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Lloyd CA, Hutti MH. Grief intensity following adolescent miscarriage or abortion: A descriptive study of recollections of adult women. Heliyon 2024; 10:e33634. [PMID: 39071695 PMCID: PMC11283081 DOI: 10.1016/j.heliyon.2024.e33634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Objective The purpose of this study was to examine women's recollected lifespan perceptions of the effect of grief intensity following adolescent perinatal death. Participants Nineteen adult women who had experienced either a miscarriage or an abortion during adolescence. The study involved the recollection of events surrounding the experience which had occurred between three and 28 years previously. Methods A 55-item online survey was used to gather recollected perceptions of adolescent miscarriage and abortion experiences. The Perinatal Grief Intensity Scale was embedded within this survey. The participants were instructed to recall their responses to the perinatal loss at the time of the event as an adolescent (T1; Time 1) and how they feel currently as adults about their previous adolescent perinatal death (T2; Time 2). Data were collected at both T1 and T2. The Perinatal Grief Intensity Scale is accompanied by an appropriately weighted Excel scoring sheet which was utilised to analyse the data at both T1 and T2. Results As adolescents, participants perceived similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 6). However, more women who had an abortion (n = 5) experienced low grief intensity compared with participants who had a miscarriage (n = 2). As adults, participants continued to perceive similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 5). In addition, women who had an abortion continued to experience more low grief intensity (n = 6) compared with participants who had a miscarriage (n = 2). Approximately one quarter of adult female respondents, 26 % (n = 5) exhibited increased grief intensity as measured by the scores over time. Thirty seven percent (n = 7) exhibited no change in scores, and 37 % (n = 7) exhibited decreased scores over time in response to adolescent miscarriage or abortion. Conclusions Support for the adoption of the Perinatal Grief Intensity Scale to identify women in need of follow-up for grief intensity after an adolescent miscarried or terminated pregnancy is evident. The results of this study have demonstrated that grief can resurge or appear in adult females as they respond to events across the lifespan, including further reproductive experiences. Therefore there is a compulsion for health care professionals to identify women at risk of intensive grief responses due to previous contributory events. Tweetable abstract Healthcare providers should screen adult women who have experienced a previous adolescent miscarriage or termination for adverse mental health issues in adulthood.
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Affiliation(s)
| | - Marianne H. Hutti
- College of Nursing, University of Kentucky, KY, USA
- Ambulatory Services, University of Kentucky (UK) Healthcare, KY, USA
- School of Nursing, University of Louisville, KY, USA
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Ennis N, Bottomley J, Sawyer J, Moreland AD, Rheingold AA. Measuring Grief in the Context of Traumatic Loss: A Systematic Review of Assessment Instruments. TRAUMA, VIOLENCE & ABUSE 2023; 24:2346-2362. [PMID: 35616367 PMCID: PMC9699905 DOI: 10.1177/15248380221093694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following traumatic loss, defined as the death of a loved one due to unexpected or violent circumstances, adults may experience a myriad of grief-related problems. Given the addition of Prolonged Grief Disorders into the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition, Text-Revision and influx of unexpected deaths due to the global Coronavirus pandemic, there is heightened interest in the measurement of grief-related processes. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify measures of grief used in studies of adults who experienced traumatic loss. Searches yielded 164 studies that used 31 unique measures of grief-related constructs. The most commonly used instrument was the Inventory of Complicated Grief-Revised. Half of the measures assessed constructs beyond diagnosable pathological grief responses. Given the wide variation and adaptations of measures reviewed, we recommend greater testing and uniformity of measurement across the field. Future research is needed to adapt and/or design measures to evaluate new criteria for Prolonged Grief Disorder.
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Affiliation(s)
- Naomi Ennis
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jamison Bottomley
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Angela D. Moreland
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
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Mainali A, Infanti JJ, Thapa SB, Jacobsen GW, Larose TL. Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia. BMC Pregnancy Childbirth 2023; 23:111. [PMID: 36782148 PMCID: PMC9923894 DOI: 10.1186/s12884-022-05318-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/20/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Perinatal loss can have long-lasting adverse effects on a woman's psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations. AIMS The primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss. METHOD This case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy. RESULTS Scandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49-1.95) and total depression score (β: 0.90, 95% CI: 0.06-1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating. CONCLUSION Women who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.
