Grief and Perinatal Loss. Session Learning Objectives. Define perinatal loss Recognize the prevalence of perinatal loss, and those who are potentially affected by each loss Classify the stages or processes of grieving that individuals may experience following a perinatal loss
Early pregnancy loss (<20 weeks gestation:
Blighted ovum: loss prior to 8 weeks in which the egg is fertilized but never develops into an embryo
Ectopic pregnancy: implantation and development of the fertilized ovum outside of the uterus. This may occur in the fallopian tube, cervical canal, pelvic or abdominal cavity
Spontaneous Abortion: a gestational age of <20 weeks or a birth weight of < 500 grams
-missed: pregnancy loss where products of conception are retained after the fetus dies
-incomplete: pregnancy loss where some but not all products of conception have been expelled
- complete : pregnancy loss where the fetus and all related tissue have been expelled from the uterus
Therapeutic abortion: intentional termination of a pregnancy, usually prior to 24 weeks gestation
Molar pregnancy: mass of cysts that forms in the uterus. It is the product of parthenogenesis which is the development of a germ cell without equal contributions of DNA from an egg and sperm. All chromosomes come from the male partner.
Stillbirth: intrauterine death of a fetus at 20 weeks gestation of greater
Neonatal Death: death of a live-born infant over 20 weeks gestation within the first 28 days of life
Vast majority are due to genetic or chromosomal abnormalities
Knowing: the deliberate effort to understand an event as it has meaning in the life of the patient. The caregiver makes no assumptions, but attends to the clues given by the one cared for.
Being with: being emotionally present to or for the other. This presence conveys continual availability for sharing feelings.
Doing for: doing for the patient what the patient would for themselves if it were possible. Service given in an unobtrusive, easily forgotten manner that preserves dignity of the patient while acknowledging their capacity for self-care.
Enabling: helping of another’s passage through the transitional and unfamiliar event or loss. Involves using expertise to help someone grow, heal and practice self-care. Involves giving accurate and applicable information, explanations, and validation of the other’s feelings. Helps the ones being cared for to focus on their concerns, to generate viable alternatives, and to think through ways to look at or act in a situation.
Maintaining belief: holding the other in esteem and believing in them as a person with the capacity to get through a transition and face a future with meaning.
What to expect : physical symptoms of grief
Exhaustion/fatigue Appetite changes
Sleep difficulties Lack of strength
Weight changes Breathing difficulties
Palpitations Body aching
Restlessness Dry Mouth
Blurred Vision Headaches
What to expect: emotional and/or psychological effects of grief
Denial Guilt Anger
Resentment Bitterness Depression
Irritability Time confusion Mood Swings
Sadness Sense of failure
Dreams Failure to accept reality
Preoccupation with the deceased
Withdrawal from normal activities of daily living
Social isolation from family and friends
Increased difficulty relating to others
If death has not yet occurred:
i.e. physicians, neonatology, spiritual care, social work, nursing
At the time of death:
At the time of death…
Suggestions to enable the move towards healing: