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Pregnancy and Infant Loss
Risk Factors &
Treatment Issues
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
AllCEUs Counselor Continuing Education

CEUs available at:

– Identify risk and protective factors for
– Prematurity/Miscarriage/Stillbirth
– Sudden Infant Death Syndrome
– Explore treatment issues for the family
Risk Factors for Miscarriage/Stillbirth
– Miscarriages occur before 20 weeks.
– Prevalence: 10-25% of all pregnancies (or more)
– ~20% of miscarriages happen in the first trimester
– 1-5% of miscarriages happen in the second trimester
– Stillbirths occur after 20 weeks
– ~1:100 births in developed countries (24,000/year in the US) and 3:100 in less developed areas

Risk Factors for Miscarriage/Stillbirth
– Prematurity
– Impacts 1 in 10 births in the US
– 17% of preterm infants die
– Many times the cause of the preterm labor is unknown but risk factors are similar to those for miscarriage
– Although the infant is born alive, the parent
– Is deprived of the idealized pregnancy
– Has to leave the hospital without baby (psychological and hormonal implications)
– May not be able to hold or even touch baby for days or weeks
– Knows that the statistics for complications and death are grim
– The peak incidence of SIDS occurs between 1 – 4 months of age
– 90% of cases occur before 6 months of age
– Babies continue to be at risk for SIDS up to 12 months
Risk Factor Summary (What do you notice?)
Risk Factors for SIDS
– Unhealthy pregnancy
– Drug exposure (including nicotine)
– Low weight gain (nausea)
– Placental issues
– History of infections (STDs, bacterial vaginosis, UTIs)
– Child factors
– Prematurity
– URI within 4 weeks
– Low birth weight
– Siblings who died of SIDS
– Sleep environments
– Stomach or side sleeping
– Loose blankets / inappropriate sleep surface
– Smoke exposure
– Bed sharing
– Overheating

Treatment Issues
– General
– In the birth parent
– Grief (complicated)
– A person looks at the pregnancy as part of themselves and when it is lost, there is an emptiness, searching and incompleteness
– Depression (up to 55%)
– Guilt and self anger: Shouldas, “I didn’t do it right”
– Guilt for having happy feelings
– Feeling incompetent: “The most natural thing in the world”
– Relief esp. for unplanned or problematic pregnancies
– Postpartum depression
Treatment Issues
– General
– Complicating Issues
– If it required the birth process or a DNC
– Waiting for a natural miscarriage to occur after a fetus has died in utero can be psychologically debilitating for parents
– Having to go to the OBGYNs office for follow up
– Seeing other newborns in public
– If it was a multiple delivery and one baby survived
– If it resulted in the parent becoming sterile
Treatment Issues
– General
– In the other parent
– Grief (complicated)
– Anger
– Relief
– Difficulty understanding why the pregnant parent is taking it so hard
– Anxiety about having another pregnancy
– Determination to get pregnant again as quickly as possible
Treatment Issues
– General
– In extended family
– Grief
– Anger/blame
– In the siblings
– Lack of understanding of what happened
– Relief
– Disappointment
– Resentment that parents aren’t instantly okay
For the Siblings
– It is important to remember the developmental capacities of children including egocentrism and making assumptions based on their limited knowledge.
– Younger children may view a new sibling like a present and want to know why you can’t just get another one
– They may feel rejected or like they are not enough when parents are grieving the loss of this child they never got to see or interact with
– They may fear that the parents will “make them go away” too and become more anxious
– They may be happy because they now have parents all to themselves which may cause friction with the grieving parents
– Learn about what happened and implications for the future (Everyone) to help reduce guilt, blame, and anxiety.
– Understand the grief process is not linear and is not the same for any two people—even in the same family
– Remember like other losses, this grief will take time to process and may flare up for a year or more
– Decide, when you are ready, what to do with your maternity clothes and baby items
– Consider joining a support group or seeing a counselor
– Consider commemorating the child’s life with a birthstone or scrapbook (ultrasounds etc.)

– Practice self care
– Recognize that the body has gone through a trauma and pregnancy induced adaptations will take time to resolve
– Give yourself permission to grieve and also to be happy
– Recognize that another pregnancy will not lessen the grief and may actually increase anxiety and depression

For the Partner
– Talk, listen and process together and with your own supports
– Practice your own self care
– Help eliminate triggers in the immediate environment if wanted
– Reaffirm the loss was not your partner’s fault
– Help share the news with friends and family so your partner is not bombarded with questions or sympathy
– Recognize that your partner’s body has to go through the postpartum process.
– Pregnancy and infant loss are devastating
– Many times there is no clear explanation for why it happened which flies in the face of closure
– Often times well meaning family and friends may probe for “explanations” and it feels like they are blaming the birth parent.
– Parents may share some similar reactions, but they also may have very different reactions, so it is important not to assume you know how either one feels.
– Prematurity, miscarriage, stillbirth and infant death all have unique issues, but all represent a loss