complex grief: how to help through pregnancy and child loss allena barbato, jd, macp

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Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

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Page 1: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Complex Grief: How to Help

Through Pregnancy and Child Loss

Allena Barbato, JD, MACP

Page 2: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

The bedrock of the Orthodox Faith is the home and family life.

Home and family life is the bedrock of our Greek

Orthodox life-style. The spirit that binds us together

as a people finds its deepest roots in the home

where the tenderest values of human existence,

love, compassion, forbearance and mutual

helpfulness thrive in abundance. Archbishop Iakovos 1972

Page 3: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Tremors in the family bedrock how to help: a mental health perspectivePregnancy issues

Childbirth complications

Miscarriage & Abortion

Infant/child loss

Page 4: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Grief ProcessElisabeth Kubler-Ross wrote a pivotal book in

1969 called On Death and Dying, identifying 5 stages of grief.

Denial Stage: Everything is just fine.Anger: This is YOUR fault!Bargaining: I will do anything to change.Depression: Why should I even bother?Acceptance: I can deal with this.

Page 5: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Varying Levels of GriefIssues that occur in Pregnancy, Childbirth,

Miscarriages and the Loss of an Infant can contain all stages of grief

They will occur at varying levels, depending on which of the above.

Page 6: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Pregnancy

Icon of the Annunciation. TheTheotokos, model for mother, threading together Godand man.

Page 7: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

PregnancyOrthodox church’s official stance on

pregnancy: life starts at conception.“Marriage is holy. The home is sacred. Birth

is a miracle. In these we find the very meaning of life itself.”-Rev Dr. Stanley S. Harakas

All life is holy and precious and must be protected and cared for.

Inherent on the mother to take the very best care of herself; physically, emotionally, and spiritually

Page 8: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

PregnancyChallenges to a healthy pregnancy are often

times unforseen; a woman and her family just assume all will go smoothly.

Physical ChallengesExhaustion, loss of vim and vigorAppetite changesBody getting bigger, skin stretchingHair composition, skin toneBedrest, gestational diabetes

Page 9: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

PregnancyEmotional Challenges

Hormone levels changingIs my baby going to be “healthy”Feeling less of a “woman”After the second trimester, can not hide

pregnancySuffered sexual abuse, not comfortable with

pregnancyUnwanted child, giving up for adoptionIn vitro testing shows a deformityWorried about Father of child

Page 10: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

PregnancySpiritual Challenges

Knowing should be thankful for God’s Gift

Asking God to take back the child

Praying for a healthy childAsking God why she has

been given a deformed child

Page 11: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Guidelines for helping a pregnant womanAsk how she’s feelingListen and comfort If having difficulty or conflicted, do

not try to palliate with “it is the will of God” or “it is a blessing”.

Remind that this is a temporary stateHormone levels will eventually

return to normalWalk through birthing scenariosEmpower with positive thoughts on

motherhood If physical, refer to obstetrician. If

spiritual, refer to spiritual father

Page 12: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

ChildbirthPlanning a childbirth Fear can be a guiding factor in choosingCompletely medicalized to completely naturalThe Orthodox church is supportive of either

choice, as long as the guiding principle of protecting life is adhered to.

Painkillers are considered ok as long as they do not become addiction.

Page 13: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

ChildbirthNegative birth experiencesWhat constitutes?

Cesarean vs. naturalNegative reactions to Cesareans are more likely if

under general anesthesia, an emergency, and if no support person was present.

Quality of mother-child bonding does not appear to be effected by caesarean vs. natural. (One study)

Women who had cesareans were more likely to have negative moods and lower self esteem.

Case study: Client D-not good enough mother

Page 14: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

ChildbirthSome studies showed the cesarean childbirth

carried “significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to post-traumatic distress and depression.” The Handbook of Women, Stress and Trauma; Kendall-Tackett, K. 2005

Interpretation of events: Sudden-how quickly did events change, was anything

explained? Overwhelming-swept away by hospital routine,

disconnected from experience? Danger-was baby’s or mother’s life threatened?

Page 15: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Childbirth Factors: level of care and decision-making.

