Grief Journey: Perception and Response Based on Cultural Beliefs in Thai Women Experiencing Perinatal Death

Nedruetai  Punaglom; Puangpaka  Kongvattananon; Bih-Ching  Shu

Authors

Nedruetai Punaglom RN, PhD (Candidate), Faculty of Nursing, Thammasat University, Pathum Thani, Thailand.
Puangpaka Kongvattananon RN, PhD, Associate Professor, Faculty of Nursing, Thammasat University, Pathum Thani, Thailand.
Bih-Ching Shu RN, PhD, Institute of Allied Health Sciences, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan.

Abstract

Studying perinatal death needs to involve cultural beliefs influencing women’s perceptions and responses to illuminate their grief journey following the loss of their baby. There is an urgent need to provide a deep understanding in this area that will be useful in meeting the unmet needs of women experiencing perinatal death. This qualitative study explored the grief journey set among cultural beliefs of Thai women experiencing perinatal death. Twenty-five participants who experienced perinatal death between six months and two years before participating in the study were recruited by purposive sampling through the medical history records of four community hospitals in a province of Thailand. Data were collected by in-depth interviews from September 2020 to March 2021 until data saturation. Content analysis was applied to analyze the data.
Findings revealed four themes: 1) bewildering in the dark (wondering what is wrong, anxiety and fear about the anticipated loss, flickering hope); 2) grief response (the world suddenly shuts down, overwhelming sorrow); 3) self-reflection (by talking to self, talking
to others); and 4) self-healing (compliance with cultural beliefs, the forgiveness of self and others). In conclusion, healthcare providers should be equipped with essential knowledge for addressing issues holistically based on cultural sensitivity that will be useful in enhancing the utmost ability of women in moving through their grief.

References

Camacho-Ávila M, Fernández-Sola C, Jiménez-López FR, Granero-Molin J, Fernández-Medina IM, Martínez-Artero L, et al. Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study. BMC Pregnancy Childbirth. 2019;19:512. doi:10.1186/s12884-019-2666-z.

Ridaura I, Penelo E, Raich RM. Depressive symptomatology and grief in Spanish women who have suffered a perinatal loss. Psicothema. 2017;29(1):43-8. doi:10.7334/psicothema2016.151.

Markin RD, Zilcha-Mano S. Cultural processes in psychotherapy for perinatal loss: breaking the cultural taboo against perinatal

grief. Psychotherapy (Chic). 2018;55(1):20-6. doi:10.1037/pst0000122.

Salenius P. Sociological and psychological effects of stillbirth: theory, research, and midwifery. Br J Midwifery. 2019;27(10):616-9. doi:10.12968/bjom.2019.27.10.616.

Faro L. Monuments for stillborn children and disenfranchised grief in the Netherlands recognition, protest and solace. Mortality (Abingdon). 2021;26(3):264-83. doi:10.1080/13576275.2020.1779202.

Tseng YF, Chen CH, Wang HH. Taiwanese women’s process of recovery from stillbirth: a qualitative descriptive study. Res Nurs Health. 2014;37(3):219-28. doi:10.1002/nur.21594.

Sriarporn P, Turale S, Lordee N, Liamtrirat S, Hanpra W, Kanthino A. Support program for women suffering grief after termination of pregnancy: a pilot study. Nurs Health Sci. 2017;19(1):75-80. doi:10.1111/nhs.12307.

Fernández-Ordoñez E, González-Cano-Caballero M, Guerra-Marmolejo C, Fernández-Fernández E, García-Gámez M. Perinatal grief and post-traumatic stress disorder in pregnancy after perinatal loss: a longitudinal study protocol. Int J Environ Res Public Health. 2021;18(6):

doi:10.3390/ ijerph18062874.

Könes MÖ, Yıldız H. The level of grief in women with pregnancy loss: a prospective evaluation of the first three months of perinatal loss. J Psychosom Obstet Gynaecol. 2021;42(4):346-55. doi:10.1080/0167482X.2020.1759543.

Kokou-Kpolou K, Menick DM, Moukouta CS, Baugnet L, Kpelly DE. A cross-cultural approach to complicated grief reactions among Togo–Western African immigrants in Europe. J Cross Cult Psychol. 2017;48(8):1247-62.doi:10.1177/0022022117721972.

Tanglakmankhong K, Thongphao P, Srisuwan J, Phuwongkrai O. The study of local wisdom of maternal and childcare using community classroom and research-based learning.J Prapokklao Hosp Clin Med Educat Center. 2016;33(4):288-99 (in Thai).

Wattanagun K. The phenomenology of supernatural belief: the ravenous spirit (Phii Pob) belief tradition in contemporary Northeast Thailand. Asian Ethnol. 2018;77(1):79-97 (in Thai).

deMontigny F, Verdon C, Meunier S, Dubeau D. Women’s persistent depressive and perinatal grief symptoms following a miscarriage: the role of childlessness and satisfaction with healthcare services. Arch Womens Ment Health. 2017;20(5):655-62. doi:10.1007/s00737-017-0742-9.

