✓ Stillbirth: how to deal with perinatal bereavement

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Almost four babies in the third trimester of pregnancy die every day before they are born. «According to the latest estimates, it is a striking phenomenon 1.400 children a year in the country: 0,29% of total births in our country (473.438 in 2022). A stable figure over the last ten years, which is in line with the European average "explains Dr. Claudia Ravaldi, psychiatrist and psychotherapist, founder and president of the CiaoLapo Onlus association, created for the protection of pregnancy, perinatal health and for support in the case of stillbirth.

Of these deaths, half (700) occur without a known cause: the unborn child and the pregnant woman appear healthy, without predictive risk factors, and are included in a normal birth path envisaged by the National Health System.

How to deal with the perinatal bereavement?

What is meant by "perinatal death"

The World Health Organization defines one "Perinatal death" the one that occurs between the twenty-eighth week of pregnancy and seven days after giving birth.
La "Prenatal death" on the other hand, it concerns those that occurred during gestation.
"A formal difference that has no psychological implications: perinatal bereavement, in fact, is experienced with specific and defined signs and symptoms, independent of the gestational age and the causes that led to death" reads an article written by the experts Claudia Ravaldi and Carmen Rizzelli.

1. Before and during pregnancy

"All women of childbearing age should be properly informed and know, even before becoming pregnant, that unfortunately, despite the adoption of healthy behaviors, there is always a small amount of risk that negative events occur, which cannot be foreseen. It would be necessary to help young women and boys starting from education in high school, both to talk about prevention, but also to accept these eventualities »explains Ravaldi.

"When an event of this type occurs, in fact - continues the expert - have received adequate information before or during pregnancy it helps to face the situation with more tools and to feel less wrong, alone, incapable, unprepared and abandoned by everyone. It is a resource that helps you to seek information and help. We do not suffer less, but it is an important tool in the recovery process ».

Read also: Death in utero: the emotions of a mother for her unborn child

2. When mourning occurs

"The death of the child expected at the end of pregnancy is an event that occurs at a time when couples are often less focused on anxieties than pathologies or malformations or in general on the health of the child - explains Carmen Rizzelli, psychologist, psychotherapist, specialized in Psychology of perinatal mourning, of the Pomegranate-Maternity and Birth Information Center, of the city -. It is the phase in which we prepare for the meeting, in which delivery and birth are awaited. In which the parents feel that life is coming together with their child and the realization of what they have imagined and desired ».

For this it comes to a very painful mourning, “A shocking event that causes enormous stress and pain which, unfortunately, cannot be relieved, but must be worked through. The only way to overcome it is to give yourself time, talk about it and feel free to express and feel your pain »adds the founder of Ciao Lapo Onlus.

Here are some tips:

Express your pain. When the diagnosis is received is very important do not be shy, but feel free to express all emotions, ask questions and requests, without feeling wrong or afraid of exaggerating. It is normal, in fact, to be hungry for security and reassurance.
Get informed to make the right choices for you. Often people have a hard time dealing with pain, they would like it to disappear as soon as possible. Instead, right now it is important to take some time to reflect and really understand what you want to do. “This is because the moment we undergo such a sudden, unexpected traumatic experience that makes us feel helpless, it strips us of the ability we think we have in controlling events, reacting or modifying situations. This is why it is important, right from the start, to try to regain the capacity for self-determination: in this way people find some of their resources and feel more capable of choosing for themselves »says Carmen Rizzelli. "Few people know that, once the diagnosis is received, which generally occurs in the emergency room, it is not necessary to be hospitalized immediately: if the medical conditions allow it and there are no ongoing pathologies, you can wait up to two days »emphasizes Claudia Ravaldi. A useful time to reflect on your situation, learn about the options available and make an informed choice. In case of stillbirthin the absence of a particular urgency, in our country we proceed with the induction of childbirth. The Caesarean delivery is not expected normally in these cases by the National Health System. "However, the parental couple can make choices as regards the timing and methods of delivery: in some cases, you can choose to go to a private clinic for a caesarean, opt for induction or waiting for a spontaneous birth. She can be assisted by a specialized midwife or give birth in a maternity home. After the birth, you can ask to stay in hospital for more than 24 hours and, sometimes, also decide in which ward to be admitted. In addition, she may or may not ask to see her child. The advice is always to make informed choices, knowing their rights, on the basis of their conditions and beliefs ".