All this can add up to “birth trauma” Result: overwhelming fear, helplessness, loss

of control, and horror.Effect of birth trauma

Fear/anxiety can last for a number of months or longer

Replaying of events-daytime flashbacks, nightmares Anger-at doctor, hospital, husband, self Denial of negative experience Depression compounded by history of abuse/PTSD

Page 16: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

ChildbirthHow effects of birth trauma

can effect relationshipsWith Baby

Bonding View of baby as being “not as

good” View of children as being “out

of control” or “nasty”With HusbandOther children

Page 17: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Guidelines for helping a woman through negative birth experience Do not try to talk the mother out of a negative birth experience by telling her that “it wasn’t so bad” or that the important thing is that

she had a healthy baby.

Encourage the mother to talk with someone she trusts who can listen and not minimize the experience. Also, there are support organizations and groups that can assist the mother while she talks about her experience.

Learning as much as possible about the experience helps the mother to understand the birth in a cognitive way, this can reduce anxiety. Getting the birth records to review and reading books on the subject takes the issue “out of the dark”.

The husband or other family members may also have been traumatized. He may have felt powerless while he watched events unfold around him. Because of this, he may not be emotionally available to provide the support the new mother needs.

Gently remind the mother that as bad as the birth experience was, it is the beginning of this little person’s new life and the rest of his/her life is the positive thing to focus on. This can bring perspective to the traumatized mother.

If the mother is talking immediately about having another baby, in order to “get it right” help her to understand that the important thing right now is to process what happened and to get to know your new little one, giving him/her all the attention they need and deserve.

Similarly, if the mother talks about never having another pregnancy due to the experience, help her to understand that taking drastic steps could cause further trauma.

Finally, suggest that the mother forgive herself if she is blaming herself for the negative experience. The “if onlys” can be very damaging to the mother’s psyche. This would be a good opportunity for her to go to her spiritual father and talk about forgiveness in general.

Page 18: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Miscarriages and AbortionThe official stance of the Orthodox church on

Abortion is: this is the taking of a life, and therefore a sin unless the mother’s life is endangered and then it is considered an involuntary sin.

If there is an abortion as the result of mother’s life being endangered, help the mother to process the death, as she and family grieve.

Abortion as a choiceThis choice can very negatively affect a

woman’s psycheOne study found 82% of women had PTSD

symptoms(Russia)Primary form of birth control abortion

Page 19: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

AbortionAnother study found that women who aborted

their first pregnancy were four to five times more likely to abuse drugs and alcohol. (U.S.)

Women seeking early abortions were more likely to have been abused as children and have insecure attachments with partners.(Australia)

Multiple abortions can be indicator of past or present abuse.

Counsel the woman with grief counseling and refer to priest about sin.

Page 20: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

MiscarriagesOrthodox church’s stance on miscarriages: it is the

death of a living being; a baby.Each year approximately one million births end in

miscarriage in U.S. October is Pregnancy and Infant Loss Awareness Month.

Complexity:The baby is often not visible (as most miscarriages

occur before the second trimester) and therefore not real.

Many families are still quiet about the pregnancy at outset, in case something goes wrong.

Is not a child that has touched others’ hearts.

Page 21: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

MiscarriagesComplexity (cont)

Where parents were once anticipating a birth, they are now facing death.

Millions of grieving parents Case studies

Client A; the miscarried babies counted in family Client M; bi-polar characteristics compounded by

miscarriage Fr John Breck writes of the mother who has

miscarried, “Her pain needs to be acknowledged, accepted, and palliated through words and gestures of understanding, sympathy and love, offered by her family and the parish community.” –oca.or

Page 22: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Empathy and John 11:33-36

Jesus wept when He visited Martha and Mary after the death of Lazarus. Those who stood near Him on that day were quick to interpret His behavior, for they said, "See how he loved him" John 11: 35, 36! Grief was rightly seen as an expression of love.

Jesus knew that He would soon raise Lazarus from the dead, so why was He so disturbed by the events of that day? Probably for several reasons. First, there was His great sense of compassion. He hurt to see others hurt. His emotions were pushed to the limit by witnessing the sorrow of Mary. Those with compassion are able to "weep with them that weep" and all Christians ought to have this ability (Romans 12:15).

