The impact of miscarriage and stillbirth on maternal-fetal relationships: an integrative review.

Objective: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal-fetal relationships subsequent to miscarriage and stillbirth.

Background: Although now widely accepted that the relationship between mother and child develops in utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy.

Methods: An integrative review methodology was chosen for the review.

Results: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal-fetal relationship, and coping following perinatal loss and the subsequent maternal-fetal relationship.

Conclusions: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal-fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother-fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal-fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.