Perinatal Grief: Psychological Support After a Loss

Sarah sits across from me in my Nantes practice, her hands clenched on her bag. Three months have passed since she lost her baby at 22 weeks of pregnancy. "I can't understand why I can't just 'move on,' as my loved ones tell me to," she confides in a trembling voice. "I feel like I'm in a permanent fog, and sometimes I wonder if I'll ever feel normal again."

This situation comes up regularly in my practice as a CBT psychotherapist in Nantes. Perinatal grief — the loss of a child during pregnancy, childbirth, or the first months of life — is a particularly complex ordeal psychologically. Unlike other types of grief, it means mourning a future, a life project, a child who was imagined but sometimes barely known.

Psychological support in these situations requires a specialized and compassionate approach. As a practitioner trained in cognitive-behavioral therapies, I observe daily how essential it is to offer support tailored to the specifics of this type of grief, which today affects one family in four.

Understanding the specifics of perinatal grief

A loss invisible to society

Perinatal grief has unique characteristics that set it apart from other forms of grief. In my practice in Nantes, I find that bereaved parents face what I call "the double penalty": not only do they go through a devastating loss, but that loss is often not socially recognized.

Society tends to minimize this suffering with clumsy phrases like "you can have other children" or "at least you didn't really know them." These reactions, though well-intentioned, can intensify the parents' sense of isolation.

The psychological mechanisms at play

From a cognitive-behavioral perspective, perinatal grief activates several complex psychological mechanisms:

• Dysfunctional cognitions: "It's my fault," "I shouldn't have...," "I'm a bad mother"
• Behavioral avoidance: avoiding places linked to pregnancy, baby stores, pregnant women
• Intense emotional reactions: guilt, anger, anxiety, deep sadness
• Somatic symptoms: sleep disturbances, chronic fatigue, physical pain

Differentiated impact depending on the stage of loss

Every perinatal grief situation is unique. An early miscarriage, a medical termination of pregnancy, an in-utero fetal death, or a neonatal death generate different psychological experiences, requiring a tailored therapeutic approach.

The stages of the perinatal grieving process

Initial shock and stupor

In the first days following the loss, I observe in my patients a state of psychic stupor. Marc, a 35-year-old father I see in consultation, describes it: "I felt like I was in a dream, as if none of it was real. I was operating on autopilot."

This shock phase is normal and protective. It allows the psyche to gradually prepare to integrate the reality of the loss. However, when it lasts beyond several weeks, psychological support becomes necessary.

Confronting the reality of the loss

Gradually, the reality of the loss sets in. It is often at this moment that parents seek help, overwhelmed by an intense emotional wave. Cognitive therapy techniques then make it possible to identify and restructure the negative automatic thoughts that maintain the suffering.

Gradual reorganization

This stage, the longest, consists of relearning to live with this absence. It is not about forgetting, but about integrating this loss into one's life story. The ACT approach (Acceptance and Commitment Therapy) proves particularly effective in this phase.

"Perinatal grief is not a linear process. It is a path made of advances and setbacks, where each parent finds their own pace of healing."

Specialized therapeutic approaches

Cognitive-behavioral therapies (CBT)

In my practice, CBT is the reference approach for supporting perinatal grief. It makes it possible to:

• Identify dysfunctional thoughts: "If I had done things differently, my baby would still be here"
• Restructure negative cognitions with more realistic and helpful thoughts
• Develop coping strategies to manage difficult moments
• Gradually reintroduce avoided activities

#### Example of a cognitive exercise

I often suggest this exercise to my patients:

Note the automatic thought that crosses your mind

Rate how much you believe it (0 to 100%)

Look for evidence for and against this thought

Formulate a more balanced alternative thought

Reassess how much you believe the initial thought

EMDR to treat trauma

Some perinatal losses are accompanied by post-traumatic symptoms, particularly when the loss occurred in difficult conditions. EMDR (Eye Movement Desensitization and Reprocessing) then makes it possible to specifically treat these traumatic aspects.

