Perinatal bereavement

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Perinatal bereavement or perinatal grief refers to the emotions of the family following a perinatal death, defined as the demise of a fetus (after 20 weeks gestation) or newborn infant (up to 30 days after birth). [1] Perinatal loss affects one in every ten women across the globe [2] with the worldwide perinatal death rate at approximately 2.7 million deaths per year. [3] Perinatal death is recognized as a traumatic life event as it is often sudden, unexpected, and devastating to parents who have had little to no direct life experiences with their child before their death. [4]

Contents

Perinatal bereavement, while sharing similarities with grief for other loved ones, is unique due to its nature as the loss of an idealized future relationship. [5] Parents often experience grief over the loss of their sense of self and role, which can complicate the grieving process. This type of grief may lead to prolonged or severe symptoms, including complicated grief or psychiatric illnesses like depression, making it critical to differentiate between normal and complicated grief. [5]

Types of perinatal loss

Miscarriage

A miscarriage, or spontaneous abortion, is defined as a "natural pregnancy loss before 20 weeks of gestation." [6] According to The American College of Obstetricians and Gynecologists (ACOG), miscarriage is the most frequent type of pregnancy loss. [7] Approximately 15% of all pregnancies result in a miscarriage, with one in every four women experiencing a miscarriage at some point in their life. [8] 50% of all miscarriages result from chromosomal abnormalities, while the remaining cases could be a mixture of physical, hormonal, environmental, and lifestyle factors. [9] Risk factors for miscarriage include advanced maternal age, history of previous miscarriages, obesity, autoimmune disorders, substance use, and more. [6] Despite recommendations of bed rest, administrations of hormones such as β-hCG and prophylactic progesterone, uterine relaxants, and other therapies, there are no effective means of preventing a miscarriage. [10]

Common symptoms of miscarriage include vaginal bleeding and lower abdominal cramping. [11] However, these symptoms are not definitive of a miscarriage occurring. To distinguish a miscarriage from other pregnancy complications, a thorough evaluation of a patient's medical history, as well as a physical examination, transvaginal ultrasound, and blood tests are recommended. [10]

Stillbirth

Pregnancy loss that occurs after 20 weeks of gestation is referred to as a stillbirth. Stillbirth involves the delivery of a fetus that has passed away before or during birth. Almost 1.9 million stillbirths occur each year, with unexplained stillbirths accounting for 76% of cases across the globe. [12] [13] Risk factors for stillbirth include placental abnormalities, advanced maternal age, diabetes, substance use, hypertension, previous stillbirths, and more. [13] However, it is often difficult to assess the cause of stillbirth if systematic investigations into the cause of death are not undertaken. [14]

Neonatal mortality

Neonatal mortality refers to the death of an infant within the first 28 days after birth. 75% of all neonatal deaths occur during the first seven days of life (also referred to as early neonatal mortality), with the main causes of neonatal death being preterm birth, congenital malformations, perinatal asphyxia or trauma, neonatal infections, and other birth disorders. [15] [16] Approximately 2.4 million neonatal deaths occur each year, with the majority of deaths taking place in low- and middle-income countries. [17] [18] In 2020, almost half of all deaths in children under the age of five occurred during the newborn period. [19]

History

Women have documented their experiences of perinatal bereavement since at least the 19th century. However, modern research into the effects of this type of loss began in the 1960s, led by a small number of psychoanalysts. [20] One of the first to recognize miscarriage as a traumatic event was psychoanalyst A.C. Cain in 1964. Cain explored the impact of child loss on siblings and described the profound emotions women often face after a miscarriage, including fear, grief, anger, and despair. [20] In 1970, Kennell, Slyter, and Klaus conducted seminal research on the mourning response of parents to the death of a newborn infant, providing the first empirical evidence that women experience a profound mourning process following such a loss. [20] [21]

Before the 1970s, the medical community often dismissed perinatal loss classifying it as insignificant, resulting in little recognition of perinatal bereavement. Over time, three key factors contributed to the acknowledgment of perinatal bereavement as a legitimate experience: [21]

The recognition of perinatal bereavement sparked a significant increase in research and literature on the topic in the 1980s. Since then, there has been an effort to address gaps in the field by conducting more systematic studies with larger sample sizes, providing a deeper understanding of perinatal bereavement. [21]

Measurement

The most widely used measure for perinatal grief is the Perinatal Grief Scale (PGS), developed by Lori J. Toedter, Judith N. Lasker and Janice M. Alhadeff in 1988. [22] PGS is used both by researchers to understand perinatal grief and by psychiatrists as a testing instrument to assess a patient experiencing perinatal bereavement. The PGS consists of 33 statements regarding feelings following perinatal loss and a scale of answers ranging from "strongly agree" to "strongly disagree." [23] The 33 statements are categorized into three subscales, each consisting of 11 items:

Elevated scores within specific subsections, particularly the Difficult Coping and Despair subscales, serves as a valuable predictor of complicated grief. These insights can help healthcare providers identify individuals who may benefit from follow-up care. [5]

Critics of the Perinatal Grief Scale (PGS) argue that it places excessive emphasis on emotions specifically related to the loss of the baby, while neglecting other grief-related feelings. Additionally, the scale has been criticized for overlapping significantly with indicators of depression. [5] [24] Despite the development of other perinatal grief instruments, the PGS remains the most consistent and reliable means of assessing perinatal grief for clinicians and researchers. It has been instrumental in gauging grief responses in patients, assessing related psychological and social factors, and evaluating the effectiveness of bereavement interventions. [22] The widespread use of the Perinatal Grief Scale (PGS) may be attributed to its ease of application, quick analysis, and successful validation across various languages and cultures, reinforcing its utility as both a clinical and research tool. [5]

