Anxiety Experiences and Support Needs of Women in Early Pregnancy Following Perinatal Loss: A Qualitative Phenomenological Study

Abstract

Purpose

This study aimed to explore the anxiety experiences, coping strategies, and support needs of women in early pregnancy following perinatal loss, in order to inform individualized psychological support and continuity of care strategies.

Methods

A descriptive phenomenological study was conducted using purposive sampling. Sixteen women in early pregnancy following perinatal loss were recruited from Guangdong Women and Children Hospital between December 2025 and April 2026. Data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step phenomenological method, supported by NVivo 15.0 software.

Results

Four themes were identified: the continued presence of previous loss experiences in the current pregnancy; heightened vigilance under uncertainty and its intrusion into daily life; maintaining a fragile balance through reassurance-seeking and boundary control; and expectations for continuous understanding and support during the subsequent pregnancy. These findings indicate that anxiety in early pregnancy following perinatal loss is a persistent and fluctuating process shaped by traumatic memory, uncertainty, active attempts to regain control, and the need for continuous individualized care.

Conclusion

Women in early pregnancy following perinatal loss may experience anxiety as a complex, persistent, and fluctuating process. Early pregnancy care should include individualized risk communication, timely recognition of anxiety, early psychological support, and continuity of care. These strategies may help women strengthen their sense of safety and control and support adaptation during a subsequent pregnancy.

Introduction

Perinatal loss is one of the most severe adverse pregnancy outcomes and may impose a prolonged psychological burden on women and families.¹ Although definitions of perinatal loss vary across countries and studies, fetal and neonatal loss remains a substantial public health and reproductive health burden. In 2019, an estimated 2.0 million babies were stillborn at 28 weeks or more of gestation worldwide, corresponding to a global stillbirth rate of 13.9 per 1,000 total births.² In addition, a recent global modelling study estimated that 2.3 million neonatal deaths occurred worldwide in 2024.³ Beyond mortality, perinatal loss may have sustained psychological consequences, including grief, anxiety, depression, post-traumatic stress symptoms, sleep disturbance, reproductive concerns, and difficulties in subsequent pregnancy adaptation.^1,4,5 In this study, perinatal loss refers to loss occurring in the late fetal or early neonatal period, including termination for fetal abnormality, intrauterine fetal death, stillbirth at 20 weeks of gestation or later, and neonatal death within 1 month after birth.⁶ This term is related to, but not identical with, the broader concept of pregnancy loss, which may also include earlier miscarriage. Such distinctions are important because timing, cause, medical decision-making, and parental attachment may shape psychological responses and care needs.⁷

Many women who experience perinatal loss continue to have a strong desire for childbearing.^8,9 However, a subsequent pregnancy does not signify the end of the previous traumatic experience.⁴ This may be particularly evident in early pregnancy, when outcomes remain uncertain and women cannot yet perceive fetal well-being through signs such as fetal movement.¹⁰ Bodily sensations, early ultrasound findings, laboratory results, and symptom changes may therefore become important but ambiguous cues. Minor symptoms and waiting periods between examinations may intensify uncertainty, repeated monitoring, reassurance-seeking, and heightened vigilance.^4,9 In a subsequent pregnancy, anxiety may also be compounded by unresolved grief and anniversary reactions related to the previous loss.¹¹ Approaching the date or gestational age associated with the previous loss may reactivate traumatic memories and heightened vigilance, making women more sensitive to bodily cues and waiting periods between examinations.^11,12

Anxiety is a negative emotional experience that arises when individuals face potential threats, uncertainty, or risks that are difficult to control.¹³ During pregnancy, anxiety may affect sleep, daily life, health-related behaviors, and maternal and infant outcomes.^14,15 The Chinese sociocultural and healthcare context may further shape these experiences.¹⁶ In China, pregnancy after loss may be embedded within strong family expectations and intergenerational involvement. Such involvement may provide support but may also increase perceived pressure and self-protection needs.¹⁶ In busy tertiary hospitals, scheduled outpatient antenatal care may also limit relational continuity with healthcare professionals.¹⁷ For women with a history of perinatal loss, this may lead to repeated recounting of traumatic experiences and fragmented communication, highlighting the importance of individualized risk communication and continuity of care.¹⁸

Mishel’s Uncertainty in Illness Theory provides a useful conceptual lens for understanding anxiety in early pregnancy following perinatal loss.¹⁹ According to this theory, uncertainty arises when individuals are unable to assign clear meaning to health-related events because available cues are insufficient, ambiguous, unfamiliar, or inconsistent. In early subsequent pregnancy after perinatal loss, ambiguous bodily cues, intermittent reassurance, and fragmented professional explanations may make it difficult for women to establish a stable sense of safety.^4,9,19 From this perspective, repeated monitoring, reassurance-seeking, information searching, and reliance on examinations can be understood as attempts to reduce uncertainty and regain control, whereas professional and family support may help women interpret uncertainty and adapt to the current pregnancy.^9,19

