Stillbirth and the Grieving Process, Term Paper Example

Stillbirth and the Grieving Process of Mothers and Fathers

“ Most maternity units have good practice protocols, advising that after stillbirth parents should be encouraged to see and hold their dead infant. Our aim was to assess whether adherence to these protocols is associated with measurably beneficial effects on the psychological health of mother and next-born child. This study forms part of a wider case-control study of the psychological effects of stillbirth” (Hughes, Turton, Hopper, & Evans, 2002, p.114).

“We identified 65 women in the pregnancy after stillbirth, and enrolled matched controls for 60 of them. Outcome measures included depression, anxiety, and post-traumatic-stress disorder (PTSD) in pregnancy and 1 year after the next birth, and disorganised attachment behaviour in the next-born infant. Comparison variables included seeing and holding the stillborn infant, having a funeral, and keeping mementoes” (Hughes et al., 2002, p.114).

“Behaviours that promote contact with the stillborn infant were associated with worse outcome. Women who had held their stillborn infant were more depressed than those who only saw the infant, while those who did not see the infant were least likely to be depressed (13 of 33, 39%, vs three of 14, 21%, vs one of 17, 6%; p=0.03). Women who had seen their stillborn infant had greater anxiety (p=0.02) and higher symptoms of PTSD than those who had not (p=0.02), and their next-born infants were more likely to show disorganised attachment behaviour (18 of 43, 42%, vs one of 12, 8%, p=0. 04). Having a funeral and keeping mementoes were not associated with further adverse outcomes, but small numbers limited interpretation.  Our findings do not support good-practice guidelines, which state that failure to see and hold the dead child could have adverse effects on parents’ mourning” (Hughes et al., 2002, p.114).

“The trauma of stillbirth can have long-term effects on the family. About a fifth of women have prolonged depression, and a fifth post-traumatic-stress disorder (PTSD) in the subsequent pregnancy.  Other children in the family can also be affected; case reports indicate that these children might be vulnerable to psychological problems possibly related to maternal anxiety, and an association between adolescent anxiety disorder and maternal experience ofstillbirth has been reported.  We have already noted that infants next-born after stillbirth showed a significant increase in disorganisation of attachment behaviour to the mother, mediated not by maternal depression or anxiety, but by a measure of maternal unresolved mourning. This attachment pattern in young children is associated with vulnerability to later adverse psychosocial development, and could be a link in explaining later child disturbance after maternal stillbirth” (Hughes et al., 2002, p.114).

“The hypothesis that a father’s exposure to radiation increases the risk of leukaemia in children subsequently conceived was suggested in 1990 by Gardner and colleagues.  The proposal gave rise to intense publicity, much concern among workers in the nuclear industry, and expensive litigation. Further studies have given at most weak support to this hypothesis, and some scientists have dismissed it entirely.  Others have noted that heritable effects are more likely to manifest themselves as congenital anomalies than as leukaemia, and no excess of these anomalies near Sellafield (the nuclear establishment in Cumbria, UK, around which Gardner’s study1 on leukaemia was conducted) has been found.  An association with neural-tube defects was reported in 1988 from the USA,5 but was dismissed by the researchers themselves as a chance finding” (Inskip, 1999, p.1400).

“The findings described by Louise Parker and colleagues in this issue of The Lancet will come as a surprise to many.  By linking the birth registration and stillbirth records in Cumbria from 1950 to 1989 to the database of workers at Sellafield, they examined the stillbirth risk according to the father’s exposure to radiation before conception of the child. Lifetime exposure, and that in the 90 days before conception, were derived from annual exposure summaries for each worker.  Exposures recorded on individual film badges for the fathers of each stillborn child and for up to four matched controls were also examined.  The researchers found an association between paternal preconceptional irradiation and stillbirth with an odds ratio of 1·25 for stillbirth after 100 mSv lifetime exposure. The odds ratio increased to 1·7 for stillbirth with a neural-tube defect” (Inskip, 1999, p.1400).

“It’s said that parents never recover from the death of a child. For bereaved mothers, the loss appears to shorten their own lives, according to a study in The Lancet.  Danish researchers who compared the health records of some 300,000 parents found that mothers whose children had died were 40 percent more likely to die within 18 years than mothers who had not suffered such a loss. Three years after the loss, a mother is almost four times more likely to die of disease or suicide.  A child’s death also affects fathers, but far less, researchers found” (Lawson, 2003, p.18).

