Effect of Abortion and Miscarriage - Report Example

Report: Abortion and Miscarriage Institution Name Executive Summary The loss of an infant through miscarriage and abortion is a traumatic event and often results to complicated grief (CG) responses that affect the physical and psychological well-being of the mothers. This study finds that the experiences of miscarriage are often described as grief based on the grieving symptom. Review of literature on women’s psychological response after miscarriage indicates that many go through grief, depression, guilt, anxiety and depression. It is further established that signs of grief have to be differentiated to determine whether they are mentally disturbed condition based on duration and intensity. The Stage Theory of Grief and the Attachment theory of grief are applied in promoting an understanding and organising people’s responses to loss or attending to the duration of grief after the loss. It is concluded that grief counselling is critical and individuals who are going through the grief have to work through their memories, feelings and thoughts while at the same time venting out the pain of the loss and releasing themselves from attachment to the foetus. This enables individuals to cope with grief after miscarriage or abortion. Table of Contents Executive Summary 2 Table of Contents 3 Introduction 4 Situation: Current research and literature on Miscarriage and Abortion 4 Theories of Grief 7 Stage Theory of Grief 7 Attachment Theory of Grief 8 Counselling: Issues for clients and counsellors working with grief 10 Conclusion 11 References 13 Introduction Miscarriage is tersely defined as spontaneous abortion. It is a likely natural outcome of pregnancy and has existence since time immemorial. On the other hand, induced abortion -- which is defined as a procedure that is undertaken deliberately to end pregnancy -- is generally considered to be more of recent origin. Induced abortion and miscarriage have some similarities in the fact that they are both considered as the ending of life. During miscarriage or spontaneous abortion, a loss of the foetus can greatly disrupt a mother’s emotions. Hence, miscarriage can easily be considered as an acute grief. Consequently, both miscarriage and abortion involve death and grief, both of which are typically traumatic and often induce crisis. In view of these, this paper reviews and critically analyses the current research and literature on miscarriage and abortion. It further discusses the theories of grief that inform understandings about the situation. Lastly, it identifies issues for clients and counsellors working with grief, trauma and crisis associated with this issue. Situation: Current research and literature on Miscarriage and Abortion Abortion is a critical health issue across the globe because of its severity and the high incidences of its complications, which may include septic abortion, vaginal bleeding, death, infertility, ill-health and the resulting psychological disorders such as depression (Blum et al. 2009). The loss of an infant through miscarriage, neonatal death, abortion or still birth is considered as a traumatic event and often marks a difficult time for the mothers. Most often, it results to complicated grief (CG) responses that affect the physical and psychological well-being of the mothers. As stated by Adolfsson and Lasrsson (2010), a woman who has experienced miscarriage not only loses the foetus or the embryo as she also loses the dreams and plans for the eventual child. Miscarriage, also known as spontaneous abortion, refers to the termination of pregnancy naturally before the foetus is regarded as viable. On the face of it, abortion and miscarriage generate trauma for women who undergo the conditions (Broen et al., 2004). According to Brier (2008), between 15 percent and 20 percent of pregnacies are likely to end up in miscarriage, with some of them happening during the twelfth week of gestation. Abortion and miscarriage experience are recognised to be traumatic for the mother since they incur bleeding and physical pain. Kersting and Wagner (2012) stated that the experiences of miscarriage are described as grief based on the grieving symptom. The symptoms of depression after induced abortion of miscarriage are fond in up to 50 percent of women in the first few weeks following the event of miscarriage or abortion. According to Guttmacher Institute, around 8 million women witness complications and the need for medical intervention during pregnancy, although only 5 million get to access the medical care (Pisirai, 2010). Of the 175 million pregnancies each year, some 75 million are unwanted pregnancies that end up in complications such as miscarriage (Pisirai, 2010). These statistics show the extent to which the trauma may often induce a crisis. Most often, these result to incidences of grief on the mothers who have undergone through the processes. Despite the increased acceptance that miscarriege signifies a significant experience of loss, empirical literature that relates grief to miscarriege is limited. Kersting and Wagner (2012) described grief as the normal response to lasting stress. In their view, while grief is a normal phenomenon, it has a range of emotional features. Brier (2008) defined the term grief as a psychological eaction to the loss of something that is emotionally important and usually includes mild or severe anguish. Some researchers have tried to define what makes up normal grief after miscarriage through description of the systems observable during the period of emotional anguish. Pisirai (2010) defined holistic set of symptoms of grief in an effort to differentiate beween normal and complicated grief. They further noted that during the period, there is sense of disturbance, physical complaints, somatic complaints, loss of energy and constant exhaustion. When it comes to miscarriage and abortion, scholars have viewed grief as widespread and unavoidable. Its duration and intensity however depends on an individual. While some individuals grieve intensifies for short durations, others tend to grieve moderately for long periods. Still, other