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Gestational and Neonatal Loss

Gestational and neonatal loss involves a set of loss situations that occur during pregnancy or after childbirth. The World Health Organization (WHO) distinguishes between losses that occur before the baby is expelled or extracted from the mother's body, regardless of gestational age, and those that occur after birth (this is called early neonatal death if it occurs up to the 7th day after birth, or late neonatal death if it occurs between the 7th and 27th day after birth).

October is gestational and neonatal loss awareness month. On 15 October, all over the world, the grief of these parents and families is recognized and validated, and the babies who have died are honored.

Knowing, validating and intervening in gestational and neonatal loss is essential.

The causes of gestational and neonatal loss

Fetal deaths occur essentially due to obstetric or labor complications, maternal health problems or unidentified causes. Deaths that occur after childbirth are related to serious malformations in the baby, prematurity, obstetric complications, or complications that occur during childbirth, difficulties adapting to extrauterine life and infections resulting from bad practices after childbirth (WHO, 2006).

Around 25 per cent of pregnancies end during the first trimester; other, later, situations are less frequent, but they all have devastating potential, with tangible and intangible losses that affect the individual, families, health systems and society.

But how do we deal with such a significant loss?

Scientific research has described pregnancy loss as a potentially traumatic event (Rolim & Canavarro, 2001), with a profound psychological impact on parents and their families who, as well as having to deal with the suffering related to the death of the baby, usually desired and planned, face changes in various areas of life. The planned family structure is altered due to the absence of one of its members; parents lose an opportunity to exercise parenthood; their social identity may be altered (e.g. exclusion from the group of friends with children); they are forced to readjust expectations and dreams in relation to pregnancy and life in general; particularly in women, there may be changes in self-esteem and beliefs in relation to the body.

The psychological impact of gestational and neonatal loss can vary from person to person but is often characterized by the experience of a deep sense of grief, sadness, emptiness, guilt, anger, irritability, anxiety, shock, despair, helplessness, disappointment, and hopelessness. In addition, parents may feel inadequate and a failure, questioning their ability to carry out a healthy pregnancy or care for a child. A sense of isolation and loneliness is also prevalent, leading parents to feel cut off from friends and family, who may not fully understand their pain or know how to offer support. They may also find it difficult to relate to other people who have not suffered a similar loss, as their grief is unique and deeply personal.

Symptoms such as confusion, difficulty concentrating, lack of memory and thoughts of worrying about the baby may appear. There may be agitation, fatigue, crying, isolation, and a tendency to seek out or avoid stimuli associated with the baby.

The psychology of pregnancy and parenthood

Seeking support from mental health professionals and support groups can be crucial in helping parents and families deal with the psychological impact of gestational and neonatal loss. These resources can provide a safe space to express emotions, share experiences and receive guidance on how to deal effectively with the grieving process.

Psychological intervention in situations of gestational and neonatal loss seeks to promote parental adaptation to the loss - acceptance of the loss and restoring emotional balance in the different areas of life.

The therapeutic process, which should encompass various intervention contexts (e.g. individual, marital), can be divided into 4 phases:

1. Identifying parents and family members at risk of developing non-adaptive responses to loss.

2. Favoring acceptance of the loss and making the grieving process known.

3. (Re)introducing the usual routine pattern, re-establishing a sense of control, and helping to construct new meanings.

4. To help make informed and considered reproductive decisions.

The pain of losing a child is hard, indescribable, legitimate, and real. I cannot remind you enough of the challenges faced by parents and families who experience such losses. May they have the courage and strength to live beyond the loss.

--- Nazaré, B., Fonseca, A. D. D., Pedrosa, A. A., & Canavarro, M. C. (2010). Avaliação e intervenção psicológica na perda gestacional.

World Health Organization (2006). Neonatal and perinatal mortality: Country, regional and global estimates. Geneve: Author.

Rolim, L. & Canavarro, M. C. (2001). Perdas e luto durante a gravidez e o puerpério. In M. C. Canavarro (Ed.). Psicologia da gravidez e da maternidade (pp. 255-297). Coimbra: Quarteto Editora.

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