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Complex Grief: How to Help Through Pregnancy and Child Loss

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Allena Barbato, JD, MACP Thank you and God Bless! * * * * * The bedrock of the Orthodox Faith is the home and family life. Home and family life is the bedrock of our ... – PowerPoint PPT presentation

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Title: Complex Grief: How to Help Through Pregnancy and Child Loss


1
  • Complex Grief How to Help Through Pregnancy and
    Child Loss
  • Allena Barbato, JD, MACP

2
The bedrock of the Orthodox Faith is the home and
family life.
Home and family life is the bedrock of our Greek
Orthodox life-style. The spirit that binds us
together as a people finds its deepest roots in
the home where the tenderest values of human
existence, love, compassion, forbearance and
mutual helpfulness thrive in abundance.
Archbishop Iakovos 1972

3
Tremors in the family bedrock how to help a
mental health perspective
  • Pregnancy issues
  • Childbirth complications
  • Miscarriage Abortion
  • Infant/child loss

4
Grief Process
  • Elisabeth Kubler-Ross wrote a pivotal book in
    1969 called On Death and Dying, identifying 5
    stages of grief.
  • Denial Stage Everything is just fine.
  • Anger This is YOUR fault!
  • Bargaining I will do anything to change.
  • Depression Why should I even bother?
  • Acceptance I can deal with this.

5
Varying Levels of Grief
  • Issues that occur in Pregnancy, Childbirth,
    Miscarriages and the Loss of an Infant can
    contain all stages of grief
  • They will occur at varying levels, depending on
    which of the above.

6
Pregnancy
Icon of the Annunciation. The Theotokos, model
for mother, threading together God and man.
7
Pregnancy
  • Orthodox churchs official stance on pregnancy
    life starts at conception.
  • Marriage is holy. The home is sacred. Birth is a
    miracle. In these we find the very meaning of
    life itself.-Rev Dr. Stanley S. Harakas
  • All life is holy and precious and must be
    protected and cared for.
  • Inherent on the mother to take the very best care
    of herself physically, emotionally, and
    spiritually

8
Pregnancy
  • Challenges to a healthy pregnancy are often times
    unforseen a woman and her family just assume all
    will go smoothly.
  • Physical Challenges
  • Exhaustion, loss of vim and vigor
  • Appetite changes
  • Body getting bigger, skin stretching
  • Hair composition, skin tone
  • Bedrest, gestational diabetes

9
Pregnancy
  • Emotional Challenges
  • Hormone levels changing
  • Is my baby going to be healthy
  • Feeling less of a woman
  • After the second trimester, can not hide
    pregnancy
  • Suffered sexual abuse, not comfortable with
    pregnancy
  • Unwanted child, giving up for adoption
  • In vitro testing shows a deformity
  • Worried about Father of child

10
Pregnancy
  • Spiritual Challenges
  • Knowing should be thankful for Gods Gift
  • Asking God to take back the child
  • Praying for a healthy child
  • Asking God why she has been given a deformed
    child

11
Guidelines for helping a pregnant woman
  • Ask how shes feeling
  • Listen and comfort
  • If having difficulty or conflicted, do not try to
    palliate with it is the will of God or it is a
    blessing.
  • Remind that this is a temporary state
  • Hormone levels will eventually return to normal
  • Walk through birthing scenarios
  • Empower with positive thoughts on motherhood
  • If physical, refer to obstetrician. If spiritual,
    refer to spiritual father

12
Childbirth
  • Planning a childbirth
  • Fear can be a guiding factor in choosing
  • Completely medicalized to completely natural
  • The Orthodox church is supportive of either
    choice, as long as the guiding principle of
    protecting life is adhered to.
  • Painkillers are considered ok as long as they do
    not become addiction.

13
Childbirth
  • Negative birth experiences
  • What constitutes?
  • Cesarean vs. natural
  • Negative reactions to Cesareans are more likely
    if under general anesthesia, an emergency, and if
    no support person was present.
  • Quality of mother-child bonding does not appear
    to be effected by caesarean vs. natural. (One
    study)
  • Women who had cesareans were more likely to have
    negative moods and lower self esteem.
  • Case study Client D-not good enough mother

14
Childbirth
  • Some studies showed the cesarean childbirth
    carried significant psychological risks
    rendering those who experience these procedures
    vulnerable to a grief reaction or to
    post-traumatic distress and depression. The
    Handbook of Women, Stress and Trauma
    Kendall-Tackett, K. 2005
  • Interpretation of events
  • Sudden-how quickly did events change, was
    anything explained?
  • Overwhelming-swept away by hospital routine,
    disconnected from experience?
  • Danger-was babys or mothers life threatened?