individuals tend to act fast in resolving the grief. In Kersting and Wagner’s (2012) view, such kind of variation has made it difficult to define inadequate, excessive, or normal grief, or what complicated grief should actually consists of. Researches on women’s psychological response after miscarriage indicate that many go through grief, depression, guilt, anxiety and depression (Broen et al., 2004). Women may undergo grief reaction after abortion and miscarriage which is a sufficient response to loss. Hence, signs of grief have to be differentiated to determine whether they are mentally disturbed condition based on duration and intensity. Indeed, lack of grief reactions may also increase risks of depression later in life. Some studies have also explored evidences that miscarriage may contribute to posttraumatic stress disorder (PTSD) and acute stress disorder. Studies on induced abortion are scarce although some researchers have shared the view that induced abortion in the first three months of pregnancy does not have serious mental disorders compared to miscarriage or spontaneous abortion (Broen et al., 2004). According to Adolfsson and Lasrsson (2010), many women experience relief after they make the decision. However, there are several risk factors that may promote negative emotional responses after induced abortion. Women who terminate pregnancy due to foetal abnormality that occur later during pregnancy usually experience severe distress, including extended grief and depression. Few studies have examined traumatic aspect of induced abortion within the first trimester. A study by Broen et al. (2004) used the Impact of Event Scale (IES) that found that six months after induced abortion, 10 percent of the women studied were traumatised. A related study found that 1 percent of women suffered from PTSD two years after abortion (Major et al. 2000). Broen et al. (2004) pointed out that despite the similarities between induced abortion and miscarriage, the mental stress responses after the processes have not been explored. Theories of Grief Stage Theory of Grief The Stage theory of Grief can be applied in promoting an understanding and organising people’s responses to loss or attending to the duration of grief after the loss (Shear, 2007). The theory suggests that in the initial stages of grief there is disbelief and numbness, which is followed by the separation distress stage where individuals’ yearning is critical. This is later followed by a period of despair and sadness and lastly the concluding stage of recovery (Maciejewski et al., 2007). In respect to miscarriage and abortion, the idea of natural psychological reaction to loss is made up of a sequence of stages of grief that have been generally accepted by clinicians. Maciejewski et al. (2007) suggested that the Stage Theory of Grief is made up of shock-numbness, searching, despair and reorganisation. Identifying these patterns of grief symptom is essential since it improved an understanding of how individuals emotionally respond to miscarriage or spontaneous abortion. Figure 1 below indicated the hypothesised series of stages of grief, as including disbelief, yearning, anger, depression and finally acceptance. Figure 1: Hypothesised Stage Theory of Grief (Maciejewski, 2007). Despite the fact that the Stage Theory does not indicate the precise timing of the stages, several studies have concluded that for a typical case of miscarriage or loss of a loved one, the stages can be completed within six months. Attachment Theory of Grief The Attachment Theory hypothesises that attachment representations are special forms of long-term memory that are organised to guide individuals’ expectations after grief. The theory also enables an understanding of the nature of grief. It views grief as a natural product of the continuing attempt of an individual to hold onto a figure of attachment or to lessen the separation from the figure (Shear, 2007). Critically, this perspective that is promoted by the theory may be significant in understanding the tendency of an individual to experience a strong sense of longing for an anticipated or imagine relationship after abortion or miscarriage. The theory proposes that initially, an individual has energetic responses to the absence of proximity after a loss that consists of searching, protesting as well as undergoing through a passive response that signifies the start of a process of disengaging from what an individual is attached to. According to Shear (2007), the attachment theory is based on two essential principles. These include the effective functioning attachment relationship that brings a ‘secure base’, which provides comfort and support under stress. Next is the attachment relationship that is internalised in the form of models that are made up of many of the ‘secure base’ functions. During miscarriage or spontaneous abortion, a loss of the foetus can greatly disrupt a mother’s emotions. Hence, it can easily be considered as an acute grief. Shear (2007) suggested for principles of attachment functioning that helps in the understanding of complicated grief. The first include attachment relationship, which offers support for psychological functioning. The second is the mental representations of attachment figures, which has plans that outline the expectations of responsive care-giving under stress. The third principle is that stress triggers the tendency to seek proximity and safe haven while, the fourth principle is that in adults, providing is equally valued even more than receiving care. Counselling: Issues for clients and counsellors working with grief As stated by Kersting and Wagner (2012), expression of grief is critical and individuals who are going through the grief have to work through their memories, feelings and thoughts while at the same time venting out the pain of the loss and releasing themselves from attachment to the foetus. This signifies the significance of counselling. Counselling is described as the professional activities that make use of interpersonal relationships to enable individuals to develop self-understanding to make positive changes in their behaviours. In