The Right to Grieve: Norwegian Women’s Experiences of Care During Termination of Pregnancy in Second Trimester

Study Context

At the time of the study, routine ultrasound screening around gestational week 18 was part of the Norwegian public antenatal care programme, providing information about gestational age, number of foetuses, placental position, and foetal anatomy and structural development (Norsk Helseinformasjon, 2025). Under the Abortion Act in force during the study period, self-determined abortion was permitted until the end of gestational week 12, while termination between gestational weeks 12 + 1 and 21 + 6 required approval from a regional abortion committee (Abortloven, 1975). ¹ In 2022, a total of 193 committee-approved terminations of pregnancy were performed after gestational week 18 in Norway under the indications specified in the Abortion Act (Løkeland et al., 2023), compared with 52,026 live births (Thomsen et al., 2023).

Legal and organisational frameworks also shape women’s experiences of pregnancy loss. In Norway, women are not entitled to maternity leave until 12 weeks before their estimated due date, and pregnancy termination before gestational week 22 does not qualify for maternity leave or benefits in the same way as perinatal death (Folketrygdloven, 1997, §14–5, §14–9, §14–17). There are no national psychosocial guidelines for hospital care and follow-up for women who experience late termination of pregnancy or late miscarriage. These structural conditions may influence how loss is recognised, supported, and followed up within the healthcare system.

Study Design

This study employed a qualitative, descriptive, and interpretivist research design (Berger & Luckmann, 1966) informed by a process-oriented and narrative understanding of experience. Qualitative interviews are particularly suitable for exploring sensitive and under-examined experiences (Rapley, 2004). A semi-structured interview with initial open-ended questions allowed participants to reflect on their experiences while providing flexibility to explore emerging themes (Kvale & Brinkmann, 2015). User perspectives were integrated through an advisory group recruited from an interest organisation. This group, consisting of three women with lived experience of termination for foetal anomaly, contributed to the study planning, interview design, recruitment strategies, and participant information materials. The study is reported in accordance with the COREQ checklist for qualitative research (Tong et al., 2007).

Sample and Recruitment

Participants were recruited using criteria-based purposive sampling through the Norwegian SIDS and Stillbirth Society (Landsforeningen for uventet barnedød, LUB). The organisation offers bereavement support and peer fellowship for grieving parents and engages in preventive efforts and research to reduce child mortality in Norway (Landsforeningen for uventet barnedød, nd).

Eligibility criteria were as follows:

• Received serious prenatal information at an ultrasound examination in or around gestational week 18

Due to the small number of potential participants with experience of late pregnancy loss within this specific gestational window, recruitment through LUB was considered appropriate. Moreover, they had likely already reflected on and articulated their thoughts on their loss, enabling them to make an informed decision about volunteering for the study. Given the small population, the inclusion criterion was set at a maximum of five years since the loss.

A recruitment email was distributed through the organisation, and 36 individuals volunteered for the study. Following screening conversations by telephone, five participants were found to meet all inclusion criteria and consented to participate. The participants ranged in age from 29 to 39 years (mean age 33.8), and all identified as Scandinavian.

Sample adequacy was considered in relation to the specificity of the study aim, the narrowly defined eligibility criteria and difficult-to-recruit study population, as well as the depth, adequacy and information richness of the interviews conducted.

Data Collection

Individual in-depth qualitative interviews were conducted online via Microsoft Teams by the first author and lasted between 90 minutes and 3 hours. Participants were interviewed in their homes to enhance their sense of safety, privacy, and autonomy.

A semi-structured interview guide (Supplemental file 1) was developed to allow a flexible approach enabling the participants to narrate their experiences in their own words. The guide consisted of broad, open-ended questions concerning the pregnancy and loss trajectory, encounters with healthcare professionals, decision-making, post-loss experiences, coping, and support needs. Suggested prompts were used flexibly to explore issues raised by each participant. They were invited to start with their present situation and then reconstruct the sequence of events surrounding the loss, including their interactions with healthcare professionals. The aim was not to establish a factual reconstruction of events but to explore how the encounters were experienced, interpreted, and remembered. No participants withdrew from the study.

