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Researching early pregnancy loss.

What does it mean to lose a pregnancy? There's no universally accepted answer to this question, as the experience of pregnancy loss is individual, personal and unique to each woman, their partner and, in some instances, the wider family/whanau.

Spontaneous miscarriage is the most common complication of pregnancy, occurring in about 15 percent of all pregnancies. (1) Despite this statistic, many women complain about the lack of care and compassion they receive. Failure to identify women in need of support and care following spontaneous miscarriage has been reported as leading to worsening psychological problems and even a future risk of repeated miscarriage. (2)

At the opposite end of the pregnancy loss spectrum, the literature available on the experiences of women who have an elective termination of pregnancy is limited. There's a presumption that a woman who chooses to abort does not suffer psychologically as much as those who have a spontaneous miscarriage. (3) Interestingly, the study also established that women who have undergone an induced or elective abortion showed higher avoidance strategies and an increased sense of intrusion when asked about their experiences. These behaviours can indicate psychological distress. (3) The NZNO Women's Health Section has identified the care of women who have suffered an early pregnancy loss (defined, for the purpose of this article, as less than 20 weeks' gestation) as of interest to a number of its members. It is looking to undertake a project to draw on the current collective practice of those engaging with these women and to propose a mode[ of care. The section has identified the significance of the role of nurses in providing care and support to women experiencing early pregnancy loss and is interested in collating evidence of what is currently being done. The value of the nurse is anecdotally recorded but not well supported in current literature.

The section recognises the diversity of environments, points of entry to the health system, discharge and follow-up procedures and workforce issues within New Zealand. It wants nurses to document their experience caring for women experiencing an early pregnancy loss, of any description. Feedback on the following questions is sought:

* Where are women experiencing an early pregnancy loss cared for in your workplace, eg the emergency department, gynaecology ward, designated early pregnancy or women's health assessment unit, obstetric ward?

* How are these women nursed--do they receive one-on-one care or are they part of a normal busy shift workload? Do women having a spontaneous miscarriage stay overnight in your workplace? Are these women given a single room?

* Are the partners/family/whanau invited to be with the woman at all times (if she desires this)? Can they stay overnight?

* What facilities are available in your workplace for women who are having an elective abortion? Do they stay overnight? If so, where are they cared for?

* What information is given to women having a spontaneous miscarriage or an elective abortion? Do they get this pre or post their event/ episode of care? What follow-up is offered to these women, either formal or informal?

The section hopes the benefit of this project will be two-fold; firstly, starting the dialogue around developing an evidence-based, practice-appropriate model of care for women who are experiencing an early pregnancy loss; and, secondly, sharing and celebrating the superb work already being done in this area by dedicated and compassionate nurses. We thank you for taking the time to respond and look forward to receiving your stories, comments and suggestions.

Please send your information to suehazetwood@ccdhb.org.nz or caroline_eagle@hotmail.com by April 1, 2011. We look forward to discussing the project at next month's women's health section conference in Blenheim.

References

(1) Serrano, F. & Lima, M.L. (2006) Recurrent miscarriage: psychological and relational consequences for couples. Psychology and Psychotherapy: Theory, Research and Practice, 79; 585-594.

(2) Cumming, G.P., Klein, S., Bolsover, D., Lee, A. 3., Alexander, D.A., Macleqan, M. & Jurgens, J.D. (2007) The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months. British Journal of Gynaecology; 114, 1138-1145.

(3) Broen, A.M., Torbjorn, M., Botdker, A.S. & Ekeberg, O. (2004) Psychological impact on women of miscarriage versus induced abortion: A two-year follow-up study. Psychosomatic Medicine; 66, 265-271.

Report by women's health section committee member Caroline Eagle
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Title Annotation:SECTION/COLLEGE NEWS
Author:Eagle, Caroline
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Feb 1, 2011
Words:718
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