regards to miscarriage and abortion, the Doughty and Hoskins (2011) draws grief counselling to attention. The researchers defined grief counselling as a type of psychotherapy aimed at helping individuals to cope with grief after losing a loved one (Doughty & Hoskins, 2011). Murphy et al. (2012) suggested some strategies to provide some form of psychological follow-up after miscarriage or spontaneous abortion, which vary from telephone counselling offered by women who have previously had miscarriage or formal counselling sessions conducted by professional counsellors. In counselling, the mode or intervention may be passive, including electronic or written information or through clinic appointment, telephone, group support of one-on-one counselling. Murphy et al. (2012) concluded that counselling for women after spontaneous abortion or miscarriage may have significant positive impacts on psychological wellbeing. Counsellors work with clients who deal with issues of loss and grief. It is widely accepted that mothers who have undergone miscarriage or spontaneous abortion are influenced by a range of factors such as personality, experience and culture and each influences the way individuals who are bereaved express and come round from their grief (Doughty and Hoskins, 2011). Based on this perspective, it is critical for counsellors to conceive their clients from a social and cultural perspective. According to Doughty and Hoskins (2011), current practice in grief counselling stresses the need for counsellors to understand the culture of the clients. Reflecting the current literature in the field of grief, Murphy (2012) pointed out that adaptive grieving styles consider the unique and complex nature of the grieving process and are not specific to certain clients or practitioners. Rather, an individual’s adaptive grieving style is seen to be a reflection of his use of affective, behavioural and cognitive strategies. Howarth (2011) suggests taking the clients through the reconciliation process in order to recover from the grief. Reconciliation is the process through which an individual who is grieving attempts to adopt new reality of moving on in life without the physical presence of the person he is emotionally attached to. Reconciliation is attained through certain tasks that occur during the process of grieving. Howarth (2011) proposes the tasks to include acceptance of the reality of loss, experiencing the pain linked to the loss, adjusting through life, including certain aspects of the loved on into own identity, transforming the relationship from one of ongoing interactions to one of memories, finding meaning in the loss and committing to new relationships with other people. Conclusion During miscarriage or spontaneous abortion, a loss of the foetus can greatly disrupt a mother’s emotions. Hence, miscarriage and abortion are considered as acute grief. Additionally, miscarriage and abortion involve death and grief, both of which are typically traumatic and often induce crisis. Researches on women’s psychological response after miscarriage indicate that many go through grief, depression, guilt, anxiety and depression. Hence, signs of grief have to be differentiated to determine whether they are mentally disturbed condition based on duration and intensity. The Stage theory of Grief can be applied in promoting an understanding and organising people’s responses to loss or attending to the duration of grief after the loss. The Attachment Theory hypothesises that attachment representations are special forms of long-term memory that are organised to guide individuals’ expectations after grief. Expression of grief is critical and individuals who are going through the grief have to work through their memories, feelings and thoughts while at the same time venting out the pain of the loss and releasing themselves from attachment to the foetus. This signifies the significance of counselling. It is critical for counsellors to conceive their clients from a social and cultural perspective. References Adolfsson, A., Lasrsson, P. (2010). Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale. Ups J Med Sci. 115(3), 201–209. Blum, J., Winikoff, B., Gemzell-Danielsson, K., Schiavon, R. & Weeks, A. (2009). Treatment of incomplete abortion and miscarriage with misoprostal. International Journal of Gynecology and Obstetrics 99, S186-S189 Brier, N. (2008). Grief Following Miscarriage: A Comprehensive Review of the Literature. Journal of Women's Health 17(3), 451-464 Broen, A., Moum, T., Bodtker, A. & Ekerber, O. (2004). Psychological Impact on Women of Miscarriage Versus Induced Abortion: A 2-Year Follow-up Study. Psychosomatic Medicine 66:265–271 Doughty, E. & Hoskins, W. (2011). Death Education: An Internationally Relevant Approach to Grief Counseling. Journal for International Counselor Education 3(1), 25-38 Howarth, R. (2011). Concepts and Controversies in Grief and Loss. Journal of Mental Health Counseling 33(1), 4-10 Kersting, A. & Wagner, B. (2012). Complicated grief after perinatal loss. Dialogues Clin Neurosci. 14(2), 187–194. Maciejewski, P., Zhang, B., Block, S. & Prigerson, H. (2007). An Empirical Examination of the Stage Theory of Grief. JAMA, 297(7), 716-723 Major B, Cozzarelli C, Cooper ML, Zubek J, Richards C, Wilhite M, Gramzow RH. Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry 57, 777–84 Murphy F., Lipp, A. & Powles, D. (2012). Follow-up for improving psychological well being for women after a miscarriage (Review). New York: JohnWiley & Sons Pisirai, N. (2008). A Study To Determine Factors Contributing To Abortions Among Patients Reporting At Chitungwiza Population Service Zimbabwe Reproductive Health Care Clinic. Retrieved: < http://s3.amazonaws.com/academia.edu.documents/30609671/A_STUDY_TO_DETERMINE_FACTORS_CONTRIBUTING_TO_ABORTIONS.docx?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1406448440&Signature=pbtPydRTznrPax2utr6gwPy1NP4%3D> Shear, K., Monk, T., Houck, P., Melhem, N., Frank, E., Reynolds, C. & Sillowash, R. (2007). An attachment-based model of complicated grief including the role of avoidance. Eur Arch Psychiatry Clin Neurosci. 257(8), 453–461. Read More