Data Analysis

All interviews were transcribed verbatim by the first author, resulting in 119 pages of transcripts. The analysis was based on Braun and Clarke’s (2022) reflexive thematic approach, which treats researcher subjectivity as an analytic resource and emphasises an iterative process that enables in-depth engagement with the data.

The analysis proceeded through several stages. First, transcripts were read repeatedly to gain familiarity with the material, supported by field notes from the interviews. Initial codes were generated inductively through close reading, focusing on recurring meanings, experiences, and language use. Coding was first conducted within each interview as a vertical analysis, then across interviews as a horizontal analysis, to identify shared patterns and variations.

Codes and preliminary themes were discussed collaboratively among the authors and refined through iterative comparison with the data in several analytical workshops. Discrepancies in interpretation were resolved through dialogue and re-examination of transcripts. Analytic notes and reflexive discussions documented the development of codes and themes. The final analysis resulted in four theme clusters with associated sub-themes, representing participants’ experiences of key moments in their stories. Participants did not provide feedback on the findings.

Researcher Reflexivity

Reflexive thematic analysis acknowledges and values researchers’ impact on the research process (Braun & Clarke, 2022), necessitating a critical examination of the researchers’ roles. The four female authors have complementary experiential and professional backgrounds, contributing interdisciplinary insights related to pregnancy loss. The first author, Follestad, is a trained nurse with a master’s degree in mental health care and extensive counselling experience in reproductive care. The second author, Kalstad, is a trained grief counsellor and cognitive therapist with extensive experience in bereavement support and is employed by LUB. The third author, Christoffersen, is a professor with experience in social science methods and healthcare research and expertise in parental experience of loss. The fourth author, Berg, is an associate professor with a background in health and social sciences, particularly within medical sociology and qualitative studies of vulnerable groups’ life experiences.

Reflexive discussions were held throughout data collection and analysis to critically examine assumptions, emotional responses, and interpretive choices. This collaborative reflexivity functioned as a form of analyst triangulation, strengthening interpretive rigour and combining insider and outsider perspectives.

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki (World Medical Association, 1964/2024) and approved by the Regional Committee for Medical and Health Research Ethics (REK) South East Norway (2021/288938). The collection and storage of personal data were approved by the Norwegian Agency for Shared Services in Education and Research (SIKT) (2022/742533), in accordance with the Norwegian Personal Data Act.

All participants received written and oral information about the study’s purpose and their rights as study participants, including confidentiality, and their right to withdraw from the study at any time. Written informed consent was obtained prior to participation. The participants have been given pseudonyms to ensure confidentiality.

Participation in research has been perceived as meaningful by many bereaved parents (Butler et al., 2018; Dyregrov, 2004). Nevertheless, given the emotional sensitivity of the topic, all participants were offered a follow-up conversation with a counsellor at LUB to ensure well-being after the interview.

Shifting From Anticipation to Uncertainty in the First Encounter

The women in this study felt a strong attachment to the life growing within them. They approached the routine prenatal ultrasound at 18 weeks with anticipation, looking forward to meeting what they regarded as “their ‘babies’”. Expecting reassurance, they instead learned that something was wrong, sending them into a state of shock and emotional turmoil. The moment of diagnosis marked a profound rupture, transforming an anticipated confirmation into an experience of fear and uncertainty. It became the critical incident that initiated the subsequent care trajectory.

Sophia, whose baby was diagnosed with low amniotic fluid and foetal growth restriction, described how the experience overturned her sense of safety and their expectations:

When we reached week 17, we were convinced nothing could go wrong, so we filled the house with baby equipment and built a baby crib. We were so happy and excited about the ultrasound… and leaving the hospital felt like our world had been turned upside down. (Sophia)

Similarly, Vera, who had experienced a miscarriage one year earlier, was devastated upon learning her baby had a heart defect, no kidneys, and no amniotic fluid:

We thought everything was fine, because we went to four ultrasounds that showed nothing abnormal. I was in shock and could not comprehend what had gone wrong. (Vera)

All participants described this moment as an unreal, out-of-body experience. Their expectations of a normal family life were suddenly replaced by uncertainty and emotional upheaval, leaving them struggling to grasp the implications of the diagnosis.

