MPA First Friday Forum: Supporting Families During Pregnancy Following a Perinatal Loss

The loss of a baby during pregnancy is estimated to be around 30% of all pregnancies and is almost always unexpected and sudden, thus is a traumatizing experience for the mother and her partner.  Regardless of the cause of the death, it is impossible to have another experience of pregnancy without stimulating memories of the painful past loss. As parents enter a new pregnancy rather than unresolved grief, parents experience a new layer of grief; for their deceased baby and fear that the new unborn child might also die.

Bereaved parents report common themes around their loss experience. These include viewing the loss as a major life event possibly even traumatic in nature, a sense of isolation and loneliness due to the stigma and silence around pregnancy loss, invalidation from family and friends who intentionally or unintentionally diminish their loss in some way as well as lack of support from family and friends. These themes remain as parents move into a subsequent pregnancy with additional themes including an increase in anxiety about the outcome of the subsequent pregnancy, conflicted emotions around how to grieve for one baby while trying to be hopeful for another, and lack of trust in a ‘good outcome’ for this pregnancy. For the pregnant mother, this can present as lack of trust in one’s own body to keep this next baby safe.


Over years of clinical practice, five altered tasks of pregnancy have been identified that practitioners need to be aware of in working with families pregnant again after a loss in order to help parents come to an understanding of their own loss and pregnancy after loss experience. These tasks of the subsequent pregnancy include: 1) grieving the loss of self, the part that is parent, 2) working with the fear of another abnormal pregnancy, 3) working through the avoidance of attachment for fear of future loss, 4) moving past the unwillingness to give up grieving out of loyalty to the deceased baby, and 5) attaching to the unborn child separately from the deceased baby.  Parents need help in finding meaning to understand their continued bond and attachment to the deceased baby, which  may interfere with their ability to pay attention to the physical and emotional needs of an unborn baby that follows. 

There are several ways professionals can help parents who are pregnant after a loss achieve these five altered tasks of pregnancy. Referral to a support group in addition to seeing someone in your practice can be an added resource for these parents.  Other recommendations include:

  • Remember that both parents need reassurance
  • Fathers/partners are often just as anxious as the mother but may hold back feelings to protect her
  • Help reduce anxieties
  • Provide concrete medical information
  • Acknowledge their grief and their fears
  • Understand that the relationship between a mother who has experienced a pregnancy loss and her body is complex.
  • Know that it is normal for PAL parents to be hesitant to attach during pregnancy.
  • Acknowledge that a new baby does not replace the other.
  • Use the deceased child’s name in conversation.
  • Provide special preparation for the labor and birth.
  • Do not forget to acknowledge and care for the father/partner’s fear as well.
  • Be aware that detachment after the birth can be normal.
  • Educate yourself and your patient on resources for support.
  • Provide educational materials to help parents support the siblings.
  • Anticipate anxiety during parenting.

Our recommendations are explained in further depth and can be found in our coauthored position statement with PLIDA in the article – “Pregnancy After Perinatal Loss Requires Unique Care.”

When working with families who are pregnant again after a previous perinatal or infant loss, it is important to remember that the experience of a subsequent pregnancy is unique. It comes with the tasks of parenting in grief one child while simultaneously holding hope in attaching and creating space for another during a period of increased anxiety and fear. Overall, it is important to remember that a subsequent pregnancy and birth of the next child, a sibling, does not fix or remove the grief from the child that died but adds a layer of hope for the bereaved parents by adding another member to an expanding family.

Joann O’Leary, Ph.D., M.P.H., M.S., IMH-E® (IV) has a Ph.D. in Family Education, a Masters in Maternal Child Health from the University of Minnesota and Psychology from Queens University in Belfast, Northern Ireland where she was a Rotary Scholar. She has a background in nursing, preschool special education, and as a Parent-Infant Specialist in a high risk perinatal center, teaches at the University level, is a Level IV Infant Mental Health mentor for the State of Minnesota, a Fulbright Specialist in the area of prenatal parenting and facilitates infant loss and pregnancy after loss support groups. 

Lindsey Henke, MSW, LICSW, is the Founder and Executive Director of Pregnancy After Loss Support, writer, and clinical social worker. Her oldest daughter, Nora was stillborn after a healthy full-term pregnancy in December of 2012. Lindsey wrote about her grief after the death of her daughter as a contributor for Still Standing Magazine and was later featured as Pregnancy and Newborn magazine's Knocked Up Blogger during her pregnancy with her second daughter, Zoe, who was born healthy and alive in March of 2014.  Lindsey now dedicates her time to building a peer-to-peer support community for moms pregnant and parenting their child born after a loss. Through her work as the Executive Director for Pregnancy After Loss Support, she raises awareness of the challenging time that pregnancy after loss can be in a mom’s life.  Ms. Henke received her MSW with a concentration in Child & Family Therapy and Health/Mental Health Concentration from the University of Minnesota, Twin Cities.

References
 

  1. Chez, R. (1995). After hours. Obstetrics & Gynecology, 85(6): 1959-1061.
  1. Côté-Arsenault, D., & Donato, K. (2011). Emotional cushioning in pregnancy after perinatal loss. Journal of Reproductive and Infant Psychology, 29(1), 81–92.
  1. McCreight, B.S. (2004). A grief ignored: Narratives of pregnancy loss from a male perspec­tive. Sociology of Health and Illness26(3): 326–350.
  1. O’Leary, J. M. (2004). Grief and its impact on prenatal attachment in the subsequent pregnancy. Archives of Women’s Mental Health, 7(1), 7–18.
  1. O’Leary, J. (2009). Never a simple journey: Pregnancy following perinatal loss. Bereavement Care, 28(2), 12–17.
  1. O’Leary, J. & Thorwick, C. (2008). Attachment to the unborn child and parental men­tal representations of pregnancy following perinatal loss. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 2(2): 292–320.
  1. O’Leary, J. & Warland, J. (2016). Meeting the needs of parents: Pregnant and parenting after loss. New York, New York: Routledge.
  1. PLIDA position statement found on www.plida.org

 

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