Nursing Research Critique: Loss of Pregnancy and Midwife Care

Study Summary and Purpose

Caelli, K., Downie, J., & Letendre, A. (2002). Parents' experiences of midwife-managed care following the loss of a baby in a previous pregnancy. Journal of Advanced Nursing, 39(2), 127–136.

Based on reported statistics and inferred projections, it is a fairly common occurrence for women and couples to experience the death of a baby in utero or shortly after birth. One reason the authors conducted this study was to raise awareness of this occurrence and the suffering that women and couples endure as a result. The authors note that childbearing women and couples have a moderate statistical likelihood of experiencing the death of a baby before the successful birth of a subsequent child. There is a distinct possibility of physical and psychological risk factors for parents who have suffered the trauma of a previous pregnancy loss as they experience a current or subsequent pregnancy.

The study aims to acknowledge these parents, their traumas, and gain insight into the experiences of loss and grief associated with neonatal and perinatal death. It additionally aims to assess the efficacy of the Special Delivery Service (SPS) programme — a midwife-managed form of intervention recently added to normative health treatment routines for expecting parents who have previously experienced pregnancy loss.

Research Design and Phenomenological Approach

The researchers declare very early in the study, and specifically within the Methodology section, that they chose a phenomenological research design. Their reasoning for this choice is quite specific. While neonatal loss is a medical and scientific occurrence, its effects are experiential and emotional. Because the focus of the study is on qualitative experience, a phenomenological approach is a sound choice.

Phenomenology is a field originating in philosophy that has been translated for use in other disciplines, including psychology, medicine, computer science, and media theory. In its most basic form, phenomenology is the study of experience as it occurs from the first-person perspective. There is usually some form of intention associated with the experience — for example, the experience of pregnancy carries the intention of raising a child or expanding one's family, among many other possible intentions.

It is uncertain whether another form of research design would have been more effective. An experimental methodology might have proven equally productive, but not necessarily superior. This study's focus is the quality and character of the experience of parents who have suffered a neonatal loss. Phenomenology exclusively values and upholds the truth, validity, and intensity of first-person experience; therefore, this approach is a valid and logical selection. The study also focuses on the parents' experience with the SPS and with a subsequent pregnancy — experience is fundamental to the data collection, data analysis, and conclusions. A research study that centers the primacy of experience should use a methodology that supports and complements its objectives, as phenomenology does.

Strengths of the Study

There are a number of strengths to this study. First is the choice of topic. Pregnancy and infant loss is a fairly common experience for childbearing parents, yet it remains somewhat taboo and unspoken. People do not readily engage in conversations or studies of this nature, and it is the kind of trauma that most people want to forget or move past as quickly as possible. Yet the trauma exists and occurs with relative statistical stability across several continents, as the study notes. The choice of topic is therefore a perceived strength.

Another strength is the choice of methodology. In previous decades, researchers sometimes argued against the validity of phenomenology on the grounds that experience is not objective — and objectivity was considered a paramount priority in scientific research. In the 21st century, however, fields such as experience design, interface design, and interaction design have demonstrated that experience is central to the success of many products and services. Experience has become one of the greatest assets a study can draw upon, whether in nursing, marketing, or other fields.

The study also demonstrates strong ethical awareness regarding the implications of such sensitive research. This is very important. In the process of gathering data, participants could quite likely become upset as they revisit and recount painful memories. The mental and emotional health of participants appeared to be a high priority for the researchers, which is an additional strength of this study.