40 Grief and Loss Across the Lifespan
have three functions: (a) “bringing home that the loss has occurred” (p. 127) by
allowing public expression of grief and inducting the bereaved into new roles;
(b) allowing the community to say farewell and thereby reconstitute itself as
a changed community; and (c) the occasion’s exchange of goods and services
allows expression of reciprocal altruism. Bowlby (1998) added three observa-
tions of his own: (a) a funeral allows the opportunity for the living to express
gratitude to the deceased and to take action to honor the deceased; (b) anger
may be given a socially acceptable expression (as in groups who direct anger
at neighboring tribes or at the deceased during the ritual); and (c) they usually
provide some acceptable period of mourning (sometimes ending at the end
of the funeral itself). It is important to recognize that the perinatally bereaved
usually receive none of this support as funerals are rarely held (particularly
for those who terminate due to fetal anomaly). They have no community to
validate their loss through ritual, no recognition by a community that it has
lost something, and little other support. Expressions of gratitude or caring
toward the baby make little sense when the baby never had a role within the
social community and expressions of anger are both nonsensical and socially
proscribed. Indeed, the implicit message is that since the baby did not have
standing in the community, the mourning should be done quickly and out of
sight. Because grieving rituals and social support enable more effective resolu-
tion of grief, it is not surprising that mourning perinatal death is tricky.
Race, class, and ethnicity all have a bearing on the way prenatal attach-
ment is viewed as well as the way perinatal grief is enacted. For instance,
research indicates that African American bereaved parents have higher rates
of pregnancy loss, more cumulative stress in the form of marginalization and
oppression historically and currently, and cultural norms that encourage con-
tinued bonds, higher emotional expression, yet less overt familial dialogue
about grief and loss (Boyden, Kavanaugh, Issel, Eldeirawi, & Meert, 2014).
These circumstances would seem to make grieving more challenging, and
because traditional therapy is not generally viewed as a legitimate form of
health seeking in the community, grievers may be left alone with difficult emo-
tions. It is possible that religious and other communities provide support, but
the academic literature is silent on this point. In a study that explored miscar-
riage in several cultures (Wojnar, Swanson, & Adolfsson, 2011), lesbian couples
were found to experience complex grief reactions because they had navigated
many barriers to pregnancy, dealt with disapproving social contacts, and
negotiated who would carry the pregnancy (Wojnar, 2007).
Models to assist with perinatal grief have been proposed. Wojnar et al.
(2011) suggest that the Meaning of Miscarriage Model (revised from Swanson’s
1983 model) is a useful and culturally sensitive way to assist bereaved parents.
The themes for intervention are explored with the bereaved. These themes
include (a) coming to know (about the pregnancy and its potential loss), (b) los-
ing and gaining (naming what was lost), (c) sharing the loss, (d) going public,
(e) getting through it, and (f) trying again. These explorations are to be combined
with Swanson’s theory of caring that includes (a) maintaining belief, (b) knowing,
(c) being with, (d) doing for, and (e) enabling (Wojnar et al., 2011, pp. 554–555).
Family members are affected by perinatal losses as well and some
of the “forgotten grievers” are the living siblings (Avelin, Erlandsson,
Hildingsson, & Rådestad, 2011). The death of a newborn in the neonatal