Parent's Experience with and Desire to Use Complementary and Alternative Medicine After Stillbirth: Findings from an Online Survey

Abstract

Objectives:

Approximately 5.4 million parents worldwide are affected by stillbirth each year. There are limited therapeutic options for bereaved parents to manage their grief. A questionnaire was developed to learn more about parents' experience with complementary medicine after stillbirth.

Design:

An online questionnaire-based study was conducted.

Setting:

Australian and American parents, 18 years or over, and who had experienced a stillbirth in the past 36 months were recruited. The study was open for participation for 11 months.

Main outcome measures:

The authors developed the questionnaire based on existing survey instruments used for researching prenatal loss and complementary medicine. The complementary and alternative medicines included in the questionnaire include acupuncture, Ayurveda, biofeedback, Chinese Medicine, energy healing, exercise, homeopathy, massage therapy, meditation, mindfulness, naturopathy, Shamanism, tai chi, and yoga. The questionnaire included 43 questions in 5 sections: demographics, complementary medicine use over time, impact of the loss, preferences for coping with grief, and utilization of and experience of complementary medicine for coping with grief.

Results:

Almost 30% (29.8%) of respondents used complementary medicine to help manage their grief. Themes for how complementary medicine was perceived by help respondents included (1) helping them cope, (2) a self-care tool, and (3) a sense of control. The most popular complementary medicines used after a stillbirth were massage (n = 36/72; 50%) and exercise (n = 37/72; 51.4%). Respondents who used complementary medicine to help manage their grief had significantly slightly lower impact of event scale scores than those who did not use complementary medicine [r(213) = −0.16, p = 0.021). The study identified several barriers to complementary medicine use after a stillbirth, including not knowing much about it (n = 85/103; 82.5%), cost (n = 40/103; 38.8%), and a lack of confidence (n = 23/103; 22.3%).

Conclusions:

The study found a desire for complementary medicine therapies to help manage grief especially massage and exercise.

Background

Grief is the “psychobiological response to bereavement whose hallmark is a blend of yearning and sadness, along with thoughts, memories, and images of the deceased person.”¹ Many models have been proposed to explain the way individuals experience grief and integrate the loss into their lives.^2–5 Grief is viewed as a “natural” response to loss⁶ and thus not a condition that requires treatment or a diagnosis.^1,6 However, grief, especially when grieving the loss of a loved one, has also been described as “one of most stressful experiences in life.”⁶ Adapting to life without the deceased and managing grief requires support including resources for coping. Social support and connectedness have been found to be an important factor in managing grief and the capacity to cope.^7–10 Failure to adapt or integrate grief can lead to a diagnosis of complicated grief.¹¹

Stillbirth is defined as “in utero death from 20 weeks gestation until immediately before birth.”^12,13 In 2015, there were ∼2.7 million stillbirths worldwide.^14,15 That means that each year there are ∼5.4 million parents affected and impacted by stillbirth. Research shows that “the grief of parents following a stillbirth is commonly profound and long-lasting. It affects physical, emotional and financial well-being and has negative effects on children and extended family.”¹⁶ Parents who had a stillbirth reported experiencing disenfranchised grief (grief that goes unacknowledged or invalidated by social norms)¹⁷ and incongruent grief (differences in grief responses between parents).¹⁸

Parents who have experienced stillbirth are more likely to experience complicated grief, post-traumatic stress disorder (PTSD), depression, anxiety, and sleeping disorders than those who have live births.^17,19–21 Some parents experienced “strong feelings of social isolation and disconnection from their social environment.”¹⁷ Bereaved mothers are four times more likely to be diagnosed with clinical depression, seven times more likely to meet the criteria for PTSD, and twice as likely to be diagnosed with an anxiety disorder than those who have live births.^22,23

A recent stillbirth publication found that bereavement care ideally should “be individualised to recognise bereaved parents' personal, cultural or religious needs,”²⁴ but that current care options were limited to “information and referrals to both professional support and peer-to-peer support services”²⁴ (p. e123). To manage grief and depression related to bereavement, “referral to a bereavement counsellor, peer support group, or mental health professional may be advisable” (p. e124).²⁴ There were no other options for bereaved parents to consider to help them adapt or cope with their grief.

