Today, we're going to talk about a subject that's not quite as joyful
as some of the other topics that we've covered.
Today, we're going to talk about perinatal grief and loss.
There are many different types and causes of loss,
and I want to break these down by terminology,
so that you know exactly what each term means.
Abortion refers to a pregnancy loss that occurs up to 20 weeks of pregnancy
or any pregnancy termination at any stage.
Anembryonic pregnancy refers to a nonviable pregnancy with a gestational sac
and no yolk sac or embryo.
Early pregnancy loss or embryonic loss occurs very early in the pregnancy,
usually before about 13 weeks.
A fetal demise or intrauterine demise occurs after 20 weeks of gestation.
Recurrent pregnancy loss refers to two or more spontaneous losses at any gestational age.
And a neonatal death refers to when the baby dies sometime between birth and the first 28 days.
Now, we've review a lot of terminology here. These are medical terms.
When we're talking to the family who've experienced the loss, we might not want to use any of these.
They're overwhelming and they may not know what they mean.
So maybe try words like, "I'm sorry about your miscarriage."
Or "I'm sorry that your baby died.", "I'm sorry that you experienced a fetal loss."
We also want to be careful about terms like abortion
because there's a lot of stigma attached to that term.
So that would be something we might talk amongst our healthcare professional team about,
but we may not use that with a client.
Annually, more than 900,000 families are affected by perinatal loss.
This is why it's so important that we talk about it both here at Lecturio and hopefully, in your class.
Now, let's break down this epidemiology a little bit more.
So around 25% of the perinatal losses happen between 20 and 27 weeks.
Around 25% happened after 28 weeks. Around 33% happened under the age of 28 days.
And around 16% happened sometime between 28 days and up to the end of that first year.
We've talked often about a breakdown in statistics by race and ethnicity.
I want you to pay attention to this slide.
What I hope jumps out at you is that 10.53%
which is a lot more than all the other racial and ethnic groups.
The losses are experienced by non-Hispanic Black families.
So you see the disparities that are related to social drivers of health and racism here in living color.
Now, let's think about the losses in terms of risk factors.
So what would make a birthing person at risk for experiencing a perinatal loss?
First, a maternal age greater than 35 years.
If you remember my popcorn analogy from before, the older we get,
the eggs are not as genetically normal.
So we're more likely to have genetic abnormalities which can lead to perinatal loss.
If someone has experienced a prior pregnancy loss, they're at risk for a repeat.
Also, maternal medical conditions, things like an infection or diabetes, obesity, thyroid disease
can contribute to perinatal loss.
Having extreme amounts of stress or inherited blood clotting disorders
or anything like that that may impact placental formation.
Other factors that may cause perinatal loss include pregnancy with an intrauterine device in place.
So hopefully, you don't get pregnant when you have an IUD,
but if you do, then you're more likely to experience a loss.
Also, medication and substance abuse, so things like smoking or using alcohol.
And when we think about race and ethnicity,
I want you to really pay attention to the fact that it's not the fact that someone is Black
or someone is Latina that increases their risk.
It's their exposure to racism and discrimination and that increase in stress
is what causes that increase in risk.
Also, think about environmental exposures.
So if you think about things like our, oh, maybe our TORCH infections that we talked about before,
toxoplasmosis and cytomegalovirus and herpes but also things like where you work.
So do you work in a factory? Or do you live in a place where you might be exposed to chemicals
in a river or in water or in the food that you eat?
If the birthing person experiences trauma.
So this could be an accident, falling down the stairs or being involved in a motor vehicle accident.
But also think about intimate partner violence
or anything like that can also increase someone's risk of perinatal loss.
And anytime you experience bleeding.
Bleeding in pregnancy is never normal, but if there's bleeding around the gestational sac,
there could be an issue with implantation which would ultimately lead to a perinatal loss.