Patterns of Grief
in a parent experiencing newborn death
by Mary Wyss, M.S.W., A.C.S.W., Edited by Malinda Sawyer
Prepared for AMEND (Aiding Mothers and Fathers Experiencing Neonatal Death)

Grieving is Normal
Characteristics of Grieving
Grieving as an Individual, as a Couple and as a Family
Grieving - A Time to Grow



Grieving is Normal
Grief is an intense and powerful emotion, particularly when the parent has suffered an irrevocable loss. It is a normal reaction to a distressing situation. The specific purpose of this booklet is to help parents who recently experienced a miscarriage, stillbirth or the death of a newborn to understand their feelings, the expected pattern these might take, and the normalcy of this course.

As the initial paralyzing shock of the loss wears off, the parent may be like a person recovering from frostbite: feeling returns and with feeling comes pain. If the bereaved parent is to recover properly, he or she must first come to terms with the full extent of the loss. It is grieiving that accomplishes the recovery.
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Characteristics of Grieving
Ten characteristics of grief are commonly observed by doctors and other professionals who deal with bereaved parents. Everyone goes through some or all of these stages whenever they lose anyone important; however, the parent need not necessarily experience these characteristics in the order discussed. What we are talking about is normal grief which, if not carried to extremes, can help the parent move through an important loss with minimal physical or mental harm.

The initial characteristic is shock, by which the parent is temporarily anesthetized against the overwhelming experience. This is helpful because the parent does not have to comprehend the magnitude of the loss.

Next, the parents may experience a time of emotional release as the dreadful reality of the loss begins to dawn on them. This is normal and natural and has nothing to do with religious faith or a stoic attitude. There is a tendency to respond with irritability and anger toward friends and relatives.

The third common feeling is one of utter depression, loneliness, and isolation, a feeling that there is no help. This is the depths of despair. It is during this time when those concerned and able to help should reach out to the bereaved parents.

Some parents exhibit physical symptoms of distress. Common to many are a feeling of tightness in the throat, choking with shortness of breath, need for sighing, an empty feeling in the abdomen, lack of muscular power, fatigue, loss of appetite, and insomnia. Mothers often say their arms 'ache to hold their baby.'

A typical emotion is panic, being convinced that something is wrong with them as parents. They concentrate primarily on their loss. They fear they are losing their minds. There may be a dread of being alone and unreasonable fears of danger, especially fear for safety of other children; at the same time, parents may be afraid to care for them.

One major symptom of grief, is a feeling of guilt. A sense of being a failure for not having produced a normal, living baby is common. Parents may search for evidence of personal failure and accuse themselves of negligence, exaggerating minor omissions. Guilt is often focused on etiology (cause of death), diagnosis (delay in recognizing symptoms), and treatment (inability to afford better or private care).

Most grieving parents experience hostility. At this time, the parent begins to feel better and to express feelings. The mourner becomes hostile toward anyone he or she thinks may have contributed to the problem; the doctor may be accused for neglect of duty. Provoked anger is common and expresses a need to find an outlet for outrage. (Why did this happen to me?) These are often distorted expressions of guilt feelings. The mother and father both may anguish over the possibility that they could have prevented the tragedy.

A rather immobilizing characteristic is an inability to return to normal activities. In our American culture, we make it difficult for people to grieve openly; after once offering sympathy we too frequently say, 'Back to business as usual.' We tend to make our friends carry their burdens alone. Although the bereaved parent may talk profusely, there is a marked difficulty in carrying through with normally expected activities. All daily routines are maintained with effort and lack of zest. Social skills seem lost. The parent may become dependent on others to encourage him or her to be active. At the same time, the parent may make every effort to withdraw from past friendships. Associations with parents of healthy babies may be extremely difficult.

Eventually most individuals begin to overcome their grief, especially if the parent is sustained and encouraged by caring friends and family. The duration of grief depends upon the success of the grief work the parent does; namely, achieving independence from the deceased, readjusting to the environment, and forming new relationships. Recovery may be less successful and longer in accomplishment for parents who deny grief its full display. The intensity of the symptoms gradually declines after one to six weeks, although for many years occasional brief periods of yearning may be percipitated by reminders of the loss.

Finally, the bereaved readjust their lives to reality. Although no one is ever their 'old self' after such a loss, they can be stronger and deeper people and better able to help others because of this experience.
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Grieving as an Individual, as a Couple and as a Family
It can help a grieving parent to become familiar with changes in their emotional reactions.Expressing sorrow and a sense of loss can be important. It is often helpful to talk with another parent who has had a similar experience - they can most convincingly say that time really does make a difference and things will not always look as they do today.

It is normal for parents to express grief in different ways. Mothers generally need to 'talk out' their grief, while fathers tend to suffer in silence.

Fathers are diverted by their work while mothers are often at home, recovering from childbirth, surrounded by reminders of the loss. Some mothers feel that the loss may have given them a new perspective and drawn them closer to the father. Occasionally, a father will deny having felt any grief at all while others appear to grieve as long or longer than the mother. It is often mutually beneficial if the parents talk freely about their feelings with each other, either alone, with their doctor, or with a counselor or friend.

Children are affected in some way by the death of an infant brother or sister, even those children who are born after the loss. Many factors influence how they handle this upsetting event. These include the age of the child, other experiences with loss, intellectual and emotional maturity, how secure they feel with their parents, how long the pregnancy lasted, their involvement with preparations for the baby, how long the baby lived, how long the mother and the child at home were separated.

It can be a gratifying (though often painful and difficult) responsibility for grieving parents to help their surviving children deal with death and mourning. It is generally more helpful for children to be told as much as they can comprehend and for their questions to be answered openly. Explanations should soothe the child's fears, not increase them. It is important for younger children to know their needs will be met. Maintaining regular schedules which were established before the loss and avoiding unnecessary separations from the parents and home keep to a minimum the adjustments the child must make. For example, rather than sending the child to stay with relatives while the mother recuperates, perhaps a friend or relative can come to the home, care for the child and do chores for the mother. Others who have frequent contact with the child, such as teachers, need to know about the loss in order to offer their understanding and support.

The behavior of a child in a grieving family can be a source of exasperation and frustration to the parents. The child may be excited and eager to tell everyone, even strangers, about the baby's death. Clinging to parents because of a sincere fear of separation is not unusual. Death and grief may be a prominent theme in their pretending and storytelling. Some children can become demanding and argumentative, while others seem to be totally unconcerned or to make light of the situation. These behaviors, which may continue for weeks or months, express the child's distress and confusion. When the child is given the love, attention, and understanding he or she needs, the difficult behavior will in time diminish.

On the other hand, children also frequently offer profound comfort to their parents, generously giving affection and sympathy. When mourning is shared by parents and children, all can benefit.
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Grieving - A Time to Grow
Everyone who loves is vulnerable to the pain of grief, for love means attachment and all human attachments are subject to loss. But, grief should not and need not be a destructive emotion.

Knowledge cannot erase the emotions accompanying grief but knowledge can help us guide ourselves and others toward recovery. The feelings that come with grief can be used creatively - to bind individuals more closely together and to strengthen
their sense of purpose.

- Bernadine Kreis
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Bibliography
Kennel, J. H., Howard Slyter, and Marshall Claus, 'The Mourning Response of Parents to the Death of a Newborn Infant,'The New England Journal of Medicine, Aug. 13, 1970, 344-349.

Lindemann, Erich, 'Symptomatology and Management of Acute Grief,' and 'Ten Stages of Grief Resolution,' read at the Centenary Meeting of the American Psychiatric Association, Philadelphia, Pa. May 14-18,1944.
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