Dealing with the psychological issues involved in perinatal loss exposes the medical, nursing, and midwifery staff not only to parents' distress but also their own feelings of impotence and frustration. This often leads to inadequate management of the situation, which may have long-term deleterious effects on parents and affect staff personally and professionally. Thus, mental health professionals should not only address their interventions to parents, but to staff as well, potentiating the latter's role as mental health providers. The skills needed for this kind of task involve creativity and flexibility, as well as the capacity to adapt traditional training to the active participation needed in dealing with perinatal loss. The present paper is based upon the author's 15 years' experience in consultatiodliaison in this field and describes the work carried out based on case discussion, group work, and, specially, video-recorded interviews with parents and staff accompanied by written material providing guidelines for management.
&SUM& Le personnel mtdical, les infirmikres et les sages-femmes se voient dtsormais forcts d'avoir affaire B des problkmes psychologiques lies ti la perte firinatale, non seulement avec la detresse des parents mais aussi avec leurs propres sentiments d'impuissance et de frustration. Cela mkne souvent B une mauvaise gestion de la situation, qui peut avoir des constquences A long terme nuisibles sur les parents, et affecter le personnel personnellement et professionnellement. Les professionnels de la santt ne devraient donc pas seulement adresser leurs interventions aux parents mais aussi au personnel, potentialisant leur r6le d'agent de santt mentale. Ceci requiert de la crhtivitt et de la flexibilitt, ainsi qu'une capacitt B adapter la formation traditionnelle B la participation active exigte lorsqu'on a affaire B une perte perinatale. Cet article-bast sur l'exfirience de l'auteur, qui a travaillt pendant 15 ans dans ce domaine-dkrit le type de travail effectut et rtalist B partir de difftrentes modalitts: ttudes de cas, travail de groupe et surtout entretiens enregistrts B la vidto de parents et de personnel, accompagnts de mattriel krit.
RESUMEN: El manejo de 10s aspectos psicosociales implicados en la firdida perinatal enfrenta al mkdico, la partera y la enfermera no s610 con el sufrimiento de 10s padres sino tambitn a sus propios sentimientos de frustraci6n e impotencia. Esto frecuentemente lleva a un manejo inadecuado de la situacibn, lo cual puede tener efectos delettreos a largo plazo para 10s padres y afectar al personal profesional y personalmente. De esto se deduce la necesidad de que la intervenci6n a cargo de 10s profesionales de la salud mental no estt s610 dirigida a 10s padres sino tambitn al personal, potenciando su rol de agentes de salud mental. Esta tarea requiere creatividad y flexibilidad, asi como la capacidad de adaptar la formaci6n tradicional al rol activo que es necesario adoptar en el manejo de la ptrdida perinatal. El presente trabajo esti basado en la experiencia de la autora, quien ha trabajado durante 15 aiios en Psicologia Medica en este campo, y describe el tipo de labor realizada de acuerdo a diferentes modalidades; abordaje de casos individuales, trabajo grupal y, especialmente, discusi6n e instrumentacidn de pautas de manejo en base a materiales escritos y entrevistas a padres y personal video-grabadas. I02 @Michigan Association for Infant Mental Health * see their dead baby (in neonatal death, also before death), * allow an autopsy performed. * * prevent disordered mourning, * avoid anticipated mourning, * keep alert concerning subdued reactions of mourning (especially with father) (+). * prevent replacement/vulnerable child syndromes (Cain & Cain, 1964; Poznanski, 1972), * prevent increased psychosomatic risks (Schmale, 1958), * favor discrimination between subsequent child and infant currently lost. as concerns parents' feelings and psychodynamic processes:
as concerns mourning:
favor and control evolution of normal grief work, -as concerns subsequent pregnancy: