The Meaning of Miscarriage: Measurement, Reproductive Factors, and Trajectories in Couple Dyads Public Deposited

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  • March 20, 2019
  • Huffman, Carolyn Susan
    • Affiliation: School of Nursing
  • Miscarriage impact has been studied regarding gendered emotional outcomes of coping. Lazarus and Folkman's (1984) stress and coping theory provides a framework to explore miscarriage meaning. One measure used to quantify miscarriage appraisal is the Revised Impact of Miscarriage Scale (RIMS). This dissertation consisted of three separate analyses of RIMS data from the Couples Miscarriage Healing Project, a randomized controlled trial of the effects of three interventions on 341 couples' emotional healing after miscarriage. In the first analysis, the Impact of Miscarriage Scale (Swanson, 1999) was refactored resulting in the RIMS, a 3-factor, 16-item measure with sufficient reliability in both men and women. Factors identified were Isolation/guilt (I/G), Devastating event (D/E), and Loss of baby (LB). The instrument demonstrated good test-retest reliability over the course of a year and moderate correlations with grief and depression. In the second analysis, reproductive and contextual factors were evaluated for their effect on I/G, DE, and LB in men, women, and couples. Age, mental health history, infertility, gestational age at loss, miscarriage history, and number of children, all affected one or more of the subscales. When considered separately, men were more likely to be impacted by gestational age and number of living children and women by infertility and miscarriage history. However, as a couple, these gender differences were no longer apparent. The third analysis used multi-level modeling with Bayesian inference to address whether I/G, DE, and LB were time variant phenomena and whether theory driven interventions affected I/G, DE, and LB in men and women. There was a small decline over time in I/G, DE, and LB in women. There were no treatment effects on any of the subscales scores. However, in women who were the most devastated or isolated/guilty, one nurse caring visit with self-directed sessions at home, experienced a significant decrease in I/G and DE compared to control. This study's finding suggest the need for further research to capture the partner's experience more fully and the need to understand how the meaning of miscarriage relates to positive and negative trajectories not only individually but also within couple dyads.
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  • Swanson, Kristen
  • Doctor of Philosophy
Graduation year
  • 2014

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