Follow-Up for Improving Psychological Well Being for Women after a Miscarriage

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 1001 subjects. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame in 3 trials (n=236) comparing one counselling session with no counselling. In one trial (n=242) comparing three one-hour counselling sessions with no counselling at four and 12 months, some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling. In all studies the interventions were delivered by different professional groups including a midwife, psychologists and nurses. Timing of the interventions varied from one week following miscarriage up to 11 weeks.

A systematic review 2 of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth included 52 trials. Synthesis and quantitative meta-summary was used to extract findings and calculate frequency effect sizes: support memory making (53%); fathers have different needs (18%); prepare parents for vaginal birth (23%); discuss concerns (13%); give options & time (20%); privacy not abandonment (30%); tailored post-mortem discussions (20%) and post-natal information (30%). Parents and staff both identified the need for improved training (parents 25% & staff 57%); continuity of care (parents 15% & staff 36%); supportive systems & structures (parents 50%); and clear care pathways (parents 5%).