Factors Influencing Severity

The Perinatal Grief Scale (PGS) has been instrumental in helping researchers identify key factors associated with perinatal grief reactions. A scoping review identified four primary factors commonly examined for their influence on grief responses: (1) sociodemographic characteristics, (2) support systems, (3) reproductive history, and (4) mental health status. [5]

Among these factors, support consistently emerged as the strongest predictor of lower grief scores. Higher levels of marital satisfaction, social support, participation in professional support groups, and religiosity were all associated with reduced grief as measured by PGS scores. [5] [20]

Conversely, mental health status was the factor most consistently associated with higher grief scores. Individuals with pre-existing mental health issues were more likely to report elevated levels of grief following a perinatal loss. [5] [20]

The influence of other factors, including sociodemographics and reproductive history, yielded mixed or conflicting results. [5] The lack of consensus among researchers can be attributed to variations in study designs, sample populations, and the diverse measures used to evaluate grief. [20]

Psychological impact

The loss of a child, regardless of their age, is a profoundly painful event for any parent to experience. Perinatal death is especially traumatic as it is rarely anticipated and can defy parents' expectations of the natural order of life. [25] The grieving process involved in a sudden perinatal death further includes the loss of future dreams, experiences, and expectations associated with their child's future. [2]

Reactions to perinatal loss can vary widely depending on one's personal, cultural, and situational factors. In a typical grieving process, the intensity of grief gradually lessens over the course of a year after the loss. [4] In several longitudinal studies, Perinatal Grief Scale (PGS) scores, as expected, decrease over the two years following a loss among bereaved parents as a whole. [20] However, for a majority of parents experiencing perinatal loss, varying patterns of persistent and unresolved grief remain after two years of the loss. [4] For example, around 20% of women continue to experience clinically significant symptoms even a year after the loss. [26]

Perinatal death can have profound emotional consequences for parents, families, and communities. For mothers, the consequences of perinatal loss can be physical (such as hemorrhage or infection) and psychological (such as symptoms of post-traumatic stress, anxiety, depression, and other serious mental health disorders). [2] Approximately one in five women who go through perinatal loss develop depression or post-traumatic stress disorder (PTSD). Over the course of their lives, the likelihood of experiencing PTSD linked to perinatal loss is estimated at 29%. [26] For fathers, feelings of pain, sadness, inadequacy, and helplessness may be masked to assume the responsibility of supporting their partners during the grieving process. [27] Furthermore, as bereavement care guidelines tend to be female-focused, bereaved fathers may feel overlooked and marginalized by medical professionals, workplace policies, and community support programs, leading to unresolved grief. [28] Complicated grief, or prolonged grief disorder (PGD), can develop following a perinatal death due to a lack of social support, poor marital relations, fertility struggles, pre-existing mental health conditions, and/or the absence of other children. [29] A lack of acknowledgement and support from society and healthcare professionals of the emotional impact of perinatal loss can further lead to parents experiencing disenfranchised grief, which may result in secretive mourning and heightened feelings of guilt and self-blame. [30] Maladaptive coping mechanisms, such as avoidance, emotional suppression, or self-blame for the loss, are often linked to negative outcomes. [26]

Complicating factors

There are several complicating factors associated with perinatal loss that can hinder the normal grieving process for parents. In the case of miscarriage, others may be unaware of a mother's loss due to the typical recommendation to only announce pregnancy after the end of the first trimester (week 12). As such, mothers may feel unable to share their experience of child loss with others due to the stigma surrounding child death and the perception that they are not "real mothers." [31] Furthermore, when child loss occurs during an early pregnancy stage, there is typically no funeral or other mourning rituals performed that may help parents feel that they have honored their child's existence. The lack of closure and recognition that arises from the inability to publicly acknowledge and mourn their child's death can exacerbate grief intensity and increase the likelihood of developing complicated grief. [4] The lack of societal recognition or support for parents mourning a stillbirth is referred to as disenfranchised grief. Many parents feel isolated, as their identity as parents is often not acknowledged by healthcare providers, family, or society. They face the painful reality of being parents without a living child. Fathers, in particular, frequently report feeling overlooked and marginalized in their grief, with their role as grieving parents largely unrecognized. [32] Mothers bereaved by stillbirth or miscarriage may feel that they are to blame for their child's death, or that they do not have a right to bereavement as they do not have physical memories of the child. [2] Mothers, in particular, may experience feelings of failure, guilt, or a sense that their bodies have betrayed them. [32] Parents have limited time with their child, leading them to grieve not only the loss itself but also the future they had envisioned. [33]

Loss of Identity

The death of a child during pregnancy or shortly after birth can have a strong effect on a mother's sense of identity. Bereaved mothers may find it difficult to connect to or accept their identity as a mother after experiencing child loss, resulting in a fragmented sense of self. Feelings of having failed to become a mother, being robbed of motherhood, and experiencing exclusion and silence from society can interfere with the construction of maternal identity. [34] Additionally, bereaved mothers may struggle with ongoing pregnancy-related symptoms after their baby has passed, such as lactation, postpartum hormonal changes, and alterations in body shape. These physical reminders of their pregnancy and the child that was lost can intensify emotional distress, leading mothers to feel a need to distance themselves from their bodies. Bereaved mothers frequently grapple with reconciling their identity as mothers with their identity as individuals who have suffered child loss. Their sense of motherhood can feel threatened by societal reminders, such as consent forms asking how many children they have, holidays like Mother's Day, representations of families in advertisements, and displays in baby sections. [31] Various grief responses may lead these mothers to retreat socially, avoid mentioning their deceased child, develop extreme anxiety about losing future children, and strive to create a new normal for themselves while honoring their child. [31] [35]

