Transcript Too Soon Gone:

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Faculty: Dr. Wendy Froberg
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Too Soon Gone:
Grief in Cases of Pre- and Perinatal Death
The Unique Aspects of Grief in
Pre- and Perinatal Death
A baby represents our hope for the future. We
are especially affected when children die,
perhaps because of our innate tendency to
protect the vulnerable
It is not the “natural order” for babies to die.
Often we comfort ourselves when someone has
lived a long life and it was “their time” to die
There is no name for someone who has lost a
child This can make bereaved parents feel alone,
isolated and not “counted”
The Unique Aspects of Grief in
Pre- and Perinatal Death
(Cont’d)
A prenatal death is an invisible or silent loss.
Other people never saw baby, so it may not feel
like a “real” person to them. To parents, the
baby was not abstract; it lived
Pre-/perinatal loss is a very common
experience, but it is still traumatic. Once you
start talking about it, people come forth with
their stories. It is a real loss that needs to be
grieved
Common Grief Reactions
Sadness
Anger
Irritability
Crying
Difficulty sleeping
Dreams/nightmares
Disbelief
Common Grief Reactions
(Cont’d)
Guilt
Not wanting to be alone
Not wanting to see
anyone/isolation
Wanting to talk
Confusion
These feelings can be very intense, although
they will reduce with time. Each person’s
experience is unique. Both mothers and fathers
experience varying levels of emotional upheaval
and should never be judged for the depth of
their emotional reaction
Grieving parents have the right to recover in
their own way. There is no timetable or statute
of limitations on grieving an unborn baby. The
last thing we want to do is make parents feel
more guilty because they are not grieving
“right”
Pregnancy loss places a woman at risk for
depression and anxiety in the future and may
negatively affect mother-child attachment
It can be difficult to differentiate between grief
and depression but typically, if the symptoms
are severe and impinge upon one's ability to
function for a prolonged period of time,
professional help should be sought
Signs of Depression
Having little interest in your usual
activities or hobbies
Feeling tired all the time
Gaining or losing weight
Having trouble sleeping or sleeping too
much
Having trouble concentrating or making
decisions
Thinking about suicide or death
General Suggestions for the
Bereaved Parent
Talk about your baby and your feelings about
your loss with your partner, family and friends,
your health care provider, a grief counselor
with special training, a support group with
other parents, and/or your religious or
spiritual leader
Consider having a memorial. Your hospital
may have a service each year that you can go to
Cry if you want to, privately or publicly
Read books and poems or listen to music that
you find comforting
General Suggestions for the
Bereaved Parent (Cont’d)
Write your thoughts and feelings in a journal or
write letters or poems to your baby
Make an album or memory box for keepsakes of
your baby
Leave baby items where they are until you feel
ready to put them away
Try not to make big changes in your life, like
moving to a new place or taking a new job, right
after your baby dies. Give yourself time to grieve
Unhelpful Grief Behaviours
Isolating Yourself/ Believing You’re All
Alone
Blaming Yourself
Wondering If You’re "Normal”
Listening to Negativity
Ignoring Your Emotional Needs
Unhelpful Grief Behaviours
(Cont’d)
Worrying What Others Think
Rushing Yourself
Keeping It a Secret
Ignoring Your Physical Needs
Avoiding Professional Help
Inappropriate Comments After
a Pre-/Perinatal Loss
Family and friends love you and want to help, but they
may be afraid of saying or doing the wrong thing and
feel helpless because they're not sure how to comfort
and support you. They may pull away rather than risk
upsetting you, leaving you feeling abandoned or say
inappropriate things:
”You’re young, you can try again. You’ll have
another baby”
”It was God’s will”
”Something must have been wrong. It’s for
the best; Nature just corrected her mistake”
Inappropriate Comments After
a Pre-/Perinatal Loss (Cont’d)
”Why are you so upset? You never knew/at
least you didn’t get to know the baby”
”It’s time to get over it and move on”
"At least you can get pregnant"
"At least you have other kids”
"Everything will be fine next time"
"It happened because _______"
How Others Can Help the
Bereaved Parent
Acknowledge that the baby--and the loss-were real
Offer ongoing support
Let the parent talk about the baby and share
photos, stories and memories
Offer to help with tasks
Be especially sensitive if you are pregnant
Dealing with Sibling
(Children’s) Loss:
Talk about death using simple, honest words. Don't use
words that may confuse or scare them
Encourage them to ask questions. Give as much ageappropriate information as your child needs
Be aware of changes in your children's behavior.
Younger children may regress. Older children may
worry about school, friends or show no reaction at all to
the baby's death. They may ask questions that seem
rude or uncaring. This is normal. Be as patient and
loving as you can
Dealing with Sibling
(Children’s) Loss (Cont’d):
Tell them they are not going to die
Tell them that no one is to blame for the baby's death
Read them stories that talk about death and loss
Ask them to find their own ways to remember the baby.
They may want to go to the memorial service or funeral
or draw a picture or make a keepsake for the baby.
