Reproductive Loss and Grief

Reproductive loss includes miscarriages, fetal deaths in utero and stillbirths, and termination of pregnancy in some cases. While the latter is a planned event, women may still experience grief related to the termination of pregnancy.

Cultural variations in the expression of grief

Expressions of grief in western culture can include (Queensland Health - Multicultural Services, 2009):

• Personal feelings - sadness, anger, guilt, anxiety, and helplessness.
• Physical sensations - shock, hollowness in the stomach, tightness of the chest, weakness of the muscles.
• Cognition - confusion, disbelief.
• Behaviours - sleep disturbances, crying, social withdrawal.

Women from CALD backgrounds may express their grief differently. This will be influenced by many factors including cultural and religious backgrounds, stage of the pregnancy and their personal reproductive situation (Queensland Health - Multicultural Services, 2009).

In addition to crying, grieving people may shout, bite their hands and fingers, tear out or cut their hair, jump, rock backward and forwards, or sit in a corner with their eyes closed. In some cultures, grieving people may attempt to vomit. Self-harm is an extreme psychological reaction (eg people may cut their veins or attempt suicide), and is a pathological reaction to grief.

In some cultures, people mourn for their deceased children less than they mourn for deceased adult relatives. In most societies, women are expected to mourn longer and deeper than men. Men are expected to be strong and not to show their emotions (Queensland Health - Multicultural Services, 2009).

Gender variations in the expression of grief

Women usually experience greater grief as a response to reproductive loss than do men, particularly at the time of the loss. Women may cope with the reproductive loss better if they have opportunities to express their grief (Queensland Health - Multicultural Services, 2009).

Men often internalise their feelings. They may pretend that nothing has happened, blame themselves for the lack of care they provided to the pregnant woman, feel the loss of their expected fatherhood status, or try to work extensively to occupy their time and to provide support to the grieving woman.

Reproductive loss is a severe trauma to both partners, and both partners require psychological support. Some couples may develop post-traumatic stress disorder related to reproductive loss, particularly if the grief is unresolved. The next pregnancy may be a time of high stress and anxiety for the couple.

Accessing psychological support

Unresolved parental mourning may result in psychosocial problems and vulnerability in the future. Timely psychological support may reduce the duration of mourning.

Migrants and refugees may not seek psychological support due to (Queensland Health - Multicultural Services, 2009):

• The stigma associated with mental health issues.
• A lack of knowledge of mental health services.
• A lack of familiarity with psychological services.
• Mistrust of psychologists and psychiatrists based on experiences in their country of origin.
• Believing that all required support will be provided by a medical practitioner.
• Viewing mental health issues as family issues and not a condition that can be treated by a health professional.
• Dealing with psychological issues in a culturally or religiously specific way (prayers, healing services, special ceremonies).