title: Grief after second-trimester termination for fetal anomaly: a qualitative study.
abstract: OBJECTIVE
  We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time.
  
  
  METHODS
  We conducted a longitudinal qualitative study of decision satisfaction, grief and coping among women undergoing termination (dilation and evacuation or induction termination) for fetal anomalies and other complications. We conducted three post-procedure interviews at 1-3 weeks, 3 months and 1 year. We used a generative thematic approach to analyze themes related to grief using NVivo software program.
  
  
  RESULTS
  Of the 19 women in the overall study, 13 women's interviews were eligible for analysis of the grief experience. Eleven women completed all three interviews, and two completed only the first interview. Themes that contributed to grief include self-blame for the diagnosis, guilt around the termination decision, social isolation related to discomfort with abortion and grief triggered by reminders of pregnancy. Social support and time are mechanisms that serve to alleviate grief.
  
  
  CONCLUSIONS
  Pregnancy termination in this context is experienced as a significant loss similar to other types of pregnancy loss and is also associated with real and perceived stigma. Women choosing termination for fetal anomalies may benefit from tailored counseling that includes dispelling misconceptions about cause of the anomaly. In addition, efforts to decrease abortion stigma and increase social support may improve women's experiences and lessen their grief response.
  
  
  CONCLUSIONS
  The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients' suffering and offer tools to direct their grief toward positive coping.
authors.affiliation: University of Rochester School of Medicine, 601 Elmwood Ave, Rochester, NY 14642. Electronic address: Marguerite_Maguire@URMC.Rochester.edu.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Maguire
authors.affiliation: Washington Hospital Center Department of Obstetrics and Gynecology, 110 Irving Street, NW Suite 5B-63, Washington, DC 20010. Electronic address: alexisdlight@gmail.com.
authors.forename: Alexis
authors.initials: A
authors.lastname: Light
authors.affiliation: University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110. Electronic address: kuppermannm@obgyn.ucsf.edu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.affiliation: University of Michigan Department of Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109. Electronic address: daltonvk@med.umich.edu.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.affiliation: University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110. Electronic address: steinauerj@obgyn.ucsf.edu.
authors.forename: Jody E
authors.initials: JE
authors.lastname: Steinauer
authors.affiliation: University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110. Electronic address: kernsjL@obgyn.ucsf.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kerns
mesh_terms: D000025:Abortion, Eugenic / Q000379:methods / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006117:Grief; D006167:Guilt; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000523:psychology*; D036301:Qualitative Research; D012934:Social Isolation / Q000523:psychology; D057545:Social Stigma; D012944:Social Support; D013995:Time
keywords: Abortion; Fetal anomaly; Perinatal grief; Pregnancy loss; Pregnancy termination; Second-trimester abortion