Men's experiences of grief and support following pregnancy loss and neonatal death

Abstract

This thesis explored men’s experiences of grief and support following pregnancy loss and neonatal death. While many parents experience emotional distress and enduring grief after pregnancy loss and neonatal death, little is known about men’s grief. Given potential gendered differences concerning grief styles, help-seeking and service access, this is an important gap. The research questions for this thesis were: (1) how do men experience grief following pregnancy loss and neonatal death; (2) what factors influence men’s grief following pregnancy loss and neonatal death; (3) how does type of loss (i.e., miscarriage, stillbirth, termination of pregnancy for life-limiting foetal anomaly [TOPFA], or neonatal death) impact men’s grief experiences; and (4) how can future services and bereavement care guidelines best support men following pregnancy loss and neonatal death? This thesis comprised four studies and four published papers. Study 1 was a systematic review of men’s grief following pregnancy loss and neonatal death. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and screening according to pre-defined eligibility criteria, 46 studies were included. Findings indicated that men’s grief experiences are highly varied; however, specific challenges to grief expression include balancing a desire to both support and be supported, and being overlooked as fathers by current health/support services and systems/policies. A Socio-Ecological Model of Men’s Grief was proposed as a result of this review. Study 2 was a nationwide online survey to further explore the factors contributing to men’s grief. A convenience sample of 228 men from Australia completed the survey comprising quantitative/psychometric scales and open-ended questions. Data were analysed using multiple linear regression. Findings indicated that men can experience significant grief regardless of loss type. Factors contributing to grief also differed depending on grief styles, which ranged from intuitive (emotion-focused) to instrumental (activity-focused). Study 3 explored a subset of survey data reflecting men’s experiences of returning to work following pregnancy loss and neonatal death using a combination of descriptive statistics and content analysis. Findings highlighted the importance of available workplace leave to provide recognition of men’s grief and to allow time to be with their partner, attend to practical needs, and process emotional impacts. Study 4 involved in-depth interviews with 10 men who had experienced a TOPFA. Thematic analysis resulted in the generation of three overarching themes, each with two sub-themes. Overall, findings indicated that TOPFA is an extremely difficult experience for men, characterised by challenges in decision-making and perceived stigma toward termination. Participants described feeling overlooked by current pregnancy and TOPFA support services and indicated that they need support tailored to men to assist with their grief. Overall, the findings indicated that understanding the factors contributing to men’s grief requires a socio-ecological conceptualisation including individual, interpersonal, community and policy/system perspectives. Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement, validation and tailored support from healthcare professionals, family/friends, and communities/workplaces. Future support and policy strategies should consider grief styles and expansion of existing perinatal care infrastructure, drawing upon existing family-centred recommendations that are father-inclusive.