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Counseling parents after stillbirth

INTRODUCTION

Almost one-half of stillbirths occur in apparently uncomplicated pregnancies, usually before labor begins; therefore, most parents are unprepared when told that the fetus has died. The family's anticipation of a joyous event is supplanted by despair and confusion. Even when the loss is not unexpected or occurs early in pregnancy, the death of offspring is a severe emotional stress. Observational studies describe psychological sequelae, such as depression, posttraumatic stress disorder, and anxiety, as well as deleterious effects on maternal-child attachment, in pregnancies subsequent to a stillbirth [1]. As a result, it is important for all care providers to be knowledgeable about these issues when they approach parents during the stressful situation of a stillbirth or fetal demise [2,3]. However, the effect of any form of intervention (medical, nursing, midwifery, social work, psychology, counselling, or community-based) on parents and families who experience perinatal death has not been rigorously evaluated, particularly in trials comparing different approaches [4].

Care of parents who experience stillbirth will be reviewed here. A general discussion of the normal and dysfunctional grieving processes can be found separately. (See "Grief and bereavement".)

PURPOSE

The impact of perinatal loss is felt in terms of loss of a desired child, loss of self-esteem in the role of parent, and loss of confidence in the ability to produce a healthy child [5]. Counseling parents can serve many different emotional purposes, for the couple as well as for the provider. Counseling:

Helps parents in both connecting to and separating from the baby. It makes the loss of a baby real and helps prevent emotional withdrawal from the loss.

Helps the individuals involved identify and express their feelings of anger, guilt, blame, fear, anxiety, sorrow, grief, and failure.

                

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Literature review current through: Mar 2014. | This topic last updated: Nov 15, 2013.
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