The Helping after Neonatal Death (HAND) offers a helpful guide for professionals (www.handonline.org): 1.) Recognize that the baby is unique and irreplaceable. Do not rationalize the loss (i.e. you can have other babies). Do say “I’m sorry”, “This must be so hard” or “How can I help?” 2.) It is important for you to realize that parental bonding begins long before the birth. And this baby was already very much a part of this family. 3.) Reassure the parents that their expression of grief is normal. 4.) Be real; share feelings of distress & sadness with the parents. Parents appreciate caring hospital staff. 5.) If a baby dies at or shortly after birth, develop a system to flag the mother’s room so that everyone on staff can be aware of what has happened. 6.) Let parents know they may take their time. Nothing needs to be decided immediately. 7.) Encourage parents to see their baby. You can help reduce fears parents may have by describing how their baby looks. Suggest that they hold and touch their infant and have alone time. The baby should be wrapped in a clean, warm baby blanket. 8.) Encourage parents to name their baby & use the baby’s name when talking to the parents. 9.) Take pictures of the infant. 10.) Let the family know they can ask for mementos. 11.)Teach parents about the grief process. During acute grief parent may experience--somatic complaints, feelings of unreality, loneliness, depression, guilt, anger, irritability, loss of routine patterns, preoccupation with the child that died, insomnia, and difficulty with friends and family. 12.) Offer the parents phone numbers to mortuaries close to their home. Also, provide number to support groups. 13.) Be sensitve to cultural differences. Not all cultures express grief or respond to death in the same manner.
The loss of a baby is often unexpected, sending parents into shock. This shock may leave parents unable to ask for the emotional help they need. “The mother’s loss is compounded by physical pain from the delivery and her body’s hormonal response to birth.” Social workers can help parents through the grieving process by understanding the path grief often takes. “Grief over the loss of a baby usually follows expected bereavement phases, although the phases may overlap, or pass and then return. The initial phase of shock often includes feelings of numbness and denial, which are protective reactions that arrive with news of the tragedy. The phase of acute grief usually follows as the reality of the loss sinks in, with physical and emotional anguish such as uncontrollable crying and problems with sleep, appetite, and daily functioning. Acute grief gradually yields to grief work, with painful feelings of anger, jealously, and blame, as well as yearning for the baby who has died. During grief work, parents slowly reinvest emotionally in their present activities and in future plans” (Perinatal Loss: Helping Families Grieve and Heal). Hospital social workers will probably observe the initial shock and acute phase of bereavement. “The psychological response to trauma is similar to that of accident victims. Parents may uncontrollably relive in their minds the news of the loss or the delivery of their baby. They may experience debilitating anxiety and recurrent nightmares, as well as panic about another loved one coming to harm.” Social workers can normalize feelings & “help them distinguish the sorrow over the loss from irrational fears about the future. When parents can freely and safely process their overwhelming feelings, the traumatic images and paralyzing fears usually subside within a few weeks. Social workers can also help parents by explaining “incongruent grief, the term used to describe the differing rates and intensities between a mother’s and a father’s sorrow” (Perinatal Loss). Mom’s typically experience intense grief, that may last longer then a father’s. A woman may feel a sense of failure & blame herself for the loss. Men tend to take on the role of the “strong one”. A father may return to work & want to get back to his normal routine. The father may not understand that it will likely take a long time for a mom to grieve. She may want to talk about the baby and loss, and he may want to avoid the topic. A mom might feel that the father did not love the baby as much as she did, thus causing feelings of anger & resentment. The social worker can help by explaining the differences in ways individuals grieve & you can stress the importance of communication.
You should be able to help support parents as they make important decisions about naming their baby, taking pictures, creating a memory box, & planning for disposition.
Social workers can also help by talking to parents about asking for help. You could offer to call a friend or family for the pt or help them to delegate this to a close family member. It can also be helpful for parents to ask their supervisor at work to let their colleagues know about the loss before they return to work. Parents may want to plan in advance what they are going to tell people, so they will feel better prepared. Social workers can also encourage parents to let friends/family know what they need (dinner, groceries, chores, etc...), as they might not know how to help or what to say.
