Psychological and Emotional Issues as Relates to a Known Stillbirth - Essay Example

You're 26 August 2006 Exploring the Psychological and Emotional Issues as Relates to a Known Stillbirth Miscarriage is sadly a common occurrence in pregnancy but the current case being discussed which concerns a pregnancy that has reached 38 weeks of gestation and has resulted in a still birth is far less common. However, research clarifies that 15% to 20% of pregnancies do end in the stillbirth of the fetus (Cosgrove 2004). The main concern here is the psychological wellbeing of the mother because there are numerous emotional issues that take place following such a traumatic incident which the mother requires professional help on dealing with. Although an early pregnancy loss has been defined by medical practitioners and midwives as being critically straightforward, there is always the psychological outcome of the mother, and the father as well that must be taken into consideration. Pregnancies that reach 38 weeks of gestation normally don't result in the fetus being still born but occasionally this does take place. When it does the midwife and other medical professionals have to be prepared and willing to help the mother cope and seek professional help to get through the devastating tragedy she has to deal with (Geller & Neugebauer 2001, p. 432). The problematic situations that take place are of high concern and the grieving process in itself is just as complicated as attempting to understand the stillbirth of the baby. What makes the grieving process so difficult is the fact that the mother has not had the opportunity to bond with her baby so there are no memories there to comfort the parent at all. This is medically termed, 'the token of remembrance' and leads to high anxiety levels for many of these mothers due to the facts that they never had the opportunity to dress, caress, hold, or even speak with their babies (Radestad et al 1996, pg. 1505). Often the mother falls into a deep depression and goes through a series of psychological phases, some having been briefly mentioned. The traumatization is one very important factor that presents itself in cases such as this one. Some of these are self-blame, and guilt even though there might not exist a medical explanation for the loss whatsoever (Frost 1996, p. 54). As the research will show, psychoanalytical theory, although utilized in the past for assessments following stillbirths was popular in decades past it is now considered unreliable and does not provide relevant information that correlates with the emotional state of women who suffer from such a loss. Stillbirth is now considered to be an event that creates intense feelings of sorrow and depression which can turn to more serious psychological problems, far exceeding the regular baby blue syndrome that women have following a normal delivery of a live baby. Ultimately from having had personal experience with this young woman I can strongly say that I believe the psychosocial factors are what are of the highest concern in ensuring her well-being following this loss. The support that she needs from her spouse, a woman's support network, and her own relatives will definitely affect how she will appraise her loss and cope with it. These also will have a part in how well she manages the various emotional stages that she will indeed have to endure and how her level of distress will have to be managed as well. As was mentioned, depression and high levels of anxiety are the two most common psychological influences following such a tragic occurrence for women. The Case Study The case study shows a woman that was physically fit and took care of herself following the full 38 weeks of her pregnancy. There is no mention of cigarette smoking or alcohol abuse that could be tied in with the untimely death of her fetus in utero. Often these concurrent problems are what medical experts have found that can cause still-births and other related problems with a fetus while still in utero (Lester et al 2004, pg. 1477). However, as was stated, in this case there was no known substance abuse or smoking involved. When the mother received the news it was simply for a routine examination to ensure everything was ok and the gestation was accurate. What actually lead to the diagnosis was the fact that during the antenatal exam the midwife was unable to detect a fetal heartbeat. During this occurrence I personally noticed from my observations that the midwife's personality changed drastically during this time as well as the mother's. This is quite common as of course there is going to be a shift in personality characteristics of all that are involved in a despairing situation such as this (Huizink et al 2002, pg. 133). The midwife had been very enthusiastic during the exam up until she could not detect the heartbeat. Once this occurred immediate concern, anxiety, and distress were replaced as the midwife continuously tried to locate a heart beat. The mother's emotions became strained and she was overwhelmed with anxiety, as her stress levels rose considerably. The father also showed signs of emotional distress and immediately seemed to attempt to bring more support for his wife, showing his personality change from a previous extrovert to an introvert (Turton 2006, pg. 165). The situation was indeed very dire as a couple once ecstatic to soon give birth to a live baby had their emotions turned upside down as the unexpected news of their baby's death was given to them. The mother became very irrational and angry at the staff as well as she felt that they had to have known something beforehand instead of just suddenly and without warning giving her such devastating news. Her personality that had once been that of an introvert now turned to an extrovert type of mentality; something that takes place quite often as well . Although this is common for many mothers who lose their baby while still in utero, her personality shift was more aggressive and also disengaging from the reality of what was happening. Evidence to back this up shows that the mother did not want to see her baby, she did not want to see any pictures, nor did she want to hold and name her baby either. This is clearly a symptom of depression and psychological distress (Davis 2006, pg. 15). She remained alienated by her own accord through the entire still-birth. The midwife felt this was a negative sign and indicated that the mother was already entering into a withdrawal phase. Also, the midwife had every reason in becoming