Previous research on pregnancy anxiety has mainly focused on nulliparous or multiparous women, high-risk pregnancies, assisted reproduction, and the overall psychological status of women or couples during pregnancy after loss.^20–23 However, limited attention has been paid to the specific anxiety experiences of women in early pregnancy following perinatal loss.²⁴ Their sources of anxiety, coping strategies, and support needs remain insufficiently understood.²⁵ Rather than measuring anxiety severity alone or treating subsequent pregnancy as a broad period, this study focuses on early pregnancy after perinatal loss, when uncertainty is high and continuous reassurance remains limited.²⁴ In-depth qualitative interviews may capture how women interpret bodily cues, manage uncertainty, seek reassurance, regulate information exposure, control pregnancy disclosure, and express professional, family, and peer support needs. These experiences may not be fully captured by quantitative symptom scales alone.

Therefore, guided by Mishel’s Uncertainty in Illness Theory, this study adopted a descriptive phenomenological design to explore the anxiety experiences, coping strategies, and support needs of women in early pregnancy following perinatal loss. The aim was to inform individualized risk communication, continuity of care, and psychological support in early pregnancy.

Materials and Methods

Research Design

This descriptive phenomenological study used semi-structured interviews to gain an in-depth understanding of the anxiety experiences, coping strategies, and support needs of women in early pregnancy following perinatal loss. A descriptive phenomenological approach is appropriate for exploring participants’ lived experiences and the meanings they assign to specific life events and health-related conditions.²⁶ In the present study, this design allowed the researchers to focus on how women made sense of bodily cues, uncertainty, coping actions, and support needs in the context of a subsequent pregnancy after perinatal loss.

Participants and Sample

The study population consisted of women in early pregnancy following perinatal loss who attended the obstetric outpatient clinic of Guangdong Women and Children Hospital, a tertiary hospital in Guangdong Province, China, between December 2025 and April 2026. To enhance the richness of the interview data and ensure sample heterogeneity, purposive sampling based on the principle of maximum variation was used.²⁷ Participants were selected with consideration of age, place of residence, education level, employment status, type of previous perinatal loss, and current gestational week.

The inclusion criteria were: 1) aged 18 years or older; 2) a history of perinatal loss, defined as termination for fetal abnormality, intrauterine fetal death, or stillbirth at 20 weeks of gestation or later, or neonatal death within 1 month after birth;⁶ 3) currently pregnant and in early pregnancy (≤12weeks) following perinatal loss; 4) no other severe pregnancy complications; 5) willingness to participate and provision of informed consent; and 6) adequate ability to communicate, read, and understand the interview content. The exclusion criteria were: 1) severe psychiatric illness, cognitive impairment, or disturbance of consciousness that prevented participation in the interview; 2) severe physical illness; and 3) other major stressful life events within the previous 3 months.

Sampling and analysis proceeded concurrently. After the 13th interview, no new codes or themes emerged during preliminary coding. Three additional interviews were conducted to confirm data saturation. The research team compared the codes, categories, and emerging themes after each of these interviews and documented the saturation decision in analytic memos. A total of 16 women were ultimately included in the study. Participants’ socio-demographic and obstetric characteristics are presented in Table 1.

Table 1.

Socio-Demographic and Obstetric Characteristics of Study Participants (n = 16)

Code	Age (Years)	Residence	Education Level	Employment Status	Gravidity/Parity	Conception Method	Current Gestational Age (Weeks)	Gestational Age at Previous Perinatal Loss	Cause of Previous Perinatal Loss
N1	28	Urban	Bachelor’s degree	Employed	G2P0	Spontaneous conception	9	28+4	Intrauterine fetal death
N2	31	Rural	Junior college	Employed	G2P0	Spontaneous conception	8	30+2	Stillbirth
N3	35	Urban	Bachelor’s degree	Employed	G3P1	Spontaneous conception	10	24+5	Neonatal death
N4	27	Rural	High school	Unemployed	G2P0	Assisted reproduction	7	22+1	Termination for fetal developmental abnormality
N5	30	Urban	Master’s degree	Employed	G2P0	Spontaneous conception	11	25+3	Severe fetal malformation
N6	29	Rural	Technical secondary school	Self-employed	G2P0	Spontaneous conception	9	27+6	Intrauterine fetal death
N7	33	Urban	Junior college	Employed	G3P1	Assisted reproduction	8	23+4	Chromosomal abnormality
N8	26	Rural	High school	Unemployed	G2P0	Spontaneous conception	7	21+5	Severe fetal structural abnormality
N9	37	Urban	Bachelor’s degree	Employed	G3P1	Spontaneous conception	10	32+1	Neonatal death
N10	32	Urban	Junior college	Employed	G2P0	Assisted reproduction	9	26+2	Congenital heart disease
N11	34	Rural	Bachelor’s degree	Employed	G3P1	Spontaneous conception	11	29+3	Stillbirth
N12	25	Rural	Technical secondary school	Unemployed	G2P0	Assisted reproduction	8	20+6	Chromosomal abnormality
N13	29	Urban	Master’s degree	Employed	G2P0	Spontaneous conception	7	24+2	Cleft lip and palate
N14	36	Urban	Bachelor’s degree	Self-employed	G4P1	Assisted reproduction	10	31+5	Neonatal death
N15	27	Rural	Junior college	Employed	G2P0	Spontaneous conception	9	22+3	Stillbirth
N16	31	Urban	Bachelor’s degree	Employed	G2P0	Spontaneous conception	8	23+6	Termination for fetal developmental abnormality

