Perinatal Mourning and Obstetric Violence

by Claudia Ravaldi

Eleven years of work on the subject of perinatal death and mourning have brought us into contact with a very critical situation in our country.

We are among the few who do not have specific and detailed guidelines on this complex issue. By 2020, the WHO asked us to reduce stillbirths by 20%, preventing all avoidable ones, and Lancet in 2016 explicitly indicated that training and care for operators is essential if we want to offer effective and valid support to grieving parents.

Unfortunately, despite the numbers (one pregnancy out of six) would be such as to allow adequate training and support courses in a more organized state than ours, the Ministry of Health and that of Education, responsible for university training courses, have not yet focused the problem with the attention it deserves.

And it is in this institutional gray area that what the WHO and various countries define as “Abuse and disrespect in hospitals” or “Obstetric Violence” was born and developed.

There is Obstetric Violence (understood as Violence that occurs in the path of pregnancy childbirth puerperium, describes the place, not the operator!) After a perinatal bereavement every time one of these things happens:

“I want to see my baby”

“Can not be done”

“Because?”

“Because it is the practice. And then it’s better that you don’t see it “

“I want to do the autopsy”

“Anyway, you can’t find anything. Better not to do it. “

“Do I have to do any specific tests?”

“No madam, up to three abortions is normal, it’s nature, you work hard”

“I don’t feel my son move well, there is something wrong”

“Eventually they move less, and she’s just an anxious mom”

“It is not possible that there is no more …”

“Madam, look, there is nothing left, it must have fallen into the toilet”

“Can I have the epidural?”

“But what didn’t they tell you that you give birth with pain?”

“I would like to have a natural birth”

“For what? To suffer in vain? Come on, let’s put her to sleep so she doesn’t think about it anymore “

“Is there a psychological service in these cases?”

“Only for perinatal bereavement. Hers was just a small abortion “

“What tests should be done in these cases?”

“Nobody, she died in a cot but in utero, next time it won’t happen again, don’t worry!”

“Don’t bind your head so much about this misfortune, otherwise there will be no more (children)”

“I would like to have the burial”

“And why on earth? Better not to have a cross to cry on “

“Can I bury my baby?”

“Child? But which child? Here are just a bunch of cells “

“I’d like to have the funeral”

“Lady choose, either the funeral or the autopsy”

“Can I take a picture of her?”

“A footooooo? She is happy “

“I saw that there are self-help groups for perinatal bereavement”

“Madam, listen to me, forget about all these things that feed the pain, and do another one as soon as possible, you will see, it will all pass”

“I am in mourning”

“There are more serious things than an accident, believe me”

“Please, now you must be strong for your wife”

“Tell us what is best for your wife”

“Look, it’s better if you stop trying again, you see it’s not what”

“Keep the tablets to get rid of the milk”

“I would like to donate some more to the other premature babies”

“Absolutely not! Then she gets depression “

These phrases were spoken by healthcare professionals, both directly to mothers during their hospital stay , and in my training courses during case discussions and group exercises.

Many of these phrases arise from a serious educational gap , which we are trying to counter with congresses, articles, information campaigns, ever since, in 2006, I was told the first sentence on the list.

All guidelines on perinatal bereavement care, at all gestational ages, contain the correct answers to these disrespectful statements, which for many parents have become real abuses: an abuse occurs whenever an “expert” interlocutor questioned about his or her skills in the field replies not based on what should know, or what it could be of use to your client, but on the basis of your personal opinion, or hearsay.

The main responsibility for these abuses does not lie with individual operators, totally abandoned in this specific sector since their university studies, but with those who organize both pre and post graduate training courses. A large part of the responsibility also lies with the hospitals , which leave the operators in the trenches without providing them with any updates and no support that allows them to carry out a respectful and competent job even with couples affected by perinatal bereavement. The fact that three or four companies do training is commendable, for those specific companies, but it does not solve the problem of all the other hundreds of Italian hospitals, which assist women and even women in mourning.

This chain of repeated neglect leaves many victims in the field: women, their companions, their stillborn or short lived children, the operators involved in care without suitable tools for care.

The first victims of obstetric violence alongside women are health workers.

Why no woman should beg to be able to see her dead child;

Why no woman should receive the wrong information on diagnostic investigations in case of abortion, preterm birth and perinatal death;

Why should no woman feel ridiculously romantic when she asks to be able to bury her nine-week-old son, since this option is provided for by Italian law;

Because no operator ignoring the studies on stillbirth gives wrong information to bereaved parents;

Because no operator has to grope in the dark when assisting a woman suffering from prenatal or perinatal death and be forced to improvise a support for which he is not prepared;

So that pain, physical and psychological, is recognized and duly treated, together with the woman, and not in her place or “For her good”;

So that every child can be recognized as such and treated with dignity and respect, and not as a mass of dead cells, or a meaningless anatomical finding;

So that Italy also puts its citizens, parents and operators in the condition of being able to work at their best with all women and all pregnant couples, even when the pregnancy leads to mourning;

Because abuse and disrespect during a traumatic event amplify the trauma, adding secondary traumatization and hindering grief processing;

Because abuse and disrespect during a traumatic event hinder the victim’s resilience, and complicate access to his or her inner resources;

Because ignorance is the enemy of resilience.

Today, 25 November 2017, I will be in Parliament #InQuantoDonna but above all #InQuantoDonnaMedico #InQuantoMammaSpeciale for all the families of CiaoLapo and for all our operators, who every day, with dedication and responsibility, work with us to change things and humanize care . Even after a perinatal bereavement.

Thanks to the girls of #bastatacere, respectful travel companions;

Thanks to my midwife friends, wise and precious;

Thanks to my teachers, from whom I learned that without listening and respect there is no curriculum that holds;

Thanks to our children, a continuous source of inspiration and beauty.

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