concerned with the mother's attitude because her psychological reactions alerted her that there would have to be some forms of interventions established to help this mother through such a very difficult and saddening time in her life (Saflund et al 2004, pg. 132). All involved in this case expressed severe forms of sadness, even the midwife as no one is every ready to find out such news and a midwife is certainly not always prepared to deliver a still-born baby either, especially not on a mother who has turned introvert and disengages herself from the entire occurrence. Saddening as it is, as has been stated, it is an occurrence that has to be medically dealt with and whatever medical help can be given following the birth is applied and established for the mother. The Emotional Stages and Individual Personality Traits Within the emotional stages of perinatal loss there exists a common psychiatric theory that ties into the grieving process very well. Science has found that when a mother loses her fetus before birth but must deliver her baby still born the process is similar to that of actually facing the death of an actual person that has been in her life for a long period of time (Leon 1992, p. 1465). The loss has been found to lead to a developmental interference in the mother's life, affecting her social interactions with her peers and often leading to isolation away from people that she has been familiar with during her pregnancy. Also, psychiatric studies have shown that there is also a stage of narcissism where the mother experiences rage due to the perinatal loss and lashes out at those closest to her. Sigmund Freud developed Psychoanalytical theory in an attempt to understand specific emotional responses within humanity, especially with regard to the loss of life and mental disturbances (Benoliel 1999, p. 263). Freud stated that a mother who is grieving over a lost fetus goes through a systematic process of grief the first being 'hypercathexis' and the secondary being 'decathexis' (Benoliel 1999, p. 263). Freud also believed that the grieving process had to do with the internalized attachment that the mother had to the unborn fetus. For instance, although this current patient never delivered a live full-term infant she still did give birth to what could be medically termed a full term infant although still born. The pain of the loss of the baby is said to be just as strong for a mother such as the one being discussed as it is for a mother who is able to hold her live infant before losing it to illness or some other medical problem. This is due to the fact that the mother did bond with her baby due to feeling the fetus kick and move while she was pregnant. Although psychoanalytical theory can analyze the grieving process it has been said to be very cold in doing so. This is due to the fact of how this theory views a mothers' perinatal loss. Following the classical Freudian approach, psychoanalytical theory views an occurrence of a still born fetus as something that doesn't necessarily require mourning over since it never came to be and was somewhat a fantasy of the mother (Leon 1996, p. 162). Furthermore, if one stays with the Freudian "phallocentric orientation" then the mother supposedly equates the wished for baby with a penis, which logically does not make any sense because the baby was a human life, not a penis (Leon 1996, p. 162). Personally, I don't feel that this current patient whom I have had clinical experience with would benefit from following any of these points and other medical experts, I have found, tend to agree that this theory would not be helpful in regards to the grieving process either. The loss of a baby is tragic and there is nothing ambivalent about it at all, such as the psychoanalytical theory seems to insinuate (Davis 1990, p. 186). So, although it might provide some form of ideas about grief and why there is such a psychological shift in the mentality of a mother who suffers from the loss of her infant, it is not significant in understanding all the emotional stages that the woman directly goes through. This is due to the fact that it appears disengaged from the actual identification with human emotions and the reasoning for them in a case such as this. If any theory works well in understanding why the grief is so heavy following a situation such as this, Bowlby's attachment theory is one of the best to be utilized. It clearly shows how the bonding experience, when denied can psychologically impact a mother to a severe point which leads to isolation and negativity in her life (Holmes 1993, pg. iii). In fact, as is being shown a persons whole personality shifts, such as I personally have witnessed with this patient. Bowlby's Attachment Theory and Personality Changes Bowlby has been defined as one of the 20th centuries leading psychiatric doctors as his attachment theory has been utilized in many different case studies, specifically studying traumatic incidents in human life (Holmes 1993, pg. i). This theory has worked well in areas where there have been attempts in trying to understand childhood development, social work, psychology, psychotherapy, and psychiatry as well. In this particular case this theory is being utilized to examine and draw conclusions about the mother's psychological well being due to the loss that she has suffered. The theory has studied processes of attachment and loss, and has even been found to have done experimental studies on infant loss and the affect that this has placed on to the mother (Holmes 1993, pg. i). Bowlby's theory shows that this mother's anxiety and separation of grief is well-founded and these are also common characteristics that can be associated with the attachment theory through this incident of a still-birth. Bowlby also defines that these forms of anxiety and withdrawal from reality can lead to many psychiatric illnesses, many resulting in total breakdown of the emotional state of the mother (Holmes 1993, pg. 86). This is why this theory also helps to provide those suffering from a traumatic loss a process in which they can recuperate and deal with their emotions through a medically facilitated environment and or counseling services on site of a medical facility. Attachment is the strong emotional response of the mother to the infant and vice versa. When something prevents this from occurring, (such as the unexpected death of the infant in utero) then it promotes many self-defeating behaviors and halts the bereavement process in many cases of still-births in