coping with perinatal bereavement

Cyndie Franklin, MSEd
Northeast Iowa Family Medicine
January 22, 2014
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
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
 Regardless of the gestational age of the
 Regardless of the length of the parental
Perinatal and early infant loss
is complex because
One must cope with their own grief.
 One must cope with their partner’s
 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
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
Establishing a sense of structure in their
 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
contacts and
See, hold, touch the
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
 They may worry that they will die, too,
or that they are to blame
Some Ways to Help Them
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
The marital relationship is
re-stablized by:
 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
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
 -PregnancyInfant-Loss-Support-Inc/112835372099879
Etc., etc. . .