Perinatal grief: experiencing and dealing with loss
Elena Iracheta, a specialist from the Women's Unit, explains what perinatal grief consists of and how its treatment should be approached from a professional point of view.
According to the WHO , the World Health Organization, the perinatal period extends from the 22nd week of gestation until the first week of life of the newborn.
From an obstetric point of view:
Fetal death
It is the death of the product of conception before expulsion or its complete removal from the mother's body, regardless of the length of the pregnancy. It is divided into:
Early fetal death
All deaths from conception to the 22nd week of gestation. We would be talking about abortions here.
Intermediate fetal death
Fetal deaths that occur between the 22nd and 28th week of gestation.
Late fetal death
From the 28th week of gestation.
Neonatal death
It is the death of the newborn in the first 4 weeks of life (28 days):
Early neonatal death
Of the newborn in the first 7 days of life.
Late neonatal death:
Of the newborn from 7 complete days to 28 complete days of life.
Perinatal grief
The causes of perinatal loss can be multiple and complex, and in many cases it is not possible to identify the cause.
Perinatal losses experience the same reactions as other situations of grief, but with special characteristics , some of which are:
- The first loss is the actual loss of the baby.
- Another is the loss of the stage of life the parents are currently immersed in, which is the loss of the 'future of that couple.' The loss of hope.
- Loss of the 'creation of the baby.' The baby represents life, and its death is much harder to bear than other losses in life.
- In some cases, parents face "accumulated losses." For example, if they have already faced previous losses (miscarriages) or if the pregnancy is the result of fertility treatment... In these cases, resolving this conflict leads to greater complications for the parents' psychological recovery.
Symptoms associated with perinatal grief
The most frequent symptoms associated with losses are ( Moscarello, 1989 ):
Level…
- physical: empty stomach, oppression, fatigue, weakness…
- behavioral: Social isolation, avoidance of pregnant women, babies, and children, insomnia, lack of appetite…
- cognitive: Difficulty concentrating and making decisions, intrusive thoughts about the subject, perceptual phenomena such as hearing babies cry or continuing to feel their movements.
- emotional: anger, failure, confusion, guilt, disbelief…
In grief, it's normal to experience feelings of depression, and these two processes can be confused. During grief, it's common for women to experience sadness for the lost child. It's also normal for their avoidance of pregnant women and babies to increase. All of these feelings will evolve in a healthy way, unlike in depression.
Psychological treatment for this particular type of grief should begin as soon as the perinatal death occurs. The sooner it begins, the better the results will be.
Support should be constant in the first few days after the event, but it's also important to allow parents space to express their feelings in private. It's crucial to adapt to the situation and to be there for the couple, respecting their needs and timing.
Professionals must be trained to be able to handle these types of situations.
Psychological intervention should be based on:
- help the expression of feelings by the couple jointly. Also by each individual individually to the extent needed.
- Accompany in doubts, fears, uncertainties…
- Linking past losses and traumas with present grief.
- Teach strategies for managing family and work situations.
- Being able to listen to others and listen in addition.
- Express feelings linked to memory.
- Help express emotional pain throughout the family.
Ultimately, it's about letting go. About creating the necessary relationship with patients. Teaching them how to manage pain, navigate the grieving process in a healthy way... For all of this, the role of the physician and the clinical psychologist are fundamental.
Article written by clinical psychologist Elena Iracheta.
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