Grief and Loss Across the Lifespan, Second Edition

2 Perinatal Attachment and Loss 43

embryos; and loss of innocence about the “natural ease” of creating a family.

Many issues must be resolved: how much ART to use; how long to keep trying;

how to assess the ethics of using donors and surrogates; and what and when to

tell children about their conceptions (Paul & Berger, 2007). Additionally, losses

due to the birth of very premature children are common after ART (either in

the form of a death loss when not yet viable or loss of the healthy baby as

when multiples are born and have the sequela of prematurity such as cerebral

palsy, vision and hearing impairments, and cognitive impairments). Multifetal

Selective Reduction is recommended when more than three fetuses “take” and

some even recommend taking the pregnancy down to a singleton (Evans &

Britt, 2005). As the reading by Elizabeth shows, these reductions leave a feel-

ing of loss and grief even when they go as planned. Although the joy of a

child joining one’s home may be great, there are challenges with ART that may

entail loss, as can be seen in the following: http://www.nytimes.com/2009/10/11/

health/11fertility.html?ref=assistedreproductivetechnology

Medically Complicated Pregnancies and Loss

Women often expect that pregnancy, once achieved, will proceed with little

effect on their lives until the time of delivery. Advances in pregnancy care have

reduced maternal death and pregnancy complications over the last century,

though recent concerns about maternal mortality worldwide are attributed to

everything from aging mothers, more women with chronic illnesses becoming

pregnant, anemia, ART, and poor obstetrical care (Lumbiganon et al., 2014).

Complications occur in 10% to 20% of pregnancies in developed countries and

range from hyperemesis gravidarum (Munch, 2002a, 2002b, 2009) to placenta

previa to premature labor to pregnancy induced diabetes or hypertension. All

of these conditions have biological, psychological, and social aspects unique to

the condition, but all have outcomes in common. Women experiencing these

conditions experience loss of control, both because their bodies are not behav-

ing in the ways they would choose, and because required medical care limits

autonomy (Bachman & Lind, 1997). Anxiety, grief, boredom, fear, ambiva-

lence, and guilt are also commonly associated with pregnancy complications

(Bachman & Lind, 1997). Social workers and other caregivers can validate a

woman’s frustration and fear and also promote control where it is possible.

Notably, mental health status prior to conception is a primary determinant

of pregnancy outcome (Witt, Wisk, Cheng, Hampton, & Hagen, 2012) often

affected by prior losses and/or psychosocial contexts. Social workers and

other counselors may be able to intervene to improve the odds of healthier

mothers and babies.

Prenatal Diagnosis and Termination for Fetal Anomaly (TFA)

With the advent of ultrasound and amniocentesis, the ability to see inside

the uterus to assess fetal health became a reality. Most pregnant women

do not hesitate to engage in prenatal screening (which determines risk of