He has entered into all of our experiences and knows how we feel. In fact, being the perfect God-Man, Jesus experienced these things in a deeper way than we do. His tears assure us of His empathy.

“When Jesus saw her weeping, and the Jews who had come along with her also weeping, he was deeply moved c in spirit and troubled. “Where have you laid him?” he asked. “Come and see, Lord,” they replied. Jesus wept. Then the Jews said, “See how he loved him!”. (John 11:33-36)

Page 23: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Death of a newbornThy departure from this earthly life is a cause of

grief and sorrow for your parents and all who love you, O little child; but in truth you have been saved by the Lord from sufferings and snares of many kinds.

O Savior and Master of our life: comfort the faithful parents of this departed child with the knowledge that to innocent children, who have done no deeds worthy of tears, are granted the righteousness, peace and joy of Thy kingdom.

—Canon Ode 9, The Service of Burial of an Infant

Page 24: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Death of a NewbornStillbirth

1% of births, can be due to cord or placenta accident, infection or toxemia.

Baby could die before termBaby could die during birthAllow women to donate breastmilk.

Prematurity and Neonatal DeathBirth weight and gestational age-factors for

survivalTeen pregnancy, poverty lack of natal careWomen can blame self

Page 25: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Death of a NewbornSudden Infant Death Syndrome (SIDS)

1 in 700 babies in U.S., but lower in other countries

90% of SIDS deaths occur within first 6 months3rd most common form of death for babies in

U.S.Risk FactorsCigarette smoke, prematurity, sleeping on

stomach, formula fed at highest risk.None risk factors present can still succomb to

SIDS

Page 26: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Death of a Newborn This loss is perhaps the most

difficult of all losses discussed thus far. One author described it thus:

There are no shortcuts or quick fixes in these phases of healing for grief is relentless, and it will not be shortchanged. We cannot completely evade its presence in our lives no matter how desperately we may try. Yet, peace is possible in the mind and the heart when grief and pain are embraced, released and openly expressed.-Ended Beginnings, Panuthos and Romeo

Page 27: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Death of a NewbornCommon Reactions:

Overwhelming SorrowNumbness and DenialFeeling of UnrealityAnger and RageIsolationGuiltFearPowerlessness and Loss of IdentityDepression

Page 28: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Emotional Factors of GriefGrief involves complex emotional factors which are all

related to the crisis of bereavement. We grieve because of self-pity, "What will become of me now that he's gone?" Or anger, "After all I've done for her during her illness, how could she just leave me?" Or guilt, "If I had only known, I would have " Or simply. because we will miss the departed individual. "How am I ever going to get along without you?" or a variety of other feelings which the loss of someone we love evokes in us. All these emotions are important and permissible. It is pointless and even harmful to argue that one should not feel anger or guilt, or self pity or a sense of loss. The feelings, even some very negative feelings must be accepted, expressed, and worked through before

healing can begin.

Page 29: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Grieving death To lack some feeling of grief at the time of death would be to lack love

itself. Love binds us to other people. When death comes those bonds are severed, at least in a temporal, physical bodily sense. In a time of such separation, grief is evidence of love, itself a divine gift.

Sometimes as we fight back the tears and heroically suppress our feelings of grief, in the name of our Christian faith, it is almost as if we are trying to be more Christian than Christ Himself!

Lately, some have come to the erroneous conclusion that death should not be an occasion for grief. Some think death should be viewed as something natural and acceptable. Orthodox Christians know death is not acceptable even though inevitable. Amid Resurrection celebration, there is a definite place for tears and sorrow. While we cannot advise a joyous funeral, our living ought to point in that direction even though human reality will be pained and afflicted with our loss in death. While it is true we should look at death in view of Christ's triumph, as a process we rejoice in rather than mourn over, the human response to death is more complex than a simple smiling affirmation of the glory of the afterlife.

Page 30: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Greiving Death Grief is a process of working out and living through some very

painful feelings, coming to some tough decisions, and performing some difficult actions. But it must be done. Suppressing grief is tragic. When we drug or rationalize our feelings away, or cover our pain with a sugar coating or religious platitudes, we fail to face up to something that must be faced. Namely, someone we love has died and is now- gone from us. We are going to feel` the pain of their absence and we are going to miss their presence. Our life is going to be affected by their absence.

