2 Perinatal Attachment and Loss 41
intensive care unit (NICU) has been shown to have lifelong effects for some
siblings (Fanos, Little, & Edwards, 2009). It is likely that siblings who are
aware of a miscarriage or stillbirth will react similarly to those who experi-
ence the death of a sibling in the NICU: they will likely have raised anxiety
and worry about their parents’ health and coping, and a feel like they are
“not enough” for their parents (Fanos et al., 2009). Working to avoid fam-
ily secret-keeping, and promoting rituals such as scrapbooking and other
memorializations, seemingly assist siblings in coping after perinatal death
(Youngblut & Booten, 2013).
Grandparents are often put into the “forgotten griever” category as well
(Gilrane-McGarry & O’Grady, 2011). They have “double grief” as they mourn
the grandchild that will not join the family, and also grieve for their son or
daughter. Gilrane-McGarry and O’Grady observe that as most grandparents
have experienced many other losses due to age, they experience cumulative
grief as well as “double grief.”
Other times, family and peers offer little comment, assuming that
everyone can move on as if nothing happened. The general lack of rituals for
enlisting support and saying good-bye in this type of loss differ drastically
from other types of loss where funerals, memorial services, and social sup-
port are common following a death. This lack of ritual has consequences as
the mother and her supporters try (mostly in vain) to either move on with-
out acknowledgment (difficult because the mother is feeling loss) or find new
ways of observing the loss.
Social recognition of loss is complicated further when the mother has
a fetal anomaly diagnosed and subsequently ends the pregnancy. These are
desired pregnancies, “electively” terminated (McCoyd, 2007, 2008, 2009a,
2009b; Rapp, 1999), and if miscarriage and stillbirth are silently disenfran-
chised losses, the termination of a pregnancy affected by fetal anomaly is
actively hidden because of the stigma associated with abortion in U.S. culture
(McCoyd, 2010b). Although women may disclose the loss to their intimates,
they often do not provide the full story. This may leave them feeling that what
support they receive is the result of deception and they have difficulty utiliz-
ing it effectively (McCoyd, 2007).
Perinatal bereavement is experienced and expressed in a variety of ways.
The level of prenatal attachment has much to do with the way the loss is expe-
rienced and mourned, just as the medical care providers’ responses and sup-
port, and the social network members’ responses are crucial to how bereaved
parents grieve. Only a full biopsychosocial assessment prepares the clinician
to practice intelligently and sensitively in such cases.
Other Types of Perinatal Loss
Perinatal loss is experienced most often in miscarriage, stillbirth, and neonatal
death. Aside from these obvious forms, infertility is a type of disenfranchised
perinatal loss. We address this in detail in Chapter 7 (Young Adulthood). Here,
we briefly address the alternative (and ever-expanding) pathways to parent-
hood that entail loss of the typical and highly valued pregnancy and childbirth
experience.
