Handling Bereavement and Grief before Conception, during Pregnancy and as a Family
This year, not only is the world facing emotional distress and trauma in many aspects of life but personally my husband and I have lost our fathers two months apart.
I haven’t been able to truly grieve my father due to other factors happening simultaneously after that. I also had to pull myself together to be there for my 3 year old son.
My husband will most definitely go through the same process, as having his father pass away in the COVID-19 pandemic era means funeral arrangements are not as they used to be.
If you are wondering on how you can handle bereavement without it significantly affecting your children, your unborn baby and even your future pregnancy in the long term. This post is for you.
I hope this will help those of you that are going through similar journeys, by taking it one day at a time and knowing that you are not alone.
The Stages of Grief
Grief is not a quick process, it is also unique to the individual. No one grieves in exactly the same way.
The experience of mourning a loss will be influenced by the type of relationship, the circumstances surrounding the death, the emotional support system and the cultural and religious background.
The time following a death is often filled with emotional turmoil, chaos, and change. Some people may experience a range of contradictory emotions, including but not limited to rage, sadness, numbness, anxiety, guilt, emptiness, regret, and remorse.
A theory introduced by psychiatrist Elisabeth Kübler-Ross in 1969, suggests five distinct stages of grief after the loss of a loved one: Denial, Anger, Bargaining, Depression, and finally Acceptance.
This theory has become readily known as the most commonly experienced by the grieving population but the stages are not linear and some people may not experience any of them.
Grief, most often, does not require professional intervention. It is a natural, instinctive response to loss and generally leads to accepting, adapting and yearning after several months.
Although 7-15% of those mourning the loss of a loved one may experience a prolonged grief disorder, also known as complicated grief or persistent complex bereavement disorder (PCBD) which usually extends beyond 12 months (Cozza et al.,216) . PCBD is associated with long-term feeling of isolation and loneliness or intense distress and suffering.
In these extreme cases, therapy may be the only way to get back those who grieve on their feet. Cognitive behavioural therapy with exposure therapy (CBT/exposure), where patients relive the experience of a death of a loved one, have resulted in greater reductions of prolonged grief disorder (Bryant et al. ,2014).
How can Grief affect Health?
Grief affects the mind and the body. It can increase stress induced physiological changes which can cause or exacerbate physical ailments. This can include poor memory & lack of concentration, inflammation (Fagundes et al., 2019), post traumatic stress, anxiety and depression, a weakened immune system (Oconnor, 2012), sleep and appetite disturbance, heart problems (Mostofsky et al. , 2012), chronic diseases (Lannen, P.K., 2008) and fatigue.
Age can be a factor too. In people aged 30 years or older, the unexpected death of a loved one can roughly double the risk of a wide range of psychiatric disorders in otherwise healthy individuals (Keyes, et al., 2014). The risk was more than five-fold in those over 50.
Emotional and physical self-care should be of a high priority to ease complications of grief and boost recovery. Exercising, eating nourishing foods, spending time in nature, being in sunlight, getting enough sleep, being patient and kind to oneself and talking to loved ones can help with physical and mental health.
Bereavement before Conception
Mourning experienced by women in the months prior to pregnancy may be a sensitive developmental period and a risk factor for early infant mortality by 50% (Class et al., 2015). Grieving may lead to changes in the maternal stress system which could affect the vulnerable period of early organ development or alter the mother’s biological readiness for pregnancy.
WHAT CAN YOU DO?
In addition to taking care of your physical and emotional self ( see above), You can also go through the suggestions and information mentioned in the post ‘Emotional & Pshycological Trauma Can Be Passed On’. This can be a valuable guide during the preconception period.
Bereavement during Pregnancy
Dealing with death is one of the most severe sources of stress for expectant mothers. I have discussed in detail the impact of high levels of anxiety and stress during pregnancy on mother and baby and what steps expectant mothers can take to lower their stress levels.
But studies on bereavement and pregnancy loss or stillbirth are inconsistent (Warselius et al., 2019;László et al., 2013). While on the other hand, many studies have shown the impact of acute antenatal stress on the child’s long term cognitive, behavioural and physical development.
WHAT CAN YOU DO?
In addition to taking care of your physical and emotional self ( see above),
Connect with your baby : If you are absorbed in mourning, it would be difficult to develop what the paediatrician & psychoanalyst Donald Winnicott called the "primary maternal preoccupation". This is a psychological process allowing the expectant mother to establish an emotional bond with her child.
