What if 25% of our adult female clients were affected by trauma? Do not we want to know that? Not only is this a hypothesis for consultants, but there is a possibility that we, as clinicians, may be ill prepared to effectively identify and treat our clients who fall into this population.
In the United States, one in four women experiences some form of loss of infants or pregnancies. This statistic includes the more than 26,000 women who stillbirth each year. A stillbirth occurs late after an otherwise healthy baby outside the womb could have survived. Stillbirth is often defined as a child's death after 26-week gestation.
Long before I decided to become a Professional Advisor, I became one of those 26,000 mothers. It was only natural that the area of stillbirth became a field of interest for my own research during my doctorate. However, it was my experience in my job that made me see the gap in our field of expertise that is competent and competent enough to provide assistance. Every time she received a new recommendation that reported a pregnancy loss, she was immediately referred to me. This is because most people have one of two positions: 1) The person who has experienced what the client experiences is the best person to help the client, or 2) I can not help anyone with something that I've never experienced it myself]
This erroneous referral process poses a problem as our profession is able to provide quality care to clients with stillbirths. The referral of these clients only to those consultants who have themselves experienced a stillbirth can be harmful to both the client and the counselor. The counselor may be overwhelmed by the number of clients with this specific need, so close to their own traumatic experience, and may potentially lead to burnout for the clinician. An equally troubling result of this referral process is that other counselors are denied the opportunity to treat and learn from this population. The number of competent consultants is thus lower than necessary.
Understanding the Trauma
The death of a child is an inexplicable pain. The author Jay Newborn famously wrote: "A woman who loses a husband is called a widow. A husband who loses a wife is called a widower. A child who loses his parents is called an orphan. There is no word for a parent who loses a child. So terrible is the loss. "It is unnatural for parents to survive their children, regardless of the age of the child in which it dies. However, stillbirth has unique characteristics that make this scenario even more complicated for surviving parents.
The experience of stillbirth is highly ambiguous. The death of a child leaves so much unknown and mothers often wonder why their baby died, what their baby looked like, how the child's voice sounded, how their family had died had been different, the child had lived. This ambiguity often leads to death having no meaning, as the mother often searches for the purpose of the child's life. Mothers may repeatedly ask questions such as "Why me?" Or "Why did God give me a baby to let it die?"
Stillbirth does not only include grief; it is also a trauma or multiple traumas. Most people believe that a stillbirth occurs when parents are told at birth that their baby was born dead. This is not the case in modern medicine. As a rule, parents are alerted to the death of their child before delivery, and the mother then causes her to contract. The news that her baby is dead begins with the first trauma.
The trauma continues during labor and deliveries. This is the opposite of the joyful experience the mother had expected during her pregnancy. Grief and silence replace what used to be the elation and cry of a new baby. After the painful experience of labor and delivery, the mother has the opportunity to see her baby. Depending on how long ago it has been since the baby died, the appearance of the baby may be affected. Some mothers want to see and hold the baby, rock and take photos of their child.
After delivery, the mother is transferred to a room that is often located in the work and delivery area. On the way from the delivery room to her recovery room, the mother experiences sights and sounds like banners reading "It's a boy!" And the families of other families gathering in the corridors to see their own bundles of joy. The room of the grieving mother is empty and quiet. Her door remains closed to drown the crying of newborns from other rooms.
After a few days of hospital care, the mother is sent home to take care of her recovering body. In the following days she will develop the same physical reaction to a birth as a mother with a living child. Mothers who have had a stillbirth are often asked to tie their breasts to "dry out" the milk.
Within a birthday, the mother has to make decisions about the autopsy and funeral arrangements for her baby. The mother has to deal with the decision to keep the coffin open or closed during the funeral or funeral. This decision is often based on the appearance of the infant at birth (as the skin of a stillborn is often affected). Often, a tiny coffin is presented that seems out of place in the vicinity of the funeral home.