Relationships

Parental relationships are at a higher risk of dissolution following a miscarriage or stillbirth compared to relationships after a live birth. [36] The impact of a miscarriage on a relationship typically manifests within the first two to three years, whereas the effects of a stillbirth can persist for up to a decade. [36] Research indicates that stillbirths have a more significant impact on parental relationships than miscarriages. However, because miscarriages are more common, they collectively affect a greater number of relationships. [36]

Parents may exhibit different grieving styles in response to loss, with research suggesting that mothers are more likely to grieve intuitively, while fathers often adopt an instrumental grieving style. [37]

The intuitive grieving style is characterized by the expression of emotions and a focus on processing grief through verbal communication and emotional sharing. Individuals who grieve intuitively may find comfort in discussing their feelings, crying, or seeking social support as a way to cope with their loss. [38]

In contrast, the instrumental grieving style emphasizes action-oriented coping mechanisms. This approach involves engaging in practical activities or projects, such as creating memorials, working towards specific goals, or focusing on problem-solving tasks, rather than expressing emotions openly. [38]

While these patterns are often associated with gender differences, they are not exclusive, and many individuals display a blend of both grieving styles. [37] Differences in grieving styles may lead to interpersonal conflict; a lack of willingness to understand each other can threaten the sense of unity in a relationship and create a feeling of isolation in one’s grief. [37] [32] However, while pregnancy loss increases the overall risk of relationship dissolution, its effects are not universally negative. [36] Many couples report feeling closer to their partner following the loss of a child and describe a sense of sharing a unifying bond through the shared experience. [39] [37] When partners demonstrate tolerance and respect for each other’s expressions of grief, many parents report increased cohesion and a strengthened relationship. [39] [37] [32]

Perinatal loss can significantly affect intimacy and sexual relationships. Some individuals report feelings of guilt, intrusive thoughts, or distressing mental images that hinder their ability to engage in sexual activity. [32] Women may develop negative perceptions of their bodies, particularly due to the physical changes associated with pregnancy and childbirth, which can diminish their desire for intimacy or affect their ability to find pleasure in it. [32] Others experience a strong urgency to conceive again, viewing sexual activity primarily as a means to achieve pregnancy. Conversely, some prefer to wait before attempting to conceive, feeling unable to face the idea of "replacing" the child they lost. [32]

Coping strategies

Coping strategies play an essential role in helping bereaved mothers manage the psychological and emotional hardships of losing a child. For some mothers, personifying their deceased child by attributing individuality, identity, and human qualities to them helps maintain a bond and grieve for a real person rather than an abstract loss. [40] Similarly, for others, preserving the memory of their deceased child through tangible objects such as ultrasound photos, stuffed animals, and clothing can help honor their lost child and maintain their sense of motherhood. [31]

Making and Preserving Memories

Parents who experience stillbirth often seek ways to preserve memories that affirm their baby’s existence. Many parents value photographs taken in the hospital, though the style of the photos plays a significant role in their emotional impact. [41] Natural or candid images are generally preferred over posed ones, as these tend to feel more authentic. Additionally, photos that resemble those taken during a live birth, avoiding overly confronting or graphic elements, are often favored. Such images are less distressing for parents to revisit and are more suitable for sharing with others. [41] In addition to photographs, parents often cherish keepsakes that commemorate their baby. Commonly valued mementos include ink or plaster imprints of the baby’s hands and feet, name cards, hospital ID bands, locks of hair, and clothing or blankets the baby wore. These tangible items provide a lasting connection and serve as meaningful reminders of their baby’s presence and their status as parents. [41] Many parents benefit from support and gentle guidance from hospital staff to engage in memory-making with their stillborn child. Factors such as insufficient information, overwhelming grief, and fear can influence parents’ decisions during this time. Many later express regret for declining the opportunity to hold their child or for not spending more time with them. [41] [32]

Interventions

Grief support groups, bereavement care programs, and individual counseling can help with emotional regulation, processing the loss, developing maternal identity, and expressing grief in a supportive environment. [42] [43] [44] A meta-analysis of psychosocial interventions demonstrated their effectiveness in reducing depression, anxiety, and grief among parents coping with perinatal loss. [45] Interventions implemented within the first six weeks after a perinatal loss had a significant positive impact, whereas interventions initiated after six weeks showed no significant effect. [45]

Cognitive Behavioral Therapy

Multiple randomized controlled trials have demonstrated that cognitive behavioral therapy is highly effective in reducing chronic psychological disorders following the loss of a child. [26] [46] Here is an example of components included in a CBT treatment used in a study on perinatal loss:

Swanson's Care

Swanson’s Caring Theory provides a compassionate framework for supporting women who have experienced a miscarriage. It emphasizes the importance of a therapeutic relationship between the healthcare provider and the woman to help her navigate the emotional and psychological challenges of the event. [47] The theory outlines five key elements of the caring process:

Swanson's approach has proven to be effective for parents who experienced a miscarriage before 22 weeks, with randomized controlled trials showing significant reductions in grief symptoms. [46]