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Affiliation(s)
- Anustha Mainali
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jennifer J. Infanti
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Suraj Bahadur Thapa
- grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir W. Jacobsen
- grid.5947.f0000 0001 1516 2393Present Address: Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tricia L. Larose
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Alaradi M, Hutti MH, Chaffin N. Arab Muslims' Perceptions of Perinatal Loss Care in the United States of America. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1838-1846. [PMID: 34617365 DOI: 10.1111/hsc.13563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/10/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
One in four American women will experience a miscarriage, stillbirth or neonatal death each time she becomes pregnant. These perinatal losses occur even more frequently in women who are immigrants from developing countries. Care of Muslim families after perinatal loss is based primarily on expert opinion as opposed to research evidence, as few, if any, studies exist on this topic. It is critically important to know what parent's preferences for care actually are, since care that is incongruent with the desires of the bereaved parents may intensify their grief. The purpose of this study was to examine the perceptions and attitudes of immigrant Arab Muslims regarding psychosocial bereavement practices common in the United States after perinatal loss and to pilot test an investigator-developed instrument for collecting data regarding culturally relevant psychosocial bereavement practices of immigrant Arab Muslims after perinatal loss. The study employed a cross-sectional survey design using an investigator-developed instrument entitled the Arab Muslim Perceptions of Perinatal Loss Care (AMPPLC). The AMPPLC, available in both English and Arabic, was used to collect data on perinatal loss care from a convenience sample of 79 immigrant Arab Muslim adults (male n = 43 [54.4%]; female n = 36 [45.6%]). The study opened in June 2017 and closed in August 2019. The AMPPLC instrument demonstrated good reliability (α = 0.89) in measuring participants' responses. Responses by survey participants did not always agree with prior published literature on Muslim preferences after a loss. Optimal care for Arab Muslim immigrants involves offering all options that are typically part of Western bereavement care as well as options that may be more specifically associated with Islam. This information will enable healthcare providers to provide more culturally sensitive and compassionate care to Middle Eastern Muslim parents during this difficult and tragic experience.
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Affiliation(s)
- Maryam Alaradi
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
| | - Marianne H Hutti
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
- Women's Health Nurse Practitioner in Independent Practice, Louisville, Kentucky, USA
| | - Nikki Chaffin
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
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Wesselmann ED, Parris L. Miscarriage, Perceived Ostracism, and Trauma: A Preliminary Investigation. Front Psychol 2022; 12:747860. [PMID: 35153890 PMCID: PMC8828504 DOI: 10.3389/fpsyg.2021.747860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
Miscarriage often is a traumatic experience with serious mental health implications. Friends and family members are often uncomfortable with and avoid discussing the topic with bereaved individuals, potentially making them feel ostracized (i.e., being ignored and excluded), contributing to their mental health concerns. We investigated the correlation between posttraumatic stress symptoms, perceived ostracism, and recalled grief intensity measures in a sample of cisgender women (N = 97) who have had a miscarriage. These participants were recruited using Qualtrics’s Panel Recruitment Services. Women’s perceived ostracism correlated positively with posttraumatic stress symptoms and negatively with grief congruence (i.e., the degree to which they felt that their miscarriage process was as satisfactory as possible, given they had to experience it). Perceived ostracism also explained additional variance in posttraumatic stress symptoms when considered alongside grief intensity measures (e.g., congruence).
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Affiliation(s)
- Eric D Wesselmann
- Department of Psychology, Illinois State University, Normal, IL, United States
| | - Leandra Parris
- College of William & Mary, Williamsburg, VA, United States
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Abstract
Parents who choose to carry a pregnancy complicated by a life-limiting congenital anomaly such as anencephaly may give birth to a live neonate and be discharged home. Very little guidance is available to health care professionals providing palliative care in the home setting to this population. This article is a secondary analysis that discusses the concerns and complications that parents experienced after bringing home a neonate with anencephaly. Each parental experience is a qualitative descriptive summary extracted from a larger study on the impact of anencephaly on parents. Parents reported feeling alone in their grief and struggled with their partners' differing style of grief. Parents' primary concerns after hospital discharge included transporting their neonate home, feeding their neonate, changing cranial defect dressings, managing pain and seizures, addressing uncertainty, and facilitating a good death. All parents received hospice services from health care professionals without perinatal bereavement training or experience. Only 1 woman received follow-up care after the death of her son. Preparing and educating health care professionals providing hospice and palliative services with perinatal bereavement training may be beneficial. Identifying and allocating local and online perinatal bereavement resources may provide parents with the tools and support necessary to facilitate healing after perinatal loss.
