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Neonatal loss: grieving and recovery

The question of whether women and their partners should wait a year to conceive after the loss of a pregnancy is a complicated one. Dr. Hughes and his colleagues’ study suggests there may be some benefit to waiting a year, but each family needs to consider their individual situation and talk with their caregivers about what makes the most sense for them.

My experience has been that many families may choose to wait a year or more to get pregnant after delivering a stillborn child. Each pregnancy is accompanied by hopes, dreams and wishes that end with the loss of a child. Families may need time to deal with the fear and anxiety that accompany such a loss and to mourn the death of that child. Grieving is not easy, it is often long, unpredictable and requires a lot of energy. Parents and family members need time to work through this pain toward healing.

Conversely, some families are anxious to begin another pregnancy quickly. We are seeing more women beginning their families at a later age, and those families must weigh the need to wait with the potential diminishing of fertility. And many of my patients who have a miscarriage early in their pregnancy decide to wait a couple of months and then begin trying to conceive again.

These decisions are personal ones and are best made on an individual basis. The Hughes’ study recognizes that fact and acknowledges that many families have considerations that outweigh the possible higher risk of psychological symptoms.

Grieving process
Although the optimal timing of a subsequent pregnancy varies with each family, the importance of grieving for a pregnancy loss is unequivocal whether that loss occurs a few weeks after conception or at term.

As recently as the early 1980s, it was common practice to whisk away a stillborn child before the parents saw the child or had a chance to hold it in an effort to spare them pain. Stillborn babies were often quickly buried in unmarked graves, and parents had few ways to express their feelings of loss and grief.

We now have a better understanding of how important it is for everyone to acknowledge the loss. When a woman delivers a stillborn child today, it is likely she and her family will have an opportunity to see and hold the child. They may be encouraged to have a memorial service or funeral for the child. At Yale-New Haven Hospital, clergy are available and specially trained bereavement nurses counsel the family and prepare memory boxes with the child’s bracelet, blanket, photos and footprints.

It is not unusual for women to be depressed after a pregnancy loss. My experience has been symptoms are more severe with full-term losses, but recognition of grief must be acknowledged in even the earliest of pregnancy losses. The symptoms of depression may range from severe postpartum depression and suicidal thoughts, to sleep disturbances, to withdrawal from family and friends, eating disorders and feelings of hopelessness. She and her family need time to express their fears, share their grief and come to terms with their loss. Taking time to go through this process may take some families longer than others, and I often suggest counseling to my patients or participation in bereavement support groups.

Hygeia, a sharing site for families
In 1995, I launched a web site (www.hygeia.org) to provide a place for grieving families to express their pain and share the stories of their losses. Since that time, more than 70,000 families have visited the site, which includes poetry and stories about neonatal loss as well as medical information written by caregivers. More than 4,000 families have registered so they might share their stories with others.

Parents and family members will not forget about the child they lost after a month or a year, but encouraging them to express their feelings and concerns can help them work through this painful experience and may help prepare them for a less stressful subsequent pregnancy.

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Dr. Berman is an attending obstetrician/gynecologist at Yale-New Haven Hospital and a clinical professor of obstetrics and gynecology at the Yale School of Medicine. He is president of the County Obstetrics and Gynecology Group with offices in New Haven, Branford, Clinton and Wallingford and founder of the Hygeia® Foundation for Perinatal Loss and Bereavement.