When the mother or father is employed, their free time quickly passes before returning to their "normal" life. In many cases, these parents do not receive paid leave or funeral leave because the stillborn child has never been considered a living person. For the same reason, parents do not receive a birth or death certificate for their child. For a birth certificate to be issued, the baby must have shown signs of life, even if it was just a single breath or heartbeat. In most states, a stillborn baby can not be considered dependent on taxation. (Hint: Some states offer a death certificate, which may be a resource for clients, if appropriate for their treatment.)
Best Practices for Screening
In many cases, the admission process contains a general demographic question to indicate the family size. This may include an option to fill in the gap for the number of children of the customer or the number of children living. (Hint: Replace "Number of Children" with "Number of Pregnancies, Number of Live Births, and Number of Living Children.") This will ensure that all areas – miscarriage, stillbirth, or later death of a child – are covered.)
Screening for stillbirths through demographic paperwork is the first step. This first paperwork provides a glimpse into the customer's entire history. Reviewing the material prior to the first clinical interview will alert the clinician to the need to discuss the experience of the stillbirth client (if the client discloses this in the documentation).
The clinical interview can be difficult for both the counselor and the client to discuss a stillbirth. Due to social expectations and the ambiguity of their loss, the likelihood of women reporting stillbirth is lower than other experiences. It is much easier for a person to put a number on the receiving paper in terms of the number of pregnancies and the number of living children than to openly mention a stillbirth during the clinical interview. For this reason, a direct survey of the consultant is essential.
Counselors may find it uncomfortable to ask clients about some kind of pregnancy loss. It is important for counselors to use the correct terminology and language for stillbirth. In addition, they should familiarize themselves with other terms that can be used by the mother, eg. "Dead", "dead", "dead", "dead baby" or "dead child" say it. If counselors feel comfortable with stillbirths and other pregnancy losses, they are likely to recognize this and move on to a higher degree of openness to their own experiences sooner rather than later. As a result, the therapeutic relationship can develop faster, resulting in faster patient outcomes and a higher retention rate.
For many clients disclosure of a stillbirth may or may not occur later, largely due to societal views of stillbirth (eg they do not count, they never exist, mothers need to move on "). This will affect the overall depth of the therapeutic relationship and may also prevent proper treatment of the trauma.
Worth Knowing
As a consultant, it is our responsibility to ensure that we are aware of the variety of issues our clients face. With such a high prevalence of stillbirths, it is important that we truly understand this experience to ensure competent treatment. There are several important points that consultants need to be aware of.
>> Social Support: It is not surprising that the presence of strong social support is an important factor in the recovery of a person from stillbirth. Such assistance may include a spouse or an important third party, family members, friends and participation in a church or religious community. A person's support system often declines after a stillbirth because the experience is "hushed up".
>> Dealing with Customer Language: Mothers of stillborn babies often give their babies a name. When the client uses the baby's name in the session, the counselor must name the stillborn child by name, not "the baby." The mother may hesitate to pronounce the baby's name, which in turn is due to the stillness of stillbirth. It may benefit the therapeutic relationship when the counselor asks, "What should I call the baby?". This also avoids the question "Did you name the baby?" Which could mean that the mother should be ashamed if she was ashamed to call the child.
>> Suicide : Mothers who have had a stillbirth often report the feeling, "I want to go to sleep and not wake up" or " I do not want to live anymore. "It's important to understand the difference between these thoughts and the active suicidal thoughts. This is especially important as these mothers often experience postpartum depression along with the stillbirth distress and trauma.
>> Postpartum Depression: Mothers giving birth to stillborn babies are not relieved of postpartum depression. This can lead to the complex problem of depression associated with grief, trauma and sometimes psychosis. Many people, including doctors, make the mistake of assuming that these mothers are dealing with "only" grief, "only" postpartum depression, and so on.
>> Trauma: Stillbirths are often regarded as mourning or depression. If you only look at it from this lens, instead of understanding the trauma associated with the experience, it may cause the treatment to become ineffective. This limited approach can also prevent the client from feeling fully understood, resulting in a poor therapeutic relationship.