According to the Cochrane Collaboration “complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.”²⁵ In Australia, 36% of the population consult a complementary medicine practitioner.²⁶ Figures are similar in the United States with more than 30% of adults using complementary medicine practices.²⁷ The most popular CAM therapies are massage therapy, meditation, deep breathing, mindfulness, and yoga.^26,27

Despite the popularity of CAM there is limited research into CAM options for improving emotional or physical health after a stillbirth. Since 1981 there have been only two experimental interventions (mindfulness and grief support) researched that improve emotional, mental, or physical health after a stillbirth.²⁸ The mindfulness study was a feasibility study and while the intervention was well received, only six participants completed the study and this limits the study findings.²⁹ A recent randomized control feasibility trial on the use of online yoga to reduce PTSD in women who have experienced a stillbirth found significant decreases in PTSD and depression, and improvements in self-rated health for both intervention yoga groups (a low-dose and moderate-dose group).³⁰

The study found a significant difference in depression scores (p = 0.036) and grief intensity (p = 0.009) between the moderate-dose yoga group and the stretch-and-tone control group. PTSD decreased in all groups with no difference between the groups.³⁰ Given the prevalence of complementary medicine use and the mental health risks for parents who have experienced a stillbirth, there is a need for evidence on interventions that could support parents' mental and physical health after their loss, with a specific focus on the capacity to manage their grief. The objective of this study is to learn more about parents' experience with complementary medicine after stillbirth and their desire to use complementary medicine therapies to help manage grief after a stillbirth.

Methods

An online questionnaire-based study was conducted. The study was approved by Western Sydney University Human Ethics Committee (Approval No. H13150) on April 9, 2019.

Sample and recruitment

The study sought Australian and American parents, 18 years or over, and who had experienced a stillbirth in the past 36 months. Inclusion criteria was being a parent (the definition of a parent was left to individuals to self-determine), 18 years or greater, able to read and understand English, and having experienced the death of a baby to stillbirth within 36 months of participation. Current pregnancy was not an exclusion from the study. Participants were recruited using convenience sampling.³¹

Parents were recruited through collaboration with nonprofit stillbirth advocacy organizations such as SANDs Australia,* M.E.N.D USA,^† Return to Zero H.O.P.E USA^‡ who posted details about the study on their social media accounts (Facebook and Twitter) and through snowball sampling (sharing information about the study with others). The study was hosted on the Qualtrics online survey platform and was open for participation for 11 months from April 30, 2019 to March 30, 2020. Parents who responded within the time frame became the sample. Consent was implied by participants undertaking the survey.

Questionnaire design and data collection

A questionnaire was developed to learn more about parents' experience with complementary medicine after stillbirth and their desire to use complementary medicine therapies to help manage grief after a stillbirth. The authors developed the questionnaire based on existing survey instruments used for researching prenatal loss and complementary medicine³² and stillbirth and exercise³³ (see Supplementary Data S1). The CAMs included in the questionnaire include acupuncture, Ayurveda, biofeedback, Chinese Medicine, energy healing (e.g., Reiki), exercise, homeopathy, massage therapy, meditation, mindfulness, naturopathy, Shamanism, tai chi, and yoga based on the CAM therapies included in previous research on prenatal loss and complementary medicine.³² Questions were sourced from experts in complementary medicine and stillbirth, as well as an existing validated instrument used to measure the impact of a stressful event.³⁴ The questionnaire options included dichotomous scales such as yes or no, rating scales (mostly Likert scales in a matrix format with a single answer per row), open ended-questions, and multiple-choice questions.

The survey was difficult to validate due to the descriptive nature of the questions and as such principal components analysis was unable to be undertaken. The final version included 43 questions in 5 sections: demographics, complementary medicine use over time, impact of the loss, preferences for coping with grief, and utilization of and experience of complementary medicine for coping with grief. Details about the study were included at the beginning of the survey, including information about the purpose of the study, anonymity, what participants were required to do, instructions, perceived benefits for the research, contact details for study researchers and contact details for 24/7 community pregnancy loss services if participants experienced discomfort or stress during or after the completion of the survey.

