Past Trauma Impacts Family Connections After Perinatal Loss

The impacts of prenatal and neonatal loss may ripple out to all family members. Circumstances preceding and surrounding the death of a prenate or newborn often involve traumatic experiences during pregnancy, birth, and a baby's time spent in the neonatal intensive care unit (NICU). Parents' and family members' past experiences of trauma and loss can add to the complexity and challenge of processing the grief that follows perinatal loss. Parents who have suffered previous prenatal and neonatal losses may find they are repeatedly triggered into states of overwhelm while their child is in the NICU as they fear the loss of this child.

Support for parents from family and friends is crucial at this time but has been limited during the pandemic due to restrictions on who and how many people can visit patients in the hospital. A mother may be hospitalized for pregnancy complications for weeks or months before the birth of her baby and separated during this time from her support network. The quality of support family members, including grandparents, siblings, aunts, uncles and cousins, as well as friends may be capable of offering is shaped by how their own past experiences of trauma may or may not be triggered by the current circumstances. How dysregulating is this loss for them and what is their capacity to regulate themselves in the face of this trauma? There are resources in place for parents who have preterm babies and seriously ill babies in the NICU, and for parents whose babies have died. These resources rarely extend to other family members who may be left to cope with the current loss and the triggered trauma of their own past losses.

How family members cope with their own reactions to their relative's loss of a prenate or neonate may have long-term consequences for family relationships. Interpersonal misattunements between family members may lead to fractures in relationships that are difficult to repair. Families may suffer more than the loss of the prenate or neonate, but additional losses of connection between family members which fragment the family unit.

Recent literature explores grandparents' experiences of grief following pregnancy loss or neonatal death of a grandchild. Grandparents have been called "forgotten grievers." I believe this term may extend to other family members—siblings, aunts, uncles, cousins and also close friends. Grandparents are in the extremely painful position of witnessing their own child's loss of their baby, as well as their progeny.

Babies die in hospitals during pregnancy, birth and in the NICU. Offering families, even and especially during COVID-19, the opportunity to gather and share a ritual or ceremony in the hospital before and during a neonate's death is one way to support vital connections parents and families will need as they process their grief and trauma in the aftermath of the loss of their child. Parents are sent home with empty arms and see other parents carrying their newborns in their arms as they leave the hospital. For the parents who lose babies, this is a heartbreaking ending to days, weeks or months of unprocessed traumatic experiences. For those with new babies in their arms, it is a beginning. For parents who go home with their baby after experiencing a traumatic pregnancy, birth and time in the NICU, processing and healing from the multiple aspects and layers of trauma will take time and support.

Parents who lose babies may be very isolated at home. The hospital staff who cared for the women during pregnancy and their child in the NICU—people with whom parents may have had daily contact over weeks and months—are no longer available to them. Connecting with support on the outside, especially during the pandemic has been very challenging. Grief counseling may be helpful but may not be accessible to parents who do not have the financial resources to pay for it.

When asked by an acquaintance, parents of a prenate or neonate who died may find they are not sure how to respond to the question, "Do you have any children?" Though their child has died, their identity as a mother or father stays with them. People who are close know what happened, but parents may not want to tell other people about their pregnancy and loss. Parents' hesitation about whether to share with others who ask about children may, in part, arise from how our society and medical system deals with the death of prenates and neonates. For parents who have suffered the loss of a very young child, not acknowledging that child's life however brief, and their identity as a mother or father, may feel like they are keeping a secret. The emotions that may arise in these situations are complex. Parents may assess whether the person who asks the question has the capacity to compassionately hold the answer or whether this person's discomfort with the truth will be yet another thing they will have to deal with. When a lost child's existence and their mother's or father's identity as their parents are not acknowledged, the child and parents become invisible in that context.

Finding ways for families to repair fractured relationships that may have occurred during the stress and trauma of a complicated pregnancy, birth and stay in the NICU is a significant challenge that parents and family members may not have the inner resources to address while they are going through the grieving process. Each family member is on their own healing trajectory. How and when they cope with and heal from their experience of trauma and loss of a prenate or neonate within their circle shapes their capacity for future connections with each other. Until that time, bearing witness with heartfelt love and compassion for all family members during this process may be all that is possible.