44 Grief and Loss Across the Lifespan
an anomaly), particularly in Westernized nations (Santalahti, Hemminki,
Latikka, & Ryynaen, 1998; McCoyd, 2013). Advancing maternal age is known
to increase the risk of trisomy conditions (chromosomal abnormalities), yet
obstetricians encourage screening for all pregnant women because other fetal
anomalies might be detected (genetic, cardiac, and neural tube defects for
example) (ACOG, 2007). Because many more young women get pregnant than
older women, the number of pregnant women under age 35 whose fetus gets
diagnosed with an anomaly is greater than the number of “older” women with
an affected pregnancy (Choi, Van Riper, & Thoyre, 2012). Most women who
are told that their fetus is at higher risk for an anomaly have not previously
considered this possibility (McCoyd, 2007, 2013) and may not understand that
they must have a diagnostic test to determine whether the fetus does indeed
have whatever condition is of concern.
Positive diagnoses rarely predict the degree (intensity) of the condition.
As indicated in the reading by Elizabeth that follows this chapter, or the read-
ing following Chapter 3 (Toddler/Preschool) by Heather Douglas, there is
frequently much uncertainty about the viability of the pregnancy, the possi-
bilities of a term birth, and the outcomes for the baby born with any particular
condition. Complicating matters further, women and their partners have only
a brief time to decide whether to trust the information they have (McCoyd,
2010a, 2016) and whether they believe themselves capable of bringing such
a pregnancy to fruition and raising the child (McCoyd, 2008). Following the
angst of quick decision making under conditions of uncertainty, when ter-
mination is elected women often feel a short surge of relief, but this is often
followed by grief they do not expect. Although most women are clear that
they are losing a pregnancy/fetus they desired and became attached to, they
often feel constrained in their grief because the “treatment” of pregnancy ter-
mination is, technically, an abortion—a medical procedure fraught with stigma
(McCoyd, 2010b). Women and their partners end up mourning in secrecy,
making a loss that is already difficult even more challenging. Helping women
to recognize the reasons for their decision, helping them lower their sense of
guilt, and helping them recognize their right to grieve the healthy child they
hoped to have are critical to effective intervention.Delivery of a Premature or Medically Compromised Neonate
Sometimes a medically complicated pregnancy yields a premature baby or neo-
nate. Other times, premature labor starts and cannot be stopped or membranes
rupture and the neonate is born. Time magazine recently referred to a “Preemie
Revolution” (Kluger, 2014), noting that 478,790 babies were born prematurely
in 2010 and 462,408 survived (p. 29). Yet of those born at 24 weeks EGA, just
over half will survive, and most of these will experience complications such as
cerebral palsy, neurocognitive delays, and hearing and vision impairments. By
28 weeks EGA, most will survive and over half will survive without noticeable
complications (Kluger citing CDC, 2014, p. 29). Even when survival is likely,
parents must endure the highly technology driven neonatal intensive care unit
(NICU) with its frightening alarms and machines, and manage fears for their
child’s welfare currently and in the future. Parents are also concerned about