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Objective: To explore the potential factors that mediate the relationship between mindfulness and symptoms of posttraumatic stress (PTS) in women who experienced stillbirth., Design: A cross-sectional analysis of baseline data before women's participation in an online mindfulness intervention (i.e., online yoga)., Setting: This was a national study, and women participated in their own homes., Participants: Women who experienced stillbirth (N = 74) within the past 2 years and resided in the United States., Methods: Women were recruited nationally, primarily through social media. Participants (N = 74) completed baseline assessments (self-report mental and physical health surveys) via a Web-based survey tool. We conducted an exploratory factor analysis of the COPE Inventory subscales to reduce the number of variables before entry into a mediation model. We then tested the mediation effects of sleep quality, self-esteem, resilience, and maladaptive coping on the relationship between mindfulness and PTS symptoms., Results: Through the exploratory factor analysis we identified a two-factor solution. The first factor included nine subscales that represented adaptive coping strategies, and the second factor included five subscales that represented maladaptive coping strategies. Results from multiple mediation analysis suggested that mindfulness had a significant inverse relationship to PTS symptoms mediated by sleep quality., Conclusion: Mindfulness practices may have potential benefits for grieving women after stillbirth. Evidence-based approaches to improve sleep quality also may be important to reduce PTS symptoms in women after stillbirth., (Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the ability of the Perinatal Grief Intensity Scale (PGIS) when used within 8 weeks of perinatal loss to predict intense anxiety and severe depression symptoms in women 3 months later (Time 2 [T2])., Design: Prospective survey., Setting: Participants were recruited from hospitals in Louisville, KY and via the Internet., Participants: Women (N = 103) who experienced perinatal loss., Methods: Data were collected using the PGIS, Beck Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale. We used logistic regression, odds ratios, and receiver operating characteristic curve analysis., Results: The PGIS had 97.9% sensitivity and 29.6% specificity to predict severe depression symptoms and 95.2% sensitivity and 56.2% specificity to predict intense anxiety at T2. A baseline PGIS score greater than or equal to 3.53 predicted severe depression symptoms (odds ratio = 1.82, 95% confidence interval [CI] [1.46, 2.18], p = .014) and intense anxiety (odds ratio = 1.43, 95% CI [1.07, 1.82], p = .029) at T2. The receiver operating characteristic curves of the PGIS suggest the PGIS performs well at predicting (screening positive) for severe depression symptoms (area under the curve = 0.86, 95% CI [0.79, 0.94], p < .001) and intense anxiety (area under the curve = 0.86, 95% CI [0.78, 0.93], p < .001) after perinatal loss., Conclusion: The PGIS accurately predicted intense anxiety and severe depression symptoms 3 to 5 months after perinatal loss. This instrument may help health care providers identify women who need further mental health evaluation after perinatal loss., (Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss., Design: A qualitative, descriptive design with secondary data analysis., Setting: The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States., Participants: Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review., Methods: We used thematic analysis to analyze interview data., Results: Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death., Conclusion: Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances., (Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the experiences of, meaning for, and personal consequences for obstetric, emergency, and surgical nurses caring for women after fetal death and to determine how these nurses use Swanson's caring processes in providing such care., Design: Four focus groups., Setting: Two hospitals within the same health care system., Participants: Registered nurses (N = 24) working in the obstetric, surgery, or emergency departments., Methods: Swanson's Theory of Caring guided focus group questions that were audiotaped and transcribed verbatim. Data were analyzed using a continuously emergent process of data collection, data reduction, data display, and interpretation., Results: All participants demonstrated all of Swanson's caring processes but used them preferentially according to situational exigencies and level of rapport with each woman. Nurses had positive and negative feelings associated with caring for women after fetal loss., Conclusions: Obstetric nurses provided relatively equal focus on all processes in the Theory of Caring except Maintaining Belief. Surgical and emergency department nurses focused primarily on the caring processes of Knowing and Doing For. The negative feelings reported by nurses mirror some emotions commonly associated with compassion fatigue. More research is needed to determine whether nurses caring for mothers experiencing fetal loss are at risk for compassion fatigue. Research is also needed to identify strategies and interventions to help nurses so they may continue to give the best care possible to these