Fathers and Perinatal Loss Pt. 17: Ryan's Grief Scores

Tracy Schaperow, Psy.D.

Tracy Schaperow

Licensed Clinical Psychologist


This article is part of a larger work.

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Initial Responses to Belinda’s Death. When Ryan first learned that Belinda had died in-utero, he responded with shock, sadness, and helplessness. He described his shock by stating, “I was so surprised that I didn’t know whether to sit or to stand.” Ryan explained that he felt extremely sad when he noticed that Belinda’s shoulders were hunched over, noting, “It was just the saddest day.” Ryan felt helpless over not being able to do anything to make Belinda better. He stated, “All we could do was wait for the hospital to open up and that was it.”

Ryan talked at length about Belinda’s delivery. Although he knew that her death was negative, he tried to “turn the day [of delivery] around and not let it be a bad day.” Throughout the interview, he explained that he focused on the “good” and on the “present” because he knew he only had a limited amount of time with Belinda. The following narrative illustrates how Ryan stayed focused on the “present” and on the “positive” the day of delivery:

It was a really good experience because we were focusing on the good, instead of focusing on the path of, what we could have done to avoid it. We were in the present, and it was actually the most in the present I have ever had. We were there for that moment and I have never felt like that before. It’s just we knew that we didn’t have much time with her. And I think that helped us because if you concentrate on the good part of her life, you will remember them better. What we did was concentrate on that, and that we knew we only had a limited time with her. . . Being there, in the present, was really, really helpful because we were able to remember more.

When Belinda was born, Ryan was excited. He ran out of the delivery room, and shouted, “Oh, It’s a girl!.” He felt proud of Belinda, and described her as if she were alive:

She delivered and came out perfect in every way. She actually couldn’t close her mouth. Her mouth was propped open and every time we tried to take a picture, we tried to close her mouth. And she’d open it up. So, we realized that she was trying to say something.

With his friends and family, Ryan both bonded with Belinda and celebrated her birth. He dressed her, covered her with a blanket, and took pictures of her with everyone at the delivery. Ryan made handprints and footprints of Belinda, which he described as “really cool because with just pictures, you can’t really feel and touch.” He was proud of making the molds because he learned that he was the first father that the nurse saw make them.

After celebrating Belinda’s birth, Ryan learned that his wife, Megan, was bleeding internally. The doctors had punctured her uterus when they did a Dilation and Curettage procedure (not all of the placenta came out when Belinda was born). Ryan became anxious, fearing that he not only had lost Belinda, but that he would also lose Megan:

For about thirty-two hours, she was bleeding internally. And that was pretty drastic for me because I thought I would lose her too. It really scared me. We couldn’t move her . . .at all. We had to cut her open. It was really scary for me.

Fortunately, the doctor was able to drain the blood and allow Megan’s uterus to heal. Ryan felt relieved.

Ryan received a lot of support from friends and family, both on the day of Belinda’s delivery and at her funeral. Between four and twenty people were at the hospital for delivery, while over one hundred attended the funeral. He reported that this support “. . . validated the fact that what we had to go through was real.” Ryan felt that having friends and family at the delivery and funeral extended their support because “. . . they [friends and family] were able to understand what’s going on a little bit more.”

The First Three Months After the Loss to the Present. During the interview, Ryan talked at length about how he feels disorganized and in a state of “disarray” since Belinda’s death. He has had a great deal of trouble concentrating, prioritizing, completing projects, and being on time for appointments. The following narrative illustrates Ryan’s struggle in completing tasks and prioritizing:

One of the hard parts for me is there’s like a thousand things to get accomplished and I can’t accomplish anything. It’s like I can’t finish a task. I can’t find the time to finish a task. I would rather start a new task than finish an old task. And then I have other things on my list because I am creating a bigger list by not finishing anything. I mean, if you had to put your finger on the hardest thing, that being in a state of disorganization constantly and then just not being able to prioritize things. That’s my biggest problem.

Ryan’s state of disorganization has led to difficulty at work. He described feeling “scatter-brained” and feeling as if his thoughts were “mushpot” when he works. He feels frustrated over this feeling: “It is the most foreign thing to me I have ever had.” To illustrate, Ryan provided the following example:

Like yesterday I went to the office to go print. I had to print like five things and do some other stuff. It took me all day because everyone was asking me questions and we got a new machine at the office, and it’s just so compounded with things like that.

Ryan described time as passing “really, really slow” since Belinda’s death. He reported that every day seems extremely long, and that it is hard for him to believe that it has only been three months since the loss.

Ryan expressed a variety of strong emotions in response to Belinda’s death. One of his most notable experiences was his sense of guilt and self-blame. Although he reported that he “knew” that he did not cause her death, he still felt that it was his fault. In one instance, he blamed himself after having painted her crib, when he noticed that the paint can said that it could cause a reproductive trauma. Ryan further explained this incident in the following narrative:

Even though it was only really harmful if you’re a painter, it [her death] happened around the same time. So, in the back of my mind, I said, “You kind of created this problem.” I feel that it [her death] is partly my fault.