By emotionally tuning in with your baby during your pregnancy you can increase the "love" hormone, oxytocin, which is an indispensable part of the mother-infant emotional relationship as well as the baby's emotional development, lowering therefore the level of stress that could impact the baby.
Get a massage : Research has found that receiving regular soothing massages after the death of a loved one can provide much-needed consolation during an intense, stressful period of grieving (Cronfalk et al., 2010).
Bereavement as a Family
Sometimes parents are so overwhelmed by the loss of a family member or loved one they would often wonder if they have any energy left to take care of their children. I know I did.
In the face of this grief, it can be difficult to remain patient and understanding of the ongoing, daily demands of your child’s extra needs. Parents sometimes would want to send their children away to be cared for by others, until they feel they are coping better with the loss themselves. While this may be necessary on occasion, in most cases it is not what is best for the children.
No child is too young to be affected by the death of a loved one. Even infants respond to a death. But to their advantage, they have a more robust immune response to stress levels when encountering bereavement (Vitlic et al., 2014) . Having a caring and loving adult who will guide them through this process will only help them further.
WHAT CAN YOU DO?
In addition to taking care of your physical and emotional self ( see above),
Explain simply: When discussing the death of a loved one, avoid making abstract statements that a child could misunderstand. Instead, use clear and direct words to minimise confusion.
Express emotions: Some adults when faced with the loss of a loved one will try to maintain their composure especially when they are parents. But it is healthier to ditch the stiff upper lip and freely express emotions (Lopez et al, 2020). In doing so, it reassures children that feeling sad or upset is okay, as children will often imitate the grieving behaviour of their parents for their own mourning. However, reacting explosively or uncontrollably teaches your child unhealthy ways of dealing with grief.
Reading age-appropriate books on bereavement can also help children in expressing sad feelings.
Maintain a routine: Children find great comfort in routines. A structured schedule provides stability and organisation at a time when grief can cause instability and chaos. By having set bedtimes, family meals, story times, recreational and academic activities , the child feels grounded and understands that life does go on.
Observe & Listen: Children can grieve deeply, even though they may not appear to be doing so. They do not sustain strong emotions and usually mourn in doses. It is important to encourage questions,observe any changes or repetitive behaviours and respond in a loving and caring way.
Treasure memories: Finding ways to keep the loved one’s memory alive is part of the healing process. Children often appreciate having physical reminders of the person who has died. This might be from creating a memory box to visiting exclusive places where the loved one is remembered. These special times are necessary for children and can become part of a family’s ritual.
+References
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Bryant, R.A., Kenny, L., Joscelyne, A., Rawson, N., Maccallum, F., Cahill, C., Hopwood, S., Aderka, I., and Nickerson, A. (2014). Treating Prolonged Grief Disorder. JAMA Psychiatry 71, 1332.
Class, Q.A., Mortensen, P.B., Henriksen, T.B., Dalman, C., D’Onofrio, B.M., and Khashan, A.S. (2015). Preconception maternal bereavement and infant and childhood mortality: A Danish population-based study. Psychosomatic Medicine 77, 863–869.
Cozza, S.J., Fisher, J.E., Mauro, C., Zhou, J., Ortiz, C.D., Skritskaya, N., Wall, M.M., Fullerton, C.S., Ursano, R.J., and Katherine Shear, M. (2016). Performance of DSM-5 persistent complex bereavement disorder criteria in a community sample of bereaved military family members. American Journal of Psychiatry 173, 919–929.
Cronfalk, B.S., Ternestedt, B.M., and Strang, P. (2010). Soft tissue massage: Early intervention for relatives whose family members died in palliative cancer care. Journal of Clinical Nursing 19, 1040–1048.
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Lannen, P.K., Wolfe, J., Prigerson, H.G., Onelov, E., and Kreicbergs, U.C. (2008). Unresolved grief in a national sample of bereaved parents: Impaired mental and physical health 4 to 9 years later. Journal of Clinical Oncology 26, 5870–5876.
László, K.D., Svensson, T., Li, J., Obel, C., Vestergaard, M., Olsen, J., and Cnattingius, S. (2013). Maternal bereavement during pregnancy and the risk of stillbirth: A nationwide cohort study in Sweden. American Journal of Epidemiology 177, 219–227.
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DR NAUF ALBENDAR
My name is Dr Nauf AlBendar and I am the founder of The Womb Effect. As a medical scientist with a BSc in Molecular Genetics and Genomics, an MSc in Nutrition & Food Science and a PHD in clinical medicine, I have developed a deep appreciation and understanding for the developmental origins of health and disease.