The Many Faces of Childbirth Loss: Helping Families Heal

Andrea Werner Insoft, LICSW Fredda Zuckerman, LICSW

PIPH May 12, 2015

When a parent dies, you lose your past. When a child dies, you lose your future.

Overview •  Evolution of Care

•  Types of Loss

•  Role of Social Work

•  Continuation vs Termination

•  Grief

•  Trauma

•  Healing

•  Next Steps

•  Self Care

Evolution of Care •  Terminology

•  How Management of Losses Has Changed and Evolved

•  Minimization à Recognition

•  Current Trends of Care

•  Challenges for Inpatient and Outpatient Providers

Types of Pregnancy Loss •  Abortion

•  Early Miscarriage

•  Ectopic Pregnancy

•  Late Loss

•  Twin Death

•  Still Birth

•  Neonatal Death

•  Selective Reduction

•  Termination

Role of the Social worker in Outpatient Setting

• Part of health care team • Helping with the decision making process • Acknowledge • Explore • Reflect

• Educate • Support • Bear Witness

Prediagnostic Testing: The Good News and The Bad News • Early Diagnosis • Early Identification • Opportunity to Gather Information • Unknown Prognosis

• Burden of Choice

Decision Making: The Burden of Choice

https://youtu.be/xf3rETOO62s

After Tiller

After Tiller

Termination of Pregnancy: Types of Intervention

• Medical Abortion • D & E • Saline Induction • Selective Reduction

Continuation of Pregnancy

Process for people with losses other than termination

• Early Loss • Late Loss • Twin Death • Stillbirth • Neonatal Death

Role of therapist: Other Pregnancy Losses

• Acknowledge • Explore • Reflect • Educate • Support

• Bear Witness

Companioning

• Alan Wolfelt • Beyond the medical model • ~com – with • ~pane – bread • Literally breaking bread with someone

Grief Process •  Instrumental Griever •  Intuitive Griever • Guilt • Anger • Fear

• Anxiety • Self Esteem

PTSD • Not all wounds are visible • Triune Brain • Thinking – frontal lobe • Limbic system activates – amygdala • Brain stem responds—either speed up or shut down

• DSM Diagnosis

Healing

•  Individual Therapy • Couples’ Therapy • Support Groups • On-line support • Social Media

Other Avenues for Healing

• Acupuncture • EMDR or Sensorimotor psychotherapy to address

trauma • Donating Breast Milk • Donating to hospital •  Setting up a fund •  Find knowledgeable providers •  Funerals/Rituals

Call The Midwife

Support Groups

• Goals • Five Week Mode • Major Issues • Group Ritual • Pros and Cons of Group

Next Steps

Implications for Future Pregnancies •  Information gathering

•  Decision making

•  Capacity for dealing with anxiety

•  Developing support network

•  Complicated process of grieving while pregnant

•  Duality of attaching while mourning

•  Potential for •  PPD •  Attachment issues •  Relief àjoy or Sadness

Self Care •  Breathe…

•  Personal Loss History

•  Know your limits

•  Know when to ask for help

•  Reserve judgment of your self and the patient

•  Allow enough time

•  You don’t need to have all the answers

•  Separate work from home

•  Expect that you will make mistakes

THANK YOU

Listening is hearing with thoughtful attention.

Don’t try to be too wise; don’t always try to search for something profound to say.

You don’t have to do or say anything to make things better. Just be there as fully as you can.

References •  Cacciatore, Joanne, LMSW, FT. “Effects of Support Groups on Post

Traumatic Stress Responses in Women Experiencing Stillbirth.” OMEGA, Vol. 55(1) 71-90, 2007

•  Davis, Deborah L. Stillbirth, Yet Still Born: Grieving and Honoring Your Precious Baby. Fulcrum Publishing, August 26, 2014

•  Golden, Thomas R. Swallowed By A Snake: The Gift Of The Masculine Side Of Healing. Golden Healing Publishing; 1 edition, January 1, 2010

•  Hlavsa, D. “My First Son: A Pure Memory.” New York Times. Modern Love September 19, 2008

•  Kelley, Maureen C and Trinidad, Susan B. “Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis.” BMC Pregnancy and Childbirth 2012

References (continued) •  LaFarge, C, Mitchell, K, and Fox, P. “Women’s Experiences of Coping

With Pregnancy Termination for Fetal Abnormality.” Qualitative Health Research 23(7) 924–936 2013

•  McCoyd, J. L. M. Pregnancy interrupted: Loss of a desired pregnancy after diagnosis of fetal anomaly. Journal of Psychosomatic Obstetrics & Gynecology, 28(1), 37-48. 2007

•  McCoyd, J. LM. “I’m not a saint”: Burden assessment as an unrecognized factor in prenatal decision making. Qualitative Health Research, 18, 1489-1500. 2008

•  McCoyd, J. L. M.. Discrepant feeling rules and unscripted emotion work: Women coping with termination for fetal anomaly. American Journal of Orthopsychiatry, 79(4), 441-451. 2009

References (continued) •  McCoyd, Judith LM. “Women in No Man’s Land: The Abortion

Debate in the USA and Women Terminating Desired Pregnancies Due to Foetal Anomaly.” British Journal of Social Work (2010) 40, 133–153

•  Minnick, MA and Delp, KJ. A Time to Decide. A time To Heal. Pineapple Press, 1992

•  Muthler, S. “Breaking the Silence of Still Birth.” New York Times, Motherlode. February 10, 2013

•  Wolfelt, Alan D. Companioning the Bereaved: A Soulful Guide for Counselors & Caregivers. Companion Press: 1 edition (March 2005)