[4] Perinatal bereavement, while sharing similarities with grief for other loved ones, is unique due to its nature as the loss of an idealized future relationship.
[6] Despite recommendations of bed rest, administrations of hormones such as β-hCG and prophylactic progesterone, uterine relaxants, and other therapies, there are no effective means of preventing a miscarriage.
To distinguish a miscarriage from other pregnancy complications, a thorough evaluation of a patient's medical history, as well as a physical examination, transvaginal ultrasound, and blood tests are recommended.
Cain explored the impact of child loss on siblings and described the profound emotions women often face after a miscarriage, including fear, grief, anger, and despair.
Since then, there has been an effort to address gaps in the field by conducting more systematic studies with larger sample sizes, providing a deeper understanding of perinatal bereavement.
[5] Critics of the Perinatal Grief Scale (PGS) argue that it places excessive emphasis on emotions specifically related to the loss of the baby, while neglecting other grief-related feelings.
It has been instrumental in gauging grief responses in patients, assessing related psychological and social factors, and evaluating the effectiveness of bereavement interventions.
[21] The widespread use of the Perinatal Grief Scale (PGS) may be attributed to its ease of application, quick analysis, and successful validation across various languages and cultures, reinforcing its utility as both a clinical and research tool.
A scoping review identified four primary factors commonly examined for their influence on grief responses: (1) sociodemographic characteristics, (2) support systems, (3) reproductive history, and (4) mental health status.
[5] The lack of consensus among researchers can be attributed to variations in study designs, sample populations, and the diverse measures used to evaluate grief.
[4] In several longitudinal studies, Perinatal Grief Scale (PGS) scores, as expected, decrease over the two years following a loss among bereaved parents as a whole.
For mothers, the consequences of perinatal loss can be physical (such as hemorrhage or infection) and psychological (such as symptoms of post-traumatic stress, anxiety, depression, and other serious mental health disorders).
[28] A lack of acknowledgement and support from society and healthcare professionals of the emotional impact of perinatal loss can further lead to parents experiencing disenfranchised grief, which may result in secretive mourning and heightened feelings of guilt and self-blame.
[32] Additionally, bereaved mothers may struggle with ongoing pregnancy-related symptoms after their baby has passed, such as lactation, postpartum hormonal changes, and alterations in body shape.
Their sense of motherhood can feel threatened by societal reminders, such as consent forms asking how many children they have, holidays like Mother's Day, representations of families in advertisements, and displays in baby sections.
Individuals who grieve intuitively may find comfort in discussing their feelings, crying, or seeking social support as a way to cope with their loss.
This approach involves engaging in practical activities or projects, such as creating memorials, working towards specific goals, or focusing on problem-solving tasks, rather than expressing emotions openly.
[35] Differences in grieving styles may lead to interpersonal conflict; a lack of willingness to understand each other can threaten the sense of unity in a relationship and create a feeling of isolation in one’s grief.
Some individuals report feelings of guilt, intrusive thoughts, or distressing mental images that hinder their ability to engage in sexual activity.
[31] Women may develop negative perceptions of their bodies, particularly due to the physical changes associated with pregnancy and childbirth, which can diminish their desire for intimacy or affect their ability to find pleasure in it.
[31] Coping strategies play an essential role in helping bereaved mothers manage the psychological and emotional hardships of losing a child.
For some mothers, personifying their deceased child by attributing individuality, identity, and human qualities to them helps maintain a bond and grieve for a real person rather than an abstract loss.
[40][41][32] A meta-analysis of psychosocial interventions demonstrated their effectiveness in reducing depression, anxiety, and grief among parents coping with perinatal loss.
[42] Multiple randomized controlled trials have demonstrated that cognitive behavioral therapy is highly effective in reducing chronic psychological disorders following the loss of a child.
[25][43] Here is an example of components included in a CBT treatment used in a study on perinatal loss: Swanson’s Caring Theory provides a compassionate framework for supporting women who have experienced a miscarriage.
[44] The theory outlines five key elements of the caring process: Swanson's approach has proven to be effective for parents who experienced a miscarriage before 22 weeks, with randomized controlled trials showing significant reductions in grief symptoms.
[47] Mindfulness-based stress reduction programs have been shown to reduce anxiety and depression levels in women who have experienced miscarriage or ectopic pregnancies in a randomized controlled trial.
[55] These events provide a space for bereaved parents to share their grief and connect with others, with the aim of raising public awareness and encouraging dialogue about the prevalence of baby loss.