Studies to prevent stillbirths

Regional studies have also started in Del Paese, coordinated by the Istituto Superiore di Sanità, to work on these "inexplicable" and "sudden" losses. All with thetarget to lower the number of stillbirths by 20% not related to health complications.

"All over the world, associations such as CiaoLapo are working together with the International StillBirth Alliace project to improve tools to reduce the risk of stillbirth," says Claudia Ravaldi, founder and president of the association. The tools identified are two:

1. Fall asleep on your side
"From the twenty-eighth week of gestation it has been seen that mothers who fall asleep on the side and not supine, reduce the risk of stillbirth because this position allows better oxygenation of the fetus".

2. Learn the baby's habits in the tummy
“It is not true that in the third trimester of pregnancy babies move less because they have less space. The fetuses maintain the same habits and activities as always, it only changes the way we feel them. So it is very important that mothers know their children's habits and monitor them. Last year, thanks to a project to educate women on the habits of their children, in Scotland they managed to halve the number of stillborn children ».

3. When you go home

At the end of pregnancy, the death of the child is particularly unexpected and sudden, cruel and experienced as profoundly unjust and senseless. “Death comes when, in most cases, both parents have built one attachment relationship, that is, an emotional relationship with that specific child, unique and irreplaceable for them. With the son they felt moving, which they saw in the ultrasound scans and which they fantasized about together ”explains Carmen Rizzelli, therapist at the Melograno-Centro Informazione Maternità e Nascita.

For this reason, when the pregnancy stops, the loss of the child involves a physiological experience of mourning and pain for his death. «The couple lives one shock it's a trauma very strong, the interruption of the life project and a split in one's identity as parents. They no longer really know who they are. Your life loses its meaning and nothing seems to matter anymore. For parents left with empty arms it is difficult to believe what happened, to be able to accept it and there is a drive to want to go back to when you were pregnant and the child was alive ".

Read also: Therapeutic abortion: this is how it happens and what are the times required by law

One of the most difficult moments to have to face is certainly the return home: «We return to a place that was ready to welcome a new life and which instead remains empty, filled only with our pain».

Here's what to do.