Page 31: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Guidelines for Helping Someone Grieve A Miscarriage or Death of an Infant The first and one of the most important things you can do is to acknowledge that a baby has died

and this death is just as “real” as the death of an older child. The parents’ grief and healing process will be painful and take time, lots of time. They will not have stopped “grieving about their baby” after a month or even a year. In fact, the parents will hold that child in their hearts and memories for the rest of their entire lives. Realize that the parents are sad because they miss their baby, and that he or she can never be replaced by anyone else, including future children or children they may already have.

Contact spiritual father or parish priest to notify him of the situation and ask for assistance with prayers and grief counseling.

Let the parents know that they and their family and the baby are in your prayers. Call or send a sympathy card. You don’t have to write a lot inside, a simple “You and your baby are in my thoughts and prayers” is enough.

What the parents need most now is a good listener and a firm shoulder, not a lecture or advice. Listen when they talk about the death of their baby. Don’t be afraid, and try not to be uncomfortable when talking about the loss. Talk about the baby by name, if they have named the child. Ask what the baby looked like, if the parents saw the baby. Most parents need and want to talk about their baby, their hopes and dreams for their lost child.

Give a hug. This is a sign of love and concern. Even if this is all you do, it’s a nonverbal way of saying “I’m sorry” or that “I’m praying for you.”

Offer to baby-sit their other children. Often there are follow-up doctor’s visits and the parents need a chance to be together as a couple as well.

Offer to bring over meals; often mothers have no energy to do even basic things. Organize parishoners to put together a meal calendar so the family has regular meals.

Page 32: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Guidelines for Helping Someone Grieve A Miscarriage or Death of an Infant Offer to go food shopping, help clean the house, do laundry; anything that lightens the burden of daily chores

that need to be done. This is especially helpful if the mother is still waiting to miscarry the baby. That process may take days and is physically and emotionally draining.

Be careful not to forget the father of the baby. Men’s feelings are very often overlooked because they seem to cope more easily. The truth is that they are quite often just as devastated as their partner. Encourage other men in the parish to reach out to the father so he has a chance to unburden his heart.

Give special attention to the baby’s brothers and sisters. They too are hurt and confused and in need of attention which their parents may not be able to give at this time.

If the children want to talk about the death, don’t be afraid to engage them in conversation. Children have a natural relationship to death and they are open and direct with adults with whom they feel comfortable. When children are allowed to share their dreams and thoughts openly, the difficulty of their grief can be reduced.

It may be hard for the bereaved parents (especially the mother) to see or even talk to a pregnant woman, small children and especially babies, they are all reminders of what she has lost. This is a very difficult situation as the bereaved mother can be jealous and then get angry at herself for feeling that way.

Remember that any subsequent pregnancies can be a roller-coaster ride of joy, fear and bittersweet memories. Try to remember the anniversary of the death and due date with a card, call, or visit. Anniversaries can trigger

grief reactions as strong as when the loss first happened. Months down the road a simple “How have you been doing since you lost your baby?” can give much comfort.

Remember also that mourning puts a tremendous strain on relationships between family and friends. It is okay to admit that you don’t know how they feel. A good thing to say is, “I can’t imagine how you feel. I

just wanted you to know that I am here for you and am very sorry.”

Excerpted from “Comforting those Who Have Lost a Baby During Pregnancy or Shortly Thereafter” By Dennise Kraus

Page 33: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Further Research“Comforting those Who Have Lost a Baby During

Pregnancy or Shortly Thereafter” By Dennise Kraus, Diocesan Journal, Jacob’s Well

The Hidden Feelings of Motherhood by Kathleen A. Kendall-Tackett, PH.D.

Empty Cradle, Broken Heart: Surviving the Death of Your Baby by D.L. Davis

On Death and Dying, by Elisabeth Kubler-Ross Breastfeeding Made Simple by Nancy Mohrbacher and

Kathleen Kendall-TackettEnded Beginnings, Panuthos and Romeogoarch.orgoca.org

Allena Barbato, JD MACP

Page 34: Complex Grief: How to Help Through Pregnancy and Child Loss Allena Barbato, JD, MACP

Thank you and God Bless!