Feeling Abandoned at the Outset of Care

As the participants attempted to absorb the unexpected diagnosis, they expected reassurance, guidance, or emotional support from healthcare professionals. Instead, they encountered a clinical environment in which medical terminology dominated the conversation, while their emotional needs remained largely unaddressed.

Vera expressed a strong sense of being left without support at the very outset of care:

I wished they had something to offer me, someone to talk to. It was just a matter of ending the appointment and going home, left to digest everything that had been said on my own. (Vera)

The impersonal nature of these early encounters made participants feel like just another case within the system. Their transition from expectant mothers to patients facing possible miscarriage or termination occurred with little emotional scaffolding. This early lack of recognition and support contributed to feelings of abandonment and shaped how they approached the care that followed.

Participants described feeling disoriented and uncertain about what would happen next. They were referred for further investigations without receiving clear information. The shift from routine prenatal care to specialised foetal medicine thus unfolded as a continuation of an experience already marked by disruption and vulnerability.

Navigating Ambiguity in the Decision-Making Process

After referral, hospital specialists confirmed or refined the initial findings, emphasising the severity of the diagnosis. Although extensive medical information was provided, participants experienced a lack of guidance on how to approach the termination decision itself. Being presented with life-altering choices without supportive discussion deepened their distress, as the ethical dimensions of the situation added a further emotional burden.

Struggling to navigate the complexity of the situation, participants expressed a strong need for certainty before making such a profound decision. They described feeling powerless in encounters with specialists, experiencing them as clinically detached and insufficiently responsive to their need for clarity and emotional support.

Some participants sought additional information independently. Mary and Sophia described turning to the internet and consulting external experts in an attempt to validate the information they had received and find reassurance. However, they encountered conflicting information, deepening their uncertainty. They found the emotional weight of the decision overwhelming as they struggled with the idea of ending a life that still might be viable.

Sophia captures the emotional impact of this period:

When the doctor confirmed the news that our baby had a severe disease, our world seemed to spin out of control. I was on the verge of passing out, consumed by a sense of sheer panic. The doctor presented us with the choice of continuing the pregnancy or terminating it. He explained that due to the scant amount of amniotic fluid, a miscarriage was likely. Nevertheless, we held onto hope until the very last moment, grappling with mixed feelings and a tug-of-war between logic and the heart. (Sophia)

Mary described trying to envision her son’s prospective life and whether he had a realistic chance of survival. The burden of this decision felt crushing. While she clung to the hope of a ‘life worth living’, the phrase ‘incompatible with life’ echoed persistently, pushing her towards termination.

The notion of time emerged as a crucial factor for several participants. Although they appreciated the prompt referral to the hospital, they also felt pressured to decide before they were emotionally ready. They feared regretting a rushed choice yet simultaneously wanted to escape the painful situation. Ultimately, Mary, Vera, and Sophia decided to terminate their pregnancies, but all three reported a lingering sense of not having had enough time to fully process their emotions before proceeding.

For two participants, the pregnancy ended without an active decision. In Eliza’s case, the foetus died in utero, while Ruth experienced a miscarriage at 19 weeks after a period of indecision.

Eliza described this period as follows:

I felt like I was being transported on an assembly line from one medical examination to another, receiving only technical and medical information at each stop, but no emotional support confirming the loss of a baby. (Eliza)

For the women who opted for termination, the legal requirement to seek approval from the Norwegian abortion committee initially provoked anxiety and fear of being judged. Contrary to their expectations, the committee meetings were experienced as respectful and supportive. Although the broader process was marked by isolation, the committee meeting provided a brief moment of reassurance and shared responsibility.

As Mary explained:

I also felt that it was not only the two of us making the decision; in a way, they were part of it too, so we did not have to carry the decision entirely alone. It was not that I needed someone to take the responsibility away from me, but it felt reassuring not to be completely alone and to know that the professionals did not disagree with us. (Mary)

Committee members acknowledged the severity of their situation, adopted a neutral and non-judgemental stance, and provided clear, unbiased information. This recognition alleviated some of the ethical and emotional strain of decision-making and created a sense of shared responsibility. Although the broader process was marked by isolation, this encounter provided a brief moment of reassurance.