On another occasion, Ryan found some mold on his bathroom wallpaper, and thought that it caused her death. He immediately stripped the wallpaper and scrubbed the walls.

Ryan’s guilt and self-blame also came in the form of wondering whether or not he could have done something to prevent her death. The following narrative further illustrates these feelings:

What if I, what if she could have been on complete bedrest? Then would this have happened? What if that time I made her go to the store and she didn’t do it? Of what if that one time we had sex we wouldn’t have done that?

Ryan also described feeling guilty about having any “good” feelings, which he explained by stating, “Even if you have a good minute, it’s a bad minute because you feel guilty for being in a good minute.”

In addition to feeling guilty, Ryan felt angry. Since Belinda’s death, Ryan found himself easily agitated. Although he was not angry at “anyone in particular,” he found himself directing his anger toward his coworkers by yelling at them. To further illustrate his anger, Ryan provided the following description:

It’s like you’re holding an automatic rifle and just spinning around trying to hit anything. You’re angry at your parents. You’re angry at your spouse. You’re angry at yourself. You’re angry at the people. You’re angry at everyone and everything because you happen to be the one going through it.

Ryan continues to feel sad about Belinda’s death. He was somewhat

confused by this emotion, describing it as being “tied up” with other emotions, such as fear and regret.

Ryan has spent a great deal of time worrying about his wife’s well-being. He described “. . . constantly worrying about how she is doing,” especially while he is at work.

Ryan experiences his emotions as a “roller coaster.” That is, their intensity goes up and down. As time has passed, the intensity of these emotions has dissipated, and he has experienced them less often. To illustrate his “roller coaster” of feelings, Ryan provided the following description:

The way I try to describe it is when it first happened, it was every feeling that you have, whether it was good or bad, turned on at all times. And then some of them turned off. Like I had anger, I had regret, I had guilt, I had pain, I had happiness. I had everything you can think of. I was dead tired at the end of the day because I had all of these emotions turned on. Then slowly, the happiness turned off, and slowly the sadness turned off, and then the happiness turned back on and then sooner or later, you go from having everything on to like some of them on.

One of the biggest changes for Ryan since Belinda’s death is that he plans his life less than he did before. He is now more present-focused. He feels that he is tired of planning his entire life and having it not “work out.” To further illustrate why he plans his life less, Ryan stated, “It’s like I can’t plan anymore. I mean I planned my whole life for all these things and when we wanted to get pregnant, we started this month because we wanted to have a baby this month.” He now buys items more impulsively and enjoys not saving his money for the future. Ryan also engages in prospective mourning, reporting that he often imagines “. . . what could have been and what was.”

Ryan believes that Belinda’s death has “intensified” his relationship with Megan, describing every event and emotion in their relationship, whether positive or negative, as more powerful than before. To illustrate these changes in his relationship with her, Ryan provided the following description:

Everything is more intensified than it was before. Loving feelings are more intensified. Anger feelings are more intensified. Everything is just one notch up. And it’s not always easy being one notch up. It’s not always bad either. It’s a weird mix. I don’t know how to describe it, but like everything is just a little bit more important, even if it’s stupid little things like taking out the trash. Now that issue is more important. Spending more time together is more important than finishing a project.

Ryan also described Megan’s moods as “inconsistent” since the loss. That is, her moods fluctuate and are not predictable. He finds that coping with a partner who is “inconsistent” is difficult because he can not predict what will be important to her when he sees her. To exemplify, he stated, “Small things, like her cleaning, are either completely irrelevant or paramount [to Megan], and I never know when it is which. It’s not as consistent as it was before. I never know what it’s going to be.” This inconsistency had led Ryan to a state of feeling helpless.

Another challenge in Ryan’s relationship with Megan is that their moods are often incongruent. He stated, “ A lot of times she’s up and I’d be down or vice versa.” Ryan further explains how difficult it is for him to be in a different mood than Megan in the following narrative:

And like, if I was in a happy mood, that I had put myself into, dealing with her being down is a little bit harder but it was even harder to be supportive when I was down as well.

In addition, he often fears bringing up Belinda’s death to Megan because, if she is “feeling good,” he does not want to make her “feel bad.”

Ryan has coped with Belinda’s death in a variety of ways. He talked at length about how he started a fund to create packages of baby items for parents after they have a miscarriage, a stillbirth, or a neonatal death. He was enthusiastic about this project, and proudly explained how he created “a huge following” of people who donated money, totaling about $3,000.00. These donations made Ryan feel excited, as he stated, “Wow! People really care.” Ryan described his project in the following narrative:

Inside these packages we had some stuff for when the baby died. They have baby blankets, baby clothes, and a camera so people could take pictures. It was just the personal touch that we wanted. We are also creating cards for people, if they want them, for every year – to show that someone is thinking of them. We gave birth certificates because if you have a stillbirth, you can’t get a birth certificate because it is a certificate of a live birth.

