Pregnancy Loss, Infant Death, and Maternal Mental Health

Mental Distress   

  • Perinatal loss is an unexpected, traumatic, and life-changing event (Caccitore, 2013; Gold, Leon, Boggs, & Sen, 2016; Kersting & Wagner, 2012)
  • It can cause severe distress (Gold, Leon, Boggs, & Sen, 2016) presenting as depression, anxiety, obsessive compulsive disorder, social phobia, post-traumatic stress, and suicidal ideations (Caccitore, 2013; Caccitore, Schnebly, & Froen, 2008; Gold, Boggs, Muzik, & Sen, 2014; Gold & Johnson, 2014; Hutti, 2004).
  • Bereaved mothers have 4 times greater odds of depressive symptomatology and 7 times increased odds of post-traumatic stress disorder than non-bereaved mothers (Gold, 2016).
  • The existence of mental health problems is also an added risk factor for poor fetal outcomes during a subsequent pregnancy (Gold, Leon, Boggs, & Sen, 2016) and can negatively affect the attachment to this child (Gaudet, Sejourne, Camborieux, Rogers, & Chabrol, 2010; Hutti, 2004).

Existential Dilemma   

  • After this type of loss, a mother’s values, beliefs, and spirituality can be challenged.
  • The experience of death at birth is an existential dilemma (Uren & Wastell, 2002).
  • The mother’s assumptive world is jeopardized (Uren & Wastell, 2002) and things that once had meaning to her no longer do.

Loss Affects Everyday Life   

  • The death of an infant impairs a mother’s day-to-day functioning (Kersting & Wagner, 2012; Jaffe, 2014).
  • Mothers report changed appetite and sleep patterns, decreased social participation, decreased marital satisfaction, and increased isolation (Caccitore, Froen, &  Killian, 2013; Caccitore, Schnebly, & Froen, 2008; Kersting & Wagner, 2012).
  • This type of loss frequently affects her professional career and relationships with workplace colleagues (Caccitore, 2013; Jaffe, 2014).

Cultural Reactions to the Death of a Baby   

  • Perinatal loss leads to the deconstruction of motherhood and role confusion (Caccitore, 2013).
  • Society does not recognize this type of death, and without a live baby in her arms, the mother has lost her maternal identity (Caccitore, 2013). This is also known as disenfranchised grief.
  • There is social pressure to forget the baby who died, move on, and try to have other children (Caccitore, 2013).
  • Perinatal loss also carries a stigma with it, leaving these mothers to feel shame and guilt (Caccitore, 2013; Kersting & Wagner, 2012).
  • Women report a discrepancy between the intensity of their grief and the extent to which they are allowed to express it (Uren & Wastell, 2002).

Improving Mental Health   

Finding meaning and connection with your baby

  • Women who find meaning in their loss report decreased mental distress, increased marital satisfaction, ongoing bonds with their deceased child, and better physical health (Caccitore, 2013; Jaffe, 2014).
  • It is not uncommon for mothers to remain connected to their baby and continue the relationship through ritual for many years after the death of their baby (Caccitore, 2013; Cote_Arsenault & Mahlangu, 1999; Jaffe, 2014; Uren & Wastell, 2002).
  • Parents feel empowered when they create their own rituals to maintain this connection (Brin, 2004).
  • It may take many years to come to a sense of meaning and experience healing (Caccitore & Bushfield, 2007).

Social Support

  • Social support plays a role in buffering the effects of trauma and in mediating stress after bereavement (Caccitore, 2013; Caccitore, Schnebly, & Froen, 2008; Kersting & Wagner, 2012).
  • Women are searching for an environment where they have permission to talk about their child’s death and meet other mothers in a similar situation (Caccitore, Schnebly, & Froen, 2008; Jaffe, 2014).
  • An intervention that allows mothers to express their emotions and retell their stories helps to decrease depression, self-blame, and trauma (Caccitore, 2013).
  • Women find bereavement support groups and talking with other parents helpful because they validate their experience, provide comfort and connection, and reverse isolation (Caccitore & Bushfield, 2007). 
  • Resilience is a character trait that has been observed to be a counterweight to mitigate mental distress. Support networks are a major ingredient of resilience and are significantly associated with decreases in both depression and PTSD (Caccitore, Schnebly, & Froen, 2008; Gold, Leon, Boggs, & Sen, 2016), as well as with improvements in health outcomes and prevention of disease (Hutti, 2004).

