Treating Patients Who Have Experienced Stillbirth
Stillbirth is associated with suicidal ideation, depression, anxiety and other manifestations of post-traumatic stress disorder.
“Stillbirth is an embodied loss. The death came either while the baby was still in the mother's body or immediately afterwards. The mother's body is still responding as if the baby is alive. For example, she feels the physiological aftereffects of labor and pregnancy. Her breasts produce milk.”
Moreover, “all eyes are turned toward her.” Family and friends wait for her to bring home a baby. Unsuspecting acquaintances ask how the baby is. She returns to a home that was prepared for the new arrival. She sees pregnant women in the supermarket, “forcing her to relive the baby's death again and again.”
Parents who lost babies to stillbirth often hear clichés by well-meaning friends and acquaintances because “we do not live in a grief-sensitive culture,” Cacciatore said. “For example, ‘At least you didn't get attached yet. At least it wasn't one of your older children. It wasn't even a real person yet.'” These platitudes make them feel more isolated and less understood.
Stillbirth is an “existential and spiritual crisis,” Cacciatore added. Beyond the biological question of why it happened, parents are haunted by questions of why God allowed it, or simply “Why me? Why my child?” These questions “can precipitate a crisis of faith often overlooked by society and even by healthcare professionals.”
Don't Pathologize Normal Grief
Stillbirth is associated with suicidal ideation, depression, anxiety, social phobia, agoraphobia, and other manifestations of post-traumatic stress disorder (PTSD) that can persist even years after the event has taken place.7 It may lead to avoidance of certain social settings and conflicting emotional reactions to sexual relationships. Parents often become hypervigilant when caring for their other children, afraid to become pregnant again, and anxious during subsequent pregnancies.7 Marital relationships are often strained.8
“Many professionals do not realize that parents are in a state of acute traumatic grief,” said Cacciatore. “And I have worked with parents who are still grieving years after the event.”
Cacciatore encouraged psychiatrists not to “pathologize” the parent's reaction. “Jumping to medicate sadly happens all too often,” she observed. She described a study she coauthored focusing on 235 bereaved parents following perinatal/neonatal death, 37.4% of whom were being treated with psychotropic medication (antidepressants, and benzodiazepines/sleep aids).9 “Disturbingly,” 32% of prescriptions were written within 48 hours of the death, 43.7 within a week, and 74.7% within a month.
“Look at the entire context before assuming the mother is expressing pathological grief or requires medication,” Cacciatore advised. While some parents might eventually need medication, it is important to recognize that healing does not happen according to a timetable.