Le deuil périnatal de « l’enfant né sans vie »

RésuméLes parents confrontés à un deuil périnatal, en particulier d’un enfant « né sans vie », sont affectés psychologiquement de façon durable. Si pendant longtemps cet événement a eu tendance à être banalisé, depuis une vingtaine d’années les pratiques ont évolué et ce deuil est maintenant reconnu comme un deuil à part entière. Il a pourtant la spécificité d’être peu gratifié socialement, la perte étant jugée peu significative pour l’entourage. C’est un défi pour les couples confrontés rapidement à l’isolement. Différents types d’interventions existent afin de soutenir les familles. Il est essentiel que les professionnels soient formés au deuil périnatal et que les équipes soignantes soient soutenues dans leurs pratiques.

Giving birth to a stillbirth baby is part of perinatal loss. This event has been considered for a long time as being of little or of no significance. But for more than 20 years now, taking care of these losses has much evolved and now they’re recognized as tragic life events like the loss of any other family members. We know now that it psychologically affects parents on a long-term basis. Stillbirths occur in about 8.7 births out of 1000, 20 times more frequent than sudden infant death syndrome. Two stillbirth situations can occur: either a fetal death or elective and therapeutic abortion. Following these deaths the same grief stages as in other losses are described (shock and numbness, bargaining, depression, acceptance). Gestational age at the time of the loss does not alone explain pain intensity, which is probably more linked to pregnancy investment. Attachment theory is of great contribution in understanding grief process. Finding a meaning to the lost and having secured attachment both help. What seems particularly specific in this bereavement is the lack of social support leading to a strong feeling of loneliness. No souvenirs can be shared with close relations and if short-term support is effective during the maternity stay, it often doesn’t last much longer. A solution to the sorrow is given by the couple's relationships or the couple itself: having another baby. Social pressure is strong and the social message could be resumed as this: don’t think about it, forget quickly, it's not as terrible as if it was an older living baby, get pregnant again is the solution. Couple often react differently, father being affected during a shorter time and felling ready earlier for the next pregnancy. Understanding and supporting these families is essential for the couple and the family's future as well as for the subsequent children. Different types of interventions exist: during hospital stay and after discharge. Self-help groups are of good support as the feeling of being misunderstood and lonely is important. Professional support should always be proposed. Specific questionnaires to assess perinatal grief exist, one is translated in French. Interpersonal psychotherapy is well indicated in case of death and well developed during the perinatal period. It is of great importance to train (or continue training) health professionals in general as perinatal grieving starts being recognized but also to provide support to maternity professionals.