2 Perinatal Attachment and Loss 45how to pay for both the hospitalization and therapies to ensure that the child
will catch up with developmental milestones over time. These fears (and loss
of the expected joys of having a child) combine with a sense of vulnerability
that accompanies most losses; additionally, parents must allow the medical
system to take charge of nearly every aspect of their newborn’s care, denying
them bonding opportunities and the confidence of competence derived from
providing the newborn’s care.
The losses identified in Kudeva’s reading at the end of this chapter are
heightened when a baby is born prematurely. Not only do parents have little
chance to have the birth experience and bonding time they wish for, but they
have real concern about whether their child will survive the hospitalization
unscathed. As Boiler’s piece (following Chapter 3) indicates, the losses keep
coming as the parents navigate each day hoping to keep home life and work life
managed while they try to spend as much time as possible at the NICU doing
“kangaroo care” (holding skin to skin—known to enhance the well-being of
preemies both short- and long-term).
These same types of losses are often experienced by parents whose child
is diagnosed with a disability or developmental disorder of some sort at birth.
As Douglas’ reading (end of Chapter 3) notes, parents sometimes are aware that
their fetus has a diagnosis, but many are hoping the newborn does not show evi-
dence of the diagnosis, or is less affected than predicted. The losses involved in
starting the parenting relationship in a medical setting give way to the ongoing
losses of learning what delays their child is likely to experience and advocating
for needed services rather than enjoying the congratulations of friends. Notably,
such congratulations are often awkwardly tinged with sadness or left unspoken.INTERVENTION
Intervention for perinatal grief is as hidden as the loss. OB/GYN providers
seem unfamiliar with resources for psychosocial intervention, whether Shear’s
work with complicated grief, perinatal loss support groups, or other targeted
psychosocial intervention (Lacasse & Cacciatore, 2014). In a study of medica-
tions used after perinatal bereavement, those given either benzodiazepines/
other sleep aids or antidepressants were most often given the prescriptions
by their OB/GYNs, most frequently within a week of the loss (Lacasse &
Cacciatore, 2014). This raises concerns about the wisdom of intervening with
treatment that has potential for iatrogenic harm prior to allowing natural heal-
ing or trying less intrusive psychosocial treatment.
McCoyd (1987) developed a framework for intervention for use with
perinatal loss that has been applied by MSW students to multiple types
of loss over the last decades. Called the Five Vs, it provides interventions
the practitioner can use to guide the work without resorting to structured,
predetermined tasks. The Five Vs provide a model for grief therapists who
desire some structure for the work, yet recognize the importance of allow-
ing the bereaved to follow their own needs and inclinations. (The reading by
Douglas following Chapter 3 [the Toddler chapter] also provides interven-
tion strategies for use in perinatal work and with parents who have a child
with a disability.)