The death of a child can take the form of a loss in pregnancy, the perinatal period or infancy. For example:
■early pregnancy loss such as ectopic pregnancy and miscarriage
■stillbirth
■perinatal death
■neonatal death
■sudden infant death syndrome (SIDS)
■death of an older child.
■infertility.
In the majority of cases, parents experience acute grief. The death of a child could be considered to be one of the most intense forms of grief and one of the hardest to bear (Shane, 1992). For the majority, the death of a child is an event that evokes unbearable anguish and sorrow (Stack, 2003). A childbearing woman does not simply get over her loss; instead, she will need to adapt and learn to live with it. Interventions and support can make all the difference to the fortitude of a parent in this type of grief, with risk factors such as family break-up or suicide a potential outcome. Feelings of responsibility, whether legitimate or not, are omnipresent. Also, the nature of the parent-infant relationship may result in an assortment of problems, as women, partners and families seek to cope with their loss. Parents who suffer miscarriage or a regretful termination of pregnancy may experience resentment towards others who have accomplished successful pregnancies.
OTHER LOSSES
Parents may grieve due to loss experienced through events other than death. For example:
■having a child adopted or fostered
■termination of a pregnancy for medical or social reasons
■loss of a healthy child through prematurity, illness or abnormality
■legal termination of parental rights incited by the social work department
■having a history of child abuse, neglect or incompetent parenting
■loss of paternal identity due to separation from the childbearing woman
■loss of a romantic relationship (i.e. divorce or break-up)
■for a childbearing woman who strongly identifies with her occupation, a sense of grief from having to discontinue or alter work arrangements due to parenting responsibilities
■a loss of trust, which may also constitute a form of grief.
Each society has its own particular cultural approaches to managing bereavement within the community. These include specific rituals, styles of dress and habits, as well as attitudes that the bereaved are expected to follow. For example, in China where Buddhism guides the majority of citizens, devotees continue their ties with the deceased through religious rituals that express continued attachment. Some of these customs involve presenting plates of conscientiously prepared food and bestowing gifts of cardboard replicas of essential domestic items for use in the spirit world; for example, clothes, shoes, cars, houses and bags of paper money. The significant other proceeds to burn these cardboard items in an incinerator provided by the monks who dwell within the Buddhist temple. The underpinning belief is that the deceased loved one will bestow good fortune upon the initiator and guide them towards positive action here in the physical world. In contrast, amongst the Hopi people of Arizona, the deceased are swiftly forgotten and life continues. In essence, different cultures grieve in different ways and these will be discussed in more detail in Chapter 7. Also, later on in this workbook you will be looking at some of the rituals that maternity care professionals in the UK undertake when dealing with loss of a baby in clinical practice.
Stillbirth is the label given to a fetus who has died in utero. A stillborn is a baby who is born dead after 24 completed weeks of pregnancy. If the baby dies before 24 completed weeks, it is known as a late miscarriage. Stillbirths are not uncommon, with approximately 4,000 occurring every year in the UK.
■1 in 200 births in the UK conclude in stillbirth.
■11 babies born in the UK are stillborn every day.
■In the UK, stillbirth occurs ten times more often than cot death.
The majority of stillbirths arise in full-term pregnancies.
WHAT ARE THE CAUSES OF STILLBIRTH?
A post mortem does not always elicit cause of death, with 50 per cent of stillbirths remaining undiagnosed. Possible instigators of stillbirth include:
■maternal health problems, e.g. intrahepatic cholestasis, diabetes, hypertension, pre-eclampsia, eclampsia etc.
■maternal drug addiction
■anoxia due to placenta or umbilical cord malfunction, e.g. placental abruption, placenta praevia, true knot in cord, cord prolapse, short cord (<30 cm), long cord (>70 cm), cord entanglement
■rhesus disease
■bacterial infection
■congenital defects, e.g. pulmonary hypoplasia
■congenital abnormality
■intra uterine growth retardation (IUGR)
■trauma, e.g. road traffic accidents (RTA)
■radiation exposure
■twin competition for intrauterine resources or cord entanglement.
The concept of carrying a deceased fetus may be traumatic for the woman, with immediate induction being the solution. The mother is usually expected to labour and give birth vaginally, quite simply because caesarian section increases risk of complications and produces a uterine scar that may in future rupture. A caesarian birth is only recommended when vaginal birth is predicted to be or has become problematic. A pregnancy may be purposely terminated late when the fetus has been diagnosed with a congenital abno...
