articulate their needs. Less educated, lower income women often express a sense of isolation and a lack of support in attempting to cope with their loss. An infant death is unexpected, so there may be no rituals or traditions passed along to support grieving parents through the tragedy. Also, grieving parents typically have no access to the understanding and empathy that can only be provided by others who have also experienced the loss of a child. Bereaved women often do not know other African American women who are also grieving the loss of their babies. Therefore, there may be no support network. Mothers tend to internalize their pain, in part because they feel that they are the only ones that are experiencing such loss.
Funds for burial are also an issue. Most women interviewed wanted to have a burial, but could not afford it. Some hospitals offer free cremation, but in most cases it is a group crema- tion of several people. Generally, the women are unable to recover their own baby’s ashes and so they prefer to have a burial. Occasionally, a funeral home or a community member will donate services but most mothers must settle for a group cremation. This is another source of pain because their baby is lost again--cremated with other people.
Different issues arise when a fetal or infant loss occurs in the hospital. Even though the mother may feel very isolated in her community after she has gone home, at the hospi- tal relatives and friends arrive to be supportive. Hospital staff should provide adequate space to accommodate the visitors. Regardless of family functioning, all the relatives will visit. Even though they haven’t seen each other in years, the word goes out that a baby has died and all of these family members are going to show up to give support. They will all be quite distraught, yet they will be an important source of support to the mother and to each other.
The few days or so after a woman loses an infant or a fetus in the hospital, there may be much support. The hospital staff may have given her a bereavement packet with some information. If she delivered between 8:00 a.m and 5:00 p.m. on a weekday, a social worker may have talked to her. Friends and family visit to express condolences and share the grief. However, after a while, hospital staff have moved on, and family members go their own ways and return to their routines. Then, the mother is left alone with no one available to discuss her feelings. Consequently, the woman has no one who understands her experience of grieving the loss of a child. She doesn’t have the verbal or written lan- guage skills to express her needs. She is locked inside of herself with her pain. The ability to articulate her emotions may be limited. Consequently, staff may think, “Well, she’s stoic. You know, she’s internalizing this and does not need help.” In reality, she just has difficulty expressing her emotions. As health professionals, it is important to remember that lack of emotional expression may not reflect the emotional state.
Another observation is that most if not all women who lose a baby have a certain sense of guilt. Almost any mother feels responsible for her children’s welfare, and she tends to feel guilty over every bad thing that happens to them, including death. Many mothers will feel responsible for the loss, no matter what cause is listed on the death certificate. Some women blame themselves for the death of their child and view it as some form of punishment, and some women blame their social and economic circumstances.
“We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.” —Martin Luther King, Jr., Letter from a Birmingham Jail, 1963
VOICES FROM THE COMMUNITY: CROSS CULTURAL EXPRESSIONS OF GRIEF AT THE LOSS OF AN INFANT
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