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Helping Patients Cope with Helping Patients Cope with Perinatal and Neonatal LossPerinatal and Neonatal Loss

Joseph A. Banken, M. A. Ph.D. HSPPAssociate Professor

UAMS Department of Obstetrics & Gynecology

Licensed Psychologist

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ObjectivesObjectives• Understand coping with loss• Recognize high-risk groups who have

higher risk of have complications with Perinatal and Neonatal loss

• Be able to offer helpful strategies to help patients cope with Perinatal and Neonatal loss

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Facts about Perinatal LossFacts about Perinatal Loss

• Approximately 15-20% of all pregnancies result in miscarriage or stillbirth

• The causes of such losses vary greatly and many remain medically unexplainable

• Parents want an attributive “reason” why loss has occurred

• Large proportion of parents experiencing loss feel misunderstood by others• Medical professionals• Family, friends, support systems

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Factors Influencing Factors Influencing Perinatal and Neonatal Loss Perinatal and Neonatal Loss

• Diverse coping patterns• Age of parents

• Behavioral health history of mother

• Religious influences

• Cultural differences

• Family dynamics

• History of previous loss• Perception of support for loss experience

• Less recognized by support system

• Less validated by others

• Not well understood in clinical literature

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Four Periods of Four Periods of Perinatal and Neonatal LossPerinatal and Neonatal Loss

• Immediate• Acute• Working through• Reorganization

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Complicated Bereavement Complicated Bereavement (Prolonged Grief Reaction)(Prolonged Grief Reaction)

• Clinical concern if improvement in adaptive functioning is NOT seen in about 2 months

OR• Moderate to severe clinical symptoms

meeting criteria for psychiatric disorder

OR

• Suicidal ideations

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Risk Factors for Risk Factors for Complicated Reactions to Perinatal Complicated Reactions to Perinatal

and Neonatal Lossand Neonatal Loss• Lack of social support• History of psychiatric

disorder• Initial grief reaction

exceeding cultural norms

• Unanticipated death• Multiple deaths

• Concurrent significant stressors

• Previous child death or miscarriage

• Previous history of suicide attempts

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Neonatal Death: Special Risk Neonatal Death: Special Risk ConcernsConcerns

• Risk for development of psychiatric disorder is greatest during first year after infant/child death

• Remains elevated for 5 years

• Increased rates of schizophrenia, depression and drug abuse

• Danish Study (2005)• Mother at least

• 6x more likely to be hospitalized for mood disorder

• 4x more likely to be hospitalized for schizophrenia

• 3x more likely to be hospitalized for drug abuse

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New Approaches to Help Patients New Approaches to Help Patients Cope with LossCope with Loss

• Recognize heterogeneity of grief reactions and supportive needs

• “Letting go” approaches less effective than originally thought

• Constructive continuity approaches likely more helpful • “Meaningful connections”• Constructive meaning to loss experiences

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BASIC ID: BASIC ID: Practical Strategies to Help with CopingPractical Strategies to Help with Coping

B B Behavior – action-oriented coping, activities

A A Affective – elicitation of positive emotion, feeling “good”

S S Sensory – sensory pleasure, experiencing comfort, avoid drugs and alcohol

I I Insight - meaning of loss, existential orientations

C C Cognitive – “re-script” negative thoughts, “meaningful connections” cognitive reconstructions

I I Interpersonal – support, open “connective” discussions

DD Drugs – consideration of medication, reduce maladaptive symptoms, anxiolytics to target severe symptoms

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Hope and Help for Parents Hope and Help for Parents Who Have Lost a Baby: The Who Have Lost a Baby: The

Recovery RoomRecovery Room• Part of ANGELS Program• Available through UAMS Telemedicine • Support group for grieving parents• Family members welcome• Confidential forum • Share thoughts, feelings, expectations• Receive support

• health care providers trained to address loss

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While grief is fresh, every attempt to divert only irritates. You must wait till it be digested, and then amusement will dissipate the remains of it.

Samuel Johnson

English author, critic, & lexicographer (1709 - 1784)

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