1 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

2 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

3 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

4 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

5 Four Periods of Perinatal and Neonatal Loss Immediate Acute Working through Reorganization

6 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

7 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

8 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

9 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

10 BASIC ID: Practical Strategies to Help with Coping B B Behavior – action-oriented coping, activities A A Affective – elicitation of positive emotion, feeling “good” S S Sensory – sensory pleasure, experiencing comfort, avoid drugs and alcohol I I Insight - meaning of loss, existential orientations C C Cognitive – “re-script” negative thoughts, “meaningful connections” cognitive reconstructions I I Interpersonal – support, open “connective” discussions D D Drugs – consideration of medication, reduce maladaptive symptoms,anxiolytics to target severe symptoms

11 Hope and Help for Parents Who Have Lost a Baby: The Recovery Room 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

12 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 Samuel Johnson English author, critic, & lexicographer ( )

13