“You can greatly comfort a bereaved couple by letting them know that it is normal and expected for them to need support well beyond their hospital stay, and to assure them that resources are available. This validates their sense of loss and helps them to accept that they are not alone in experiencing this sorrow” (Perinatal Loss: Helping Families Grieve & Heal).
Questions: Can you share a time when you worked w/ a grieving client? Do you have any advice on how to best support clients during this difficult time?
Katie, Your post is very thoughtful and very informational. I love it.
I heard a quote the other day that left a great impression on me. It stated basically "the acute stressful event that you are experiencing for example whether that means losing a child to to a misscarriage or still birth is abnormal. However, the feelings that one feels as a result of anger, guilt, shame, jealousy are all very normal"
It just stuck in my mind as everyone is always trying to move people through grief because of their own anxieties. I think it complicates things even more when our society has difficulty viewing miscarriages and neonatal deaths as real deaths . But, whether people are philosophically or emotionally ready yet, mothers, fathers, brothers and sisters view these as real lost love ones. As clinicians, we really have the opportunity to validate and normalize these concepts. Awesome, awesome post. I can't wait for this discussion
Katie, Thank you for suggesting this topic and starting this discussion with such an informative post. I have been dealing with grief and loss much more lately and I have been feeling like I have just been "winging it." The HAND model offers a nice framework for working with parents who have experienced the loss of a child. Many of the suggestions are ones that are used at the Pavilion.
One thing for me about this topic is being able to work through my own discomfort with different ways that individuals express and cope with their grief. I have personally been uncomfortable with the idea of taking photos, but many of the parents at the Pavilion want those photos. I have also witnessed loud, shocking, and emotionally charged reactions to grief and loss at Harborview and I haven't quite figured out a way to work with people when they are having these out of the norm grief reactions. I really look forward to talking with the group about this important topic!
Perinatal Loss
ReplyDeleteThe Helping after Neonatal Death (HAND) offers a helpful guide for professionals (www.handonline.org):
1.) Recognize that the baby is unique and irreplaceable. Do not rationalize the loss (i.e. you can have other babies). Do say “I’m sorry”, “This must be so hard” or “How can I help?”
2.) It is important for you to realize that parental bonding begins long before the birth. And this baby was already very much a part of this family.
3.) Reassure the parents that their expression of grief is normal.
4.) Be real; share feelings of distress & sadness with the parents. Parents appreciate caring hospital staff.
5.) If a baby dies at or shortly after birth, develop a system to flag the mother’s room so that everyone on staff can be aware of what has happened.
6.) Let parents know they may take their time. Nothing needs to be decided immediately.
7.) Encourage parents to see their baby. You can help reduce fears parents may have by describing how their baby looks. Suggest that they hold and touch their infant and have alone time. The baby should be wrapped in a clean, warm baby blanket.
8.) Encourage parents to name their baby & use the baby’s name when talking to the parents.
9.) Take pictures of the infant.
10.) Let the family know they can ask for mementos.
11.)Teach parents about the grief process. During acute grief parent may experience--somatic complaints, feelings of unreality, loneliness, depression, guilt, anger, irritability, loss of routine patterns, preoccupation with the child that died, insomnia, and difficulty with friends and family.
12.) Offer the parents phone numbers to mortuaries close to their home. Also, provide number to support groups.
13.) Be sensitve to cultural differences. Not all cultures express grief or respond to death in the same manner.
The loss of a baby is often unexpected, sending parents into shock. This shock may leave parents unable to ask for the emotional help they need. “The mother’s loss is compounded by physical pain from the delivery and her body’s hormonal response to birth.” Social workers can help parents through the grieving process by understanding the path grief often takes. “Grief over the loss of a baby usually follows expected bereavement phases, although the phases may overlap, or pass and then return. The initial phase of shock often includes feelings of numbness and denial, which are protective reactions that arrive with news of the tragedy. The phase of acute grief usually follows as the reality of the loss sinks in, with physical and emotional anguish such as uncontrollable crying and problems with sleep, appetite, and daily functioning. Acute grief gradually yields to grief work, with painful feelings of anger, jealously, and blame, as well as yearning for the baby who has died. During grief work, parents slowly reinvest emotionally in their present activities and in future plans” (Perinatal Loss: Helping Families Grieve and Heal).