particular (Jones 1983, pg. 235). Bowlby's theory has discussed how traumatic separation can be on infants. However, when the separation anxiety is due to a still birth he discusses how this can be just as traumatizing to the mother due to never having the attachment experience outside of her pregnancy. It is true that the mother does form an attachment with her infant while pregnant but the sensations and experiences are different following a live birth. The point that is being made following Bowlby's theorization is the fact that the separation from the infant has created disturbances in the mother's personality that have resulted in threatening disturbances in her attitude and demeanor. The mother; knowing that she will never get to experience the bond that comes following birth drifts off from reality in many of these types of cases, as the research has clearly identified and discussed. However, psychiatric therapy services can help the mother through this by the usage of intervention processes. This is if they are established right away when noticeable signs of the mother's personality changes start occurring (Jones 1983, pg. 236). Human beings are normally very social creatures as Bowlby's theory points out in particular. When in cases like this one however, the lack of attachment and bonding impacts the social aspects of life and this mother wants no type of human contact due to her depressive state and possibly even denial over what has actually taken place. Again, though these are common characteristics following a still-birth they can not be left to linger due to the fact that they can cause such detrimental life disturbances and ultimately transform a mother's personality into one that is totally extroverted and angry at the world (Hughes et al 1999, pg. 1722). Therefore, these cases have to have the right form of counseling services and the correct theorizations have to be used to efficiently help the mother move forward with her life and come to accept what has happened to her. Conclusion It is now obvious what the impact of stillbirth has on not only the mother but on the father and the rest of the family (relatives) as well. The experience can be considered tragic and shocking because it occurs often so unexpectedly and without any type of warning (Barry 2002, pg. 5). There are even times where the still-birth is not even realized until the mother actually goes into the initial stages of labor. The midwife and other medical staff are also shocked and stunned by experiences such as this which seemingly take a normal healthy, soon to be born infant's life away without pre-warning. Therefore, the role of the midwife and the other health Care professionals are important in coping with this loss of life (Limerick 1988, pg. 147). Providing early explanations and reassurance to the family along with the support of counselors, parents' organizations, and pastoral counseling are helpful especially when there might be a legal investigation to try and determine the possible cause of a stillbirth, especially when there are no clear causes of death (Barry 2002, pg. 7). It is up to such health professionals to provide families with the support and the advice that they need in order to cope with their loss. Losing an infant because of sudden still-birth can be one of the most devastating events in the lives of many parents, especially when they might feel that the death was their fault, when a lot of times it was due to outside circumstances that are beyond their control (Philip 1994, pg. 1194). There are some things that parents can have no control over, and still-birth is one of these tragic events that can happen to a family unit. Overall, I feel that I have explained the psychological occurrences that can take place following a still-birth rather fluidly. Through my own clinical experience with this particular patient I have attempted to bring a clearer comprehension into what the symptoms and characteristics are of a patient following such a traumatic and life altering event. Stillbirth can be related to SIDS, as both are unexpected and detrimentally psychologically altering to the mother (Philip 1994, pg. 1197). Therefore, stillbirth (and occurrences like SIDS as well) are a real problem in our society today, and the occurrences of stillbirths in particular must be dealt with in the right manner. More scientific research needs to be done to try and determine what causes such a horrible occurrence to take place to begin with. Though the occurrences of still-birth are not as high as occurrences of SIDS they are still so relatively similar that it makes many researchers wonder if stillbirth is actually the action of SIDS taking place while still in Utero (Smith 2004, pg. 978). Too many mothers have to suffer through these experiences and it should not be this way. Even though the health care system within the UK is considered to be one of the best, especially for prenatal treatment and midwifery care in pregnancy there are still high incidences of stillbirths taking place, or baby's not surviving following birth. Research studies have stated that this can be prevented with more thorough research just as the mother's personality and emotional states can be improved and recovery more positive if the right types of psychological tactics are used in a timely manner (Raphael & Sprague 1996, pg. 27). The emotional strain and psychological upset that still-births place on parents is unbelievable, and can not be understood to its fullest extent unless one was to experience it first hand, in my opinion. There is a lot of research that is being done in this area to try to combat the causes of still births, but right now there is just no clear idea why this type of fatality does take place, especially when no drug or alcohol abuse is detected in the pregnancy. In finality, excellent counseling services, more in-depth research methods, family support, psychiatric services and other assistance that the midwife can give to the mother and immediate family during the grieving process can make all the difference in the coping mechanisms the mother projects and how she will function in her life a few months down the road as well (Cox et al 1987, pg. 785). Works Cited Barry, David. "Grief and Recovery." The Journal of Pastoral Counseling 37 (2002): 1-132. Benoliel, Jeanne. "Loss and Bereavement: Perspectives, Theories, and Challenges." Canadian Journal of Nursing Research 30 (1999): 263-272. Cosgrove, Lisa. 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