Short summary

Parents bereaved of a child in pregnancy or labour face a mourning process unlike the experience at the death of other loved ones. The impact is felt not only in the real loss of the wished-for child but also in the loss of self-esteem, the role of parent, and the loss of future dreams and expectations. Relatives might disregard the loss and be reluctant to talk about the dead child, leading to an emotional isolation of the parents and complicating the grief process.

Rationale

For parents who chose termination of pregnancy for fetal anomaly, guilt and rumination may furthermore muddle the mourning process. The loss of a child during pregnancy may have long-term physical and mental health consequences for the parents, but there is a lack of studies assessing the impact, specifically in Danish data. Furthermore, we know little about how bereavement support groups can facilitate the mourning process.
Grief research generally shows that unprepared, traumatic and untimely death increases the risk of poor physical and mental health in the bereaved and such factors will most often apply to losing a child in the perinatal period. Regarding poor physical and mental health mothers are usually more affected than fathers. International studies find intensified grief, lasting for up to 1-2 years. In a subsequent pregnancy after perinatal loss, the mother is at increased risk of depression and anxiety.

Some studies find an increased risk of relationship dissolution after stillbirth and miscarriage, but marital closeness can function as a protective factor against the harmful effects of bereavement of a child.

Many parents, who suffer a loss in pregnancy, will be inexperienced in dealing with death and bereavement and this may be their first encounter with a profound personal loss. Their worldviews may be shattered, existential values challenged and they may loose the innocent illusion of immortality. Some parents describe an experience of new meaning following the loss of a child and they express gratitude for the lessons learned through the bereavement.

When losing a child, having adequate support may help the grieving process. Even in a small country as Denmark the care and support offered to parents who experience a pregnancy loss seem to differ remarkably. Some hospitals have shielded wards for parents who loose a small child with staff trained specifically, while at other hospitals the parents are placed at regular maternity or gynecology wards. After discharge some Danish hospitals offer parental bereavement support groups, consultations with information on autopsy findings and some offer individualized antenatal programs in the following pregnancy. Generally, there is a lack of overview of the care given in Denmark and from clinical experience it seems random how the parents are guided through the process from hospital to hospital.                 

Findings on the benefit of participation in parental bereavement support groups differ and no randomized controlled trials have been performed. Generally, grief counseling targeted individuals vulnerable to bereavement complications improves the chance of positive results.

Evidently, loosing a child may have far reaching consequences in the parents' life. Loosing a child at the very beginning of life is in essential ways unlike bereavement in general, for instance the lack of memories or even proof of the child's existence, the mother's very recent psychical connectedness with the baby during pregnancy, the surroundings' disregard of the "concealed" loss and perhaps the feelings of guilt from choosing to terminate the pregnancy due to fetal anomaly.

Purposes of the study:

Assess if and how a bereavement support group can be helpful to parents who loose a child during pregnancy or loose a newborn child.

Assess the consequences of the loss of a child: physical and mental health, impact on partnership and on existential views, values and beliefs.

Assess the parents' contentment with the care provided at the hospital during the loss of their child.

The parents will complete the questionnaires individually, facilitating assessment of gender differences.

Description of the cohort

Included in the study are parents in the Region of Southern Denmark who lose a child during pregnancy from gestational week 14, parents who lose a child during delivery and parents who lose a child during the first months of the child's life.

Data and biological material

Data from questionnaires.

Collaborating researchers and departments

Department of Psychology and Behavioural Sciences, Aarhus University

• Assistant Professor Maja O Connor