Abortion and miscarriage experience are recognised to be traumatic for the mother since they incur bleeding and physical pain. Kersting and Wagner (2012) stated that the experiences of miscarriage are described as grief based on the grieving symptom. The symptoms of depression after induced abortion of miscarriage are fond in up to 50 percent of women in the first few weeks following the event of miscarriage or abortion. According to Guttmacher Institute, around 8 million women witness complications and the need for medical intervention during pregnancy, although only 5 million get to access the medical care (Pisirai, 2010).

Of the 175 million pregnancies each year, some 75 million are unwanted pregnancies that end up in complications such as miscarriage (Pisirai, 2010). These statistics show the extent to which the trauma may often induce a crisis. Most often, these result to incidences of grief on the mothers who have undergone through the processes. Despite the increased acceptance that miscarriege signifies a significant experience of loss, empirical literature that relates grief to miscarriege is limited. Kersting and Wagner (2012) described grief as the normal response to lasting stress.

In their view, while grief is a normal phenomenon, it has a range of emotional features. Brier (2008) defined the term grief as a psychological eaction to the loss of something that is emotionally important and usually includes mild or severe anguish. Some researchers have tried to define what makes up normal grief after miscarriage through description of the systems observable during the period of emotional anguish. Pisirai (2010) defined holistic set of symptoms of grief in an effort to differentiate beween normal and complicated grief.

They further noted that during the period, there is sense of disturbance, physical complaints, somatic complaints, loss of energy and constant exhaustion. When it comes to miscarriage and abortion, scholars have viewed grief as widespread and unavoidable.

Its duration and intensity however depends on an individual. While some individuals grieve intensifies for short durations, others tend to grieve moderately for long periods. Still, other individuals tend to act fast in resolving the grief. In Kersting and Wagner’s (2012) view, such kind of variation has made it difficult to define inadequate, excessive, or normal grief, or what complicated grief should actually consists of. Researches on women’s psychological response after miscarriage indicate that many go through grief, depression, guilt, anxiety and depression (Broen et al., 2004). Women may undergo grief reaction after abortion and miscarriage which is a sufficient response to loss.

Hence, signs of grief have to be differentiated to determine whether they are mentally disturbed condition based on duration and intensity. Indeed, lack of grief reactions may also increase risks of depression later in life. Some studies have also explored evidences that miscarriage may contribute to posttraumatic stress disorder (PTSD) and acute stress disorder. Studies on induced abortion are scarce although some researchers have shared the view that induced abortion in the first three months of pregnancy does not have serious mental disorders compared to miscarriage or spontaneous abortion (Broen et al., 2004). According to Adolfsson and Lasrsson (2010), many women experience relief after they make the decision.

However, there are several risk factors that may promote negative emotional responses after induced abortion. Women who terminate pregnancy due to foetal abnormality that occur later during pregnancy usually experience severe distress, including extended grief and depression.

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