During holidays and other celebrations, there are many words that come to mind: joy, family, and a happy heart. But for those who have experienced a miscarriage or stillborn birth, these times represent something else: Grief, trauma, and the infamous, “There’s no heartbeat. I’m sorry.” While grief should not define our holidays and celebrations, experiencing such a loss has a way of overshadowing even the most joyful of events. As we navigate our grief, there should be one word that we must keep firm in our minds: resiliency. Finding a way to be resilient is the key
The Grief and Trauma of Child Loss
Grief is often examined as a short-term process; however, the long-term psychological, physiological, and spiritual consequences of the trauma of child loss are not examined enough. Many studies report that the loss of a child produces a greater stress response than with the death of a parent or spouse.1 The trauma of child loss (at any age, whether perinatal, stillbirth, or otherwise) can lead to extensive psychological, physical, and spiritual consequences to include anxiety, panic attacks, depression, and often overlooked, neuro-cognitive and medical symptoms.
Grief is usually treated with the same interventions used for depression and anxiety; however, trauma symptoms often go overlooked. In some cases the grief is so intense that parents describe experiencing “recurrent, intrusive” thoughts about their child. For example, a patient once described “reliving” the death of their child several times a day. In reality, she was describing a “flashback” experience to the moment during a sonogram when the doctor informed her the baby had no heartbeat. Parents who have lost a child exhibit many symptoms similar to Posttraumatic Stress Disorder (PTSD) to include intrusive thoughts (unwelcome, involuntary thoughts), rumination (constant focus on stressful thoughts), sleep disturbance, guilt, anxiety, avoidance, and fatigue.
While trauma is often associated with losing a child, few women receive the appropriate therapeutic intervention to address the psychological symptoms associated with a trauma experience. In fact, women who suffer child loss often report symptoms consistent with PTSD. While it is not uncommon, it is often undiagnosed. Symptoms include: nightmares, insomnia, panic attacks, anxiety, intrusive thoughts, constant fear, avoidance, and the “reliving” of the traumatic event. Psychologically, this re-experiencing of a past traumatic memory is often referred to as a “flashback” or an “involuntary recurrent memory.” These experiences can make it difficult to heal, but they can also be signs the person needs to address the PTSD symptomology in order to achieve a future path of serenity.
Sometimes grief can also develop into what has been termed as “complicated or complex grief.” It is a diagnosis currently under discussion for future inclusion into the Diagnostic and Statistical Manual of Mental Disorders (DSM). It describes a set of symptoms that addresses more of the trauma piece of loss. It includes experiencing symptoms such as “intrusive thoughts” or “ruminating” about their loved one and “traumatic distress” symptoms (i.e., detachment, numbness, difficulty accepting the death, anger, inability to enjoy life, depression, isolation, guilt).2 The symptoms must last at least six months and lead to impairment in overall functioning. It is critical that providers understand that parents who have experienced child loss are at greater risk for the development of these symptoms and therefore are at a greater risk to develop complicated grief.3
Remember the Spirit
Not only do medical/psychological providers need to strive to understand the short and long-term grief of a mother who has lost her child, but also their spiritual providers and leaders of their faith. Often the grieving mother may ask “Where can I go for help?” This profound question is answered in the Psalms, “Our help is in the name of the Lord, who made heaven and earth” (Ps. 124:8). We should receive help from those who carry the name of the LORD, the Church! Therefore, the Church calls her clergy and the laity to help those who have lost a child by laying a foundation of love. This comes through acts of mercy; in being “merciful like our Heavenly Father” (Lk. 6:36) with the corporal work of mercy-burying the dead, and the spiritual works of mercy: Counseling the doubtful, comforting the sorrowful, praying for the Living and the Dead, and instructing the ignorant (sharing knowledge about this issue of miscarriage/stillborn births).
Many parents do not know that they can bury their baby if lost early in the pregnancy (<20 weeks). It is a corporal work of mercy to bury the dead (see Tob. 1:16-17) and so burying the miscarried/stillborn baby brings the family in contact with the mercy of God which in return can start the journey of healing. Then, the family does not face abandonment during this time of loss, but accompaniment on their journey by the Church. This accompaniment is crucial for developing resilience along with not being a source of spiritual trauma to the woman and her family while grieving. It is hard to heal if a woman thinks that God has abandoned her; or if she thinks God is punishing her; or that God and the Church do not care about her situation. For this reason, the Church recommends that the people of God, especially the clergy accompany the family as well as help them to find closure through funeral rites. Canon Law states, “The local ordinary can permit children whom the parents intended to baptize but who died before baptism to be given ecclesiastical funerals” (Can. 1183 §2).4 The Church through its funeral rites commends the dead to God’s merciful love and pleads for the forgiveness of their sins” (including original sin).5
Many also experience physical manifestations of the traumatic grief. Providers should be vigilant for not only the psychological symptoms of trauma associated with child loss but the physical symptoms as well: loss of appetite, sleep, fatigue, cognitive changes, cardiac symptoms, etc. And spiritual leaders should understand the psychological and physical manifestations of child loss that many of their parishioners experience.
