A Guiding Framework
Perinatal loss is an emotionally traumatic experience for many individuals. In fact, 60% of parents who experience perinatal loss meet the criteria for PTSD up to five years after their loss. This is a staggering number, especially in comparison to the 4% of the population that experiences complicated grief following the death of a spouse, parent, friend, or older child.
Why is the perinatal loss experience so different from other types of loss? The primary reason for this difference is due to the shroud of silence that blankets perinatal loss. The silence prevents parents from talking about their loss with others. When grief is not allowed to be expressed, it becomes disenfranchised.
The silence of perinatal loss also prevents parents from receiving support, both professionally and socially. Healthcare professionals have an important role in helping parents cope after their loss. With perinatal trauma informed interventions, healthcare professionals can facilitate healing.
The Perinatal Trauma Informed Care (pTIC) framework is an evidence-based framework that integrates Trauma Informed Care into the perinatal loss experience. The framework outlines strategic interventions to prevent traumatization and retraumatization.
Critical Milestones
There are four critical milestones within the perinatal loss experience. A “milestone” is a time of change an individual faces that requires adaptation to transition through the change. Adaptation can be either positive (adaptive) or negative (maladaptive). For example, the transition from being a high school graduate to being a college student is a major life milestone. The individual must learn how to cope with the stress of college life. They may use adaptive coping strategies, such as reaching out for social support, exercising, or going to therapy. They may also use maladaptive coping strategies, such as over or undereating, or using illegal substances. The coping strategies utilized influence the degree to which the individual is able to healthfully transition through the milestone.
Healthcare professionals play a pivotal role in facilitating a healthy, adaptive transition through a milestone. Within the perinatal loss experience, there are four critical milestones. At each of these milestones, healthcare professionals can provide pTIC interventions to facilitate healing.
The Diagnosis
The first critical milestone is the moment parents learn of the terminal nature of their pregnancy. Whether it is miscarriage, fetal demise, or the diagnosis of a congenital anomaly, how that diagnosis is conveyed influences parents’ journey towards healing.
The Birth
The next critical milestone is the birth. The birth experience will differ depending on the etiology of loss. However, there are trauma informed interventions that can mitigate the emotional trauma within the experience.
Disclosing the Loss
Parents must eventually tell those within their social sphere that their baby died. Disclosing the loss to others is the third critical milestone within the perinatal loss experience. Though healthcare professionals are not present during parents’ conversations with others, healthcare professionals can equip parents with tools to have these difficult conversations.
Beyond the Loss
The perinatal loss experience does not end the moment the baby is born. Parents’ experience transforms and often becomes more difficult as they attempt to learn how to live in a new reality without their baby. Follow-up care, allocation of resources, and professional support is lacking yet highly important in the months following perinatal loss.
Trauma Informed Care
Trauma exposure impacts everyone differently. Research has found that those who experience traumatic stress undergo neurobiochemical changes. When an individual is triggered by something that reminds them of their traumatic experience, the brain relives that trauma in ‘real time.’ The Substance Abuse and Mental Health Services Administration (SAMHSA) identified six key principles in providing trauma informed care. The purpose of trauma informed care is to avoid retraumatizing individuals experiencing symptoms of traumatic stress. This is accomplished by enhancing safety, establishing trust and transparency, utilizing peer support, multidisciplinary collaboration, and remaining cognizant of historical, cultural, and gender issues to empower the individual to overcome their trauma.
Perinatal Trauma Informed Care
The pTIC framework integrates specific trauma informed care interventions into each of the four critical milestones. A toolkit has been provided to guide healthcare professionals in establishing pTIC practices within their facility. Components of the toolkit include an instructional video (coming soon), a worksheet to begin preliminary planning, and resources with examples of trauma informed interventions within the four critical milestones.