Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale

Abstract

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.

Figure 1.

Factor analysis with two factors and orthogonal (varimax) rotation of the 13 variables, 5 from Bonanno taxonomy, 3 from the sub-scale of Perinatal Grief Scale (PGS), and 4 background variables, as well as sub-diagnosis of miscarriage. The variables contained in the circle have statistical significance and vary in correlation. The PGS: despair, difficulty coping, and grief; as well as Bonanno: dysphoria, cognitive disorganization, and disrupted social functioning are of clinical importance and varied in correlation statistically. (1 = PGS despair; 2 = Dysphoria; 3 = PGS difficulty coping; 4 = Cognitive disorganization; 5 = Disrupted social functioning; 6 = PGS grief; 7 = Number of miscarriages; 8 = Positive aspects; 9 = Age; 10 = Diagnosis; 11 = Gestational week; 12 = Health deficits; 13 = Number of children).