In the Lit

This section of the newsletter will contain brief summaries and critiques of recently appearing articles related in some way to understanding stillbirth, supporting families and so forth. If you are unable to obtain the relevant journals and wish to have a copy of any article reviewed here, WiSSP can supply single photocopies to you for your personal use.

Reactions to perinatal loss: A qualitative analysis of the national maternal and infant health survey. Covington SN, Theur SK. Amer J Orthopsychiat 63:215-222, 1993.

As part of the 1988 National Maternal and Infant Health Survey, more than 8,000 women who had experienced stillbirth or neonatal death were asked to complete a questionnaire. Included was a single open-ended question: "Is there anything else you would like to tell us about yourself, your pregnancy, your baby, or anything else in the questionnaire?" More than 400 of the respondents wrote replies. This article is a qualitative analysis of those responses. Many related to negative feelings regarding their care, or were about unanswered questions, about unresolved guilt, about anxieties regarding recurrence, about their lack of access to others to discuss their mourning.

If any of you doubt the purpose of what you do, of what we do, or need justification for continuing involvement with families who have experienced intrauterine death this article is of real relevance. It validates the need for providing both sensitive help and real understanding of the cause of their baby's death to parents of stillborns.

Clearly, with a highly self-selected sample and no manner of extrapolating that sample to the larger group it is uncertain whether this is really representative of the feelings of most mothers. We hope someday to complete the preliminary questionnaire followup we initiated through WiSSP about 7 years ago in order to further validate the conclusions of this paper.

Genetic causes of stillbirth. Schauer GM, Kalousek DK, Magee JF. Seminars Perinatol 16:341-351, 1992.

This review contains little new information. It is, however, a quality summary of the needs for comprehensive evaluations of stillborns. The implicit philosophy is similar to WiSSP's. Because it is written by pediatric pathologists, considerable emphasis is placed on the role of those individuals. It is a reasonably nice resource for all health professionals.

Pregnancy outcome following a second- trimester loss. Goldenberg RL, Mayberry SK, Copper RL, Dubard MB, Hauth JC. Obstet Gynecol 81:444-446, 1993.

In those instances in which no clear cause of death is demonstrated, estimating risks in next pregnancies for couples who have had a stillbirth or other adverse outcome must be based on empiric (population based) experience. Most of the data related to such estimates derive from studies more than 3 decades old. Goldenberg et al. have looked at one piece of the stillbirth experience and have analyzed outcomes of subsequent pregnancies. After a second trimester loss, the next pregnancy resulted in stillbirth in 5% of couples as well as increased risks for neonatal death (6%) and prematurity (approximately tripled). One might use those figures in counseling families with a loss between 13 and 22 weeks gestation. Unfortunately virtually nothing was done to determine cause in either the index pregnancies or the subsequent adverse outcomes, so that little more can be said about genetic based risks, preventability etc.

Intrauterine fetal death: Medico-nursing and psychosocial considerations for the childbearing patient. Maurer MC. J perinatol 13:36-45, 1993.

The title is far better than the contents. This article does contain some reasonable summaries of medical nursing care of the mother during the process of giving birth to a stillborn baby. It uses the 'Snyder trajectory model' of pregnancy to explain what happens to mothers psychologically; the model is so simplistic and self-evident as to be completely unhelpful. Fathers are barely mentioned. Little is said about need to understand the cause of a stillbirth and virtually nothing regarding the nurse's role in educating parents about the importance for etiologic evaluation.