Data Collection

To ensure research rigor, the interviewers received unified training in qualitative research methods, interviewing techniques, and communication skills prior to the study initiation. The interviews were conducted by two female researchers with nursing backgrounds who had received training in qualitative research and perinatal mental health. Neither interviewer was involved in the clinical care, treatment decision-making, or routine antenatal management of the participants. Before each interview, the interviewer introduced her role, explained the purpose of the study, and emphasized that participation was voluntary and would not affect the participant’s medical care. The data collection was completed with the following tools, including a socio-demographic and obstetric characteristics form, semi-structured interview questions, and a recording device. Socio-Demographic and Obstetric Characteristics Form.

Semi-Structured Interview Questions

Semi-structured interview questions were designed to explore the anxiety experiences, coping strategies, and support needs of women in early pregnancy following perinatal loss. One-on-one face-to-face interviews were conducted. Owing to the semi-structured format, additional probing questions were used as needed to facilitate participants’ responses to the core research topics. Based on the objectives of the study, a preliminary interview guide was developed through a review of the relevant literature and research team discussion. The draft interview guide was subsequently reviewed by two experts in qualitative research methodology and one obstetric clinical expert to improve the scientific rigor, appropriateness, and sensitivity of the interview questions. Three eligible women in early pregnancy following perinatal loss were then invited to participate in pilot interviews. The pilot interviews were used only to refine the wording and sequencing of the interview questions and were not included in the final analysis. The final version of the interview questions was determined following these expert reviews and pilot interviews.

The Following are the Interview Questions

1. Since learning about this pregnancy, how has your emotional state changed during this period?

2. During this process, what situations or experiences have made you feel most anxious?

3. How do you think these feelings of anxiety have affected your daily life or well-being?

4. How have you tried to manage or cope with these feelings of anxiety?

5. What kinds of support would you most like to receive to help you cope with these feelings of anxiety?

Data Collection Process

Data were collected from December 2025 to April 2026. Potential participants were recruited from the obstetric outpatient clinic of Guangdong Women and Children Hospital through purposive sampling according to the predefined selection criteria. Both the purpose of the study and the interview procedures were explained to each participant before the interview, and written informed consent was obtained.

Before the formal interview, the interviewers received unified training in qualitative research methods, interviewing techniques, and communication skills. One-on-one face-to-face interviews were then conducted using semi-structured questions. Interviews were arranged by appointment and held in a quiet and private interview room to ensure a comfortable and uninterrupted environment. During the interviews, the researchers used open-ended questions and flexibly adjusted the order of the questions and follow-up prompts according to participants’ responses, while avoiding leading questions and subjective judgment. All interviews were audio-recorded, and non-verbal information, including tone of voice, facial expressions, pauses, and body language, was documented in field notes. Each interview lasted approximately 20 to 40 minutes. To protect privacy, codes were used in place of participants’ real names, and participants were encouraged to fully express their authentic feelings and experiences.

Data Analysis

Data collection and analysis were carried out concurrently. No statistical hypothesis testing was conducted, because the aim of this study was to explore lived experiences and meanings rather than to estimate prevalence, test associations, or infer causality. The Colaizzi seven-step analysis method was used.²⁸ Although coding and theme development were primarily inductive and grounded in participants’ original accounts, Mishel’s Uncertainty in Illness Theory was used as a sensitizing conceptual lens during interpretation and theme integration, rather than as a predetermined coding framework.¹⁹ Within 24 hours after each interview, two researchers independently transcribed the audio recordings verbatim and supplemented the transcripts with non-verbal information recorded in the field notes. All interviews were conducted in Chinese and transcribed verbatim in Chinese. Data coding and theme development were first performed using the original Chinese transcripts to preserve participants’ meanings and emotional expressions.²⁹ Representative quotations were then translated into English by a bilingual researcher with a nursing background and checked against the original Chinese transcripts by another bilingual researcher. Translation focused on semantic accuracy and preservation of emotional nuance rather than literal word-for-word equivalence. Any discrepancies were discussed within the research team until consensus was reached. After transcription, the interview texts were returned to the participants for verification to ensure the authenticity and accuracy of the data. NVivo 15.0 software was used to assist in organizing, coding, and managing the interview materials. Before the transcripts were imported into NVivo 15.0, all audio recordings were checked against the verbatim transcripts, field notes were integrated, and identifying information was removed. The transcripts were reviewed for completeness, accuracy, and relevance to the research questions. Only verified textual data from formal interviews were entered into NVivo for coding and management. NVivo 15.0 was used as a software-assisted tool to organize transcripts, codes, categories, memos, and theme development, but the interpretation of meanings, coding decisions, and theme refinement were conducted by the researchers through repeated reading, comparison, discussion, and return to the original data. In practice, two researchers first independently coded three transcripts line by line to develop a preliminary codebook. The codebook was then discussed and refined within the research team and applied to the remaining transcripts with continuous comparison. New codes were added when necessary, and earlier transcripts were revisited to ensure coding consistency. Coding disagreements were discussed between the two coders by returning to the original transcripts and field notes. If consensus could not be reached, a senior qualitative researcher was consulted. NVivo 15.0 was used to organize transcripts, codes, categories, analytic memos, and theme development. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).³⁰