Data analysis

Data were screened for those not meeting the inclusion criteria and missing responses. Respondents who did not meet the inclusion criteria or those that did not answer any of the complementary medicine use over time questions were removed. Descriptive statistics of demographic information are presented as means and standard deviations for any continuous data and frequency distributions for any discrete data (percentages). A Pearson correlation analysis was undertaken on the variables complementary medicine use to cope and the Impact of Event Scale score. The open-ended questions were analyzed using inductive content analysis. The first author (S.F.) read the data and created codes directly from the open-ended survey responses. The codes were then condensed into meaningful categories and themes.³⁵

Results

Three hundred and ten parents started the questionnaire and after removal of those who did not meet the inclusion criteria (n = 33) and those who only completed demographic information (n = 35), there were 242 respondents. The survey took participants an average of 8.5 min (standard deviation [SD] 7.7) to complete. Unless stated otherwise, all results are from respondents' answers to dichotomous scale questions, rating, or multiple-choice questions.

Demographics

The majority of the respondents were Caucasian women (>90%) from either America (n = 110/242; 45.5%) or Australia (n = 119/242; 49.2%) with a level of tertiary education (n = 210/242; 86.8%) and who were in a relationship, married, or partnered (n = 226/242; 93.4%). The average gestation at the time of the respondent's stillbirth was 30 weeks and 3 days. See Supplementary Data S2 for respondent's demographics. Snowball sampling led to 11 of 242 (4.5%) respondents not being from America or Australia.

Complementary medicine use over time

The majority of respondents did not use complementary medicine before pregnancy (n = 163/242; 67.4%), during their pregnancy (n = 170/242; 70.2%) or after their child was stillborn (n = 142/242; 58.7%) (see Table 1). For respondents who did use complementary medicine, massage was the most popular complementary medicine therapy used before and during pregnancy (n = 51/74; 68.9% and n = 38/65; 58.5%, respectively). Exercise, followed closely by massage, were the two most common complementary therapies used after the stillbirth (n = 49/89; 55.1% and 48/89; 53.9%, respectively).

Table 1.

Complementary Medicine Use and Complementary Medicines Used During Preconception, Antenatal, and Postnatal Periods

Complementary medicine use during preconception, antenatal, and postnatal periods (n = 242), n (%)
	Complementary medicine use before pregnancy, n (%)	Complementary use during pregnancy, n (%)	Complementary use after child was stillborn, n (%)
Yes	74 (30.6)	65 (26.9)	89 (26.8)
No	163 (67.4)	170 (70.2)	142 (58.7)
Did not answer	5 (2.1)	7 (2.9)	11 (4.5)
Complementary medicines used during preconception, antenatal, and postnatal periods
	Complementary medicines use before pregnancy (n = 74)	Complementary use during pregnancy (n = 65)	Complementary use after child was stillborn (n = 89)
Acupuncture	30	17	32
Ayurveda	0	0	1
Biofeedback	0	0	1
Chinese Medicine	10	3	10
Energy healing (e.g., Reiki)	4	6	14
Exercise	35	26	49
Homeopathy	6	5	10
Massage	51	38	47
Mediation	15	13	30
Mindfulness	20	17	30
Naturopathy	6	2	12
Shamanism	0	0	1
Tai Chi	0	0	0
Yoga	33	21	39
Other, please specify	17	19	19
Other included:	Chiropractor (n = 9), physiotherapy (n = 2), physical therapy, vitamins, psychology, osteopathy, essential oils, and float therapy (all n = 1)	Chiropractor (n = 9), physiotherapy (n = 2), physical therapy, vitamins, psychology, osteopathy, exercise physiology, hydrotherapy, essential oils, and float therapy (all n = 1)	Chiropractor (n = 7), Pilates (n = 3), psychology (n = 2), physical therapy, vitamins, TRS-zeolite detox spray, osteopathy, physiotherapy, essential oils, and float therapy (all n = 1)

Impact of the loss

The mean impact of events scale—revised (IES-R) score was 37.5 (SD 16.1).

