Hope as a therapeutic resource in pregnancy after loss: operationalising woman-centred support in midwifery care

Background Pregnancy after loss constitutes a particularly vulnerable period characterised by the paradoxical coexistence of fear and hope. Despite growing recognition of this phenomenon, significant gaps remain in understanding how hope can be operationalised as a structured therapeutic resource in midwifery practice. Aim This paper argues that hope can and should be operationalised as a structured, evidence-informed therapeutic intervention in midwifery practice, particularly in the care of women experiencing pregnancy after loss. Discussion Drawing on contemporary theories of hope as a cognitive-motivational process and trauma-informed care principles and illustrated through a single practice-based clinical vignette, this paper advances a theoretically informed conceptual model for operationalising hope in pregnancy after loss. The discussion explores how woman-centred interventions can support the coexistence of fear and hope, foster adaptive meaning-making, and facilitate emotional engagement with the ongoing pregnancy, while maintaining clinical coherence and transferability across maternity care settings. Implications for Practice This paper proposes that structured, evidence-informed interventions may meaningfully support women's emotional well-being during pregnancy after loss. The model challenges common practices of premature reassurance and suggests that fear and hope are not mutually exclusive. Midwives and maternity care providers can use hope-centred approaches to support women in reconstructing their parental project whilst honouring the memory of previous losses. Conclusion Hope is not a passive emotional state but an active therapeutic resource that may be intentionally cultivated through structured midwifery interventions, advanced communication skills, and the capacity to tolerate uncertainty.