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Today, I am going to explore the

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Today, there are three types of definitions of health which seem to be used by the vast majority. The first definition is that, “Health is the absence of any disease or impairment”. The second one is, “Health is a state which allows an individual to sufficiently cope with all day-to-day life activities” Lastly, health has been defined as, “the state of balance, an equilibrium that an individual has established within themselves and their social and physical environment” (Sartorius,2006). However, people come from different backgrounds which means that they may have different definitions of health, depending on the circumstances in which the matter is raised. Wellbeing can be defined as a global assessment of a person’s quality of life according to his own chosen criteria (Johnson and Shin, 1978). For the purpose of this essay, my definition for health would be, being free from diseases and wellbeing as the satisfaction with life.

 

I am going to explore the definition of miscarriage and its psychological impact in relation to loss. I will firstly discuss grief and how it affects women psychologically using the Elisabeth Kübler-Ross’s five stages of lose to support my research. Furthermore, I will also focus on how it affects men and the couples overall. I will then proceed on to how depression has an impact on women’s appetite and how it causes changes in emotions and mood which then takes me to anxiety. prior to this essay, I have done some research focusing on how culture has an impact in how people view miscarriage. this will be included in this essay using research work to back this up. Lastly, I will look at PTSD and how women who have experienced a miscarriage deal with it.

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A miscarriage is the death of the foetus under 22 weeks (Tsartsara and Johnson 2002). Miscarriages are the most common complication of a pregnancy which occurs in up to 20% of all clinically recognised pregnancies (Hammerslough, 1992). Women who go through a miscarriage are often unprepared for the loss and this shocking event can lead to women experiencing a range of psychological effects. These psychological effects range from grief to anxiety and depression. Women are also most likely to experience Post-Traumatic Stress Disorder (PTSD) according to a study conducted by (Farren et al.,2016) of Imperial College London. Due to a lot of research work that has been conducted over the years, there has now been an increased evidence that miscarriage is linked with psychological morbidities.  For instance, research has shown that about 50% of miscarrying women go through some psychological morbidity in the weeks and months after loss. About 40% of miscarrying women were discovered to be showing signs of grief shortly after miscarriage, and pathological grief can follow. Furthermore, there is an elevated anxiety and depressive symptoms and major depressive disorder has been reported in 10- 15% after miscarriage (Neugebauer, 2007).

 

Grief has an immense impact on the health and wellbeing of women who have just experienced miscarriage. Women will tend to feel angry, guilty and lonely when they are mourning their child. Also, a desire to talk about the loss and a search for a meaningful explanation of the loss contributes to women’s grief. A psychiatrist named Elisabeth Kübler-Ross introduced five stages of grieving which was inspired by her work with individuals who are facing death. The model of grieving described by (Kübler-Ross, 1970) were: denial or isolation, confusion or anger, bargaining, depression and acceptance. The grief stages after miscarriage appear to be the same as those reported after the loss of children, family and friends. Women will tend to have guilt in them following self-blame which has been found to have a bigger aspect of grief (Toedter et al., 2001). Pathological grief can also develop which will make women to feel worthless and hopeless. It will inhibit women to deal with day to day activities e.g. interacting with people which I will discuss further on. However, comparing normal grief to pathological grief, pathological grief tends to stay longer due to lack of social support.

 

However, grieving is not only experienced by the mothers but also the fathers too. Guilt will impact women as they tend to put the blame on themselves for the loss of their pregnancy especially if they haven’t been given any medical explanations as to why that has occurred. Many women form an attachment with their unborn child especially if it’s their first child or if they have been trying for a baby. This is supported by John Bowlby’s theory of attachment. (Bowlby, 1979), suggests that there is a correlation between adult grief and separation anxiety when women lose a loved one which means that the connection is also lost, leaving a void in their lives. On the other hand, men tend to deal with grief differently from women as they are not the ones carrying the baby in their womb therefore is no attachment in the early stages.

