers, London. • O’Leary J. and Thorwick (2006) Fathers’ perspectives during pregnancy postperinatal loss. Journal of Obstetric, Gyneacologic, and Neonatal Nursing 35, 78-86. • Radestad I., Surkan P. J., Steineck G., Cnattingius S., Onelov E. & Dickman P. W. (2007) Long-term outcomes for mothers who have not held their stillborn baby. Midwifery. Retrieved (16/03/2009) from http://www.elsevier.com/doi:10-1016/j.midw.2007.03.005 • Roehrs C., Matterson A., Alles R., Witt C. & Rutt P. (2008) Caring for families coping with perinatal loss. Journal of Obstetric, Gynaecologic, and Neonatal Nursing37, 631-639. • Serrano F. and Lima M. L. (2006)Recurrent miscarriage: psychological and relationship consequences for couples. Psychology and Psychotherapy: Theory, Research and Practice 79,585-594.

  20. References • Simmons R.B., Singh G., Maconochien N., Doyle P. and Green J. (2006) Experience of miscarriage in the UK: qualitative findings from the National Women’s Health Study. Social Science and Medicine63(7), 934-1946. • Walker T. M. and Davidson K. M. (2001) A preliminary investigation of psychological distress following surgical management of early pregnancy loss detected at an initial ultrasound scanning: a trauma experience. Journal of Reproductive and Infant Psychology19(1), 7-16.

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