COPING WITH PERINATAL BEREAVEMENT

Cyndie Franklin, MSEdNortheast Iowa Family

Medicine ResidencyJanuary 22, 2014

Objectives

Improve understanding of the process of perinatal grief

Discuss the role of the physician and/or healthcare professional in managing perinatal grief

Provide information on local services available to patients and families

About 15% of all pregnancies terminate in spontaneous

abortion.At least 80% of those do so in

the first trimester.

Parents mourn for what was and for what might have been.

Regardless of the stage of the pregnancy

Regardless of the gestational age of the child

Regardless of the length of the parental relationship

Perinatal and early infant loss is complex because

One must cope with their own grief.

One must cope with their partner’s grief.

One must cope with changes in the relationship because of the loss.

Additional Stressors

Parenting of other children Financial difficulties Lack of consensus as to a “proper”

mourning period.

Grieving always takes place within a social context.

There are few mutually understood social rituals to

aid the perinatally bereaved.

Medical personnel are on the front lines of this family crisis.

Understanding Grief

Grief as a series of stages: Kubler-Ross model Parkes/Bowlby model

Grief does not appear to be tied to a fixed order of

emotional states.It seems to be a more complex and disorderly sequence of events than stage theorists suggest.

Current thinking is that grief:

Appears related to the closeness of the relationship with the deceased.

Is impacted by the perception of preventability of death.

There may not be final resolution of grief.

Normal grief is normal for each person in its own way.

“Losing someone you love is less like losing a very valuable and irreplaceable possession

than like finding the law of gravity to be invalid.”

--a Parent

Time and Grief

Time stands still Time’s up Doing Time Wasting time Looking back in time First times Time out Time heals Schwiebert, P from Grief Watch Newsletter, 2011

Perinatal loss disrupts parents’ assumptions of life:

The meaning of the child Personal invulnerability Positive view of oneself and one’s

child The belief in an orderly world

Coping with grief requires a re-definition of “ normal.”

Parents cope with their loss by:

Establishing a sense of structure in their life.

Gathering information about the experiences of others.

Searching for meaning. Blunting and sealing.

The Importance of Rituals

Rituals are tools that help us make sense of loss

Active participation in the grief process is the best way to cope with the loss of a loved one.

(Kobler & Kavanaugh, 2007)

Some rituals that may help

Memory boxes Naming the baby Religious/spiritual

contacts and practices

Cultural/family traditions

See, hold, touch the infant

Take photographs Consider a funeral Collect mementos Journal or blog

Helping Children Understand

Children of all ages grieve They may not look like they’re

grieving They often “re-grieve” a loss when

they experience a new stage of cognitive development

They may worry that they will die, too, or that they are to blame

Some Ways to Help Them Understand

Use simple, honest words about death Reassure them they are not going to die Tell them no one is to blame for the

baby’s death Use age-appropriate books about death Help them find their own way to

remember the baby

Most couples will experience at least temporary marital

conflict .This is largely due to an

underlying disagreement in beliefs and expectations.

Common differences experienced by couples

Meaning each parent gives to the loss

Each partner’s view of the couple Views of appropriate grief behavior Individual experiences surrounding

the loss

The marital relationship is re-stablized by:

Communication Positive outlook on their

relationship Perception of a shared experience

Social support from outside the marriage is also important.

Health care professionals play a pivotal role in healing.

Physicians and health care professionals help by:

Providing accurate information about what has happened about what to expect

Information needs to be delivered in a caring and humane fashion

Common support tactics that DON’T work include:

Giving advice Encouragement of recovery Minimization of feelings Identification with feelings

REMEMBER:

The handling of the situation during the immediate

impact of the child’s death will be vividly remembered

by the parents!

Take Home Points Perinatal loss is experienced as a real

and significant event that is grieved by the parent(s) and family

With support, most parents and family ultimately accommodate this loss

As a healthcare professional, your actions and management of this loss make a difference in the process of grief

Online Sources of Support http://www.mend.org http://www.mayoclinic.com/health/pregnancy-l

oss/PR00098 http://www.babyloss.com http://marchofdimes.com http://facebook.com/pages/Share -Pregnancy-I

nfant-Loss-Support-Inc/112835372099879Etc., etc. . .