the many faces of childbirth loss: helping families heal
TRANSCRIPT
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)