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While the focus of this chapter is on perinatal loss, other reproductive losses including miscarriage, ectopic pregnancy, infertility, and pregnancy termination for fetal anomaly are briefly considered and contrasted.

Identifying Perinatal Grief Prior to the 1970s, the medical and psychological literature showed little awareness that perinatal loss caused substantial distress.

Lewis poignantly documented how seemingly psychotic behavior by a newly bereaved mother, who tried to walk her dead baby and frantically kissed his navel, mouth, and penis, enabled her to optimally mourn her child by: ' ...

attempting to come to terms with the baby’s lost future.

However, methodological weaknesses such as failing to use measures specific to perinatal loss or to track the trajectory of this grief made it difficult to clearly understand what is unique about death at the inception of life and also made it difficult to detect early high-risk factors leading to later psychological difficulty. This decade marked the increasingly routine use of protocols embedded in perinatal bereavement programs helping parents to grieve the death of their child.

Kellner pioneered perhaps the earliest multidisciplinary, hospital-based Perinatal Mortality Counseling Program integrating effective counseling with data collection and research.

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Mourning the Death of a Baby Attachment to the Baby-to-Be By the last trimester of pregnancy, both expectant parents, but especially the mother, develop an intense attachment to their unborn child as a unique, separate person, Parental images of the unborn child are so powerfully established by this time that there is a statistically significant degree of continuity in parental perception of the baby’s temperament (e.g. Perinatal loss is frequently traumatic, occurring quite suddenly and without any anticipation in this age of high technology, where there is the increasing belief that deaths like this no longer occur.

Under the direction of Sister Jane Marie, for more than a decade, SHARE (founded in 1977) provided a model for more than 400 community-based self-help groups oriented to pregnancy loss throughout the United States and other countries.

are most frequently given to parents soon after a perinatal loss, helping them to normalize their powerful reactions and encouraging the construction of memories to facilitate grieving.

While “active grieving,” the normatively most benign and time-limited response to pregnancy loss, is strongly associated with a longer gestation and mothers (versus fathers), the subscales “difficulty coping” and “despair” often presage more long-term and difficult grief reactions significantly associated with poorer internal and interpersonal resources (i.e. After the initial shock and numbness on learning of the death (especially if it was unexpected), a period of intense confusion usually follows with lapses in memory, anxiety, restlessness, irritability, and somatic distress.

prepregnancy emotional problems and less social support, both between partners and among family and friends). As the reality of the death is gradually absorbed, the bereaved yearns for the return of the deceased.