2 Perinatal Attachment and Loss 39
of anxiety and depression in subsequent pregnancies. Critics of this research
observed that all bereaved women in the sample were strongly urged to see
their baby rather than merely being told that they might do so. Also, while
anxiety in subsequent pregnancies is likely for those with pregnancy loss, the
comparison group in the Hughes et al. study consisted of women who had not
had a previous pregnancy loss.
More recently, research has focused on how the option to see one’s dead
baby is presented. Erlandsson, Warland, Cacciatore, and Radestad (2013) con-
clude that when contact between mothers and their dead babies is managed as
a matter of course rather than emphasized by giving a choice, women tend to
feel better supported and less frightened. While this study had its own weak-
nesses, the findings are consistent with McCoyd’s experiences working with
hospitalized women after perinatal death.
Klaus and Kennell (1976) asserted that “replacement pregnancy” may
occur when fetal loss occurs and the mother is unable to work through the
task of separation from the expected child. They wrote:
[W]e strongly encourage the parents to refrain from having a replace-
ment infant until they have completed their mourning reaction. We
explain that it is difficult to take on a new baby at the same time one is
giving up the baby who has died. (p. 237)
They suggest a waiting period of at least 6 months.
There is no well-developed theoretical or empirical basis for such a
prescription. More recently, the replacement child concept has been called
a myth (Grout & Romanoff, 2000). As Koopmans et al. (2013) note, we are
still improving our knowledge about effective supports for families affected
by perinatal grief; becoming prescriptive about whether and when to have
another pregnancy is surely premature. It is clear, however, that meaning-
making (Neimeyer, 2001) is what counts most for grievers of all sorts of losses.
For perinatally bereaved parents, the loss challenges their sense of coherence
(meaning) and their assumptive world (Uren & Wastell, 2002).
Social Aspects of IUFD
It is likely that 15% to 20% of all recognized pregnancies result in miscarriage
or fetal death (Cole, 1995) and that when early conceptions are included the
level of loss may be as high as 70% (Freidenfelds, 2013). Although much more
acknowledged than before, social recognition of perinatal grief remains lim-
ited. Although not all women grieve early miscarriages, women who have
actively attached prenatally are likely to do so. With social norms and prenatal
technology that promote such attachments, it seems sensible to assume that
many women will benefit from some level of support and validation for their
mourning.
Although Bowlby (1998) is most identified with attachment theory, he
was also very aware of the influence of culture on mourning. In his chapter on
“Mourning in Other Cultures,” he cited Firth’s (1961) observations that funerals
