36 Grief and Loss Across the Lifespan
it is known that levels continue to rise for the duration of a pregnancy) and a
smaller drop may lead to less intense mourning. But the medical literature is
silent on this subject.
Phenomena frequently mentioned in the lay support literature (Davis,
1996; Layne, 2003) are the physical sensation of aching arms, a feeling of an
abdominal void, and occasionally hearing baby cries when no babies are
around. These sensations have provoked little interest from the medical com-
munity; however, many peer counselors (parents who have had previous peri-
natal loss) believe that these are biological phenomena. They explain that the
mother’s body was primed to respond by holding the baby, with the weight of
the baby supported by the mother’s arms and abdomen, and that one’s body is
mourning these sensations. Some even speculate that hearing baby cries is due
to a heightened awareness (with the implication that this is also biologically
primed) that either allows one to hear at great distance or that interprets other
sounds as the sounds one was expecting to hear.
Furman (1996) explains the phenomena of aching arms and abdominal
voids in psychoanalytic terms. She observes that the integral role the fetus had
to the mother’s own body means that after birth there is a “lack of restitution
by being unavailable on the outside” (p. 432). She posits a need for restitution
(or a body to hold) as a result of violated body ego integrity. She views the
flexible body ego boundaries of pregnancy as too quickly stretched with no
time to transition: the change from accommodating another (the fetus) within
oneself to a return to “aloneness” happens rapidly. This quick return to a non-
pregnant state, with no subsequent close physical contact with a dependent
baby, leads to a sense of violated body ego that requires time for readjustment.
She notes that therapeutic interventions designed to acknowledge the loss of
the mother’s body integrity (comparing it to an amputation) and designed to
promote a sense of the baby’s external existence (something the lay literature
refers to as memory building) are beneficial to this readjustment.Psychological Aspects of IUFD
Before the early 20th century, women seldom responded very emotionally to
an early miscarriage as these were common, and actual birth was physically
threatening to a woman’s health (Freidenfelds, 2013). More recent norms in
Westernized countries include early diagnosis of pregnancy and heavy valu-
ation of even the fertilized egg, which has changed the experience of miscar-
riage for many women (Friedenfelds, 2013). Miscarriage (loss of the pregnancy
before the 20th week of gestation) has become more recognized as a source of
emotional pain for many women—there are sympathy cards for miscarriage.
A robust lay literature and network of support groups for perinatal losses of
many sorts have evolved since the early 1980s. Stillbirth (intrauterine death
between the 20th week of pregnancy and birth) has traditionally been viewed
as a “legitimate” death.
A recent Cochrane Collaboration systematic review observed that women
were historically separated from their dead and dying infants due to the belief
that if they did not see the neonate, there would be no attachment and hence