Should Parents and Families of Stillborn Babies be Encouraged to See, Hold, and Have Funerals?

This article was originally posted on nursingcenter.com

MCN, The American Journal of Maternal/Child Nursing

May/June 2014, Volume :39 Number 3 , page 146 - 147 [Free]

PRO

The stillbirth of babies has been found to cause profound and lifelong grief among parents. In the past, medical professionals commonly removed the stillborn baby very quickly after birth, attempting to "protect" the parents from experiencing grief and bonding with the deceased babies. Stillbirth and miscarriages often were "invisible to society" (Capitulo, 2005, p. 2).

Since the 1960s, the grief of pregnancy loss, stillbirth, and perinatal death has been studied. Parents who were not allowed to see and hold their deceased baby expressed lifelong emotional distress. Denying families the opportunity to see and have funerals for their stillborn and deceased infants causes the bereaved to be at increased risk for disenfranchised grief. This complicated grief can be manifested in mental health disorders, feelings of anger and perpetual sadness, and dreams that their babies looked like monsters.

Parents and Families

It has been reported that the mothers who had contact with their stillborn babies had better long-term psychological outcomes compared with those who did not. People who have experienced the death of a family member, usually make meaning of their losses by expressing grief through mourning ceremonies and rituals. For families who have experienced stillbirth or neonatal death, the funeral process includes saying good-bye and presenting the deceased body for parents' viewing. These rituals have a healing effect on the grief (Wijngaards-de Meij et al., 2008). Making memories validates the identity of the deceased baby and recognizes the "living" relationship the parents still have with their child. Rituals such as blessings, baptisms, and funerals have been found to be comforting, supportive, and psychotherapeutic for individuals who experience a baby's death.

Social support during a major life event, such as a perinatal death, is a key factor in the prevention of psychological disorders and promotion of healthy readjustment. Many bereaved mothers have voiced the lack of support given to them during their grieving process. This lack of social support and lack of validation of the ongoing bond one has with a deceased child can lengthen and intensify the grieving process. Without this support, bereaved parents can feel alone, isolated, and misunderstood, which can contribute to the development of complicated grief (Shear, 2012).

Healthcare professionals and hospital staff have a great influence on parents' decisions during acute grief. Most of the mothers who did not see and hold their stillborn babies regretted their decision (Cacciatore, Radestad, & Frederick Froen, 2008). Thus, it is the duty of hospital professionals to encourage the parents to see and hold their stillborn babies and to facilitate and advocate for ceremonies, such as funerals and rituals congruent with the family's culture and spiritual views. Healthcare professionals should help bereaved parents make meaning of their losses, create positive and loving memories of their deceased babies, and support them through their individual journeys of grief. Healthy mourning includes validating the reality of the death and value of the baby as a human being. Healthcare professionals provide a calm, supportive environment in which parents can say their final good-byes, enable parents to spend as much time as they want with their deceased child, and provide ongoing support to promote healing grief and decrease the potential for future stress disorders and psychic trauma. Although grief is universal, each family is entitled to appropriate healing interventions, including seeing their baby and holding rituals of remembrance.

References

Cacciatore J., Radestad I., Frederick Froen J. (2008). Effects of contact with stillborn babies on maternal anxiety and depression. Birth, 35(4), 313-320. doi:10.1111/j.1523-536X.2008.00258.x [Context Link]

Capitulo K. L. (2005). Evidence for healing interventions with perinatal bereavement. MCN, the American Journal of Maternal-Child Nursing, 30(6), 389-396. [Context Link]

Shear M. K. (2012). Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 119-128. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384440/[Context Link]

Wijngaards-de Meij L., Stroebe M., Stroebe W., Schut H., Van den Bout J., Van Der Heijden P. G..,, Dijkstra I. (2008). The impact of circumstances surrounding the death of a child on parent's grief. Death Studies, 32(3), 237-252. doi:10.1080/07481180701881263 [Context Link]

CON

Giving birth to a stillborn child is a major life event and can lead to psychological trauma. Publications of researchers, nurses, social workers, and bereavement counselors have encouraged healthcare professionals who care for parents of stillborn babies to view and hold the deceased body, and even have funerals in the hospital. These interventions are aimed at helping the parents cope with the painful loss of their child and prevent them from developing severe distress. However, these practices have been called into question in recent years.

