Parenthood after reproductive loss: How psychotherapy can help with postpartum adjustment and parent–infant attachment.

Abstract

Parenting after pregnancy loss is often complicated for people who have not effectively grieved the loss and worked through the trauma. Reproductive losses can trigger shame and self-doubt, damage the sense of self-as-parent, and inflict narcissistic injuries, which, in turn, may impede the resolution of grief. If not addressed, these unresolved feelings may be projected onto subsequent children, potentially disrupting attachment relationships and the child's sense of self. The reproductive story, a lifelong internal narrative that comprises the thoughts, feelings, and hopes about how parenting and adulthood will unfold, and forms the core of parental identity, can be used as a tool in helping parents understand the depth of their feelings, integrate current and past losses into the self, and resolve grief. The authors discuss 3 crucial aspects of intervention with parents who have had pregnancy losses, aimed both at healing the parents themselves and at protecting attachment relationships with subsequent children: (a) initially staying present-focused and engaging with the painful details of the loss experience, to normalize and validate the patient's grief and trauma, counteract shame, and begin repairing narcissistic injuries; (b) eliciting the reproductive story to identify and integrate past losses, and in its revision, to allow for hope and repair; and (c) attending to both acknowledged and denied grief. The challenges and satisfactions of working with this population and potential countertransference reactions are also discussed. (PsycINFO Database Record

Core belief challenge, rumination, and posttraumatic growth in women following pregnancy loss.

“…Women who experience pregnancy loss often lack avenues to express their feelings and do not receive social recognition for their loss (Markin & Zilcha-Mano, 2018) compared to other types of death. As a result, women are left to cope in isolation, especially if they have not yet announced their pregnancy, perpetuating feelings of shame and guilt (Diamond & Diamond, 2017). Therefore, it is important to explore whether women's ability to discuss their experiences with family, friends, and other individuals relates to their levels of engagement in repetitive thought and psychological outcomes following miscarriage or stillbirth.…”

“…Parents may not receive social recognition of their loss, forcing them to grieve in isolation, which may also affect their psychological adjustment (Markin & Zilcha-Mano, 2018). Parents lose their expected social roles, which can impact their sense of identity, sense of self as a parent, and self-esteem (Diamond & Diamond, 2017; Wonch Hill, Cacciatore, Shreffler, & Pritchard, 2017). For example, women are socialized to view their self-worth, femininity, and reproductive success as interrelated, and not being able to have children may diminish their sense of value in society (Whiteford & Gonzalez, 1995).…”

Cultural Dimensions of Early Pregnancy Loss: Spiritual and Religious Issues

“…The use of Bronfenbrenner's (1994) ecological model may be useful in understanding the proximal and distal systemic influences on women's experiences of early pregnancy loss (Rogers et al, 2019). Additionally, the application of attachment theory may help counselors to understand the impact of an early pregnancy loss on the client's relationship to themselves, others, and the world (Diamond & Diamond, 2017), as well as their relationship to their faith or higher power (Beck & McDonald, 2004). The application of theories like these may provide valuable insights for both counselors and clients, as well as facilitate empowerment-oriented assessment and treatment.…”

“…Because of cultural norms, these clients may be particularly vulnerable to experiences of marginalization, increasing the importance of an empathic bond between counselor and client. Those coping with early pregnancy loss may experience isolation, self‐doubt, shame, and guilt; encounter experiences of marginalization; and feel dismissed, judged, or minimized by providers, friends, family, or others in their community (Diamond & Diamond, 2017; Markin, 2017). These factors may exacerbate the already existing power differential in the counselor‐client relationship.…”

“…Researchers have emphasized the need to break the culture of silence and help clients name their loss(es), examine how they make meaning of their loss, and explore how this meaning shapes their responses to the loss (Jaffe, 2017; Markin, 2017; Rowlands & Lee, 2010). Some researchers have suggested exploration and revision of meaning making within the context of “the reproductive story,” defined as “a lifelong internal narrative that comprises the thoughts, feelings, and hopes about how parenting and adulthood will unfold, and forms the core of parental identity” (Diamond & Diamond, 2017, p. 373; Jaffe, 2017). These researchers have posited that as clinicians address clients' reproductive story and any related grief, clients gain a deeper understanding of their affective responses and themselves in relation to the loss, and that these processes help clients to process and resolve grief or other symptoms of distress.…”