15
Childbirth
  • Factors level of care and decision-making.
  • All this can add up to birth trauma
  • Result overwhelming fear, helplessness, loss of
    control, and horror.
  • Effect of birth trauma
  • Fear/anxiety can last for a number of months or
    longer
  • Replaying of events-daytime flashbacks,
    nightmares
  • Anger-at doctor, hospital, husband, self
  • Denial of negative experience
  • Depression compounded by history of abuse/PTSD

16
Childbirth
  • How effects of birth trauma can effect
    relationships
  • With Baby
  • Bonding
  • View of baby as being not as good
  • View of children as being out of control or
    nasty
  • With Husband
  • Other children

17
Guidelines for helping a woman through negative
birth experience
  • Do not try to talk the mother out of a negative
    birth experience by telling her that it wasnt
    so bad or that the important thing is that she
    had a healthy baby.
  • Encourage the mother to talk with someone she
    trusts who can listen and not minimize the
    experience. Also, there are support
    organizations and groups that can assist the
    mother while she talks about her experience.
  • Learning as much as possible about the experience
    helps the mother to understand the birth in a
    cognitive way, this can reduce anxiety. Getting
    the birth records to review and reading books on
    the subject takes the issue out of the dark.
  • The husband or other family members may also have
    been traumatized. He may have felt powerless
    while he watched events unfold around him.
    Because of this, he may not be emotionally
    available to provide the support the new mother
    needs.
  • Gently remind the mother that as bad as the birth
    experience was, it is the beginning of this
    little persons new life and the rest of his/her
    life is the positive thing to focus on. This can
    bring perspective to the traumatized mother.
  • If the mother is talking immediately about having
    another baby, in order to get it right help her
    to understand that the important thing right now
    is to process what happened and to get to know
    your new little one, giving him/her all the
    attention they need and deserve.
  • Similarly, if the mother talks about never having
    another pregnancy due to the experience, help her
    to understand that taking drastic steps could
    cause further trauma.
  • Finally, suggest that the mother forgive herself
    if she is blaming herself for the negative
    experience. The if onlys can be very damaging
    to the mothers psyche. This would be a good
    opportunity for her to go to her spiritual father
    and talk about forgiveness in general.

18
Miscarriages and Abortion
  • The official stance of the Orthodox church on
    Abortion is this is the taking of a life, and
    therefore a sin unless the mothers life is
    endangered and then it is considered an
    involuntary sin.
  • If there is an abortion as the result of mothers
    life being endangered, help the mother to process
    the death, as she and family grieve.
  • Abortion as a choice
  • This choice can very negatively affect a womans
    psyche
  • One study found 82 of women had PTSD
    symptoms(Russia)
  • Primary form of birth control abortion

19
Abortion
  • Another study found that women who aborted their
    first pregnancy were four to five times more
    likely to abuse drugs and alcohol. (U.S.)
  • Women seeking early abortions were more likely to
    have been abused as children and have insecure
    attachments with partners.(Australia)
  • Multiple abortions can be indicator of past or
    present abuse.
  • Counsel the woman with grief counseling and refer
    to priest about sin.

20
Miscarriages
  • Orthodox churchs stance on miscarriages it is
    the death of a living being a baby.
  • Each year approximately one million births end in
    miscarriage in U.S. October is Pregnancy and
    Infant Loss Awareness Month.
  • Complexity
  • The baby is often not visible (as most
    miscarriages occur before the second trimester)
    and therefore not real.
  • Many families are still quiet about the pregnancy
    at outset, in case something goes wrong.
  • Is not a child that has touched others hearts.

21
Miscarriages
  • Complexity (cont)
  • Where parents were once anticipating a birth,
    they are now facing death.
  • Millions of grieving parents
  • Case studies
  • Client A the miscarried babies counted in family
  • Client M bi-polar characteristics compounded by
    miscarriage
  • Fr John Breck writes of the mother who has
    miscarried, Her pain needs to be acknowledged,
    accepted, and palliated through words and
    gestures of understanding, sympathy and love,
    offered by her family and the parish community.
    oca.or

22
Empathy and John 1133-36
When Jesus saw her weeping, and the Jews who had
come along with her also weeping, he was deeply
moved c in spirit and troubled. Where have you
laid him? he asked. Come and see, Lord, they
replied. Jesus wept. Then the Jews said, See how
he loved him!. (John 1133-36)
  • Jesus wept when He visited Martha and Mary after
    the death of Lazarus. Those who stood near Him on
    that day were quick to interpret His behavior,
    for they said, "See how he loved him" John 11
    35, 36! Grief was rightly seen as an expression
    of love.
  • Jesus knew that He would soon raise Lazarus from
    the dead, so why was He so disturbed by the
    events of that day? Probably for several reasons.
    First, there was His great sense of compassion.
    He hurt to see others hurt. His emotions were
    pushed to the limit by witnessing the sorrow of
    Mary. Those with compassion are able to "weep
    with them that weep" and all Christians ought to
    have this ability (Romans 1215).
  • He has entered into all of our experiences and
    knows how we feel. In fact, being the perfect
    God-Man, Jesus experienced these things in a
    deeper way than we do. His tears assure us of His
    empathy.

