Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
by
Elizabeth Camilleri
Bachelor of Psychology
University of Malta
April 2005
i
Forgive me if I do not cry
The day you die
The simplest reason that I know is
Fathers are not supposed to cry
I figured you would expect me
To be strong
To act the way I would have
Taught you
Forgive me, my son, if I do not cry
The day you die…
Forgive me if I do…
Anonymous
ii
BORN SLEEPING
PATERNAL GRIEF
RESPONSES IN RELATION
TO A PERINATAL LOSS
By Elizabeth Camilleri
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Authors Declaration
Signed:
Elizabeth Camilleri
April 2005
iv
Dedication
v
Acknowledgements
Thanks is also due to all the fathers who participated in this study and
shared their personal accounts in the hope of benefiting others.
Finally, I would also like to thank my parents for their constant belief in
me, and my aunt Chris for giving me her apartment for some peace and
quiet and my friends Nicole, Sam, Keki and Du for their patience and
never ending support. A special mention is also due to Sean who proof
read my final chapters and made sure I went running to clear my mind.
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Table of Contents
____________________________________________
_
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viii
Chapter 1
Introduction
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Perinatal death is a life event that parents are unprepared for. In one
instant, they are saying “goodbye before saying hello” (Kirk & Schwrebert,
1981).
It is rarely discussed in pregnancy, childbirth, and sex education materials
up to the 1980’s, mothers were advised not to see the dead baby and to
forget what happened, while the father was seen as having the role of
comforting the mother. They were not considered to have any feelings of
distress. (Hughes,1998).
from grief by preventing any contact with the child, it was actually
x
al., 2000). A Maltese nurse who experienced a miscarriage and stillbirth
herself, confirmed that this was also the adopted policy at St Lukes during
parents go through severe loss. (Condon, 1986; Kirkley, Best & Van
overlooked, the ‘forgotten mourners’ (Kellner & Lake, 1993, Worth ) and
their grief underestimated by society. In a way, men are left ‘on the
disappointment, regret and guilt; have been the focus of many studies
(Mander, 1994; Toediter & Lasker; 2000). However, there is still very little
xi
as regards their partners, the men. In fact, some studies have specifically
made reference to this and our lack of understanding from the man’s
perspective.
never the sole focus of a study (Lasker & Toedter,2000; Robson, 2002;
Gray, 2001). Some researchers even report men walking out of the
interview mid- way (Zeanah, Danis, Hirshberg, and Dietz, 1989). Other
researchers have specifically called out for more research on the male
having a healthy baby. The Maltese Islands have seen a decrease in the rate
of stillbirth over the last 50 years. Latest statistics available showed that
a man finds out his partner is pregnant, he goes from adjusting to the idea
xii
of pregnancy, to preparing to being a new parent. When it suddenly all
ends, this sense of aloneness and isolation can be very deep. (Robson,
2002)
Normally grief is not talked about and when it is, it’s with an air of
discomfort. When we see people grieve, we often want to hurry them along
so they can put it behind them quickly. If we don’t see any signs of grief
identified that men’s grief responses are different from women’s (Black,
1991; Doka & Martin, 2001; Gray, 2001; Rando, 1993). Peppers & Knapp
xiii
loss” (infant lost during late pregnancy), “stillbirth” (infant loss during
birth, and “death” (loss that occurs after the infants birth). Medical
definitions relate to infant viability, with infant losses that occurs prior to
However, for the fathers I spoke to, regardless of the duration of the
which left them forever changed. I therefore consciously chose to use the
term “perinatal death” or “perinatal loss” to refer to all the losses in this
that a father goes through after losing his child to stillbirth and to:
٭ Understand how his partner, medical staff, family and friends can
provide support.