>> Convenience Concepts: The experience of stillbirth is often silenced and encounters an expectation movement in society. Partly for this reason it is important for consultants to recognize and avoid common concepts of comfort. These include:
• "At least you know you can get pregnant."
• "This was part of a plan."
• "Thank God you have your other children."
• "It was not meant that way."
• "There could have been something wrong with it."
>> Long-term Presence: The close relationships of the mother can be exerted or even dissolved after the death experience. It has also been found that divorce rates are influenced by the experience of stillbirth. Without treatment, stillbirth trauma can manifest as a personality disorder or substance disorder.
Treatment Considerations
Due to the complexity of the stillbirth experience, counselors often feel lost about the possible direction of treatment. These clients have many interventions to treat grief, and other interventions can be used to treat depression and anxiety.
For example, suppose a counselor has a new customer who begins caring six months after the birth of her first child. She was referred by her family doctor when she made an appointment with the doctor for medication. She is married, has no living children, comes from a large family and regularly visits a non-denominational church. The client reports that she had to quit her job because she could not concentrate and cry all day. The client announces that she had a stillborn daughter named Sarah. A funeral and funeral were held, but the client says she can not "go ahead".
The client's faith and large family can serve as protective factors as they provide her with a great support system. At the same time, they can also be risk factors by triggering the client and reminding her of her loss. One possibility is to examine with the client, if she is frustrated with her support system, or if she has negative ideas and thoughts about herself when she is near her support system. The client may respond that she would like to avoid being with baby and young children at family reunions and services. The counselor should then not focus on helping the client deal with babies and children, as this could potentially convey the message to the customer that he gets over it. Instead, the counselor could examine the client's feelings of injustice and injury in order to confirm and normalize how she feels. The counselor would then allow the client to decide on the small steps he would like to take.
The experience of stillbirth is accompanied by a considerable ambiguity. Some clients feel comforted when they find meaning in their loss, others do not. The counselor may investigate this with the client and should be aware that the client's feelings may change over time. If the client can not credit her loss, or finds no comfort in meaning, the counselor should validate her feelings of injustice, hurt, and anger, and empower her to invent her own meaning. How can the client use this meaningless loss, for example, for the future?
It is often helpful to encourage the use of rituals by customers. This special client called her baby and also had a funeral and a funeral for her. The counselor could examine how the client can use other rituals to keep her daughter in her life. For example, she could hang pictures of her daughter in her house, keep a photograph of her daughter in her car, visit the cemetery on a regular basis, have an object such as a candle or a decoration depicting the daughter on vacation, and so on.
The consultant can also introduce the customer to online resources and support. This can give the client a sense of normalization and counteract the feeling of being isolated in their pain. It can also be provided a network that offers creative ideas for rituals.
There are many ways to consult with these clients, but there are also things to avoid. For example, consultants should avoid contributing their own beliefs and expectations to these customers (as with all customers). These mothers should not feel rushed or feel guilty unless they "get better" earlier. Consultants should avoid using the general comfort terms listed above. Counselors also need to remember that the therapeutic relationship is more important than a particular technique, and they should allow those clients to actively decide what their sessions will look like.
Each mother experiences another stillbirth. The family, religious beliefs and culture of the mother influence her response to stillbirth. In addition, her experience is influenced by the protocol of the medical facilities in which she has provided services, and the attitudes of participating health care providers. Counselors should address all of these factors in the session to ensure that mothers are treated according to their individual experiences. Our society tends to "cover up" these mothers and their experiences because it is so uncomfortable to deal with stillbirths. However, these mothers must be heard, understood and recognized as mothers, even if they have no other living children. After all, born is still born.
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Samantha Rouse is a licensed clinical consultant at Hosparus Health in central Kentucky. She is a fourth-year doctoral student at Lindsey Wilson College and researches motherhood and stillbirth. Contact her at [email protected].
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