38 Grief and Loss Across the Lifespan
This provides a different interpretation for why some women experience
chronic, complicated, or delayed grief reactions (an interpretation that has noth-
ing to do with gestational age). One might assume that the securely attached
would grieve in a healthy manner. Further, women who have anxious attach-
ment patterns may grieve in an extended and self-reproaching manner, while
women who have avoidant attachment styles may delay or resist mourning.
It is clear from clinical practice that women differ in the intensity of their grief
and their level of anger directed at self or medical providers (as well as at
women currently pregnant). Generally, the due date after a loss is a challeng-
ing time, yet it is also often a point when emotions and longing begin to give
way to restoration orientation.
Klaus and Kennell (1976) seem to have been the first to study perinatal
loss empirically. They were pediatricians influenced by Bowlby’s conceptu-
alization of maternal-infant bonding. They likened perinatal loss to the loss
of a spouse. To posit such a serious equivalence was quite unusual as, at the
time pregnancy loss was something to be hidden and forgotten. Most women
were told to go home and get pregnant again as quickly as physically pos-
sible. Hospitals disposed of the fetal remains, with women assured that they
should not concern themselves with such details. Women found little support
for their sense of loss and felt their expressions of grief to be stifled. Klaus and
Kennell supported the development of hospital protocols to allow contact with
the infant, and to avoid tranquilizing medications (noting that they interfere
with grief work). They introduced the idea of “group discussions,” observing
that bereaved mothers benefit from reading other bereaved mothers’ diaries
(pp. 235–239).
Although comparing perinatal grief to that of being widowed made such
grief more legitimate, this conceptualization did not recognize the unique
aspects of perinatal grief. Perinatal loss involves losing a part of oneself (the
pregnancy), which differs from mourning an object separate from the self (a
spouse). Further, social norms about the care and responsibility parents owe
to children are unique to the parent-child bond, adding levels of guilt that
are qualitatively different from those found between spouses. Parents are
expected to protect children from harm, and fetal death can be interpreted as
a tragic role failure.
Bowlby (1998) accepted Klaus and Kennell’s (1976) assertion that mourn-
ing a stillbirth is like the mourning of a widow. Bowlby acknowledged that
perinatal bereavement includes “[n]umbing, followed by somatic distress,
yearning, anger, and subsequent irritability and depression... [and] preoccu-
pations with the image of the dead baby and dreams about him” (1998, p. 122).
He supported changed hospital protocols allowing women to hold their dead
babies and to encourage naming them and conducting simple funerals. He
recognized women’s need to acknowledge the baby’s existence as a separate
entity in order to effectively mourn it. He notes “this loss becomes a nonevent
with no one to mourn” (p. 123). Bowlby acknowledged the need to attach to
the deceased baby in order to mourn. This chance to see and hold the baby had
been implemented in most hospitals by the early 1980s, but came into question
again following a study by Hughes, Turton, Hopper, and Evans (2002) that con-
cluded that women who held their stillborn infants experienced higher levels