Ana Carcedo: "Perinatal and conventional bereavement are very different".
In this interview with psychologist Ana Carcedo we will learn the keys to perinatal grief.
Pregnancy and motherhood are part of a complex area of life in which many emotions are involved.
For better and for worse, expecting a baby significantly alters the daily life of women who have conceived, and this implies the emergence of important expectations about what it is like to raise a son or daughter. Therefore, losing a baby is a major blow at a time of particular vulnerability in terms of emotional balance.
To understand more about the perinatal grieving process, we have interviewed psychologist Ana Carcedo Bao, expert in perinatal psychology..
Interview with Ana Carcedo Bao: the keys to perinatal bereavement
Ana Carcedo Bao is a psychologist and founder of the maternity psychology center PsicoPerinatal. She currently attends both in her therapy center located in Madrid and through the online format, via video call.
On this occasion she talks to us about perinatal grief, a phenomenon that affects many women who unfortunately lose their baby.
In your experience as a psychotherapist, what are the aspects of abortion that generate the most discomfort in the short and medium term in women who have suffered it?
For me there are two key moments around perinatal loss, which are the first time the news of the loss is communicated to the parents and the following process of unallowed grief.
Regarding the first, the lack of support and empathy on the part of the professionals who accompany such a difficult and painful moment usually generates a lot of discomfort and is recorded in phrases that have a very painful emotional charge.
In consultation, when I work on these traumatic memories, I often see how "there is no heartbeat", "a woman with a curettage, a pregnant woman", "you are very young, you will have another pregnancy" or "better now than later", become important targets when working on this memory stored as very painful or traumatic.
Depending on the emotional support provided by the professionals, this will have an important effect on how the memory of the loss is experienced and stored, and will therefore be a factor to be taken into account when repairing the experience.
The second important aspect is that after this first medical phase, what the parents find is an emptiness, an absence of support and emotional accompaniment, as well as a mourning that receives little consideration. All this means that the loss is experienced in solitude and without support to be able to express what they feel, nor to find a place where they can feel listened to and accompanied.
Is it common for a miscarriage to leave long-term psychological sequelae?
Perinatal loss is a unique experience that each person will face differently according to his or her resources and capacities. It will also depend on how the loss occurred in order to be able to bear in mind the more or less traumatic impact of the loss.
What is known is that between 10% and 30% of women (and also of couples) suffer clinical symptoms of anxiety, depression, post-traumatic stress, and complicated grief during the months and years after the loss.
It often becomes evident during the pregnancy following the loss with symptoms of perinatal anxiety or depression, as well as with many difficulties in establishing a bond with the new baby (not wanting to tell until very late in the pregnancy, avoiding the usual purchases until the last phase, always talking about the possibility of loss, not thinking of a name until the end, etc.).
The step from imagining being the mother of a baby that will grow up to be an adult, to knowing that this person will not be born, can be very hard. Does it usually produce problems in the relationships of the couple who were expecting the child?
It is usually a very hard stage, which is experienced in a very different way. What I often find in the consultation room is a mother with a lot of emotional baggage and a father who in some way acts as a support.
This lack of harmony can sometimes generate conflicts in the relationship, also when seeing that the times and coping mechanisms may be completely different although at the base there may be the same intensity of suffering.
Psychological support at this stage can help a lot to integrate these difficulties and to be able to find a point where together a form is given to the Pain that allows the couple to move forward in harmony towards the future.
Are there differences between the psychological grief that women who have suffered an abortion go through and the grief that anyone goes through when they lose a loved one, for example, through natural death due to old age?
Of course. Perinatal bereavement and conventional bereavement are completely different. Intrauterine death is silenced, hidden and surrounded by taboo. This means that the phases or stages of grief are not allowed in the environment and the social and family response that is so necessary in any process of loss is not found.
Not "giving permission" to cry such immense pain, to talk about it, to be able to say goodbye, to be able to feel what is being lived, prevents the normalization of such a natural and inherent process in life itself, besides becoming a key factor to avoid a complicated mourning.
A loss is a blow that must be dealt with, but in order to do so it is necessary to be able to talk about it, to be able to support each other and to be able to feel that what you are feeling is absolutely valid and normal, because it simply breaks with everything that was expected. A postpartum without a baby is one of the most painful experiences a woman can face, and yet, one of the loneliest that is so hard to watch and accompany.
Grief is a unique and dynamic process, but it is known that the correct emotional accompaniment by professionals, the family and social environment, allow it to be reworked and placed in the person's life history in order to be able to move forward into the future.
What are some of the techniques and methodologies used in psychotherapy sessions to help women who have suffered an abortion?
As a clinical psychologist with expertise in the perinatal and trauma areas, I have learned to look at the person over the technique, although my integrative training helps me every day to be able to incorporate various techniques that help each person to be able to work through their pain and difficulties in a healthier and more functional way.
When the experience of loss is loaded with a lot of trauma surrounding the process, I usually use techniques such as EMDR (Eye Movement Desensitization and Reprocessing). Grief processes, however, mobilize many different tools such as working with thoughts (from a more cognitive approach) as well as working with the emotions that are occurring.
We will need a lot of emotional containment and present resources, such as Mindfulness. That is why under a reciprocal interaction therapy model (strategic therapy, cognitive, systemic and interpersonal techniques in addition to those developed in the model), we will be able to address in a much broader way all the needs that arise.
And how does the process of emotional recovery and improvement take place?
It is important to know that pain is like the waves of the sea, sometimes they are small and although they are there they are bearable, but there are other moments, when we least expect it, that a big wave can come and throw us to the ground, especially in the early stages of recovery, as very specific dates that remind us or reactivate the painful moment of the loss.
As everything that happened is repositioned, what occurs is a kind of reorganization, in which, without forgetting the loss, and often keeping it very present for life, you can rebuild your life, the ability to connect with the present and to give another format to so much pain without generating so much suffering in the present, and therefore continue moving forward into the future.
(Updated at Mar 28 / 2023)