Transcript Grief and Perinatal Loss

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
• Identify the unique aspects of grief due to perinatal
loss versus grief due to other losses
• Discuss strategies for supporting a patient and her
support network
Perinatal or Pregnancy Loss
• the death of an unborn fetus or baby at any time
during pregnancy
Early pregnancy loss (<20 weeks gestation:
• 15-20% of diagnosed pregnancies are lost in the
first or second trimester of pregnancy with most
occurring in the first trimester
• 1% of pregnancy losses occur after 16 weeks
gestation
Types of pregnancy loss:
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
Causes of Pregnancy Loss
Vast majority are due to genetic or chromosomal
abnormalities
Other factors:
• Abnormal embryo development
• Hormone maternal abnormalities (decreased
progesterone or abnormal thyroid function)
• Maternal diabetes
• Uterine abnormalities (scar tissue, formation, shape or
tumors)
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Incompetent cervix
Infections (CMV, Listeriosis, toxoplasmosis)
Antifetal antibodies from maternal immune system
Autoimmune diseases (i.e. lupus erythematosus)
Smoking
Exposure to toxic substances and chemicals
Grief and Loss
• Grief: the emotional response to a loss
• Mourning: the way in which feelings and
emotions are dealt with
• “Visible” loss: death of a family member or
friend, have established rituals that facilitate and
encourage mourning. For example: funerals,
religious services, memorials
Grief due to Loss of a Pregnancy
• Pregnancy loss is devastating, no matter when it
happens.
• Misconception that the degree of loss experienced
is in proportion to the length of the pregnancy
• Grieving is a process with a number of phases.
These phases are experienced in different ways
and may overlap or be re-experienced.
• There is no right or wrong way to grieve
Phases of grief:
• Avoidance and disbelief: it may be impossible to grasp
what has happened. The loss is so overwhelming, it may
be necessary, at first, to take the time to break it down
into manageable pieces.
• Pain: may be experienced in the form of depression,
physical illness (colds, flu), forgetfulness, difficulty
concentrating, anger (at self, partner, higher being),
guilt.
• Acceptance and adaptation: acceptance of pregnancy loss
or infant death. Acknowledgement that internal change
has occurred will ease pain. Integration of infant’s
memory into a meaningful place in one’s life allows for
self-growth
Support from the Caregiver
• Care given to each person differs with their needs but the
support provided should be based on a theoretical base.
It is not necessarily “what comes naturally”.
• Swanson’s Caring Components can be applied to the
particular needs of any person experiencing grief at any
level or stage.
• Can be considered an interdisciplinary model as it
focuses on the caregiver’s receptiveness to the feelings of
a patient or family member. All caregivers can be
involved in this communication.
• This model is not stage-dependent.
Swanson’s Caring Components
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.
Swanson’s Caring Components
(cont’d)
Enabling: helping of another’s passage through the
transitional and unfamiliar event or loss. Involves using
expertise to help someone grow, heal and practice selfcare. 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.
Anticipatory Guidance
What to expect : physical symptoms of grief
Exhaustion/fatigue
Sleep difficulties
Weight changes
Palpitations
Restlessness
Blurred Vision
Appetite changes
Lack of strength
Breathing difficulties
Body aching
Dry Mouth
Headaches
Anticipatory Guidance
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
Decreased self-esteem
Preoccupation with the deceased
Withdrawal from normal activities of daily living
Social isolation from family and friends
Increased difficulty relating to others
Providing Support
If death has not yet occurred:
• Invoke the Perinatal Loss Program process
• Provide timely information to the family
• Involve the family in discussions regarding care
decisions i.e. re: induction of labour, palliative care, etc.
• Encourage and provide time for questions
• Use lay terminology
Providing Support
• Include the family in decision-making with all
disciplines
i.e. physicians, neonatology, spiritual care, social
work, nursing
• Allow for cultural differences in communication.
Use interpreters as needed.
• Promote an appropriate environment that includes
privacy, low lighting, music
• Encourage the family to hold and comfort the
baby. Use role modeling
• Provide support for all family members involved.
Providing Support
At the time of death:
• Express your own sympathy. Give the family time to
express themselves. Offer to stay if they are alone. Unit
team work is important at this time.
• Allow the family time to process the news of the death
before asking for responses to important questions
regarding organ donation, autopsy or funeral
arrangements
• Declaring time of death by physician
• Assure family of their privacy
Providing Support
At the time of death…
• Encourage the expression of feelings and facilitate good
communication between members of the family. Answer
all questions to the best of your ability.
• Offer options for loved ones to participate in the care of
the body, or watching care, or of not being present at the
time of body care and preparation.
• Perinatal Loss Keepsake initiative: pictures, hair locks,
foot and hand prints, clothing
• Many details and decisions
• Create a warm environment
• It is okay to cry
Providing Support
Suggestions to enable the move towards healing:
• Be independent in decision-making
• Create baby memories
• Take it slow
• Take care of yourself
• Postpone major decisions
• Talk and share time with your partner
• Journal
• Seek help from loved ones, professionals
• Support groups