The loss of a desired child, during pregnancy, at birth or immediately after childbirth, is a dramatic experience.
A traumatic situation that abruptly interrupts the parenting process and the attachment bond under construction, involving an intense emotional shock and a profound mourning experience.
The non -social and cultural recognition of perinatal mourning, which is often totally denied or minimized, leaves the couple and families in solitude and silence. That’s why it becomes necessary to sensitize all health workers, so that parents and family members can receive adequate psychological support.
The non-legitimacy of the pain connected to the loss, together with often inappropriate assistance, the absence of socio-emotional support and the lack of expert support spaces, are among the main factors that can lead parents to complications in the elaboration of mourning, with the risk of further harmful effects on their psychophysical health.
Although there are no right reactions, ways and times for everyone to live and cross mourning, give themselves the opportunity to tell what has happened, to share their emotions and thoughts, without judgments and prejudices, can help many parents who have suffered the loss of a child.
Each pregnancy, regardless of its duration and outcome, is an integral part in the life history of the mother and the parental couple and every child, any week of life, has an indisputable importance.
In perinatal mourning the needs are few and simpler than it is believed. Through the participating listening, the healthcare professional has a key role in the management of perinatal death: if he manages to provide sensitive support and an adequate presence of care he can facilitate the processing of parental mourning, on the contrary, with incorrect attitudes, he can hinder the processing process.
Give parents the opportunity to think about what you can still and must be done and to decide consciously, giving them the right time and explaining the right options, reassures them on their ability to have been able to manage that dramatic moment and makes the elaboration of mourning better.
Faced with a parent who lost the child before or after birth, the operator often has a difficult role, that of communicating the news and simultaneously offering support. The communication of death is painful, for those who do it and for those who receive it, but it is important to seek a contact with the parent.
It would be appropriate to give the news looking at the parents in the face, with simple words and promoting an attitude of opening, availability and sincere displeasure. Everyone, after years, remember what they were told and how it was said, and bad communication has a traumatic effect on the parent. In general, everything that tends to underestimate the importance of the loss and death of that child or insinuating some types of responsibility is in any case inappropriate.
It is important to try to prove yourself available and above all not avoid the topic, without pushing people to talk about what happened if they don’t feel it first. For parents to perceive a little interest can be of great comfort; It is essential to never trivialize this loss, do not diminish it.
It is to practice to offer parents the opportunity to embrace and touch their child and have time to get to know and greet their child, in an environment as possible protected. Many mothers have a sort of refusal and initially ask not to see the child. This decision can and must be thoughtful, so as not to create future anxieties and guilt.
Parents need to conclude that specific parenting path with that child, even if things went in 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 adequately overcome the mourning; Arrangeing memories is an important part of mourning, where it has nothing, increases the feeling of precariousness and emptiness that parents feel in these cases.
Some mothers prefer, after appropriately discussed them 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 himself to collect the child’s memories on behalf of the parents.
It must also be reflected on the fact that outside the hospital, the path of mourning will inevitably continue and the parents will be called to relate to the death of their child. The loss of a child in the perinatal era drastically modifies the existential path of the parental couple: this mourning, often miserable 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 mourning path.
Having lost a child in the perinatal era represents a well -known psychological and behavioral risk factor also for subsequent pregnancies and for the future style of child parent attachment: an approach adequate to mourning is therefore essential, by all operators, for the health of parents and to provide optimal assistance. Basic training often does not provide for the care of psychological aspects and difficult events, so many operators find themselves unprepared, despite having to periodically face death.
Instead, the operator recognizes that child as a human being worthy of respect and care, who pays attention to that body by providing those few treatments he needs after death, who does not be frightened, creating the conditions for that creature can be left to go to his parents in the best way, helps parents significantly to undertake a good mourning path.
The role of the healthcare professional is to adopt a good practice (not only technical, but also emotional and empathic) with the parent, trying to understand from time to time the particular needs of that couple. Many parents, even after years, clearly report memories related to bad care and the profound 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 ability of the individual to face a negative event and to overcome it without psychopathological consequences, observe how in addition to the mournful event, even any additional traumas, linked to the context, are a source of considerable psychological distress and significantly complicate the elaboration of mourning. Many studies tell us that an comprehensive and empathic attitude by operators facilitates a correct mourning process in parents.
We remind you that the death of a child during pregnancy or in the perinatal era is an unexpected and sudden event, even during a pregnancy at risk; Family members are emotionally unprepared when they face this situation. For parents, it is often the first direct meeting with the death of an important person and can be very difficult, in the acute phases, to organize the possible choices with rationality and lucidity.
In the very first phases of shock and confusion, the operator has the task of supporting the parent and guiding him without conditioning his choices or choosing in his place, has the task of informing the parent of all the possibilities present and must for this carefully know the protocols on the perinatal mourning and all possible care options.
For parents, at any gestational era, a child is a child, a person, and needs respect, memory and memory; So particular attention must be paid to the ways of referring to the event. For these reasons in many countries of the world there are protocols that provide for not only assistance to the parent, but also training and assistance to the operator, considered its central role for the elaboration of mourning and for the correct management of pregnancies following the loss.
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, the participant silence is needed, in others a simple explanation of the causes may serve. Feeling alone in such a dramatic moment increases anxiety levels and makes it difficult to process trauma.
The most frequent emotions felt after an experience of prenatal mourning They are the sense of guilt and shame, which can induce couples not to seek comfort in others and to experience even more solitude and loss. Mothers not only live theMourning experience But also a deep existential wound, which can generate thoughts of inability to generate a life and neglect in having been able to protect their child. This type of brood of depressive and guilt type 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 the life of a man, a mentally and physically devastating experience, capable of putting in crisis the deepest beliefs, the vision of life, emotional relationships and the meaning and self -image.
The drama of pre and perinatal mourning can be partially alleviated if the figures involved in loss can rely on competent, sensitive and empathic people, capable of providing them with a space of listening, human understanding, emotional support, clear and complete communications, adequate times and spaces. For this reason it is good that those who have been victims of such a dramatic event turn to competent professional figures who support them in the slow and gradual path of elaboration of suffering.
Auto-mutual help groups and associations in the sector (eg hello Lapo) are a valid help because they provide information and support, and promote sharing between parental pairs that live the same condition. Psychotherapy can also provide a valid support to accompany people towards the processing of traumatic experience (e.g. work protocols with EMDR techniques).
The death of a child in the perinatal era is a serious life event, which leaves an indelible imprint in the experience of parents and families; The loss of a child is a difficult event to face for all, including healthcare professionals, simply because it is an unnatural and humanly painful event. Assistance to children affected by perinatal death is a very particular moment, complex and emotionally relevant in the clinical practice of health workers.
International literature provides continuous support for the parental couple, based on the participation and widespread organization of intervention protocols, which involve intra and extra hospital figures in order to create a protective and participatory nucleus.
In many foreign hospitals there is a psychological assistance service for families and for members of the hospital staff, in order to develop the experiences of loss both in the parents and in the operators involved in the acute phase (and not late, after resignation, when everything has already happened).
The indisputable respect and recognition of the value of every life is essential to understand the pain of the parents and to intervene professional but empathicly during all the phases of the path.
