ACOUST 1994, V01.

60 •Whrelel •

Psychosocial Needs of Women During Miscarriage or Ectopic Pregnancy

Aapproximately 650.000 pregnancies end in miscarriage or ectopic pregnancy every

year in the United States: These pregnancy losses rquesrat 15% to 20% of the live With
rate in this country. There an many reasons the prod-ucts of conception do not implant
in the uterus (ie. ectopic pregnancy) or why the fetus does not develop (ie, miscarriage).
These biologic reasons may be hard for the woman or family members to understand or
accept: therefore. early pregnancy losses require skilled nursing care and psychosocial
support. The perioperative nurse's role during this rime is crucial to helping the woman
and her family members with these feelings of shock, guilt, anger. frustration. and
sadness. The nurse must carefully assess the woman's and family members' responses to
the mis-carriage or cyanic pregnancy because the perception of loss varies with each
individual. The perioperative nurse also mut he prepared to put aside any values and
beliefs that may influence his or her perception of the impact of surgery and pregnancy
loss on the woman and her family members.

MURMUR, SWIM Research on miscarriage and cctopic pregnancy has identified

varying perceptions and feelings related to the experience of preg-nancy loss.
Perceptions range from feelings of no loss to intense feel-ings toward losing
pregnancies and babies. The individual's response to miscarriage or temple pregnan-cy
depends on her perception of what has been lost. Three studies of women who had
experienced unexpected, early pregnancy loss report that approximately 75% of

thc women interviewed had feelings of lass associated with their miscarriages or ectopic
pregnancies. Some of the women believed their miscarriages were merely life
experiences, and they indicated no feelings of grief. The majority of these women,
however, had deep feelings of sadness. emptiness, and loneliness associated with their
lost pregnancies and babies;

THI WM 'WPM Grief is defined as the appropriate. self-limited. emotional response to

an external and consciously recognized lost' The physical. emotional, and social
reverses to grief encompass many feelings and vary in their intensity and duration.
Anticipatory grief. A woman and her family members experience anticipatory grief
when they learn of an impending pregnancy loss, such as when a woman recognizes that
she "doesn't feel as pregnant as she did before" or when she has uterine cramping or
bleeding. Sometimes a woman may have very little lime to anticipate her unpending
loss, as during rou-tine prenatal visits when an ultrasound study may reveal a pregnancy
loss. Within a short rime, the woman can learn that her pregnancy hat ended. that her
baby has died, and/or that she is scheduled for surgery within the next 24 hours. She and
her family members have little time to cope with their anticipatory grief. One woman
described her experience, "In less than four hours. it was all over—my pregnancy. my
hopes. my dreams, and my baby." Shock/numbness and scorch. ingtyearning. At the
time of hospi-talization, the woman and her fami-ly members may express feelings

ABSTRACT The woman who experi-ences a miscarriage or Klock pregnancy may

express her grief with many different responses. Per'operative nurses can enable the
woman and her family members to adequately grieve the loss of pregnancy and the baby
by using sensitive commu-nication, therapeutic listening, and empathy skills and by
coor-dinating follow up. AORN J 60 (August 1994) 221-231.

SARA RICH WHEELER, RN

221 AORN.10474NAL