Counseling

Several studies have examined the impact of counseling following perinatal loss. Counseling can take many forms, including family-based bereavement counseling, group counseling, individual counseling, and couples counseling. [48] It may be provided by various professionals, such as psychologists, psychotherapists, psychiatrists, therapists, nurses, midwives, or professional counselors. [48] While not all counseling interventions effectively improve psychological outcomes for bereaved mothers, several studies have demonstrated positive results. [48] For instance, one semi-experimental study found that grief counseling significantly reduced post-traumatic stress symptoms in mothers after a stillbirth. [49]

Social Support Programs

A randomized controlled trial assessed a social support program in which a nurse educated family members on effective listening and support skills. The nurse worked closely with each family to develop a personalized support plan, addressing the pregnant woman's specific needs and circumstances. Once finalized, the plan was shared with the family for implementation. The program significantly improved family support and reduced depression and post-traumatic stress symptoms in women. [50]

Mindfulness

Mindfulness-based stress reduction programs have been shown to reduce anxiety and depression levels in women who have experienced miscarriage or ectopic pregnancies in a randomized controlled trial. [51] [52]

Awareness

To raise awareness of perinatal loss and support affected families, many countries observe a dedicated day of remembrance. October 15th is recognized as Pregnancy and Infant Loss Remembrance Day and is observed in countries including Canada, [53] the United States, [54] Australia, [55] Ireland, [56] and the United Kingdom, where the observance has been extended to a week. [57] The day provides an opportunity for families to remember and honor their children who have passed away. Observances include candle-lighting vigils such as the Wave of Light [58] and commemorative events like the Walk to Remember. [59] These events provide a space for bereaved parents to share their grief and connect with others, with the aim of raising public awareness and encouraging dialogue about the prevalence of baby loss. [60]

See also

Related Research Articles

<span class="mw-page-title-main">Miscarriage</span> Natural premature termination of pregnancy

Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can survive independently. Miscarriage before 6 weeks of gestation is defined as biochemical loss by ESHRE. Once ultrasound or histological evidence shows that a pregnancy has existed, the term used is clinical miscarriage, which can be "early" or "late". Spontaneous fetal termination after 20 weeks of gestation is known as a stillbirth. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called perinataldepression, is a mood disorder which may be experienced by pregnant or postpartum individuals. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

<span class="mw-page-title-main">Stillbirth</span> Death of a fetus before or during delivery, resulting in delivery of a dead baby in some manner

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies a short time after being born alive.

<span class="mw-page-title-main">Grief</span> Response to loss in humans and other animals

Grief is the response to the loss of something deemed important, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.

Prenatal development involves the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal development until birth.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

<span class="mw-page-title-main">Perinatal mortality</span> Medical condition

Perinatal mortality (PNM) is the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Perinatal means "relating to the period starting a few weeks before birth and including the birth and a few weeks after birth."

Disenfranchised grief is a term coined by Dr. Kenneth J. Doka in 1989. The concept describes the fact that some forms of grief are not acknowledged on a personal or societal level in modern Eurocentric culture. People might not like how you may or may not be expressing your grief or view your loss as insignificant, and thus they may feel uncomfortable, or judgmental. This is not a conscious way of thinking for most individuals, as it is deeply engrained in our psyche. This can be extremely isolating, and push you to question the depth of your grief and the loss you’ve experienced. This concept is viewed as a "type of grief", but it more so can be viewed as a "side effect" of grief. This also is not only applicable to grief in the case of death, but also the many other forms of grief. There are few support systems, rituals, traditions, or institutions such as bereavement leave available to those experiencing grief and loss.

Pregnancy and Infant Loss Remembrance Day is an annual day of remembrance observed on October 15 for pregnancy loss and infant death, which includes miscarriage, stillbirth, SIDS, ectopic pregnancy, termination for medical reasons, and the death of a newborn. Pregnancy and infant loss is a common experience that has historically been complicated by broadly applied social and cultural taboos to stay silent, a condition that the World Health Organization advocates reversing in favor of open expression. A growing number of public figures have come out in support of open expression, with many leading by example through the disclosure of their personal experiences of pregnancy loss and infant death.

<span class="mw-page-title-main">Prolonged grief disorder</span> Medical condition

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

Antenatal depression, also known as prenatal or perinatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed or stressed mother feels the affects. The child is less active and can also experience emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, but at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.

The Mariposa Trust is a charity in the United Kingdom founded by Zoë Clark-Coates, to support people who have suffered baby loss, in pregnancy, at birth or in infancy. It holds public Services of Remembrance, of any or no religious faith, across the UK to acknowledge the loss of a baby by their families, and by arranging specialist support divisions to help people with their associated grief and trauma. It is one of the organizations that supports baby loss awareness week.

<span class="mw-page-title-main">Miscarriage and grief</span>

Miscarriage and grief are both an event and subsequent process of grieving that develops in response to a miscarriage. Almost all those experiencing a miscarriage experience grief. This event is often considered to be identical to the death of a child and has been described as traumatic. "Devastation" is another descriptor of miscarriage. Grief is a profound, intensely personal sadness stemming from irreplaceable loss, often associated with sorrow, heartache, anguish, and heartbreak. Sadness is an emotion along with grief, on the other hand, is a response to the loss of the bond or affection was formed and is a process rather than one single emotional response. Grief is not equivalent to depression. Grief also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. Bereavement and mourning refer to the ongoing state of loss, and grief is the reaction to that loss. Emotional responses may be bitterness, anxiety, anger, surprise, fear, and disgust and blaming others; these responses may persist for months. Self-esteem can be diminished as another response to miscarriage. Not only does miscarriage tend to be a traumatic event, women describe their treatment afterwards to be worse than the miscarriage itself.

