Couples cope in different ways following death of premature baby

Most parents who have lost a premature baby still hold the baby in a central place in their lives two to six years after the baby's death, physicians report in a new small study.

According to lead author Stefan Büchi, M.D., how they share this grief and suffering depends on the emotional exchange and communication between the partners.

"Our research indicates that communicating about the death of a baby can be very important," says Büchi. "It is natural to grieve alone, but if a couple is not communicating about the loss of their baby within the first year after death, I would encourage them to seek professional help."

Büchi, who heads the division of psychosomatics at Hohenegg, the Clinic for Psychotherapy and Psychosomatics, in Meilen, Switzerland says, "Communication appears to be crucial for a process of concordant grief."

Concordant couples share similar feelings about the death of their baby. With discordant couples, however, the death affects one partner less- or that is what their partner perceives. When discordant couples differ considerably in their grief, it might be that the father is less likely to acknowledge the extent of his distress. "Men often don't talk about being sad," Büchi said.

He suspects that non-shared grief isolates partners, whereas the experience of shared grief encourages intimacy and the feeling of belonging together, thereby benefiting the parents' relationship.

This research on neonatal bereavement came from parents who had given birth to a baby at 24 to 26 weeks at the University Hospital in Zurich. Forty-four parents (22 couples) completed questionnaires regarding grief, anxiety, depression and post-traumatic growth. Doctors interviewed six couples at length.

The study appears in the March-April issue of the journal Psychosomatics .

Büchi was surprised to learn that the death of babies induced an enormous process of personal change in most couples that they described somehow as also positive, called post-traumatic growth. For example, couples described a new quality to their relationships - especially with one another. Parents also experienced a changed philosophy of life with new priorities, appreciation and spirituality.

His biggest surprise in this research, however, was that the suffering of fathers in concordant relationships ranked as greater than that of mothers. "I think there is no other research data that would point to this finding."

Camille Wortman, Ph.D., a professor of social and health psychology at Stony Brook University, said the researchers draw conclusions that might be unwarranted. The study has a cross-sectional design, with all variables assessed at a single point time. "It is not possible to infer causality from such a design," she said.

For instance, she questioned Büchi's finding that parents' grief and suffering led to post-traumatic growth. "Causality could just as well be operating in the opposite direction, with post-traumatic growth influencing the nature of interactions exhibited between the spouses," she said. "Suffering, depression and anxiety may influence interaction, too. For all of these reasons, I believe it is premature to follow the investigators' suggestion of alerting clinicians who treat the bereaved about these findings."

Psychosomatics, the official journal of the Academy of Psychosomatic Medicine, publishes peer-reviewed research and clinical experiences in the practice of psychosomatic medicine/consultation-liaison psychiatry. For information about the journal, contact the Editor-in-Chief of Psychosomatics (Ted Stern, M.D.), at [email protected]

Büchi, et al. Shared or discordant grief in couples 2-6 years after the death of their premature baby: effects on suffering and posttraumatic growth. Psychosomatics 50(2), 2008.

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