CLINICAL ISSUES
Interconceptional Counseling After Perinatal and Infant Loss

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Historically, preconceptional health promotion has been recommended for all prospective parents to improve perinatal outcomes. Preconceptional health promotion and interconceptional counseling may be even more beneficial for parents who have had previous perinatal losses. Perinatal loss can be devastating, with long-term effects on subsequent pregnancies and children. A theoretical framework for interconceptional counseling after perinatal loss needs to be developed. Interconceptional counseling can give couples important information to improve outcomes, acknowledge fears and anxieties, evaluate genetic risks, facilitate grieving, and explore attachment and parenting issues.

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Significance of Perinatal Loss

For the purpose of this article, a broader definition of the perinatal period will be used. The perinatal period encompasses conception through the 1st year of the child’s life (Kowalski, 2001). Using this definition, perinatal loss would include ectopic pregnancies, miscarriage, stillbirth, preterm birth, neonatal death, congenital anomalies, infant death, selective reduction or death of multiples, and relinquishment for adoption (Wallerstedt & Higgins, 1994).

There are many types of losses.

Evaluating Risks for Subsequent Pregnancies

Counseling a couple after perinatal losses would be deficient without addressing the couple’s reproductive risks. To evaluate these risks, one must evaluate any medical, psychological, genetic, environmental, and obstetric concerns. Even if the medical records give details that the parents’ reproductive and genetic concerns were addressed soon after the loss, it is imperative to review this information with the couple to clarify any misunderstandings. In addition, it is important to discuss the

Care During Subsequent Pregnancy

Pregnancy after loss raises new concerns regarding ambivalence, fears, attachment, and parenting; therefore, counseling is continued through the subsequent pregnancy and birth. In studies of parents during subsequent pregnancies, anxieties overshadowed the pregnancies and couples found they were more guarded in an effort to protect themselves. Armstrong and Hutti (1998) found that mothers with previous perinatal loss had less attachment to their pregnancies than mothers with no previous

Conclusion

Preconceptional health promotion has been recommended for all prospective parents to improve perinatal outcomes. In cases of previous perinatal losses, interconceptional counseling for this special needs population is an innovative and invaluable concept. Vital resources, scientific research, and support for parents with previous losses or deaths need to be improved for professionals helping families after perinatal loss.

Interconceptional counseling can give couples important information to

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