Psychodynamics of perinatal loss

Medical and mental health professionals have been slow to recognize and treat the often traumatic impact of perinatal death. It has only been within the past ten years that researchers have begun to appreciate that a miscarriage, stillbirth or neonatal death can be a devastating loss to the parent, especially the mother (Berezin 1982; Borg and Lasker 1981; Friedman and Gladstein 1982; Peppers and Knapp 1980a). Bereaved mothers mourn pregnancy loss through the grieving process, which includes denial, yearning and despair, usually followed by recovery. Typical maternal reactions during the first months of grief are shock, disbelief, sleeplessness, irritability, crying, sadness, rage, anxiety, somatic distress and sometimes hallucinatory experience of the dead baby (Dunlop 1979; Giles 1970; Kennell et al. 1970; Kirkley-Best and Kellner 1982; Peppers and Knapp 1980b). This paper will explore the impact of perinatal death on the psychological resolution of pregnancy. In order to evaluate the outcome of maternal bereavement, the meanings of the perinatal death in the context of the revived conflicts and identifications occurring in the pregnancy will be considered. After presenting key concepts in the psychoanalytic interpretation of pregnancy, I will discuss the unique aspects of perinatal loss. A clinical case will then be described in some detail to illustrate an adaptive resolution of perinatal loss.