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Total of 10 Pages Only May Be Xeroxed CENTRE FOR NEWFOUNDLAND STUDIES TOTAL OF 10 PAGES ONLY MAY BE XEROXED (Without Author's Permission) The Meaning of Perinatal Loss fof' Women in Newfoundland: A Phenomenological Study by Kathy VV'atkins, R.N., B.N. A thesis submitted to the School of Graduate Studies in partial fulfillment of the requirements for the degree of Master of Nursing School of Nursing Memorial University of Newfoundland St. John's, Newfoundland May 2001 DEDICATION This thesis is lovingly dedicated to my late father, Roy Gordon Watkins, whose strong work ethic, integrity and humor have inspired and sustained me throughout life. ll ABSTRACT Pregnancy is generally a time of joyous anticipation and positive outcomes for expectant couples. However, the expected birth of a healthy baby can come to a tragic end with a sudden, unanticipated pregnancy loss. This event can be devastating for women, their partners, and their families. Although there is a large body of literature on parental responses to perinatal loss and some of the factors influencing grief intensity, very few studies have examined a woman's lived experience with perinatal loss. This phenomenological study used van Manen's method to explore the question: What is the meaning of perinatal loss for women who have experienced a miscarriage or stillbirth? From the data collected in unstructured interviews, seven themes were identified: shattering of hopes and dreams; centrality of the loss; shared grieving: identifying and accepting differing coping styles; dealing with others; dealing with the loss; living with emotional uncertainty: gentle reminders; and letting go and moving on. The essence of this experience was searching for meaningful integration. The findings indicate that women who have early and late perinatal losses cope with feelings of loss and grief in an individualized manner. In searching for meaning in her experience, each woman was influenced by the responses of partners, family, others in the social world, and health care providers. iii ACKNOWLEDGEMENTS I would like to first express my sincere gratitude to the women in this study who shared their thoughts and experiences with me during a very emotional time in their lives. Your stories of loss have affected me personally and professionally. I gratefully acknowledge the guidance, support and wisdom of my thesis supervisor Dr. Christine Way. I will always remember your exemplary commitment to students and research. Also, a special thank you is extended to the other member of my thesis committee Kathryn Hustins. Throughout my undergraduate and graduate studies you continuously provided time, direction and encouragement. I sincerely thank Cheryl Trask RN for your assistance in recruiting participants. You are a very special nurse and friend. I gratefully appreciate the financial support provided by the ARNNL Education and Research Trust, Newfoundland and Labrador Nurses' Union, Memorial University of Newfoundland School of Graduate Studies, Health Care Corporation of St. John's, and Department of Health and Community Services. I wish to acknowledge my colleagues and friends at the Centre for Nursing Studies, especially Patricia Grainger, Anne Lilly and Karene Tweedie, iv who provided constant support through many personal and academic challenges. I sincerely thank Gail Piercey for her expertise, time and typing throughout my graduate studies. Finally, I could not have completed this study without the support and encouragement of my husband, children and family. My husband, Larry, continuously provided love, support and understanding. Your endless commitment to our family enabled me to see the completion of my graduate studies. My children, Zachary and Rebecca, inspired me to reach my goal. sincerely appreciate your patience and love. I would also like to thank my mother, Ruby Watkins, for her love, energy and time throughout my graduate studies. Thank you for taking care of all of us. I gratefully acknowledge the support and encouragement from my sisters, Margaret Harvey and Janice Simms. You willingly cared for Zachary and Rebecca when I needed time to work. I sincerely appreciate your encouragement, love and sense of humor. v TABLE OF CONTENTS DEDICATION .......... .. ......... ............... .. ........... .................. .. .. .......... ..................... II ABSTRACT .. .......................... ............ ......................... ....................... .. .. ............ III ACKNOWLEDGEMENTS ............. .......................................... ........................... IV TABLE OF CONTENTS ... ............. ..................... ......................... ... .................... VI CHAPTER 1 .................... ............. ......... ... .............. ... ............. ............ ... ........ .. .... 1 Introduction .. .. .. ....... .............. .. .... ... ..... ..... ... ... .............. ................. ....... .... 1 Background and Rationale .. .. .... ................................................... 3 Problem Statement.. .................................... .......... .......... .............. 5 Research Question ............................. .. .. ..................... .................. 6 CHAPTER 2 ... .. .. .......... ... .......... ............. .. ................................... ... ..................... 7 Literature Review .. .. ....... ........ .. .. .. ........ ....... ... .... .. ................... ... ... ... .. .... .. 7 The Experience of Perinatal Loss ....................... .. .......... .. .. .......... 7 Parental Responses to a Perinatal Loss ................... .......... 9 Grief Intensity .. ..... ..... ............ .... ... ........ .. .............. .. .......... 16 Health Outcomes ......... ..................................... ... ..... .. ...... 26 Summary .. .. ... .................. ... .. ............. ..................... .. ........ 29 Factors Influencing Parent's Experience with Perinatal Loss ...... 29 Support Mechanisms ........................... .......... ..... .. .. .......... 30 Additional Factors .... ... .................. .................................... 44 Vl Summary ......................................... ................................. 48 Discussion ................................................................................... 48 CHAPTER 3 .............................................. .. .................................... .................. 51 Methodology ............... ........................... ............................................... 51 Phenomenology as a Research Methodology .. .. ......................... 51 Hermeneutic Phenomenology ................................ ... ........................... .. 54 Turning to the Phenomenon ......... ............................................. .. 54 Investigating the Experience ...... .. ............................................... 55 Phenomenological Reflecting ... .. ................................................. 55 Describing the Phenomenon .. ....................... ........... ...... .... ......... 56 Strong/Oriented Relation to the Phenomenon ............... ............. 57 Balancing ..... ............................................ ... ....................... .......... 57 Methods ................................. ....................... , ........................................ 57 Participants ....................................... ........................................... 58 Procedure ... .......................... ................... ... ........ ......................... 59 Ethical Considerations ................... .. ............... ............................. 60 Data Analysis .. ....................................................................................... 62 Credibility of Findings ... .. .......................................... .............................. 64 CHAPTER 4 ............... .............................. .. ................................................. .... .. 66 Findings ............................... ... .. .... .. .. ................................................... .. 66 vii Participants' Characteristics ..................... ............................ .. ................ 66 Thematic Analysis ......................................... ......................................... 67 Shattering of Hopes and Dreams .. .................................. ............ 68 Centrality of the Loss ................................................................... 76 Shared Grieving: Identifying and Accepting Differing Coping Styles .. ............ ............. ............................................. ... ................ 80 Dealing with Others ..................................................................... 85 Dealing with the Loss ...... .............. .......................................... .... 96 Living With Emotional Uncertainty: Gentle Reminders .............. 100 Letting Go and Moving On ....................... ................................. 1 07 The Essence ................................................................. ... ............. ....... 112 CHAPTER 5 ............ ......... ....................................... ........................................ 117 Discussion ... ........... .. .. .......................... .... .................................. .. .. ...... 117 Discussion of Themes in Relation to the Literature .......... .. ....... 117 Shattering of Hopes and Dreams .. ................. ................ 117 Centrality of the Loss ........................... ...... ....
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