23
Death of a newborn
  • Thy departure from this earthly life is a cause
    of grief and sorrow for your parents and all who
    love you, O little child but in truth you have
    been saved by the Lord from sufferings and snares
    of many kinds.
  • O Savior and Master of our life comfort the
    faithful parents of this departed child with the
    knowledge that to innocent children, who have
    done no deeds worthy of tears, are granted the
    righteousness, peace and joy of Thy kingdom.
  • Canon Ode 9, The Service of Burial of an Infant

24
Death of a Newborn
  • Stillbirth
  • 1 of births, can be due to cord or placenta
    accident, infection or toxemia.
  • Baby could die before term
  • Baby could die during birth
  • Allow women to donate breastmilk.
  • Prematurity and Neonatal Death
  • Birth weight and gestational age-factors for
    survival
  • Teen pregnancy, poverty lack of natal care
  • Women can blame self

25
Death of a Newborn
  • Sudden Infant Death Syndrome (SIDS)
  • 1 in 700 babies in U.S., but lower in other
    countries
  • 90 of SIDS deaths occur within first 6 months
  • 3rd most common form of death for babies in U.S.
  • Risk Factors
  • Cigarette smoke, prematurity, sleeping on
    stomach, formula fed at highest risk.
  • None risk factors present can still succomb to
    SIDS

26
Death of a Newborn
  • This loss is perhaps the most difficult of all
    losses discussed thus far. One author described
    it thus
  • There are no shortcuts or quick fixes in these
    phases of healing for grief is relentless, and it
    will not be shortchanged. We cannot completely
    evade its presence in our lives no matter how
    desperately we may try. Yet, peace is possible in
    the mind and the heart when grief and pain are
    embraced, released and openly expressed.-Ended
    Beginnings, Panuthos and Romeo

27
Death of a Newborn
  • Common Reactions
  • Overwhelming Sorrow
  • Numbness and Denial
  • Feeling of Unreality
  • Anger and Rage
  • Isolation
  • Guilt
  • Fear
  • Powerlessness and Loss of Identity
  • Depression

28
Emotional Factors of Grief
  • Grief involves complex emotional factors which
    are all related to the crisis of bereavement. We
    grieve because of self-pity, "What will become of
    me now that he's gone?" Or anger, "After all I've
    done for her during her illness, how could she
    just leave me?" Or guilt, "If I had only known, I
    would have " Or simply. because we will miss the
    departed individual. "How am I ever going to get
    along without you?" or a variety of other
    feelings which the loss of someone we love evokes
    in us. All these emotions are important and
    permissible. It is pointless and even harmful to
    argue that one should not feel anger or guilt, or
    self pity or a sense of loss. The feelings, even
    some very negative feelings must be accepted,
    expressed, and worked through before healing can
    begin.

29
Grieving death
  • To lack some feeling of grief at the time of
    death would be to lack love itself. Love binds us
    to other people. When death comes those bonds are
    severed, at least in a temporal, physical bodily
    sense. In a time of such separation, grief is
    evidence of love, itself a divine gift.
  • Sometimes as we fight back the tears and
    heroically suppress our feelings of grief, in the
    name of our Christian faith, it is almost as if
    we are trying to be more Christian than Christ
    Himself!
  • Lately, some have come to the erroneous
    conclusion that death should not be an occasion
    for grief. Some think death should be viewed as
    something natural and acceptable. Orthodox
    Christians know death is not acceptable even
    though inevitable. Amid Resurrection celebration,
    there is a definite place for tears and sorrow.
    While we cannot advise a joyous funeral, our
    living ought to point in that direction even
    though human reality will be pained and afflicted
    with our loss in death. While it is true we
    should look at death in view of Christ's triumph,
    as a process we rejoice in rather than mourn
    over, the human response to death is more complex
    than a simple smiling affirmation of the glory of
    the afterlife.

30
Greiving Death
  • Grief is a process of working out and living
    through some very painful feelings, coming to
    some tough decisions, and performing some
    difficult actions. But it must be done.
    Suppressing grief is tragic. When we drug or
    rationalize our feelings away, or cover our pain
    with a sugar coating or religious platitudes, we
    fail to face up to something that must be faced.
    Namely, someone we love has died and is now- gone
    from us. We are going to feel the pain of their
    absence and we are going to miss their presence.
    Our life is going to be affected by their
    absence.

