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While the focus of this chapter is on perinatal loss, other reproductive losses including miscarriage, ectopic pregnancy, infertility, and pregnancy termination for fetal anomaly are briefly considered and contrasted.
The growing recognition of the usually intense grief after perinatal loss culminated in the first major study of this death by Peppers and Knapp 7 infollowed by more than a dozen handbooks over the next decades directed at bereaved parents.
Illumination of the typical pattern of profound grief after this type of death coincided, ironically, with richly textured descriptions of the individualized reactions to perinatal loss.
In her mind she maintained the continuity of the cycle of life. By kissing the umbilicus she was remembering her creative link with the baby in utero; kissing the mouth may be linked to the kiss of life, to resuscitation.
The mother longed for her son to grow teeth and learn to walk. Creating memories about her baby in this way facilitated mourning. See reviews by Leon 1112 and Zeanah 4 for more extended discussion.
Studies in the United States, Canada, Great Britain, Sweden, and Australia revealed a similar pattern of intense grieving after this loss.
However, methodological weaknesses such as failing to use measures specific to perinatal loss or to track the trajectory of this grief made it difficult to clearly understand what is unique about death at the inception of life and also made it difficult to detect early high-risk factors leading to later psychological difficulty.
Hospital practice, however, dramatically improved. This decade marked the increasingly routine use I ll explain it to you by deborah tannen protocols embedded in perinatal bereavement programs helping parents to grieve the death of their child.
Kellner 13 pioneered perhaps the earliest multidisciplinary, hospital-based Perinatal Mortality Counseling Program integrating effective counseling with data collection and research. Finally, nonmedical caregivers played a crucial role in spawning self-help groups and materials emphasizing the importance of developing social support and recognition for this previously ignored loss.
Under the direction of Sister Jane Marie, for more than a decade, SHARE founded in provided a model for more than community-based self-help groups oriented to pregnancy loss throughout the United States and other countries.
Improving Research and Individualizing Care During the late s and throughout the s, more sophisticated questionnaire measures of perinatal loss were developed, helping to longitudinally track long-term outcome as well as understand the different dimensions of this loss.
Using their Perinatal Bereavement Scale, Theut and colleagues 1819 reported that recovery from pregnancy loss was often facilitated by a successful subsequent pregnancy. This scale has been used among subjects in 22 studies from 4 countries with strikingly consistent findings.
The emotional expression embodied in "active grieving" has been shown to limit more extended and despairing grief, and dreaming has been reported to facilitate coping with grief. One study of middle-class, mostly college-educated, African-American women indicated the importance of sharing grief with family and support networks, nurturing memories and keeping memorabilia of the baby, and considering a subsequent pregnancy with trepidation—all common findings in the usual middle to upper-middle class population of almost all perinatal loss studies.
In discussing the psychological tasks confronting the parents after perinatal loss, the corresponding meanings of pregnancy will be reviewed.
Mourning the Death of a Baby Attachment to the Baby-to-Be By the last trimester of pregnancy, both expectant parents, but especially the mother, develop an intense attachment to their unborn child as a unique, separate person, 26272829 indicating the importance of applying attachment theory in understanding perinatal loss.
I feel this is a very, very emotional and intense child—very active. Very verbal and very intense. I cried when something beautiful happened at work. I was sure the baby cried, too. The baby kicked and kicked. It felt what I was feeling. He likes to stay up and observe things. Likes human contact, likes a lot of love.
As the reality of the death is gradually absorbed, the bereaved yearns for the return of the deceased. Inconsolable sadness and preoccupation with memories of the deceased, with intensely painful periods of loneliness, guilt, anger, and hopelessness over ever feeling better periodically wash over the bereaved in waves of emotion.
Over the next year or two, the bereaved gradually becomes reconciled to this permanent loss.
There is a resumption of everyday activities, a renewed interest in other relationships and the world in general, and a restored capacity to feel pleasure.
Perinatal loss is frequently traumatic, occurring quite suddenly and without any anticipation in this age of high technology, where there is the increasing belief that deaths like this no longer occur.
Children are not supposed to die before their parents do. It leaves bereaved parents feeling more helpless and dazed, doubting the reality of what has happened.
By preventing a more gradual, manageable, and total assimilation of the reality of the loss and the pain of active grieving, traumatic deaths often lead to a less completely resolved loss than deaths after a terminal illness.
Grieving demands recollecting the sights, sounds, smells, and touch of the beloved—the favorite chair in which he would sit, the sound of his laughter, and the image of his smile.
When the unborn child dies, there is so little to grieve—very limited sensory memories or interactions and, in times past, not even a body to see. So much of perinatal loss involves grieving the loss of the future: Because the identity of the baby in perinatal loss is initially so vague, ephemeral and lacking social validation, finding ways to, respectively, distinguish, remember and memorialize this loss is particularly crucial.
Rituals may become a vital means to purposefully create meaning, especially when personalized by the parents rather than following the caregivers' agenda or preferences.Auto Suggestions are available once you type at least 3 letters.
Use up arrow (for mozilla firefox browser alt+up arrow) and down arrow (for mozilla firefox browser alt+down arrow) to review and enter to select. Rebecca Solnit, a TomDispatch regular, is the author of 17 books, including an expanded hardcover version of her paperback indie bestseller Men Explain Things to Me and a newly released anthology of her essays about places from Detroit to Kyoto to the Arctic, .
Linguist Deborah Tannen described a similar phenomenon, noting that repeated exclamation points in a message can convey a sincere tone, like in the following text message. JACKIE I AM SO SO SO.
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Deborah Tannen holds the esteemed rank of University Professor at Georgetown University in Washington, D.C. A respected linguistics scholar who has written extensively within the scholarly community, she is also author of six books for popular audiences, .