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Perinatal Loss Among Adolescent Parents Essay

Updated August 14, 2022
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Perinatal Loss Among Adolescent Parents Essay essay

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Every year, approximately 50,000 to 750,000 teenage women in the United States experience pregnancy, many of which are unintended. Thirty-one percent of young american women become pregnant at one before they reach the age of 20 (National Campaign to Prevent Teen Pregnancy, 2009), averaging approximately 75,000 pregnancies a year (U.S. Teenage Pregnancy Statistics, 2009). Unfortunately, many of these pregnancies conclude in perinatal death. Whether the loss is the result of voluntary abortion, miscarriage, sudden infant death syndrome, or health related issues, the adolescent parent become burdened to the consequences of grief that are associated with death and loss.

Adolescent parents who experience pregnancy loss are at increased risk at of suffering serious psychological disturbance, which may be manifest in a variety of psychological symptoms that can be likely impaired daily living. Investigations have consistently found that perinatal death may have profound and long-term effects on parents (Vance, Boyle, Najman & Thearle, 2002). Clinicians and researchers have presupposed that perinatal loss generates posttraumatic stress disorder and depression. It is estimated that the lifetime risk for posttraumatic stress disorder from perinatal loss to be 29% (Hughes, Turton, Hooper, and Evans, 2002). After evaluating 65 women who had experienced stillbirth, reported that approximately 20% experience prolonged depression and another 20% developed PTSD.

The effects of an unexpected perinatal loss can be devastating to families. The ensuing bereavement from a perinatal loss has been found to result in a crisis for families (Page-Lieberman & Hughes, 1990). The grieving process can hinder each family member’s growth and development and impair family relationships. Approximately 10-25% of parents who lose a baby either through miscarriage, stillbirth, SIDS, and induced abortion have been linked with pronounced psychological problems.

It is estimated that 25-35% of pregnancies result in early pregnancy loss, occurring before 20 weeks gestation. Each year in the United States there are approximately 30,000 stillbirths, which is defined as fetuses dying in the uterus and then born after 20 weeks gestation. This occurs in 1 out of 150 pregnancies and represent 7 fetal deaths per 1000 live births. 16 in 1000 pregnancies end with a stillborn infant or the death of an infant after birth. Neonatal deaths occur at a rate of 6.8 per 1000 live births (Callister, 2006). It is important that the experience of adolescent parents during a perinatal loss be explored. The aim of this study is to explore the adolescent parents’ perinatal loss experience to facilitate understanding and development of effective evidence-based interventions for resolution of paternal grief that promote healthy family functioning and provide a platform for professionals and practioners to develop services that cater to the proposed research study participants. The study may lend itself to further exploration on the topic of perinatal loss and adolescent grief.

Feelings of guilt and shame are common among bereaved parents after perinatal loss, especially among women (Lang, Gottlied& Amsel, 1996). At one to to months post-loss, perinatal bereaved mothers appear to experience guilt and shame significantly more than father do (Lang et al, 1996). Fathers’ reaction to a perinatal loss can be different from their parents because they did not carry the child and thus did not experience a long, direct, growing physical attachment. Although the fathers’ attachment to the child may have been less, their child’s death may be no less significant. Many fathers report helplessness, frustration, and anger at the pain of the mother of their child. Fathers often focus on being present to the mother’s needs instead of attending to their own grief (Conway & Russell, 2000; Samuelsson, Radestad & Segesten, 2001).

To conceptualize the enormity of loss associated with the death of a child, researchers must understand the parent-child relationship beginning long before birth (Raphael, 1983). The death of an infant places strains that persist for many years on parents and family. One third of mothers experience a marked deuteriation in their health and well-being after infant loss (Nicol, Tompkins, Campbell, & Syme, 1986).

Contended adolescent parents who expierence pregnancy loss are at increased risked of suffering serious psychological issues. In 2005, the U.S. infant mortality rate was 6.86 per 1000 live births; the relative position of the U.S. in comparison to counties with the lowest infant mortality rates appears to be worsening (MacDorman, 2008).

Each year, 500,000 pregnancies in the U.S. will end in either abortion or miscarriage (Centers for Disease Control and Prevention, 2009). Despite this frequency, little is known about how these expierences will affect the young mother, or how adolescents grieve this type of loss. Sexually active unmarried adolescents who experience an early pregnancy loss either by choice or by circumstance are often not viewed as having a legitimate right to grieve in our society (Doka, 1989). This stigmatized type of loss can leave adolescents alone and unsupported by family, friends, and healthcare professionals (Sanders, 1999).

The proposed qualitative research will use a non-experimental, exploratory research framework guided by Husserl’s phenomenology. Any object can be a phenomenon if observed in the special way, which characterizes the method of phenomenology. This manner of observation attempts perception through the processes of bracketing and phenomenological reduction. Reduction represents the process of continually identifying one’s presupposition concerning the nature of the phenomenon. Bracketing attempts to set observer’s presupposition aside to observe the phenomenon objectively. This process involves a gradual shift from one’s natural, conditioned way of experiencing the world to a more conscious awareness of one’s presuppositions, and then a development of a transcendental attitude (Husserl, 1931).

Bowlby’s Attachment Theory

To guide the proposed research, Bowlby’s attachment theory will be applied to explore grief reactions among adolescents who have expierence the death of their infant. Before a researcher can fully comprehend the impact of a loss and associated behaviors, the researcher must have some comprehension of adolescent parents’ attachment and bereavement. Bowlby’s attachment theory allows conceptualization of human inclination to generate affection bonds with others. Bowlby stated attachments come from a need for security and safety. Attachments develop early in life, are usually directed towards a few specific individuals, and have a propensity to continue throughout a large part of the life cycle. Attachment theory explains the greater impact of unexpected losses on grief (Bowlby, 1977).