Actually, depression and anxiety after child loss continue for years, even after subsequently giving birth to a healthy infant. Cacciatore and her colleagues' study showed that grieving mothers who have seen or held their deceased babies tend to have higher anxiety in a subsequent pregnancy. The positive effect of holding babies may be just temporary and reversed after a following pregnancy. In this study, participants who were pregnant had more symptoms of anxiety if they had seen and held their baby, indicating seeing and holding the baby may be associated initially with fewer anxiety and depressive symptoms than not doing so, but the beneficial effect is temporarily reversed during a subsequent pregnancy (Cacciatore, Radestad, & Frederick Froen, 2008).

Symptoms of posttraumatic stress disorder (PTSD) have also been found more prevalent in the pregnancy that follows loss. Holding a stillborn baby after birth causes an increase in symptoms of PTSD and marriage breakdown in the pregnancy following loss, with symptoms of PTSD continuing 7 years after the loss (Turton, Evans, & Hughes, 2009). Women who did not see or hold their child had significantly lower depression scores in the subsequent pregnancy, and had less symptoms of anxiety and PTSD (Hughes, Turton, Hopper, & Evans, 2002).

The psychosocial effects of stillbirth are long lasting and traumatic. During a subsequent pregnancy after the loss, mothers have fewer symptoms of depression and anxiety. These studies found that seeing and holding the deceased baby dose not benefit mothers, psychosocial state during a subsequent pregnancy. Interestingly, even their next-born infants were more likely to show disorganized attachment behavior (Hughes et al., 2002).

Should a parent have contact with the deceased baby or not? Women usually relied on the judgment of the health professionals to make this decision. The impact of holding the baby, keeping memories of a stillborn, or even having a funeral is still in question. In my point of view, the parents should not be encouraged to have contact with the stillborn. Parents should make their own decisions. In respecting the wishes of the parents, healthcare professionals should give parents the choice of seeing the baby or not, without encouraging them. Mothers who do not choose to see their dead infants should not be persuaded to do so. The staff should not force the mother to hold, caress, or kiss the dead child. Such actions may not be beneficial in reducing the risk for anxiety or depression.

Rather than encouraging mourning rituals, healthcare professionals should choose protocols that diminish the risk of long-term psychological complications and benefit future pregnancies. It is safer and more effective to facilitate hospital staff, friends, and bereavement counselors to provide social support to the grieving couple. Supportive interventions can include visiting with the bereaved parents to provide comfort in their loneliness, giving them an opportunity to talk about their feelings freely and listening to them, recognizing adjustments in family relationships, and supporting their mental and physical health to prepare for a subsequent pregnancy. Of course, healthcare professionals should pay special attention to mothers during a subsequent pregnancy. Easing their anxiety of repeat child loss may lead to a better prognosis for both the PTSD from the former stillbirth and the stress of a subsequent pregnancy.

References

Cacciatore J., Radestad I., Frederick Froen J. F. (2008). Effects of contact with stillborn babies on maternal anxiety and depression. Birth, 35(4), 313-320. doi:10.1111/j.1523-536X.2008.00258.x

Hughes P., Turton P., Hopper E., Evans C. D. (2002). Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: A cohort study. The Lancet, 360(9327). 114-118. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09410-2/fullte[Context Link]

Turton P., Evans C., Hughes P. (2009). Long-term psychosocial sequelae of stillbirth: Phase II of a nested case-control cohort study. Archives of Women's Mental Health, 12(1), 35-41. doi:10.1007/s00737-008-0040-7 [Context Link]