Document Type : Original Article
Authors
Psychology Department, Faculty of Psychology, Tabriz University, Tabriz, Iran
Abstract
BACKGROUND: Mother–child attachment is formed from early stages of pregnancy and peaks in
the second trimester and continues until after childbirth. The fetal or neonatal death as a tragic event
could lead to the grief experience among parents, especially mothers. The present study aimed to
determine the effect of a coping program on mothers’ grief following perinatal deaths.
MATERIALS AND METHODS: This trial study was performed on 56 women with the experience of
perinatal death during the last 1–3 months with a score of Perinatal Grief Scale (PGS) ≥91, who
were referred to the health centers of Tabriz, Iran, from September 2020 to June 2021. Participants
were randomly assigned into the intervention and control groups through stratified blocking on the
basis of the stillbirth and neonatal death using Random Allocation Software with a block size of 4
and 6 with a ratio of 1:1. The intervention group received a coping program individually during three
sessions, once a week for 45–60 min. Data collection tools included the demographic and obstetric
characteristic questionnaire and PGS. The data were analyzed using SPSS24. The groups were
compared through t‑test, and ANCOVA after adjusting the effect of baseline score.
RESULTS: Prior to coping program, the mean standard deviation of the grief total score was
108.32 (14.31) in the intervention group and 107.92 (6.65) in the control group (P = 0.89). After
coping program, the mean of the grief total score was 82.28 (16.72) in the intervention group and
101.05 (12.78) in the control group. After adjusting the effect of baseline score and stratified factors,
the mean of the grief total score in the intervention group was significantly lower than that in the
control group [Adjusted mean difference (AMD): −18.77, 95% confidence interval: −26.79 to − 10.75,
P ≤ 0.001].
CONCLUSION: Conducting a coping program during 1–3 months after experiencing perinatal deaths
is effective in reducing the mothers’ grief reactions. It is recommended to evaluate the effectiveness
of the same intervention after perinatal deaths for both parents with a longer follow‑up period in
further studies.
BACKGROUND: Mother–child attachment is formed from early stages of pregnancy and peaks in
the second trimester and continues until after childbirth. The fetal or neonatal death as a tragic event
could lead to the grief experience among parents, especially mothers. The present study aimed to
determine the effect of a coping program on mothers’ grief following perinatal deaths.
MATERIALS AND METHODS: This trial study was performed on 56 women with the experience of
perinatal death during the last 1–3 months with a score of Perinatal Grief Scale (PGS) ≥91, who
were referred to the health centers of Tabriz, Iran, from September 2020 to June 2021. Participants
were randomly assigned into the intervention and control groups through stratified blocking on the
basis of the stillbirth and neonatal death using Random Allocation Software with a block size of 4
and 6 with a ratio of 1:1. The intervention group received a coping program individually during three
sessions, once a week for 45–60 min. Data collection tools included the demographic and obstetric
characteristic questionnaire and PGS. The data were analyzed using SPSS24. The groups were
compared through t‑test, and ANCOVA after adjusting the effect of baseline score.
RESULTS: Prior to coping program, the mean standard deviation of the grief total score was
108.32 (14.31) in the intervention group and 107.92 (6.65) in the control group (P = 0.89). After
coping program, the mean of the grief total score was 82.28 (16.72) in the intervention group and
101.05 (12.78) in the control group. After adjusting the effect of baseline score and stratified factors,
the mean of the grief total score in the intervention group was significantly lower than that in the
control group [Adjusted mean difference (AMD): −18.77, 95% confidence interval: −26.79 to − 10.75,
P ≤ 0.001].
CONCLUSION: Conducting a coping program during 1–3 months after experiencing perinatal deaths
is effective in reducing the mothers’ grief reactions. It is recommended to evaluate the effectiveness
of the same intervention after perinatal deaths for both parents with a longer follow‑up period in
further studies.
Keywords:
Bereavement, grief, perinatal death, stillbirt
Keywords
The relationship between hope and happiness with prenatal care.
J Educ Health Promot 2020;9:206.
2. McDonald LR, Antoine DG, Liao C, Lee A, Wahab M, Coleman JS.
Syndemic of lifetime mental illness, substance use disorders, and
trauma and their association with adverse perinatal outcomes.
J Interpers Violence 2020;35:476‑95.
3. Scott J. Stillbirths: Breaking the silence of a hidden grief. Lancet
2011;377:1386‑8.
4. Brandon AR, Pitts S, Denton WH, Stringer CA, Evans HM.
A history of the theory of prenatal attachment. J Prenat Perinat
Psychol Health 2009;23:201‑22.
5. Noroozi M, Gholami M, Mohebbi‑Dehnavi Z. The relationship
between hope and resilience with promoting maternal attachment
to the fetus during pregnancy. J Educ Health Promot 2020;9:54.
6. Ruschel P, Zielinsky P, Grings C, Pimentel J, Azevedo L,
Paniagua R, et al. Maternal‑fetal attachment and prenatal
diagnosis of heart disease. Eur J Obstet Gynecol Reprod Biol
2014;174:70‑5.
7. Golmakani N, Gholami M, Shaghaghi F, Safinejad H, Kamali Z,
Mohebbi‑Dehnavi Z. Relationship between fear of childbirth and
the sense of cohesion with the attachment of pregnant mothers
to the fetus. J Educ Health Promot 2020;9:261.