Mindfulness and acceptance

Mindfulness techniques help parents to:

• Welcome their emotions without judgment


• Develop a different relationship with their suffering


• Cultivate self-compassion

Managing the specific challenges of daily life

Facing triggering situations

In my Nantes practice, I regularly support parents in managing difficult everyday situations:

Unexpected encounters:

• Passing a pregnant woman on the street
• Receiving an invitation to a baby shower
• Hearing a baby cry

Anniversary dates:

• Expected due date
• Date of the loss
• Family celebrations

Practical strategies:

• Mentally prepare for these difficult moments
• Develop personalized commemoration rituals
• Allow yourself to temporarily avoid certain situations
• Clearly communicate your needs to those around you

Rebuilding intimacy as a couple

Perinatal grief deeply affects the couple relationship. Each partner goes through grief at their own pace, with their own defense mechanisms. Analyzing your couple conversations can help you better understand your relational dynamics during this difficult period.

Points of vigilance:

• Respect each person's different pace
• Maintain communication despite the pain
• Consult together when misunderstandings set in
• Do not rush the resumption of physical intimacy

The question of a new pregnancy

"When will I be ready to get pregnant again?" This question comes up frequently in my consultations. There is no universal answer, but a few indicators can guide reflection:

• Ability to talk about the loss without being overwhelmed
• Desire for a child distinct from the need to "replace" the lost child
• Restored emotional stability
• Calmer communication within the couple

Building a suitable support network

The importance of professional support

Beyond psychological support, other professionals can intervene:

• Midwife specialized in perinatal grief
• General practitioner aware of these issues
• Discussion groups led by professionals
• Support associations for bereaved parents

Educating those around you

I often offer my patients tools to help those around them provide better support:

What truly helps:

• Acknowledge the reality of the loss
• Listen without trying to console at all costs
• Offer concrete help
• Respect silences and tears

What to avoid:

• Minimizing the loss
• Giving unsolicited advice
• Setting "healing" deadlines
• Avoiding mention of the lost child

Using self-assessment tools

Take our free psychological tests to assess your emotional state and identify possible signs of depression or anxiety requiring specialized support.

When should you consult a professional?

Warning signs

Certain signs should alert you to the need for psychological support:

Persistent symptoms after 3 months:

• Significant sleep disturbances
• Significant loss of appetite
• Avoidance of all social activity
• Constant intrusive thoughts
• Excessive guilt
• Dark thoughts

Major functional impact:

• Inability to return to work
• Neglect of other children
• Repeated marital conflicts
• Complete social isolation

Course of therapeutic support

In my practice in Nantes, psychological support for perinatal grief generally follows this progression:

Initial assessment (2-3 sessions): understanding the history, assessing symptoms

Stabilization phase (4-6 sessions): emotional management techniques

In-depth work (10-15 sessions): cognitive restructuring, graded exposure

Consolidation (3-5 sessions): relapse prevention, life project

The total duration varies between 6 months and 2 years depending on the complexity of the situation and each person's personal resources.

Finding meaning in life again after the loss

The therapeutic work does not aim to "forget" the lost child, but to give them a peaceful place in the family history. Many of my patients develop, over time, a special ability to support other bereaved parents, transforming their suffering into a source of help for others.

Some create personalized commemoration rituals: planting a tree, writing letters, participating in associations. Others get involved in awareness or medical research efforts. These meaningful projects facilitate personal reconstruction.

Perinatal grief irreversibly transforms those who go through it. But this transformation, accompanied with compassion and professionalism, can also reveal unsuspected resources of resilience and humanity. In my Nantes practice, I witness daily this extraordinary human capacity to rebuild after the most difficult ordeal of all: the loss of a child.

If you are going through this ordeal, do not hesitate to ask for help. Perinatal grief deserves specialized support, and you deserve to be supported with the competence and delicacy your suffering requires. Reach out to a professional trained in these matters: your reconstruction depends on it, and it is possible.