Perinatal Loss and the replacement child - Marguerite Reid

This presentation focuses on the area of perinatal loss and the birth of the ‘replacement child’ (Cain and Cain 1964). Individual psychotherapy with children whose birth or adoption followed the loss of a baby or child highlighted for me the immense nature of difficulties experienced by some of these children within the mother-child relationship and within the child’s family. They spoke of feeling that they could not be as important to their mother as the dead baby and that they perceived her mind as being full of the lost infant. They expressed a certainty that they would not have been conceived if the loss had not occurred and they spoke of a fear that an angry ghost haunted them.

My impression whilst working with ‘replacement children’ was that their mothers had not mourned and that the intensity of their emotional pain remained as great many years later. This was further clarified for me through my work in the Perinatal Service with recently bereaved women and couples who were referred to the service by the obstetric and midwifery teams following perinatal loss. I realised that patients expressed their grief in a similar way whether it was immediately after the loss or several years later and after the birth of another baby.

The importance of enabling women and couples to grieve following the trauma of perinatal loss will be considered. As we are aware a pregnancy has a life of its own from the time of conception to the estimated date of delivery and when cut short by premature delivery, miscarriage or termination because of fetal abnormality this has to be acknowledged. For many women there is an immediate wish to conceive again following the trauma but research does show that pregnancy inhibits the mourning process. It is difficult to mourn when preoccupied with new life. Even when there has been a period of mourning women often speak of the difficulty of not confusing the two pregnancies. The mother’s emotional state following the delivery of the new baby will be considered using clinical material. There will be further discussion of the importance of anniversary dates and gender issues for women who have difficulty mothering their new infant.