®

2006 ALSO® Syllabus Update

R: Birth Crisis: Caring for the Family

Evidence Review completed 12/31/2005

By: Maureen C. Van Dinter, MS, FNP-C, CPNP

Update published:

SORT B Recommendation   Although lack of emotional support and grief acknowledgement for mothers suffering from perinatal loss places subsequent pregnancies at risk for poor attachment,7, 8, 9 no specific psychological support or counseling can be recommended based on current evidence.1

A 2000 Cochrane Review failed to identify a benefit to mothers for providing specific psychological support or counseling after perinatal death.¹ Numerous professional organizations and researchers have studied women (primarily) who have suffered pregnancy related losses. Canadian studies have identified issues related to “disenfranchised grief”, mourning complicated by lack of usual societal norms such as funerals, time off of work for fathers, and lack of support from the medical community.^{2, 3} For many families not only is the pregnancy loss a failure to provide for the future, but also a demonstration of inadequacy in fulfilling the basic role of procreation. Despite numerous educational offerings, many families continue to report inadequate emotional support from their care providers.^{4, 5} Minority women report even less support and consideration in managing their losses, both at the time of the event and subsequently. ⁶

Studies have documented ongoing psychological distress in subsequent pregnancies when grief has not been acknowledged or resolved through normal socially approved processes.^{7, 8, 9} Funerals, cards, food offerings, and paternal support all lend credence to women that their child had value and was recognized and mourned. Those studies also showed that subsequent symptoms of depression have been traced to issues of unresolved grief. Studies continue to demonstrate the controversies of having women hold their stillborn or deceased children,¹⁰ suggesting disorganized attachment to the infants and subsequent anxiety over the losses. Those same studies however have noted that continuing to weave the memories¹¹ of those babies into the fabric of their families’ lives was integral to their future grief resolution. Such information serves to remind clinicians that their personal presence with grieving families is important, and that well-defined follow-up is critical to the ongoing health and support of the mother.

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1. Chambers HM, Chan FY. Support for women/families after perinatal death. Cochrane Database Syst Rev. 2000;(2):CD000452. Review. [Evidence level 2, meta-analysis of studies with inconsistent findings]

2. Malacrida C. Complicated mourning: the social economy of perinatal death. Qual Health Res. 1999;9:504-19. [Evidence level 3, case series]

3. Guidelines for health professionals supporting families experiencing a perinatal loss. Paediatrics & Child Health 2001;6: 469-77. [Evidence level 3, consensus guidelines]

4. DiMarco M, Renker P, Medas J, et al. Effects of an educational bereavement program on health care professionals’ perceptions of perinatal loss. J Contin Educ Nurs. 2002;33:180-186. [Evidence level not rated, qualitative methods]

5. Kavanagh K, Trier D, Korzec M. Social support following perinatal loss. J Fam Nurs 2004;10:70-92. [Evidence level 3, case series]

6. Van P, Meleis AI. Coping with grief after involuntary pregnancy loss: Perspectives of African American women. J Obstet Gynecol Neonatal Nurs 2003;32:28-39. [Evidence level 3, case series]

7. Armstrong DS. Impact of prior perinatal loss on subsequent pregnancies. J Obstet Gynecol Neonatal Nurs 2004;33:765-773. [Evidence level 2, cross-sectional survey]

8. Gamble J, Creedy D, Moyle W, et al. Effectiveness of a counseling intervention after traumatic childbirth: A randomized trial. Birth 2005;32:11-19. [Evidence level 2, lower-quality RCT]

9. Vance JC, Boyle FM, Najman JM, et al. Couple distress after sudden infant or perinatal death: A 30-month follow up. J Paediatr Child Health 2002;38:368-72. [Evidence level 2, cohort study]

10. Hughes P, Turton P, Hopper E, Evans CD. Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. Lancet 2002;360:114-18. [Evidence level 2, cohort study]

11. Côté-Arsenault D. Weaving babies lost in pregnancy into the fabric of the family. J Fam Nurs 2003;9:23-37. [Evidence level 3, case series]