Experiencing Being Unprepared for Termination

Although the abortion committee’s validation provided a moment of relief, it did not lessen the emotional weight of the decision. As participants moved towards termination, they found themselves confronting new medical and emotional challenges.

They described the period between the final decision and giving birth as entering unfamiliar terrain, characterised by uncertainty and a lack of support to prepare for what lay ahead.

Eliza described her experience as this:

I felt like I was being transported on an assembly line from one medical examination to another, receiving only technical and medical information at each stop, but no emotional support confirming the loss of a baby. (Eliza)

The participants noted a discrepancy between the clinical follow up, the language used in the care and their own understanding of the situation. Regardless of gestational age or prognosis, they viewed the foetus as their unborn child and a baby and compared their loss to stillbirth. Moreover, they perceived the seriousness of their loss as being measured by the duration of their pregnancy, leaving them feeling inferior to women who gave birth later in pregnancy. Mary perceived the clinical definition of viability as a threshold that resulted in different treatments for patients whose foetuses did not meet this threshold. She found it unfair that, in encounters with doctors and nurses, her termination was frequently referred to as a ‘late abortion’ rather than the birth of a baby. She felt deprived of the same rights and recognition as other bereaved mothers, despite experiencing a profound loss.

All participants felt positioned as patients yet desired to be treated more like expectant mothers, wanting to be recognised as women giving birth rather than as patients undergoing a procedure. Instead of prepared and guided, they experienced to navigate this transition largely on their own. The absence of clear information about labour and delivery heightened their anxiety and left them feeling unprepared for what lay ahead. As they approached childbirth, the need for recognition, guidance, and emotional support for an experience that held profound emotional and psychological significance became increasingly evident.

Experiencing Bodily Strength and Agency During Birth

In contrast to the turmoil of decision-making, childbirth offered a moment of clarity, shaped by the compassionate support of midwives who provided predictability and structure. The delivery room was perceived as a sanctuary where time seemed to stand still and events unfolded naturally under specialised care. During delivery, midwives used emotionally resonant words such as ‘baby’ and ‘birth’ rather than clinical terms such as ‘foetus’ and ‘abortion’. The participants felt that the midwives offered support, regardless of gestational age. They described giving birth as ‘a pause on the express train’: a precious opportunity to immerse themselves in the present and focus on a tangible task under the management of midwives. Eliza described this experience as follows:

When I gave birth to my son, a wave of serenity washed over me, hormonally induced tranquillity that I had never experienced before. Despite the physical exhaustion and the mixed emotions, I felt a sense of joy and contentment. (Eliza)

The pain served as a catalyst, compelling participants to concentrate on the physical aspects of labour and reaffirming their identity as mothers. They attributed their heightened sense of control during childbirth to the plans, compassionate care, and support provided by the midwives. They felt that their identity as mothers going through labour and birth was legitimised, as opposed to feeling like patients undergoing medical procedures. For Sophia, giving birth became a turning point that fostered a sense of strength and resilience. The physical endurance required during labour seemed to momentarily restore a sense of control, offering respite from the emotional turmoil that had characterised the preceding period.

Despite knowing that their babies were unlikely to survive, the participants continued to hope for a different outcome. For some, this hope remained present until the moment of birth, when the reality of the loss became unavoidable.

I had hope that until the baby was born, he would be healthy and alive, even though deep down I understood it would not happen. After he was born, I felt relieved it was over, before I slowly but surely realised that my baby was dead. In a way, this is how I would describe my existence at the time, moving in and out of reality and grief. (Mary)

Mary’s account highlights the tension between her rational understanding of the situation and the emotional attachment she continued to feel towards her child, particularly in light of the possibility of a live birth.

Missing Support to Bond With the Child

The transition from the deeply personal experience of giving birth to the impersonal nature of post-birth care felt stark and overwhelming. During labour and delivery, midwives played a key role in validating the participants’ identities as mothers who had lost their children. In those moments, participants were met with compassion and recognition, reinforcing their profound bond with their babies. However, this recognition was short-lived once the birth was over.

