Transcript coping with perinatal bereavement

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.
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/pregnancyloss/PR00098
 http://www.babyloss.com
 http://marchofdimes.com
 http://facebook.com/pages/Share -PregnancyInfant-Loss-Support-Inc/112835372099879
Etc., etc. . .
