[en] The pregnancy loss -involuntary pregnancy loss and termination of pregnancy for foetal anomaly- and neonatal death cause a varied, dynamic and highly individualized response in parents. Literature recognizes the special characteristics of these losses, due to the multiple losses that such a process entails for parents. However, the stigma surrounding these losses means that they are considered taboo losses and that they are silenced and made invisible in social and health settings. The care provided by health professionals, and especially nurses and midwives, is crucial to the short- and long-term well-being of parents. However, healthcare professionals report being poorly prepared and how stressful and emotional demanding it is to provide care for parents who have suffered these losses. This care is often superficial and based on the performance of procedures. Aims: This doctoral thesis is made up of two main axes. First, to know the experiences of parents in coping with pregnancy or perinatal losses and, later, to know the experiences of midwives and nurses in caring for parents who have suffered an involuntary loss of pregnancy. Methodology: This doctoral thesis is composed of 4 qualitative research studies, of which an empirical study and a meta-ethnography were developed for each objective. Regarding the first aim, 16 Spanish women who suffered an involuntary loss of pregnancy have been interviewed through a grounded theory study and a meta-ethnography of 14 qualitative studies has been carried out to XXVI Abstract synthesize the research results regarding the coping experiences of parents after pregnancy and neonatal losses. For the second objective, a metaethnography was also carried out, which included ten primary qualitative studies to discover the experiences of midwives and nurses in caring for parents who have suffered an involuntary pregnancy loss. In addition, an interpretive phenomenological study was conducted in which 11 primary care midwives were interviewed. Results: Regarding the experiences of parents, the coping strategies of parents were based on the experiences of connectedness/confrontation and disconnectedness/avoidance. These experiences were related through a dynamic process between the two. The use of these elements was conditioned by personal, social and cultural factors. On the other hand, the nurses and midwives who cared for parents who have suffered an involuntary pregnancy loss, faced difficulties that required leaving their comfort zone. This caused them not to get emotionally involved with parents and that, if they did, the care was based on their intuition. Conclusions: The coping strategies of parents were based on the experiences of connectedness/confrontation and disconnectedness/avoidance through a dynamic process between the two. For nurses and midwives, caring for parents who have suffered these losses involved leaving their comfort zone and dealing with difficulties, which caused them not to get emotionally involved with parents or, if they did, it was using their intuition.

[gl] A perda do embarazo -perdas involuntarias e a terminación do embarazo por anormalidades fetais- e a morte neonatal xeran unha resposta variada, dinámica e altamente individualizada nos pais. A investigación recoñece as características especiais destas perdas debido ás múltiples perdas que supón para eles. Sen embargo, o estigma en torno a estas perdas xera que se consideren perdas tabús e que se silencien e que non se visibilicen nos ámbitos sociais e sanitarios. O coidado dos profesionais sanitarios, e especialmente das enfermeiras e matronas, é crucial para o benestar dos pais a curto e longo prazo. Non obstante, os profesionais sanitarios informan do pouco preparados que están e do estresante e esixente que é coidar destas perdas. Varias dificultades á hora de coidar xeran que este coidado a miúdo sexa superficial e baseado na realización de técnicas. Obxectivos: Esta tese doutoral componse de dous eixes principais. En primeiro lugar, coñecer as experiencias dos pais no afrontamento das perdas do embarazo ou perinatais e, posteriormente, coñecer as experiencias das matronas e enfermeiras no coidado dos pais que sufriron unha perda involuntaria do embarazo. Metodoloxía: Esta tese doutoral está composta por 4 estudos cualitativos de investigación, dos cales un estudo empírico e unha meta-etnografía foron elaborados para cada obxectivo. Para responder ao primeiro, entrevistáronse 16 mulleres españolas que sufriron unha perda involuntaria de embarazo a través dun estudo de teoría fundamenta e realizouse unha meta-etnografía de 14 estudos cualitativos para sintetizar os resultados da investigación sobre o afrontamento dos pais trala perda do embarazo ou dun bebé. Para o segundo obxectivo, tamén se levou a cabo unha meta-etnografía, que incluíu dez estudos cualitativos primarios para coñecer as experiencias das matronas e enfermeiras no coidado de perdas involuntarias do embarazo. Ademais, fíxose un estudo fenomenolóxico interpretativo no que se entrevistaron 11 matronas de atención primaria. Resultados: Respecto ás experiencias dos pais, as estratexias de afrontamento dos pais baseáronse nas experiencias de conectividade/confrontación e non conectividade/evitación. Estas experiencias relacionáronse a través dun proceso dinámico entre ambas. O uso destes elementos estivo condicionado por factores persoais, sociais e culturais. Por outra banda, as enfermeiras e parteiras ó coidado de pais que sufriron unha perda involuntaria do embarazo, trataron con dificultades que esixiron saír da zona de confort. Isto provocou que non se involucraran emocionalmente cos pais e que, se o fixeron, o coidado se baseara na súa intuición. Conclusións: As estratexias de afrontamento dos pais baseáronse nas experiencias de conectividade/confrontación e non conectividade/evitación mediante un proceso dinámico entre ambos. Para as enfermeiras e matronas, coidar estas perdas implicaba saír da zona de confort e afrontar dificultades, provocando que non se involucrasen emocionalmente cos pais ou, se o facían, fose baixo a súa intuición.