Child bereavement occurs when a child loses someone of importance in their life. There is substantial research regarding grief in adults, but there is less focus in literature about grief among children. Children will experience instances in their life that could involve losing a parent, sibling, or friend through suicide, unintentional injury, homicide, or natural causes. The levels of grief and bereavement differ among children, including uncomplicated and complicated bereavement. Unlike adults, children may experience and express their grief and bereavement through behaviors, and are less likely to outwardly express their emotions. The children who experience bereavement and grief can receive treatment involving group intervention, play therapy, and cognitive behavioral therapy. Different forms of treatment for children experiencing bereavement and or grief can help to reduce symptoms of anxiety, depression, social adjustment, and posttraumatic stress. Research has shown that it is important to be aware of the difficulties in predicting how losing a closed one can impact a child’s emotionality and how their coping abilities will differ across ages and cultures.

Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.

A rainbow baby is a child born to a family that has previously lost one or more children due to stillbirth, miscarriage, ectopic pregnancy, termination for medical reasons, or death during infancy. These subsequent pregnancies can bring "strong feelings of anxiety, guilt, and even fear" but also "immense joy, reflection, healing, and mixed emotions". The term "rainbow" is symbolic of the hope brought by the child after the emotional storm of the previous loss.

Suicide bereavement is the experience of those who are grieving the loss of someone to suicide. Over 800,000 individuals die by suicide every year. It was stated by Shneidman (1978) that every suicide leaves behind 6 "survivor-victims". However, new research shows that each suicide leaves behind approximately 135 who personally knew the decedent. The #not6 hashtag has been used by Cerel and colleagues to represent that suicide bereavement is many more than publicly portrayed.

Reproductive loss, sometimes reproductive disappointment or reproductive grief, describes a potential emotional response to unsuccessful attempts at human reproduction or family-building. These experienced losses may include involuntary childlessness generally, pregnancy loss from all causes, perinatal death, stillbirth, infecundity and infertility from all causes, failed attempts to conceive, failed fertility treatments, failed gestational surrogacy procedures, and losses related to all dimensions of the adoption process. Responses to miscarriage, stillbirth, selective reduction and neonatal death are a subtype of reproductive loss called perinatal bereavement.

Bereavement groups, or grief groups, are a type of support group that bereaved individuals may access to have a space to process through or receive social support around grief. Bereavement groups are typically one of the most common services offered to bereaved individuals, encompassing both formalized group therapy settings for reducing clinical levels of grief as well as support groups that offer support, information, and exchange between those who have experienced loss.

The Memory Garden is the first Jewish sacred space in the United States dedicated to expressing grief over infertility, pregnancy loss due to miscarriage or abortion, or stillbirth or death of a newborn. Judaism has a complex definition of the beginning of life, and does not have a traditional ritual for mourning fetuses or newborns prior to the age of thirty days. The Memory Garden builds on existing traditions, following halakah, and acknowledges the need of expectant parents and other family members across all streams of Jewish practice to recognize the emotional toll these losses take.

