Loss is one of the most painful and often isolating experiences within the perinatal community. Perinatal loss, which encompasses miscarriage, stillbirth and death of an infant in the first month of life, is a deeply personal and often unspoken grief. The silence surrounding this loss can lead grieving individuals to suffer alone, without the support they desperately need. For psychotherapists, understanding and addressing perinatal loss requires specialized training and a deep sensitivity to the unique challenges faced by grieving parents. This article aims to illuminate the complexities of perinatal loss and offer clinicians tangible tools for supporting their clients. We will explore the different types of perinatal loss, their occurrence rates, the potential for subsequent mood, anxiety, or trauma-related disorders, and the most effective therapeutic approaches and healing rituals.
Perinatal loss includes several types of loss that occur during pregnancy or shortly after birth, including miscarriage, stillbirth, neonatal death, and ectopic pregnancy. Miscarriage, the loss of a pregnancy before 20 weeks, occurs in about 10-20% of known pregnancies. Stillbirth, the death of a baby at 20 weeks or later, affects approximately 1 in 160 pregnancies. Neonatal death, which refers to the death of a newborn within the first 28 days of life, occurs in about 4 out of every 1,000 live births. Ectopic pregnancy, where the embryo implants outside the uterus, accounts for about 1-2% of all pregnancies and can be life-threatening. These statistics highlight the frequency and impact of perinatal loss, underscoring the urgent need for informed care and support.
The clinical impact of perinatal loss on clients is profound, often accompanied by a complex array of emotions, including trauma, guilt, and deep sorrow. Unlike other forms of grief, perinatal loss can be disenfranchised—society may not fully recognize or validate this grief, making it even harder for individuals to seek and receive support. Therapy provides a vital space for individuals to process their emotions, make sense of their experiences, and develop coping strategies that can help them navigate their grief and begin the healing process.
Given the unique demands of working with perinatal loss, specialized care is essential. Two evidence-based practices, Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), are particularly effective in supporting clients through their grief. ACT and DBT offer practical tools for managing intense emotions, fostering acceptance, and building resilience—key components in navigating the profound and often overwhelming grief associated with perinatal loss. By applying these techniques to the six stages of perinatal loss—initial shock, anticipatory grief, acute grief, grief work, integration of grief, and anniversary reactions—therapists can help clients move through their grief in a structured and supportive manner. For instance, ACT’s emphasis on acceptance and mindfulness can help clients stay present and avoid becoming overwhelmed by their grief, while DBT’s focus on emotional regulation and distress tolerance offers strategies for managing the intense emotions that often accompany perinatal loss.
However, while ACT and DBT are invaluable in addressing the psychological aspects of grief, they may not fully satisfy the deep need for meaning-making and closure that many grieving parents experience. Rituals play a crucial role in this process, offering tangible ways to honor the loss, create lasting memories, and provide a sense of continuity and connection. These practices help bridge the gap between the internal emotional work of therapy and the external expression of grief, facilitating a more holistic healing process.
Whether through creating a memory box, holding a memorial service, or participating in community support, rituals can provide a profound sense of closure and continuity for grieving parents. The National Share Office, for example, offers numerous rituals for grieving parents in their book, *Bittersweet…Hello Goodbye: A Resource in Planning Farewell Rituals When a Baby Dies*, which can serve as a meaningful resource for both parents and clinicians.
We also encourage you to download a copy of Coping with Infertility: A Resource Guide for additional resources to support individuals navigating this unimaginable type of loss. For therapists looking to deepen their understanding and enhance their practice in this challenging yet profoundly important area of mental health, we invite you to join our online training, Embracing Grief: Integrative Approaches for Psychotherapists Addressing Perinatal Loss (1.5 CEUs, 1.5 hours to obtain or renew the PMH-C).
