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Obstetrics and Gynecology Faculty Publications Obstetrics and Gynecology

2016

Infant Loss & Bereavement: A Journey for Families and Health Infant Loss & Bereavement: A Journey for Families and Health

Care Professionals Care Professionals

Kelly A. Rabah Wright State University, kelly.rabah@wright.edu

Follow this and additional works at: https://corescholar.libraries.wright.edu/obgyn

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Repository Citation Repository Citation

Rabah, K. A. (2016). Infant Loss & Bereavement: A Journey for Families and Health Care Professionals. .

https://corescholar.libraries.wright.edu/obgyn/8

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Infant Loss & Bereavement- A

Journey for Families and Health Care

ProfessionalsKe lly Ra b a h, Dire c to r o f Pa tie nt Sa fe ty &

Qua lity Imp ro ve me nt fo r GME

Wrig ht Sta te Physic ia ns

Loss…• Pe rina ta l lo ss inc lud e s infe rtility d uring the

p re c o nc e p tio n p e rio d , fe ta l d e a th d uring

p re g na nc y a nd infa nt d e a th in the first ye a r o f life .

• Lo sing a wishe d -fo r c hild is sta rtling a nd

une xp e c te d .

• Re sp o nse s to this lo ss ra ng e fro m d isa p p o intme nt to

life -c ha ng ing a ng uish (Wo o d s & Wo o d s, 1997).

Types of Loss• Ec topic pre g na nc y

• Ele c tive a bortion

• Fe ta l de a th

• Infe rtility

• Misc a rria g e (sponta ne ous a bortion)

• Ne ona ta l de a th

• Stillbirth

• Sudde n infa nt de a th syndrome (SIDS)

• Sudde n une xpla ine d de a th in infa nc y (SUID)

• The ra pe utic a bortion

Historical Perspective• Ame ric a ’ s p e rsp e c tive s o n d e a th a re e vo lving (SLOO WLY…)

• Altho ug h lo sse s in p re g na nc y a nd b irth we re se e n a s re a l p o ssib ilitie s in the 18th a nd 19th c e nturie s, fa milie s still mo urne d the se lo sse s (Ho ffe rt, 1989).

• Birth mo ve d fro m the ho me to the ho sp ita l in the e a rly 1900s.

• Pa in re lie f e ffo rts le ft wo me n una wa re o f the ir p a in a nd o f a c tua l b irth, whe the r stillb o rn o r live (Le a vitt, 1986).

• The sta g e wa s se t fo r hid ing d e a th fro m wo me n a nd the ir fa milie s; a shro ud o f sile nc e g re w a ro und p e rina ta l d e a th.

Progress…

• Ac kno wle d g e me nt a nd inte g ra tio n o f lo ss into c a re

b e g a n slo wly, b ut it ha s p e rse ve re d .

• The ne e d fo r this a p p ro a c h fo rms the b a sis fo r

tra ining fo r nurse s, b e re a ve me nt c o unse lo rs a nd

re se a rc h into b e st-c a re p ra c tic e s.

Theories of Attachment• Kla us a nd Ke nne l (1976) d e sc rib e b e ha vio rs tha t

d e mo nstra te a b o nd b e twe e n mo the r a nd b a b y

b e fo re b irth.

• Pe p p e rs a nd Kna p p (1980) sho w tha t a tta c hme nt

b e g ins whe n p la nning a p re g na nc y.

• Bo wlb y (1969) wa s the first to id e ntify a nd d isc uss

huma n a tta c hme nt.

Rubin’s Tasks of Pregnancy

• The mo the r: (Rub in, 1984)1. Ensure s sa fe p a ssa g e fo r se lf a nd b a b y

2. Ensure s so c ia l a c c e p ta nc e o f se lf a nd b a b y

3. Bind s-in to the b a b y

4. G ive s o f he rse lf

• Rub in’ s fra me wo rk he lp s nurse s id e ntify ho w

wo me n a re a ffe c te d whe n p re g na nc y ta sks

a re inc o mp le te .

Pregnancy as a RITE of Passage

• Ea c h rite o f p a ssa g e ha s thre e sta g e s: 1. Se p a ra tio n

2. Tra nsitio n

3. Inc o rp o ra tio n

• A wo ma n se p a ra te s he rse lf fro m he r o ld

sta tus whe n she a nno unc e s he r p re g na nc y

• The tra nsitio n ta ke s p la c e d uring the 9

mo nths o f p re g na nc y

Investment • Ultra so und

• Ge ne tic Te sting

• Fe ta l Mo nito ring

• Ele c tive te rmina tio n

Swanson’s Theory of Caring

Thro ug h ind uc tive a na lyse s, Swa nso n (1991)

id e ntifie d five c a ring p ro c e sse s:1. Kno wing

2. Be ing with

3. Do ing fo r

4. Ena b ling

5. Ma inta ining b e lie f

The mo re we inve st the mo re we c a re ….

