There are approximately 2.4 million miscarriages и stillbirths in the U.S. each year, which means that most women of childbearing age are likely to either experience perinatal loss or know someone else who has gone through it. In fact, miscarriage, which is defined as the loss of a pregnancy before 20 weeks gestation, affects between 10% and 20% of known pregnancies. Stillbirth, which is the loss of a child between 20 weeks gestation and delivery, происходит in 1 out of 177 pregnancies in America (0.5%). In this article, we will discuss perinatal loss, which includes miscarriage, stillbirth, and neonatal death, which is the death of a baby in the first 28 days after birth.
Unfortunately, many medical providers are not equipped with the training necessary to sensitively and effectively care for patients facing perinatal loss. In fact, some women have expressed that they felt like their experience was downplayed or inadequately acknowledged by their doctor. While perinatal loss is a reality that healthcare professionals face on a regular basis (potentially making it seem less significant to them), the personal nature of the loss for expectant parents (as well as the often unexpected timing) can lead to serious grief.
When grieving parents are not met with the care and guidance they need during their time of loss, they may experience complicated grief, because they don’t have the necessary tools to process their grief. This reality reveals the need for healthcare professionals to be informed about perinatal loss and prepared to help parents experiencing loss in a holistic way.
Common responses to perinatal loss & infertility: The effects of trauma
As with any type of loss or suffering, the way each person responds to perinatal loss is unique and dependent on many interacting factors. Specifically, though, miscarriage, stillbirth, and neonatal death can have profound consequences because of the way it impacts a person’s neuropsychological state [1]. One mental health professional whose focus is to help couples navigate the process of reproductive grief asserts that reproductive loss will affect a couple’s expectations about the future, and may even cause ontological death, which is a disruption of the dreams inherent to a person’s identity (such as parenthood). The Institute of Reproductive Grief Care нашёл that 60% of people who have experienced perinatal loss will face depression, anxiety, or PTSD.
The Institute of Reproductive Grief Care has found that 60% of people who have experienced perinatal loss will face depression, anxiety, or PTSD.
Specifically, trauma experienced due to perinatal loss can dysregulate the HPA axis, which can disrupt the hippocampus (and cause neurotransmitter imbalances). Depending on the severity of the trauma and the effectiveness of interventions received, a person may experience memory impairment, attention deficits, and emotional imbalances. They may struggle to process their experience and find themselves “stuck” in their grief. Some common experiences of people facing perinatal loss include послеродовая депрессия, post-traumatic stress disorder (PTSD), and disenfranchised grief. In fact, women experiencing perinatal loss are four times as likely to screen positively for depression and seven times as likely to screen positively for PTSD [2].
Послеродовая депрессия
In an earlier Natural Womanhood статья, we outlined potential causes of postpartum depression (PPD), which might include “a combination of genetics, the physical changes a woman undergoes after giving birth (especially hormonal changes, such as seriously low progesterone), …and the difficulties/life changes that come from caring for a newborn.” While a mother experiencing perinatal loss is not living with the same realities as a mother of a newborn, her body is still undergoing many of the same biological processes. This, coupled with the grief she is experiencing, makes it far more likely that she will experience PPD [2].
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) also commonly affects people who have experienced infant loss. In fact, rates of PTSD for those who’ve experienced infant loss are as high as 43%, despite the population rate being 2-3%. Because trauma evokes a physiological response that impacts how the brain responds to stress, it may have long-term effects on how individuals cope with stress. In parents who have experienced perinatal loss, PTSD could be experienced as hyperarousal, intrusive memories, and avoidance. Even if they bring home a healthy baby after experiencing loss, it is not uncommon to continue experiencing and responding to fears from the past. For example, a father who’s previously experienced the death of a child might anxiously wake up multiple times per night to make sure his baby is still there or hasn’t stopped breathing.
Disenfranchised Grief
Finally, it is worth noting that perinatal loss is often experienced as disenfranchised grief, or grief that cannot be publicly mourned. All too often, outsiders may struggle to respond to the grief of bereaved parents. And, because they don’t know how to help, they may not acknowledge the situation at all. This can lead suffering parents to feel even more isolated, and feel as though they must face their grief alone, which can exacerbate symptoms.
Realities of perinatal loss that may not be considered
While psychological realities are important to be aware of, many people experience enhanced grief and mental health symptoms because they were unprepared for the physical realities of perinatal loss. Sometimes their lack of awareness is because of their doctors’ intentions to “protect” them (because they think information about what is to come will cause more harm than good). However, in the case of perinatal loss, knowledge is power, and equipping grieving parents with information about what is to come will enable them to prepare well.