Step 1, Material transcription: The audio recordings were transcribed into text within 24 hours after each interview, and non-verbal information was supplemented based on the field notes.

Step 2, Material reading: Two researchers repeatedly read the transcribed texts to gain a comprehensive understanding of the participants’ experiences.

Step 3, Meaning unit extraction: Two researchers identified significant statements related to the research topic from the interview texts.

Step 4, Meaning unit coding: The significant statements were summarized, refined, and coded independently by two researchers. Any disagreements were resolved through discussion within the research team until consensus was reached.

Step 5, Code aggregation: All coded meaning units were compared and grouped to identify shared concepts and form preliminary categories.

Step 6, Theme refining: Categories and theme clusters were further refined through in-depth analysis and integration of the relationships among codes and categories, and the essential structure of the phenomenon was distilled.

Step 7, Theme validation: The findings were returned to some participants for validation to enhance the credibility of the results, and the final themes were determined after research team discussion and consensus.

Rigor

Quality control was emphasized throughout the study process. Before the interviews, the researchers received standardized training to ensure consistency in interviewing style, questioning techniques, and communication strategies. During the interviews, the researchers maintained an objective and neutral attitude, avoided leading questions and subjective evaluation, and used restatement, probing, and clarification to obtain in-depth and authentic accounts from participants. During data analysis, the researchers repeatedly reviewed the original data and interpreted participants’ expressions within their full context in order to minimize the influence of personal experience and subjective judgment. Any disagreements arising during coding or theme development were discussed within the research team until consensus was reached, thereby improving the credibility and rigor of the findings.

An audit trail was maintained to enhance dependability and confirmability. The audit materials included recruitment records, audio recordings, verbatim transcripts, field notes, reflexive notes, coding files, codebook versions, analytic memos, theme development records, and research team discussion notes. These materials allowed the research team to trace how raw data were transformed into codes, categories, and final themes.

To support bracketing during data analysis, the researchers explicitly discussed and recorded their pre-understandings before formal coding, including assumptions derived from clinical nursing experience, previous exposure to perinatal loss care, and expectations regarding anxiety and support needs in subsequent pregnancy. During coding and theme development, these pre-understandings were treated as potential sources of bias rather than analytic conclusions. The researchers repeatedly returned to the original transcripts, field notes, and participants’own words to ensure that codes and themes remained grounded in the data. Interpretations that could not be clearly supported by participants’ accounts were revised or discarded during team discussions. This process helped the research team distinguish participants’ lived experiences from researchers’ clinical assumptions as far as possible.

Reflexivity was considered throughout the study. The research team included nursing researchers with experience in maternal and child health, which helped the team understand the clinical context but might also have introduced assumptions about women’s anxiety and support needs. To reduce this influence, the interviewers used open-ended questions, avoided giving clinical judgments during the interviews, and recorded reflexive notes after each interview. During analysis, researchers repeatedly returned to the original transcripts and field notes, discussed alternative interpretations, and distinguished participants’ own accounts from researchers’ pre-understandings as far as possible.

Results

A total of 16 women in early subsequent pregnancy after perinatal loss were interviewed in this study. Their ages ranged from 25 to 37 years, with a mean age of 30.6 ± 3.6 years. Other socio-demographic and obstetric characteristics are presented in Table 1. Four core themes and ten subthemes were identified from the analysis.

Themes Identified

Using Colaizzi’s seven-step phenomenological method, four major themes and 10 subthemes were identified from the interview data, reflecting the anxiety experiences and support needs of women in early pregnancy following perinatal loss. The themes and subthemes are summarized in Table 2.

Table 2.

