3 questions for psychologists in the gynecology and obstetrics maternity departments on perinatal bereavement

Perinatal grief occurs after the death of a fetus or baby in the perinatal period (before, during or after birth), which consensually extends from the 22nd ^week of amenorrhea (during pregnancy) until 7 days after birth. In reality, the experience of couples who were preparing to become parents and who are suddenly confronted with the loss of a pregnancy and/or a child, goes far beyond these official limits. These are fortunately rare but extremely complex situations since they can occur at different times during pregnancy and the postpartum period, or unexpectedly.

Unexpected prenatal situations include spontaneous termination of pregnancy (formerly called “miscarriages”), whether early or late. In the postnatal period, this concerns the unexpected death of the baby in the first days/weeks following birth.

Anticipated situations, related to Antenatal Diagnosis, concern decisions regarding Medical Termination of Pregnancy (MTP) or palliative care after birth (under the Claeys-Leonetti Law). These decisions are made jointly between the medical team and the parents.

Each situation is unique, and each parent's experience will depend on their investment in the pregnancy, their relationship with their baby, the context, but also their own history, the support they can benefit from...

This is why it is difficult to give a strict definition of perinatal bereavement, since it depends above all on the experiences of parents struggling with a real psychological breakdown in a period of fragility, brutally and irreversibly disrupting the order of things, death interfering where life was expected.

Perinatal grief is a unique form of grief, often poorly recognized socially. Long considered a "sub-grief," it has sometimes been minimized under the pretext of the brevity of life or the absence of shared memories. Even today, it remains difficult to address in a society where pregnancy and birth are associated with happy events.

Yet this loss confronts parents with a double void: that of the expected child and that of the future they had imagined with him or her. Perinatal grief is all the more difficult because it relies on few concrete traces—an ultrasound, a chosen name, a few items of clothing, photos. Some parents have only these fragments as proof of their baby's existence. Others question their own identity: are they still parents, without children?

This grief is often accompanied by a feeling of isolation. Those close to them, helpless in the face of this pain, do not always know how to react. Attention becomes scarce, sometimes leaving parents alone in a mourning period that lasts much longer than society tolerates. Each person then goes through their own personal journey, marked by sadness, anger, injustice, guilt, or even incomprehension.

This grief is not only for the loss of a child, but also for a future, a life project interrupted. Birthdays, holidays, and family occasions become painful reminders of what should have been.

Support for people facing the various clinical situations leading to the development of perinatal grief work is above all multidisciplinary, and carried out at all levels by the various professions of the healthcare services concerned, generally the gynecology-obstetrics services. The first step is to guarantee a network of care that makes it possible to contain this experience, very often experienced as a psychological breakdown by the parents. Sometimes the hospital is the first or even the only place where the existence of this child is met and acknowledged, where the parents face the unspeakable, and are supported in the reality of the situation and in the choices they can make, from a medical, psychological, but also administrative point of view.

Psychological support is always offered to them fairly early in the care pathway, but it is not a mandatory step. Everyone must be free to take advantage of it or not, or when they wish, according to their timeframe and adaptive abilities. This support can sometimes be started at a later date than the event occurred, in the hospital or in the community. Some parents cannot take advantage of it at the time, then feel the need for it several weeks or months after the death.

This type of support can be beneficial for them for various reasons. When bereaved parents feel alone with their grief, helpless, destroyed in their psyche – and more precisely in their identity, when they feel misunderstood by those around them who were initially supportive, being able to benefit from a space for sharing, listening and transforming their feelings can be a valuable support in this crossing of the desert. In addition, this work of elaboration, when it is successful, can allow them to free up psychological space to then reinvest in other life projects, while dealing with the integration of this painful loss into their life story.

Camille ORTEGA, Charlotte MANCEL-ARROUËT and Émilie LOUVET-ALEXANDRE

Maternity psychologists – gynecology-obstetrics department, Caen Normandy University Hospital