Loss, Memory and Hope
Pregnancy loss is a difficult topic, too often hidden from view. Recent research, however, has shed light on the importance of helping families to remember, recover and cope with the impact of the loss on future pregnancies.
Finding Support for Perinatal Loss
Bereavement experts stress the importance of recognizing the loss and supporting parents as they process their grief. Physicians and other care providers urge these families to join support groups to share their experience with other grieving and healing families, as these groups have been shown to reduce the risk of lasting depression and anxiety.
One recent study collected data from pregnancy-after-loss support groups and found conflicts between common cultural expectations of how parents should feel after perinatal loss and how the parents actually felt (including whether loss of a pregnancy is the same as the loss of a baby). Group members felt the other participants validated their own perspectives, even when society at large did not. Accepting their own responses to loss led members to learn coping skills.
per·i·na·tal Adj. of, relating to, or being the period around childbirth, especially the five months before and one month after birth: perinatal mortality; perinatal care.
The Gift of Time
Another study suggests that there is some benefit to waiting 12 months after a loss, if possible, before becoming pregnant again. While most women in this study who became pregnant again within a year did not suffer depression, investigators report increased depression and anxiety among those who did become pregnant in this first year, compared with those who waited. The women who gave birth sooner were also more likely to be suffering one year after giving birth to healthy babies than the other group.
The researchers commented that the difference may be due to the need to mourn for at least a year before beginning another pregnancy, or because women who chose to conceive sooner may be intrinsically more vulnerable to depression and anxiety. They also noted that, for some parents, other personal considerations, including maternal age, may outweigh the higher risk of psychological symptoms.
Parents and family members will not forget about their loss after a month or a year, but medical caregivers now know that encouraging them to express their feelings and concerns can help them work through this painful experience, and may help prepare them for a less-stressful subsequent pregnancy.
Impact of Loss on Subsequent Pregnancies
A study of 40 new mothers who had experienced previous perinatal loss found that 45 percent showed symptoms of depression with the birth of a child, while 23 percent of fathers did. Both mothers (88 percent) and fathers (90 percent) reported elevated stress. While maternal depression has been linked with lower maternal-infant attachment in other studies, this study found no correlation between the parents' levels of stress and their ability to attach to their new baby.
Earlier studies also discovered that women with previous pregnancies that ended in stillbirth had significantly higher levels of depression and anxiety during a subsequent pregnancy than those who had not experienced loss.
Depression and anxiety during subsequent pregnancies may surface whether the loss occurred a few weeks after conception, or at term. Depression is signaled by trouble sleeping, social withdrawal, changes in eating habits, and feelings of hopelessness. Anxiety is correlated with a woman's desire to see her care provider more often, and an increased number of phone calls between visits.
While researchers cannot say that this anxiety itself complicates subsequent pregnancies, one study did find a link between maternal adverse reproductive history and increased risk of preterm labor and delivery. Whatever the reason for the link, it underscores the importance of giving bereaved parents the help they need to recover from loss.
Sources: American Journal of Maternal/Child Nursing 26 (2001): 135-40; Journal of Obstetric, Gynecologic, and Neonatal Nursing 33 (2004): 765-73 and 32 (2003): 623-29; Western Journal of Nursing Research 26 (2004): 650-70; Maternal and Child Health Journal 7 (2003): 53-58.
Support for parents is available through peer groups, web sites and reading materials. Here are a few places to start:
On the Web
- A Place to Remember - Features links and other resources for those dealing with troubled pregnancy, pregnancy loss or the loss of a baby.
- Compassionate Friends - Offers support to those grieving the death of a child.
- The Hygeia Foundation - www.hygeia.org - Provides support through message boards and email communities to families who have lost a pregnancy or a newborn.
- March of Dimes - Offers resources for couples, as well as their friends and family, who have lost a pregnancy or a newborn.
The following books are recommended by parents who have experienced prenatal loss and may be reviewed or purchased online from Amazon.com (click on title):
- A Silent Sorrow, by Isabelle Wilkins, M.D., Ingrid Kohn, M.S.W., and Perry-Lynn Moffitt, Brunner-Routledge, 2000.
- Empty Cradle, Broken Heart, by Deborah Davis, Ph.D., Fulcrum Publishing, 1996.
- Free to Grieve, by Maureen Rank, Bethany House, 1985.
- Grieving the Child I Never Knew, by Kathe Wunnenberg, Zondervan, 2001.
- Life After Loss, by Raymond Moody Jr. and Dianne Arcangel, Harper SanFrancisco, 2002.
- Pregnancy After a Loss, by Carol Cirulli Lanham, Berkley Trade, 1999.
- Stillborn: The Invisible Death, by John DeFrain and Leona Martens, Lexington Books, 1986.
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