Motivation
A relative of mine lost a child and while his wife managed to move
forward, he found the loss more difficult to accept. Support was offered to
his wife however, his state of well being and how he was coping was
hardly touched upon. He was expected to support his wife and make the
xiv
explore this area further. Judith Lasker (personal correspondence, 14th
March 2004) stated that it “sounds like a great topic…I am not aware of
any research on pregnancy loss and men in the Mediterranean area, so that
Chapter 2
A Literature Review
xv
This literature review provides a broader foundation and context to help
understand how men grieve the loss of a child due to perinatal death. This
establishing meaning.
This chapter is divided into three sections. The first explores the
learn their they are expecting a child, The second presents various models
systems men and their partners look towards to help resolve or manage
their grief.
on the paternal birth experience and ways of enhancing the quality of this
xvi
experience (Draper, 2002).Recent work documents the profound grief
confirming phase in the first trimester which produce feelings of joy if the
father is ready for parenthood. The father attaches his hopes and dreams for
that child.
of the pregnancy. The father has to realise he must give up some freedom
due to impending fatherhood, that things will never be quite the same.
May (1982) states that the longer time spent in the moratorium phase
that the shorted and less stressful this stage, the more prepared he feels
about being a father. The final stage is the focusing stage, which is when
Therefore when a father experiences the loss of a child due to still birth ,
father.
xvii
Styles of paternal involvement include expressive, in which the
can intensify as early as the first three months of a pregnancy, there is any
quoted in The Age Newspaper, 2003 ) found that out of 116 first time
before or just after birth often entails great grief and despair on the part of
the fathers as they have formed a bond with the unborn child and do not
expect the baby to die before them (Radstad et al, 2001; Malacrida, 1999).
Childbirth education classes help the couple explore how to make the
childbirth experience, and parenting theirs instead of hers alone (Kohner &
and claim it as their own. Women too, report that the scan makes the
xviii
pregnancy seem more real for their partners (Hughes, 1998).Studies by
Puddifoot (as cited in Lasker & Toediter 2000) found higher grief scores
amongst men who had seen the ultrasound image. This was seen to be
2.1.1 Conclusion
antenatal classes, looking at early scans, feeling, and singing to the bump.
xix
Peppers & Knapp, 1998).Attachment can begin even before conception;
when their child dies. This is due to their preparation for fatherhood, and
successful pregnancy.
feelings of grief in both fathers and mothers, (Peppers & Knapp, 1987;
(Nadeau, 1998; Rando, 1993; Kastenbaum, 1998). One distinction that can
loss. Mourning is the process one goes through to accommodate that loss.
xx
to have something that one formerly possessed or to which one was
attached.
the idea that something of value has been taken away against our will.
bereavement grief and mourning and then I will look at the Stages theories
of the bereaved was Sigmund Freud, as set out in his book ‘Mourning and
Melancholia’ (1917). In it, he laid the blueprint for what would later be
xxi
known as ‘Griefwork’. Noting that emotional attachments are created
(cathexis) that hold individuals such as parent and child together, Freud
hard to establish a new identity in which the deceased is not present, and
when the bereaved observes that the object of their affection or attachment
However, grief work models fail to take into account the vast
array of human responses to loss and assume that love objects can be
replaced. Several theorists have also proposed that grief takes the form of a
Ross (1970). Through her work with the dying, she came up with five
come under a lot of scrutiny in recent years especially the sequence and
xxii
Nevertheless, several valuable contributions of Kubler- Ross’s
approach, including the stage theory should be kept in mind. The
value of her work in awakening societies sensitivity…has not
been called into question. Accepting the stage theory is not
essential for appreciation of her many useful insights. (p.69)
grief. This is known as griefwork. The bereaved are seen as active rather
relationship.
xxiii
Malta is largely, made up of practicing Catholics. Abela (1994)
notes that “The Maltese have retained their traditional value system”
(p.251). It is an island where abortion is still illegal and where the church is
given much importance in every day life. Mitchell (1996) writes that one
children. This is to prove both their sexuality and responsibility for the
family which is the possibly the most important of all institutions on the
island. Therefore, the loss of a child to stillbirth may challenge and test
held notion that grief depicts a journey moving from the acknowledgement
Martin & Doka, (2000) have provided a new paradigm for grief.