very vulnerable families without detriment to themselves., (Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the experiences of lactation suppression (LS) among Taiwanese women who experienced stillbirth after 20-weeks gestation., Design: Qualitative research combining practitioner ethnography and the observ-view method (participant observation and unstructured interviews while caring for participants)., Setting: Participants were recruited from a medical center in central Taiwan between June 2013 and November 2014., Participants: Seven Taiwanese women who had stillbirths., Methods: Data were collected by the observ-view method. Recorded interviews were analyzed by content analysis., Results: Participants described three core experiences: deciding to use LS without careful deliberation; psychological pain is substantially stronger than physical pain; and not regretting their choice regarding method of LS., Conclusion: Physical pain often remains unaddressed because of the greater psychological pain following fetal death. Therefore, LS should be an essential component of follow-up care as part of the discharge plan. Follow-up should be for at least 14 days. More research is needed on nonpharmacological LS to address cultural differences and personal beliefs about methods of LS., (© 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objectives: To evaluate the reliability and validity of the Perinatal Grief Intensity Scale (PGIS) for identifying a woman's grief intensity in the immediate subsequent pregnancy after a miscarriage, stillbirth, or neonatal death., Design/setting/participants: A web-based approach was used to collect data from 227 pregnant women after each woman had experienced a perinatal loss in her previous pregnancy., Methods: Participants completed a demographic information form and the 14-item PGIS., Results: Cronbach's alphas for the PGIS total scale and subscales were high: 0.75 (PGIS total), 0.80 (Reality), 0.82 (Confront Others), and 0.80 (Congruence), which indicated good internal consistency reliability. Validity was supported by factor analysis of the PGIS, which accounted for 66.94% of the total variance. Mothers in the neonatal death group experienced more intense grief, as measured by the PGIS, when compared with mothers in the miscarriage or stillbirth groups., Conclusions: Data from this study provided initial support for the reliability and validity of the PGIS in women in their immediate subsequent pregnancies after perinatal loss as well as the concepts of the grief intensity theoretical framework., (© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Objective: To describe support needs and comfort level of labor nurses caring for families experiencing perinatal loss., Design: Qualitative descriptive study., Setting: A western hospital birthing unit., Participants: Ten labor nurses., Method: Participants completed online surveys and follow-up interviews; data saturation was reached. Content analysis produced themes and recommendations related to providing perinatal bereavement care. Participants reviewed and confirmed accuracy of the results., Results: Nurses are generally comfortable but find it difficult to provide perinatal bereavement care. Strategies for coping include focusing on needed care, talking to nursing peers, and spending time with their own family members. Nurses take turns providing care depending on "who is best able to handle it that day" and prefer not to be assigned a laboring patient in addition to the grieving parents. Developing clinical expertise is necessary to gain the comfort level and the skills necessary to care for these vulnerable families. Orientation experiences and nursing staff debriefing would help. Needed education includes grief training, communication techniques, and guidelines for the extensive paperwork., Conclusions: Initial and ongoing education of nurses about perinatal bereavement care is needed. Effective strategies for coping during and after providing care would support nurses in meeting the emotional challenge of providing high quality perinatal bereavement care.

Objective: To describe women's late pregnancy after loss experiences (from 25 weeks gestation to birth), document the timing and frequency of their common discomforts and events, and explore changes in these experiences over time., Design: A longitudinal, qualitative study of pregnancy calendar entries and field notes., Setting: Prenatal care providers and community canvassing in Central New York and the Internet., Participants: Pregnant women (N= 69) with a history of perinatal loss., Main Outcome Measures: Women's pregnancy calendar entries and field notes., Results: Thematic data analysis yielded two main themes and several subthemes: (a) Precarious Pregnancy Security with subthemes of Informed Awareness and Varying Emotions and (b) Prudent Baby Preparations with subthemes of Physical, Social, and Emotional Preparation., Conclusion: Women reported an increased sense of security about the pregnancy and baby over time but this security was easily shaken. For women with a history of later or multiple loss, anxiety may remain high or increase as the due date approaches. Fetal movement is the most common barometer of fetal well-being during this part of pregnancy. With a better understanding of pregnancy after loss, clinicians can have a positive impact on women's prenatal experiences.