[Coping with grief following perinatal death: a multifaceted and natural process]. / Rouwverwerking rond perinatale sterfte: een veelvormig en natuurlijk proces.

Coping with grief following perinatal death is a natural process that every individual experiences in his own personal and unique way. Parents go through varying emotions in the months following the death of their baby. Empathic support and understanding, both from the parents' social network and from professional caregivers, have a positive effect on the mourning process. Parents benefit from individually focused counseling and assistance in making their own choices with regard to saying goodbye and the way in which they will cope with their grief in the immediate future, as parents, within the family and in relation to the people in their surroundings. It is recommended that the attention for the parents and their lifeless child and all care behaviour be the same, as much as possible, as after the birth of a living child.

Coping with termination of pregnancy for fetal abnormality in a supportive environment.

OBJECTIVES: To study the feelings of parents during and after termination of pregnancy (TOP) for fetal anomalies. METHODS: Semi-structured interviews were conducted before TOP, after six weeks and six months after TOP. The study group consisted of 89 couples, treated at our institution between 1994 and 1998, who terminated their pregnancy in the second and third trimester. Eighty-six of them participated in at least one of the three interviews. RESULTS: Most parents were able to cope with the decisions they had to make, although a struggle between reason and emotion often occurred. Seeing the dead baby and saying farewell gave all parents a good feeling afterward. Feelings such as doubt, guilt, failure, shame, anger, anxiety and relief were experienced during the period of TOP and the following weeks but practically disappeared after six months; these feelings were more prevalent in women. Most of the couples mentioned that their relationship grew closer as a result of the loss and the grief. Relatives offered good support to most parents in the first weeks after delivery, but parents felt that this support lasted too short a time. CONCLUSIONS: Seeing the child and saying farewell and the medical and psychosocial support received from professional caregivers were of great value for the interviewees. Parents found the interviews helpful in the grieving process.

Follow-up of pregnancies, infants, and families after multifetal pregnancy reduction.

OBJECTIVE: To evaluate the course of multifetal pregnancies and also the long-term pediatric and psychosocial follow-up of surviving offspring and their parents after selective reduction. DESIGN: Follow-up study. SETTING: University hospital and subject's homes. PATIENTS: Twenty-one couples with high-order multiple pregnancies resulting from infertility treatment were referred from all over the Netherlands. A total of 36 infants (15 twins and 2 triplets) were included in the follow-up. INTERVENTION: Pregnancy reduction by transabdominal approach at a median of 11 (9 to 13) weeks gestation. One assessment took place between the age of 9 months and 6 years after delivery. MAIN OUTCOME MEASURES: Pregnancy outcome, health of the infants, and psychosocial impact upon their parents after infertility treatment and the multifetal pregnancy reduction. RESULTS: Abortion within 4 weeks after pregnancy reduction did not occur in this series. Six infants (13.7%) died perinatally. Two infants (4.4%) died at the ages of 12 days and 3 months, respectively. Early preterm delivery was the cause of death in all cases. The development of the infants was appropriate to gestational age and birth weight. At follow-up, 14 couples disclosed at the time they were unaware of the risks and the consequences of infertility treatment. Nine couples indicated they had feelings of guilt after pregnancy reduction. These feelings, however, were not disclosed at the time of the interviews, during which none of the families showed either regret or distress about their decision. Two couples only occasionally experienced some grief and mourning reactions for the reduced fetuses. CONCLUSIONS: Pregnancy reduction is an acceptable option in the case of excessive multifetal conceptions after infertility treatment regimes. There are no adverse effects on either the infants and their families provided that the procedure is carefully planned and performed and the couples are given full support both before and after the procedure.

[Care in stillbirth; mothers' opinion]. / Hulpverlening bij doodgeboorte; het oordeel van de moeders.

Semi-structured interviews were conducted with 49 women who had experienced stillbirth in 1987-1989. Only 55% were satisfied with the manner in which the first suspicion had been communicated to them, while 85% were satisfied with the communication at the time of the diagnosis. Opinions about care in the labour ward, while largely positive, indicate that lack of tact from an individual may cloud the entire perception of care. Although only 40% had expressed a desire to see the baby, the others were happy to have been persuaded to do so and all were positive about the contact with the dead baby. Of 42 women (86%) who gave consent for autopsy, only one regretted this decision. Support received post partum was considered to be inadequate or insufficient by 10%. Despite the short hospital stay (average 1 day), most women afterwards felt that they would have preferred to return home earlier; only 9% felt that they would have preferred to stay longer.