Rando ( as cited in Martin & Doka, 2000) states that they “have challenged
xxiv
high level of harm to a significant proportion of bereaved individuals and
the notion that research has shown that fathers reaction’s were less intense
and they grief was resolved over a shorter period of time when compared
to the mothers (Peppers & Knapp, 1987; Lasker & Toediter ,2000; Radstad
marginalised, as they do not grieve like the norm. Several writers such as
quarter of the mothers and a third of the fathers were deemed to have
muted responses to the loss. They were said to suffer less severe
xxv
themselves as coping fairly well. Hughes (1998) states that this is “clearly
a common way to cope with loss and grief and deserves more research”
1997, Doka & Martin 2000). Doka & Martin (2000) state that:
grieving is put forward by Martin & Doka, 1998; 1999 ; 2000.) and is
explained below:
or publicly shared, and the griever is not recognised. When a baby dies
xxvi
before birth, the loss can be devastating for the fathers and very often, the
world that surrounds them tends to discount their loss (McCreight, 2004).
mix of the two styles. Each type has an experience of grief that is different
and uses different coping strategies. The first style is called Intuitive
feelings.
appetite, anger and irritability. Intuitive grievers want to and need to talk
about his or her experience and find the retelling of the story necessary as
xxvii
Studies on perinatal loss and miscarriage, including local studies
subject show that most women, rather than most fathers exhibit
cried. And I think that’s what helped me at the time because you
One of the themes that emerged from the above study was that
all the mothers spoke of the need to talk about the death, and how they
perceived distinct differences in the way they and their husbands grieved.
Zeanah et al (as cited in Lasker & Toediter 2000) noted that although in
their sample mothers on average scored higher on grief than fathers. A full
one- quarter of the families found that the fathers grief exceeded that of the
mother. This suggests that some of the men in these studies also showed
together as a system:
xxviii
2. Their desire to master their feelings. Mastery of oneself and the
environment.
intellectually with their losses and use thoughts, rather than affect cues.
Often a father feels he must be strong and set his grief aside.
Grief Scale. (Potvin, Lasker, & Toediter 1989). Lower grief scores were
xxix
still consistent with the male gender, though “ findings of high scores in
proportion of men may be instrumental grievers and may score lower due
to the way they express their grief. Strategies for dealing with perinatal loss
differed between mothers and fathers. Mothers were more likely to seek
Cultural norms not only influence the experience of grief but the
2001), states that every society has ‘feeling rules’ that govern the
Doka (2001) state that a subset of these feeling rules may be caused by
xxx
grieving rules that define who and what one may grieve, and how one’s
grief is expressed.
roles men and women are likely to exhibit differential grieving patterns
(Martin & Doka, 2001). Hence, for men, masculinity becomes a filter
argues that men are not discouraged from expressing all emotions, only
tends not to be associated with masculinity, and this can present a dilemma
for men when feelings of grief clash with societies deeply ingrained
expectations” (p.32)
himself at odds with himself. On the one hand he is expected to show some
emotion, and on the other hand he is expected to take on the role of the
strong care giver and support for his wife (Henley & Kohner, 1991). A
xxxi
Fathers are just as upset when a baby dies. They get involved,
they feel the baby growing in its mother’s stomach, feel it kicking.
It’s their child too. Yet, men are supposed to be able to get on
with things. We aren’t supposed to sit at our desks and cry. Other
men may come up and say, “If you need to talk, I’m here,” but
they don’t mean it. Men don’t like listening to other men’s
problems. (p.69)
Many men have been trained to think with their heads and
2000). When men approach grief, they often engage in intellectual or work
related activities as this allows them to work their minds in a way they are
after the loss. Support will be viewed in the light of Vaux’s theory on
social support (1988). This has been defined as a process in which persons
xxxii
manage their social resources to meet social needs. A support network is a
person’s social network, which he or she turns to, or can ask for assistance
the mode in which this support is given can influence whether this support
partner, who is also going through her own feelings of despair and grief, as
well as family, friends, people in the work place and in the medical
profession can all give social support. This is vital in assisting him and his
Kavanaugh 2000). This can be especially true if the loss is trivialised or not
by feelings of sadness and emptiness (Kohner & Henley, 1991). Her hopes
and dreams for the future have been shattered. Fathers are expected to
support and are often the ones who have to hold it in emotionally and break
the news to family and friends as well as making the funeral arraignments.
