By Austine Duru
Perinatal care is fraught with complicated emotions and challenging dynamics. Issues may come up during the pre-term labor and delivery, or in the neonatal intensive care unit. Sometimes families may face the unthinkable loss of a baby before, during or after labor. In each of these situations, chaplains play a crucial role in supporting the complex needs associated with perinatal care. There is substantive research literature that provides insights and helpful strategies for effective spiritual and emotional support for patients and families in chaplains’ care.
Nurses are often closest to patients and families and are consistently able to correctly identify their needs. In perinatal care the nurses play a crucial supportive role at a very emotionally turbulent time. This becomes a bit tricky when the needs are not clearly clinical, but deeper existential and spiritual needs. In a 2017 study, “Perinatal Loss Chaplain Utilization: What Nurses request and what Patients Actually Need”, Melanie L. Chichester and Sheryl Allston explore how frequently nurses accurately assessed the spiritual needs of patients and families in perinatal loss, and they compared this to the spiritual care assessment completed by chaplains for the same patients. The results suggest that while nurses did include the chaplain most of the time, they did not consistently accurately identify the family’s needs for emotional or spiritual support. A more telling finding is that nurses underestimated their own need for support in the midst of care. The findings suggest that chaplains have an opportunity to educate nurses and other clinicians about the spiritual needs of perinatal patients and their families, as well as help address the needs of the caregivers.
Cultural sensitivity and humility are crucial in perinatal care. Three recent articles explore this subject from Muslim, Latino, and African-American cultural perspectives. In “Perinatal Grief in Latino Parents,” C. Whitaker, K. Kavanaugh, and C. Klima (2010) explore the literature surrounding perinatal grief and loss in Latino culture. In a similar literature survey, “Experiences of African-American parents following perinatal or pediatric death: A Literature review” J. Boyden, K. Kavanaugh, L.M. Issel, K. Eldeirawi, and K. Meert explore the unique factors that impact African-American perinatal bereavement. “Psychosocial impact of perinatal loss among Muslim women” speaks to the importance of attending to the family as a unit in addressing perinatal grief for Muslim patients.
Estimates of stillbirths in the United States suggest that about 25,000 stillbirths occur each year, or about 70 each day (M.C. Kelley and S.B. Trinidad, 2012). The growing research and focus on perinatal loss often does not account for lived experiences of patients and families. “Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth – a qualitative study” attempts to address the praxis of experiencing stillbirth and the challenges of the stigma and taboo that surround it. The authors highlight the importance of creating conducive environments to address the needs of women and families experiencing a stillbirth, as well as attending to the emotional, physical, spiritual, and cultural needs of patients. The importance of recreating memory for these patients raises important questions about the use of rituals in their care. Chaplains could be key partners for clinicians here.
It is often said that a picture is worth a thousand words. This is symbolically and literally true when dealing with perinatal loss, whether it is a fetus, stillbirth or an infant. Words often fail to convey the depth of loss and devastation felt by parents and families. In a very recent study, “Professional bereavement photography in the setting of perinatal loss: A qualitative analysis” F.D. Ramirez, J.F. Bogetz, M. Kufeld, and L.M. Yee (2019) investigate the role of professional bereavement photography in perinatal loss and grief. They also explore the perspectives of bereaved parents, professional photographers, and interdisciplinary healthcare teams. The final analysis identified five major themes that suggest bereavement photography does add value to parents. These include, “validation of experience, permission to share, creation of a permanent and tangible legacy, creation of positive memories, and moving forward after loss.” This seems to become more effective when combined with other grief support initiatives.
“The spiritual and theological issues raised by stillbirth for healthcare chaplains” by D. Nuzum, S. Meaney, K. O’Donoghue, and H. Morris (2015) published in the Journal of Pastoral Care & Counseling explores the spiritual and theological questions that chaplains wrestle with as they attend the parents who have experienced perinatal loss. The study recognizes the emotional toll of attending to the complex needs of bereaved parents, and aims to understand how ongoing support for families experiencing perinatal loss affects the chaplain’s theological and spiritual attitudes. The findings suggest that encounters with perinatal loss raise serious existential, theological, and spiritual questions for chaplains. The authors identified three main theological themes that surfaced from the study: suffering, doubt, and presence. They recommend self-care and the practice of theological reflection as a tool for coping with perinatal care chaplaincy. A full text of this article is available by logging in to the publication through the resources link in the NACC website.*
Austine Duru, BCC, is Vice President of Mission for Bon Secours Mercy Health in Northeast Ohio.
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