The trauma of a stillbirth can leave parents afraid to prepare for the birth of a subsequent baby and can damage self-esteem and confidence in parenthood and child rearing.
This devastating psychological legacy, as well as the direct and indirect costs of stillbirth, is examined in a seminal paper published in The Lancet entitled ‘Stillbirths: Economic and psychosocial consequences’.
Among the findings from the wealth of international studies examined are that women tend to report volatile emotional stages following a stillbirth, with some struggling to differentiate their dead baby’s identity from their subsequently-born live baby.
“Some women avoided contact with babies, creating social isolation and worsening depressive symptoms,” the authors said. “Some mothers were hesitant to meet neighbours or those who had known them when they were pregnant. Many women stopped going out, leading to voluntary social isolation.”
In the period shortly after the stillbirth, some women reported being embarrassed by their body after pregnancy, while others wanted “to keep a pregnant body shape, maintaining a connection with their baby”.
“Some women linked the grief to their physical body through physical symptoms, such as pain and by developing an image of themselves as unattractive and ugly,” the authors or the report said.
The paper said fathers tended to report suppression of their feelings, and “the burden of these men keeping feelings to themselves increased the risk of chronic grief”.
Fathers reported feeling unacknowledged “as a legitimately grieving parent” and many studies described “disenfranchised grief, when parents felt their grief was not legitimised or accepted by health professionals, family, or society”.
The paper, which is based on reviews of existing literature and new analyses of published and unpublished data, also looked at the effect of stillbirth on health professionals, with contributions from consultant obstetrician/gynaecologist Keelin O’Donoghue and healthcare chaplain Daniel Nuzum, both from the Pregnancy Loss Research Group at UCC.
Dr O’Donoghue and Mr Nuzum conducted a review of 20 studies from which it was clear that staff suffered, “showing symptoms of trauma, diminished emotional availability, stress, and affective states such as guilt, anger, blame, anxiety, and sadness”.
The professional effect of stillbirth was characterised by fear of litigation and disciplinary action.
Dr O’Donoghue and Mr Nuzum found that most studies emphasised the need for further education and professional support for staff, “especially in terms of the psychosocial care and communication skills needed after a stillbirth”.
From an economic perspective, the cost of stillbirth was less clear. The paper said that, despite the 2.6m stillbirths experienced worldwide in 2015, the costs “are largely unknown and therefore unappreciated by contrast with other adverse pregnancy outcomes”.
The authors said the most frequent theme in one survey was the long-term financial effect on families, with reduced earnings from employment or an inability to return to paid employment.
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