Themes and Subthemes

Themes	Subthemes
1. Theme One: The Continued Presence of Previous Loss Experiences in the Current Pregnancy	1.1 The shadow of another loss hanging over the present pregnancy 1.2 Abnormal signs being rapidly interpreted as precursors of risk 1.3 Others’ attention intensifying vulnerability and tension
2. Theme Two: Heightened Vigilance Under Uncertainty Persistently Intruding Into Daily Life	2.1 Daily life becoming increasingly cautious and restricted 2.2 Emotions repeatedly oscillating between brief reassurance and renewed tension
3. Theme Three: Maintaining a Fragile Balance Through Active Confirmation and Boundary Control	3.1 Seeking reassurance while guarding against distressing stimulation in information exposure 3.2 Relying on examinations to obtain a provisional sense of safety 3.3 Preserving a buffer space for oneself by controlling the scope of disclosure
4. Theme Four: Expecting to Be Continuously Understood and Supported During the Subsequent Pregnancy	4.1 Expecting continuous and individualized professional understanding and guidance 4.2 Expecting understanding and companionship from family members and people with similar experiences

The Continued Presence of Previous Loss Experiences in the Current Pregnancy

The Shadow of Another Loss Hanging Over the Present Pregnancy

For most participants, the current pregnancy was not fully experienced as an entirely new beginning, but remained closely intertwined with their previous experience of perinatal loss. The past loss did not truly remain in the past. Instead, once pregnancy was confirmed again, it was rapidly reactivated, and the initial joy was soon replaced by worries about whether this pregnancy could be maintained. In this sense, a subsequent pregnancy represented not only renewed hope, but also the renewed presence of traumatic memories in the current pregnancy.

N1: Because something went wrong with my last pregnancy, I was worried from the very beginning this time.

N12: Because that previous adverse experience happened so suddenly and without any obvious warning signs, I find it especially frightening. Now, as soon as there is any little disturbance, physical discomfort, or emotional fluctuation, I become very worried.

Abnormal Signs Being Rapidly Interpreted as Precursors of Risk

In early subsequent pregnancy, participants perceived bodily changes and health-related information through a stronger risk-oriented lens. Bleeding, brown discharge, mild pain, changes in pregnancy symptoms, and even physical problems that had not been fully resolved from the past were no longer regarded as ordinary bodily manifestations, but were quickly interpreted as warning signs of potential danger. At the same time, in the interval between examinations, the lack of sustained and definite evidence of safety allowed uncertainty to accumulate continuously and repeatedly reactivate anxiety.

N16: After carrying something heavy, I had a little pink discharge. At that time, I became somewhat worried, but it was only after I went for examinations on the second and third day and was told there was no problem that I gradually relaxed.

N11: I have had brown discharge from the beginning of pregnancy until now, and I only have an ultrasound about once every two weeks, so I am always worried that something might go wrong.

Others’ Attention Intensifying Vulnerability and Tension

For some participants, attention from family members, relatives, and people around them did not always bring comfort, but instead intensified their already fragile and tense state. External attention meant having to keep explaining, responding to inquiries, accepting reminders, and even being subject to behavioral regulation, which made them more likely to feel interfered with, questioned, and placed under amplified scrutiny. As a result, what was originally a pregnancy experience belonging to the individual and the family became increasingly difficult to contain.

N9: Last time I told my family early, and later I kept having to explain things to them. I found that emotionally exhausting, so this time I did not want to tell them so early.

N7: I did not tell my family before, partly because I was afraid they would worry, and partly because I was afraid they might think it was not a good thing.

Heightened Vigilance Under Uncertainty Persistently Intruding into Daily Life

Daily Life Becoming Increasingly Cautious and Restricted

Against the background of persistent heightened vigilance, some participants’ daily lives were gradually drawn into ongoing risk calculation. Ordinary matters such as work arrangements, activity control, dietary choices, and bodily management all became issues that required repeated consideration and cautious handling. They attempted to reduce the possibility of another loss by trying not to make mistakes, but this caution also imposed varying degrees of restriction on daily life and increased practical burden.

N3: What I am mainly worried about is whether trying to protect the pregnancy will have some impact on my work.

N13: As for exercise, I basically do not dare to exercise now. In terms of diet, I also control what I eat. I avoid heavily flavored food and try to keep it light.

Emotions Repeatedly Oscillating Between Brief Reassurance and Renewed Tension

Participants’ anxiety did not fade naturally after appearing briefly, but was often manifested as a repeatedly fluctuating emotional state that was difficult to stabilize. They moved back and forth among happiness, worry, self-comfort, and renewed tension, and their emotions also rose and fell around medical examinations. Even after a brief sense of reassurance, new worries could easily reactivate distress. When alone at night, previous loss experiences were more likely to return repeatedly, leading to persistent psychological difficulties such as trouble falling asleep and lighter sleep.

N5: After learning that I was pregnant, I felt uneasy for a whole week because of my previous experience of not being able to keep the baby. Only later did I slowly persuade myself and tell myself that since it had come, I should accept it.

N6: When I lie down at home to sleep, I start thinking about the previous baby. The more I think, the more frightened I become. I force myself not to think about it, but I just cannot do it.

N14: From the initial happiness until now, I have basically felt a little worried before each examination, and then a little better afterward.

Maintaining a Fragile Balance Through Active Confirmation and Boundary Control

Seeking Reassurance While Guarding Against Distressing Stimulation in Information Exposure

When facing anxiety, participants did not remain completely passive, but actively regulated their relationship with information. Some obtained information through online searches, consultations with family members, or confirmation from doctors in the hope of reducing unease. Others, however, consciously reduced browsing after being exposed to excessive negative experiences and fragmented information in order to avoid further amplification of distress. Information could therefore serve as both a source of comfort and a source of anxiety-provoking stimulation.