xxxiii
This is often the first major life crisis that a couple have faced
together, and it can bring parents closer together or isolate them and push
them further apart. Factors that influence the marital relationship are the
couples ability to share their grief, accept each others different grief
the mothers, it is vital that they acknowledge and validate each others
mourning styles and try to accommodate each other. Studies such as those
by Lasker & Toediter (2000) and Kavanaugh, Trier & Korzec (2004) have
shown that couples who support each other, come out of this tragic event
those couples who grieve apart that often encounter difficulties later on.
Mothers should also be sensitive to their partners needs and understand the
family and friends (Kavanaugh et al, 2004; Malacrida, 1999). The way
family and friends assist men during this difficult time can have lasting
xxxiv
effects. Clyman, Green, Rowe, Mikkelsen & Ataide (as cited in
fathers perceive they are unsupported they often feel isolated and
2004) found that men felt that their feelings were discounted. This lead to
they didn’t have the same expectations of me. My job was only to
xxxv
Professional’s behaviour towards the rituals surrounding the
dead baby and their attitudes to the bereaved parents has come a long way
there is a need to support and follow up parents who have lost a child and
tends to vary, depending on the resources allocated in the areas and the
on the supportive role but not being a bereaved person in their own right
clothing and foot prints are now offered to the parents as a way of
remembering and validating the child. These practices also occur in Malta.
be sensitive to both parents following the loss of their child, and perhaps
anticipate their needs, offering guidance and literature on loss and where to
xxxvi
Malacrida, 1999). Men are often the main breadwinners and still expected
to perform to the same level at work even though they have suffered a
forward in their thinking and offer fathers time off if they choose to, or at
2.4.5 Conclusion
Chapter 2 has examined literature that supports the idea that men
bond with their baby during pregnancy and experience feelings of grief
that are often different from their partners when a baby is lost due to
xxxvii
Chapter 3
xxxviii
3.1 Introduction
study. Finally, I will describe the methods used to analyze the data.
of the pregnancy until after the late miscarriage or stillbirth occurred. The
co-researchers age was not considered a variable for the outcome of this
study, neither was the length of time that had passed between the event and
remember the details of the experience and feelings, thoughts and actions
xxxix
The sample size of men that participated in the study was 6. The
2004; Radstad et al., 2001) there was a high attrition rate. Several fathers
needed for selection, the nurse contacted several suitable bereaved parents
and explained the nature of the research study. She explained the issues of
confidentiality and how this interview was on a voluntary basis and that
subjects could drop out should they feel the need to. The men were
xl
therefore not chosen at random, but carefully selected due to the relatively
rare nature of the phenomenon they experienced. Once consent had been
given, the researcher contacted the fathers via telephone, and answered any
questions they had. The researcher explained that the interview would be
taped and then transcribed and given back to the fathers to review as co-
researchers for approval should they so wish. Once the researcher felt sure
that the subject understood and agreed to the nature of the interview an
one father was interviewed at his home and one father was interviewed at
his workplace.
3.4 Design
to perinatal loss. These interviews provided the raw data for analysis, so
that the descriptions of grief, originating from the lived experience of these
men could be “the basis for the reflective structural analysis that portrays
xli
This qualitative design has several advantages in meeting the
capture.
from which the qualitative methods used in this study have emerged. First
people describe the things and experiences they come to know through
their senses. It asserts that one can only know what one experiences, and
for people. There is only what they know the experience means to them.
