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0:00
Hello, my name is Prof.
Alexander Heazell.
I'm one of the Professors
of Obstetrics at
the University of Manchester.
I'm going to talk
to you today about
pregnancy after stillbirth
and other forms of loss.
0:17
I'm going to focus on
stillbirth in this talk.
However, there are
other complications in
previous pregnancies that
have overlapping pathology.
Including late miscarriage,
neonatal death, and also
pregnancies affected by
severe congenital
abnormalities can end in
a termination for
fetal abnormality,
stillbirth, or neonatal death.
To a lesser extent,
what I'm going to talk about
is applicable to
pregnancies complicated by
severe fetal growth
restriction and preeclampsia.
0:52
Why are previous pregnancy
complications important?
Well, the first is that
there is biomedical
evidence that
there is a high risk
of recurrence of
previous pregnancy
complications.
There is also significant
psychological impact on
both parents—largely mothers,
but there is impact
on both parents,
showing high levels
of anxiety and stress
during pregnancy which
actually can impact,
ultimately, the bonding
between the mom and the baby.
Also, we know that
high levels of stress
can actually increase
the likelihood of adverse
outcomes in pregnancy
thus linking the psychological
and biomedical outcomes.
1:37
Prior to establishing a
specialist antenatal service,
we conducted a
systematic review and
meta-synthesis to describe
women's experiences in
subsequent pregnancies.
This systematic review
identified 14 studies,
none of which had
been conducted in
the UK at that point.
This review found
three main themes.
The first is that
emotions can co-exist.
Parents often described
ongoing grief and anxiety for
the death of their baby,
and anxiety for
the well-being of their
current pregnancy.
This isolated them from
friends and family.
Parents also embarked on
helpful and unhelpful
coping activities.
In some cases, they
delayed attachment to
their unborn child because
they couldn't envisage
going home with
a live-born baby and
they didn't want to
emotionally invest in
their unborn child.
Also, they may try
to seek control.
They may sometimes
be labelled as
difficult patients because
they want to know the answers.
They don't just want their
concerns to be dismissed.
Lastly, parents sought
reassurance through
interactions with
care providers,
with their baby, and
with technology.
