title: Parents' experiences and expectations of care in pregnancy after stillbirth or neonatal death: a metasynthesis.
abstract: BACKGROUND
  Pregnancy after perinatal death is characterised by elevated stress and anxiety, increasing the risk of adverse short-term and long-term outcomes.
  
  
  OBJECTIVE
  This metasynthesis aimed to improve understanding of parents' experiences of maternity care in pregnancy after stillbirth or neonatal death.
  
  
  METHODS
  Six electronic databases were searched using predefined search terms.
  
  
  METHODS
  English language studies using qualitative methods to explore the experiences of parents in pregnancy after perinatal loss, were included subject to quality appraisal framework.
  
  
  METHODS
  Searches were initiated in December 2011 and finalised in March 2013. Studies were synthesised using an interpretive approach derived from meta-ethnography.
  
  
  RESULTS
  Fourteen studies were included in the synthesis, graded A (no or few flaws, high trustworthiness; n = 5), B (some flaws, unlikely to affect trustworthiness; n = 5) and C (some flaws, possible impact on trustworthiness; n = 4). Three main themes were identified; co-existence of emotions, helpful and unhelpful coping activities and seeking reasssurance through interactions.
  
  
  CONCLUSIONS
  Parents' experiences of pregnancy are profoundly altered by previous perinatal death; conflicted emotions, extreme anxiety, isolation and a lack of trust in a good outcome are commonly reported. Emotional and psychological support improves parents' experiences of subsequent pregnancy, but the absence of an evidence base may limit consistent delivery of optimal care within current services.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
authors.forename: T A
authors.initials: TA
authors.lastname: Mills
authors.forename: C
authors.initials: C
authors.lastname: Ricklesford
authors.forename: A
authors.initials: A
authors.lastname: Cooke
authors.forename: A E P
authors.initials: AE
authors.lastname: Heazell
authors.forename: M
authors.initials: M
authors.lastname: Whitworth
authors.forename: T
authors.initials: T
authors.lastname: Lavender
mesh_terms: D000022:Abortion, Spontaneous / Q000517:prevention & control / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000209:etiology; D003376:Counseling; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008427:Maternal Health Services; D033261:Maternal-Fetal Relations / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D055502:Secondary Prevention; D050497:Stillbirth / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology* / Q000517:prevention & control
keywords: Metasynthesis; neonatal death; perinatal loss; stillbirth; subsequent pregnancy