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Healthcare Utilization in the Pregnancy Following a Perinatal Loss

Hutti, Marianne H. PhD, WHNP-BC; Armstrong, Deborah S. PhD, RN; Myers, John PhD

MCN: The American Journal of Maternal/Child Nursing: March-April 2011 - Volume 36 - Issue 2 - p 104–111
doi: 10.1097/NMC.0b013e3182057335
Feature Article

Purpose To Evaluate the influence of previous perinatal loss, anxiety, depressive symptoms, impact of the previous loss, and maternal investment in the baby on mothers' healthcare utilization (HCU) during the subsequent pregnancy and postpartum periods.

Study Design and Methods A longitudinal, cohort study design gathered telephone interview data from 36 mothers with a history of prior perinatal loss, 32 mothers with no loss history, and 38 first-time mothers. These data were collected during the third trimester of pregnancy until 8 months postpartum.

Measures Centers for Epidemiologic Studies-Depression Scale, Spielberger State-Trait Anxiety Scale, Pregnancy Outcome Questionnaire, Impact of Events Scale, Maternal Attitude Questionnaire, and a questionnaire regarding HCU.

Results Mothers with a history of prior perinatal loss utilized more healthcare resources in the subsequent pregnancy when compared with non-loss controls. Increased HCU during pregnancy was associated with increased maternal anxiety and depressive symptoms after birth.

Clinical Implications Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early postpartum with requests for additional healthcare resources. Nurses need to listen with compassion, providing appropriate education and information, and make referrals to mental healthcare providers and support groups as indicated. These nursing interventions during the subsequent pregnancy may be a better use of healthcare resources than providing extra, but medically unnecessary, laboratory and ultrasound testing for the sole purpose of fleeting reassurance.

When women have experienced a perinatal loss, the following pregnancy can be fraught with anxiety, and result in multiple health care visits.

Marianne H. Hutti is a Professor, School of Nursing, University of Louisville, Louisville, KY. She can be reached via e-mail at

Deborah S. Armstrong is an Associate Professor, School of Nursing, University of Louisville, Louisville, KY.

John Myers is an Assistant Professor, School of Public Health and Information Sciences, University of Louisville, Louisville, KY.

The authors have disclosed that there are no financial relationships related to this article.

No conflicts of interest are identified by any of the authors of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.