Journal of Nursing Scholarship Third Quarter 2001 239 Clinical Scholarship Women’s Voices Reflecting Changed Expectations for Pregnancy after Perinatal Loss Denise Côté-Arsenault, Dianne Morrison-Beedy Purpose: To describe women’s experiences of pregnancy after loss and their long-term effects of perinatal loss. Design: Phenomenology. Methods: Three focus groups were conducted in fall 1996 with a total of 21 women. These women varied in their obstetrical and loss histories. The time since their losses ranged from 34 years ago to the previous year. Data analysis was guided by Colaizzi’s procedural steps. Findings: Women’s stories portrayed perinatal loss as a life-altering event. Women did not feel emotionally safe in their pregnancies after loss and were afraid that those babies too would die. Despite the differences in their obstetrical and loss histories and time since loss, similarities in their responses to pregnancy far outweighed their differences. These commonalities contained in six themes: (a) dealing with uncertainty, (b) wondering if the baby is healthy, (c) waiting to lose the baby, (d) holding back their emotions, (e) acknowledging that loss happened and that it can happen again, and (f) changing self. Conclusions: This study indicated many common concerns and experiences among women in response to perinatal loss and subsequent pregnancies. Variations were not linked to the number or gestational age of the losses. Care providers should acknowledge women’s past losses, address their concerns during a current pregnancy, and recognize the potentially life- long effect perinatal loss may have on these women. JOURNAL OF NURSING SCHOLARSHIP, 2001; 33:3, 239-244. ©2001 SIGMA THETA TAU INTERNATIONAL. [Key words: women’s health, miscarriage, pregnancy, perinatal loss] * * * A woman who experienced a perinatal loss at 19 weeks tearfully related the experience of her subsequent pregnancy: With my first pregnancy I spent a lot of time daydreaming about what this baby was going to be like. I had these strong feelings that it would be a girl, had a personality, and details about her .... Second time, I didn’t have nearly the vivid pictures of what this baby was going to be like. When I got to the point in my pregnancy where I lost the first one ... it was just too easy to re-experience it. I got just really paranoid with everything.... I knew that I was pregnant but I really didn’t think that I was going to have a baby. Six weeks before the due date someone sent me a baby present and I said, “They think I’m having a baby.” And my husband said, “I think you are too.” I started crying because I hadn’t let myself think that at all. Pregnancy is a critical period for maternal and fetal development, a time during which both the mother and the baby develop. However, pregnancy unsuccessfully ends with perinatal losses as frequent as 20%-45% of all conceptions as reported in North American and European studies (Rajan & Oakley, 1993; Woods & Woods, 1998). Perinatal losses are often followed by a period of intense grieving and mourning for the wished-for child, loss of innocence about pregnancy, and damage to a woman’s self-confidence about her ability to become a mother. The effects of women’s childbearing experiences can last a lifetime (Rubin, 1984; Simkin, 1991). But knowledge is limited regarding how perinatal loss affects women’s subsequent pregnancy experiences and later lives. The purpose of this study was to describe women’s experiences of pregnancy after loss and to explore any other personal effects. Denise Côté-Arsenault, RNC, PhD, Omicron, Associate Professor, Syracuse University College of Nursing, Syracuse, NY; Dianne Morrison-Beedy, RNC, PhD, WHNP, Omicron & Epsilon Xi, Associate Professor, University of Rochester, Rochester, NY. This study was supported by funding from Syracuse University, the University of Washington’s Center for Women’s Health Research (NR0739), and a the National Institute of Nursing Research (K01 NR00152). Morrison- Beedy supported by NINRK01-NR00152. The authors thank Dr. Kristin Swanson and Dr. Diana Biro for their thoughtful review of this manuscript. We also thank research team members Dr. Nancy Feinstein, Debra LaVigne, Jill Kassel, Mary Jo Carrigan, and Marie Recano-Dunham. We also gratefully thank the women in this study who shared their compelling stories with us. Correspondence to Dr. Côté-Arsenault, Syracuse University College of Nursing, 426 Ostrom Avenue, Syracuse, NY 13244. E-mail: dycotear@nursing.syr.edu Accepted for publication October 24, 2000.