Perinatal Grief and Mourning: Phases and Protocol

July 4, 2019
There’s a lot of disinformation about the process of perinatal grief. However, there are hospitals with bereavement protocols to support parents. Read on to learn more!

The loss of a loved one is always complicated. But what happens when that loss occurs during pregnancy? Today, we’d like to tell you about perinatal grief. We see it fit to shed some light on a nearly invisible topic that occurs more often than most may think. Also, there’s too much misinformation about it.

In the USA, fetal death refers to “the spontaneous intrauterine death of a fetus at any time during pregnancy”. Fetal deaths later in pregnancy, at 20 weeks or more, or 28 weeks or more, are also sometimes referred to as stillbirths.

The fetal mortality rate for pregnancies of at least 20 weeks, 5.96 fetal deaths per 1000 live births and fetal deaths, was similar to the infant mortality rate of 5.98 infant deaths per 1000 live births. (Fetal death data is published annually by the National Center for Health Statistics, in reports and as individual-record data files).

Definitions

The WHO, in the 10th revision of the International Classification of Diseases (ICD-10), differentiates perinatal loss as follows:

  • Early fetal death refers to fetus deaths when they’re less than 22 weeks of gestation and/or less than 17 ounces of weight. This is what’s known as abortion.
  • Intermediate fetal death includes fetuses between 22-28 weeks of gestation and/or weight between 17-35 ounces.
  • Late fetal death includes fetus deaths from 36 ounces of weight and/or greater than 28 completed weeks of gestation.
A seemingly depressed woman

Some authors extend the concept of grief. It includes:

  • Instances of abortion (voluntary and involuntary).
  • The voluntary interruption of pregnancy due to health problems of the fetus or because they impair the mother’s health.
  • Selective reduction in multiple pregnancies.
  • Intrapartum or intrauterine fetal death.
  • The loss of multiple pregnancies and the newborn.

Also, loss during pregnancy hasn’t always been this important. Currently, thanks to more information and more sensitivity towards this event, there are many protocols available. They’re aimed at supporting parents during their grieving process.

Protocol for Perinatal Loss and Grief

There’s a lot of good information on this subject on this website. Also, there are many hospitals where these protocols are already carried out.

In the past couple of years, a team of nurses from the Fairview Hospital Birthing Center revamped their perinatal bereavement program to help parents cope after losing a baby. Kathy Ballantine, RN, a staff nurse in Fairview Hospital Birthing Center led the task of expanding the hospital’s perinatal bereavement program in 2014. She and five other nurses are members of the Birthing Center Families Experiencing Early Loss (F.E.E.L.), a committee that facilitates the program and spreads the message about the importance of perinatal bereavement services.

The Good Samaritan Hospital offers perinatal bereavement support for parents to help support them through the various stages of grief and grief reactions. Symptoms of grief can be so overwhelming that it’s often a comfort to learn that these symptoms are a normal reaction to loss. The need to talk about one’s experience over and over is also very common. Their support groups meet monthly.

There are various stages of grief. This is how a professional can help:

After the News

  • Establish a relationship with parents based on sensitivity.
  • Understand the impact of the news on parents.
  • Ensure that parents aren’t alone throughout the process.
  • Offer clear information about the many options available to them. For example, when after performing certain medical tests the baby is found to have no heartbeat, there are two possibilities. One would be the expectant management, which consists of waiting for the body to naturally trigger the elimination of the remains. This process is very similar to that of childbirth. The second option would be curettage, necessary when the mother doesn’t spontaneously go into labor.

During Birth, at Birth

If the parents haven’t expressed any concerns about contact with their child, proceed as naturally and respectfully as you would with any parent who wishes to see their newborn.

After Birth

  • Explain things in a delicate and individualized manner, while parents get to “know” their child.
  • Normalize professional contact with the deceased child to show parents a way forward.
  • Offer the possibility of having some kind of memento of the baby.
  • Respect and fully support the wishes of parents who decline to see or spend time with their child.
  • Evaluate if they want a memento for a while before you offer it.

As of March 21, 2012, laws began allowing the issuance of a Certificate of Still Birth for fetal deaths that meet the definition of a “stillbirth”. The law defines a “stillbirth” as the unintended intrauterine death of a fetus that occurs after the clinical estimate of the twentieth week of gestation.

A grieving father.

Mourning Phases of Perinatal Grief

When someone must confront the loss of a loved one, especially when it comes to their baby, you must respect their freedom. The best way to help them is to try to understand how they feel.

The grief phases parents who lost a baby usually experience are:

  • First, shock and numbness. Also, lightheadedness and functional difficulty –all accompanied by a longing for their baby.
  • Second, disorientation and disorganization in their daily routine. This is tied up to their feeling of emptiness and helplessness.
  • Finally, they begin to reorganize and rebuild their life. In addition, they recover their ability to enjoy their life, but without forgetting about their loss.

There are bereavement resources and measures to support parents who’re coping with the loss of their baby:

  • Within the health field.
  • Referral and information about resources when discharged from the hospital.
  • Offer couples and family members information about resources: web, organizations, self-help groups, etc.
  • Likewise, facilitate emotional expression in the absence of any type of judgment.
  • Provide support during the hospitalization process. Also, listening is a powerful therapeutic tool. In addition, inform and guide to facilitate autonomous decision-making to parents.
  • Likewise, it’s necessary to train health personnel properly. That is, provide them with training skills, tools, and techniques that improve attention to parents’ loss and perinatal grief in the first moments.

Perinatal Grief Bereavement Outside the Health Field

  • Creation and development of information campaigns and social awareness.
  • Creation and dynamization of mutual help groups: aimed at mother and parents, siblings, grandparents, etc.
  • Support and companionship during the grieving process.
  • Orientation in bureaucratic procedures.
  • Grief counseling and therapy: family, couple, or individual.

In short, it’s necessary to train professionals so they can attend, be with, and support both parents and the family environment. All this without forgetting that only the grieving parents should set the pace in the mourning process.

  • Asociación Umamanita (2009): Guía para la atención a la muerte perinatal y neonatal. (en linea) https://www.umamanita.es/wp-content/uploads/2015/06/Guia-Atencion-Muerte-Perinatal-y-Neonatal.pdf
  • García, M. C., Soto, B. R., & Ingelmo, A. O. (2016). PROTOCOLO-GUIA MUERTE FETAL Y PERINATAL.
  • González Castroagudín, S., Suárez López, I., Polanco Teijo, F., Ledo Marra, M., & Rodríguez Vidal, E. (2013). Papel de la matrona en el manejo del duelo perinatal y neonatal. Cad Aten Primaria19(1), 113-117.
  • Oviedo-Soto, S., Urdaneta-Carruyo, E., Parra-Falcón, F. M., & Marquina-Volcanes, M. (2009). Duelo materno por muerte perinatal. Revista Mexicana de Pediatría76(5), 215-219.
  • Paneque, M. D. C. M. (2012). Duelo perinatal: atención psicológica en los primeros momentos. Hygia de enfermería: revista científica del colegio, (79), 52-55.
  • Vicente, N. (2014). Duelo perinatal. El duelo olvidado. Recuperado de https://gredos.usal.es/jspui/handle/10366/128540?fbclid=IwAR1tcqob0J973xlFTzwY3ZYs_c1qwJLNITa7MbyqOY4ghZp4W5-4gnHHQ3E