“When Alisa Schultz awoke at 6 a.m. with cramps 36 weeks into her first pregnancy, she did the right thing and went to the doctor’s office. Diagnosed with early labor, she was sent home. Within an hour, she started feeling terrible, with abdominal pain and nausea. Her husband rushed her to the hospital near their home in McLean, Va. They didn’t know they were already too late. Their daughter Lindsey was stillborn” (Shute, 2005, p.72-73).

“The doctors discovered that Schultz had preeclampsia, a complication of pregnancy that can threaten the life of both mother and child. It is the leading cause of maternal death worldwide. Severe preeclampsia is characterized by dangerously high blood pressure–Schultz’s had soared from normal to 180/120 within two hours–as well as deteriorating kidney and liver function, and damage to blood vessels throughout the mother’s body. It can progress to the seizures and coma of eclampsia, and death” (Shute, 2005, p.72-73).

“Preeclampsia isn’t rare–it affects about 5 percent of pregnant women, most expecting their first child. But its cause remains a mystery. “Since the beginning of time, people have been trying to understand preeclampsia,” says Richard Levine, a researcher at the National Institute of Child Health and Human Development. “We know that the placenta does not develop normally. It’s thought to make a toxic substance that is released and carried throughout the mother’s blood.” The disease, also known as toxemia, has defied all efforts to prevent or cure it. Doctors are reduced to stopping it by delivering the child, which also removes the placenta, the engine for the fetus. Because the disease can develop as early as 20 weeks into a pregnancy, those forced deliveries are a major cause of fetal death, as well as of the many complications of premature birth, including blindness, mental retardation, and cerebral palsy. Pregnant women are routinely tested for elevated blood pressure and protein in the urine, two signs that preeclampsia is developing. When those signs are found, doctors and patients find themselves in a perilous balancing act, trying to contain symptoms with bed rest and, at times, antihypertension drugs long enough for the child to have a chance at survival, while not putting the mother’s life at undue risk. But because preeclampsia often develops suddenly, some mothers, like Schultz, never get that chance” (Shute, 2005, p.72-73).

“In the past few years scientists have gained a much better understanding of preeclampsia’s toxic workings. Last week, researchers announced that they had found

abnormally low levels of a placental growth factor in the urine of women who later went on to develop preeclampsia. The deficiency was apparent by the 28th week of pregnancy. The hope is that these findings, once confirmed and expanded, will lead to a good early test for preeclampsia. “People could get better treatment. Doctors would be warned; patients would be warned,” says Ananth Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center in Boston, who collaborated with Levine and others on the study, which was published in last week’s Journal of the American Medical Association. Earlier, Karumanchi’s lab had found abnormally high levels of a protein, called sFlt-1, in women with preeclampsia. They then induced preeclampsia in rats by injecting them with the human gene for sFlt-1, proving that the errant protein is a cause, not a symptom. The theory is that sFlt-1 blocks the action of both placental growth factor and vascular endothelial growth factor, which are essential for fostering blood vessel growth and maintaining the health of cells lining vessels in the placenta and throughout the mother’s body” (Shute, 2005, p.72-73).

“Obstetricians praised the researchers’ work but said they were still a long way from being able to offer their patients the help they need. “You want not just to be able to tell people that this is coming, but that this is what we’re going to do to make you healthier and to make the pregnancy healthier,” says Jeffrey Ecker, an obstetrician specializing in high-risk pregnancies at Massachusetts General Hospital. “We don’t have that yet” (Shute, 2005, p.72-73).

“Predicting who’s going to get something if you can’t do a darned thing about it isn’t very helpful,” agrees John Repke, chairman of the department of obstetrics and gynecology at Penn State University College of Medicine. He and other researchers, including Levine, are looking into whether calcium supplements could help prevent preeclampsia. Calcium plays a role in the function of the cardiovascular system, and populations that eat a lot of calcium tend to have slightly lower blood pressure. Other researchers are investigating whether antioxidants such as vitamin E would help. And Karumanchi’s lab is working with a pharmaceutical company to see if it would be possible to come up with a therapeutic protein that would block the toxic effects of sFlt-1”  (Shute, 2005, p.72-73).

References

Hughes, P., Turton, P., Hopper, E., & Evans, C D H.  (2002). Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study.  Lancet.   360(9327), p.114. Retrieved April 26, 2010, from Business Source Complete database.

Inskip, H., (1999). Lancet. 354(9188), p.1400-1401. Retrieved April 26, 2010, from Business Source Complete database.

Lawson, W. (2003). Grieving Mothers Suffer Early Deaths. Psychology Today. 36(3), p.18. Retrieved April 26, 2010, from Business Source Complete database.

Shute, N. (2005). Babies In Peril. U.S. News & World Report, 138(2), p.72-73. Retrieved April 26, 2010, from Business Source Complete database.