Personal practice Management of perinatal bereavement

'At first the full reaction may be delayed, or there may be a period of numbness or blunting in which the bereaved person acts as if nothing had happened for a few hours or days or up to two weeks. Thereafter attacks of yearning and distress with autonomic disturbance begins. These occur in waves and are aggravated by reminders of the deceased. Between the attacks the bereaved person is depressed and apathetic with a sense ofJfutility. Associated symptoms are insomnia, anorexia, restlessness, irritability with occasional outbursts of anger directed against others or the self, and preoccupation with thoughts of the deceased. ' My study of perinatal bereavement stems from a prior interest in the emotional and psychological aspects that accompany illness in children and its impact on the family. To help me deal with these problems I sought help by joining a Balint Group on the doctor-patient relationship; and later we a group of like minded paediatricians started the Anna Freud Paediatric Study Group which lasted for some 20 years until her death. This led to the establishment of my 'Tuesday ' clinic in Woolwich where every type of emotional problem associated with illness was tackled: chronic illness, handi-capped children, life threatening illnesses, and bereavement. The bereavement clinic In the late 1960s when Machin approached us to participate in the South East Metropolitan Region study of spontaneous aborted fetuses I invited parents who had suffered a perinatal bereavement at the British Hospital for Mothers and Babies to talk thinigs over.2 There were at that time no guidelines from others experienced in the field and no litera-ture that I could find on the subject. But interest-ingly enough this 'experimental bereavement clinic' coincided with publication of some papers on the subject, which demonstrated a new climate of thinking.i-5 This motivated me to try to engage others, ' and a small group of interested profession-als and consumers came together to produce a pamphlet which the Health Education Council published in 1979 and has continued to publish, providing some 10 000 free copies a year.7 Concur-rent initiatives led to the founding of the Stillbirt