Grief is the normal and expected reaction towards a loss, particularly the loss of a loved one. While the loss of a loved one could take place in a variety of ways such as divorce, moving away, and death, the focus here will be the grief due to the passing of a family member. Bereavement is the experience of grieving the death of a loved one. Grief may be manifested through a variety of symptoms including but not limited to experiencing deep sadness, ruminating thoughts on the deceased loved one, loss of usual activities, role and identity confusion and struggles, and isolation from others.

Role and identity confusion is especially prevalent when is a parent grieving the loss of a child. The death of a child is not part of a parent’s picture of their child’s life while they still require their care. A mother imagines that their child will naturally outlive them and so parents often experience intense grief.

The death of a child of any age causes immense grief for the parent. The loss of a child before one month of age, either through miscarriage, stillbirth, or infant death, brings a different level of grief as the parent is often then faced with the loss of the anticipation of being a parent.

Understanding perinatal loss

Perinatal loss is the loss of a child before, during, or shortly after birth. Miscarriages, stillbirths, or the death of an infant within the first month of life all fall under the umbrella term of perinatal loss. In contrast to the loss of an older child, the loss of a child before one month of age is often met with unsupportive and un-empathic responses by well-meaning family, friends, and physicians. Mothers are often told that the loss happens ‘all the time’ and that they ‘can become pregnant again’.

These responses often miss the emotional toll that a perinatal loss can have on an expectant mother. Even when the mother does speak of this emotional toll, they are often dismissed by those around them or those assuming the grief will resolve once the becomes pregnant again. In fact, the pain from an earlier loss often has lasting effects including the fear of being happy when they do become pregnant again and the anxiety of losing another baby. 

Mothers who have experienced a perinatal loss are often at a greater risk of developing complicated grief and the development of depression in subsequent pregnancies. The intensity of a mother’s grieving symptoms has been found to have a higher likelihood of developing depressive symptoms. Even though depressive and grief symptoms often diminish on their own, women who have experienced a perinatal loss often find supportive services such as groups or other types of interventions to be helpful in coping with some of the more uncomfortable symptoms.

Interventions for perinatal loss

• Peer-to-peer interventions. The death of a child is a painful experience, and supportive resources have been found to be helpful. A group of researchers investigated the use of phone support for women who experienced perinatal loss. They found that women who utilised the phone support did so shortly after the loss, and the most common reasons were to ‘talk with someone who understands’. These findings indicate a need for supportive counselling for women so they may feel supported and understood by those who ‘understand’.
• Web-based support. Many women when they have experienced a perinatal loss have found web-based support groups to be helpful. Web-based support groups can be through the form of forums, social media (such as Facebook groups), or via email. Web-based groups can provide for the same factors such as universality, hope, cohesiveness, and catharsis as face-to-face groups. Web-based support is unique in the availability and flexibility of obtaining and taking in support.
• Group Interventions. Groups have been found to be an effective supportive intervention for grief and particularly for those who have experienced a perinatal loss. Five general themes (confirmation of normality, ability to share thoughts and ideas, reciprocity among others, exchange of information, and the sharing of hope) in a grief and bereavement group have been found to have a positive impact on group members. Through the participation of grief and bereavement groups, individuals can regain a sense of normality where they can see that they are not the ‘only ones’ going through the pain.  They can share with others the thoughts and feelings they are having. Participation in groups also provides for space to tell the story of the loss which many women have found to be helpful.
• Psychotherapy – Individual psychotherapy can be useful in providing a space for women to share their loss. Interpersonal Psychotherapy has specifically been found to be helpful in improving symptoms and relational problems. Individual psychotherapy can also provide a safe and confidential space to share of the loss when sharing may be too difficult to do with peers or within a group. A one-on-one therapist can also provide more individual attention and more focused intervention which may not be available with peers or within a group.

Takeaway

Even though grief can and will subside over time, there is no shame in wanting or seeking out further support. Peer-to-peer, web-based, group and individual psychotherapy have all been found to be helpful in relieving some of the more distressing symptoms and improving relationships.

Sarah Netzky is a Licensed Professional Counsellor and currently working in private practice in Chicago, Illinois.