Transcript English author, critic, & lexicographer (1709

Helping Patients Cope with
Perinatal and Neonatal Loss
Joseph A. Banken, M. A. Ph.D. HSPP
Associate Professor
UAMS Department of Obstetrics & Gynecology
Licensed Psychologist
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Objectives
• Understand coping with loss
• Recognize high-risk groups who have
higher risk of have complications with
Perinatal and Neonatal loss
• Be able to offer helpful strategies to help
patients cope with Perinatal and Neonatal
loss
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Facts about Perinatal Loss
• Approximately 15-20% of all pregnancies
result in miscarriage or stillbirth
• The causes of such losses vary greatly and
many remain medically unexplainable
• Parents want an attributive “reason” why
loss has occurred
• Large proportion of parents experiencing
loss feel misunderstood by others
• Medical professionals
• Family, friends, support systems
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Factors Influencing
Perinatal and Neonatal Loss
• Diverse coping patterns
• Age of parents
• Behavioral health history of mother
• Religious influences
• Cultural differences
• Family dynamics
• History of previous loss
• Perception of support for loss experience
• Less recognized by support system
• Less validated by others
• Not well understood in clinical literature
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Four Periods of
Perinatal and Neonatal Loss
• Immediate
• Acute
• Working through
• Reorganization
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Complicated Bereavement
(Prolonged Grief Reaction)
• Clinical concern if improvement in
adaptive functioning is NOT seen in
about 2 months
OR
• Moderate to severe clinical symptoms
meeting criteria for psychiatric disorder
OR
• Suicidal ideations
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Risk Factors for
Complicated Reactions to Perinatal
and Neonatal Loss
• Lack of social support
• History of psychiatric
disorder
• Initial grief reaction
exceeding cultural
norms
• Unanticipated death
• Multiple deaths
• Concurrent significant
stressors
• Previous child death
or miscarriage
• Previous history of
suicide attempts
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Neonatal Death: Special Risk
Concerns
• Risk for development of psychiatric disorder is
greatest during first year after infant/child death
• Remains elevated for 5 years
• Increased rates of schizophrenia, depression and drug
abuse
• Danish Study (2005)
• Mother at least
• 6x more likely to be hospitalized for mood disorder
• 4x more likely to be hospitalized for schizophrenia
• 3x more likely to be hospitalized for drug abuse
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New Approaches to Help Patients
Cope with Loss
• Recognize heterogeneity of grief reactions
and supportive needs
• “Letting go” approaches less effective than
originally thought
• Constructive continuity approaches likely
more helpful
• “Meaningful connections”
• Constructive meaning to loss experiences
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BASIC ID:
Practical Strategies to Help with Coping
B Behavior – action-oriented coping, activities
A Affective – elicitation of positive emotion, feeling “good”
S Sensory – sensory pleasure, experiencing comfort, avoid
drugs and alcohol
I Insight - meaning of loss, existential orientations
C Cognitive – “re-script” negative thoughts, “meaningful
connections” cognitive reconstructions
I Interpersonal – support, open “connective” discussions
D Drugs – consideration of medication, reduce maladaptive
symptoms, anxiolytics to target severe symptoms
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Hope and Help for Parents
Who Have Lost a Baby: The
Recovery Room
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Part of ANGELS Program
Available through UAMS Telemedicine
Support group for grieving parents
Family members welcome
Confidential forum
Share thoughts, feelings, expectations
Receive support
• health care providers trained to address loss
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While grief is fresh, every
attempt to divert only
irritates. You must wait till it
be digested, and then
amusement will dissipate the
remains of it.
Samuel Johnson
English author, critic, & lexicographer (1709 - 1784)
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