Preconception Counseling after a Perinatal Loss

Problem statement: Many women who have had a perinatal loss will attempt pregnancy again someday. Preconception counseling may be very important in clarifying or reducing their risks in a subsequent pregnancy. This study seeks to understand when the opportune time to discuss preconception counseling after a perinatal loss is.

 

Literature review: After perinatal loss, another pregnancy is undertaken with great fear and anxiety (Côté-Arsenault & Morrison-Beedy, 2001). After a woman has experienced a perinatal loss, at some point health care providers should counsel their patient about what risks the woman may face in a future pregnancy (Freda, 2006), pregnacy spacing (Conde-Agudelo, Rosas-Bermudez, & Kafury-Goeta, 2006), monitoring during the pregnancy, and possibly how to prevent or minimize the risk of a second bad outcome. It is not known when the woman be most receptive to such a discussion. Many women are may be anxious or distressed about planning another pregnancy (Armstrong, 2004) and self-blame and criticism are common after a perinatal loss (Franche, 2001). Care after a perinatal loss needs to reflect the reality of the loss, the woman’s fears, and her "changed expectations"(Côté-Arsenault & Morrison-Beedy, 2001).

 

Methodology: This was a survey study of women who have attended a local perinatal loss support group, had a perinatal loss between 16-41 weeks gestation, had the loss was greater than one year previously, and had agreed to participate in surveys regarding their loss. Surveys were sent out with an explanatory cover letter to 45 women, inquiring about when they wanted to discuss another pregnancy, with whom they wanted to speak, and what information they sought. No follow-up calls were made so as not to distress those who did not wish to participate.

 

Data analysis/Results: Twenty surveys were returned. The sample consisted largely of Caucasian women in their mid-30s with college-level education. Forty percent preferred to have a preconception discussion at a special office visit, with 70% of those at a time of the woman’s choosing. Another 25% would prefer to discuss at the 6 week postpartum visit, and 15% said "anytime after the loss". Seventy-seven percent most wanted to speak with their own OB. There was no strong preference in the topics discussed at this visits, ranging from possible causes of the loss, health needs or tests which could be addressed before another pregnancy, and desired monitoring during the next pregnancy. Limitations of the study include the small, homogenous sample size, making it difficult to generalize the data.

 

Implications for care/Future research: One of the best opportunities to reduce risks in pregnancy is through preconception counseling (Moos, 2004). However, timing of this conversation after a perinatal loss can be difficult. Although ideally counseling should take place upon maternal request, information should be offered starting at the 4-6 week postpartum visit should the woman become pregnant within a short interval after the loss. Future research should try to seek a more diverse group of women.