Fundamentals of Midwifery: A Textbook for Students (157 page)

Thromboembolism
The term that encompasses the two pathological conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE).
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Chapter 17‌‌
Bereavement and lossLiz Smith
University of Hull, Hull, UK
Brenda Waite
Diana Princess of Wales Hospital, Grimsby, UK
Learning outcomesBy the end of this chapter the reader will be able to:

discuss the theories relating to bereavement and loss

utilise theories of bereavement and loss to inform care

recognise that bereavement practices may be influenced by culture and religion

understand the value of support for women, their families and colleagues.
Introduction
Whilst pregnancy and childbirth are generally associated with the joy and happiness of a newbaby there are unfortunately some pregnancies which do not end happily and midwives need to draw on all their skill to support the parents and their family through their loss. It is important to remember, however, that loss is not just associated with miscarriage, stillbirth and neonatal death; it is also associated with premature birth, unexpected illness and abnormality irrespec- tive of the ultimate outcome. In order to provide sensitive care to women and their families, midwives need to have an understanding of the theories of grief whilst remembering that these are theories not facts and that everyone is different. This chapter will therefore discuss the main theories of grief in the context of midwifery and consider some of the situations where midwives can make a difference to the experience of loss for women and their families.
Terminology
In order to enhance understanding of theory and of care needs it is necessary to use terminol-ogy appropriately. The terms associated with loss are often used interchangeably but in truth have differing meanings.
Fundamentals of Midwifery: A Textbook for Students
, First Edition. Edited by Louise Lewis.© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion website: www.wileyfundamentalseries.com/midwifery
Grief
– is a natural and personal response to loss and is multidimensional involving emotional, physical, behavioural, cognitive, social and spiritual aspects (Greenstreet 2004; Buglass 2010).
Mourning
– is the active and outward expression of grief and contributes to its resolution.
Bereavement
– is the state of having experienced a loss and is often associated with the period of time following the loss. It is this association with time that often leads people to have erroneous beliefs about how long someone should grieve for.Stroebe et al. (1993) summarise the links between the terms by suggesting that bereavement is a state of loss that triggers a grief reaction that is associated with behaviours that are known as mourning. Responses to loss are affected by culture and religion as well as personality and circumstances (Buglass 2010) and it is important therefore to treat everyone as an individual and every situation as unique.374
Theories
The theories associated with responses to loss can assist midwives in understanding the process
of grief, but it should be remembered that a theory is not an absolute fact; those experiencing bereavement will not necessarily follow one single theory and behaviour cannot necessarily be predicted. Theories do provide a guide and an explanation of some of the behaviours acted out by individuals.Possibly the best known theory of grief in healthcare comes from Kübler-Ross (1969). Her work is commonly used by healthcare professionals and is based on clinical impressions gained when working as a psychiatrist with dying patients (Buglass 2010). Kübler-Ross (1969) identified five stages of grief that are moved through and these are: