The loss of a desired child, whether during pregnancy, at birth or shortly after delivery, is a dramatic experience.
A traumatic situation that abruptly interrupts the parenting process and the bond of attachment being built, leading to intense emotional shock and a deep experience of grief.
The lack of social and cultural recognition of perinatal bereavement, which is often totally denied or minimized, leaves the couple and families in solitude and silence. This is why it becomes necessary to sensitize all health professionals, so that parents and bereaved family members can receive adequate psychological support.
The lack of legitimacy of the pain associated with the loss, together with often inappropriate assistance, the absence of socio-emotional support and the lack of spaces for expert support, are among the main factors that can lead parents to complications in bereavement. with the risk of further damaging effects on their psychophysical health.
Although there are no right and equal reactions, ways and times for everyone to live and go through mourning, giving oneself the opportunity to tell what happened, to share one’s emotions and thoughts, without judgments and prejudices, can help to many parents who have suffered the loss of a child.
Every pregnancy, regardless of its duration and its outcome, is an integral part of the life history of the mother and of the parental couple and every child, at any week of life, has its indisputable importance.
In perinatal bereavement the needs are few and simpler than people think. Through participatory listening, the health professional has a key role in the management of perinatal death: if he can provide sensitive support and the presence of adequate care, he can facilitate the processing of parental grief, on the contrary, with incorrect attitudes, he can hinder the processing process.
Giving parents the opportunity to think about what still can and must be done and to decide consciously, giving them the right time and explaining the right options, reassures them of their ability to have been able to manage that dramatic moment and makes it better. mourning.
When faced with a parent who has lost the child before or after birth, the caregiver often has a difficult role, that of communicating the news and offering support at the same time. The communication of death is painful, for those who do it and for those who receive it, but it is important to seek a participatory contact with the parent.
It would be appropriate to break the news by looking parents in the face, with simple words and promoting an attitude of openness, availability and sincere displeasure. Everyone remembers what they were told years later and how it was said, and poor communication has a traumatic effect on the parent. In general, anything that tends to underestimate the importance of that child’s loss and death or to insinuate some kind of responsibility is inappropriate anyway.
It is important to try to be available and above all not to avoid the topic, without pushing people to talk about what happened if they do not hear it first. For parents, perceiving a little interest can be of great comfort; it is essential never to trivialize this loss, not to belittle it.
It is good practice to offer parents the opportunity to hug and touch their child and have the time to get to know and greet their child, in an environment that is as protected as possible. Many mothers have some sort of rejection and initially ask not to see the baby. This decision can and must be considered so as not to create future anguish and guilt.
Parents need to end that specific parenting journey with that child, even if things went the worst way. There are many mothers who need to give a real face to the imaginary child, they need to keep memories in order to be able to adequately overcome mourning; having memories is an important part of bereavement, whereas having nothing increases the feeling of precariousness and emptiness that parents feel in these cases.
Some mothers prefer, after having appropriately discussed it with operators and family members, not to see their children; this decision must be respected without insistence, and it is in these cases that the operator must offer to collect the child’s memories on behalf of the parents.
We must also reflect on the fact that outside the hospital, the path of mourning will inevitably continue and parents will be called to deal with the death of their child. The loss of a child during the perinatal period drastically changes the existential path of the parental couple: this mourning, often misunderstood and denied in its drama, can permanently alter the emotional and psychological balance of the parents, who remain anchored to that loss without progressing in the path of mourning.
Having lost a child in the perinatal period represents a known psychological and behavioral risk factor also for subsequent pregnancies and for the future parent-child attachment style: an appropriate approach to bereavement is therefore essential, by all operators, for health of parents and to provide optimal care. Basic training often does not include the treatment of psychological aspects and difficult events, so many operators find themselves unprepared, even though they have to deal with death periodically.
The operator, on the other hand, who recognizes that child as a human being worthy of respect and care, who pays attention to that body by providing the little care it needs after death, who is not frightened, creating the conditions for that creature to be let go by parents in the best way, significantly helps parents to embark on a good path of mourning.