31
Guidelines for Helping Someone Grieve A
Miscarriage or Death of an Infant
  • The first and one of the most important things
    you can do is to acknowledge that a baby has died
    and this death is just as real as the death of
    an older child. The parents grief and healing
    process will be painful and take time, lots of
    time. They will not have stopped grieving about
    their baby after a month or even a year. In
    fact, the parents will hold that child in their
    hearts and memories for the rest of their entire
    lives. Realize that the parents are sad because
    they miss their baby, and that he or she can
    never be replaced by anyone else, including
    future children or children they may already
    have.
  • Contact spiritual father or parish priest to
    notify him of the situation and ask for
    assistance with prayers and grief counseling.
  • Let the parents know that they and their family
    and the baby are in your prayers. Call or send a
    sympathy card. You dont have to write a lot
    inside, a simple You and your baby are in my
    thoughts and prayers is enough.
  • What the parents need most now is a good listener
    and a firm shoulder, not a lecture or advice.
    Listen when they talk about the death of their
    baby. Dont be afraid, and try not to be
    uncomfortable when talking about the loss. Talk
    about the baby by name, if they have named the
    child. Ask what the baby looked like, if the
    parents saw the baby. Most parents need and want
    to talk about their baby, their hopes and dreams
    for their lost child.
  • Give a hug. This is a sign of love and concern.
    Even if this is all you do, its a nonverbal way
    of saying Im sorry or that Im praying for
    you.
  • Offer to baby-sit their other children. Often
    there are follow-up doctors visits and the
    parents need a chance to be together as a couple
    as well.
  • Offer to bring over meals often mothers have no
    energy to do even basic things. Organize
    parishoners to put together a meal calendar so
    the family has regular meals.

32
Guidelines for Helping Someone Grieve A
Miscarriage or Death of an Infant
  • Offer to go food shopping, help clean the house,
    do laundry anything that lightens the burden of
    daily chores that need to be done. This is
    especially helpful if the mother is still waiting
    to miscarry the baby. That process may take days
    and is physically and emotionally draining.
  • Be careful not to forget the father of the baby.
    Mens feelings are very often overlooked because
    they seem to cope more easily. The truth is that
    they are quite often just as devastated as their
    partner. Encourage other men in the parish to
    reach out to the father so he has a chance to
    unburden his heart.
  • Give special attention to the babys brothers and
    sisters. They too are hurt and confused and in
    need of attention which their parents may not be
    able to give at this time.
  • If the children want to talk about the death,
    dont be afraid to engage them in conversation.
    Children have a natural relationship to death and
    they are open and direct with adults with whom
    they feel comfortable. When children are allowed
    to share their dreams and thoughts openly, the
    difficulty of their grief can be reduced.
  • It may be hard for the bereaved parents
    (especially the mother) to see or even talk to a
    pregnant woman, small children and especially
    babies, they are all reminders of what she has
    lost. This is a very difficult situation as the
    bereaved mother can be jealous and then get angry
    at herself for feeling that way.
  • Remember that any subsequent pregnancies can be a
    roller-coaster ride of joy, fear and bittersweet
    memories.
  • Try to remember the anniversary of the death and
    due date with a card, call, or visit.
    Anniversaries can trigger grief reactions as
    strong as when the loss first happened. Months
    down the road a simple How have you been doing
    since you lost your baby? can give much comfort.
  • Remember also that mourning puts a tremendous
    strain on relationships between family and
    friends.
  • It is okay to admit that you dont know how they
    feel. A good thing to say is, I cant imagine
    how you feel. I just wanted you to know that I am
    here for you and am very sorry.
  • Excerpted from Comforting those Who Have Lost a
    Baby During Pregnancy or Shortly Thereafter By
    Dennise Kraus

33
Further Research
  • Comforting those Who Have Lost a Baby During
    Pregnancy or Shortly Thereafter By Dennise
    Kraus, Diocesan Journal, Jacobs Well
  • The Hidden Feelings of Motherhood by Kathleen A.
    Kendall-Tackett, PH.D.
  • Empty Cradle, Broken Heart Surviving the Death
    of Your Baby by D.L. Davis
  • On Death and Dying, by Elisabeth Kubler-Ross
  • Breastfeeding Made Simple by Nancy Mohrbacher and
    Kathleen Kendall-Tackett
  • Ended Beginnings, Panuthos and Romeo
  • goarch.org
  • oca.org

Allena Barbato, JD MACP
34
Thank you and God Bless!
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