Social Support in Perinatal Grief and Mothers’ Continuing Bonds: A Qualitative Study With Italian Mourners

Title: Social Support in Perinatal Grief and Mothers’ Continuing Bonds: A Qualitative Study With Italian Mourners
Authors: Ines Testoni, Jenni Bregoli, Sara Pompele, Andrea Maccarini
Published In: Journal of Women and Social Work 2020, Vol. 35(4), Pages 485-502
DOI: 10.1177/0886109920906784
Keywords:
- Close relationships and social support
- Continuing bonds
- Disenfranchised grief
- Mothers’ grief
- Perinatal loss
- Psychodrama

The study investigates the grieving process after perinatal loss, focusing specifically on the continuing bonds (CBs) that mothers experience.
Methodology: Interpretative phenomenological analysis (IPA) based on interviews with 15 Italian mothers.
Main Themes:
1. Continuing bonds between externalized and internalized presence.
2. A difficult guilt to manage.
3. Relationships are crucial support systems.
Importance of psychodrama and art therapy in supporting mothers through grief.

Grief has unique phases and properties, and social relationships are crucial for the bereaved, as they help prevent complicated mourning (Neimeyer, 2013).
The morphogenesis of social transitions necessitates sharing meanings through communication (Maccarini, 2019).
When meaning-making fails, crises lead to disintegration (Maccarini, 2019).

Perinatal grief stems from losses before or immediately after birth (Blood & Cacciatore, 2013).
Can lead to severe repercussions for the family (Martinˇcekov´a & Klatt, 2016).
Grief could last up to two years or more (Doka & Martin, 2014).
Associated risks: depression, PTSD, and health complications (Huberty et al., 2016).
50%–80% of mothers conceive again post-loss (Huberty et al., 2016), but these pregnancies could be fraught with anxiety.

Disenfranchised grief (Doka, 2002) occurs when mourning is culturally minimized, leaving individuals unsupported in their grief.
The societal minimization of perinatal grief can lead to feelings of isolation and stigma (Testoni & De Cataldo, 2017).
Objectifying language regarding deceased children exacerbates the emotional struggles of parents (Scott, 2011; Klass, 1993).

In the Italian culture, perinatal loss is considered taboo (Bulleri & De Marco, 2013).
Societal pressures create stereotypes about men and women regarding childlessness (Lombardi, 2015; Ottaviano, 2015).
Traditional training for healthcare professionals often lacks sensitivity towards bereaved parents (Mattalucci, 2015).

Grief models:
- Bowlby and Parkes (1970): Grief elaboration involves internalizing memories of the deceased.
- Worden (1991): Describes tasks that bereaved individuals must accomplish through grief rather than strict stages.
- Neimeyer (2001): Focuses on individual experiences of restoring meaning after loss.

Continuing bonds (CBs) are ongoing relationships that bereaved individuals keep with the deceased (Klass & Walter, 2001).
Recent perspectives suggest the duality of CBs:
- Positive adaptation for some
- Distortion in relationships for others (Field, 2006)

To explore how CBs affect Italian mothers facing perinatal loss and the social strategies that can be employed for psychological support.

Participants: 15 Italian women who experienced perinatal loss between the fifth and ninth months of pregnancy (1992-2018).
Mean time since loss: 6.45 years.
Demographics of Participants:
- Age range: 22 to 40 years (mean age 31.6).
- Religious backgrounds varied; all participants had a partner at loss time.

Duration: 90 minutes each, adopting a narrative perspective.
Method: Qualitative-phenomenological approach via Interpretative Phenomenological Analysis (IPA).
IBs: Detailed narratives to explore the experience of loss and the nature of CBs.
Ethical considerations: Consent obtained, confidentiality maintained, and ethical approval from the University of Padova.

CBs manifested differently across narratives, ranging from symbolic elements to internal dialogues with the deceased.
Examples:
- Barbara sees her deceased daughter as a constant presence through small signs (e.g., butterflies).
- Giada’s children connect to their deceased brother in their play.

Guilt surfaced as a recurrent theme in narratives; participants often felt responsible for the loss.
Stigmatization of mothers leading to feelings of shame was common.
Some mothers actively sought forgiveness from their lost children, indicating an unresolved sense of guilt.

Positive partnerships and social networks were vital for coping with grief.
Personal relationships with partners helped mothers manage grief effectively while negative relationships led to sustained sorrow and unresolved grief.

Findings emphasize the intricate nature of CBs and their varying roles in bereavement.
The absence of social support exacerbated feelings of guilt and unresolved grief.
Evidence supports the need for interventions by social workers to develop effective coping strategies.
Recommended integrating psychodrama and art therapies into care practices for maternal grief management.

Limitations: Varying time since loss among participants and different methods of interviews (in-person vs. video call), which might influence intimacy in responses.
Recommendations: Future studies should explore support systems beyond mothers, focusing on fathers' and siblings' grief narratives, and interventions to address the stigma around perinatal loss.

Thanks to Novella C. Buiani and Erika Zerbini for their contributions to perinatal grief awareness.

Ines Testoni: Psychotherapist and professor specializing in death studies at the University of Padua.
Jenni Bregoli: Clinical psychologist specializing in perinatal mourning.
Sara Pompele: Clinical psychologist in fatal disease management.
Andrea Maccarini: Professor of sociology at the University of Padua.