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

Bereavement consists of having to emotionally disinvest from a deceased person. Perinatal bereavement occurs after the death of a fetus or baby in the perinatal period—that is, before, during, or shortly after birth—generally between the 22nd week of amenorrhea and 7 days following birth.
But beyond this medical definition, the experience of couples faced with the loss of a pregnancy or a child goes far beyond these limits. These situations, although rare, are extremely complex because they can occur at different times during pregnancy or the postpartum period, sometimes unexpectedly.

Unexpected prenatal losses include spontaneous termination of pregnancy (formerly called "miscarriages"), whether early or late. After birth, this particularly concerns deaths occurring in the first weeks of life.
Other situations are anticipated, particularly in the context of antenatal diagnosis , when parents make decisions regarding medical termination of pregnancy (MTP) or palliative care after birth, in accordance with the Claeys-Leonetti law.

Each story is unique: how parents feel depends on their investment in the pregnancy, the bond they already have with their child, their personal history, and the support they have. This grief, which occurs at a time of great fragility, profoundly disrupts the order of things: death intrudes 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 families facing the loss of a child is based on multidisciplinary care , provided by all healthcare teams, particularly within the gynecology-obstetrics .
The first step is to offer a secure care environment, which allows the pain experienced to be recognized and the psychological shock to be contained. The hospital is often the first place where the reality of the loss can be named, shared and supported, both medically and psychologically and administratively.

Psychological support is systematically offered, but never imposed. Each parent must be able to engage in it at their own pace, according to their needs and resources. This follow-up can begin at the hospital or later, sometimes several weeks or months after the death.
These interviews offer a space for listening and processing emotions: a place where it becomes possible to put words to the unspeakable, to give space to the lost child and, little by little, to regain the strength to consider other life projects.

The support work aims above all to enable parents to rebuild their lives, by integrating this loss into their history, without erasing it.

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

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