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COPING WITH PERINATAL BEREAVEMENT Cyndie Franklin, MSEd Northeast Iowa Family Medicine Residency January 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.
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.
“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
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-loss/PR00098 • http://www.babyloss.com • http://marchofdimes.com • http://facebook.com/pages/Share -Pregnancy-Infant-Loss-Support-Inc/112835372099879 Etc., etc. . .