Mary’s account illustrates how small, embodied acts by midwives shaped opportunities for bonding:

The midwife asked if she could place him on my chest while he was still warm… It felt strange emotionally during the circumstances. I felt happy, sad, and proud at the same time. During that precious time, I bonded with him. (Mary)

This moment of physical closeness affirmed Mary’s identity as a mother and created a tangible memory in an otherwise fragmented process. For most participants, however, such opportunities were not actively facilitated. They described how limited guidance after birth constrained possibilities for contact and memory-making, and some later regretted not having held their babies. Eliza expressed frustration over the hospital’s lack of initiative in offering simple mementoes, such as photographs, handprints, or footprints. As Ruth explained:

They could have been more present, talked with us, and emphasised the importance of forming bonds, creating memories, and, well, everything… The only memory we have is his footprints. But no pictures. My best memory is from giving birth and seeing the baby again before the funeral. (Ruth)

Across the participants, opportunities to bond and create memories were perceived as more limited than those afforded to women who experienced loss later in pregnancy. This contributed to a sense of being treated differently, as if the legitimacy of their loss was implicitly linked to gestational age. The absence of these rituals and tangible memories compounded participants’ sense of loss and left them without visible proof of their motherhood.

Participants also described limited societal recognition of their need for connection and closure, which intensified their sense of isolation. The experience of the social legitimacy of their grief as being linked to gestational age. Sophia described how responses from others made her question whether her loss was considered sufficiently serious:

I have struggled somewhat to accept my own grief because the pregnancy ended in week 21. People around us seemed very focused on how far along the pregnancy had been and on the idea that it could have been worse. But the grief is mine; I am the one who lost my child. (Sophia)

Rather than feeling supported in their grief, they were uncertain about whether their loss was acknowledged as worthy of mourning, leaving them emotionally disoriented and alone. This sense of devaluation was further reinforced by how some participants experienced their babies being handled. Acts such as placing babies in an aluminium bowl or wrapping them in a dirty towel were described as small yet deeply symbolic, intensifying participants’ pain and sense of invisibility.

Parting With the Child Without Closure

The parting with the child as an embodied experience of abrupt maternity as explained by Sophia:

All these maternal feelings have been horrible. I had milk in my breasts, and for a while, I just wanted to run back… to find her again and have her on my chest. But I did not know where she was (Sophia).

Upon leaving the delivery room, the participants were immediately confronted with difficult emotions and decisions. They had to consider when to leave the hospital, whether to consent to a foetal autopsy, and how to arrange a funeral. Yet, healthcare professionals hesitated to provide clear guidance, leaving them unsupported and uncertain. Eliza asked for guidance about funeral arrangements but received none; she had to contact the church herself to discover her options.

After giving birth, participants experienced self-imposed pressure to leave the hospital, even though healthcare professionals did not explicitly ask them to do so. They perceived their losses as not warranting an extended stay. Although all five participants reported that they needed more time, this need was not actively recognised or accommodated, and they felt they were discharged too early, only a few hours after giving birth.

This premature departure left participants with a profound sense of losing control over the whereabouts of their babies and what would happen to them next. Three participants had to contact the hospitals to ask about the progress of the autopsy. This experience further reinforced their feelings of inferiority and the perceived disparity between their loss and that of others, intensifying their grief.

Mary and her partner were unwilling to leave their baby alone, and they sat in their car outside the hospital to remain near him. Similarly, Sophia struggled to come to terms with the separation from her baby:

All these maternal feelings have been horrible. I had milk in my breasts, and for a while, I just wanted to run to the hospital… to find her again and have her on my chest. But I did not know where she was. (Sophia)

The early discharge and limited guidance surrounding the autopsy, funeral arrangements, and the whereabouts of their babies contributed to a profound sense of lost control. Rather than experiencing the separation as a supported transition, participants described leaving the hospital with unresolved questions and a lingering uncertainty about their role, rights, and connection to their child.

