A miscarriage or spontaneous abortion was described by Niven and Walker (1996) as a psychologically challenging for couples. It is the loss of the expected child (McCreight, 2004; Kimble, 1991; Murphy, 1998) for the period of pregnancy with the opportunity of hopes and dreams; and possibly, the disruption of relationship with one’s partner (Speckhard, 1997) can be as depressing for women and also with men.
This phenomenon exists before the legal age of the fetus life viability, which is 24 weeks gestation. According to reports, the rate of early miscarriage is something like 30% at four weeks gestation, while 20% between four and about thirteen (13) weeks gestation (Rajan and Oakley 1993). Moreover, it has been estimated that about 80% of all conceptions closes stage in fetal death, and the sad thing is that, majority of these happen without the knowledge of the woman (Rajan and Oakley 1993).
Miscarriage continues to be a significant problem among women. In fact, in most literatures, grief, ethical dilemmas, depression and health effects are some of the topics which are strongly associated among women as far as miscarriage are concerned, and very limited studies tackle and measured the involvement and perspective of men on the issue. During pregnancy as well as birth, the impact of the role of fathers is not clear and they are valued just as persons “to support” the mother.
Studies have reported that fathers who had the chance to see their babies on ultrasound manifested greater sense of loss as compared to those who had not seen (Armstrong, 2001; Johnson ; Puddifoot, 1998; McCreight). Worth (1997) revealed that fathers of stillborn offspring experience a dissatisfying relationship knowing that have not protected their child for the duration of pregnancy and did not have the occasion to nurture him or her (McCreight).
So much experiences have already been shared about the mother ‘ s experience and struggles emotionally in relation to perinatal loss, but too little studies were known about father’s experiences and how they are being affected by the perinatal loss of their child?
Thus, to explore the experiences and perspectives of men following miscarriage is the concern of this study. Much as miscarriage has been considered as one major event in women’s lives, this is just as the same for men. All this time, men may have accepted that no one have understood their experience of emotional upheaval due to the situation. There may be those who believe that family, their friends or even the society did not consider their experience of miscarriage also as a loss of their hopes, aspirations and dreams, to some extent, so as their fatherhood role. To them feelings were simply brushed aside as one with very little significance. The emotional disorder experienced by these men after many months needed the establishment of the therapeutic relationship.
Two reliable academic published sources (Puddifoot and Johnson, 1997 & Murphy, 1997) confirmed that miscarriage experiences of women create unpleasant impacts to their male partner. Both qualitative (exploratory) studies adopted the phenomenological approach in gathering data and stressed out that the roles and emotional difficulties of men brought about by miscarriage have been overlooked for so long a time; while much of their experiences were not so expressed on literatures.
Puddifoot and Johnson based randomly selected the pool of participants. After the referrals of staff nurses from gynaecological wards of hospitals, located in the northeast of England; Twenty (20) out of forty two (42) men whose partners had struggled from spontaneous abortion before the 24th week of pregnancy were chosen randomly and responded positively for a discussion on their experience and their reactions to the latest miscarriage of their female partner. Initial contact with the men was made via referrals from gynaecological wards of hospitals in the northeast of England by nursing staff on the wards, which approached men after their partners had miscarried. Using the thematic approach with reference to the principle of Potter and Wetherell (1987), the following areas as the main variables of the study were analyzed: the disclosure of one’s feelings to others, the feelings related to their perspective partners’ miscarriage, imagery associated to the unborn child, the explanations of causality or apportioning of blame, and also the experience of the male partner specifically in the hospital~medical context. The authors pointed out that, judging one’s own reaction; not recognizing the pain suffered by men out of the circumstances; as well as the confidence on the authenticity of one’s own reaction were the perceived weaknesses of the said study.
On the other hand, Murphy’s study was quite more complicated in terms of selecting study participants. The decision was based on Harker’s (1993) work that suggested participant should be the better half of women, who just had miscarriage at least six months later. Other than that ethical issues need have to be settled since Lee (1993) argued that as far as surrounding sex, reproduction and death would be part of the questions, those are considered taboo in Western cultures. Thus, more formal approaches were observed from local branches of the national charities to let them understand the nature of the study conducted. After the consent was granted, data were gathered through the use of the unstructured interview. Initially, a preliminary interview; measures were taken to preserve confidentiality as well as anonymity were discussed; clearly, participants were made to understand that they could withdraw any time they want, without penalty. For each selected participant, interview lasted about 30 minutes to one hour and all responses were tape recorded. One observation in this study is that, the author has not elaborated clearly the weaknesses of the study.
According to PATH (2007), around the world, reproductive health programs have increasingly recognized men as a vital audience for their services. Men have health concerns of their own and their health status as well as behaviors also affects the reproductive health of women. In cases of miscarriage, the views and roles of men are somehow seldom considered probably since the focal point of prenatal classes is more on the women’s physical care, with men’s concerns seldom addressed (Mason & Elwood, 1995). Jordan (1990) sought that the birth of a child was recognized as one of the important key transitions into fatherhood, saying men, at an instance, may not believe that they are fathers until actual birth comes and how happy they are during the said moments. Just imagine how fathers are when their baby dies during pregnancy or shortly after?
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.