8. deMontigny F, Verdon C, Meunier S, Dubeau D. Women’s
persistent depressive and perinatal grief symptoms following
a miscarriage: The role of childlessness and satisfaction with
healthcare services. Arch Womens Ment Health 2017;20:655‑62.
9. Maciejewski PK, Zhang B, Block SD, Prigerson HG. An empirical
examination of the stage theory of grief. JAMA 2007;297:716‑23.
10. Shear MK. Grief and mourning gone awry: Pathway and course
of complicated grief. Dialogues Clin Neurosci 2012;14:119‑28.
11. Bhugra D, Becker MA. Migration, cultural bereavement and
cultural identity. World Psychiatry 2005;4:18‑24.
12. Zisook S, Shear K. Grief and bereavement: What psychiatrists
need to know. World Psychiatry 2009;8:67‑74.
13. Lannen PK, Wolfe J, Prigerson HG, Onelov E, Kreicbergs UC.
Unresolved grief in a national sample of bereaved parents:
Impaired mental and physical health 4 to 9 years later. J Clin
Oncol 2008;26:5870‑6.
14. Noorizadeh R, Ivanbagha R, Ranjbar- Koochaksaraei F, Pezeshki
M.Z., Bakhtari-Aghdam F. Depression and anxiety in sterilised
women in Iran. J Fam Plann Reprod Health Care 2007;33:287.
15. Howard LM, Khalifeh H. Perinatal mental health: A review of
progress and challenges. World Psychiatry 2020;19:313‑27.
16. Malkinson R. Cognitive‑behavioral grief therapy: The ABC model
of rational‑emotion behavior therapy. Psihol Teme 2010;19:289‑305.
17. Navidian A, Saravani Z. Impact of cognitive behavioral‑based
counseling on grief symptoms severity in mothers after stillbirth.
Iran J Psychiatry Behav Sci 2018;12:e9275.
18. Barat S, Yazdani S, Faramarzi M, Khafri S, Darvish M, Rad MN,
et al. The effect of brief supportive psychotherapy on prevention of
psychiatric morbidity in women with miscarriage: A randomized
controlled trial about the first 24‑hours of hospitalization. Oman
Med J 2020;35:e130.
19. Hagigi M, Oladbaniadam K, Mohaddesi H, Rasuoli J. The effect
of an intervention based on the Warden’s principles on the level
of grief in mothers with pregnancy loss. J Kurdistan Univ Med
Sci 2020;25:31‑43.
20. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS,
Spong CY, Hoffman BL, et al. Williams Obstetrics. 25th ed.
New York: Mcgraw‑Hill; 2018.
21. Toedter LJ, Lasker JN, Alhadeff JM. The perinatal grief scale:
Development and initial validation. Am J Orthopsychiatry
1988;58:435‑49.
22. Golmakani N, Ahmadi M, Asgharipour N, Esmaeli H. The effect
of supportive care program on women’s bereavement with early
miscarriage. Iran J Obstet Gynecol Infertil 2017;20:33‑41.
23. Potvin L, Lasker J, Toedter L. Measuring grief: A short version
of the perinatal grief scale. J Psychopathol Behav Assess
1989;11:29‑45.
24. Siadatnezhad S, Ziaei T, Khoori E, Vakili MA, LaskerJ. Translation
and validation of the Persian version of the perinatal grief scale
in Iranian mothers with an experience of pregnancy loss. World
Fam Med 2018;16:55‑61.
25. Camacho Ávila M, Fernández Medina IM, Jiménez‑López FR,
Granero‑Molina J, Hernández‑Padilla JM, Hernández Sánchez E,
et al. Parents’ experiences about support following stillbirth and
neonatal death. Adv Neonatal Care 2020;20:151‑60.
26. Wilson J. Supporting People through Loss and Grief: An
Introduction for Counsellors and Other Caring Practitioner. 1st ed.
London, UK: Jessica Kingsley Publishers; 2013.
27. Johnson OP, Langford RW. A randomized trial of a bereavement
intervention for pregnancy loss. J Obstet Gynecol Neonatal Nurs
2015;44:492‑9.
28. Erlandsson K, Säflund K, Wredling R, Rådestad I. Support after
stillbirth and its effect on parental grief over time. J Soc Work End
Life Palliat Care 2011;7:139‑52.
29. Nikcević AV, Kuczmierczyk AR, Nicolaides KH. The influence
of medical and psychological interventions on women’s distress
after miscarriage. J Psychosom Res 2007;63:283‑90.
30. Raitio K, Kaunonen M, Aho AL. Evaluating a bereavement
follow‑up intervention for grieving mothers after the death of a
child. Scand J Caring Sci 2015;29:510‑20.
31. Bagheri L, Nazari AM, Chaman R, Ghiasi A, Motaghi Z. The
effectiveness of healing interventions for post‑abortion grief:
A systematic review and meta‑analysis. Iran J Public Health
2020;49:426‑36.
32. Bamniya JS, Bhatia GO, Doshi HU, Ladola HM. Assessment of
grief in mothers with pregnancy loss and role of post bereavement
counselling: A prospective study. Int J Reprod Contracept Obstet
Gynecol 2018;7:1347‑50.
33. Siev J, Huppert JD, Chambless DL. The dodo bird treatment
technique and disseminating empirically supported treatments.
Behav Ther 2009;32:69‑76.
)