Similar to when Dennis described the casket he made, Ryan described these packages with pride and great detail:

Like the boxes. I just sit there and go “Wow!” You know, not to pat ourselves on the back, I was like “Wow.” I mean everyone chipped in and they made this beautiful thing that someone can take home. We bought wedding cameras too. I mean those packages are really complete because we bought wedding cameras because that’s what we could get at Party City. . . We took all the cases off the cameras so we just have a plain camera. That’s not good enough for us. So we actually made new jackets for all the cameras. They have a little pink and blue and have all the directions for the camera. We cut out all the holes. It allowed us to do some really cool things.

Ryan felt that creating these packages helped him “channel my grief” and was a “real outlet.”

Another way that Ryan has coped with the pain he experienced after Belinda’s death was to attend a perinatal loss support group. He feels that this group has given him an opportunity to talk about her death, which he has thought that he has needed to do. In the following narrative, Ryan described how the support group has helped him cope with the loss:

Right now, I mean we’re in need of support right now. And it’s actually very helpful and we went last night. We were able to meet with people on this. It was very good. It’s always good to sit down and talk about the story. We kind of feel the need to talk about it. We could talk about it between ourselves, but it’s also nice to talk to other people who understand what is going on. Because not everyone does.

For Ryan, it has been important to share his story about his loss. Moreover, he built a web site that described how she died.

Ryan has also coped with the loss by educating himself about the physical causes of her death. He stated that he wanted to “. . . gather as much objective information as possible.”

Difference Between the Two Losses. This additional section has been added to Ryan’s results because he repeatedly discussed how he experienced the loss of Pat and Belinda differently. He explained how losing Pat was not as difficult for him as compared to the loss of Belinda, because he was not as bonded with Pat. He was much more involved in Megan’s pregnancy with Belinda, seeing her image in many ultrasounds. He felt that in the pregnancy with Belinda, he was “. . . more a part of the process of what was going on.”

Ryan rated his grief after Pat’s death as much less severe than his grief after Belinda’s death. To illustrate, he stated:

Let’s just say that one to ten, ten being the worse possible situation, I’d probably rate it [Pat’s death] one to two. Not super important, not super painful, but not something you can just “sluff” off in two days. . . [for Belinda’s death] I’d probably say with myself that it would probably be somewhere around eight or nine.

He also compared his reactions to each of their losses with the following metaphor:

[with feelings about Pat’s death] I could just put it in its own little box and put it aside. But having it happen like it happened with Belinda, it’s a lot bigger box and you know, it doesn’t close well. And that’s part of the reason I’ve been so, just a mess. The box doesn’t close.

The Perinatal Grief Scale

Ryan completed the PGS in the beginning of the first meeting. His scores were then computed and compared to the means and standard deviations of the PGS. These means and standard deviations were found in the validation study of this instrument (Potvin, Lasker, and Toedter’s,1989). Ryan’s total score was 98, indicating that his total amount of grief was .3 standard deviations above the mean (see Table XIV). His score for the Active Grief (also known as normal grief) subscale was 38, which is .23 standard deviation below the mean. On Ryan’s Difficulty Coping subscale he scored a 34, which is .82 standard deviations above the mean. On his Despair subscale, he scored 26, which is .21 standard deviation above the mean. Essentially, Ryan scored above the mean in his total score, Difficulty Coping score, and Despair score, while scoring below the mean in his Active Grief score.


Table XIV.

Ryan’s Perinatal Grief Scale Scores (compared to reference scores6)

image

image

Active Grief Difficulty Coping Despair Total Score

Ryan

Mean

SD

Ryan

Mean

SD

Ryan

Mean

SD

Ryan

Mean

SD

38

39.92

8.25

34

26.97

8.53

26

24.41

7.70

98

91.31

21.16

 

image

The reference group scores were taken from Potvin, Lasker, and Toedter’s (1989) validation study.

The following pages contain two tables of the results of the rater’s responses to the T.A.T. and the C.A.T.-H. Table fifteen illustrates the results of the T.A.T.; table sixteen, the C.A.T.-H. These tables list each rater’s description of the themes, distress level, and defenses of Ryan’s stories to each of the cards used in the study.


Table XV.

Ryan’s T.A.T. Results

Ryan's T.A.T. Results


Table XVI.

Ryan's C.A.T.-H Results

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Brief Commentary on Ryan’s Results

Ryan’s interview, PGS, T.A.T., and C.A.T.-H results were consistent with each other, all indicating that he was struggling with his losses. As noted earlier, during his interview, he talked at length about how he was struggling since his stillbirth. Rater one noted that card 3BM of his T.A.T. and card 3 of his C.A.T.-H revealed that he was experiencing a sense of loss. Similarly, his elevated Difficulty Coping and Despair subscale scores on his PGS suggests that he was having difficulty dealing with both people and activities, and had the potential for serious and long-lasting effects of the loss. Because it is beyond the scope of this chapter to further discuss these findings, these results will be discussed in greater detail in Chapter five.



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