Bowlby noted that bonding is the biological, genetic, and emotional connection between mother and baby during pregnancy and at birth. All babies have a bond with their mother. Individual response to pregnancy loss has most often been studied in relation to attachment theory (Bowlby, 1980). Attachment as also been conceptualized as beginning with the mother during the prenatal period and as reinforced though modern medical technology, such as ultrasounds (Robinson, 1999). Attachment formation and the psychological impact of pregnancy loss focus on the sudden cessations of the relationship

Erik Erikson’s Eight-Stage Model

Erik Erikson’s eight stake model of psychosocial development is one of the most influential life span developmental theories in the personality literature. Although each of his eight stages is present to varying degrees at any one point in the life cycle, developmental progression through these stages is seen as fixed, with each crisis having a time of special ascendancy. The cornerstone of Erikson’s theory is the identity versus role confusion stage.

Erikson’s identity versus role confusion begins at age 12-18 years old (Corey, 2009). Erikson stated the stage is a time of transition between childhood and adulthood. It’s a time for testing limits, for breaking dependent ties, establishing a new identity, and major conflicts center on clarification of self-identity (Erikson, 1963). Failure to achieve a sense of identity results in a role confusion. Each stage is regarded by Erikson as a psychosocial crisis, which arrises and demands resolution before the next stage can be satisfactorily negotiated.

Sander’s Model

Sander’s model identified internal and external mediators present at the time of the loss and suggested the factorsinfluence the grief process and the outcome after a loss. External mediators from the envoirnment influencing the bereaved included (a) social support systems, (b) socioeconomic status, (c) relationship with the deceased, (d) type of death, and (e) culture. Internal mediators are innate within the person and include (a) age, (b) gender, (c) personality, (d) ego strength, (e) cognitive ability, (f) physical health, (g) dependency needs, and (h) perception of loss (Sanders, 1989). Sanders’ integrated theory of bereavement model supports the proposed research by providing an explanation of varies bereavement phases the adolescent may expierence following perinatal loss. The integrated theory of bereavement also allows the bereaved adolescent to identify internal and external mediators that influence his or her grieving process. The model will be used as a foundation to allow the adolescents to explore and identify their internal feelings and thoughts associated with the loss of their infant.

This proposed qualitative study will depict perinatal deaths ‘effects on adolescent parents by articulating the adolescents’ personal experience associated with perinatal death, including a comparison of male and female grieving processes. The goal of a phenomenological approach in a qualitative research study is to describe accurately the lived experiences of adolescent parents, rather than to generate theories or models of the studied phenomenon (Leedy & Ormrod, 2005; Moustakas, 1994). Qualitative research is typically used to create or accumulate data about the complex nature of a phenomenon, often with the purpose of descriving and understanding the phenomena from the participants’ point of view (Creswell, 1998; Moustakas, 1994). Qualitative research creates in-depth interaction among the researchers and the participants (Creswell, 1998; Leedy & Ormrod, 2005).

For the proposed phenomenological study, the researcher will use on-on-one, semi-structured, in-depth interviews to understand the perceptions, perspectives, and understands of adolescent parent’s experiences about perinatal loss. The use of questions or interview guide will serve as a checklist during the interview and assure that the same information is obtained from the participants (Denzin & Lincoln, 2000). Using this approach, interview questions are asked in an open-ended fashion to minimize the imposition of predetermined responses when gathering data.

The proposed research study will include eight to ten adolescent parents who have experienced a perinatal loss during the past two years. Participant expierences will be gathered through semi-structured interviews. The interviews will begin with open-ended questions, gradually moving towards specific questions. Beginning with open-ended questions enourages each participant to engage in conversation with the interviewer, limiting simples “yes” or “no” responses. By working from general open-ended questions to specifics, participants are afforded the opportunity to answer comfortably and honestly.

The use of semi-structured questioning (Berg, 2004) can effectively elicit information on the life experiences and beliefs about the impact of perinatal loss. The development of a standard set of questions or interview guide will serve as a checklist during the interview and assure that the same information is obtained from the participants. With this approach, interview questions are asked in an open-ended fashion to minimize the imposition of predetermined responses when gathering data (Patton, 1990).

Berg (2004) recommends that telephone interviews require audio taping and transcriping for the purposes of accuracy as well and convenience. The software Nvivo 8 by QSR will be used to organize and analyze the qualitative data. To extract meanings and expierences of the participants phenomenologically, the researcher will use the Nvivo 8.

Generalizations of the findings of the study beyond a group of adolescents shouldbe made with caution. Evidence about human experience has inherent limitations because the expierence is not directly observable. Data about it depends on the participants’ abilities to reflectivelt discern aspects of their own experiences and to effectively communicate what they discern through language (Polkinghome, 2005).

Informed consent is the cornerstone of contemporary clinical research ethics. Thisng the concept of assent and consent point out of major difference in adults and children’s agreement to take part in a research project. Informed consent could be defined as an interactive process between subject and researcher involving disclosure, and a complete understanding of a proposed research activity, which culminates in the participant freely expressing a desire to participate.

Given the power differences between parents and children and between researchers and children, sitations have been widely discussed in literature whether it is possible for children to make autonomous decisions or whether they are more likely to comply with the authority of their parents or researcher. This is clearly something that should be considered when the oricess of gaining assent from young adolescents (Leikin, 1993).

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