In the case of perinatal loss, knowledge is power, and equipping grieving parents with information about what is to come will enable them to prepare well.
Early loss
The physical symptoms of early pregnancy loss will vary, depending on the gestation of the pregnancy when it ends. The mother may experience a myriad of symptoms, including but not limited to, light to heavy bleeding, cramping, and discharge.
Later loss
If the loss was later in pregnancy, the mother will likely experience symptoms similar to those experienced after a healthy delivery (which can last for 6 weeks or more). These can include bleeding, soreness, discharge, cramps, hemorrhoids, incontinence, hair loss, skin changes, sore breasts, and weight changes.
Additionally, women experiencing a later loss (including the second trimester) are likely to begin lactating, and may even have a full milk supply come in 3-5 days after birth. If women are unaware of this, they may come home after delivery grieving, only to be surprised by their incoming milk supply, which can serve as an unwelcome reminder of the loss of their baby.
Finally, women (and their partners) may experience a variety of emotions due to fluctuating hormones and grief, which may be further impacted by the various responses from family, friends and their community. Grieving parents may also struggle spiritually after loss.
What grieving parents need
After experiencing perinatal loss, the best way (for medical professionals, mental health care professionals, or someone else) to care for grieving parents is to equip them with responsive care and supplies. Project Poppyseed, an organization committed to researching perinatal loss, offering education, and responding effectively to parents, suggests that hospitals and women’s health clinics provide grieving parents with a perinatal loss care package that includes:
- Plenty of pads to manage bleeding
- Information:
- What the mother will physically experience
- How other people may respond
- Affirmation that the loss is real and significant and no response is bad
- That it may also be helpful to explain that people grieve differently so that partners can empathize and more effectively respond to one another
- A lactation consultation
- This will provide the mother with all of the information she needs about her incoming milk supply, as well as how she can respond. Some women choose to donate their breastmilk to a milk bank in memory of their baby, while others may wish to suppress milk production. While either decision should be supported, the most important thing is that women do not ignore lactation, as doing so can lead to mastitis and other issues.
- Referrals for mental healthcare, if they should decide they desire counseling
- Attentiveness to the father
- It can be easy to overlook the father of the lost baby, but men are deeply affected by perinatal loss too.
How to cope after perinatal loss
For anyone who has experienced perinatal loss, please know that you are not alone. Perinatal loss is a devastating experience that, unfortunately, many people face, but that does not make it any easier to cope with in the midst of deep pain and grief. So what do you do? How do you respond? You may even find yourself wondering if you properly grieved after perinatal loss than happened months, years, or even decades ago (if this is you, know that it’s okay if you need to go back and process a loss from the past).
First of all, give yourself permission to be not okay. Life is не going to just magically go back to normal one day, and acknowledging this is a necessary part of grieving. Healing is an ongoing process, so it’s important that you learn how to encounter your negative emotions and do so effectively. Be honest with yourself (and your partner or a close friend, if you feel comfortable) about how different settings, activities, and interactions make you feel, and accept that it’s okay if you need to take time away from something for a while. You might also consider how you feel about your current coping mechanisms. How are they serving you? (Rather than categorizing coping mechanisms as good or bad, reflect on what needs you have those mechanisms are helping to meet).
Additionally, know that it is okay to ask for help. And don’t be afraid to set boundaries for yourself. People might mean well, but it’s perfectly appropriate to advocate for yourself and let people know that “it’s not helpful when you say…”, or “It hurts my feelings when…”, or even to let them know that they don’t have to fill the silence. If you don’t feel comfortable doing so, you might consider asking your partner to speak on your behalf or writing a letter.
For more resources on perinatal loss, see:
*Author’s note: While this article primarily covered information about perinatal loss (miscarriage and stillbirth), research has shown that couples who have experienced infertility are also likely to have many of the same responses, especially in terms of mental health. You deserve respect, help, and answers, too.
Ссылки
[1] Theodoratou M, Kougioumtzis GA, Yotsidi V, Sofologi M, Katsarou D, Megari K. Neuropsychological Consequences of Massive Trauma: Implications and Clinical Interventions. Medicina (Kaunas). 2023 Dec 6;59(12):2128. doi: 10.3390/medicina59122128. PMID: 38138231; PMCID: PMC10744839. [2] Gold KJ, Leon I, Boggs ME, Sen A. Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample. J Womens Health (Larchmt). 2016 Mar;25(3):263-9. doi: 10.1089/jwh.2015.5284. Epub 2015 Aug 10. PMID: 26258870; PMCID: PMC4955602.