Wednesday, April 7, 2010

Complicated Grief: Perinatal Loss

This is the first in a periodic series about dealing with complicated grief. Today, I'm exploring the complicated grief that can accompany perinatal loss.

Defining Complicated Grief
Complicated grief is grief that is triggered by a loss that is out of context with normal, developmental losses. For example, the death of a parent when you are in your 60s is a painful event, and it is developmentally appropriate. The death of a parent when you are in your 20s is unexpected and out of context, so your experience of grief may be more traumatic. Another indicator of complicated grief is that the normal emotions of grieving (e.g. sadness, denial, anger) may be felt with greater intensity or may last longer than expected. Finally, complicated grief can occur in situations where the loss has a negative effect on your social support system.

Defining Perinatal Loss
Perinatal loss is the loss of a child either during pregnancy or delivery. Perinatal loss can include miscarriage, stillbirth, death from birth defect, or loss at delivery (e.g. cord death).

Loss Out of Context
A perinatal loss is out of the developmental context of loss. Children expect to outlive their parents. Parents do not expect to outlive their children. Living through the loss of a child can be intensely traumatic for couples, as evidenced by recent research. This developmental mis-match can also contribute to the difficult emotions that parents may face.

Intense & Challenging Emotions
Parents who experience the loss of a child or an expected child might expect to feel sadness, confusion, or uncertainty. What can take them by surprise is both the intensity of the emotions they experience after perinatal loss and their experience of the challenging emotions of anger, anxiety, and jealousy.

Sadness might seem like an inadequate description the pain parents feel. Intense grieving, including tearfulness, depressed feelings, and difficulty interacting with others, can last for months after the experience of a perinatal loss. Many clients who have experienced perinatal loss report feeling worried that they will never stop feeling sad.

Many parents are unprepared for the experiences of anger, anxiety, and jealousy they may have following a perinatal loss. Parents have talked to me about feeling angry when they see parents who do not seem to appreciate or properly care for their children. Parents can experience anxiety about whether or not they will have the same losses if they attempt future pregnancies. They also describe feelings of jealousy when they see other pregnant women or parents with very young infants.

Challenges to Social Support
The final way in which perinatal loss is a complicated grief is the potential it has to isolate parents from their natural support systems. This isolation can happen for several reasons.

First, particularly for very early miscarriages, it is possible that many people in parents' support systems either may not know about the loss, or may not characterize it as a source of grief. Parents may hear such statements as, "Don't worry, you'll get pregnant right away," or "Miscarriage is pretty common." These statements are often meant to be helpful, but many parents report feeling that their own sadness was dismissed by such statements.

Because pregnancy losses are out of developmental context, many members of parents' support systems do not have a comparable loss to draw upon. This can cause people in the support system to pull back because they are unsure of how to be helpful.

The intensity of emotion experienced by parents can also impact social support. It can be challenging to explain that you aren't able yet to attend your cousin's baby shower, or to hold another infant in the family. Parents report judging themselves (and fearing judgment from their support systems), for their feelings of jealousy or anger.

Finally, some social support systems simply aren't prepared for the duration of grief after a perinatal loss. Parents express feeling that their grief has outlasted the "grace period" that was allotted for it.

What to Do?
If you, or someone you know, has experienced perinatal loss, there are good resources for you. In the Kansas City area, Alexandra's House is a resource for parents who have learned that they may be facing loss during or shortly after pregnancy. For parents who have already suffered a loss, Shawnee Mission Medical Center offers a Perinatal Bereavement Group that meets bi-monthly.

It is important for parents to continue talking to one another, to give one another permission to grieve differently, and to seek as much support as needed.