The subjective experience incorporates the objective thing and the person’s
xlii
3. Instruments, Tools and Materials
for data collection is the researcher. As a result, the success of this method
of collecting important and useful data is directly related to the skill of the
good relationship with the men I interviewed, but to make sure I actively
were made co-researchers in this study. This was to make sure the research
findings were valid for the co-researchers as well as the readers of this
study.
relation to the interpretations I drew up from the data. Marshall (as cited in
xliii
carefully and deeply about my own possible biases and about how, my
disclosure.
been shown as critical to the reliability of any qualitative study (Seale &
tape recorder was used to record the interviews. These were transcribed,
including pauses, sighs, changes in tone and relevant body language so that
the data. The progression selected is that by Colazzi (as cited in Creswell,
the phenomenon were extracted. The aim here was to isolate the pertinent
xliv
3. Meanings were formulated by spelling out the meaning of each
significant statement .In this delicate step, the meanings arrived at were
description. This was in order to bring out those meanings hidden in the
These clusters were again re evaluated to make sure that nothing was
unaccounted for in the original text. At this point, any discrepancies were
A pilot interview was held with one of the fathers in the study.
xlv
Open ended questions were noted to be the best as men tended to
giving simple yes and no answers. After conducting the pilot study it was
noted that only four or five questions were actually needed. As a result, the
questions were used more as a checklist to make sure all areas were
covered. The opening question was often all that was needed to allow the
This pilot study was included in the data analysis, as it was felt
language the co-researchers felt most at ease in. Two of the six men
(See Appendix A) and read out to the co-researchers to ensure that each
xlvi
participant understood the nature of the study. Once again, they were
reminded that they could drop out at any moment if they felt
uncomfortable and that a copy of what they had said would be made
handed out (See Appendix B), to collect demographic data regarding age,
level of education, number of children and their age to help the interviewer
questions dealt with the co-researchers ideas and expectations during the
experiences upon finding out that their child was going to die. Next, the co-
during this time. The researcher asked about support given by friends,
family and the work place, what helped them with their loss and what
recommendations they may have for other parents, especially other men
fathers were contacted and any parts of their interviews which needed
xlvii
that they could be provided with information on their interview and the
study.
(2001). The men who were recruited had been briefed on the voluntary
nature of the study. All the co-researchers had received some form of
counselling around the time of the perinatal loss. This was seen as
important as the researcher did not want to cause any additional distress by
changed to mask identity .They were also informed that, since they were
talking about an experience that may bring about distress, they could be
3.7 Conclusion
xlviii
This chapter presented an outline of the research design and the
methods of data collection and analysis. The next chapter will give a
xlix
Chapter 4
l
4.1 Introduction
provide a brief description of the co-researchers. I will then list the themes
further study.
Matthew
Matthew is a 33 year old who has had experience within a hospital setting.
His wife had noticed that the baby had not grown since their last visit to
the doctors and that it was not moving as much. They, as well as their son
found out during a routine examination that the baby had died. His wife
delivered their baby girl two days later at 28 weeks. The cause of death
was still unknown as the interview took place only a week later. So far he
has felt is too early to go to a S.A.N.D.S support group but keeps in contact
li
Mark
Mark is a 38 year old foreigner married to a Maltese. His only son was
born at 17 weeks. His wife started bleeding and they quickly went to the
hospital for an ultrasound, after two days under observation they lost their
baby. There was no reason given for the death of their son last November.
Luke
Luke is a 23 year old and lost his daughter at 34 weeks. His wife called
him up and told him she was not feeling the baby and was going to hospital
to have a check up. He arrived to find her crying as they waited for an
ultrasound. The nurse failed to find a heartbeat. She gave birth two days
later. Their baby’s death was ruled accidental as the baby had a knot in the
chord as well as the chord wrapped around her neck. They lost their
John
John is 38 years old. He and his wife experienced both a miscarriage and a
stillbirth. The miscarriage, ten years ago was their second pregnancy and
the stillbirth, a son was six years ago. After their first loss, John was
apprehensive about the third pregnancy and said he had misgivings about it
from the onset. When his wife started spotting he was not as shocked as the
lii
first time. He and his wife decided not to have any more children. They
have one son who is eleven. There were no support groups available at the
researcher, he declined.
