THURSDAY, July 11, 2002 (HealthDayNews) -- Prevailing guidelines that are supposed to help parents of stillborn babies may actually do more harm than good.
Until the 1970s, stillborn children were usually taken away quickly to avoid distressing the parents. At the same time, parents often complained that staff members were insensitive to their feelings.
However, according to a study in this week's issue of The Lancet, removing the baby may not have been such a bad idea.
The practice of holding a stillborn infant, the study authors say, started with the writings of one London psychiatrist who had treated several women after they had suffered stillbirths. These women had difficulty recovering from their loss, and indicated they regretted not having seen their dead child.
The psychiatrist then wrote several papers advising parents to see and hold the infant as a way to facilitate grieving. "There was enormous interest, and the original papers led to an explosion of similar ones advocating increased contact," says study author Dr. Patricia Hughes, a clinical psychiatrist at St. George's Hospital Medical School in London.
The study looked at 65 women who were pregnant for the second time after a stillbirth. It found that 39 percent of the mothers who saw and held their stillborn child experienced depression, compared with 21 percent of women who only saw the infant and 6 percent of women who did not see or hold their infant.
Women who had seen their dead child also had greater anxiety and more symptoms of post-traumatic stress disorder. What's more, 42 percent of their next-born children showed evidence of disorganized attachment behavior a year later. The phenomenon is a pattern of insecure attachment, Hughes explains, that can increase the risk of later behavioral problems. Only 8 percent of the next-born children of mothers who had not seen the stillborn showed signs of disorganized attachment.
Hughes emphasizes there appears to be little or no empirical evidence to support such a practice. Nevertheless, health practitioners started recommending that parents of stillborn babies actually see and hold their children, even dress them, hold a funeral and keep mementos. Much of this approach is recommended by professionals to this day.
Susan Weitkamp, development director of SHARE Pregnancy and Infant Loss Support, which provides support to parents who have experienced a stillbirth, miscarriage or newborn death, was surprised by the findings.
"We've been doing this for 25 years, and parents will tell us how healing it was to them to hold the baby, to create memories, to have their child for the little while they get them," she says. "Parents who don't see the baby always wonder what the child looked like, whose features the child had."
SHARE encourages staff and parents to take as many as 36 pictures of every stillborn infant (and miscarried infants if they have recognizable features), dressed and undressed, next to teddy bears and in cradles.
"The rationale was that seeing and holding the dead infant would create memories, and that this would allow mourning to progress more easily," Hughes says. "I think, however, that for some parents, it left them with images that they could not forget, and that, although the intention is to foster closure, it actually kept the dead infant alive in their minds more intensely."
"All we can say with confidence from our findings is that there is association between not seeing the child and better outcome," Hughes says. "My theoretical explanation is that I think that the image of the child may stay in the mind of the mother, and may interfere with her ability to accept the finality of the loss. Closure is a good word to use here. It sums up the problem for some mothers, who I think have difficulty in making closure on the tragedy, and who may have real difficulty in accepting that the stillborn child is really dead, and that the relationship is over."
This isn't to say that all parents or mothers will react the same way to a stillbirth.
"For anybody to try to give a definitive answer on whether or not parents should view or not view or spend time with the stillborn is preposterous either way," says Michael Nuccitelli, executive director at SLS Health, a behavioral health-care facility in Brewster, N.Y. "The most important thing is to understand that the death experience is unique to the individual."
The study authors seem to support this stance.
"I hope that we can also remember other important issues: whether parents elect to see their baby is only one aspect of care at this time," Hughes points out. "There is a real need for sensitive support for parents when a baby is lost. There is need for good training for staff to know how to be sensitive. There is need for support for staff themselves, who are also intensely distressed when a pregnancy ends in stillbirth."
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