AWA: Academic Writing at Auckland

Aims and objectives

The aim of this project is to identify how women cope with a spontaneous abortion, what methods are effective, and what needs to be improved or changed to help future women cope.

Objectives include understanding how individual women cope with a miscarriage, what outside influences help or hinder her return to a normal life. This study aims to find how women feel about their loss and how they feel that their family, friends, doctors, nurses and any other medical staff understand their loss. For the women who continue to suffer, this study will identify if support services are made available to them and how effective these services are.

Background literature

It is estimated that around 20% of all pregnancies will end in miscarriage (Rowlands & Lee, 2010). Of these women there will be many who experience depression and anxiety. Friends and family members can be perceived as being insensitive in how they act and not understanding the significance of the loss (Rowlands & Lee, 2010). 

It has been found in other countries that during their ordeal, women are provided with insufficient information about implications of a miscarriage, insensitivity by medical staff, and admittance to maternity wards which all contribute to a more unpleasant experience (Geller, Psaros & Kornfield, 2010; Rowlands & Lee, 2010). Women experiencing a miscarriage believe medical professionals treat them as though their suffering and loss is not meaningful, as though it was not a baby that they lost (Geller, Psaros & Kornfield, 2010).

Not all women will suffer intensely or for a long period of time after a miscarriage, however it is evident from Rowlands and Lee’s 2010 study in Australia that women who do endure prolonged suffering are not given adequate care or support. The discrepancies between responses may make it difficult for medical professionals to react; some women feel immense loss, others feel relief, and others feel nothing (Rowlands & Lee, 2010). Medical professionals need to be aware and sensitive to the wide range of responses a woman can have so as to not impose any further grief or induce guilt if they do not feel a certain way.

Sejourne, Callahan and Chabrol showed in 2010 that a therapeutic session after miscarriage where women are able to express their feelings helped to lessen scores on anxiety and depression. Rowlands and Lee (2010) also found that women recover faster when they are able to talk honestly about their feelings, even just to friends and family, and have them legitimized.

Research questions

What do women find helpful or not helpful when living after a miscarriage? Do women talk with friends and family or internalize feelings?

Are there services available to help women cope after miscarriage and do women use these?

Naturally women have a wide range of reactions to their miscarriage; do friends, family or medical professionals make women feel wrong for feeling however they do?

From the literature it is seen that an issue for most women was the lack of support and empathy from medical professionals, these studies were done overseas so do women in New Zealand experience the same level of care?

Research design

Epistemology and methodology

This research will be undertaken with a positivist epistemology (Willig, 2001), with an experiential qualitative research design. I believe that the women will give extreme insight into how they are treated and even why they are treated that way. Previous research will also help with the theory behind perceptions around miscarriages and care that women receive. Data will be obtained in the form of interviews, participants being self selected from information available to them in medical institutions.  Methodology will be undertaken with a reciprocal feminist approach (Dyer, 2006), the aim is to understand how women are treated and what impact this has on their coping. As women are already unequal in society compared to men their experiences with medical professionals will be thought to be far away from the ideal (Hammersley, 1992), given miscarriage only happens to women, women may feel even more oppressed. Interviewers, including myself will already have ideas about miscarriages and these will unavoidably have some effect on the participants, however individual views will not be shared unless necessary.

Participant sample

 The sample will consist of 30 women who experienced a miscarriage prior to 20 weeks gestation and experienced a miscarriage in a New Zealand medical institution. All women will have miscarried up to three months before their interview. To ensure a comprehensive sample (Flick, 2004), at least 10 of the women will have to feel as though their miscarriage affected them profoundly, while at least five of the women will have to feel as though the miscarriage had no significant emotional impact on their life. Fewer women will be required whom the miscarriage did not affect largely because it has been documented that more women experience grief after a miscarriage than women who do not (Madden, 1994). The influence the miscarriage had on a woman’s life will be assessed by the survey that potential participants will be required to fill out. Women will be thoroughly informed of what their participation requires; talking about their miscarriage and potential grief associated, and will be free to withdraw from the study if they are not comfortable with it.

Data collection/analysis methods

Potential participants will fill out general information concerning age, date of miscarriage, length of pregnancy, previous miscarriages/pregnancies/abortions, and marital status. They will also fill our survey-like questions in the form of 4-point likert scales. These questions will address: how they felt when they found out about their miscarriage, how they felt the medical staff treated them during and after miscarriage, and how they felt that their family and friends responded to their feelings.

Interviews will then be held for approximately an hour long; from the questionnaire interviewers will be slightly prepared for what the participants feelings may be. The interviews will be semi structured (Willig, 2001), with interviewers aiming to go into detail about: how women felt when they found out about their pregnancy; how they felt about their miscarriage; what techniques they used to cope with their miscarriage; how supportive and caring medical professionals were; how adequately partners/friends/family responded to the miscarriage; whether support services were made available; and whether women used these services. As the topic involves discussing family members, the participants will have the choice of the interview being conducted in their home or at a neutral location. Participants will also be informed that they can bring a friend or family member if they feel as though support would help their contribution.

With the participants consent the interview will be recorded, and as soon as possible the interview will then be transcribed. Interviews will then be coded thematically for similarities and concordances, with interviewer participation being accounted for (Dyer, 2006). An inductive approach to thematic analysis will be used (Braun & Clarke, 2006), and will show whether women experience a miscarriage in similar or different ways, and where the similarities or differences are. Interviews will also be analyzed using grounded theory to deduce whether findings in other countries are valid in New Zealand.

