How to talk about perinatal bereavement (or other trauma) with our children?
A small theoretical framework and some practical ideas to keep trust and honesty at the center of the relationship with our children, small or large.
Give the word to pain: pain that does not speak
she whispers to the oppressed heart and tells it to break
William Shakespeare
Premise: perinatal bereavement as a psychological trauma
The term trauma derives from the Greek τραῦμα (-ατος) “wound” and can be considered as ” The effect of an event or stimulus perceived as perturbing that tends to upset, to hurt precisely, the dynamic organization reached by an individual or a system . ”
Trauma is therefore the abrupt and violent acquisition of very emotionally charged and completely frightening and unacceptable experiences for the person and his / her context. This experience is such as to completely distort the previous biopsychosocial learning. Everything is called into question, everyone feels on the high seas, at the mercy of the waves.
The trauma in perinatal bereavement is linked to the direct contact of the subject with the reality of death in an abrupt , non-mediated and not immediately processable way.
When we talk about psychological trauma we are talking about something that has no meaning and is not significant: the trauma corresponds to the impossibility of giving a meaning and a meaning, coherent and psychologically viable, to an episode that is located “outside” the life experience normal of the individual. None of us would like to have this experience and face its quirkiness.
We define grief, serious illness, accidents, loss of personal security as trauma.
The death of a child during pregnancy or after childbirth is a full-fledged trauma: it abruptly and violently interrupts the parenting process and the bond with the child, it is an emotional shock of great intensity and produces a deep and pervasive bereavement. which can last from 6 months up to two years following the event.
What happens after a trauma?
Precisely as a wound, a break in continuity, a traumatic event triggers an intense reaction with different consequences, on an emotional, cognitive and physical level.
The traumatic experience, unwanted and full of suffering, is difficult to express externally, one would like to remove it and it appears as untellable, inexpressible with the word. If neglected or not welcomed, the traumatic experience cannot be processed and risks remaining in the body.
It is very common for traumatized people to experience very intense physical reactions, flashbacks and intrusive thoughts as if they were constantly living “inside the trauma” in a sort of infinite present with no possibility of integration.
The possibility of expressing the traumatic event through a metaphor or a story resizes the disruptive charge of the trauma, lightens its presence and makes it tellable by triggering a process of acceptance that is precious for integration into one’s life story.
It is possible and appropriate to tell the traumatic event as a story that has a beginning, a center and an end.
The simple and honest story allows to elaborate the trauma and to place it in the past; it is very important to do this narrative process not only for oneself but also for the other family members, especially for the children of the family.
The story avoids the creation of the “family secret”, the destructive event that cannot be named and that we find at the basis of numerous stories of suffering that remain intact one generation after another.
Family secrets
Family secrets include a wide range of topics that are kept hidden, because they are considered unspeakable in the family: adults and children do NOT talk about the secret event, even if everyone knows that something has happened, children cannot know any details. In the worst cases, children know nothing and receive no explanations for their questions.
Among the most frequent family secrets we find: negative past experiences, adoption and infertility, alcoholism, extramarital affairs and trauma such as suicide, physical and mental illness of a relative and death.
These events are veiled in secrecy, as are the griefs that occurred before the birth of the child or at a very early age, whether they are the deaths of grandparents or uncles or perinatal bereavement.
The desire to protect children from the suffering generated by certain sensitive topics (because painful or because scandalous) is human and understandable: many parents would like to take on all the burden of pain linked to an event, so that their children do not suffer, in a rush of overprotectiveness which, however, is “double-edged”.
It is necessary to understand well that choosing the secret or the secret means involves risks that should be taken into account.
Children are growing people and as such they are extremely receptive to external changes: any perturbation of the family system (or of the class group) is read and codified from within: the reading of experiences is the basis for knowing the world and learning to inhabit it. . It is therefore undeniable that any experience, even if complex and painful, if well accompanied is a source of learning and allows the child to acquire information while feeling protected by his or her reference adults.
Precisely for this reason linked to their growth, children are real barometers of the family climate and are therefore particularly vulnerable in the face of a stormy climate accompanied by an aura of secrecy or a reaction of fake reassurance: their self-regulation skills are still evolving and if the answers are inconsistent or are missing the child will learn that in the face of pain you can only ignore your emotions and ignore them.
Furthermore, as previously mentioned, an unprocessed trauma can give rise to flashbacks and intrusive thoughts: when parents are traumatized, children can experience the attentional and emotional “disconnections” that unfortunately accompany the trauma and this can make the child tiring. attachment and relationship.
What to tell, how and when
We have seen that narrating family trauma to all family members is a protective factor and allows for greater integration of information and personal and family history.