Expressing your emotions. «To live and go through this mourning it is first of all important to recognize it. Do not deny all the experiences you feel, from despair to anger, from shame to guilt, to envy. And to be able to cross them without judging yourself. Self-legitimizing and being able to express them in the ways and times that each one chooses and can ».
Share the pain. «The closeness of others is important in this phase - continues the therapist -. For example, friends and family members who can stand by simply to listen and to share the pain without judgment. It is important for parents to know that other people also recognize that child's life beyond his death. That his presence was important to others too, that they miss him and that they feel pain for his absence. This sharing helps to go through the pain and grief and to take care of the memories, thoughts and emotions related to the relationship with your child. Being able to talk openly about their child, show their photos, call them by name and share what they feel helps parents not to feel weird or crazy. AND it helps them to build an affectionate internal relationship with the child who is no longer there».
Tell the traumatic event. «It is very important - continues the psychologist - that mum and dad tell the traumatic event from their point of view even in the smallest details. It is a fundamental step, because it allows you to really become aware of what has happened and fill that time gap that is created when a diagnosis is made. stillbirth. Generally, when you receive news of this kind, time stops and it is as if a hole is formed, between the before and the after. The narrative allows you to build a bridge between the past and the present and get in touch with your own emotional experience. It is the first step to begin to heal the wound that has been created, because the only way to mourn is to welcome and welcome all the emotional experiences that the loss arouses, without judgments ".
Give yourself time. Once back home, many parents resume their lives headlong, filling themselves with commitments and activities to do. The same friends and relatives, in the best of intentions, try to urge people to move on, not talk about it, recover: but this aggravates the trauma and the sense of loneliness. After the first 3-4 months, parents can't take it anymore, they stop and have to start over in the process of mourning. The best advice then is to take the time to metabolize what has happened and slow down, without fear of having to recognize your limits. “It takes several months to overcome a traumatic event of this type. Generally speaking, seven out of ten parents begin to recover after a year, a year and a half, ”highlights Ravaldi. An important element to prevent this drama from becoming unsurpassable is to try to face it in pairs, respecting each other's differences. «Mothers and fathers, in fact, react differently to the loss, but the important thing is to be together, clarifying one's wishes without feeling frustrated by the possible differences that could generate further conflicts that are difficult to live in such a tiring moment ».
Plan your return to work. From the XNUMXth week of gestation, women can take maternity leave, while for fathers the procedure is not yet clear. "A period of absence from work can be helpful for a woman who has suffered a trauma of this type, but finding herself alone at home, without her partner or some form of family support, can be very problematic. Also in this case it is essential to understand which is the best solution on a personal level for the situation you are experiencing ".
Start a therapeutic journey. To face and overcome such an event it is important to be supported. «An assistance that in some hospitals it is foreseen from the outset, but which in any case can also continue in local consultants o attraverso mutual help groups of parents who have experienced the same situation. A couple path more structured and lasting over time, with a specialized therapist, it is certainly recommended. Getting help is a way of dealing with pain and overcoming it »continues Carmen Rizzelli. All this understanding that grieving does not mean losing your child again: «Does not mean forgetting about it. Indeed, a traumatic event like this is only overcome when a new relationship - interior - is established with the lost child. In other words, a symbolic relationship is created with the child who is no longer there through the memories that one has of him, therefore of the pregnancy, and of the emotions experienced in that period. Once this symbolic relationship has been rebuilt (it can take from 6 months to 2 years), you begin to recover your energy and you can start investing in the world with your own internal resources and abilities, always having in your heart that child who has passed away ».

Getting pregnant again? Not now

Another thing that happens often, but which should be avoided, is to immediately try to have another child. "A new pregnancy is not in fact an antidote to grief. Among other things, the potential repercussions of this choice can also be very serious, for the couple but also for the new child - specifies Carmen Rizzelli, psychologist, psychotherapist, specialized in Psychology of perinatal bereavement, of the Pomegranate-Center for Maternity and Birth Information. , of the city -. Given that the bereavement period lasts about one to two years, we ask parents to wait at least 4-6 months before trying to get pregnant again».

“The idea that mourning is cured with another child is wrong, because the lost child is not recovered and we place ourselves in the condition of immediately relive an experience that was traumatic, that of pregnancy, putting a strain on one's ability to withstand emotions, anxiety and stress. Body and psyche in fact need time to be able to begin to go through and process this event: death has been contacted instead of life and life must become fertile again ».

«Before starting again to try to have another child, it is therefore important that the internal representation of the lost child has taken place. In this way, the new child will be able to have a space of his own, without overlapping the image of his brother. Good for the parents, but especially for the new child ».

Questions and answers

What do i need to know when becoming pregnant?

All women of childbearing age should be properly informed and know, even before becoming pregnant, that unfortunately, despite the adoption of healthy behaviors, there is always a small amount of risk of negative events occurring, which cannot be predicted. .

What to do when diagnosed with perinatal death?

When receiving the diagnosis it is very important not to be shy, but to feel free to express all emotions, ask questions and requests, without feeling wrong or afraid of exaggerating. It is normal, in fact, to be hungry for security and reassurance.

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