Sunday October 15 marks World Perinatal Bereavement Awareness Day. In 2019, in France, the perinatal mortality rate – i.e. the number of children born without life, by spontaneous fetal death in utero, medical termination of pregnancy (IMG) or died during the first seven days of life, reported he total births from twenty-two weeks of pregnancy – represented 10.2% of births. Perinatal bereavement affects nearly 7,000 women and couples each year.
Doctor Bérengère Beauquier-Maccotta is a child psychiatrist, head of the perinatal child psychiatry unit at the Ville-Evrard public health establishment, in Seine-Saint-Denis. Main author of the collective work Le Deuil perinatal. Clinic, practices and therapeutic devices (Elsevier Masson, 2020), she returns for Le Monde on the specificities of this mourning, the taboos which surround it and its support in France.
Perinatal mourning refers to something quite unthinkable, which is simply not in the order of things: the loss of a child before it is even born, or its death in its first moments. It therefore carries within itself a traumatic potential. This complex trauma varies according to the pregnancy experience specific to each woman and couple. Even though he is still only a fetus, this baby in the making begins to gradually take shape in the heads of the parents, who project intimate imaginations onto him.
Which means that this virtual baby, depending on when the termination of pregnancy – medical or natural – takes place and the parents’ projections, can have a very different place in their psyche. The latter are the only holders of what it represents. When they lose it, they often express the need to make it exist, by talking about it in those around them, so that it is incarnated somewhere.
The taboo around perinatal mourning exists because it has become something exceptional, thanks to advances in medicine and prevention which have allowed, in recent history, perinatal and infant mortality to decrease drastically. There was a time when all families were affected by the loss of at least one child. But as a result, society has lost the rituals that accompanied it and has made these losses invisible. Add to this the fact that in our contemporary societies, thinking about death, whatever it may be, is not simple. There is nothing more terrifying than the loss of a child. This is why we avoid thinking about it collectively.
In recent years, at the hospital, allowing parents to be able to see and welcome the body of the deceased baby has been the subject of a lot of thought. This has long been taboo because it was thought that it would reinforce the trauma. But in reality, by supporting the parents who wish it, it allows us to give a certain reality to the lost being and to have images that make a mark. It is a first step in collective sharing of grief, with caregivers, which helps many families in their grieving process.
In addition to midwives, psychologists or psychiatrists, obstetrician-gynecologists, nurses and childcare assistants who accompany families, there are also social workers who can be mobilized to accompany the baby’s funeral, if the parents express the wish to offer them a burial. Depending on the maternity wards, various other things are offered, such as taking a photo of the baby, taking hand and foot prints, etc. Once again, the management of grief remains specific to each pregnancy experience, the support provided therefore adapts accordingly.
Subsequently, for some families, it is difficult to return to the place where their baby was lost. The relay is therefore taken by health professionals outside hospitals, without forgetting the associative circle, which offers essential support, particularly within support groups.
Perinatal mourning is a theme that is still being worked on in France. The level of medical and social support remains quite heterogeneous depending on the maternity units and teams, but there has been a lot of training work which is visible in recent years. Support conditions have also improved thanks to better recognition of the fetus or child born without life in the law. Since 2008, fetuses born without life can thus be declared to the civil registry, regardless of term and viability; it is also possible, since 2021, to give a last name to children born without life. For some families, it is important to leave a trace of this lineage.
Today, the most difficult thing for women and couples going through this ordeal remains returning to the social sphere. Each step is complicated: it is almost up to parents to enlighten and guide others, while they are still in the painful process of grieving. It is on this aspect of prevention and lifting of the taboo that we must still act. It is also important to properly support these couples in the event of a new pregnancy, in order to prevent traumatic symptoms from reactivating.