 

In this generation, the psychological impacts of miscarriages are often overlooked as miscarriage has become one of the most medically common occurrences. Doctors often seem to only focus on the medical side rather than the psychological impact it has on a woman, forgetting that at times it takes more time for a woman to heal emotionally than physically. However, most women who experience miscarriage are at high risk of getting depression. According to (Moulder, 1990), “Depression is a natural response to loss and part of the grieving process”.  Depressive symptoms are common, with 20-55% of women reported to have an increase of depressive symptoms shortly after miscarriage. Whilst speaking to an individual going through a miscarriage, they mentioned symptoms relating to the emotional trauma they were going through. For example, they lost their appetite to eat, found it difficult to sleep due to feeling guilty. This is supported by (Moulder, 1990), who investigated how depression has physical impacts on a woman health. She found out that women tend to lose their appetite for food and also tend to sleep a lot so that they can escape from their worries. This can cause a strain on their relationships as the lack of grief from men can cause bitterness and anger. However, most men are not very good at expressing themselves but the fact still remains that they will equally be devastated as they would be anticipating of their child with great pleasure.

 

The other insecurity that most women face after a miscarriage is anxiety. There has been some research conducted by, (Geller et al., 2004) suggesting that women who go through the loss of a pregnancy tend so suffer a lot of anxiety lasting up to 4 months. Most women will begin to have some concerns for example, they will start to get anxious on the return of their next menstruation, trying for another baby and also fear of the miscarriage occurring again. Anxiety after a miscarriage can have a massive impact on social life. This is because some women may be feeling embarrassed and ashamed of what they have been through which leads to them isolating themselves.

Culture has been a big influence in shaping grief reactions and the way women cope with miscarriage depends on culture, racial or ethnic background. In some cultures, for example non-Western cultures were miscarriage has not been well researched, miscarriages are stigmatised and often women mourn their pregnancy loss in isolation to avoid harshness from people. Also, some cultures feel that a woman’s identity is depended on their ability to conceive and if they are unable to give birth to a live baby, its seen as something to be ashamed of. A study which was conducted by (Haw et al., 2010) in Tanzania has found out that the loss of pregnancy is masked to avoid gossip and in some serious cases, women are not allowed to grieve their lost child.

 

Women who have just experienced a miscarriage may find it difficult to maintain a good relationship with their partner, friends and family. A miscarriage is a traumatic event which can cause strains between relationships as it is a sensitive and private experience to share with other people. In the long run a miscarriage can cause changes between individuals which means that the miscarriage is likely to affect relationships. This is more common in women who have experienced more than one miscarriages which will even have a greater impact for their rest of their lives.  The relationship between the couple may change drastically as they can become disconnected and potentially drift apart. This is because this may have been the first loss they have experienced together and may find it difficult to grasp. On the other hand, this experience may also bring the couple closer together. There have been a few studies that have been carried out to support this. Kowalski 1987 (Mander,1994 described the brief and romantic period of closeness following the loss as the “honeymoon period”. However, after this period, there is a change in the couple’s relationship which causes a deterioration in their relationship.

 

Early pregnancy loss can also lead to psychological problems like Post-Traumatic Stress Disorder (PTSD). Post-traumatic stress disorder is caused by stressful, distressing events, causing women to have flashback from the event (Farren et al., 2016). Women with symptoms of PTSD tend to always have feelings associated with their pregnancy loss and also suffer from unwanted thoughts about their miscarriage. Currently there is no follow up appointments for women who are suffering from PTSD but there are checks for postnatal depression. The fact that there are no follow ups for this disorder has resulted in the disorder progressing to the next level therefore affecting everyday life, ability to work, suicidal risks and relationships with friends and family.

 

In conclusion, although miscarriage is very common, women are often unprepared for the loss of their unborn child. This leads to a range of psychological effects from grief, anxiety, depression and post-traumatic stress disorder as discussed in the essay. Unlike the 1990s were women who had just experienced a miscarriage received little attention, nowadays professionals now understand the importance of early identification and appropriate management processes to help the psychological well-being of women who miscarry. As nurses, it is important to offer emotional support. For example, bereavement counselling after the miscarriage so that they will receive support on how to adjust to the loss of their baby. However, most hospitals are now offering a second-visit within a short time after their miscarriage so that they will be able to receive answers to the general questions about why that miscarriage occurred. 

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