Lisa Zucker, MSW, LCSW Certified Thanatologist Pregnancy After Loss Lisa Zucker, MSW, LCSW Certified Thanatologist

Learning Objectives Things to know: the language of loss and models of understanding and intervening A walk in their shoes: Understanding the experience of parents who are pregnant after a loss – their concerns, how they survive, and things to look for How can I help? Ways that professionals can support, guide, and assist parents experiencing pregnancy after a loss

Things to Know

The Language of Loss Definitions Anticipatory Grief Bereavement “Complicated Grief” Disenfranchised Grief Grief Mourning Unresolved Grief

History Freud Kübler-Ross Bowlby Mourning and Melancholia (1917) On Death and Dying (1969) Five Stages (DABDA) Bowlby Attachment Theory

Modern Models Bowlby & Parkes (four Phases) Sanders (five Phases) Lindemann (anticipatory) Rando (6 R’s) Worden (4 Tasks) Wolfelt (dosing and “companioning”)

How is Grief Experienced In the Body Aches and pains Soreness Sleep changes Eating Changes In the Mind Concentration Forgetfulness Agitation Fear Anxiety Blaming

How is Grief Experienced Continued In the Heart Loneliness Anger Despair Seeking / Searching Withdrawal In our Relationships Gender difference in grief The mother vs. the father/partner The father/partner vs. the mother Changes in social activities

Dual Process Model of Bereavement Margaret Stroebe and Henk Schut (1999) Loss-oriented Restoration-oriented

Narrative Approaches Meaning Reconstruction: Thomas Attig, Robert Neimeyer, Janice Nadeau Contiuning Bonds: Klass, Silverman, and Nickman

A Walk in Their Shoes

Who are “they”? Parents Parents who have experienced the loss of a child “Age” of the child who passed (perinatal or child loss) Previous loss history “Rainbow Babies”

Bittersweet Dual Process Model Fear, anxiety, sadness, anger coexist with Joy, expectations, love, excitement Appendix 1 – CNN article

The “Should”s Grief is unique, personal, individual Everyone’s got an opinion Most “should”s come from reflection of the “should”ers own experiences or fears, an attempt to comfort, or the “should”ers discomfort with seeing pain and sadness What can a parent do? Appendix 2 Appendix 3

Our World of Social Media Birth announcements Pics of the kids Pressure on the parent Reminders everywhere, all the time Intolerance to ongoing grief of perinatal or infant loss The Holidays, Birthdays, Mother’s Day, Father’s Day, “Year in Review” or most shared status

How Can I Help?

Meet them where they’re at Acknowledge the loss Model language from parent’s language Be patient, kind, understanding, and reassuring

Social Reconstruction Be concrete and direct Understand how a mother’s trust in her body has been changed – fears, anxieties, and worries that may seem trivial are not to her Social Reconstruction Each person’s experience of reality is informed by their personality, prior experiences, and expectations / motivations

Mindfulness – for the professional Mindfulness as a tool to teach Never be afraid to engage in appropriate, honest inquiry in the form of, “I don’t know how best to support you or what I can say that would be helpful. Please share with me how I can assist” Higher risk for perinatal or postnatal mood or anxiety disorders – know when to refer and to whom Dads / partners are at risk too – disenfranchised grief, caregiver’s guilt, and own fears Appendix 4

Resources Pregnancy After Loss Support (www.pregnancyafterlosssupport.com) Baby and Bump has a Pregnancy after Loss specific forum (babyandbump.momtastic.com/pregnancy-after-loss/) Still Standing Magazine (stillstandingmag.com/) Subsequent Pregnancy After a Loss Support (www.spals.com) Reconceiving Loss (reconceivingloss.com/magazine/) Compassionate Friends: organization for bereaved parents; not pregnancy after loss specific (www.compassionatefriends.org/)

References and Further Reading Suggestions Attig, T. (1996). How we grieve: Relearning the world. New York: Oxford University Press. Bonanno, G. (2009). The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss. New York: Basic Books. Bowlby, J. (1980). Loss: Sadness and depression. (Attachment and loss, Vol. 3). New York: Basic Books. Doka, K. (2002). Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. CA: Research PRPub. Freud, S. (1917/1957). Mourning and melancholia. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud (Vol. 14, pp. 152–170). London: Hogarth Press.

Jordan, J. R. & Neimeyer, R. A. (2003). Does grief counseling work Jordan, J. R. & Neimeyer, R. A. (2003). Does grief counseling work? Death Studies, 27, 765-786.  Klass, D., Silverman, P. R., & Nickman, S. L. (1996). Continuing bonds: New understandings of grief. Philadelphia: Taylor and Francis. Kübler-Ross, E. (1969). On death and dying. New York: Springer. Lindemann, Eric. "Symptomatology and Management of Acute Grief." American Journal of Psychiatry 101 (1944):141–148. Neimeyer, R. A. (1998). Lessons of loss: A guide to coping. Boston: McGraw-Hill.

Neimeyer, R. A. (2001). Meaning, reconstruction and the experience of loss. Washington, DC: American Psychological Association. Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books Rando, T. A. (1984). Grief, dying, and death. Champaign, IL: Research Press. Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press Sanders CM (1989) Grief: the Mourning After, Wiley Series Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197–224.

Walter, T. (1996). A New Model of Grief: Bereavement and Biography Walter, T. (1996). A New Model of Grief: Bereavement and Biography. Mortality, 1, 7-25. Wolfelt, A. (2005). Companioning the Bereaved: A Soulful Guide for Counselors and Caregivers. Fort Collins, CO: Companion Press Worden, J. W. (2002). Grief counseling and grief therapy: A handbook for the mental health practitioner (3rd ed.). New York: Springer.