ReplyDeleteHospital social workers will probably observe the initial shock and acute phase of bereavement. “The psychological response to trauma is similar to that of accident victims. Parents may uncontrollably relive in their minds the news of the loss or the delivery of their baby. They may experience debilitating anxiety and recurrent nightmares, as well as panic about another loved one coming to harm.” Social workers can normalize feelings & “help them distinguish the sorrow over the loss from irrational fears about the future. When parents can freely and safely process their overwhelming feelings, the traumatic images and paralyzing fears usually subside within a few weeks. Social workers can also help parents by explaining “incongruent grief, the term used to describe the differing rates and intensities between a mother’s and a father’s sorrow” (Perinatal Loss). Mom’s typically experience intense grief, that may last longer then a father’s. A woman may feel a sense of failure & blame herself for the loss. Men tend to take on the role of the “strong one”. A father may return to work & want to get back to his normal routine. The father may not understand that it will likely take a long time for a mom to grieve. She may want to talk about the baby and loss, and he may want to avoid the topic. A mom might feel that the father did not love the baby as much as she did, thus causing feelings of anger & resentment. The social worker can help by explaining the differences in ways individuals grieve & you can stress the importance of communication.
You should be able to help support parents as they make important decisions about naming their baby, taking pictures, creating a memory box, & planning for disposition.
ReplyDeleteSocial workers can also help by talking to parents about asking for help. You could offer to call a friend or family for the pt or help them to delegate this to a close family member. It can also be helpful for parents to ask their supervisor at work to let their colleagues know about the loss before they return to work. Parents may want to plan in advance what they are going to tell people, so they will feel better prepared. Social workers can also encourage parents to let friends/family know what they need (dinner, groceries, chores, etc...), as they might not know how to help or what to say.
“You can greatly comfort a bereaved couple by letting them know that it is normal and expected for them to need support well beyond their hospital stay, and to assure them that resources are available. This validates their sense of loss and helps them to accept that they are not alone in experiencing this sorrow” (Perinatal Loss: Helping Families Grieve & Heal).
Questions:
Can you share a time when you worked w/ a grieving client?
Do you have any advice on how to best support clients during this difficult time?
Katie, Your post is very thoughtful and very informational. I love it.
ReplyDeleteI heard a quote the other day that left a great impression on me. It stated basically "the acute stressful event that you are experiencing for example whether that means losing a child to to a misscarriage or still birth is abnormal. However, the feelings that one feels as a result of anger, guilt, shame, jealousy are all very normal"
It just stuck in my mind as everyone is always trying to move people through grief because of their own anxieties. I think it complicates things even more when our society has difficulty viewing miscarriages and neonatal deaths as real deaths . But, whether people are philosophically or emotionally ready yet, mothers, fathers, brothers and sisters view these as real lost love ones. As clinicians, we really have the opportunity to validate and normalize these concepts. Awesome, awesome post. I can't wait for this discussion
Katie, Thank you for suggesting this topic and starting this discussion with such an informative post. I have been dealing with grief and loss much more lately and I have been feeling like I have just been "winging it." The HAND model offers a nice framework for working with parents who have experienced the loss of a child. Many of the suggestions are ones that are used at the Pavilion.
ReplyDeleteOne thing for me about this topic is being able to work through my own discomfort with different ways that individuals express and cope with their grief. I have personally been uncomfortable with the idea of taking photos, but many of the parents at the Pavilion want those photos. I have also witnessed loud, shocking, and emotionally charged reactions to grief and loss at Harborview and I haven't quite figured out a way to work with people when they are having these out of the norm grief reactions. I really look forward to talking with the group about this important topic!