2 Perinatal Attachment and Loss 37no grief (Koopmans, Wilson, Cacciatore, & Flenady, 2013). Contemporary
understandings about prenatal attachment are very different, of course; peri-
natal practice has changed, and women are now encouraged to acknowledge
their attachments, keep mementos (ultrasounds and bills when a fetal body is
not available), and to see and hold their baby’s body if the state of development
and delivery method allow this. Social work and chaplaincy services tend to
be involved with bereaved mothers, and some nurses are specially trained for
bereavement work. Yet none of these measures have been rigorously tested and
found to be effective at preventing complications of grief, which are found in
about one out of every five bereaved mothers (Koopmans et al., 2013). These
newer approaches of assuring that newly bereaved parents receive support from
social workers and/or chaplains in addition to their medical care providers have
been widely supported, even if not considered “evidence-based practice” due to
a lack of randomized trials of varied forms of care (Bennett et al., 2005; Koopmans
et al., 2013). Indeed, it is difficult to imagine how one might ethically refrain from
certain empathic interventions to assure randomization of treatments when
women have just experienced perinatal loss. That said, a recent memoir about
stillbirth indirectly notes the newer norm of social work intervention:
Not long after they started working on me, someone entered the room
and said they needed a parent to come with them to the emergency
room [where the baby was] to talk with the social worker and make
decisions.... I know what “social worker” means. It means death.
(Heineman, 2014, p. 21)Although supportive interventions by social workers and chaplains
may indicate “death,” it seems that some degree of supportive counseling is
recommended by lay literature and academic reviews (Bennett et al., 2005;
Koopmans et al., 2013).
Attachment theorists such as Bowlby identify psychological impacts of
loss. Bowlby observed that
many of the most intense emotions arise during the formation, the
maintenance, the disruption and the renewal of attachment relation-
ships.... Similarly, a threat of loss arouses anxiety and actual loss gives
rise to sorrow; while each of these situations is likely to arouse anger.
(1998, p. 40)He theorized that people are strongly motivated to maintain affectional
bonds and “all the most powerful forms of attachment behavior become acti-
vated” in the face of loss (p. 42). It is easy to see these behaviors and attempts
to recapture pregnancy when women are told that their fetus has died in utero.
Bowlby wrote:
In the case of the anxiously attached, mourning is likely to be character-
ized by unusually intense anger and/or self-reproach, with depression,
and to persist for much longer than normal. In the case of the compul-
sively self-reliant [the avoidant], mourning may be delayed for months
or years. (2000, pp. 139–140)