Gopichandran V, Subramaniam S, Kalsingh MJ. Psycho-social impact of stillbirths on women and their families in Tamil Nadu,

India – a qualitative study. BMC Pregnancy Childbirth. 2018;18:109. doi:10.1186/s12884-018-1742-0.

Hill PW, Cacciatore J, Shreffler KM, Pritchard KM. The loss of self: the effect of miscarriage, stillbirth, and child death on maternal self-esteem. Death Stud. 2017; 41(4):226-35.doi:10.1080/07481187.2016.1261204.

Wiriya K, Ketkaewmanee O. Experience of mental suffering in mothers who faced with dead fetus in utero: DFIU. Srinakharinwirot University (Journal of Science and Technology). 2014;6(12):1-12 (in Thai).

Rashid S, Jehan N, Khan NA, Gul S, Khan HM. Relationship between self-compassion and compassion for others. Ilkogretim Online. 2021;20(6):440-7. doi:10.17051/ilkonline.2021.06.046.

Wright PM. Perinatal loss and spirituality: a metasynthesis of qualitative research. Illn Crisis Loss. 2020;28(2):99-118. doi:10.1177/1054137317698660.

Lafarge C, Mitchell K, Fox P. Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief. Anxiety Stress Coping. 2017;30(5):536-50. doi:10.1080/10615806.2016.1278433.

Allahdadian M, Irajpour A. The role of religious beliefs in pregnancy loss. J Educ Health Promot. 2015;4:99. doi:10.4103/2277-9531.171813.

Kokou-Kpolou K, Megalakaki O, Nieuviarts N. Persistent depressive and grief symptoms for up to 10 years following perinatal loss: involvement of negative cognitions. J Affect Disord.2018;241:360-6. doi:10.1016/j.jad.2018.08.063.

Kain VJ. Perinatal palliative care: cultural, spiritual, and religious considerations for parents—what clinicians need to know. Front Pediatr. 2021;9:597519. doi:10.3389/fped.2021.597519.

Turale S. A brief introduction to qualitative description: a research design worth using. Pacific Rim Int J Nurs Res.2020;24(3):289-91.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-51. doi:10.1097/ACM.0000000000000388.

Higginbottom GM. Sampling issues in qualitative research. Nurse Res. 2004;12(1):7-19. doi:10.7748/nr2004. 07.12.1.7.c5927.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15. doi:10.1111/j.1365-2648.2007.04569.

Lincoln YS, Guba EG. Naturalistic inquiry. Thousand Oaks: Sage; 1985.

Jentoft N, Olsen TS. Against the flow in data collection: how data triangulation combined with a ‘slow’ interview technique enriches data. Qual Soc Work. 2019;18(2) 179-93. doi:10.1177/1473325017712581.

Javadifar N, Majlesi F, Nikbakht A, Nedjat S, Montazeri A. Journey to motherhood in the first year after childbirth. J Family Reprod Health. 2016;10(3):146-53.

Nuzum D, Meaney S, O’ Donoghue K. The impact of stillbirth on bereaved parents: a qualitative study. PLoS One. 2018;13(1):e0191635. doi:10.1371/journal.pone.0191635.

Testoni I, Bregoli J, Pompele S, Maccarini A. Social support in perinatal grief and mothers’ continuing bonds: a qualitative study with Italian mourners. Affil - J Women Soc Work. 2020;35(4):485-502. doi:10.1177/0886109920906784.

Watson J, Simmonds A, La Fontaine M, Fockler ME. Pregnancy and infant loss: a survey of families’ experiences in Ontario Canada. BMC Pregnancy Childbirth. 2019;19:129. doi:10.1186/s12884-019-2270-2.

Youngblut JM, Brooten D, Glaze J, Promise T, Yoo C. Parent grief 1-13 months after death in neonatal and pediatric intensive care units. J Loss Trauma. 2017;22(1):77-96.doi:10.1080/15325024.2016.1187049.

Rodsub N. Patriarchy: the reflection of the inequality between male and female in Asian society. Academic Journal of Humanities and Social Sciences Buriram Rajabhat University. 2012;4(2):30-46 (in Thai).

Kejkornkaew S, Sirapo-ngam Y, Monkong S, Junda T, Wallhagen MI. A grounded theory study of the quality relationships between family caregivers and persons with head and neck cancer. Pacific Rim Int J Nurs Res. 2016;20(2):161-73. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/39281

Phra Promkhunaporn (Prayut Payutto). Buddhadham. Bangkok: Phli-Dharma Publishing; 2014 (in Thai).

Lin CT, Yen WH. On the naturalization of karma and rebirth. Int J Dharma Stud. 2015;3:6. doi:10.1186/s40613-015-0016-2.

Cheng FK. Buddhist insights into life and death: overcoming death anxiety. Athens J Soc Sci (online). 2017;4(1):67-88. doi:10.30958/ajss.4-1-4.

Ayebare E, Lavender T, Mweteise J, Nabisere A, Nendela A, Mukhwana R, et al. The impact of cultural beliefs and practices on parents’ experiences of bereavement following stillbirth: a qualitative study in Uganda and Kenya. BMC Pregnancy Childbirth. 2021;21:443. doi:10.1186/s12884-021-03912-4.