Preferences for coping with grief

The most common way that respondents coped with their grief was engaging or talking with family or friends (n = 182/242; 75.2%) followed by using a therapist or counselor (n = 151/242; 62.4%). Just under a third of respondents used complementary medicine to cope with their grief (n = 72/242; 29.8%) (see Table 2). Of the 72 respondents who used complementary medicine to cope with their grief, 51 (70.8%) had used complementary medicine before or during their pregnancy.

Table 2.

Ways in Which Participants Coped with Grief Associated with the Death of Their Baby ( N = 242)

How did you cope with grief associated with the death of your baby	Yes, n (%)	No, n (%)	Did not answer, n (%)
Engaging/talking with family/friends	182 (75.2)	33 (13.6)	27 (11.2)
Support group	121 (50)	96 (39.7)	25 (10.3)
Physical activity (i.e., running, walking, and yoga)	131 (54)	86 (35.5)	25 (10.3)
Therapists/counselor	151 (62.4)	66 (27.3)	25 (10.3)
Medication	65 (26.9)	152 (62.8)	25 (10.3)
Complementary medicine	72 (29.8)	145 (59.9)	25 (10.3)

Preference for complementary medicine use in those who did not use complementary medicine to cope with their grief

For those who did not use complementary medicine to help cope with their grief, the majority did not consider using complementary medicine (n = 103/145; 71%). The most common barriers for not using complementary medicine were that they did not know much about it (n = 85/103; 82.5%) and cost (n = 40/103; 38.8%) (see Table 3). Forty-two respondents who did not use complementary medicine indicated that they considered using complementary medicine after experiencing a stillbirth. Those who indicated they had considered using complementary medicine most commonly considered using massage or exercise (both n = 23/42; 54.8%) (see Table 3).

Table 3.

Reasons for Not Considering Complementary Medicine Use to Cope with Grief

Those not using complementary medicine to cope (n = 145)
	No, n (%)
Did you ever consider using complementary medicine after your stillbirth	103 (71)
Reasons for not considering or using complementary medicine
Nowhere to go to try it	12 (11.7)
Emotional triggers	12 (11.7)
Cost	40 (38.8)
Don't know much about it	85 (82.5)
Clashes with religious beliefs	2 (1.9)
Clashes with personal beliefs/ethos	3 (2.9)
Safety concerns	5 (4.6)
Placebo effect	5 4.6)
Lack of insurance cover	14 (13.6)
Lack of confidence	23 (22.3)
Other	9 (8.7)
Other includes lack of time (n = 2), lack of effectiveness (n = 2), not ready (n = 1), unaware of how it would help with grief and trauma (n = 1), anxiety (n = 1), afraid to interact with other people (n = 1), and just trying to survive (n = 1)

	Yes
Did you ever consider using complementary medicine after your stillbirth	42 (29)
Complementary medicines considered for use
Acupuncture	13 (31)
Biofeedback	2 (4.8)
Chinese Medicine	2 (4.8)
Energy healing (e.g., Reiki)	5 (11.9)
Exercise	23 (54.8)
Homeopathy	1 (2.4)
Massage	23 (54.8)
Mediation	16 (38.1)
Mindfulness	14 (33.3)
Naturopathy	2 (4.8)
Tai Chi	1 (2.4)
Yoga	20 (47.6)

The most common complementary medicine approaches that would be considered in the future to help manage grief were massage (n = 101/145; 69.7%), exercise (n = 86/145; 59.3%), and yoga (n = 79/145; 54.4%) (see Table 4).

Table 4.

Complementary Medicines Approaches to Help with Grief

	Complementary medicine approaches that would be considered in the future to help manage grief by those who did not use CAM to help cope with their grief (n = 145)	Complementary medicine approaches used by those who used complementary medicine to cope with their grief (n = 72)
	n (%)	n (%)
None	12 (8.3)	0
Acupuncture	17 (11.7)	22 (30.6)
Ayurveda	3 (2.1)	0
Biofeedback	7 (4.8)	0
Chinese Medicine	9 (6.2)	10 (13.9)
Energy healing (e.g., Reiki)	34 (23.4)	14 (19.4)
Exercise	86 (59.3)	37 (51.4)
Homeopathy	16 (11)	9 (12.5)
Massage	101 (69.7)	36 (50)
Mediation	60 (41.4)	21 (29.2)
Mindfulness	65 (44.8)	32 (44.4)
Naturopathy	21 (14.5)	10 (13.9)
Shamanism	4 (2.8)	0
Tai Chi	15 (10.3)	0
Yoga	79 (54.4)	29 (40.3)
Other, please specify	2 (1.4)	8 (11.1)
Other includes	Anything that could be helpful and herbal supplements (both n = 1)	No answers recorded (n = 8)

