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Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, no 3, 201-209 p.Article in journal (Refereed) Published
Abstract [en]

Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.

Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.

Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.

Conclusion. Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.

Place, publisher, year, edition, pages
2010. Vol. 115, no 3, 201-209 p.
Keyword [en]
Content analysis, factor analysis, general grief theory, miscarriage, perinatal grief scale, women
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13810DOI: 10.3109/03009731003739851ISI: 000281013000008OAI: diva2:21696
On the day of the defence day the status of this article was Submitted.Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2010-09-03
In thesis
1. Miscarriage: Women’s Experience and its Cumulative Incidence
Open this publication in new window or tab >>Miscarriage: Women’s Experience and its Cumulative Incidence
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively.

Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss.

Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type.

We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage.

Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 939
Miscarriage, Grief, Perinatal Grief Scale in Swedish, Follow-up visit to midwife, Medical Birth Register, Spontaneous abortion
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:liu:diva-6204 (URN)91-85497-76-2 (ISBN)
Public defence
2006-04-07, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (English)
On the day of the public defence of the doctoral thesis the status of article III was In Press and article IV was In Press.Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2009-08-22

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Adolfsson, Ann-SofieLarsson, Per-Göran
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