Ethical concerns

All participants and potential participants will be informed as to what the study will entail by a handout for women to take home and then decide whether to take part. Participants will be informed that they can withdraw from the research at any time if it becomes too hard, they will also receive a debrief at the end including information on support services if they feel issues are unresolved (Sieber, 1998).  Confidentiality is a key aspect of research on a sensitive topic. In any publications, pseudonyms will be used to maintain confidentiality and no identifying features of any participants will be presented. No deception is involved at any stage, participants will always receive detailed information on the study and further elements if they require. The only possible ethical concern with this research is the well being of the participant; naturally miscarriage can be a highly sensitive and painful subject for some women. A concern with idiographic one-on-one interviews can be the intensity for the participant. During the interview the interviewer is in charge, the participant is not normally in control of the topic, or the type or depth of questions (Brickmann & Kvale, 2005). As the interviews will already be concerning a sensitive subject, the participant will be informed prior that they can forgo any question if it is too sensitive, they will also be able to ask questions themselves. Given this, the main focus of the interviews will be gaining relevant information but also making sure the participant does not feel unnecessarily distressed; interviewees will be informed of when to stop and take a break or offer support before continuing.

Anticipated outcomes

Unfortunately, I predict that outcomes of this research are most likely going to be similar to findings around the world that information given to miscarrying women is insufficient, and some are treated in careless ways (Freda, Devine, & Semelsberger, 2003). Also similar to previous findings I expect that women who feel as though they can safely and honestly express their feelings will cope better than those who are made to think they are overreacting. Women who cope well with their miscarriage I expect to mourn thoroughly, grieve as if a child has been lost, saying goodbye and acknowledging she is going through a significant loss. Women who do not cope as well I expect to be internalizing feelings and believe that no one understands their pain. I predict that women suffering will make use of support services available, however to what extent these are suggested and helpful I am unsure.

Practical application/theoretical contribution

This research will help to further knowledge of how women who experience a miscarriage cope, and what factors help these women. This study is based in a New Zealand context so will be extremely relevant for consulting when healthcare providers are assessing if women’s needs are met and how their experience could be improved. It will also be practical when support services are being established or improved, as it will show exactly what is needed locally, not solely based on studies in other countries. Knowledge of what is helpful when going through a miscarriage will be important even for pamphlets or some lesser form of support other than in depth services. This study will also pave the way for future study into miscarriages including how the number of miscarriages affect coping, how family support compares with friends support or support groups of similar women.

References:

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

Brickmann, S., & Kvale, S. (2005). Controlling the Ethis of Qualitative Research. Journal of Constructivist Psychology, 18(2), 157-181. Retrieved from http://web.ebscohost.com.ezproxy.auckland.ac.nz/ehost/search/advance     d?sid=65852e48-b0f8-4476-aa85-       f91ad94f655b%40sessionmgr112&vid=2&hid=15

Dyer, C. (2006). Research in Psychology: A Practical Guide to Methods and Statistics. Malden, MA: Blackwell.

Flick, U. (2004). Design and Process in Qualitative Research. In U. Flick, E. von Kardoff & I. Steinke (Eds.), A Companion to Qualitative Research (pp.146-152). London: Sage.

Freda, M. C., Devine, K. S., & Semelsberger, C. (2003). The lived experience of miscarriage after infertility. The American Journal of Maternal/Child Nursing, 28(1), 16-23. Retrieved from http://ovidsp.tx.ovid.com.ezproxy.auckland.ac.nz/sp-3.4.0b/ovidweb.cgi?&S=KNLKFPGPEEDDNDEBNCCLKEFBKINJAA00&Link+Set=S.sh.36%7c2%7csl_10

Geller, P. A., Psaros, C., & Kornfield, S. L. (2010). Satisfaction with pregnancy loss aftercare: are women getting what they want? Archives of Women’s Mental Health, 13(2), 111-124. Retrieved from  http://www.springerlink.com.ezproxy.auckland.ac.nz/

Hammersley, M. (1992). On Feminist Methodology. Sociology, 26(2), 187-206. Retrieved from http://online.sagepub.com.ezproxy.auckland.ac.nz/

Madden, M. E. (1994). The variety of emotional responses to miscarriage. Women & Health, 21(2-3), 85-104. Retrieved from        http://www.informaworld.com.ezproxy.auckland.ac.nz/smpp/home~db=all

Rowlands, I. J., & Lee, C. (2010). ‘The silence was deafening’: social and health service support after miscarriage. Journal of Reproductive and Infant Psychology, 28(3), 274-286. Retrieved from http://www.informaworld.com.ezproxy.auckland.ac.nz/smpp/home~db=all

Seiber, J. E. (1998). Planning ethically responsible research. In L Bickman & D. J Rog (Eds.), Handbook of applied social research methods (pp. 127-156). Thousand Oaks, CA: Sage.

Sejourne, N., Callahan, S., & Chabrol, H. (2010). The utility of psychological intervention for coping with spontaneous abortion. Journal of        Reproductive and Infant Psychology, 28(3), 287-296. Retrieved from          http://www.informaworld.com.ezproxy.auckland.ac.nz/smpp/home~db=all

Willig, C. (2001). Introducing qualitative research in psychology: Adventures in theory and method. Buckingham, UK: Open University Press.