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Similarities Among Participants Before the Loss
Most of the participants were similar in their desire for children, their excitement over the pregnancy, and their bonding with the baby before the death. Four out of the five participants described a strong desire for children. Dennis talked at length about wanting to be a father, even during his early childhood. Karl recalled “always” wanting to be a father, reporting that he fantasized about someday “. . . playing soccer and ball with my kids in the backyard.” Peter reported that he always knew that he would have kids some day. Ryan described “almost always” wanting children, deciding as an adult that he definitely wanted some. These participants’ longstanding desire for children is consistent with the literature reporting that the wish for children begins early in life (Diamond, 1995; Ross, 1975; Tyson & Tyson, 1990).
All five of the participants reported that they were excited about their pregnancy. Dennis reported that he loved his wife’s being pregnant, and was very excited to have a baby. Karl was excited about the pregnancy, making many behavioral preparations (e.g., buying a crib and painting a bureau) for the upcoming baby. Peter described the pregnancy as a positive experience, feeling extremely excited about the pregnancy as he and his wife had taken a long time to conceive this second child. Ryan described feeling very excited over the first pregnancy. For his second pregnancy, he felt both excited and scared, as it was soon after the miscarriage. Raymond grew more excited about the pregnancy as it progressed; however, his excitement dissipated when he learned that his son most likely had Down’s Syndrome.
All of the participants described bonding with their baby before the death. Dennis described how excited he was to bond with Susan while she was still alive. He talked about putting a cereal bowl on his wife’s stomach every evening to see it move as the baby kicked. Recalling these times gave him much pleasure as it was the only time he saw his daughter move. Karl described being very involved with the pregnancy with Dana, attending ultrasound scan appointments, which made him feel more a part of the pregnancy. Raymond also felt as if he bonded with his son by attending ultrasound scan appointments and feeling him kick. Peter enjoyed bonding with Tabitha during the pregnancy. He attended her ultrasound scan appointments, felt her heartbeat, and described these experiences as “pretty phenomenal and amazing.” Ryan put a lot of effort into bonding with Belinda because he felt that he had never bonded with his previous daughter who had miscarried. During the pregnancy with Belinda, Ryan attended all of the ultrasound scan appointments, took several pictures of the ultrasound scans, built a web site to share those pictures with friends and family, and bought a heart monitor to “hear things happening.” He described the first time he saw Belinda’s ultrasound scan as “the coolest day of my life.”
These bonding experiences are important to discuss because closeness to a deceased individual has been associated with higher levels of grief (Bugen, 1977). Fathers’ bonding with their unborn children appears to be a more common phenomenon than a few decades ago. As women work outside of the home, fathers have been forced to change their gender roles from that of a few years ago. Today’s fathers are more involved with pregnancy and child rearing (Soule, Standley, & Copans, 1979). Today, fathers often say “we’re pregnant,” rather than a few decades ago when they would have said, “My wife is pregnant,” suggesting that they feel more a part of the pregnancy. For fathers, the use of ultrasound scans has increased the reality of the existence of their baby, and has allowed them to become more involved with the pregnancy. Hence, seeing the scans has also been documented to increase levels of grief when the baby dies (Johnson & Puddifoot, 1996; Puddifoot & Johnson, 1997). Although it is beyond the scope of this study to determine the influence of the ultrasound scans on fathers’ grief, it is likely that these fathers’ intense bonding magnified their grief responses after the death.
Emotional Consequences to the Loss
Shock and Numbness. Four of the five participants reported experiencing shock or numbness when their baby died. Dennis’s numbness came after Susan was delivered. He recalled sitting in a chair, facing out a window, and feeling like he wanted to scream, but could not. Karl’s numbness occurred right after he learned that Dana had died at her daycare center. He described feeling that the situation was surreal, and that he was dreaming. Raymond reported that, when he first learned that Bryan died in-utero, the only real feelings he experienced were shock and numbness. Ryan described feeling shocked after both his miscarriage and stillbirth. His shock was stronger when he learned of his stillbirth. He stated, “I was so surprised that I didn’t know whether to sit or stand.” These fathers’ initial experience of shock and numbness is consistent with the literature on general grief and perinatal grief (Bowlby, 1980; Freud, 1917; Frost & Condon, 1996; Kubler-Ross, 1970; Peppers & Knapp, 1980). Several models of grief have identified shock and/or numbness as the first phase of grief (Bowlby, 1980; Freud, 1917; Kubler- Ross, 1970). In his article “Mourning and Melancholia,” Freud (1917) identified shock and denial as the first of two steps in the mourning process. Bowlby (1980) identified numbing as the first stage of grief, occurring when the individual first learns of the loss. In her model of grief based on anticipated loss, Kubler-Ross (1970) characterized the first phase of grief, denial and isolation, by shock and numbness. Shock and/or numbness have also been identified in mothers after a perinatal loss (Frost & Condon, 1996; Peppers & Knapp, 1980).
Guilt and Sense of Responsibility. All participants felt a sense of guilt and responsibility for the death of their child. The participants’ guilt and responsibility was generally over not being able to do more to prevent the baby’s death, feeling that they somehow caused the death, and/or feeling relieved about the loss. Interestingly, their guilt was often either unconscious, or only partly conscious.
These participants’ guilt and sense of responsibility is consistent with the literature on mothers after a perinatal loss (Condon, 1986; Frost & Condon, 1996; Leon, 1990; Lewis, 1979; Peppers & Knapp, 1980; Phipps, 1981). That is, these fathers expressed guilt and self-blame over their babies’ deaths, just as mothers do.
