Psychosocial implications of stillbirth for the mother and her family : a crisis-support approach

Human, Melanie (2013-03)

Thesis (M Social Work)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: According to South African annual statistics, stillbirth is a relevant issue and National health policies, social welfare services and health care providers should place special focus on pregnant women to avoid the possible occurrence of a negative pregnancy outcome such as a stillbirth. An event that should have been a joyous birth, ended in a tragic death, forcing the mother to deal with the emotions of birth and death simultaneously. The bereaved mother needs to receive special care and support as soon as possible and the crisis intervention approach is seen as being helpful to regain a sense of equilibrium in her and the family’s life before starting to adapt to the new situation. This study explores and describes the lived experience of 25 mothers who experienced a stillbirth. Focus was given to the psychosocial implications of stillbirth on mothers and their families. This study examined the mothers’ feelings about the stillbirth six months or longer after the event, as well as its impact on relationships with partners and other children. By adopting a crisis intervention approach, the effectiveness of crisis intervention shortly after the stillbirth could be investigated. This study used a combination of quantitative and qualitative research approaches and assumed an exploratory and descriptive research design to provide a detailed description of the phenomenon being studied, i.e. the psychosocial implications of stillbirth. A questionnaire was used to obtain demographic (quantitative) data and a semi-structured questionnaire – the design based on information from literature - was administered during individual interviews. Obtained data was both measurable and rich in description and revealed that mothers still longed for their stillborn babies after a period of six or more months had passed. It also indicated that the father or partner of the baby and other children were affected by a stillbirth. Gender differences in how stillbirth is experienced by each partner, consequently adds extra tension on the relationship. Most of the mothers experienced the stillbirth as a crisis and found support in their mothers, family and a counsellor. Significantly, mothers felt crisis-intervention was beneficial, but preferred that crisis intervention be followed by on-going therapy. The stillbirth also resulted in feelings of alienation from community, friends and family - who did not know how to approach them. Generally, mothers were satisfied with medical care received but several issues regarding autopsy consent and guilt feelings surrounding this are highlighted. Important recommendations resulting from the study indicate that the crisis-intervention approach as method in social work is effective when rendering service for bereaved mothers and families after a stillbirth. It helps to regain a sense of equilibrium, but further intervention is recommended to facilitate the grief process. In addition, the study emphasizes the importance of social workers being aware that the stillbirth causes tension in partner- and family relationships. Receiving social work intervention is not only highly effective, but allows bereaved mothers to feel empowered and encouraged to openly grieve for their stillborn babies - much needed in an environment where a stillbirth is seen as a silent birth.

AFRIKAANSE OPSOMMING: Volgens jaarlikse Suid-Afrikaanse statistieke, is stilgeboorte ‘n relevante onderwerp en die Nasionale gesondheidsbeleid, maatskaplike welsynsdienste en gesondheidssorgverskaffers moet fokus op swanger vroue ten einde moontlike negatiewe swangerskapuitkomstes, soos stilgeboorte, te voorkom. Tydens ‘n stilgeboorte, eindig die heuglike vooruitsig van ‘n geboorte in die tragiese afsterwe van die baba en word die moeder geforseer om emosies van geboorte en sterfte gelyktydig te hanteer. Sulke moeders benodig spesiale versorging asook ondersteuning so spoedig moontlik. Krisis intervensie is ‘n effektiewe metode om die moeder te help om ‘n mate van balans in haar en haar gesin se lewe te herwin voordat hulle kan begin aanpas by die nuwe situasie. Hierdie studie ondersoek en beskryf ervarings van 25 moeders wat ‘n stilgeboorte ervaar het. Fokus word geplaas op die psigososiale effek van stilgeboorte op moeders en hul gesinne. Moeders se gevoelens rakende die stilgeboorte ses maande of langer na die geboorte, is ondersoek, asook die effek daarvan op hul verhoudings met lewensmaats en ander kinders. Deur die krisis intervensie benadering te gebruik, kon die effektiwiteit daarvan kort na die stilgeboorte ondersoek word. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in hierdie studie gebruik. Die studie veronderstel ʼn verkennende en beskrywende navorsingsontwerp om sodoende ʼn uitvoerige beskrywing van die psigososiale implikasie van stilgeboorte te verskaf. Data word verkry deur ʼn vraelyste - demografiese (kwantitatiewe) data, asook semigestruktureerde vraelyste (kwalitatief) wat tydens individuele onderhoude toegedien is. Die ontwerp van die semi-gestruktureerde vraelys is gebaseer op inligting vanuit die literatuurstudie. Die bevindinge van die empiriese ondersoek dui aan dat moeders na ses maande of langer steeds hunker na hul stilgebore babas. Geslagsverskille rakende die wyse waarop moeders en vaders die stilgeboorte ervaar dra gevolglik by tot ekstra spanning in die verhouding. Die meeste moeders het die stilgeboorte as ‘n krisis ervaar en het ondersteuning gevind by hulle moeders, gesinne en ‘n berader/maatskaplike werker. ‘n Beduidende bevinding was dat moeders krisis intervensie as voordelig beskou het, maar verkies dat dit opgevolg moet word deur deurlopende terapie. Die stilgeboorte veroorsaak ook dat die moeders ‘n gevoel van vereensaming van die gemeenskap, vriende en familie ervaar het. Volgens hulle was mense te bang en onseker in hoe om hulle te benader. In die algemeen was moeders tevrede met die mediese sorg wat hulle ontvang het, maar kwessies rakende toestemming en skuldgevoelens rondom nadoodse ondersoeke word uitgelig. Belangrike aanbevelings dui aan dat krisis intervensie as metode in maatskaplike werk effektief is ten opsigte van dienslewering vir ‘n moeder en haar gesin na ‘n stilgeboorte. Dit help om ‘n mate van balans te herstel, maar verdere intervensie word aanbeveel om die rouproses te fasiliteer. Die studie beklemtoon ook dat dit belangrik is dat maatskaplike werkers bewus moet wees dat ‘n stilgeboorte spanning veroorsaak in huweliks- en gesinsverhoudings. Die ontvangs van maatskaplike werk intervensie is nie net hoogs effektief nie, maar bemagtig en motiveer moeders om openlik te rou vir hulle stilgebore babas, iets wat nodig is in ‘n samelewing waar stilgeboorte as ‘n geboorte beskou word waaroor daar nie gepraat word nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/80068
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