Moving Forward Amid Fragmented Aftercare

Participants’ felt that the aftercare they received was fragmented and fell significantly short of their needs. The lack of proactive and organised support further intensified the weight of their losses. Ruth described this experience as follows:

I felt we were swimming in a full glass of chaotic bubbles. We were promised a call from the hospital after returning home, but no one called. We needed someone to talk to after the worst chaos had settled, but we had no one. It was easy to use alcohol and sleeping medication to endure the hollow, lonely feeling and get through the days and nights. (Ruth)

Participants felt that their grief was disregarded and that they lacked the attention and care they needed. Eliza described feeling abandoned when she approached healthcare professionals for follow-up:

It was incredibly frustrating that no one seemed to fully understand my situation. It was like having three massive elephants perched on my chest, refusing to budge. They were heavy, stubborn, and suffocating, leaving me gasping for air. (Eliza)

In the absence of sufficient professional support, participants actively sought ways to legitimise their grief and maintain a connection to their child. They described constructing narratives around their loss, assigning their child a social and emotional status in an effort to integrate the loss into their lived experience. Through voluntary support networks, participants found a space where they felt understood, validated, and empowered to address their needs and cope with their grief.

Participants also described prolonged uncertainty related to the autopsy process. The wait of two to eight months for confirmation of the cause of death was experienced as emotionally taxing. For four participants, the autopsy confirmed the prenatal diagnosis, leaving them to question the necessity of such a long wait.

Having a grave to visit provided a tangible location through which the relationship with the child could be maintained. As Ruth explained:

It was comforting simply to sit there and think about the life that did not happen. It was a place that was, in a way, ours. He is part of us, and he always will be. (Ruth)

A physical place of rest became central to regaining a sense of control and continuity. Vera regretted choosing a memorial garden, while Ruth rejected this option, emphasising the need to know her son’s exact whereabouts. For Eliza, a sense of closure only became possible after the funeral, when her baby was given a tangible resting place. As stated: “Knowing that my baby had a place to rest and proof of his existence was a great relief. It was comforting to have a physical location to visit and remember him by” (Eliza).

Strengths and Limitations

By drawing on rich, descriptive interview data, the study illuminates how women experienced encounters with healthcare professionals at key moments across the care that informs both clinical practice and policy development. Although the sample was small, the interviews provided rich and detailed first-hand accounts that enabled an in-depth exploration of participants’ experiences. The integration of user perspectives through an advisory group of women with lived experience is another strength of the study.

The study also has limitations. First, recruitment relied exclusively on LUB, which may have introduced sampling bias. Participants had already sought contact with a bereavement organisation and may therefore have had more opportunities to reflect on and articulate their experiences than women without such support. Their accounts may also have been shaped by stories shared by other bereaved women, which could have contributed to more critical or elaborated descriptions of healthcare encounters.

Second, the interviews represent retrospective accounts of loss experiences, with time since loss ranging from several months to several years. While this may have influenced how events were remembered and narrated, such retrospective meaning-making was considered analytically relevant, as it highlights which encounters and forms of language remained salient over time.

Finally, including the perspectives of partners or healthcare professionals could have provided a more holistic understanding of encounters between parents and healthcare professionals following serious prenatal findings and late pregnancy loss.

Implications for Practice and Policy

The findings underscore the need for healthcare professionals to balance clear medical information with emotional support, recognising both the medical and existential issues involved. Healthcare professionals should receive training in how to integrate clinical and emotionally attuned communication to ensure that parents are both well-informed and emotionally supported as they grieve. This training should also address how healthcare professionals can support bereaved women in maintaining a connection with their baby, including practical guidance on memory-making after birth and information about funeral arrangements. Such practices may help parents integrate their baby into their family narrative and provide tangible recognition of the loss. Normalising women’s emotions by informing them about the range of feelings and reactions experienced by other parents in similar situations may also foster a stronger sense of security and autonomy.

Using more compassionate language and a more empathetic approach to care can empower women to feel entitled to grieve. Healthcare professionals should recognise women both as mothers who have lost a child and as patients in need of medical care. Validating this dual experience in healthcare could provide better support and understanding, enabling women to process their loss in a meaningful way.

The findings support the need for an integrated, compassionate, and continuous model of care for women experiencing late termination of pregnancy, intrauterine foetal death, or miscarriage after serious prenatal findings. This model should include national guidelines for psychosocial care and post-hospital follow-up to ensure trauma-informed care. Such guidelines could help bridge the gap between labour, and post-birth bereavement care. The findings also highlight the need for structured follow-up services, such as counselling and support groups, to ensure that women receive recognition and care beyond hospital discharge.