1. 1 DEALING WITH LOSSES: MISCARRIAGE, STILLBIRTH, ABORTION, AND HIGH-RISK PREGNANCIES

2. 2 Miscarriage and Stillbirth Miscarriage death prior to 20 weeks Stillbirth or fetal death death between 20 weeks and birth

3. 3 Rates Approximately 15-20% of all recognized pregnancies are lost through miscarriage or stillbirth 1 in 80 pregnancies end stillbirths 15-50% pregnancies are miscarried (depending on measurement) 75% of miscarriages happen before week 12

4. 4 Why? There is no one reason why women miscarry Chromosomal abnormalities Uterine malformations Cervical incompetence Nor for stillbirth Placenta bleeding and detachment Chromosomal abnormalities Increased risk from: Radiation exposure Maternal age Maternal diseases (mumps, rubella) Drug use

5. 5 Listening to the Women Prior to miscarriage, women reported their first symptoms of: 81% vaginal bleeding 12% pain 3% loss of the feeling of being pregnant

6. 6 Abortion Two issues: 1.Deciding to terminate an unwanted pregnancy 2.Being pregnant after abortion

7. 7 Choosing Abortion There is NO typical woman that chooses abortion 1/3 of women have an abortion before 45 Women seeking abortions tend to be: Younger Unmarried Pregnancy less than 10 weeks

8. 8 Reasons for Choosing Abortion Inability to afford and/or unwillingness to start or expand a family Life was not conductive to pregnancy or child rearing Did not want to raise a child as a single parent or in a troubled relationship Health status of women or fetus

9. 9 Psychological Aspects Up to 25% of women feel pressured from others to get an abortion Post-abortion psychiatric disturbances are actually rare Studies suggest distress is highest pre-abortion, possibly suggesting distress from the unintended pregnancy Women most strongly feel relief after abortion then “negative socially based emotions” – shame, guilt, and fear of judgment Only 10% of women experience negative reactions to abortion

10. 10 Psychological Aspects During Subsequent Pregnancies Women with a previous abortion tend to feel more anxious and depressed during their first planned pregnancy WHY?

11. 11 High-Risk Pregnancies Every pregnancy has risks associated In US, 10 – 20% of pregnancies are considered high risk

12. 12 High-Risk Pregnancies Higher risk associated with: Maternal age (under 16, older 35) Low SES Race (Black women higher risk) Maternal diseases Prepregnancy factors Prenatal factors Neonatal factors

13. 13 High-Risk Pregnancies Quality Assessment is VERY important Three dimensions to assess: Physiological Psychological Environmental factors

14. 14 Each of these experiences is a type of loss PSYCHOLOGICAL RESPONSES TO LOSS

15. 15 Grief: Deep mental anguish, as that arising from bereavement Normal grief: Shock Preoccupation with loss Resolution Pathological grief: Health loss Serious depression Social isolation Weight disturbances Economic decline

16. 16 Normal Grief 1.Shock! ( 1 – 2 days) Somatic symptoms Nausea Chest tightness Head aches 2.Preoccupation (weeks to months) Somatic symptoms Insomnia Guilt Fatigue Withdrawal 3.Resolution Less intense feelings of guilt, loneliness No longer preoccupied Maybe be delayed grief or triggered by anniversaries

17. 17 Normal Psychological Reactions Numbness Restlessness Sadness Guilt Fatigue Anxiety Anger Social relationships difficult Tearfulness Needing an explanation for the loss – “why me?”

18. 18 Diagnosis of High-Risk Pregnancy: Increased maternal stress Loss of ‘joyful, easy pregnancy’ Increased anxiety and fear Testing may be particularly stressful Consideration of abortion

19. 19 Pregnancy after Abortion: Doubt of previous abortion Fear of committing to current pregnancy Fear of judgment by health professionals

20. 20 Pregnancy after Miscarriage or Fetal Death: Greater fear of bad outcomes in current pregnancy Fear of committing to current pregnancy Self-blame over previous miscarriage Trying then have the ‘perfect’ pregnancy May not have fully mourned (resolved) grief from previous loss