Therefore, this study provides deeper understanding of the miscarriage experience by women from the perception of the men and this perception is extremely relevant to nursing practice, knowing that, it is nurses who deliver care regardless of gender of the clients during their limited hospitalisation period.
Early miscarriage is a common social and health event. This is supported by documented data collected at one Brisbane, Australia, hospital that revealed, some 440 women in one year who were hospitalized and went for surgical procedures due to first trimester miscarriage (Jacobs and Harvey 2000). The consequence of pregnancy loss is evidenced by significant increase in research (Boyle 1997; Gilbert and Smart 1992) on the encountered stillbirth as well as late pregnancy loss. However, despite the aspects of fetal and neonatal loss that were reported in the midwifery literature, scarceness of research about a woman’s experience of early miscarriage still remains. Furthermore, the existing research fails to center the attention on the psychosocial end result s and the social circumstance of early miscarriage.
Although men may not on the outside express their grief, the pressures produced by bereavement are substantial, particularly if they do not have the chance to openly grief (Taudacher, 1991; Frost & Condon, 1996). Whether caused by biology or culture, as compared to women, men population are less self-disclosing, they are less expressive, and also less interdependent (Levang, 1998; Stinson, Lasker, Lohmann, & Toedter, 1992).
Grieving men tend to express more anger, cry less, and are less willing to discuss about loss (Beutel, Willner, Von Rad, Deckardt, & Weiner, 1996). Men are also (a) less prone to get emotional support (Carroll & Shaefer, 1994; Smart, 1992) on the outside the matrimony relationship, (b) are more unenthusiastic to seek support within a group situation, and (c) tend to presuppose full responsibility for their bereaved position, depending upon themselves (McCreight, 2004). There are public pressures for males either to not be distressed or to recover swiftly to stay tough for the women (Evans, & Burrows, 1997; Murphy, 1998; Worth, 1997). The role of the source or provider and need to focus on occupation interfere with receiving support and is a means to keep away from the emotions of grief (Cable, 1998; Radestad, & Segesten, 2001; Staudacher; Wilson, et.al., 1988). All are barriers that make accepting and receiving help more difficult and leave fathers more at risk for developing chronic grief (Lasker & Toedter, 1991; Rando, 1986).
Some suggest that, subsequent to the loss of a child, women undergo more psychological suffering and over a longer episode of time than fathers (Hirshberg, & Dietz, 1995). Others found equivalent levels of grief in both women and men (Hoekstra- Weebers, et. al., 1991 and Rando, 1983).
A substantial group of fathers has in fact (around 20%) showed grief or distress, which surpassed that of their partners (Benfield, et. al., 1998; Dyregrov & Matthiesen, 1987 and Zeanah et al. 1995). In fact, Stinson et al. (1992) found that 29.4% of men garnered higher grief scores two (2) years post loss as compared to the 16.7% of women.
Moreover, Dyregrov as well as Dyregrove (1999) described that men’s grief scores were quite higher than that of women’s, 12 to 15 years later than the loss. Higher grief scores in the side of men, years after a loss may be brought about by their need to keep on in control and be more problem focused, supposed the defender role for the woman (Samuelsson et al. 2001and Worth, 1997). Fathers
whose partners encountered a miscarriage expressed emotions of helplessness as well as lack of control, viewed their primary role as main support for their partner, and detained back their own emotions or feelings to do this McCreight, 2004; Miron & Murphy, 1998 ). Being the protector may tone at the back of emotional response in universal, resulting to a sense of dissatisfaction and feelings of guilt, predominantly if the person who passed away was one of the “protected” (Doka & Levang, 1998).
According to Dilts (2001), men’s traditional role as protector of the family, can in fact heighten the fathers ’ vulnerability to the pain of their spouses as well as children, thereby escalating men ’ s grief. For the fathers, a succeeding pregnancy can create mixed feelings of joy as well as anxiety (Samuelsson et al. 2001 and Warland, 2000). Lack of control and the need to protect their partner (Armstrong, 2001) go on with in the subsequent pregnancy. This can generate increased alertness over the health care of the mother as well as of the baby, a heightened sense of generalized threat for the family (Armstrong; O’Leary et al., 1998), and elevated trait anxiety scores as compared to families without experience of loss (Franche, 2001; Grout & Romanoff, 2000). Others illustrate men as overwhelmed, powerless, and frustrated, and that the consequent pregnancy may be a venue of misunderstanding between couples (Cirulli-Lanham, 1999).
Some men additionally fear hurt to their partner if the earlier loss was due to a maternal medical emergency (O’ Leary & Thorwick, 1997). Most fathers
whose children passed away due to SIDS appears to have healthier coping skills in a successive pregnancy (Carroll & Shaefer, 1993-1994). With regards to value judgments on perceived differences between the male and female grief which resulted in accepted assumptions regarding difference in bereavement which may not be real (Martin & Doka, 1998).
