The contact of medical personnel with a woman after pregnancy loss is a special type of social interaction involving the exchange of emotions and instruments of action. Both medical staff, because of their competences and the nature of their work, as well as the patient's relatives belong to the group of people considered significant in the process of adapting to this difficult situation. Social support tailored to the patient’s expectations and needs reduces stress, provides a sense of security, and affects the process of diagnosing, treating, and handling the health problem. Assessment of patient expectations and their constant monitoring is conducive to the development of modern medicine and nursing, as well as to meeting the ever-greater requirements towards medical personnel [1, 12].
The type of social support that received the highest score from women after pregnancy loss, both as a result of miscarriage and termination of ectopic pregnancy (EP), was perceived available instrumental, emotional, and actually received social support. The statistical data presented in the present paper is comparable to the results of a study conducted by Konczelska et al. among parents who had experienced the death of a child .
The need for support, both in the present study and the analysis by Konczelska et al., was less intense. On the other hand, patients after miscarriage and ectopic pregnancy sought support to a lesser extent than respondents who had experienced the death of an older child. This is may be due to the fact that among the respondents studied by Konczelska et al. satisfaction with the support received was assigned the lowest score, while the score for support from individual sources given by the respondents participating in the present study was high .
Social support plays an important role in supporting therapy and maintaining health. It is also a recognized factor positively affecting an individual's quality of life (QoL). Along with the decreasing scope of social support, the incidence of poor overall health, mental stress, symptoms of anxiety and depression, limited activity, and disability increases [1, 17, 18]. Providing social support and assessing it in the medical community is therefore extremely important .
The present study showed a positive correlation between support from both primary (relatives, other patients) and secondary support systems (medical staff, clergy) and satisfaction with quality of life among women in such unique circumstances as pregnancy loss. Moreover, QoL was positively influenced by the perceived available emotional and actually received support in both study groups, while in the case of respondents who had miscarried, this was also true for perceived available instrumental support. The present analysis corresponds with the studies by Dębska et al. and Sitjar-Suñer et al., who demonstrated that social support is a key factor for perceived quality of life [20, 21].
In a regression analysis by Bastardo et al., social support was significantly correlated with all HRQL domains except for physical functioning . The work by Pietnoczko et al. showed that a growing deficit of social support from professionals increases the number of somatic symptoms and health problems . The present analysis of the correlations between the individual dimensions of social support and the overall health of women after pregnancy loss showed the impact of perceived available emotional support on mental and physical condition, overall health, and health satisfaction. Perceived available instrumental support positively correlated with the psychophysical condition of respondents after miscarriage, their overall health and health satisfaction, as well as the mental condition of women with EP. Moreover, higher scores for actually received support were associated with better mental condition in the case of respondents with ectopic pregnancy.
Natural sources of support are considered the most durable and reliable. According to researchers, they are more accessible and beneficial, generate lower costs, and do not stigmatize. Moreover, their mutual and voluntary nature significantly increases the effectiveness of the aid provided .
Interpretation of the results obtained in the course of this study showed that women who had experienced prenatal loss gave the highest scores to natural sources of support, such as their partner and family. Other sources of support that received high scores were the midwife, friends, and the doctor. The present analysis corresponds to the qualitative research conducted by Bellhouse et al. among Australian women after miscarriage, where the partner was identified as the main source of social support . A study conducted by Song et al. indicated that marital closeness mitigated the negative effects of mourning . Social support plays an important role in moving through its successive stages. Based on the theory of stress, it is concluded that it provides a buffering effect, while a low level of support from the family and friends contributes to the emergence of complex mourning reactions . A review of the literature on the subject indicates that a weak marriage relationship or lack of support from the partner are strong factors that intensify the feeling of grief after perinatal loss [6, 7].
By analyzing the correlations associated with the impact of support on the condition of patients after pregnancy loss, we showed that support from the partner of women with EP and the family of respondents after miscarriage were significant for improving their mental state. It should be noted, however, that women who had had a miscarriage assigned slightly higher scores to the level of support received from their partners compared to patients with EP who, in turn, received slightly greater support from their families. It can therefore be assumed that the very initiation of supportive actions on the part of relatives was a factor affecting the condition of patients after pregnancy loss. Moreover, it should be noted that the necessary condition for supportive social interactions to meet the expectations of a person in need is their purposefulness, consistency between the amount of aid provided and the needs and expectations of the recipient, and also mutual (donor-recipient) understanding and mobilization. The effectiveness of these actions also depends on the recipient’s resources, such as self-esteem, competences, conviction about their own effectiveness, social position, sense of control, and coherence .
In the research conducted by Mess et al. among women who had experienced the loss of a child at various stages of pregnancy, most respondents, when asked about the support received in hospital conditions, indicated that this had come from their family and the midwife . In the present analysis, the support provided by the latter also received high scores. The midwife creates, or should create, a special relationship with a patient after pregnancy loss, provides contact with another woman, a person who is a source of safety and support during pregnancy, and who then becomes a witness of the child’s death and the mother’s despair.
Patients after miscarriage and ectopic pregnancy indicated friends as another source of support, and then their gynecologist-obstetrician. 40% of women after pregnancy loss surveyed by Mess et al. indicated their doctor as a supportive person at the hospital . Another important source of social support for patients participating in the diagnostic survey for this study turned out to be other patients in a similar situation who were staying at the hospital at the same time. Bellhouse et al. obtained comparable results among individuals after pregnancy loss .
Psychological care received a high score from the women after the loss of a child surveyed by Mess et al.: it ranked third in terms of support provided to the women during hospitalization . The results of the present study did not correspond with Mess et al.'s data. The psychologist was one of the least effective sources of support for patients. This was probably due to the fact that a significant number of women with diagnosed pregnancy loss did not have contact with a psychologist or did not express an opinion on the care provided by this specialist. It should be emphasized that for patients with ectopic pregnancy, psychological care had a significant impact on improving their mental state. Therefore, it should be noted that it is necessary to include psychological care in management algorithms and monitor this process through systematic research in the field of social support among patients after prenatal loss. The task of a psychologist should not only be to provide immediate help in a difficult situation, but also to refer individuals who cannot cope with pregnancy loss to a mental health clinic, crisis intervention center, and support groups [27, 28].
Spiritual support, especially in the event of death, where suffering dominates, is very valuable. Religion reduces the feeling of irreversibility of death, explains its meaning, and offers rituals to help process the loss. In the present study support from the clergy received a low score (however, it should be noted that, as in the case of psychological care, a large group of patients did not have contact with a priest or did not express an opinion on this source of support). This result was identical with the data from the analysis conducted by Mess et al., where support from a priest was received by a small group of patients after perinatal loss (approx. 3%) . A literature review also shows that religious communities constitute beneficial sources of support, and religion is associated with increased perception of social support . Studies conducted among patients after miscarriage and ectopic pregnancy also showed a correlation between the support from the clergy and perceived available emotional support, instrumental support, actually received support, and social support seeking. The present analysis also showed a positive correlation between clerical support and satisfaction with the quality of life in women who had experienced obstetric failure.
One of the current challenges facing the healthcare system is the appropriate response to patient expectations. The quality of the services provided should be assessed constantly in order to make improvements by designating and implementing appropriate strategies. Patient expectations, as well as their experiences and opinions on maternity care, should constitute an important message for both health care employees and administrators, while ensuring the psychosocial comfort of patients, in addition to effective treatment and care, should be one of the priorities in medical personnel's daily work. Raising public awareness of the impact of pregnancy loss on psychophysical health seems necessary to shed more light on this profoundly personal experience, as well as to better understand and provide proper support to people affected by prenatal loss.