CAM, complementary and alternative medicine.

Utilization of and experience of complementary medicine for coping with grief

Utilization

For those who used complementary medicine to help manage grief, the most popular CAM therapies were exercise (n = 37/72; 51.4%), massage (n = 36/72; 50%), and mindfulness (n = 32/72; 44.4%) (see Table 4). The most common reason for using complementary medicine was to help manage the manifestations of grief (n = 51/72; 70.8%), stress relief (n = 47/72; 65.3%), and relaxation (n = 44/72; 61.1%) (see Table 5).

Table 5.

Reasons for Using Complementary Medicines Approaches to Help Manage Grief

	n (%)
Reasons for using complementary medicine
Help with depressive symptoms	33 (45.8)
Help with anxiety symptoms	40 (55.6)
Help with grief symptoms	51 (70.8)
Better overall physical health	43 (59.7)
Better overall mental health	40 (55.6)
Better quality of life	29 (40.3)
Relaxation	44 (61.1)
Stress relief	47 (65.3)
Pain management	22 (30.6)
Other	2 (2.8)
Other includes allergies and fertility (both n = 1)

Participants could choose more than one reason.

Open-ended responses indicated that the alternative medical systems of complementary medicine (Chinese Medicine, acupuncture, Ayurveda, homeopathy, naturopathy, and tai chi) were more commonly used to help them fall pregnant again and for recovery from the stillbirth. The perceived benefits were the holistic approach to treatment and feeling like they were in control of the situation or taking action.

Open-ended responses found that the most common reasons for undertaking mind–body interventions (mindfulness and meditation) were for mental health and because it was recommended. The perceived benefits were improved mental health, managing anxiety, racing thoughts, and being in the moment.

Open-ended responses denoted that the most common reasons for undertaking manipulative and body-based methods of complementary medicine (massage, exercise, yoga, and biofeedback) were relieving stress and or tension and improving mental and physical health. The perceived benefits were relaxation, connecting with the physical body and reducing tension.

Experience

For those who used complementary medicine to help manage grief, the indicated benefits were relaxation (n = 46/72; 63.9%), improved emotional health (n = 43/72; 59.7%), and improved mental health and stress reduction (both n = 38/72; 52.8%) (see Table 6).

Table 6.

Benefits Experienced from Using Complementary Medicines Approaches to Help Manage Grief

	n (%)
Benefits from complementary medicine use
Improved emotional health	43 (59.7)
Improved spiritual health	21 (29.2)
Improved mental health	38 (52.8)
Treating the whole person	28 (38.9)
Limited side effects	19 (26.4)
Stress reduction	38 (52.8)
Relaxation	46 (63.9)
Enjoyable	26 (36.1)
Improved physical health	35 (48.6)
Able to be myself	23 (31.9)
Able to talk about my loss	25 (34.7)

Participants could choose more than one reason.

Feelings of why complementary medicine helped respondents to cope

There were three main themes that came out of the open-ended question of why respondents' felt that complementary medicine helped with coping with their grief: (1) Helping me cope physically and emotionally, (2) a self-care tool, and (3) a sense of control.

Helping me cope physically and emotionally

Respondents felt strongly that complementary medicine helped them cope and manage physical stress and tension that occurred after a stillbirth. For respondent 215 it “releases all my tension, which my body literally holds from grief and stress.…” This was reinforced by respondent 182 who felt that “so much stress and tension builds up with grief and you need to let it out, complementary medicine helps this.”