N2: At first I searched for information, but later I stopped, because the more I looked, the more anxious I became. Everyone’s situation is different.

N8: For example, on Xiaohongshu, it often says that certain situations may lead to some bad outcomes, but when I search on DeepSeek, it can actually be quite comforting.

Relying on Examinations to Obtain a Provisional Sense of Safety

Some participants regarded examination results at the current stage as an important basis for maintaining emotional stability. For them, confirming an intrauterine pregnancy, seeing fetal cardiac activity, completing an examination, or hearing a doctor say that everything was normal could all bring a short-term sense of reassurance and allow them to keep moving forward. However, this sense of safety was often provisional. Once they entered the next waiting period, new uncertainty would re-emerge and could even trigger the impulse to seek repeated examinations.

N4: In fact, I do not have any symptoms or reactions at all, but I still want to come back again and again for examinations, just to confirm whether the baby is healthy. At the same time, I am afraid of having too many examinations, because I worry that doing them too frequently might affect the baby, so later I still try my best to hold myself back.

N10: Every time I see that the examination results show no problem, I feel much better and more at ease.

Preserving a Buffer Space for Oneself by Controlling the Scope of Disclosure

In addition to information regulation and examination-based confirmation, some participants also preserved a buffer space for themselves by delaying disclosure and limiting who knew about the pregnancy. They were not completely without hope; rather, before the outcome had become clear, they tried to reduce outside involvement as much as possible in order to lower the possibility of being continuously questioned, being subjected to premature expectations, or once again having to bear the burden of explanation. Controlling the scope of disclosure thus became a strategy of self-protection.

N1: This time, only his side of the family knows. My own family still does not know, just to avoid being asked about it all the time later.

N7: I will wait until the baby is more stable, maybe after three months, before telling others. That way I will feel more reassured myself.

Expecting to be Continuously Understood and Supported During the Subsequent Pregnancy

Expecting Continuous and Individualized Professional Understanding and Guidance

Most participants hoped to receive continuous and individualized professional support during the subsequent pregnancy. For them, what they truly needed was not merely routine management or being told that there was “no problem,” but being remembered continuously, receiving concrete explanations, and obtaining responses and guidance tailored to their own situation. They hoped that healthcare professionals would understand the tense state of being pregnant again after a loss, rather than making them start over at every consultation.

N1: What I need most is someone who can clearly explain my current situation, not just show me a lot of general knowledge, but tell me what this means in my own case and what I should do next.

N13: Each time I make an appointment, I may end up seeing a different doctor, and they do not really know my situation very well. Every time I come, they have to ask again about what happened before, and I feel exhausted, as if I have to start from scratch every single time.

N15: Sometimes I am not just looking to hear that everything is fine. I want to know why it is fine.

Expecting Understanding and Companionship from Family Members and People with Similar Experiences

In addition to professional support, participants also hoped for understanding, companionship, and emotional holding from those around them. For some women, their partners could offer only limited support in terms of pregnancy-related knowledge, but they could still provide important help through sharing daily responsibilities and offering emotional companionship. Meanwhile, communication with peers at a similar gestational stage or with similar experiences was more likely to bring practical reference points and emotional resonance. What they hoped for was not merely someone being present, but someone who could understand and contain their recurring fear, exhaustion, and uneasiness.

N6: I feel as if this pregnancy is something I am carrying alone. It is especially exhausting, and sometimes, when I think about it, I can barely hold back my tears.

N10: My family is not very good at comforting me, but some of my colleagues are also pregnant and at a similar gestational stage. We talk and share things together, and that relieves a lot of my anxiety.

Discussion

Using a descriptive phenomenological approach, this study explored the anxiety experiences, coping strategies, and support needs of women in early subsequent pregnancy after perinatal loss. The findings showed that anxiety in this population was a complex and persistent experience shaped by previous loss, early pregnancy uncertainty, attempts to regain control, and available professional and interpersonal support. Interpreted through Mishel’s Uncertainty in Illness Theory, these findings suggest that uncertainty may connect previous traumatic loss, heightened vigilance, reassurance-seeking, boundary control, and support needs.^19,25 Anxiety in early pregnancy after perinatal loss may therefore be understood not only as an individual emotional reaction, but also as a response to ambiguous bodily cues, intermittent reassurance, and fragmented professional communication.^12,18

Multi-Source Triggers of Anxiety and the Need for Scientific Communication About Pregnancy-Related Risk

Anxiety among women in early subsequent pregnancy after perinatal loss did not originate from a single source, but was repeatedly activated by previous loss, bodily warning signs, waiting-period uncertainty, and pressure from others’ attention. Although a new pregnancy may symbolize renewed hope, it may also reactivate traumatic memories and be interpreted as carrying the possibility of another loss among women who have experienced perinatal loss.¹²

