DiscoverCounselor Toolbox PodcastPregnancy and Infant Loss Risk Factors and Treatment Issues
Pregnancy and Infant Loss Risk Factors and Treatment Issues

Pregnancy and Infant Loss Risk Factors and Treatment Issues

Update: 2020-10-07
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Pregnancy and Infant Loss

Risk Factors &

Treatment Issues

Dr. Dawn-Elise Snipes PhD, LPC-MHSP

AllCEUs Counselor Continuing Education


CEUs available at: https://www.allceus.com/member/cart/index/product/id/1350/c/


Objectives

– Identify risk and protective factors for

– Prematurity/Miscarriage/Stillbirth

– Sudden Infant Death Syndrome

– Explore treatment issues for the family

Risk Factors for Miscarriage/Stillbirth

– Miscarriages occur before 20 weeks.

– Prevalence: 10-25% of all pregnancies (or more)

– ~20% of miscarriages happen in the first trimester

– 1-5% of miscarriages happen in the second trimester

– Stillbirths occur after 20 weeks

– ~1:10 0 births in developed countries (24,000/year in the US) and 3:10 0 in less developed areas


Risk Factors for Miscarriage/Stillbirth

Prematurity

– Prematurity

– Impacts 1 in 10 births in the US

– 17% of preterm infants die

– Many times the cause of the preterm labor is unknown but risk factors are similar to those for miscarriage

– Although the infant is born alive, the parent

– Is deprived of the idealized pregnancy

– Has to leave the hospital without baby (psychological and hormonal implications)

– May not be able to hold or even touch baby for days or weeks

– Knows that the statistics for complications and death are grim

SIDS

– The peak incidence of SIDS occurs between 1 – 4 months of age

– 90% of cases occur before 6 months of age

– Babies continue to be at risk for SIDS up to 12 months

Risk Factor Summary (What do you notice?)

Risk Factors for SIDS

– Unhealthy pregnancy

– Drug exposure (including nicotine)

– Low weight gain (nausea)

– Placental issues

– History of infections (STDs, bacterial vaginosis, UTIs)

– Child factors

– Prematurity

– URI within 4 weeks

– Low birth weight

– Siblings who died of SIDS

– Sleep environments

– Stomach or side sleeping

– Loose blankets / inappropriate sleep surface

– Smoke exposure

– Bed sharing

– Overheating


Treatment Issues

– General

– In the birth parent

– Grief (complicated)

– A person looks at the pregnancy as part of themselves and when it is lost, there is an emptiness, searching and incompleteness

– Depression (up to 55%)

– Guilt and self anger: Shouldas, “I didn’t do it right”

– Guilt for having happy feelings

– Feeling incompetent: “The most natural thing in the world”

– Relief esp. for unplanned or problematic pregnancies

– Postpartum depression

Treatment Issues

– General

– Complicating Issues

– If it required the birth process or a DNC

– Waiting for a natural miscarriage to occur after a fetus has died in utero can be psychologically debilitating for parents

– Having to go to the OBGYNs office for follow up

– Seeing other newborns in public

– If it was a multiple delivery and one baby survived

– If it resulted in the parent becoming sterile

Treatment Issues

– General

– In the other parent

– Grief (complicated)

– Anger

– Relief

– Difficulty understanding why the pregnant parent is taking it so hard

– Anxiety about having another pregnancy

– Determination to get pregnant again as quickly as possible

Treatment Issues

– General

– In extended family

– Grief

– Anger/blame

– In the siblings

– Lack of understanding of what happened

– Relief

– Disappointment

– Resentment that parents aren’t instantly okay

For the Siblings

– It is important to remember the developmental capacities of children including egocentrism and making assumptions based on their limited knowledge.

– Younger children may view a new sibling like a present and want to know why you can’t just get another one

– They may feel rejected or like they are not enough when parents are grieving the loss of this child they never got to see or interact with

– They may fear that the parents will “make them go away” too and become more anxious

– They may be happy because they now have parents all to themselves which may cause friction with the grieving parents

Interventions

– Learn about what happened and implications for the future (Everyone) to help reduce guilt, blame, and anxiety.

– Understand the grief process is not linear and is not the same for any two people—even in the same family

– Remember like other losses, this grief will take time to process and may flare up for a year or more

– Decide, when you are ready, what to do with your maternity clothes and baby items

– Consider joining a support group or seeing a counselor

– Consider commemorating the child’s life with a birthstone or scrapbook (ultrasounds etc.)


Interventions

– Practice self care

– Recognize that the body has gone through a trauma and pregnancy induced adaptations will take time to resolve

– Give yourself permission to grieve and also to be happy

– Recognize that another pregnancy will not lessen the grief and may actually increase anxiety and depression


For the Partner

– Talk, listen and process together and with your own supports

– Practice your own self care

– Help eliminate triggers in the immediate environment if wanted

– Reaffirm the loss was not your partner’s fault

– Help share the news with friends and family so your partner is not bombarded with questions or sympathy

– Recognize that your partner’s body has to go through the postpartum process.

Summary

– Pregnancy and infant loss are devastating

– Many times there is no clear explanation for why it happened which flies in the face of closure

– Often times well meaning family and friends may probe for “explanations” and it feels like they are blaming the birth parent.

– Parents may share some similar reactions, but they also may have very different reactions, so it is important not to assume you know how either one feels.

– Prematurity, miscarriage, stillbirth and infant death all have unique issues, but all represent a loss

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Pregnancy and Infant Loss Risk Factors and Treatment Issues

Pregnancy and Infant Loss Risk Factors and Treatment Issues

Charles Snipes