Broken Heart Syndrome
Mothers who have suffered pregnancy loss often describe a physical response to the loss: shortness of breath, sleep disturbance, fatigue, heart palpitations, and loss of appetite. There is even an increase in the recognition of Broken Heart Syndrome (Takotsubo Cardiomyopathy) for mothers who have experienced child loss. This disorder almost exclusively occurs in women and often occurs after a significant emotional or physical stressor, such as the sudden death of a loved one. It often mimics the symptoms of a heart attack. In fact, there are many cases where patients who suffered child loss went to the Emergency Room thinking they were experiencing a heart attack because of the physical symptoms they were experiencing (shortness of breath, chest pain, dizziness). It is critical to recognize the physical symptoms a woman faces after suffering child loss in order to help her through all aspects of the healing process. While there are many physical reactions to trauma, a current research trend is providing hope to the women who have suffered child loss.
One of the most relevant scientific research trends involves the study of microchimerism. When a woman is pregnant, genetic material (fetal cells) travel bi-directionally between the baby and mother. Interestingly, even post the birth of the child or the loss of the child, the fetal cells may remain within the mother. While the research is ongoing, initial studies suggest that microchimerism may in some cases be beneficial or adverse to the mother, specifically involving an autoimmune function. While many questions remain about the exact role remnant fetal cells play in a mother’s body after the pregnancy, this avenue of research has limitless possibilities in the field of genetics. As a mother and psychologist, who lost twins perinatally, I often find when discussing the medical/physical aspects of child loss, it provides great comfort to grieving mothers to know that a physical, tangible piece of their child will remain within their bodies long after pregnancy.
Finally, one of the most common experiences described by parents who have experienced child loss is also the lack of long-term support from family and friends who in an attempt to provide comfort say things like “at least you have other children,” “heaven has another angel,” or “you can try again soon.” Parents often report that they feel pressured to stop discussing their child loss because it makes people uncomfortable. This also hinders the recovery process. Parents tend to internalize their experience and that can again contribute to symptom escalation. Yet research indicates that parents often experience increased symptoms of anxiety and depression even years after the loss of their child.6
Ministering to the Grieving
Pastorally, we must allow the little children, especially those who are miscarried or stillborn, to come to the mercy of God through his Church. In doing this, we can lay the foundation for the physiological and psychological healing for the family who has suffered miscarriages/stillbirths. Organizations such as A Mom’s Peace (www.amomspeace.org) provide a resource for families who have experienced child loss by helping to provide burials for the children. This provides a small sense of comfort to the grieving mother by acknowledging and marking the life of her child. Oftentimes, mothers who have experienced child loss feel alone in their grief journey and seeking support networks is critical to the healing process.
As a society we view grief as something to overcome, but parents who have experienced the death of a child will never “get over it.” Rather, working with a trained mental health professional, joining a support group, seeking pharmacological intervention, and knowing there is support from those who are visible signs of the faith (if faith is part of the mother’s life) should be part of any intervention protocol. There are so many questions that go through a grieving mother’s mind: spiritual questions, questions about their physical symptoms and psychological symptoms, and the ultimate question, “How will I survive this?” Our job as medical, psychological, and spiritual providers is to provide support while the parents navigate their grief and grow in resiliency.
-  Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families; Field MJ, Behrman RE, editors. When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Washington (DC): National Academies Press (US); 2003. APPENDIX E, BEREAVEMENT EXPERIENCES AFTER THE DEATH OF A CHILD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK220798
- Shear, Katherine. Grief and mourning gone awry: pathway and course of complicated grief. Dialogues in Clinical Neuroscience. 2012 June: 14 (2): 119-128.
- Kersting, Karen. A new approach to complicated grief. Monitor, November 2004, Vol 35, No. 10.
- Code of Canon Law. Accessed at: http://www.vatican.va/archive/ENG1104/__P4C.HTM
- Order of Christian Funerals, General Introduction (New Jersey: Catholic Book Publishing, 1998), sec. 5-6.
- Kersting, Karen. A new approach to complicated grief. Monitor, November 2004, Vol 35, No. 10.