This pattern may be particularly salient in early pregnancy, when fetal well-being cannot yet be continuously perceived through stable reassuring signs such as fetal movement.¹⁰ Even when no obvious abnormalities are detected or examination results are temporarily normal, women may still find it difficult to establish a stable sense of safety.³¹ When the cause of the previous loss remains unclear, the current pregnancy may be experienced as unpredictable and uncontrollable, amplifying vigilance toward bodily changes and perceived risks.³² This finding is consistent with Mishel’s Uncertainty in Illness Theory, which suggests that unclear symptom patterns and insufficient or inconsistent cues may increase uncertainty and hinder stable interpretation of health-related situations.¹⁹ In this study, early pregnancy after perinatal loss represented such an uncertain context, in which women repeatedly interpreted bodily signs and examination results to judge pregnancy safety.

These findings suggest that a history of perinatal loss should be regarded as an important part of early antenatal assessment and initial registration, consistent with previous studies.³³ Clinical nurses and midwives should assess the gestational age, course, and cause of previous loss, together with women’s current concerns, to identify those at elevated risk of anxiety. Healthcare professionals should also strengthen risk communication by explaining the purpose of key examinations, important early pregnancy time points, and appropriate responses to common abnormal signs.¹⁸ Transforming vague risk information into concrete and actionable guidance, such as individualized monitoring forms, symptom checklists, and help-seeking instructions, may reduce excessive threat perception and enhance women’s sense of safety and control.²⁵

Dual Psychological and Functional Burdens of Anxiety and the Importance of Early Comprehensive Intervention

Anxiety among women in early subsequent pregnancy after perinatal loss extended beyond repeated worry, emotional tension, or mood fluctuation to affect sleep, daily routines, life arrangements, and emotional engagement, creating combined psychological and functional burdens. Some women repeatedly checked their bodily condition, reduced activity, modified their diet, and limited going out to reduce perceived risk and regain control. Although this error-avoidance-oriented self-management may temporarily alleviate distress, it may also maintain prolonged vigilance, consume psychological resources, and increase fatigue, life restriction, and emotional fragility. Nighttime appeared to be a particularly vulnerable period. Previous loss experiences could re-emerge as rumination or intrusive recollections, leading to repeated mental rehearsal of adverse outcomes and sleep difficulties.^1,12,34 Thus, anxiety in this population should be understood not only as an emotional response, but also as an experience that may undermine psychosocial adaptation and quality of life during pregnancy.³⁵

These findings indicate that emotional state, sleep quality, and daily functioning should be incorporated into continuous early pregnancy follow-up.^34–36 Although participants did not explicitly request specific psychological techniques, their persistent worry, sleep disturbance, and restricted functioning suggest the need for early identification and supportive intervention. In antenatal registration, follow-up visits, and online consultations, brief interviews or screening tools may help identify women with persistent worry, sleep disturbance, marked life restriction, or self-blame.³⁶ Women who excessively limit activity should receive clear guidance on safe low-intensity activity, rest principles, warning signs, and timely medical consultation.³⁷ For recurrent worry, nighttime hypervigilance, and sleep difficulties, low-intensity strategies such as scheduled worry recording, diaphragmatic breathing, and progressive relaxation may be considered to reduce rumination and sustained arousal.³⁸ These strategies could be introduced during routine obstetric outpatient care or nurse-led follow-up for women with mild to moderate anxiety symptoms, for example through brief nurse-delivered guidance, demonstration, and written practice instructions. Women with persistent insomnia, intrusive recollections, marked avoidance, severe self-blame, or impaired daily functioning should be referred to specialized perinatal mental health services or psychiatric nurse consultation where available.

Transforming Active Coping Tendencies into Adaptive Self-Management Through Individualized Behavioral Support

Women in early subsequent pregnancy after perinatal loss were not merely passive recipients of anxiety. Many actively responded to distress through information filtering, examination-based confirmation, and control over pregnancy disclosure. This suggests that their coping patterns included both emotion-regulation-oriented and problem-management-oriented elements.³⁹ Reducing exposure to negative information, delaying pregnancy disclosure, and minimizing outside interference functioned as emotional self-protection. Increased attention to examination results, information seeking, and monitoring of bodily changes reflected efforts to obtain certainty and manage perceived risk.

