Grief after second-trimester termination for fetal anomaly: a qualitative study



      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.

      Study design

      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.


      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.


      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.


      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.


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      1. ACOG practice bulletin #77: screening for fetal chromosomal abnormalities.
        Obstet Gynecol. 2007; 109: 217-227
        • Crane J.P.
        • LeFevre M.L.
        • Winborn R.C.
        • et al.
        A randomized trial of prenatal ultrasonographic screening: impact on the detection, management and outcome of anomalous fetuses. The RADIUS Study Group.
        Am J Obstet Gynecol. 1994; 171: 392-399
        • Anderson N.
        • Boswell O.
        • Duff G.
        Prenatal sonography for the detection of fetal anomalies: results of a prospective study and comparison with prior series.
        AJR Am J Roentgenol. 1995; 165: 943-950
        • Boyd P.A.
        • Devigan C.
        • Khoshnood B.
        • Loane M.
        • Garne E.
        • Dolk H.
        Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down's syndrome.
        BJOG. 2008; 115: 689-696
        • Pryde P.G.
        • Drugan A.
        • Johnson M.
        • Isada N.B.
        • Evans M.I.
        Prenatal diagnosis: choices women make about pursuing testing and acting on abnormal results.
        . 1993; 36: 496-509
        • Shaffer B.L.
        • Caughey A.B.
        • Norton M.E.
        Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy.
        Prenat Diagn. 2006; 26: 667-671
        • Salvesen K.Å.
        • Øyen L.
        • Schmidt N.
        • Malt U.F.
        • Eik-Nes S.H.
        Comparison of long-term psychological responses of women after pregnancy termination due to fetal anomalies and after perinatal loss.
        Ultrasound Obstet Gynecol. 1997; 9: 80-85
        • Korenromp M.J.
        • Christiaens G.C.
        • van den Bout J.
        Long-term psychological consequences of pregnancy termination for fetal abnormality: a cross-sectional study.
        Prenat Diagn. 2005; 25: 253-260
        • Lilford R.J.
        • Stratton P.
        • Godsil S.
        • Prasad A.
        A randomised trial of routine versus selective counselling in perinatal bereavement from congenital disease.
        BJOG. 1994; 101: 291-296
        • National Abortion Federation
        Clinical policy guidelines. National Abortion Federation, Washington, DC2013: 3 ([])
        • Kersting A.
        • Kroker K.
        • Steinhard J.
        • Hoernig-Franz I.
        • Wesselmann U.
        • Luedorff K.
        • et al.
        Psychological impact on women after second and third trimester termination of pregnancy due to fetal anomalies versus women after preterm birth—a 14-month follow up study.
        Arch Womens Ment Health. 2009; 12: 193-201
        • Barr P.
        Guilt- and shame-proneness and the grief of perinatal bereavement.
        Psychol Psychother Theory Res Pract. 2004; 77: 493-510
        • Charmaz K.
        The search for meanings — grounded theory.
        in: Smith J.A. Harre R. Van Langenhove L. Rethinking methods in psychology 2996. London Sage Publications, 1995: 27-49
        • Friedman T.
        • Gath D.
        The psychiatric consequences of spontaneous abortion.
        Br J Psychiatry. 1989; 155: 810-813
        • Beutel M.
        • Deckardt R.
        • Von Rad M.
        • Weiner H.
        Grief and depression after miscarriage: their separation, antecedents, and course.
        J Psychosom Med. 1995; 57: 517-526
        • McCoyd J.L.M.
        Pregnancy interrupted: loss of a desired pregnancy after diagnosis of fetal anomaly.
        J Psychosom Obstet Gynecol. 2007; 28: 37-48
        • Burgoine G.A.
        • Van Kirk S.D.
        • Romm J.
        • Edelman A.B.
        • Jacobsen S.-L.
        • Jensen J.T.
        Comparison of perinatal grief after dilation and evacuation of labor induction in second trimester terminations for fetal anomalies.
        Am J Obstet Gynecol. 2005; 192: 1928-1932
        • Kerns J.
        • Vanjani R.
        • Freedman L.
        • Meckstroth K.
        • Drey E.A.
        • Steinauer J.
        Women's decision making regarding choice of second trimester termination method for pregnancy complications.
        Int J Gynaecol Obstet. 2012; 116: 244-248
        • Ekstrand M.
        • Tyden T.
        • Darj E.
        • Larsson M.
        An illusion of power: qualitative perspectives on abortion and decision-making among teenage women in Sweden.
        Perspect Sex Reprod Health. 2009; 41: 173-180
        • Gravensteen I.K.
        • Helgadottir L.B.
        • Jacbonsen E.M.
        Women’s experiences in relation to stillbirth and risk factors for long-term posttraumatic stess syndrome: a retrospective study.
        BMJ Open. 2013; 3
        • Leon I.G.
        The psychoanalytic conceptualization of perinatal loss: a multidimensional model.
        Am J Psychiatry. 1992; 149: 1464-1472
        • Dlin B.M.
        • Fischer H.K.
        The anniversary reaction: a meeting of Freud and Pavlov.
        Psychosomatics. 1979; 20: 749-755
        • Franco K.
        • Campbell N.
        • Tamburrino M.
        • Jurs S.
        • Pentz J.
        • Evans C.
        Anniversary reactions and due date responses following abortion.
        Psychother Psychosom. 1989; 52: 151-154
        • Asplin N.
        • Wessel H.
        • Marions L.
        • Georgsson Ohman S.
        Pregnancy termination due to fetal anomaly: women’s reactions, satisfaction and experiences of care.
        Midwifery. 2013;
        • Jones O.W.
        • Penn N.E.
        • Shuchter S.
        • Stafford C.A.
        • Richards T.
        • Kernahan C.
        • et al.
        Parental responses to mid-trimester therapeutic abortion following amniocentesis.
        Prenat Diagn. 1984; 4: 249-256