On the other hand, cultural norms may have obstructed men from expressing grief, and they may have responded to a grief measurement tool based on the viewpoint of something they think is culturally proper rather than what they may actually feel ( Samuelsson et al. 2001). Others propose that the full range of men’s sorrow reactions were not tapped because nearly everyone measurements focused more on the feminine characteristics of loss such as sadness and tenderness (Staudacher, 1991) speculates that a person who expresses, releases, or entirely works through grief is exclusion rather than the rule. Additionally, little attention has been paid to the association between ontology and masculinity; in fact, believed to have an important bearing on the male occurrence of grief (Thompson, 2001). This supports the call for a clearer understanding about what it is like for fathers to experience pregnancy then after is perinatal loss.
The lack of awareness to the emotional dimensions of care is also seen in the medical management of miscarriage. Time and again, the woman is admitted to hospital to undergo some surgical procedure of dilatation and also curettage in order to remove any residual products of conception (Hull et al 1997). Except there are complications noted, the woman is discharged back home after a couple of hours. Consequently, the care given concentration on the physical management of the woman and also implies that this is all what is required. Little if any thought seems to be certain to her emotional wellbeing. The short hospitalisation as well as discharge may in fact consider as a major contributing factor to this perceptible lack of concern. It is comprehensible that the spotlight on community health care will prolong to encourage early release of women following miscarriage. Note that, this is not just an Australian occurrence. Hemminki (1998) for example, studied the Finnish health service intended for medical management in cases of miscarriage and the underlying principle for practice. He concluded that, a lot of countries treat women as outpatients; or support management by the woman’s family physician. It is obvious that there is a lack of weight on how a woman feels regarding early release following miscarriage and a lack of concern for the emotional after effects of miscarriage. But, there are, however, studies accessible that suggest that miscarriage create an emotional impact on the woman. An investigation on the psychological effects of miscarriage (Neugebauer, 1992) reported that, women
were in an extremely symptomatic depressed condition at six weeks and at 6 months. Comparable findings have been assisted in other studies of depression subsequent miscarriage (Beutel et al 1995) reported the existence of symptoms unfailing with psychological trauma next miscarriage. The study highlighted that women experienced upper levels of current subjective anguished than did men. The intensity of distress was positively associated to the length of pregnancy as well as increased as the pregnancy progress.
Further studies have disclosed the poor effect of pregnancy hammering on women (Ney et al 1994). Also, Bourne and Lewis (1991) showed a lack of regard for emotional wellness following early miscarriage. It was suggested that grief next to miscarriage should not be viewed as a serious defeat. In contrast, Mander (1994) contended that as an alternative of belittling the grief in which women experienced following miscarriage, civilization should recognize the women’s loss for what it means to them. Therefore, even in the literature at hand, is dissention in how society looks early miscarriage and its impacts on the woman. However, despite of indications the miscarriage could have an emotional impacts on the health of a woman, as to Prettyman et al (1993) they may likely to experience early on discharge and also just as likely not to be given some form of counselling after miscarriage.
In addition, the outcome of research will provide strong broad-based knowledge as to how clinicians will be able to understand better the nature of women as well as the men’s grief in relation to the perinatal loss and thereby better help the clients cope. This is the opportunity in the same way that, men’s general views and feelings be and understood, so the community will be able to acquire better expectations as to how they would likely feel and for how long will this take.
Objectives
This study discusses the relationship between miscarriage and men’s perspectives about it. It highlights significant literatures on miscarriage that is more focused to its nature, incidence, intensity, as well as its impact to men. In the totality, the study is directed to accumulate men’s perspectives on miscarriage; specifically it will address the following specific aims:
1. Describe men’s “fatherhood” during and aftermath of the woman’s pregnancy.
2. Relate the general and specific roles of men beginning gestational stage of woman and following perinatal loss.
3. Describe the general feelings and struggles of men about pregnancy and following miscarriage.
4. Document common experiences of men on miscarriage, as well as its clinical implications.
Problem Statement
In the light of the aforementioned aims; the study is directed to explore the various perspectives of fathers on miscarriage. In particular, the study shall address the following research questions:
- How was “fatherhood” during the onset of pregnancy and during the course of perinatal loss?
- What are the roles of men during pregnancy and following miscarriage?
- What are the difficulties confronting men who lost their baby?
- How do men overcome their struggles after losing their child?
- How do men describe the overall support given to them and to the women, following miscarriage?
- What are the points of view of men about miscarriage?
