Mental Health After Pregnancy and Infant Loss

MENTAL DISTRESS

  • Perinatal loss is an unexpected, traumatic, and life-changing event (8, 15, 22).

  • It can cause severe distress presenting as depression, anxiety, obsessive compulsive disorder, social phobia, post-traumatic stress, and suicidal ideations (8, 9, 15, 16, 17, 19).

  • Bereaved mothers have 4 times greater odds of depressive symptomatology and 7 times increased odds of post-traumatic stress disorder than non-bereaved mothers (15).

  • Women pregnant after stillbirth had a higher prevalence of anxiety and depression compared with women with a previous live birth. Looking at the postpartum period, women who had experienced a stillbirth continued to be at greater risk for anxiety than women who had not experienced a stillbirth (18).

  • The existence of mental health problems is also an added risk factor for poor fetal outcomes during a subsequent pregnancy and can negatively affect the attachment to this child (14, 16, 19).

EXISTENTIAL DILEMMA  

  • After this type of loss, a mother’s values, beliefs, and spirituality can be challenged.

  • The experience of death at birth is an existential dilemma (24).

  • The mother’s assumptive world is jeopardized (24) and things that once had meaning to her no longer do.

LOSS AFFECTS EVERYDAY LIFE  

  • The death of an infant impairs a mother’s day-to-day functioning (21, 22).

  • Mothers report changed appetite and sleep patterns, decreased social participation, decreased marital satisfaction, and increased isolation (10, 11, 22).

  • This type of loss frequently affects her professional career and relationships with workplace colleagues (8, 21).


CULTURAL REACTIONS TO THE DEATH OF A BABY

  • Perinatal loss leads to the deconstruction of motherhood and role confusion (8).

  • Society does not recognize this type of death, and without a live baby in her arms, the mother has lost her maternal identity (8). This is also known as disenfranchised grief.

  • There is social pressure to forget the baby who died, move on, and try to have other children (8).

  • Perinatal loss also carries a stigma with it, leaving these mothers to feel shame and guilt (8, 22).

  • Women report a discrepancy between the intensity of their grief and the extent to which they are allowed to express it (24).

REFERENCES
 

1 Altounji, D., Morgan, H., Grover, M., Daldumyan, S., & Secola, R. (2012). A self-care retreat for pediatric hematology oncology nurses. Journal of Pediatric Oncology Nursing, 30(1), 18-23.

2 Azri, S. & Ilse, S. (2015). The Prenatal Bombshell. Lanham, Maryland: The Rowman & Littlefield Publishing Group.

3 Boyle, F. M., Vance, J. C., Najman, J. M., & Thearle, M. J. (1996). The mental health impact of stillbirth, neonatal death or SIDS: Prevalence and patterns of distress among mothers. Social Science and Medicine, 43(8), 1273-1282.

4 Brin, D. J. (2004). The use of rituals in grieving for a miscarriage or stillbirth. Women & Therapy, 27(3/4), 123-132.

5 Centers for Disease Control and Prevention (2016). Infant Mortality. Retrieved from http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

6 Centers for Disease Control and Prevention (2017). Facts about Stillbirth. Retrieved from https://www.cdc.gov/ncbddd/stillbirth/facts.html.

7 Cacciatore, J. (2007). Effects of support groups on post traumatic stress responses in women experiencing stillbirth. Omega, 55(1), 71-90.

8 Caccitore, J. (2013). Psychological effects of stillbirth. Seminars in Fetal & Neonatal Medicine, 18(2), 76-82. doi: 10.1016/j.siny.2012.09.001

9 Caccitore, J. & Bushfield, S. (2007). Stillbirth: The mother’s experience and implications for improving care. Journal of Social Work in End-of-Life & Palliative Care, 3(3), 59-79.

10 Caccitore, J., Froen, J. F., & Killian, M. (2013). Condemning self, condemning other: Blame and mental health in women suffering stillbirth. Journal of Mental Health Counseling, 35(4), 342-359.

11 Caccitore, J., Schnebly, S., & Froen, J. F. (2008). The effects of social support on maternal anxiety and depression after stillbirth. Health and Social Care in the Community. doi : 10.1111/j.1365-2524.2008.00814.x

12 Cote-Arsenault, D. & Mahlangu, N. (1999). Impact of perinatal loss on the subsequent pregnancy self: Women’s experiences. Journal of Obstetric, Gynecologic & Neonatal Nursing, 28(3), 274-282.

13 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. (2015). Stillbirth Collaborative Research Network. Retrieved from https://www.nichd.nih.gov/research/supported/Pages/scrn.aspx

14 Gaudet, C., Sejourne, N., Camborieux, L., Rogers, R., & Chabrol, H. (2010). Pregnancy after perinatal loss: association of grief, anxiety and attachment. Journal of Reproductive and Infant Psychology, 28(3), 240-251.

15 Gold, K. J., Leon, I., Boggs, M. E., & Sen. A. (2016). Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. Journal of Women’s Health, 25(3), 263-269.

16 Gold, K. J., Boggs, M. E., Muzik M. & Sen, A. (2014). Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss. General Hospital Psychiatry, 36, 650-654.

17 Gold, K. J. & Johnson, T. R. B. (2014). Maternal mental health outcomes after perinatal death. Obstetrics & Gynecology (abstract).

18 Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø (2018). Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: A prospective study. BMC Pregnancy Childbirth, 18(1): 41. doi: 10.1186/s12884-018-1666-8.

19 Hutti, M.H. (2005). Social and professional support needs of families after perinatal loss. Journal of Obstetric Gynecologic, and Neonatal Nursing, 34(5), 630-638.

20 Jaffe, J. (2014). The reproductive story: Dealing with miscarriage, stillbirth, or other perinatal demise. In D.L. Barnes (ed.), Women’s reproductive mental health across the lifespan (pp. 159-176). New York: Springer.

21 Jaffe, J. & Diamond, M.O. (2011). Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients. Washington, D.C.: American Psychological Association.

22 Kersting, A. & Wagner. B. (2012). Complicated grief after perinatal loss. Dialogues in Clinical Neuroscience, 14(2), 197-194.

23 MacDorman, M. F. & Gregory, E. C. W. (2015). Fetal and perinatal mortality: United States, 2013. National Vital Statistics Report, 64(8).

24 Uren, T. H. & Wastell, C. A. (2002). Attachment and meaning-making in perinatal bereavement. Death Studies, 26(4), 279-308.

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