All this is extremely important when there has been a history of the child’s illness or prematurity, in cases of long hospitalizations of the child or mother or in cases of perinatal bereavement where there are already children at home or where new children are subsequently born ( the so-called “rainbow” children).
What to tell?
Building a narratable story involves thinking carefully about the internal coherence of the story, what is important to tell in order for the story to be understandable and what can be omitted.
It is also necessary to consider that telling what happened to the little brother we were expecting is a task we take care of in the hours following the bereavement (with an intense traumatic load, as we said before), while telling children born after the story of a little brother or a little sister dead is a process with less pressing times, which we can face with relative calm.
Even if overwhelmed by grief, we can do a good storytelling of the event for our other children, with little tricks.
The narrative of an acute event will be:
- short (two or three sentences accompanied by body language, such as standing at the same height as the baby, speaking in a calm voice, hugging him or shaking his hand are a great start and may be enough)
- realistic (because our children will continue to work on it and ask us for further explanations or ask us questions later)
- kind (we choose terms that describe allowing the child to understand, with the time and resources he has, without expecting his reactions different from his: he is a child!)
- honest (let’s avoid lies)
- concrete
- accompanied by a short sentence that tells about our emotions.
If we are talking about a baby who died during pregnancy, we can tell that the baby we were expecting was born too early / had a heart that was too small and was unable to survive and stay with us. How much to deepen and what words to use depends on the age of the children we are telling. Let’s take into account that abstract thinking is not yet structured before the age of 7/8. If we say something like, “Jesus took it”, the little child will truly believe that Jesus can take the children and may perhaps be frightened by this idea. Small children are concrete, and the stories we tell must be oriented as much as possible to concreteness.
When to tell?
Often we want to be driven by the urge to share with our child and to explain the grief, which we do not even know how to explain to ourselves. The urgency to say, without knowing what to say, risks precipitating things and making us make choices that are not very functional. Let’s take a few hours, up to a day, a day and a half after the traumatic event to choose the right words for us. The “right words” are chosen by the mother and father (if there are both) or by the parent present and must be communicated to the rest of the family and to the nursery / nursery teachers etc. The narrative must be as uniform and coherent as possible for the parents and the child.
If it is true, in fact, that there is no perfect “recipe” to tell the story of mourning, it is also true that some important considerations must be clearly understood.
- I cannot tell another person in a non-traumatizing way (even a story can be) something that for me is still extremely painful and unspeakable because the overwhelming emotions risk overwhelming both me and the child.
- The story must be the story of our history, of our family and must be immersed in the reality of the child.
- The story must use terms that are understandable at the age of the child but truthful and correct, avoiding turns of words.
- The narrative should not be too long but be exhaustive taking into account the main events.
When the children are already in the family and are experiencing the event “live” (not so much because they are present in the place of the loss, but because they are part of the family) it is neither possible nor desirable to wait for the traumatic memory of the parents to “cool down” “To be helped to elaborate and integrate the event into their personal and family history.
In these cases it is extremely important that, always with shared words and actions suitable for their age, children can participate in what is happening and can understand, through the story of their parents, the events, thoughts and emotions connected to them.
When the narration concerns an event from the past, for example the story of the death of the little brother to the rainbow child born one two years later, the story of the premature birth of the child and of the tin when the child is 3 or 4 years old, the story of infertility and of egg donation thanks to which the child was born) must take into account the emotional impact that telling the trauma can re-emerge. In fact, the traumatic wave risks overwhelming both the parent and the child. Not being an urgent situation, in this case we have the time to prepare ourselves and carefully choose the words to say to tell a significant piece of our family’s history.
It is very important that the parents talk to each other first and try to write the story and read it to each other before submitting it to the child.
If during the writing of the narrative or while trying to read it you realize that the trauma is still too emotionally charged, it is essential to first get help to process the trauma from a therapist and only then tell the child.
Finally, a note on “books” to tell children about traumatic events.
In acute, there is no book that replaces the authentic and coherent words of one’s parents.
In narrating a traumatic event from the past, significant as such, there is no book that can replace the storytelling work of the parents.
You can therefore find some accompanying books (this , and this ) but please pay attention to “themed” products (infertility, perinatal bereavement, etc.): the quality is so low that they respond more to the parents’ urgency to feel adequate than in order to build a narrative that protects against the effects of trauma effectively.
You may also be interested in this article and this one .
Article edited by
Dr. Micaela S. Darsena
Psychotherapist psychologist
perfected in perinatal clinical psychology
Lombard contact person for the CiaoLapo APSETS association
And
Dr. Claudia Ravaldi
Psychotherapist psychiatrist
perfected in perinatal clinical psychology
founder and president CiaoLapo APSETS
