In this article I will return to a topic that as a mother, father, family member, acquaintance or whatever the link can be experienced. It is important to know the different reactions of grief that can arise in the parents or relatives of the baby or be of little gestation time, recently deceased. Especially for the woman who carries the baby with her, it is a very delicate and deep issue. Due to the low importance given to this topic, I would like to talk a little more about it, and bring on the table what is often not spoken but is silent, perhaps because of pain or fear or perhaps considering it something minor when in reality it is very important.
Today due to the great technological advancement there are multiple ways to conceive a baby . As well as the increasingly early images that can be taken from being in gestation . These images obtained from the ultrasound, facilitate the attachment and the illusions of the parents towards the being that is growing inside the belly. This same technology allows to know from the beginning if the baby presents problems, and it is from this information that many choose not to continue with the development of the embryo and prefer to interrupt it.
Remember that the difference between fetus and child lies in the quality of the place that parents give to that being . That is, that being will be considered as a child when parents give him a place in his inner world, in his family, in his heart, in his mind, in their lives . Before this, that son is simply an embryo growing in a womb. Hard to say, but very true.
Reactions to loss.
The reactions to perinatal loss depend on several factors, and the main one has to do with the expectations of the parents in relation to that being. The other variables that greatly influence the culture, family, family ideology, and prosperity of the society in which their parents are inserted. Different studies have shown, in relation to what has been commented above, that depending on the culture, it is how society reacts to perinatal loss and how its parents will do it, it is not the same in India except in Israel, for example.
Depending on the prevailing culture and religion, it will be how that loss will be interpreted and who will be blamed (or not) for such a situation. Many times, that is to say in many societies, the mother is blamed for not having been able to sustain and carry out a healthy pregnancy. Others simply do not give importance or consider it as normal, part of the life cycle.
The importance of perinatal grief
It is important to talk about this issue since it can trigger great suffering in their parents and loved ones although at first glance one would believe that it is something simple to cope with.
What is the duel?
The word "duel" comes from the Latin term "dolos" which means pain and from "duellum" which means challenge or challenge . Grief is a psychological process that is caused by the loss of a loved one . It is a universal, unique emotional experience and requires the need to adapt to the new situation . In the opposite case we would be talking about a pathological duel.
To be able to determine if it is a pathological or normal duel, an analysis of it must be carried out, through which a whole series of emotional, behavioral, rational, temporal manifestations, feelings and actions resulting from the loss of what is considered He loved himself.
Differences between depression and grief
Many times it can happen that we confuse the grieving processes with a picture of major depression or simply the grieving process can be overlapped by that. That is why it is very important to consult with a specialist and not take anything for granted in the face of events of these characteristics.
Depressive symptoms that are not present in the duel:
- Blame of the survivor for what he did or did not do at the time the loved one dies
- Thoughts about death
- Absence of will and desire to live
- Feelings of worthlessness
- Slowening of gait and movements in general
Manifestations of Duel
Physical Manifestations: chest and throat tightness, choking, emptiness in the stomach, sighs, palpitations, sleep disturbances, nightmares, anergy, sexual reluctance, weight loss, poor appetite or anxious type, indigestion, dry mouth, headaches, somatic complaints, noise sensitivity.
Emotional manifestations: sadness, guilt, reproach, anger, despair, hostility, irritability, numbness, lightheadedness, anhedonia, emptiness, relief, longing, helplessness.
Behavioral manifestations: crying crisis, search and / or avoidance behaviors, functioning as in automatic mode, mentally absent, social isolation, toxic consumption, mummification, hyperactivity, attachment objects.
Psychological manifestations: confusion, unreality, unbelief, denial, ideas about suicide, idealization and debasement, sense of presence, ruminated about the deceased, hallucinations and illusions, lack of concentration.
Spiritual manifestations: awareness of death itself, rethinking beliefs, search for meaning.
Possible complications that may appear during the grieving process:
Psychological and / or psychiatric complications: anxiety, phobia, post-traumatic stress syndrome, behavioral disorders, depression, mania, toxic abuse, schizophreniform reaction.
Physical Complications: adrenocortical activation (ulcer, HT), increase in serum prolactin (with menstrual disorders), immune response modifications, elevation of growth hormone (with diabetes, HT), mortality due to heart problems.
Perinatal Duel
Perinatal grief has to do with a loss during pregnancy . This loss brings those affected to the experience of death, to the consciousness of finitude of life. It is a deep and unique experience . As we said before it will depend on the prevailing society, culture and religious ideologies in which these people are inserted to determine the possible type of duel they will carry out, rather if they will be able to make the duel openly or in an overlapping way because of the denial of said society to accept this kind of grief.
Due to the critical and important part of this experience, it is necessary to know a little more about it, since parents generally live this duel in solitude, friends and family try not to talk about the issue so as not to hurt those parents anymore.
There are different types of loss depending on the gestation time and other issues. In the next article we will talk more about the type of duel.
