Research
Parenting after Pregnancy Loss: Maternal Depression and Mother Infant Interaction
Author: Sarah Kye Price, MSW
Affiliation: Doctoral Student (dissertation study), Washington University in St. Louis
This dissertation study uses a national data set, the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), which was designed by the National Center for Education Statistics to examine factors early in children’s lives that may impact their readiness for school. 10,688 children born in 2001 and their families participated in an interview when children were 9 months old. Since we were able to obtain some birth certificate information, we were able to look at previous births and losses. Pregnancy loss was defined by the total number of pregnancy terminations (i.e. the pregnancy terminated prior to a live birth) present on the mother’s birth certificate and did not specify the nature or gestational timing of the death that occurred. In this study, 7,781 (75%) had no known loss history, 1,804 (17%) had a single loss history and 973 (8%) had a multiple loss history of two or more fetal deaths.
Overall, most findings from the study showed that those in the “no loss” and “singular loss” groups were very similar, suggesting that a singular experience of pregnancy loss during one’s lifetime does not significantly alter the mental health or parenting of women following subsequent childbirth. These findings do no suggest that women experiencing a singular pregnancy loss do not grieve or respond to the loss, but that the effect over time and after a subsequent childbirth appears more similar to women without a history of pregnancy loss.
However, the multiple loss group had a very different experience. Women in the multiple loss group were more likely to be of lower socioeconomic status, live below poverty, and have less than a college degree, controlling for the effects of maternal age. African-American women were at higher risk for both singular and multiple losses, with nearly two times the risk for multiple loss. There was no relationship between urban vs. rural geography and pregnancy loss history, and women received a similar amount of prenatal care during the subsequent pregnancy in all groups. The multiple pregnancy loss group was also more likely to be married multiple times, have a non-resident father of the enrolled child and have other children in the household, controlling for maternal age. While the multiple loss group was less likely to utilize parents as a source of emotional support, they were more likely than others to utilize friends and neighbors for social support. Relationship satisfaction, overall social activity participation, and religious involvement did not differ based on loss history. However, women with multiple losses were more likely to participate in volunteering or community service participation than others.
This study also found a relationship between multiple loss history and elevated symptoms of depression, measured using the Center for Epidemiologic Studies Depression Screener (CES-D), after the birth of the child enrolled in this study. This risk for elevated depressive symptoms persists when controlling for maternal mental health history, child disability and temperament, and demographic influences. Women with multiple loss also tended to rate some items more often than those without loss. Even with all the challenges present in the multiple loss group, there was no significant difference detected in the quality of mother-infant interaction with the enrolled child based on loss history alone or loss history in combination with depressive symptoms.
An interesting finding from the study was that women in the multiple loss group had a higher level of involvement in some positive activities such as reading books and singing songs with their child. This finding is not consistent across all parent involvement items in the study, the majority of which are the same across loss history groups. This positive finding, along with the finding that women with multiple loss experiences are more likely to engage in community services, suggests that there may be positive adaptation over time for those with multiple experiences of loss that results in increased investment in their future children and their communities.
In conclusion, the study supports past demographic and public health literature indicating socioeconomic and racial disparities in fetal mortality. It sheds light on an understanding of demographic, familial and social patterns that are particularly pronounced for women experiencing multiple loss, while reinforcing the knowledge that multiple pregnancy loss has a relationship with increased depressive symptoms even after subsequent childbirth. The study challenges the assumption, however, that elevated depressive symptoms which sometimes accompany pregnancy loss impairs the quality of mother-infant interaction. In spite of the challenges identified for the multiple loss history group, parent-child interaction is relatively equal across categories of loss history. Further investigation into the positive parent-child involvement and social activity involvement of the multiple loss history group may help understand both the challenges and the potential for resilience and personal growth that can result in time after the experience of pregnancy loss, even in the face of personal challenges.
For further information, please contact Sarah Kye Price, MSW at sprice@wustl.edu