References

  1. ↑ Cassidy, Paul Richard (2021-10-09). "The Disenfranchisement of Perinatal Grief: How Silence, Silencing and Self-Censorship Complicate Bereavement (a Mixed Methods Study)". OMEGA - Journal of Death and Dying. 88 (2): 709–731. doi:10.1177/00302228211050500. ISSN   0030-2228. PMID   34632863. S2CID   238582116.
  2. 1 2 3 4 Delgado, Laia; Cobo, Jesus; Giménez, Cristina; Fucho-Rius, Genís Felip; Sammut, Stephanie; Martí, Laia; Lesmes, Cristina; Puig, Salut; Obregón, Noemí; Canet, Yolanda; Palao, Diego J. (2023-01-11). "Initial Impact of Perinatal Loss on Mothers and Their Partners". International Journal of Environmental Research and Public Health. 20 (2): 1304. doi: 10.3390/ijerph20021304 . ISSN   1660-4601. PMC   9858910 . PMID   36674059.
  3. ↑ Fernández-Sola, Cayetano; Camacho-Ávila, Marcos; Hernández-Padilla, José Manuel; Fernández-Medina, Isabel María; Jiménez-López, Francisca Rosa; Hernández-Sánchez, Encarnación; Conesa-Ferrer, María Belén; Granero-Molina, José (2020-05-14). "Impact of Perinatal Death on the Social and Family Context of the Parents". International Journal of Environmental Research and Public Health. 17 (10): 3421. doi: 10.3390/ijerph17103421 . hdl: 10835/8275 . ISSN   1660-4601. PMC   7277582 . PMID   32422977.
  4. 1 2 3 4 Kersting, Anette; Wagner, Birgit (2012-06-30). "Complicated grief after perinatal loss". Dialogues in Clinical Neuroscience. 14 (2): 187–194. doi:10.31887/DCNS.2012.14.2/akersting. ISSN   1958-5969. PMC   3384447 . PMID   22754291.
  5. 1 2 3 4 5 6 7 8 9 Setubal, M.S.; Bolibio, R.; Jesus, R.C.; Benute, G.G.; Gibelli, M.A.; Bertolassi, N.; Barbosa, T.; Gomes, A.; Figueiredo, F.; Ferreira, R.; Francisco, R.; Stein Bernardes, L. (2021). "A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions". Palliative and Supportive Care. 19 (2): 246–256. doi:10.1017/S1478951520000826. ISSN   1478-9515. PMID   32867873.
  6. 1 2 Alves, Clark; Jenkins, Suzanne M.; Rapp, Amanda (2024), "Early Pregnancy Loss (Spontaneous Abortion)", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32809356 , retrieved 2024-10-23
  7. ↑ Hupe, Meghan (2024-07-02). "StatPearls". Journal of Electronic Resources in Medical Libraries. 21 (3): 147–152. doi:10.1080/15424065.2024.2389325. ISSN   1542-4065.
  8. ↑ Ghosh, Jay; Papadopoulou, Argyro; Devall, Adam J; Jeffery, Hannah C; Beeson, Leanne E; Do, Vivian; Price, Malcolm J; Tobias, Aurelio; Tunçalp, Özge; Lavelanet, Antonella; Gülmezoglu, Ahmet Metin; Coomarasamy, Arri; Gallos, Ioannis D (2021-06-01). Cochrane Pregnancy and Childbirth Group (ed.). "Methods for managing miscarriage: a network meta-analysis". Cochrane Database of Systematic Reviews. 2021 (6): CD012602. doi:10.1002/14651858.CD012602.pub2. PMC   8168449 . PMID   34061352.
  9. ↑ Obstetrics, The Johns Hopkins University School of Medicine Department of Gynecology and; Hurt, K. Joseph; Guile, Matthew W.; Bienstock, Jessica L.; Fox, Harold E.; Wallach, Edward E. (2012-03-28). The Johns Hopkins Manual of Gynecology and Obstetrics. Lippincott Williams & Wilkins. ISBN   978-1-4511-4801-5.
  10. 1 2 "Early Pregnancy Loss". www.acog.org. Retrieved 2024-10-22.
  11. ↑ Sapra, K.J.; Buck Louis, G.M.; Sundaram, R.; Joseph, K.S.; Bates, L.M.; Galea, S.; Ananth, C.V. (April 2016). "Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort". Human Reproduction. 31 (4): 887–896. doi:10.1093/humrep/dew010. ISSN   0268-1161. PMC   4791918 . PMID   26936888.
  12. ↑ "Improving maternal and newborn health and survival and reducing stillbirth - Progress report 2023". www.who.int. Retrieved 2024-10-25.
  13. 1 2 Maslovich, Mark M.; Burke, Lori M. (2024), "Intrauterine Fetal Demise", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32491465 , retrieved 2024-10-25
  14. ↑ Silver, Robert M.; Reddy, Uma (August 2024). "Stillbirth: we can do better". American Journal of Obstetrics and Gynecology. 231 (2): 152–165. doi:10.1016/j.ajog.2024.05.042. ISSN   0002-9378. PMID   38789073.
  15. ↑ "Newborn mortality". www.who.int. Retrieved 2024-10-27.
  16. ↑ Dattani, Saloni; Spooner, Fiona; Ritchie, Hannah; Roser, Max (2023-12-28). "Child and Infant Mortality". Our World in Data.
  17. ↑ Steenhoff, Andrew P.; Coffin, Susan E.; Kc, Ashish; Nakstad, Britt (2023-04-13). "Editorial: Neonatal health in low- and middle-income countries. Now is the time". Frontiers in Pediatrics. 11. doi: 10.3389/fped.2023.1168915 . ISSN   2296-2360. PMC   10133691 . PMID   37124177.
  18. ↑ Tamir, Tadesse Tarik (2024-06-01). "Neonatal mortality rate and determinants among births of mothers at extreme ages of reproductive life in low and middle income countries". Scientific Reports. 14 (1): 12596. Bibcode:2024NatSR..1412596T. doi:10.1038/s41598-024-61867-w. ISSN   2045-2322. PMC   11144189 . PMID   38824152.
  19. ↑ "Newborn mortality". www.who.int. Retrieved 2024-10-27.
  20. 1 2 3 4 5 6 7 8 Toedter, Lori J.; Lasker, Judith N.; Janssen, Hettie J. E. M. (2001-04-01). "International Comparison of Studies Using the Perinatal Grief Scale: A Decade of Research on Pregnancy Loss". Death Studies. 25 (3): 205–228. doi:10.1080/074811801750073251. PMID   11785540.