Complementary medicine also helped respondents cope emotionally and psychologically. For a number of respondents, complementary medicine was important in managing anxiety and depression, such as respondent 170 who felt “if I didn't have those things to get me out of the house or be active then it would have been very easy to slip into depression” and respondent 8 for whom “it's the only thing that calms my anxiety without taking medication.” Respondents acknowledged the importance of mental health and the importance of having options to manage grief illustrated by respondent 40: “Mental health is extremely important. Having outlets is a must to help with grief.”

A self-care tool

Respondents used complementary medicine as a self-care tool to help manage their grief, such as respondent 211 for whom “self-care and putting an emphasis on connecting back with my body and emotions following the trauma was paramount.” This was reinforced by a number of respondents who felt that complementary medicine allowed them to receive self-care in the form of “remembering to look after myself” (respondent 112) or giving “me a time out and sense of recharging” (respondent 74) or allowing “me to retreat inside myself for a while” (respondent 198).

A sense of control

For a number of respondents, a sense of control was important in why they used complementary medicine to manage their grief. An important aspect of complementary medicine use was the “sense of accomplishment” (respondent 50) respondents felt, illustrated by respondent 51, “being able to physically recover makes me feel like I've accomplished something, and I can be active.” The capacity to “do something” was important to many respondents and provided respondents with an option when they “otherwise felt helpless” (respondent 109). A sense of control was also important for women preparing for another pregnancy such as respondent 202 for whom it gave her “something practical to do in the early days so I felt proactive about preparing for another pregnancy.”

Impact of events scale scores and use of complementary medicine to cope

There was a small significant negative relationship between the impact of events scale scores and the use of complementary medicine to cope with stillbirth, that is, those who used complementary medicine to cope had a lower impact of events scale score, r(213) = −0.16, p = 0.021.

Discussion

The purpose of this study was to learn more about parents' experience with complementary medicine after stillbirth and their desire to use complementary medicine therapies to help cope with grief after stillbirth. The study found a desire for complementary medicine therapies to help manage future episodes of grief especially massage and exercise. The study identified barriers to complementary medicine use for managing grief and identified the ways in which respondents were using complementary medicines to help manage grief (stress relief, relaxation, and better overall physical health). Complementary medicine was perceived by respondents to help them cope, as a self-care tool and it gave them a sense of control. Respondents who did use complementary medicine to help manage their grief had a slightly lower impact of event scale scores than those who did not use complementary medicine.

The ability to access information on options for support after experiencing a stillbirth is extremely important. Research has reported a desire and a consumer need for interventions to help cope with the mental and physical stressors of traumatic grief, including complementary therapies.^33,36,37 The majority of respondents in this study were open to using complementary medicine to help manage grief suggesting respondents had a desire for other options beyond counseling or psychology²⁴ to help them manage the sequelae of their grief. Massage and exercise were the two most popular complementary medicines used and considered for future use for managing grief.

Evidence for the role of physical activity to help bereaved individuals is growing.^{17,30,33,37,38} Research shows that physical activity has the capacity to impact the bereaved both mentally and emotionally,^17,36 and can reduce depressive symptoms^30,33 and reduce grief intensity scores.³⁰ There is, however, limited evidence on the effects of massage in helping to manage grief or the sequelae of grief,^39,40 and more research is needed. It is important that parents have access to high-quality health information that they can use to determine the most appropriate tools and or treatments to help them manage their grief.

The study identified a number of barriers to complementary medicine use after a stillbirth with the majority of respondents indicating that they did not know much about it. Cost and a lack of confidence were also barriers to use. Fear of being judged, reluctance to ask for help, lack of available information, poor mental health literacy, thinking no one could help, cost, and distance are similar barriers identified as in individuals bereaved by suicide seeking support.⁴¹ Bereaved individuals are often in need of signposting to appropriate and acceptable resources and support⁴² and general practitioners are recognized sources of health care information and support for bereaved individuals.⁴³

General practitioners may not always have bereavement information and a lack of formal education for grief and bereavement has been identified as a barrier to treatment.^42,43 Given that general practitioners referral to complementary medicine practitioners is influenced by a lack of personal knowledge on the subject,⁴⁴ not receiving enough education about complementary medicines,⁴⁵ not knowing suitable complementary medicine practitioners,⁴⁴ seeing positive results previously,⁴⁶ and a lack of evidenced-based research,⁴⁷ it is unlikely that bereaved individuals will be provided with complementary medicine referrals for grief support. More research on complementary medicine and grief is needed so that there is a clearer pathway of support options that health professionals can refer to.

