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

Perinatal bereavement occurs after the death of a fetus or baby during the perinatal period (before, during, or after birth), which is generally defined as extending from the 22nd ^week of amenorrhea (during pregnancy) until 7 days after birth. In reality, the experience of couples preparing to become parents who are suddenly confronted with the loss of a pregnancy and/or a child far exceeds these official boundaries. These situations are thankfully rare but extremely complex, as they can occur at various times during pregnancy and the postpartum period, or even unexpectedly.

Unexpected prenatal events encompass spontaneous pregnancy losses (formerly called “miscarriages”), whether early or late. In the postnatal period, this refers to the unexpected death of the baby in the first days or weeks following birth.

Anticipated situations, related to prenatal diagnosis, concern decisions regarding medical termination of pregnancy (MTP) or palliative care support after birth (within the framework of the Claeys-Leonetti Law). These decisions are made jointly by 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 receive…

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

Perinatal bereavement is a unique form of grief, often poorly recognized by society. Long considered a "lesser form of 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 discuss in a society where pregnancy and childbirth are associated with happy events.

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

This bereavement is often accompanied by a feeling of isolation. Those around them, overwhelmed by this pain, don't always know how to react. Expressions of support become less frequent, sometimes leaving parents alone in a grieving process far longer than society tolerates. Each person then navigates their own personal journey, marked by sadness, anger, a sense of injustice, guilt, or even incomprehension.

This grief is not only for a child, but also for a future, for a life project cut short. Birthdays, holidays, and family gatherings become painful reminders of what should have been.

Supporting individuals facing the various clinical situations that lead to the process of perinatal bereavement is primarily multidisciplinary and provided at all levels by the different professions within the relevant healthcare services, generally obstetrics and gynecology. The initial aim is to ensure a comprehensive network of care that allows parents to cope with this experience, which is very often perceived as a profound psychological trauma. Sometimes, the hospital is the first, or even the only, place where parents encounter and acknowledge the existence of their child, where they confront the unspeakable and are supported in the reality of their situation and the choices they can make, from a medical, psychological, and administrative perspective.

Psychological support is always offered fairly early in the care process, but it is not mandatory. Everyone should be free to choose whether or not to access it, and when they wish, according to their own timing and coping abilities. This support can sometimes begin later than the event itself, either in the hospital or in the community. Some parents are unable to access it immediately, but only feel the need for it several weeks or months after the death.

This type of support can be beneficial for several reasons. When bereaved parents feel alone with their grief, distraught, and devastated psychologically—and more specifically, by their sense of identity—and when they feel misunderstood by their initially supportive circle of friends and family, having access to a space for sharing, listening, and processing their emotions can be invaluable during this difficult time. Furthermore, when successful, this process of reflection can free up mental space for them to pursue other life projects, while simultaneously integrating this painful loss into their life story.

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

Psychologists in the maternity ward – gynecology-obstetrics department, Caen Normandy University Hospital