  21. 1 2 3 Fenstermacher, Kimberly; Hupcey, Judith E. (2013). "Perinatal bereavement: a principle-based concept analysis". Journal of Advanced Nursing. 69 (11): 2389–2400. doi:10.1111/jan.12119. ISSN   0309-2402. PMC   3675189 . PMID   23458030.
  22. 1 2 Wright, Patricia Moyle; Carpenter, Joan (2023-10-04). "A Review of the Psychometrics of Perinatal Grief Instruments". Illness, Crisis & Loss. 31 (4): 655–670. doi:10.1177/10541373231163260. ISSN   1054-1373.
  23. ↑ "Perinatal Grief Scale, Scoring and Translations". 2018-05-28. Retrieved 2024-10-24.
  24. ↑ Klier, C. M.; Geller, P. A.; Ritsher, J. B. (2002-12-01). "Affective disorders in the aftermath of miscarriage: A comprehensive review". Archives of Women's Mental Health. 5 (4): 129–149. doi:10.1007/s00737-002-0146-2. PMID   12510205.
  25. ↑ Albuquerque, Sara; Ferreira, Luana Cunha; Narciso, Isabel; Pereira, Marco (2019). "Interactive Processes in Grief and Couples' Adjustment After the Death of a Child". Journal of Family Issues. 40 (5): 689–708. doi:10.1177/0192513X18820385. ISSN   0192-513X.
  26. 1 2 3 4 5 Bennett, Shannon M.; Ehrenreich-May, Jill; Litz, Brett T.; Boisseau, Christina L.; Barlow, David H. (2012). "Development and Preliminary Evaluation of a Cognitive-Behavioral Intervention for Perinatal Grief". Cognitive and Behavioral Practice. 19 (1): 161–173. doi:10.1016/j.cbpra.2011.01.002.
  27. ↑ Mota, Cecilia; Sánchez, Claudia; Carreño, Jorge; Gómez, María Eugenia (2023-03-10). "Paternal Experiences of Perinatal Loss—A Scoping Review". International Journal of Environmental Research and Public Health. 20 (6): 4886. doi: 10.3390/ijerph20064886 . ISSN   1660-4601. PMC   10049302 . PMID   36981791.
  28. ↑ Obst, Kate Louise; Due, Clemence; Oxlad, Melissa; Middleton, Philippa (10 January 2020). "Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model". BMC Pregnancy and Childbirth. 20 (1): 11. doi: 10.1186/s12884-019-2677-9 . ISSN   1471-2393. PMC   6953275 . PMID   31918681.
  29. ↑ Kishimoto, Makiko; Yamaguchi, Arisa; Niimura, Marina; Mizumoto, Miki; Hikitsuchi, Tatsuo; Ogawa, Kohei; Ozawa, Nobuaki; Tachibana, Yoshiyuki (2021-08-26). "Factors affecting the grieving process after perinatal loss". BMC Women's Health. 21 (1): 313. doi: 10.1186/s12905-021-01457-4 . ISSN   1472-6874. PMC   8394104 . PMID   34446003.
  30. ↑ Grauerholz, Kathryn R.; Berry, Shandeigh N.; Capuano, Rebecca M.; Early, Jillian M. (2021-05-12). "Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider". Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.673050 . ISSN   1664-1078. PMC   8149623 . PMID   34054675.
  31. 1 2 3 4 Minton, Elizabeth A.; Wang, Cindy Xin; Anthony, Carissa M.; Fox, Alexa K. (December 2023). "The Process Model of Stigmatized Loss: Identity-Threatened Experiences of Bereaved Mothers". Qualitative Health Research. 33 (14): 1262–1278. doi:10.1177/10497323231203643. ISSN   1049-7323. PMID   37848195.
  32. 1 2 3 4 5 6 7 8 Burden, Christy; Bradley, Stephanie; Storey, Claire; Ellis, Alison; Heazell, Alexander E. P.; Downe, Soo; Cacciatore, Joanne; Siassakos, Dimitrios (December 2016). "From grief, guilt pain and stigma to hope and pride – a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth". BMC Pregnancy and Childbirth. 16 (1): 9. doi: 10.1186/s12884-016-0800-8 . ISSN   1471-2393. PMC   4719709 . PMID   26785915.
  33. ↑ Bennett, Shannon M.; Ehrenreich-May, Jill; Litz, Brett T.; Boisseau, Christina L.; Barlow, David H. (2012). "Development and Preliminary Evaluation of a Cognitive-Behavioral Intervention for Perinatal Grief". Cognitive and Behavioral Practice. 19 (1): 161–173. doi:10.1016/j.cbpra.2011.01.002.
  34. ↑ Rossen, Larissa; Opie, Jessica E.; O’Dea, Gypsy (2023-10-23). "A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss". OMEGA - Journal of Death and Dying. doi: 10.1177/00302228231209769 . ISSN   0030-2228. PMID   37871980.
  35. ↑ Pollock, Dr Danielle; Pearson, Dr Elissa; Cooper, Dr Megan; Ziaian, Associate Professor Tahereh; Foord, Claire; Warland, Associate Professor Jane (2021-02-01). "Breaking the silence: Determining Prevalence and Understanding Stillbirth Stigma". Midwifery. 93: 102884. doi:10.1016/j.midw.2020.102884. ISSN   0266-6138. PMID   33246144.
  36. 1 2 3 4 Gold, Katherine J.; Sen, Ananda; Hayward, Rodney A. (1 May 2010). "Marriage and Cohabitation Outcomes After Pregnancy Loss". Pediatrics. 125 (5): e1202–e1207. doi:10.1542/peds.2009-3081. PMC   2883880 . PMID   20368319.
  37. 1 2 3 4 5 Avelin, Pernilla; Rådestad, Ingela; Säflund, Karin; Wredling, Regina; Erlandsson, Kerstin (2013). "Parental grief and relationships after the loss of a stillborn baby". Midwifery. 29 (6): 668–673. doi:10.1016/j.midw.2012.06.007. PMID   22863238.
  38. 1 2 Martin, Terry L.; Doka, Kenneth J. (2000). Men Don't Cry, Women Do: Transcending Gender Stereotypes of Grief. Psychology Press.
  39. 1 2 Cacciatore, Joanne; DeFrain, John; Jones, Kara L. C.; Jones, Hawk (24 November 2008). "Stillbirth and the Couple: A Gender-Based Exploration". Journal of Family Social Work. 11 (4): 351–372. doi:10.1080/10522150802451667. hdl: 2286/R.I.28306 .