Pregnant women who used complementary medicine before pregnancy was a factor in using complementary medicine use during pregnancy.⁴⁸ The majority of the study respondents who used complementary medicine to help manage their grief, did so having utilized complementary medicine before or during their pregnancy implying familiarity with complementary medicines may influence complementary medicine use after a stillbirth. More than a quarter of respondents who used complementary medicine to cope with their grief had not used complementary medicine before experiencing a stillbirth. Individuals reporting an unmet medical need had greater complementary medicine usage than those who did not.⁴⁹ The respondents using complementary medicine for the first time may represent mothers whose grief needs were not being met. More research into the factors influencing the decision to use complementary medicine after stillbirth is needed.

The study identified the ways in which respondents were using complementary medicine to help manage after a stillbirth with complementary medicine used to help manage the manifestations of grief, for stress relief, relaxation, and better overall physical health. Those who did use complementary medicine to help manage their grief had a slightly lower impact of event scale scores. While it was not within the scope of this study to determine potential relationships between complementary medicine use and the slightly lower impact of event scale scores, the factors of self-care self-efficacy and a sense of empowerment and control might be factors involved in lower impact of event scale scores. The sense of empowerment and personal power experienced when using complementary medicine has been shown in qualitative studies of women receiving acupuncture while undergoing in vitro fertilization treatment.^50,51 More research is needed on the role of complementary medicines, coping, self-care self-efficacy, and a sense of empowerment and control.

Implications

Social support and connectedness is one of the “strongest determinants of positive psychosocial outcomes after bereavement”¹⁰ and it is one of the few factors that is modifiable after bereavement.¹⁰ This study indicates that complementary medicine could be a social support option for women experiencing a stillbirth with those who used complementary medicine to cope having a lower impact of events scale score. In addition to helping to address the physical and emotional sequelae of grief, complementary medicine services may provide social support through reducing isolation,^42,52 reinforcing their identity as a parent,¹⁷ validating and “normalising” feelings and thoughts, and encouraging self-agency through exploring coping strategies, provide options for referral.⁴²

Limitations

The sample of respondents is a convenience sample and may not be representative of all parents who have experienced a stillbirth. In addition, it over-represents women, and the results may not be generalizable to men who have experienced a stillbirth. Comparisons experiences of grief between males and females after pregnancy loss have found both similarities and differences; however, pregnancy is not an embodied experience for cisgender men and there are unique barriers for men seeking help after pregnancy loss such as social expectations of supporting their partner expectation and a lack of recognition of men's grief.⁵³ Recruitment was through bereavement support groups and support groups may not include marginalized groups who do not have the same access and resources to support poststillbirth.

Conclusion

A survey of parents who had experienced a stillbirth in the past 26 months established that just under a third of respondents had used complementary medicine, particularly massage and exercise, to help manage their grief. Respondents who used complementary medicine to help manage their grief had a slightly lower impact of event scale scores than those who did not use complementary medicine. Complementary medicine encouraged a sense of self-agency and self-efficacy. Respondents were open to using complementary medicines to deal with future episodes of grief with massage and exercise again being respondents favored treatments. Barriers to complementary medicine use for grief were similar to barriers to complementary medicine use generally. Complementary medicine services may provide parents bereaved by stillbirth social support to help address the physical and emotional sequelae of grief and reduce isolation.

Footnotes

Authors' Contributions

All persons listed as authors have participated sufficiently in the study to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the article. S.F. collected the data and drafted the article. All authors contributed to the conception or design of the study, data analysis and interpretation, and critically revised the article.

Author Disclosure Statement

S.F. declares that she works as a massage therapist. P.H., A.B., and J.H. declare they have no conflict of interest.

Funding Information

No funding was received for this article.

Supplementary Material

Abbreviations Used

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