Perinatal Death - Losing the Baby During Pregnancy
It’s the wish of any parent for their baby to be healthy. Unfortunately, this is impossible when perinatal death occurs. This unexpected outcome is usually due to complications that may arise throughout the pregnancy.
Parents need to go through a path of emotional recovery and reestablish new future illusions when this happens. This is because it’s an experience that deeply puts a dent in one’s soul. Indeed, its memory remains forever in the hearts of the parents but there’s a possibility to emerge from the pain and build new possibilities.
“I’m not functioning very well. Living with the knowledge that the baby is dead is painful. I feel so far away from you, God. I can only try to believe that you are sustaining me and guiding me through this. Please continue to stand by my side.”
-Christine O’Keeffe Lafser-
The physical changes in a woman and perinatal death
Pregnancy involves a journey of physical and emotional preparation. There’s proof that the brains of mothers change during this period. This is because the body prepares to attend to and meet the needs of the child. According to a study published in 2010, the mother generates new neural connections in specific areas of the brain during gestation.
The hippocampus, a brain structure that regulates emotions, is among them. It also increases the production of some hormones such as prolactin (to promote milk production) and oxytocin (to relax the parasympathetic system). This occurs for the purpose of reducing the mother’s anxiety and promoting contractions during labor.
Different investigations have tried to determine the impact of stress on the mother and the fetus. In this regard, researchers determined that maternal stress during gestation could condition the emotional and behavioral development of her child. Even up to the onset of adulthood.
Stressful life events in the first trimester of pregnancy increase the risk of perinatal death (Nepomnaschy et al., 2006) or experiencing congenital alterations (Izquierdo and Ximenez, 2019).
A continued state of anxiety during pregnancy causes physical changes in the child. Most specifically in the brain circuitry responsible for controlling stress responses.
Maternal stress can originate from many things: psychosocial deficiencies, complications during pregnancy, psychiatric illnesses, emotional imbalances, etc. Thus, the fetus will either respond adaptively or become highly vulnerable.
Taking the above into account, it’s best for the mother, the main context of pregnancy, to be in an environment in which she feels supported and protected. A safe and structured context enhances the gestation process. It acts as a protector against future physical and psychological complications.
Does pregnancy affect maternal mental health?
Contrary to the scientific community of the last century, motherhood has no protective factor on women’s psychological health, at least according to Izquierdo and Ximenez (2019). In fact, the most updated scientific evidence highlights that the process of pregnancy, and what motherhood entails, can become a breeding ground for psychopathological maladjustments. Being a mother implies strong physical, cognitive, emotional, and social changes from the very beginning.
Motherhood is supposed to entail absolute happiness and fulfillment. This biased approach can isolate those women who don’t experience the process in this way, none of them. This is because motherhood is often stressful, and presenting only the good side doesn’t really help.
The journey can be complex, depending on each woman’s circumstances. Lack of socioeconomic support, illness, relational problems with a partner, or emotions of insecurity, guilt, or sadness are some of the reasons that complicate motherhood.
According to Navarro and his collaborators (2008), the mental pathologies most present in mothers during the perinatal stage are affective disorders, depression, and anxiety disorders.
In this regard, the Spanish General Council of Psychology recently published that one in five women experience mental disorders during the perinatal period. Also, there’s a lack of specialized psychological care in the public system to treat and prevent the development of these disorders. Thus, there’s an urgent need to increase investment in maternal mental health.
The psychological impact of perinatal death
Perinatal death is just one of many complications that can occur during pregnancy. According to statistics, the rate of spontaneous abortion increases with the mother’s age, being less than 15 percent under 35 years of age, 25 percent between the ages of 35 and 40, and more than 50 percent in women over 40.
In addition, more than 80 percent of miscarriages occur before 12 weeks. In more than 60 percent of cases, they’re due to alterations in the chromosomes of the embryo. Furthermore, the psychological mourning process for perinatal death has several stages:
- Shock. The main characteristic here is confusion and despondency in the face of what happened. Denial and mixed feelings of unreality are common.
- Longing. This manifests through intense feelings of grief and anxiety. A strong rage wells up from within, along with the insecurity and pain caused by the separation.
- Disorganization. The mind is invaded by constant thoughts about the loss during this stage. There are desperate rumination and a lack of hope. Thus, the vision for the future depresses the person.
- Reorganization and recovery. The reconstruction of reality begins with a new meaning in the face of the absence. The loss integrates at an emotional level and feelings pacify. The mind opens to the projection of the future. It doesn’t imply that a person forgets. However, they can start a more functional life.
It’s common for the “anniversary effect” to occur once a person overcomes the mourning process. That is to say, the transitory emotional worsening coinciding with special dates — the day of the loss or the estimated dates of birth.
It’s also important to note that every person experiences the grief process in their own unique and intimate way. The same response isn’t to be expected in all those who experience such painful experiences.
Every parent needs their own pace of coping with the loss. There are no written rules about the estimated time to overcome the death of a child. Thus, the emotional healing process will take its own shape and path in each individual.
Psychotherapy, the key to healing
According to empirical evidence, the absence of a psychological approach when a mother experiences some difficulty can have negative consequences on the physical and neurological development of their baby. For example, a depressive disorder in the mother has been associated with spontaneous termination of pregnancy, prematurity, low birth weight, instrumental delivery, and/or hemorrhage.
Once the baby is born, the literature identifies several consequences: sudden death, growth retardation, physical deterioration, colic, irritability, attention deficit, behavioral disorders, or language delay, among others.
Psychological intervention is of unquestionable importance because the mother’s mental health has a direct impact on the development of the fetus. Psychotherapy can help overcome grief over the loss of a child, cope with postpartum depression or depression during pregnancy, deal with anxiety disorders and post-traumatic stress, abandon addictions, and prevent complications during pregnancy, among others.
Therapy provides psychological strategies for those in pain. It’s also an important means of prevention to avoid the development of perinatal mental disorders, identifying risk factors in advance, and acting on them. Above all, psychotherapy is the door to hope when you believe there’s no way out.