FROM THE LENDING LIBRARY

C. A. Reiser, M.S.

For parents who have suffered the loss of a baby, the future can become particularly overwhelming when they face another pregnancy (see this issue’s ‘In The Lit’).

Reviewed here are two new resources in the WiSSP lending library pertaining to this issue in bereaved parents’ lives.

After Loss: Journey of the Next Pregnancy.

Videotape by Abbott Northwestern Hospital, Pregnancy After Loss program, Minneapolis, MN, 1995.

“After Loss: Journey of the Next Pregnancy” is intended for both health care providers who care for bereaved parents in a pregnancy after a loss and the parents themselves, either as they plan for or are in the midst of a next pregnancy. Loss is defined as the death of a child through pregnancy loss or the experience of an unexpected outcome (birth of an impaired child). Health care professionals should watch the video with the goal of providing a framework for the interventions they might use as they care for parents in a subsequent pregnancy. Parents will benefit from the reinforcement that they are not alone as they listen to other parents share their stories of loss and through the journey of the next pregnancy.

As with the manual reviewed in the last issue of WiSSPers (After Loss: Parenting in the Next Pregnancy), the authors maintain there are developmental tasks to be accomplished in order for parents to bond with their unborn baby. Throughout the video mothers and fathers share the difficulty of living through their fears and anxieties of a subsequent pregnancy. They also share the joy following a healthy delivery which is often accompanied by renewed grief over the son or daughter they had lost. A common theme among parents was the difficulty of bonding with their unborn or newly delivered baby for fear that this baby, too, will die.

The video offers anticipatory guidance around issues and events that might be particularly provoking for parents (e.g. the gestational age when the previous pregnancy was lost) and ways to help parents through them. It is suggested that a special birth class for parents be formed and that a specific birth plan be developed.

The strength of the video is, as you might expect, the parents themselves. The couples profiled were able to share their emotions openly. Mothers and fathers were given equal attention, and a grandmother and a single mother rounded out the participants. Noticeably lacking, however, was any ethnic diversity. Comments from professionals were appropriately and nonintrusively interspersed with parents’ commentary.

The video ended with clips of joyful outcomes, which is what we wish for all parents in our care.

Labor and Birth:

Rebuilding Trust. Videotape by Abbott Northwestern Hospital, Pregnancy After Loss program, Minneapolis, MN, 1995.

This video provides a more in depth look at issues surrounding labor and birth in a pregnancy subsequent to a loss. Fears and anxieties during a next pregnancy are to be expected, and it is unrealistic to think that there is anything that parents or healthcare providers can do to change this. The premise set forth in the video is that it is important to acknowledge that this fear exists while offering concrete ways to help parents cope with the new birth experience.

Professional viewers are reminded that bereaved parents’ frame of reference for pregnancy is that the result is loss, and not a healthy baby. Tasks important to the current pregnancy are establishing trust with health care providers and acceptance of a new labor and delivery. These should guide us as we plan interventions for the families for which we care.

Emphasis is placed on three different activities: emotional support, prenatal care, and a birth plan. A suggested support activity includes visiting the Labor and Delivery room with parents to assess how it can be made a nurturing and safe environment, e.g. use of a different room than the previous birth, having the bed in a different position than previously, etc. Support group involvement was also stressed. Anticipatory medical care during the pregnancy included offering immediate assessment if parents sense that something is wrong, and discussion of antenatal testing options. Early induction of labor was also presented as an option parents may want to raise with their obstetrician, although balancing of associated risks is necessary. (I wonder how obstetricians feel about this request. Let us know.) Thirdly, there needs to be a birth plan specific to this new pregnancy. Benefits of involvement of a third person, such as a doula, in labor and delivery should be considered as this plan is developed. Inclusion of a support person relieves the father from the demands of being the only maternal support, and also ensures that there is someone to support him through the delivery too.

Lastly, professionals are reminded that the need for support doesn’t end with the delivery of a healthy baby. The birth may bring intense reminders of the previous experience with a profound knowledge of what it is that was lost.

As with the previously reviewed video, the parents who so openly share their stories are the strength of “Labor and Birth: Rebuilding Trust” This film is sensitive to many family constellations and types of loss. Families who experienced miscarriage, stillbirth, neonatal and infant death and SIDS are included, as well as parents who have experienced loss within a multifetal pregnancy. Unlike the previous video, “Labor and Birth” is also exceptionally culturally sensitive as well.

“Labor and Birth: Rebuilding Trust” and “After Loss: Journey of the Next Pregnancy” are both relatively short (18 minutes and 32 minutes, respectively) and should be adaptable to most inservice and support group settings. Each video offers much from which we can learn. Both are available through the WiSSP lending library.