The loss of a baby and the birth of the next infant: The mother's experience

Abstract

This paper considers the area of perinatal death by focusing on the mother's experience. An argument is made for questioning whether mothers attempt to replace a dead infant. It is suggested instead that they long to mother their lost baby and as a result their new infant is mothered in the shadow of the dead baby. The term ‘penumbra baby’ is suggested instead of ‘replacement baby’. Literature is considered from an historical perspective. Three clinical cases are discussed: one patient was seen immediately following a late miscarriage, the second soon after an intrauterine death and the third patient during both her pregnancy and the post-natal period, following a neonatal death. Consideration is given to the relationship between the parental couple when there has been a perinatal loss, and the way this may impact on the woman's ability to mourn and regain her emotional well-being.

Résumé

En se focalisant sur le vécu de la mère, l'auteur explore divers aspects de la mort périnatale. Cet article met en doute l'idée reçue selon laquelle la mère cherche à remplacer son enfant mort. Selon l'auteur, la mère a plutôt envie de materner son enfant perdu, de sorte que son nouveau bébé est élevé dans l'ombre de celui qui est mort. II serait donc plus exact d'utiliser le terme „ bébé du pénombre “ plutôt que celui de „ bébé de remplacement “. Divers textes portant sur ce thème sont examinés selon une perspective historique. Trois études cliniques sont proposées : la première patiente est vue en consultation aussitôt après une fausse couche survenue tardivement au cours de sa grossesse, la deuxième peu après la mort intra-utérine du fœtus et la troisième pendant sa grossesse puis au cours de la période postnatale à la suite du décès de son nouveau-né. L'auteur souligne l'importance de la relation au sein du couple parental en cas de mort périnatale et l'influence de cette relation sur la capacité de la mère à faire le deuil de son enfant et à retrouver son bien-être émotionnel.

Riassunto

Nell'articolo viene considerata l'area della morte perinatale focalizzandosi sull'esperienza materna. Si contesta che la madre rimpiazzi il bambino morto. Si suggerisce invece il desiderio materno di far da madre al bambino perso e come risultato il nuovo neonato viene accudito all'ombra di quello morto. Viene suggerito il termine di ‘neonato nella penombra’ invece che ‘neonato di rimpiazzamento’. Viene considerata la letteratura da una prospettiva storica. Si discutono tre casi clinici: una paziente fu vista immediatamente di seguito ad un aborto tardivo, la seconda subito dopo una morte intrauterina e la terza sia durante la gravidanza che nel periodo post-natale successivo alla morte del neonato. Vengono fatte delle considerazioni sulla relazione tra i genitori quando c'é una morte perinatale, ed il modo in cui questa influenza l'abilità della donna ad elaborare il lutto e riacquistare il suo benessere emotivo.

Keywords:

• Perinatal death
• stillbirth
• late miscarriage
• mourning
• replacement child
• penumbra baby
• anniversary dates

Mots-clés:

• Mort périnatale
• enfant mort-né
• fausse couche tardive
• deuil
• enfant de remplacement
• bébé du pénombre
• dates anniversaires

Parole chiave:

• morte perinatale
• bambino nato morto
• elaborazione del lutto
• bambino di rimpiazzamento
• bambino in penombra
• date di anniversario

Acknowledgements

I should like to thank Gianna Williams, Michael Rustin, Margaret Rustin and Margot Waddell for their supervision and support. I should also like to acknowledge the supervision I received from Sandra Stone as a trainee child psychotherapist. She most generously shared with me her knowledge about perinatal loss.

Notes

This article is based on a paper given at a conference at the Tavistock Marital Studies Institute in collaboration with the Tavistock Clinic in London, July 2003: The prospect and experience of the death of a child: impact on parents, families and professionals.