The “Fetus” is a Person• The issue o f fe ta l p e rso nho o d is c o mp le x with so c ia l,

re lig io us, le g a l a nd e thic a l d ime nsio ns.

• Be re a ve d p a re nts ha ve a ssig ne d so me d e g re e o f

p e rso nho o d to the ir b a b y; the re fo re , the ir lo ss is re a l,

fo r a re a l p e rso n who wo uld ha ve b e e n a p a rt o f

the ir life a nd the ir fa mily (Cô té -Arse na ult &

Do mb e c k, 2001).

Tentative Pregnancy Anticipatory Grief

• Ro thma n (1986) fo und tha t wo me n withhe ld the ir

e mo tio na l b o nd s fo r the p re g na nc y a nd b a b y until

a fte r the y re c e ive d te st re sults.

• Antic ip a to ry g rie f is the p re p a ra tio n fo r d e a th

d uring o r p rio r to a n ine vita b le lo ss (Hyna n, 1986;

Ra nd o , 1986), a s o p p o se d to g rie f a fte r a lo ss.

Grief and Bereavement• Grie f is a n e mo tio na l re sp o nse to the lo ss o f

so me thing o r so me o ne he ld d e a r; it is the inte rna l

re sp o nse to lo ss.

• Mourning is a p ub lic o r e xte rna l re sp o nse to the

d e a th o f a lo ve d o ne .

• The p e rio d o f time d uring whic h g rie f a nd mourning

o c c ur a fte r a d e a th is c a lle d be re a ve me nt.

Grief and Bereavement cont.…

• No two p e o p le re sp o nd to the sa me e ve nt o r lo ss in e xa c tly the sa me wa y; g rie f is ind ivid ua l a nd d e p e nd s o n ho w lo ss a ffe c ts e a c h p e rso n.

• Inte nse a nd c o ntinue d d istre ss symp to ms b e yo nd 6 mo nths to 1 ye a r tha t inte rfe re with o ne ’ s a b ility to func tio n a nd e njo y life sho uld b e e va lua te d b y a me nta l he a lth p ro fe ssio na l (Mo rro w, 2009).

• While se ve rity o f lo ss is o fte n re la te d to the sta g e o f p re g na nc y whe n lo ss is e xp e rie nc e d , this is no t a lwa ys the c a se .

Normal Grief Reaction• Ang e r

• Sa d ne ss

• Numb ne ss

• Ac hing Arms

• Guilt/ “wha t if ? “

• Rumina ting

• Ba rg a ining

• Iso la tio n o r fe a r o f b e ing a lo ne

• Dre a ms

• Wa nting to e nd the e ve nt o r p ro lo ng it

Be aware of• Ang e r, frustra tio n, o r re se ntme nt o f e xisting c hild re n

• Suic id a l id e a tio n

• Po o r o r no n- e xiste nt sup p o rt ne two rk

• Hig h- risk ho me e nviro nme nt

• Prio r histo ry o f lo ss

• **True la c k o f a c c e p ta nc e o f lo ss**

• Histo ry o f hig h risk b e ha vio rs

How we handle the initial news is critical to

grief formation & bereavement

• Sha p e s p a re nt’ s e xp e rie nc e fo re ve r

• Ca n ha ve la sting imp a c t o n yo ung e r c hild re n

• No rma lizing a nd b e ing p re se nt is Imp o rta nt

• Be a wa re o f g e nd e r d iffe re nc e s in g rie f

• Ag e a p p ro p ria te fo r c hild re n

• Emp o we r p la nning , c o ntro l, a nd p a rtic ip a tio n

whe ne ve r p o ssib le

• He lp p a re nts a ntic ip a te wha t’ s c o ming

• Thing s to sa y a nd no t to sa y

Readiness• Fo r g rie f ma te ria ls

• To d isc uss o p tio ns (kno w wha t the y a re )

• To ho ld the b a b y, o r no t

• To re c e ive visito rs & p ho ne c a lls

• Offe r c ha p la in/ p ra ye r/ b a p tism

• Pho to s & me me nto s

• Emp ha sis o n se lf- p re se rva tio n

• Enc o ura g e a c c e p ta nc e o f he lp

Personal Awareness• Yo ur o wn histo ry with Lo ss

• Ho w c o mfo rta b le o r no t a re yo u with d isc ussing

• Pe rso na l e mo tio na l trig g e rs

• The a rt o f Pre se nc e

Resources• www.b e re a ve me ntse rvic e s.o rg

• http :/ / www.c hild re nsd a yto n.o rg / c ms/ b e re a ve me nt

• http s:/ / www.no wila yme d o wnto sle e p .o rg

• www.b a b ylo ssc o mfo rt.c o m/ g rie f-re so urc e s/ e -c a rd s

• Fa c e s o f Lo ss Sup p o rt Gro up (Se e ha nd o ut)

• Sha d e s o f Blue Sup p o rt Gro up ( MVH use s)