Empathic psychotherapy for pregnancy termination for fetal anomaly.

Pregnancy termination for fetal anomaly is a unique reproductive loss with many issues distinct from spontaneous pregnancy loss, as typically addressed in the current literature. After providing a brief overview of this loss and the impact of stigma, some of the therapeutic tasks particular to this loss will be identified, including absorbing the impact of learning about the anomaly, defining what or who has been lost, deciding whether to continue or terminate the pregnancy, and deciding who to tell what. These therapeutic tasks are discussed using the available research literature, but primarily illustrated through clinical vignettes and therapist-client dialogue. Therapeutic empathy will be demonstrated as both an instrument of healing in itself, as well as a means of realizing other therapeutic goals and interventions such as empowerment, normalization, validation and processing grief and trauma, all crucial elements of doing therapy with this population. Contrasting perspectives of this loss in therapy and the role of the therapist are discussed. (PsycINFO Database Record

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample.

INTRODUCTION: Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. METHODS: We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. RESULTS: Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. CONCLUSION: This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.

Understanding and treating infertility: psychoanalytic considerations.

This article describes how the intrapsychic, psychosocial, and social ramifications of infertility may be addressed when infertility patients present with distress at the psychotherapist's office. Self psychology provides a valuable framework for the therapist, given the profound and multiple narcissistic assaults on self-esteem, consolidation of identity, developmental aspirations, and other self attributes which infertility causes. The therapist's empathy becomes the primary tool of both understanding and alleviating suffering resulting from infertility. The current medical and interpersonal experiences of the infertile person must be part of the therapeutic process. A psychodynamic model of treatment is outlined which includes goals of reestablishing narcissistic equilibrium, diminishing internalized stigma, and ameliorating other adverse psychological consequences of infertility diagnosis and treatment.

National survey of obstetrician attitudes about timing the subsequent pregnancy after perinatal death.

OBJECTIVE: After stillbirth or early infant death, parents often query when they can try for another pregnancy. We conducted a national survey of US obstetricians to assess attitudes about optimal timing of next pregnancy and advice given to parents. STUDY DESIGN: The study was an anonymous mail survey of 1500 randomly selected US obstetricians asking about physician experiences with perinatal death. RESULTS: In all, 804 of 1500 obstetricians completed the survey for a 54% usable response rate. Two-thirds of respondents endorsed a waiting time <6 months for parents bereaved by stillbirth who desired another pregnancy. CONCLUSION: Physicians in this national survey supported very short interpregnancy intervals for parents bereaved by perinatal death. Responses may reflect efforts to support parents emotionally while recognizing individuals vary in coping and clinical circumstances. However, this is a provocative finding since short intervals may confer greater fetal risks for poor outcome.

Adoption losses: naturally occurring or socially constructed?

The American definition of kinship based on biological ties, the practice of closed adoption, and stigmas associated with adoption may decisively influence adoption-related losses. Cross-cultural and historical accounts of adoption that do not apply to these contemporary American constructs of parenthood and practices of adoption suggest outcomes that are not as integrally based on loss. Adoption in infancy is defined as parenting a child with one set of (adoptive) parents and two (adoptive and birth) families. Implications for adoption research, policy, and practice are discussed.