COPING WITH PERINATAL BEREAVEMENT Cyndie Franklin, MSEd Northeast Iowa Family Medicine Residency January 22, 2014
Dec 18, 2015
COPING WITH PERINATAL BEREAVEMENT
Cyndie Franklin, MSEdNortheast Iowa Family
Medicine ResidencyJanuary 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.
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