Leon (1990) has written at length about guilt among mothers after a perinatal loss, identifying several sources of this emotion. One explanation for this guilt and responsibility is that, as mothers progress through their pregnancy, they further develop their maternal identification, preparing them to take total responsibility for a helpless infant. This identification and sense of responsibility leads them to feel both responsible and guilty when the infant dies.
The guilt that women experience after a perinatal loss also stems from the normal ambivalence during their pregnancy. They wish to have a child and simultaneously fear the changes that having a child entails. This ambivalence leads them to feel that the loss is a result of their forbidden wish (Leon, 1990). Similarly, parents often view perinatal loss as a punishment for a perceived misdeed. Guilt can also be seen as a way to feel in control over helpless feelings.
Participant one, Dennis, discussed a variety of topics suggesting that he was experiencing guilt, but his guilt was unconscious. He denied feeling guilty when directly asked about this emotion, stating that he knew that there was nothing he could have done to prevent the death. Interestingly, his guilt may have been displaced onto his friend’s loss. A couple of years after Dennis’s stillbirth, a friend had a stillbirth. He talked at length about how he felt guilty and blamed himself for his friend’s stillbirth, even though logically he knew he could not have caused it. He somehow felt that because his friend knew him, he caused the stillbirth. Perhaps Dennis’s feeling of guilt, previously unconscious, was triggered when his friend’s baby died. It was also interesting how Dennis talked at length about his feelings of responsibility over his wife’s welfare during the pregnancy. He stated that if she died or was injured, he would feel guilty because it was his “fault” that she was pregnant. Given his guilt for his friend’s baby’s death and his sense of responsibility for his wife’s pregnancy, it is likely that he experienced intense guilt over Susan’s death, but that the guilt was primarily unconscious or repressed. Additionally, due to his sense of responsibility for his wife’s welfare, it is likely that he blamed himself for her depression and anxiety after losing Susan. Therefore, his sense of responsibility and guilt was compounded; he felt guilty both for Susan’s death and his wife’s psychological pain.
As discussed in his individual analysis, participant two, Karl, also expressed a sense of guilt and self-blame. Similar to Dennis, Karl felt responsible for both his daughter’s death and his wife’s distress, doubling these emotions. Karl’s guilt, however, was primarily conscious. He spoke at length during the interview about how he was extremely disappointed in himself because his daughter died on his “watch,” implying that he was somehow at fault for her death. Karl was further along in developing his paternal identity than the other participants, as his daughter was already four months old. Therefore, he had already developed a sense of responsibility for her life. His well-developed paternal identity, and his sense of responsibility that stemmed from this identity, may have exacerbated his guilt and self-blame when his daughter died.
As noted above, Karl not only felt responsible for his daughter’s death, but also for his wife’s reactions to it. He talked at length about how it was extremely difficult to tell his wife, since he was not able to comfort her. This may have caused him to feel an overwhelming sense of helplessness. He may have taken responsibility for his wife’s reactions, hence feeling guilty, to feel in greater control of his helplessness.
Participant three, Raymond, also expressed a sense of guilt; however, his guilt appeared to be partly conscious. He attributed his guilt to his sense of relief when his son died, for he was unsure if he could raise a Down’s Syndrome child. He denied feeling any guilt over the loss itself. When applying Leon’s (1990) theory, that a mother’s ambivalence over having a baby during pregnancy may lead her to feel that having a loss is a result of her own forbidden wish, Raymond may have felt that Bryan died because of his own unconscious aggressive wishes and ambivalence. Furthermore, Raymond spoke at length about how Bryan’s life was entrusted to him, and how responsible he felt for him. Given his ambivalence, unconscious aggressive wishes, and feelings of responsibility for Bryan’s life, Raymond felt guilty about his sense of relief, and blamed himself, at the unconscious level, for Bryan’s actual death.
Participant four, Peter, also expressed guilt. His guilt appeared to be more conscious, and came in the form of regret. Peter talked at length about regretting not investigating his wife’s medical condition more. He felt that, by investigating more, he might have been able to challenge the doctors’ methods, effectively preventing the early delivery of Tabitha. Parents are not expected to have a great deal of medical knowledge. Therefore, Peter’s regrets might be more related to his need to feel in control of her death by taking responsibility, rather than being a reality-based expectation that he did not fulfill. Furthermore, by taking this internal locus of control stance, he may have felt that if he had done something to cause her death, he could do something to prevent future deaths. This coping mechanism may be adaptive. Leon (1990) reported that if self- blame after perinatal loss leads the parents to feeling more in control of the future events
(i.e. being able to have a live birth), then it is adaptive. Perhaps for Peter, self-blame for Tabitha’s death, and, in turn, feeling in control of having a future live child may be an adaptive strategy. Supporting this view is Peter’s focus since Tabitha’s death: education and prevention. This focus suggests that his guilt is adaptive, helping him to perceive control over having a baby in the future.
Participant five, Ryan, also expressed much guilt over his losses. He talked at length about how he “knew” that he did not cause Belinda’s stillbirth, yet he still felt that his behaviors could have caused her death (i.e. exposure to paint, failure to remove mold). It is likely that his guilt was exacerbated by the fact that he had two losses. Both most likely made him feel helpless, increasing his need to feel in control of this emotion by feeling guilty. It is also possible that, similar to Peter, his self-blame served to increase his control over future events. Ryan very much wanted to have children, but did not have any. He is faced with the fact that he may never be a biological father to a living child, and may consequently have a strong need to feel in control of this. Stated differently, he may need to feel control over having future children. Therefore, his guilt and self-blame may be adaptive. On the other hand, as mentioned in his individual analysis in this chapter, Ryan may view these losses as a punishment for his previous abortion, believing that he does not deserve a baby.
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