Childbirth Education for Parents Experiencing Pregnancy After Perinatal Loss
Perinatal loss is when parents lose their child during pregnancy or after birth. Families are biologically, emotionally, culturally, and spiritually exhausted during perinatal grief. It is estimated that there are over 2.7 million deaths annually across the world, and about 5.69 percent for every 1000 births in the U.S (Ely & Driscoll, 2020). Parents who have experienced pregnancy after perinatal loss often feel like their experiences are misunderstood by family, friends and even healthcare providers. Reactions to perinatal loss can only be understood if we appreciate the occurrence of this death during pregnancy. Identifying the gap and filling it with accessible information and measures on how to handle the loss is what is missing, but what can we do about it?
Causes of Perinatal Loss
Infant Respiratory Distress Syndrome
Also called respiratory distress syndrome, it happens when a baby’s lungs are not fully developed and cannot provide enough oxygen to the body, causing breathing difficulties. The syndrome is most common in premature babies born six or more weeks before their due date (Fernández‐Basanta et al., 2020) It begins shortly after birth and manifests by fast breathing, a fast heart rate, Chest wall retractions, expiratory grunting, nasal flaring, and blue skin discoloration during the breathing efforts. Despite the considerable advances in care, the baby dies, making the syndrome the single most common cause of neonatal deaths.
Usually, pregnancy lasts about 40 weeks, but when birth occurs before the 37th week, it is said to be a preterm birth. When a pregnancy does not last the entire term, it carries its fair share of complications. In the final week, vital organs of the body include the lungs, brain, and liver. With these organs not developed, the immature lungs make it difficult for the infant to breathe; poor feeding, difficulty regulating body temperature, slow weight gain, cerebral palsy, hearing, and vision problems also come from the under-developed body organs (Ravaldi et al., 2018).
Medication and Substance Abuse
During pregnancy, anything and everything that goes into the mother’s body can affect the unborn baby. Smoking, drinking alcohol, abusing prescription drugs, or using illicit substances can pass through the placenta and harm the unborn baby. Estimates show that about 5 percent of pregnant women use one more addictive substance (Heazell et al., 2019). The regular use of some substances can cause neonatal abstinence syndrome (NAS), congenital disabilities, low birth weight, premature births, small head circumference, and sudden infant death syndrome (SIDS).
Prior Pregnancy Loss
The loss of any pregnancy through miscarriage, ectopic pregnancy, stillbirth, or neonatal death is a significant event for any woman, often presenting a substantial crisis in her life. The crisis presents many losses, including but not limited to the loss of future hopes, low self-esteem, loss of anticipation of being a parent, loss of perinatal medical attention, and concern over the potential ability to create another new life (Fernández-Sola et al., 2020). Eventually, when the parents decide to have a new baby, not so much effort is put in, which may increase the chances of losing the baby again.
Care and Teaching Interventions
Parental grief has been linked to a general decline in physical and mental health. Bereaved parents had higher healthcare utilization, more sick days away from work, and more sleep problems. Parents may associate reduced health behaviour with increased risks such as poor diet, lack of exercise, excessive alcohol consumption, or drug abuse. Critical caregivers may want to encourage positive health behaviours in bereaved parents, knowing the risks.
Creating keepsakes with or for the parents provides a tangible memory of the child. Keepsakes provide parents with a way to cherish a part of their child when a child is no longer present, especially in neonatology, where parents will not have been outside the hospital with their child. They keep the parents attached and close to their child to provide comfort. Keepsakes can help parents remember the child and conceptually process the loss while revising autobiographical memories and the child’s memories to adjust to reality over time. (October et al., 2018, p.18)
Parents value ongoing contact with hospital staff because it allows them to interact with their children before they die. When parents believe that the hospital staff remembers their child, it is as if the hospital acknowledges their identity and validates that their child had an impact and mattered. The conversations that ensue during the follow-up contact sessions assist the parents in coping with the loss. The sessions also provide a platform for reassurance that nothing could have been done differently (Ravaldi et al., 2018). During the follow-up, the parents are allowed to re-adjust their memories of the situation, address their doubts about themselves, and treasure memories of their child, which results in readjustment to new memories and thus the creation of new plans about themselves, their child, and past events.
Information, folders, booklets, workshops, and seminars can assist parents in regaining some control over the many different challenges they face when placed in new, unknown, and insecure situations. This helps the parents feel more prepared for practical matters such as financial aid, funeral arrangements, and locating additional emotional support when needed (Furtado-Eraso et al., 2021) The information provided and the validation of their emotions assist parents in developing new knowledge structures and plans for their grief and the future they face. It aids in the appraisal process and provides fresh-looking models.
Remembrance activities allow you to reconnect with your child and recall memories from their life. It also implies a sense of support from friends, family, hospital staff, and the community, which may aid the parents in coping with their loss (October et al., 2018). Memorabilia events create a safe environment where parents can feel connected to their child and their bond in the new reality.
Health professionals who work with bereaved parents must learn how to support bereaved parents both during their child’s stay and in the early post-death period. Parental bereavement is an adaptive process, and for vulnerable families, ongoing professional support may be required. Following the child’s hospitalization and death, a bereavement follow-up meeting with the physician(s) and staff may provide parents with additional information, emotional support, and an opportunity to provide feedback on their experience (Heazell et al., 2019). Instituting systems to take up the challenge of providing information on gradually dealing with loss and expectance at the same time should be a priority in our health care systems. Although there are existing systems to help manage loss, there is still a lot to be done in that same pipeline.
Ely, D. M., & Driscoll, A. K. (2020). Infant mortality in the United States, 2017: data from the period linked birth/infant death file. National Vital Statistics Report, 69(7), 1-18.
Fernández‐Basanta, S., Coronado, C., & Movilla‐Fernández, M. J. (2020). Multicultural coping experiences of parents following perinatal loss: A meta‐ethnographic synthesis. Journal of Advanced Nursing, 76(1), 9-21.
Fernández-Sola, C., Camacho-Ávila, M., Hernández-Padilla, J. M., Fernández-Medina, I. M., Jiménez-López, F. R., Hernández-Sánchez, E., … & Granero-Molina, J. (2020). Impact of perinatal death on the social and family context of the parents. International Journal of Environmental Research and Public Health, 17(10), 3421.https://doi.org/10.3390/ijerph17103421
Furtado-Eraso, S., Escalada-Hernández, P., & Marín-Fernández, B. (2021). Integrative review of emotional care following perinatal loss. Western Journal of Nursing Research, 43(5), 489-504. https://doi.org/10.1177/0193945920954448
Heazell, A. E., Wojcieszek, A., Graham, N., & Stephens, L. (2019). Care in pregnancies after stillbirth and perinatal death. International Journal of Birth and Parent Education,6(2), 23-28.
October, T., Dryden-Palmer, K., Copnell, B., & Meert, K. L. (2018). Caring for parents after the death of a child. Pediatric Critical Care Medicine: A Journal of The Society of Critical Care Medicine and The World Federation of Pediatric Intensive and Critical Care Societies, 19(8), S61. https://doi.org/10.1097/PCC.0000000000001466
Ravaldi, C., Levi, M., Angeli, E., Romeo, G., Biffino, M., Bonaiuti, R., & Vannacci, A. (2018). Stillbirth and perinatal care: Are professionals trained to address parents’ needs? Midwifery,64, 53-59. https://doi.org/10.1016/j.midw.2018.05.008