 

References  

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Azri, S. & Ilse, S. (2015). The Prenatal Bombshell. Lanham, Maryland: The Rowman & Littlefield Publishing Group.

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Brin, D. J. (2004). The use of rituals in grieving for a miscarriage or stillbirth. Women & Therapy, 27(3/4), 123-132.

Centers for Disease Control and Prevention (2016). Infant Mortality. Retrieved from http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

Centers for Disease Control and Prevention (2017). Facts about Stillbirth. Retrieved from https://www.cdc.gov/ncbddd/stillbirth/facts.html.

Cacciatore, J. (2007). Effects of support groups on post traumatic stress responses in women experiencing stillbirth. Omega, 55(1), 71-90.

Caccitore, J. (2013). Psychological effects of stillbirth. Seminars in Fetal & Neonatal Medicine, 18(2), 76-82. doi: 10.1016/j.siny.2012.09.001

Caccitore, J. & Bushfield, S. (2007). Stillbirth: The mother’s experience and implications for improving care. Journal of Social Work in End-of-Life & Palliative Care, 3(3), 59-79.

Caccitore, J., Froen, J. F., & Killian, M. (2013). Condemning self, condemning other: Blame and mental health in women suffering stillbirth. Journal of Mental Health Counseling, 35(4), 342-359.

Caccitore, J., Schnebly, S., & Froen, J. F. (2008). The effects of social support on maternal anxiety and depression after stillbirth. Health and Social Care in the Community. doi : 10.1111/j.1365-2524.2008.00814.x

Cote-Arsenault, D. & Mahlangu, N. (1999). Impact of perinatal loss on the subsequent pregnancy self: Women’s experiences. Journal of Obstetric, Gynecologic & Neonatal Nursing, 28(3), 274-282.

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. (2015). Stillbirth Collaborative Research Network. Retrieved from https://www.nichd.nih.gov/research/supported/Pages/scrn.aspx

Gaudet, C., Sejourne, N., Camborieux, L., Rogers, R., & Chabrol, H. (2010). Pregnancy after perinatal loss: association of grief, anxiety and attachment. Journal of Reproductive and Infant Psychology, 28(3), 240-251.

Gold, K. J., Leon, I., Boggs, M. E., & Sen. A. (2016). Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. Journal of Women’s Health, 25(3), 263-269.

Gold, K. J., Boggs, M. E., Muzik M. & Sen, A. (2014). Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss. General Hospital Psychiatry, 36, 650-654.

Gold, K. J. & Johnson, T. R. B. (2014). Maternal mental health outcomes after perinatal death. Obstetrics & Gynecology (abstract).

Hutti, M.H. (2005). Social and professional support needs of families after perinatal loss. Journal of Obstetric Gynecologic, and Neonatal Nursing, 34(5), 630-638.

Jaffe, J. (2014). The reproductive story: Dealing with miscarriage, stillbirth, or other perinatal demise. In D.L. Barnes (ed.), Women’s reproductive mental health across the lifespan (pp. 159-176). New York: Springer.

Jaffe, J. & Diamond, M.O. (2011). Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients. Washington, D.C.: American Psychological Association.

Kersting, A. & Wagner. B. (2012). Complicated grief after perinatal loss. Dialogues in Clinical Neuroscience, 14(2), 197-194.

MacDorman, M. F. & Gregory, E. C. W. (2015). Fetal and perinatal mortality: United States, 2013. National Vital Statistics Report, 64(8).

Uren, T. H. & Wastell, C. A. (2002). Attachment and meaning-making in perinatal bereavement. Death Studies, 26(4), 279-308.