Dyadic Coping and Couple Resilience After Miscarriage

• Published date: 01 February 2021
• Author: Angela R. Hiefner
• Date: 01 February 2021
• DOI: http://doi.org/10.1111/fare.12475

A R. H Saint Louis University, University of Texas Southwestern Medical Center

Dyadic Coping and Couple Resilience

After Miscarriage

Objective: The purpose of this phenomenologi-

cal study was to explore the impact of miscar-

riage on the couple relationship, particularly

lived experiences related to partners’ percep-

tions of increased closeness and strength in the

relationship.

Background: Current miscarriage literature

lacks a process-oriented understanding of how

miscarriage inuences partner interactions and

how partner interactions inuence resilience

and coping after this loss.

Method: This qualitative study used semistruc-

tured interviews to conduct a combination of

dyadic and individual interviews with six cou-

ples, resulting in 18 interviews.

Results: The couples described themes of both

positive and negative impact on the relationship,

the shared nature of the loss, dyadic coping

strategies, and specic partner interactions that

supported resilience.

Conclusion: Experiencing miscarriage as

a shared loss seemed to create important

opportunities for healthy dyadic coping and

interactional processes.

Implications: Findings can guide medical and

mental health professionals in providing more

effective support to couples after miscarriage.

Current estimates indicate that about 15% to

20% of pregnancies end in miscarriage, dened

Department of Family and Community Medicine, Univer-

sity of Texas Southwestern Medical Center, Dallas, TX

(angela.hiefner@utsouthwestern.edu).

KeyWords: couples, dyadic coping, grief, miscarriage, qual-

ity of intimate partner relationship, resilience.

as the spontaneous pregnancy loss of a fetus

before 20 weeks of gestation (American Col-

lege of Obstetricians and Gynecologists, 2013).

Given these high rates, many couples will

experience this loss during their lifetime, and

some will experience multiple losses (Ser-

rano & Lima, 2006). Despite this prevalence,

many miscarriages go unreported because

the pregnancy was not clinically conrmed

by a medical provider or health care services

were not sought for the miscarriage (Van den

Akker, 2011). Consequently, it is reasonable

to expect that the true prevalence rate may be

higher. Despite the high prevalence of mis-

carriage, the signicance of this type of loss

is frequently overlooked or dismissed by oth-

ers, and mothers and fathers who do not have

living children are often not recognized as

parents (Lang et al., 2011). Thus, throughout

this article, individuals who have experienced

miscarriage are referred to as parents in an

effort to be intentionally inclusive of all forms

of parenthood.

With miscarriage largely viewed as a

women’s issue, the majority of research focuses

on understanding this loss from the mother’s

point of view. Fewer studies have examined

fathers’ experiences, and the literature has

minimally described how miscarriage impacts

the couple relationship. A process-oriented

understanding of how miscarriage inuences

partner interactions and how partner interactions

inuence resilience and coping after this type

of loss is a necessary next step. Specically, an

understanding of how couples successfully nav-

igate miscarriage can provide needed guidance

for clinical support in both medical and mental

Family Relations 70 (February 2021): 59–76 59

DOI:10.1111/fare.12475

60 Family Relations

health settings and the development of effective

dyadic interventions.

M   C R

Overall, little is known about what enables

couples’ resilience in the face of miscarriage,

because few studies have focused specically on

how couples successfully navigatethis loss. Cou-

ple resilience has been dened as a process in

which partners engage in relationship behaviors

that support positive adaptation during stressful

life situations (Sanford et al., 2016). Although

individual coping is important, research indi-

cates that dyadic coping, a process in which

both partners are mutually engaged in coping

(Bodenmann, 2005), is a stronger predictor of

relationship functioning than individual coping

(Badr et al., 2010; Papp & Witt, 2010) and

also is positively correlated with relationship

satisfaction (Falconier et al., 2015).

The current literature has largely adopted

an individual lens in the exploration of het-

erosexual parents’ experiences of miscarriage,

with many studies exploring mothers’ and (to

a lesser extent) fathers’ experiences separately.

These studies indicate that men and women

experience similar emotional responses after

a miscarriage, including sadness, grief, isola-

tion, anger, and guilt (Adolfsson et al., 2004;

Hamama-Raz et al., 2010; McCreight, 2004).

However, men and women tend to differ in how

they express their grief and the coping strate-

gies they use, with women often expressing

their grief more openly and seeking out social

support, while men often grieve more inter-

nally and use more avoidance coping strategies

(McCreight, 2004).

Further, existing couple-level research on

miscarriage lacks a resilience perspective and

has primarily used quantitative methodologies

to examine the negative impact this loss has

on the couple relationship. This research sug-

gests that differences in partners’ responses

to miscarriage can result in increased tension

within the relationship, which reduces partners’

abilities to provide support for one another

(Hutti et al., 2015; Lang et al., 2011; Swan-

son et al., 2003). This has been referred to as

incongruent grieving, a term used to describe

partners’ differing ways of navigating grief

(e.g., timing and intensity of grief, expression

of grief, and coping strategies) over a loss they

both experienced (Peppers & Knapp, 1980).

After miscarriage, partners often have different

expectations about how to react, how to behave,

and the appropriate amount of time to grieve

(Lang et al., 2011), in part informed by cultural

expectations and gender norms (Leon, 2008;

Rinehart & Kiselica, 2010). As an example,

a woman may have grown up in a culture in

which lost loved ones’ lives are celebrated with

expressions of love for several months after the

loss and on anniversaries of the loss, while her

male partner may have experienced a cultural

upbringing in which expression of grief was

limited as a way to avoid pain and men were

expected to remain stoic and unemotional.

Additional impacts of miscarriage on the couple

relationship include reduced sexual satisfaction,

avoidance of sexual intimacy, and decreased

desire (Franche, 2001; Serrano & Lima, 2006;

Swanson et al., 2003); increased emotional

distance and decreased relationship satisfaction

(Hutti et al., 2015; Trepal et al., 2005); and a

greater risk of separation (Gold et al., 2010;

Shrefer et al., 2012).

Although some couples experience these neg-

ative impacts on their relationship after miscar-

riage, some research indicates that other couples

experience greater closeness, perhaps as a result

of the shared experience of loss and attempt-

ing to support each other through that loss

(Swanson et al., 2003). This research suggests

that open communication, acceptance of differ-

ences in grieving, and supportivebehaviors (e.g.,

spending time together, efforts to care for each

other) may be important dyadic coping skills that

enable couples to experience greater closeness

and strength in their relationship after miscar-

riage. Given the negative effects of miscarriage

on the intimate partnership, as well as the poten-

tial impacts of incongruent grieving on rela-

tionship quality, intervening at the couple level

is critical for promoting resilience and dyadic

coping. However, existing research lacks mean-

ingful dyadic-level data, and most studies have

focused on the challenges parents face after mis-

carriage and have been limited in their reliance

on quantitative analyses. Toinform dyadic inter-

ventions, additional research is needed to rst

understand couple resilience and dyadic coping

after miscarriage. Knowledge gained from quali-

tative research in this area may be especially well

suited to informing medical and mental health

professionals in providing more effective sup-

port for mothers and fathers experiencing mis-

carriage.