Methods
A descriptive design, phenomenological approach will be employed in this exploration (Husserl 1970) on the phenomena of early miscarriage. The proponent will adopt the definition of miscarriage, which refers to the loss of a fetus that exists up to 16 weeks gestation stage (Murphy 1998). The phenomenology approach as a qualitative method in research recognizes that experience has a very essential meaning of knowledge (Husserl 1970). Therefore, the researchers turned to the father’s experiences in order to discover what is like to live the experience of miscarriage. The researchers were more interested on the participant’s perspective and while questions will have to be raised, the degree of bias has to be avoided. The assumptions regarding miscarriage rooted from the actual experiences and the literatures which were long time been published.
A universal or purposive sampling will be utilized in the recruitment of male participants who had experienced or witnessed on their partner’s miscarriage will be selected in the study. They are those whose partners had miscarriage during the period of 2008-2009 (not later than 6 months period) and were invited to participate. Participants were referred to by the hospital and/or birthing home or clinic staff and friends. Purposely, this is not to meet the statistical requirements, since the study is qualitative, but to demonstrate disparity in the description being relayed by the respondents (Munhall and Oiler 1986). The most indispensable aspect of the story is that men had experienced miscarriage, as well as the set recall of the said experience.
Ethical Considerations
Prior to the data gathering process, permission to conduct the study must be sought and be approved by the appropriate local government authorities (if necessary) and hospital ethics board or committees. Participants were obtained through three methods of contact. They were recommended by the: a) friends of previous parents who had been engaged in a pregnancy after lost of their support group, b) a note in a bereavement bulletin, and (c) the staff at a perinatal center. Finally, about 10-15 fathers are expected to participate. After the consent was granted by the proper authorities, data will be gathered through the application of the unstructured interview. Principles of beneficence, respect to human dignity and justice will be practiced all the time until the study is completed. Initially, a preliminary interview; measures were taken to preserve confidentiality as well as anonymity were discussed; Participants will have to be clarified that in the event they would want to withdraw their participation, he researcher will accept it, without penalty. For each selected participant, interview lasted about 30 minutes to one hour.
Data Collection Process
Appropriate consent to authorities and most of all to the concerned participants will have to be secured prior to the interview process. An open-ended, unstructured interview guide will be the main research instrument in t he data collection process. The entire interview sessions will then be carried out in the respective homes of the male participants. Initially participants will be asked to some ‘ice breaking questions, then questions about the main variables will follow. Each interview with the participant will consume approximately one hour. This will be recorded using audio-taped with the permission of the participant. This procedure will ensure accuracy of the data to be collected and enable researcher to properly note significant points from the participants.
Data Analysis
Following verbatim transcription of each interview the transcripts were compared with the audiotapes for accuracy. Colaizzi’s method was used for data analysis (cited in Valle and King 1978, p.59-61). Colaizzi’s method was chosen as it is consistent with the phenomenological bracketing of held assumptions and is a method of analysis that has been shown to be valid and reliable by other phenomenological nurse researchers (Munhall and Oiler 1986). This method involved the researcher becoming immersed in the descriptions of the experience. The researcher read the transcripts to gain understanding and clarification, while intuiting or wondering about the phenomenon under investigation in relation to the various descriptions generated by the three women. Significant statements about miscarriage were extracted from each transcript. The next step was to formulate meanings from each significant statement. The formulated meanings illuminated what each participant revealed about their experience. The researcher then sought to cluster the meanings into themes. Finally the themes were integrated into a description of early miscarriage. This paper presents a description of early miscarriage and discusses the emerging themes.
Consequently, this review comprehensively surveys the literature on grief following miscarriage. It emphasizes studies that have focused on grief in regard to early miscarriage, specified the assessment intervals used so that the time since loss can be considered, and used a reliable and valid measure to assess prenatal grief. Qualitative studies are included when the results can be employed to develop hypotheses. The purpose of this review is threefold: to elucidate the nature of grief following an early miscarriage; to determine the incidence, intensity, and duration of grief at this time; and to identify the variables that potentially moderate its intensity and duration. First, the terms grief and miscarriage are defined. Next, the nature, duration, and intensity of grief following miscarriage are discussed, including differences in grief associated with gender. Key moderators are then noted. In the final section, the research and clinical implications of the review are described.
Time Scale
Budgetary Requirements
The Interview Guide
Following the appropriate principles in the conduct of an interview, the following questions below shall be asked and it is completed after 30 minutes to 1 hour:
- Can you describe how your partner all throughout her pregnancy was?
- What were your feelings when she (partner) got pregnant?
- Did you ever desire to be a father?
- How was “fatherhood” during the onset of pregnancy and during the course of perinatal loss?
- What are the roles of men during pregnancy and following miscarriage?
- What are the difficulties confronting men who lost their baby?
- What motivated you to confront the impacts of miscarriage?
- How do men overcome their struggles after losing their child?
- How do men describe the overall support given to them and to the women, following miscarriage?
- What are the points of view of men about miscarriage?
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