Based on different authors, such as Kowalski, we consider that the period of grief goes from conception to the neonatal period, so with the end of perinatal grief we would be covering ectopic pregnancies, induced abortion or spontaneously, to the intrauterine or intrapartum dead fetus, selective reduction, death of a twin in gestation, death of the premature infant or the newborn and even babies born with congenital anomalies and the children ceded for adoption.
Types of perinatal losses:
1) Miscarriage
It refers to the natural and spontaneous termination of pregnancy, usually occurs before 12 weeks of gestation . This situation can be experienced as traumatic or not, since everything will depend on each case. This loss may be accompanied by grieving symptoms . Returning to what was investigated by Moscarello who adds that, in addition to the symptoms of grief, feelings of ineffectiveness and the feeling of imperfection develop that will harass the mother against the impossibility of having developed a normal pregnancy. Different authors consider that women feel that their body has betrayed them, so their ability to give life, their very essence as a woman is questioned . In this way, these women may feel excessive guilt and feelings of self-reproach . One way they find to be able to face this situation is to tell the event many times, both to other people and to themselves. In relation to her partner, she hopes that she has similar behaviors, such as reading about the duel, about the effects it generates, on the natural mechanism of the body for which this occurred, which would reinforce her femeneidity, in In the case that he did not do it, she will surely feel that her partner does not care as much as she does and may even think that the couple silently blames her for what happened. It is also notable a decrease in their sexual interest. It is common to look for support in support groups and in the people in your closest circle . This situation is difficult since it is an inexplicable and uncomfortable loss because it implies announcing to the same people who had already been told about the pregnancy, that there will be no such. In addition to this, there will be many people who, unaware of this event, consult the course of pregnancy, which does not allow to close or begin to heal the wound.
Usually the people around you will not talk about the issue and will pretend that nothing happened, they will even assume that the couple will have children again. It may even happen that the recent loss is downplayed, reducing the baby who was gesturing to an incomplete being, as if it were not a son, but something that grew and was simply lost.
2) Voluntary abortion
Although one from the outside does not believe it, when a woman or couple decides to carry out a voluntary abortion it is very likely that this event will trigger grief reactions, both in the woman and in her partner.
3) Voluntary termination of pregnancy due to problems of the fetus or threat to maternal health
These losses are usually carried out in women who have serious health problems and in cases in which the being who lies in the mother's belly presents some congenital disease or malformation . These women, especially, suffer from a lot of guilt and shame since their body has formed a being that is not like the one they dreamed of and even decided to end their development. It is a very ambiguous situation because the woman usually feels that the termination of pregnancy responds and is an act of love but she can also feel it as a murder, that of her son.
4) Selective reduction in multiple pregnancies
With the words "multiple pregnancies" we mean babies that are fathered by different fertility techniques, so they are usually couples who have a long history of losses and frustrations . In these cases when the survival of the fetuses is unfeasible, between 10 and 12 weeks, a reduction is made by lethal injection. The reduction is carried out since if the pregnancy had continued, there was a risk of extreme prematurity, severe disability or the death of all fetuses. It is a very difficult decision to make, coupled with not having much time to decide since time is running and every minute that passes is essential. These parents face the uncertainty of how many attempts are sufficient, since they are many years of trying and "failing . " These couples usually feel a lot of pain and misunderstanding because of the continuous impossibility of not giving life, they feel lonely because they generally live in silence . Women particularly often feel these processes as invasive, stressful and frightening.
On this subject and the psychological consequences that it entails, there are not many studies carried out, nor on the effects on the psyche of the members of each of the couple or of the children who have survived.
5) Loss due to intraborn, intrapartum (stillborn) dead fetus
According to some authors such as Stroebe and Schut, the death of the fetus is already inside the uterus or during childbirth, triggers several losses which will function as stressors.
The main loss is that of the long- awaited baby, but there are other secondary losses that are also important, they are:
The moment and the illusion of becoming a father or mother
Concern for the role of father or mother if he is the first child,
Expectations and ideals about the imagined family composition,
The recognition of that child by others despite the time elapsed
Confidence and security in other children
6) Loss in multiple pregnancies
In this type of loss, what is very relevant are the expectations of both parents and those around them, making this process difficult and special. This is why, when one or more fetuses die, parents lose two babies or a twin / twin . Many times one of the fetuses is alive, and in the event that the woman can continue with the pregnancy, having a living fetus and a dead fetus in her womb, she needs a lot of family and sanitary containment . The time of delivery will therefore be a long-awaited but at the same time fearful moment . This event is, again, an ambiguous situation since there are still feelings of joy for the baby that was born and much sadness for the baby that was not born.
7) The loss of the newborn
Many times and sometimes not, it is anticipated from the belly some serious problems of the baby, which compromise its survival, so they will not be a surprise for the parents or the treating team.
Other times, however, problems appear unexpectedly during childbirth or in the first hours or days of the newborn's life. In these cases we are talking about an anticipatory duel due to the severity and risk of death of the newborn baby, which is presented to the parents and medical professionals in a totally surprising way.
REDACTORA: Gisela S., editor of the great family of the White Brotherhood.
SOURCE:
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0211-57352011000100005
http://www.agamfec.com/wp/wp-content/uploads/2014/07/19_2_ParaSaberDe_2.pdf
