Understanding and Treating the Psychosocial Consequences of Pregnancy Loss

Abstract

This chapter reviews research on the psychological impact and treatment of pregnancy loss for women, men, and families. The psychological sequelae of pregnancy loss can include mild to severe grief, complicated grief, depressive disorders, post-traumatic stress disorder (PTSD), and other anxiety disorders. Effects on couples, men, and other family members, including the impact on subsequent pregnancies, parental attachment to subsequent children, and gender differences in how men and women cope and grieve, are discussed. The authors present a conceptual framework for understanding pregnancy loss, positing that reactions largely depend on deeply personal and often unconscious meanings of pregnancy and on how parenthood fits into personal identity and the achievement of adult developmental tasks. The authors discuss unique aspects of pregnancy loss that may explain its broad impact and describe ways in which psychotherapy with pregnancy loss patients differs from psychotherapy with the general population, especially regarding countertransference and attitudes toward self-disclosure.

The process of change in psychotherapy with a pregnant patient following perinatal losses: An analysis of a case study

“…A perinatal loss has a relatively high incidence. International rates show that 12 to 24% of detected pregnancies fail to result in the birth of a living infant, across all cultural and socioeconomic groups (Diamond & Diamond, ; Keren, ).…”

“…There is a wide agreement that pregnancy loss can lead to painful and lasting grief and to a wide variety of other psychological and social consequences. Studies estimate that approximately 30% of pregnancy losses are followed by significant emotional reactions, often by diagnosable disorders, including depressive disorders, anxiety disorders such as posttraumatic stress disorder (PTSD), or substance abuse (Diamond & Diamond, ; Markin, ).…”

“…The majority of women who suffer perinatal loss become pregnant again, with estimates ranging between 50 to 85%. There are demonstrable effects of pregnancy loss on emotional states during subsequent pregnancies and on the attachment to subsequent children (Diamond & Diamond, ). After pregnancy loss, pregnant women often re‐experience the traumatic event of the loss, avoid what is associated with the trauma, and experience impaired functioning and increased arousal.…”

“…The supportive end of the continuum includes interventions aimed at strengthening patients' abilities that are temporarily inaccessible to them because of the acute stress caused by the traumatic event of perinatal loss (Diamond & Diamond, ; Leichsenring & Leibing, ). Supportive techniques aim to strengthen the patient's ego, enhance self‐esteem, and promote exploration of emotions while facilitating the use of higher‐level defenses.…”

“…According to Book (), supportive techniques in supportive‐expressive therapy include defining the therapeutic frame, offering empathic comments, noting gains, and demonstrating genuine interest and respect. With pregnant patients who have experienced multiple perinatal losses, the therapist may normalize and validate their reactions and describe them as natural responses to the death of a baby to whom they were attached (Diamond & Diamond, ).…”