Helping Women During Difficult Pregnancies
College of Nursing professor Denise Côté-Arsenault ’76, G’85 knows how devastating an unsuccessful pregnancy can be for a woman. She experienced the loss of her own baby and endured a difficult subsequent pregnancy. Since 1983, she has reached out to others who’ve shared similar experiences.
College of Nursing professor Denise Côté-Arsenault studies how women who've experienced perinatal loss deal with subsequent pregnancies.
Côté-Arsenault, who earned bachelor’s and master’s degrees from the College of Nursing and has taught there for 14 years, chose the topic of pregnant women who’ve previously suffered perinatal loss for her University of Rochester doctoral dissertation. “It has been my program of research ever since,” says the former labor, delivery, and postpartum nurse. “It’s been a much richer area of research than I ever dreamed.”
When Côté-Arsenault began working on the dissertation in 1992, only about five studies had been done on women in pregnancies after perinatal loss. Today, some 35 studies have been conducted on the subject, and Côté-Arsenault is working on her fifth. “In my first study, I compared pregnant women who have experienced perinatal loss with those who haven’t,” she says. “I found that those with previous loss had more of what I call 'pregnancy anxiety' more concerns about their pregnancy, their baby, and themselves.”
Côté-Arsenault found that many of the women felt they had lost a baby, not just a pregnancy, even though the majority had first trimester losses, generally called miscarriages. Some women, however, had carried the babies to near full term, or lost them shortly after delivery. “I looked at the anxiety of women who thought they had lost a baby with more personhood' a baby who was given a name, or who would now be a certain age,” she says. “Those who lost a baby who to them had become a person had greater pregnancy anxiety. The more they thought they had lost, the more anxious they were about the current pregnancy.”
In subsequent studies, Côté-Arsenault asked these women why they called the doctor’s office more frequently than other pregnant women, or why they changed doctors after the loss of a baby. She also did two focus group studies, including one with women who became pregnant again after a loss. “The metaphor I came up with to describe them is having one foot in the pregnancy and one foot out,” she says. “They could not totally count on having the baby because they knew that babies don’t always survive. They were doing everything they could to be sure the pregnancy went well, but emotionally they were leaving room for the possibility of something happening to this baby.”
Côté-Arsenault is now studying support groups for such women in Minneapolis and Seattle. In talking to group members, she has found that the women lack trust in the health care delivery system, they worry about their ability to carry a healthy child to term, and some feel like failures. The study also has revealed that such women often need more reassurance from their medical professionals that the pregnancy is going well—they request more monitoring or testing than do women who have not experienced a failed pregnancy. Côté-Arsenault believes medical professionals should be supportive of these women, accommodate their needs, and understand their anxiety. “There are no specific protocols for care given to these women,” she says. “That’s what I am working on. Ultimately, my goal is to change how we care for these women and their families. We need to provide more sensitive care and be aware of their concerns.”
Côté-Arsenault includes students on her research teams, finding them a “tremendous asset.” “They are especially helpful with qualitative work because they take a fresh look at what the women are saying,” she says.
Nursing graduate Kate Foley ’00, who worked with Côté-Arsenault, listened to interview tapes of women who had experienced a loss. She found hearing their words to be a moving experience. “Everyone thinks of pregnancy as a perfectly happy time, but the things these women said were heart wrenching,” Foley says. “I hope that being part of this research will help me be more understanding of what these women go through.”
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