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Affiliation(s)
- Shandeigh N Berry
- Shandeigh N. Berry, PhD, RN, CNOR, is assistant professor, College of Arts & Sciences, Saint Martin's University, Lacey, Washington
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Berry SN, Severtsen B, Davis A, Nelson L, Hutti MH, Oneal G. The impact of anencephaly on parents: A mixed-methods study. DEATH STUDIES 2021; 46:2198-2207. [PMID: 33866956 DOI: 10.1080/07481187.2021.1909669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.
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Affiliation(s)
- Shandeigh N Berry
- College of Arts & Sciences, Saint Martin's University, Olympia, Washington, USA
| | - Billie Severtsen
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Andra Davis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Lonnie Nelson
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Marianne H Hutti
- College of Nursing, University of Kentucky, Louisville, Kentucky, USA
| | - Gail Oneal
- College of Nursing, Washington State University, Spokane, Washington, USA
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Berry SN, Marko T, Oneal G. Qualitative Interpretive Metasynthesis of Parents' Experiences of Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2020; 50:20-29. [PMID: 33212051 DOI: 10.1016/j.jogn.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss. DATA SOURCES We searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents' experiences of perinatal loss. STUDY SELECTION We included research on parents' experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature. DATA EXTRACTION We used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents' perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis. DATA SYNTHESIS We used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding-Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere. CONCLUSION Our findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents' overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.
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Nurse-Clarke N. Managing Ambiguity When Caring for Women Who Experience Stillbirth. J Obstet Gynecol Neonatal Nurs 2020; 50:143-153. [PMID: 33197434 DOI: 10.1016/j.jogn.2020.09.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To examine the interactions and social processes involved when nurses care for women who experience fetal demise and subsequent stillbirth. DESIGN Qualitative design using grounded theory. SETTING Single-site urban medical center in New York City. PARTICIPANTS Twenty registered nurses who worked in the labor and delivery department. METHODS I collected data via in-depth interviews and recorded, transcribed, and analyzed the data using constant comparative analysis. RESULTS Managing Ambiguity emerged as the overarching preliminary theory to describe how nurses cared for women who experienced stillbirth. This preliminary theory included three themes: Experiencing a Spectrum of Emotions, Managing Patient Care in an Ambiguous Context, and Managing Institutional Ambiguity. These themes provided an overview of the creative/protective and avoidant/conflicted behaviors that nurses brought to their work with women whose fetuses died in utero and were stillborn. These interactions were complicated by institutional policies and additional factors, such as workload, that often denied nurses the resources needed to engage in the patient care processes required to address the trauma experienced by women and their families. CONCLUSION The preliminary theory Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for women who experience stillbirth. The absence of preparatory education, effective protocols, and institutional support contributed to the ambiguity inherent in caring for these women.
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A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions. Palliat Support Care 2020; 19:246-256. [PMID: 32867873 DOI: 10.1017/s1478951520000826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. METHOD Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. RESULTS A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. SIGNIFICANCE OF RESULTS The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
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Mecdi Kaydirak M, Aslan E. Efficacy of Nursing Support in the Pre- and Postmedical Termination of Pregnancy Phases: A Randomized Study. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:51-68. [PMID: 31550199 DOI: 10.1177/0030222819877791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to evaluate the efficiency of a nursing support program developed in accordance with the Roy adaptation model that was applied in addition to routine nursing care during the treatment process of pregnant women for whom the medical termination decision. This study, which was conducted using a pretest-posttest design, was a prospective, single-blind, and randomized-controlled empirical study. In the experimental group, although the first and last assessment State Anxiety Inventory scores were higher than those in the control group after the medical termination nursing support program, there was no significant difference. Compared with the control group, there were positive differences in the Scale of Ways of Coping with Stress, Adaptation Assessment Form for Role Function Area, and physical complaints in the experimental group. At the follow-up assessment, the total Perinatal Grief Scale score was significantly higher than that in the control group.
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Affiliation(s)
- Meltem Mecdi Kaydirak
- Department of Obstetrics and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Turkey
| | - Ergül Aslan
- Department of Obstetrics and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University - Cerrahpasa, Turkey
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Abstract
There are several ways, clinically, to approach grief after perinatal death, including from a humanistic or a medicalized perspective. The death of a baby is complicated. The loss is an embodied one that incites deep psychological wounds and can be isolating for many parents. Parents process their grief experiences within a sometimes oppressive social context that either sees their expressions of loss as a normal response to an abnormal tragedy or as pathology. Several diagnostic categories have been proposed relative to the traumatic grief experiences of grieving parents that potentially affect them. We explore this nomenclature and, through the lens of a Social-Cognitive Processing Model, examine social support, attitudes, context, and oppressive interpersonal and social structures that affect parents. Clinical implications are discussed.
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