  40. ↑ Persson, Margareta; Hildingsson, Ingegerd; Hultcrantz, Monica; Kärrman Fredriksson, Maja; Peira, Nathalie; Silverstein, Rebecca A.; Sveen, Josefin; Berterö, Carina (2023-08-15). Raghuveer, Pracheth (ed.). "Care and support when a baby is stillborn: A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries". PLOS ONE. 18 (8): e0289617. Bibcode:2023PLoSO..1889617P. doi: 10.1371/journal.pone.0289617 . ISSN   1932-6203. PMC   10427022 . PMID   37582089.
  41. 1 2 3 4 Thornton, Rebecca; Nicholson, Patricia; Harms, Louise (2020). "Creating Evidence: Findings from a Grounded Theory of Memory-Making in Neonatal Bereavement Care in Australia". Journal of Pediatric Nursing. 53: 29–35. doi:10.1016/j.pedn.2020.04.006. PMID   32344367.
  42. ↑ Alvarez-Calle, María; Chaves, Covadonga (2023-06-01). "Posttraumatic growth after perinatal loss: A systematic review". Midwifery. 121: 103651. doi: 10.1016/j.midw.2023.103651 . ISSN   0266-6138. PMID   36963142.
  43. ↑ Nournorouzi, Leila; Nourizadeh, Roghaiyeh; Hakimi, Sevil; Esmaeilpour, Khalil; Najmi, Leila (2022-08-25). "The effect of a coping program on mothers' grief following perinatal deaths". Journal of Education and Health Promotion. 11 (1): 248. doi: 10.4103/jehp.jehp_1156_21 . ISSN   2277-9531. PMC   9621366 . PMID   36325232.
  44. ↑ Rossen, Larissa; Opie, Jessica E.; O’Dea, Gypsy (2023-10-23). "A Mother's Voice: The Construction of Maternal Identity Following Perinatal Loss". OMEGA - Journal of Death and Dying. doi: 10.1177/00302228231209769 . ISSN   0030-2228. PMID   37871980.
  45. 1 2 Shaohua, Liu; Shorey, Shefaly (2021). "Psychosocial interventions on psychological outcomes of parents with perinatal loss: A systematic review and meta-analysis". International Journal of Nursing Studies. 117: 103871. doi:10.1016/j.ijnurstu.2021.103871. PMID   33548593.
  46. 1 2 Xie, Jiaying; Hunter, Andrew; Biesty, Linda; Grealish, Annmarie (2024). "The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review". International Journal of Nursing Studies. 157: 104814. doi:10.1016/j.ijnurstu.2024.104814. PMID   38833996.
  47. 1 2 Jarvis, Keri (2019-09-01). "Swanson's Theory of Caring: An Application to the Role of Nursing Education". International Journal for Human Caring. 23 (3): 266–271. doi:10.20467/1091-5710.23.3.266. ISSN   1091-5710.
  48. 1 2 3 Shaohua, Liu; Shorey, Shefaly (2021). "Psychosocial interventions on psychological outcomes of parents with perinatal loss: A systematic review and meta-analysis". International Journal of Nursing Studies. 117: 103871. doi:10.1016/j.ijnurstu.2021.103871.
  49. ↑ Navidian, Ali; Saravani, Zahra; Shakiba, Mansour (2017). "Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths". Issues in Mental Health Nursing. doi:10.1080/01612840.2017.1315623. ISSN   0161-2840.
  50. ↑ Sun, Shiwen; Li, Junqin; Ma, Yuanying; Bu, Huilian; Luo, Qiong; Yu, Xiaoyan (2018). "Effects of a family-support programme for pregnant women with foetal abnormalities requiring pregnancy termination: A randomized controlled trial in China". International Journal of Nursing Practice. 24 (1): e12614. doi:10.1111/ijn.12614. ISSN   1440-172X.
  51. ↑ Xie, Jiaying; Hunter, Andrew; Biesty, Linda; Grealish, Annmarie (2024). "The impact of midwife/nurse-led psychosocial interventions on parents experiencing perinatal bereavement: An integrative review". International Journal of Nursing Studies. 157: 104814. doi:10.1016/j.ijnurstu.2024.104814. PMID   38833996.
  52. ↑ Nasrollahi, Masumeh; Ghazanfar Pour, Masumeh; Ahmadi, Atefeh; Mirzaee, Mogaddameh; Alidousti, Katayoun (2022-12-29). "Effectiveness of mindfulness-based stress reduction on depression, anxiety, and stress of women with the early loss of pregnancy in southeast Iran: a randomized control trial". Reproductive Health. 19 (1): 233. doi: 10.1186/s12978-022-01543-2 . ISSN   1742-4755. PMC   9801648 . PMID   36581926.
  53. ↑ Canada, Public Health Agency of (2023-10-13). "Message from the Minister of Mental Health and Addictions and Associate Minister of Health – Pregnancy and Infant Loss Remembrance Day". www.canada.ca. Retrieved 2024-11-13.
  54. ↑ Congress of the United States (2006-09-28). "H. CON. RES. 222 Supporting the goals and ideals of National Pregnancy and Infant Loss Remembrance Day". www.govinfo.gov. Retrieved 2024-11-13.
  55. ↑ "Remembrance day for lost babies". Yahoo News. 2014-10-15. Retrieved 2024-11-13.
  56. ↑ Reporter, Staff (2020-10-14). "'Wave of Light' event for Pregnancy & Infant Loss Awareness Day this Thursday". Limerick Post Newspaper. Retrieved 2024-11-13.
  57. ↑ "About – Baby Loss Awareness Week" . Retrieved 2024-11-13.
  58. ↑ "Global Wave Of Light 2024 - Awareness Days Events Calendar 2024" . Retrieved 2024-11-13.
  59. ↑ "A Walk to Remember". PAIL Network. Retrieved 2024-11-13.
  60. ↑ Carper, Theresa (2020-10-15). "Pregnancy and Infant Loss Remembrance Day". National Today. Retrieved 2024-11-13.
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