Previous studies have often emphasized emotional distress, fear of recurrence, or the need for professional reassurance in pregnancies after loss.^18,35 In contrast, women in this study used multiple boundary-regulating strategies to manage uncertainty, including filtering distressing information, seeking examination-based confirmation, delaying pregnancy disclosure, and selectively engaging with professional, family, and peer support. These strategies suggest that coping in this population was not simply avoidance or passive reassurance-seeking, but an active process of negotiating information exposure, bodily monitoring, interpersonal involvement, and temporary control under uncertainty.^19,25,39,40

To some extent, these strategies may help alleviate anxiety and preserve a sense of control.⁴⁰ A certain degree of risk sensitivity may not be entirely maladaptive, as it can motivate attention to antenatal examinations, self-observation, and pregnancy management. However, without appropriate professional guidance, some coping behaviors may become excessive. Repeated information searching, overreliance on examinations, avoidance of communication, or withdrawal from social support may transform short-term self-protection into a new source of stress.^41,42

Clinical nurses should recognize women’s active coping efforts and provide individualized support according to different coping tendencies. For women with emotion-regulation-oriented coping, healthcare professionals should respect self-protection needs, encourage emotional expression and reflective recording, and offer strategies such as breathing exercises or mindfulness-based regulation.³⁸ For women with problem-management-oriented coping, clear and actionable information should be provided to help them understand examinations, arrange follow-up visits, interpret bodily signals, and focus on controllable self-care behaviors.¹⁸ Women who frequently search for information, repeatedly request examinations, or avoid information should be identified early and supported in developing bounded information-seeking habits and evidence-based reassurance strategies, so that anxiety management can shift toward adaptive self-management.⁴²

Diverse Support Needs and the Optimization of Continuity of Care

Women in early subsequent pregnancy after perinatal loss had substantial support needs, including individualized professional guidance and emotional support from family members and peers with similar experiences.⁴³ However, these needs are often insufficiently recognized within existing maternal healthcare services.⁴⁴ Repeatedly recounting previous loss during clinical encounters increased emotional burden and weakened women’s trust and sense of security in care. When family members responded with generic comfort rather than practical understanding and support, women could feel further isolated and unsupported.⁴⁵ From the perspective of uncertainty in illness, continuous explanations, consistent communication, and family support may help women interpret ambiguous pregnancy-related information and reduce uncertainty.^18,19,43

Anxiety in this population should not be viewed merely as an individual emotional problem, but as closely related to continuity of care, family support, and social understanding.⁴⁴ Clinical nursing practice should therefore integrate these support needs into antenatal registration, follow-up visits, and health education, while exploring sustainable continuity-of-care models.⁴⁶ Knowledge booklets, outpatient educational materials, or online support platforms could provide information on anxiety triggers, early pregnancy examinations, abnormal symptoms, emotion regulation, and help-seeking pathways.⁴⁷

At the family level, spouses and primary caregivers should be included in early pregnancy health education to better understand women’s vigilance and worries and to provide concrete support, such as listening, accompanying examinations, sharing daily responsibilities, and reducing pressure.^43,45 Where privacy and safety can be ensured, small-scale peer support opportunities involving women with similar experiences may be explored.⁴⁸ However, peer support should not be organized as an unsupervised sharing group. Because repeated exposure to traumatic loss narratives may increase secondary traumatization risk, peer support should be facilitated or supervised by qualified professionals. Therapeutic boundaries, privacy protection, emotional safety rules, and referral pathways should be established before implementation. Through experience sharing, emotional resonance, and mutual encouragement, these approaches may reduce loneliness and build a triadic support system involving healthcare professionals, family, and peers, thereby enhancing anxiety coping and pregnancy adaptation.⁴⁹

Limitations

Our study has several limitations. First, participants were recruited from a single tertiary hospital in Guangdong Province, China, which may limit the transferability of the findings to other regions, healthcare settings, and cultural contexts. Future studies in diverse settings are needed to broaden understanding of anxiety experiences and coping needs in this population. In addition, although participants varied in previous loss type, conception method, and socio-demographic background, the sample size and descriptive phenomenological design did not allow systematic comparison across subgroups. Future studies with larger and purposively stratified samples could explore how loss type, reproductive history, and social context shape anxiety experiences and support needs.

Second, this study included only women’s perspectives and did not incorporate the views of spouses, family members, or healthcare professionals. Given the role of family interaction and continuity of care in women’s anxiety experiences, future research should include multiple perspectives to better understand the support system surrounding this population.

Third, because all interviews were conducted during early pregnancy, the findings mainly reflect this stage. The cross-sectional qualitative design did not allow examination of changes in anxiety experiences, coping strategies, support needs, or clinical outcomes across pregnancy. Longitudinal qualitative or mixed-method studies are needed to explore the dynamic evolution of these experiences over time.

Conclusion

The findings suggest that women in early pregnancy following perinatal loss may experience anxiety as a persistent uncertainty-driven process shaped by previous loss, ambiguous bodily cues, limited reassurance, and discontinuous professional communication. They may attempt to regain control through bodily monitoring, reassurance-seeking, information filtering, and pregnancy disclosure control, indicating a need for individualized and continuous support. In this study context, early pregnancy care should give greater attention to previous loss history, individualized risk communication, continuity of care, and timely psychological referral when needed.

Funding Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data Sharing Statement

The data analyzed during the current study are not publicly available because they contain information that could compromise participant privacy and confidentiality, but may be available from the corresponding author Wenli Liang upon reasonable request.

Ethics Statement

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangdong Women and Children Hospital (No. 20250095). Written informed consent was obtained from all participants, including consent for the publication of anonymized responses and direct quotes.

Disclosure

The authors declare no conflicts of interest in this work.