Include them in grieving rituals
Ask a counselor to meet with you and your children to
help all of you understand your feelings
Tell your children's teachers and other caregivers what
has happened so they can support your children, too
The Partner Relationship
Men and women often react differently to the loss of a
pregnancy, which can complicate a relationship
Men do suffer the loss of a pregnancy and can
experience many emotions. Their feelings may be
overlooked because they seem to cope more easily
This can be a very difficult time for fathers since they
may feel there is little they can do to help their wife,
something men are socialized to do
Traditionally, a man has been expected to remain
outwardly strong to support his partner. He may hide
feelings of sadness and loss as he tries to take care of
her
The Partner Relationship
(Cont’d)
Men tend to grieve more privately. They are less likely to cry,
which doesn't necessarily mean they are not sad, although
their wife may perceive it that way
Men’s grief may be funneled into projects or the examination
of facts. Women feel connected to the pregnancy earlier and
express their feelings more openly. They connect and receive
emotional support by verbally sharing their stories
Both partners may feel their own emotions are "wrong" and
feel bad about not having the same grief reaction as their
spouse
Often both partners feel guilty. If they believe the other
blames them, it can lead to more anger, sadness and
withdrawal
Types of Prenatal/Perinatal
Loss and Associated Issues
Miscarriage: first and second trimester: Usually the reason is not
known, so decisions about trying again must be made in the
absence of information. Because it is medically common, it was
once assumed to have less impact than we now understand
Ectopic pregnancy: A ruptured ectopic pregnancy is a potentially
life-threatening event for the mother and affects her ability to
conceive in the future
Termination due to poor prenatal diagnosis (therapeutic
abortion): Parents have to make the choice about the baby’s life:
this may conflict with cultural and religious beliefs. Parents often
fear being judged for their decision
Stillbirth: There is the distress of assuming everything would be
fine up until the last minute and having to deliver a baby who has
died
In Cases of Unexpected Loss
Parents experience disbelief and shock, with no time to
prepare
They may be on a labour and delivery unit surrounded
by living babies and happy parents, leave the hospital
with an empty car-seat and go home to baby
preparations that remind them of their painful reality
They may be asked to make decisions when
emotionally overwhelmed/ unable to process
information; may make choices that they will regret in
the future
Offer expert and compassionate guidance to these
parents. Never force them to do something that makes
them uncomfortable but rather give choices and the
wisdom of your past experiences with other cases
When the Loss is Expected
Parent’s emotional and cognitive task is to
absorb the reality that their baby has already
died or will not survive. Grieving begins before
the loss is finalized
Parents are faced with decisions that must be
made, often in short order and without full
information
Palliative principles can be utilized. The patient
is not the baby but the parents, extended family
and other loved ones
When the Loss is Expected
(Cont’d)
Goals are to help the bereaved parents to accept
their child’s death, to be as comfortable as possible
while they go through the birth/death or
termination process, to affirm death as a natural,
albeit painful, process, to create meaningful
memories and to spend brief, precious moments with
their baby
A multidisciplinary team approach can be utilized,
with medical, psychological, social and spiritual
caregivers/practitioners each taking an important
role in alleviating the family’s suffering. Volunteers
such as other parents who have lost a baby can be
very helpful as well
Remembering and Honouring
Your Baby
Dealing directly with a baby’s death is painful;
we may want to shy away from it and avoid
talking about the loss because it makes people
uncomfortable
Parents may feel that expected to forget what
happened or hide the memories away. It may
seem like they have nothing to show for the
pregnancy
Grief work includes remembering
At the Time the Baby
Enters the World
Hold Your Baby in Your Arms
Name Your Baby
Bathe Your Baby
Dress Your Baby
Footprints/Handprints and Certificates
Take Pictures
Visitation
Later On: Rituals of
Remembering/Celebrating Life
Keep and collect mementos of your baby in a
special box or scrapbook
Light a candle on special days and holidays
Say a prayer
Write a poem or letter
Paint a picture
Release balloons or butterflies
Plant a tree or a small garden
Later On: Rituals (Cont’d)
Have a piece of jewelry made
Donate to a charity or give something to a needy child
who is about the same age as your baby would be
Get involved in a special project dedicated to your baby
or volunteer with a charity
Have a memorial service or funeral at your home or
place of worship, with just a few people or with all your
friends and family. It may include burying your baby or
spreading his ashes in a special place
Have a special time to remember. Pick a date that is
meaningful to you. Do something on your own, or
bring family and friends together to remember your
baby
Why a Funeral?
It gives you the opportunity to make some
decisions for your child when so many of those
decisions were taken from you
Making personalized choices for your baby
helps to honor your baby as a person
Since funeral planning is something we are used
to after a death, it may help you come to terms
with the sudden loss of your baby
It will give you something to do when your
thoughts are likely to be unfocused
Programs in Calgary for
Pre- and Perinatal Loss
The Alberta Health Services Pregnancy and Infant Loss
Program, Foothills Medical Centre:
In 2000, the first PAIL Coordinator was hired to
provide assessment, development and implementation
of services for families experiencing a perinatal loss and
to provide grief counseling following discharge from
hospital
The program now offers a standard of care for families,
including memory building, reading materials and
support groups, plus educational seminars for
healthcare professionals
Programs in Calgary for Preand Perinatal Loss (Cont’d)
Scott Smed Family Birthing Rooms and Centre of
Excellence : After Shannon and Peter Smed lost their
unborn son in 2000, they were inspired to help other
parents to have continuous support, comforting
surroundings and a more positive experience as they
went through their loss
Their yearly golf tournament has raised funds to build
three family rooms at the Rockyview, Foothills and
Peter Lougheed hospitals. Parents and family members
using these rooms while their child enters the world
experience privacy and understanding at a traumatic
time, and receive a memory gift box filled with items to
help their child's memory live on in their lives forever
Programs in Calgary for Preand Perinatal Loss (Cont’d)
Memory Boxes:
These include a a teddy bear, a hand-knitted blanket and cap,
a nightgown, a diaper, a certificate of life, a measuring tape, a
ceramic baby-booties ornament with birthstone, a hospital
bracelet, a folder for a lock of hair, a bassinet card, cards for
footprints and handprints and a condolence card
Caring Beyond:
A volunteer-run, peer-support group of bereaved parents
existing since the early 1990‘s. Services include a telephone
support line, monthly facilitated support meetings,
presentations on relevant topics, a website with links to
various resources, a lending library and a yearly candlelighting ceremony of remembrance