Perinatal bereavement: a specific form of grief

The World Health Organisation (WHO) defines perinatal bereavement as occurring between the 22nd week of amenorrhoea and the 7th day after birth. However, there are many other situations in which this grief is a reality.

Perinatal bereavement thus encompasses all pregnancies that do not reach full term, for whatever reason (miscarriage / natural pregnancy loss, intrauterine foetal death, ectopic pregnancy, voluntary termination of pregnancy, medical termination of pregnancy, embryo reduction…).

It is important to recognise that there is no connection between the length of the pregnancy and the intensity of the impact of the loss.

Early miscarriage, or early natural pregnancy loss, is far too often trivialised by the medical world. The statistics are repeated as though they are "normal": 1 in 4 women will experience this event in their lifetime.

It is important to understand that a woman who wishes to have a child and goes through this experience is not only facing something that is physically very difficult, but which also represents, psychologically, the loss of a project — the project of having a child that took shape from the moment the test came back positive.

Each person faced with these events is free to define themselves within this grief or not. And it is not always consciously recognised.

Support and a listening ear must, however, remain constant. Non-judgemental accompaniment through the experience is of great importance.

Finally, as grief is a process, it unfolds over time. And recovery can take a long time.

Perinatal grief is a difficult and complex subject. It often frightens those close to the bereaved and can lead to well-meaning but clumsy responses.

It can feel difficult to support someone through it or to broach the subject. And every story is unique.

It is a specific form of grief for a being who never got to see the world. Unlike the loss of a loved one, there are few or no physical traces or shared memories built with the baby.

The brutality and illogicality of this event is deeply unsettling. It is a true emotional storm.

Every choice we make involves giving something up, and therefore grieving a possibility. A voluntary termination of pregnancy is therefore just as legitimately a form of perinatal loss.

Whatever the reasons that led to this choice, they are beyond question, and any pain that may be felt and experienced has every right to be heard and supported, without judgement. Everything is valid.

The pregnancy that follows is often a source of questions. The fear of it happening again is ever-present.

Within the body, the mind and the heart of the woman and the couple, an ambivalence unfolds. The sensation of bringing into existence both a new life and the one that is no longer there. It is possible to feel both joy and sadness at the same time, and to carry the apprehension of "replacing" or "abandoning" the baby from the previous pregnancy.

Parents, consumed by grief, may be less focused on their child or children. Older siblings may then feel abandoned, guilty, or jealous… Some children will do their utmost to meet their parents' expectations.

They need to be reassured and valued, and to have words put to the events and the emotions and sensations they experience.

There are now a few books very well suited to children for approaching the subject gently.

Every story is unique, and so is every journey through this grief.

Because this is a complex form of grief, loved ones do not always know how to respond. Parents facing this loss often hear or read remarks that are out of place, unwelcome, or clumsy. Sometimes even guilt-inducing.

There are therefore many phrases that should no longer be said or written:

"You can always have another one": the parent does not want another child; they want the one they have just lost.

"It just wasn't meant to be" or "It wasn't viable": the parent may feel guilt.

"At least it wasn't a disabled child!": this causes guilt and makes the parent wonder what they did not do "correctly" to protect their child.

"It wasn't the right time" or "Maybe you weren't ready": guilt, and questioning of the desire for parenthood.

"Just bad luck" or "These things happen — do you know so-and-so? Well, something even worse happened to them!": the parent does not want to hear about what others are going through; they already have enough to deal with in their own grief.

But what do you say in the face of such pain?

What matters most is not what you say, but listening and welcoming the pain without judgement. Being present, offering a kind gesture, is sometimes far more comforting than words. A small home-cooked meal or a thoughtful act can mean more than any phrase.

And above all, remind them that they are not responsible and that you are there for them (each in their own way, according to their capacity).

After the loss of a baby in utero or a termination for medical reasons, it is possible to care for your baby by washing, dressing and keeping them close for a few hours.

It is also possible to arrange for a photographer to attend.

The care team also take the time to make hand and footprints.

There are also various ways to say goodbye to your baby, and depending on the stage of pregnancy, to have them entered in the family record book.

Some hospitals and maternity units have memorial spaces and gardens for little ones.

The 15th of October is dedicated to perinatal bereavement.