The role of the healthcare professional is to adopt a good practice (not only technical, but also emotional and empathic) of working with the parent, trying to understand each time the particular needs of that couple. Many parents, even after years, clearly report memories linked to bad assistance and the deep state of abandonment and neglect in which they were left, especially at the worst moment (diagnosis of intrauterine death, childbirth, discharge).
Numerous studies that deal with psychic trauma study the individual’s ability to cope with a negative event and overcome it without psychopathological consequences, observe how in addition to the mourning event, even any additional traumas, related to the context, are a source of considerable distress. psychological and complicate grieving considerably. Many studies tell us that an understanding and empathic attitude on the part of the operators facilitates a correct process of bereavement in parents.
Remember that the death of a child during pregnancy or in the perinatal period is an unexpected and sudden event, even during a high-risk pregnancy; family members are emotionally unprepared when faced with this situation. For parents this is often the first direct encounter with the death of an important person and it can be very difficult, in the acute phases, to organize possible choices rationally and clearly.
In the very early stages of shock and confusion, the operator has the task of supporting the parent and guiding him without influencing his choices or choosing in his place, he has the task of informing the parent of all the possibilities present and for this he must accurately know the protocols on perinatal bereavement and all possible treatment options.
For parents, at any gestational age, a child is a child, a person, and needs respect, remembrance and memory; therefore particular attention should be paid to ways of referring to the event. For these reasons, in many countries around the world there are protocols that provide not only assistance to the parent, but also training and assistance to the operator, considering his central role for the elaboration of grief and for the correct management of post-loss pregnancies.
The behavior of health workers can contribute to a better adaptation to the situation and a participatory presence of those who offer support at this time is very important. In some cases participatory silence is needed, in others a simple explanation of the causes may be needed. Feeling alone in such a dramatic moment increases anxiety levels and makes it difficult to properly process the trauma.
The most frequent emotions experienced after a prenatal bereavement experience are guilt and shame, which can cause couples not to seek comfort in others and to feel even more loneliness and bewilderment. Mothers live not only the experience of mourning but also a deep existential wound, which can generate thoughts of inability to generate a life and carelessness in having been able to protect their child. This type of depressive and guilty brooding is greater in mothers who have invested in pregnancy, as a moment of realization of their existence.
The loss of a child can be counted among the most traumatic experiences in a man’s life, a mentally and physically devastating experience, capable of undermining the deepest beliefs, the vision of life, emotional relationships and the meaning and the self image.
The drama of pre and perinatal bereavement can be partially alleviated if the figures involved in the loss can rely on competent, sensitive and empathic people, capable of providing them with a space for listening, human understanding, emotional support, clear and complete communications, times and spaces. adequate. For this reason it is good that those who have been victims of such a dramatic event turn to competent professionals who support them in the slow and gradual process of processing a suffering.
Self-help groups and associations in the sector (eg Ciao Lapo) are a valid help because they provide information and support, and encourage sharing between parental couples who live the same condition. Psychotherapy can also provide valid support to accompany people towards the elaboration of the traumatic experience (eg working protocols with EMDR techniques ).
The death of a child during the perinatal period is a serious life event, which leaves an indelible mark on the lives of parents and families; the loss of a child is a difficult event for everyone, including health professionals, to deal with simply because it is an unnatural and humanly painful event. Caring for children affected by perinatal death is a very particular, complex and emotionally relevant moment in the clinical practice of healthcare professionals.
The international literature provides for ongoing support to the parental couple, based on the participation and capillary organization of intervention protocols, which involve intra and extra hospital figures in order to create a protective and participatory core.
In many foreign hospitals there is a psychological assistance service for families and for members of the hospital staff, in order to process the experiences of loss both in the parents and in the operators involved in the acute phase (and not late, after discharge, when everything has already happened).
Respect and indisputable recognition of the value of each life is essential to understand the pain of parents and to intervene in a professional but empathetic way during all stages of the journey.
