After stillbirth some parents may seek isolation, can change their uptake of religious practice, approach to sexual intercourse, engagement with health promoting activities, work and social media and this may continue into subsequent pregnancies. 20.1 The fathers in this study were exhausted, physically and emotionally. When asked to say more about how they managed, a common response was ‘I keep myself busy’. Men looked at sex as a tension reliever and attributed a therapeutic value to it. Many parents relied on their spirituality to deal with their loss. For some parents this was in the form of praying; for others, it was going to church. ‘I cry when I talk to a real person so it was easier to talk to someone online, less emotional’. O’Leary 2006 Dyregrov 2011 Kavanaugh 2005 Gold 2012 USA Norway USA USA Some parents feel the need to suppress outward grief, including during subsequent pregnancy. 18.1 Fathers felt they denied their own emotional reactions in order to protect and support and care for their partners. According to Taiwan’s culture talking about death is a taboo subject and these mothers often dealt with their grief privately and alone. ‘I I genuinely suppressed a lot of my anxiety because of my [desire to protect my] family. Yes, I wanted to stay strong for my husband and myself. Outward I was strong but inside I was a mess’. Armstrong 2001 Sun 2011 2011 USA Taiwan USA Stillbirth may lead to avoidance of activities that remind them of the pregnancy and the baby. 13.2 Most mothers found it very difficult to be in situations that reminded them of “what could have been.” Examples of these situations were being around pregnant women or infants, attending baby showers, and celebrating holidays. Kavanaugh 2005 USA Parents report stigmatisation, rejection, and spousal abuse. 13.2 ‘There were a few people at work who just never spoke to me again…I mean I definitely got the feeling… like I was bad luck’. time I walked into the living room, my in-laws lowered their voices. Mostly, they stopped talking. I disappointed them Murphy 2012 Hsu 2004 UK Taiwan
because I didn’t give them a descendent like every should do. I felt unwomanly, since I failed to have a baby.’ ‘I know a girl who was in school and married off by her parents. the marriage, she repeatedly lost her new-borns and was divorced. Not to face the humiliation in the village she ran away to a city and now she is a commercial sex worker.’ Sisay 2014 Ethiopia Parents may have feelings towards the decisions they made e.g. post mortem or seeing/holding their baby. 12.5 In the limited time available for mothers to meet the child, mothers did not know how to spend time with their child, and had multiple hesitations due to their child being dead, and regretted this later on. Akiko 2009 Japan Parents may experience external or internal pressures to prioritise or conception. 9 Some mothers did not plan on a subsequent pregnancy because of their concern about their ability to deal with another perinatal loss. Perinatal loss signalled a potential underlying health problem, which in turn accentuated anxieties relating to both future reproductive abilities and investment of limited resources on another potentially unsuccessful pregnancy. Such women described feeling pressure to prove their reproductive capabilities as soon as possible. Kavanaugh 2005 Fottrell 2010 USA Benin Bereaved parents may become hypervigilant with siblings and subsequent children, and anxious about other people’s children. 7.6 All mothers shared stories of feeling out of control, especially when faced with ‘normal’ or ‘common’ childhood events, such as tonsillitis, middle ear infection or being stung by a bee. These events were enough to cause them to feel hysteria and intense fear they were about to lose another child. Warland 2011 Australia Bereaved parents may increase or decrease their use of health care services; and in subsequent 6.9 Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early Hutti 2011 USA USA
Stillbirth has powerful psychological impacts on professionals. Emotional response/ distancing Trauma Anger Fear Stress Anxiety Blame Depression Frustration Sadness Powerlessness Challenge to faith Humiliation 95 40 42 35 30 30 30 25 20 20 15 15 10 5 5 “I think it’s possible to experience too much grief in this work” “It is a mixture of everything, anxiety, rage, oppression, impotence…” “… I had to cut off my emotions to just get through it “It me to my core” “… you’ve got anger, huge anger, especially where a mistake has been made or something has been missed” “It sort of haunted me for a couple of days. …I had some issues falling asleep that night and getting the images out of my head” 201485 Pastor Montero 201184 Puia 201137 Puia 201137 Nuzum 201485 McKenna 201136 Ireland Spain USA USA Ireland Australia Stillbirth has a professional impact. Effect of litigation Fear of disciplinary action Fear of public censure Exposure 65 30 10 5 5 “Is this the one that is going to blame you?” “If you … lose a mother or a baby, you will lose your license, your income, your work” Kelley 201282 McCool 200986 USA USA Professionals need support Education Peer support Institutional support 65 30 5 5 “I think what would be helpful … is having that debriefing time after it’s over and not being directly assigned” “… they do not teach you the necessary strategies to provide support in these situations” “… we need to support each other and not tear each other down” Jonas Simpson 201034 Pastor Montero 201184 Roehrs 200838 Canada Spain USA