David
David is 30 years old and he and his wife have suffered two miscarriages
and two stillbirths. The first two losses were early miscarriages after which
they sought professional help. It was determined that his wife would need
progressed smoothly up to the 19-week mark last March, when his wife
started spotting; she was then rushed to a private hospital where they tried
to stop her waters from breaking. After keeping her elevated for two days,
their baby girl was born alive. She died shortly after. Their last pregnancy
sadly ended with a stillbirth, last November after 23 weeks of full bed rest,
this time the child was a boy. David and his wife remain hopeful that they
S.A.N.D.S course.
Ian
Ian is 47 years old and has a vast medical background. Ten years ago, he
and his wife had to go overseas for the final stages of pregnancy due to a
liii
blood group incompatibility. The pregnancy has been trouble free apart
from all his family, except himself, contracting chickenpox. The doctor
assured them that there was nothing to worry about and even prolonged
inducing the birth since everything seemed normal. A few days later, his
wife could no longer feel the baby and she rushed alone to hospital while
he looked after their other two children. He found out over the phone that
inconclusive although the doctor suspected it may have been caused by the
the hospital by the trained staff and S.A.N.D.S overseas, prompted Ian and
his wife to set up a support group locally. His wife now helps run support
groups while he remains behind the scenes helping others who face similar
liv
4.3 Phenomenological Reduction
the interview transcripts. They have been grouped into clusters that
Initial reactions
٭Providing support
٭ Hope
Incongruent grief
Coping strategies
scientific worldviews.
٭Emotional focus
lv
Social Sanctions of Pregnancy Loss
٭Partners support
٭Discounted loss
٭
٭Tokens of remembrance
family.
lvi
All of the fathers (6) knew that their unborn baby was going to
die or was dead before the actual delivery. This time span ranged from one
to four days. During this time, all of the fathers (6) spoke about how they
hoped against all odds that the baby would somehow be all right. Mark
said, “We still had a little hope then”. Ian recalled that he “hoped she
would come back with good news, I was praying, really praying. Myself
and the kids.” Luke said he “didn’t give up hope immediately... I said
maybe the baby will be born alive”. (ma qtajtx qalbi mill- ewwel...ghedt
forsi tohrog hajja il- bejbi ). David spoke about having hope right up to the
birth and said that the doctor gave him “ courage and hope” ( kuragg u )
even though the doctor had told him that there was only a slight chance
like that. How could it happen? What happened? ”. Luke described himself
as “paralysed” and said that it felt like he had been dreaming and “fallen
off a cliff”. David recalled that he “was shocked, at that moment I didn’t
lvii
Mark’s first reactions were of shock as well as what he described as a
“the feeling that I was going to be sick”. All fathers (6) reported strong
You can’t even describe what you start feeling at that moment.
Overwhelming sadness, like you wish you were dying at the time,
because you already have an awful memory of the last time and at
that time, I began to bring back that vision from last time.”
All fathers spoke (6) about feeling great disappointment when all
the dreams and expectations for the awaited baby were thwarted. For
anger. Luke said that immediately after the delivery he punched a wall
and broke his hand “blood everywhere but I didn’t feel it” David turned his
anger towards his religion and almost smashed a statue of the virgin Mary
All the fathers (6) had bonded with their child during the pregnancy and
were looking forward to the new addition to their families. Mark stated that
he and his wife “ had started bonding with the baby”, John spoke about
lviii
putting his hand on his wife’s tummy and feeling “ the kid go round and
Since all fathers had begun to develop a bond with their unborn child, they
Most fathers (6) described their initial reaction to the news of the
death of their baby was to forget their own pain and think of their wife and
how they could help her. Mark said “I was more concerned about her than
about the baby in the beginning ...it’s like, what am I going to do. You
don’t think about the baby in the first few seconds”. John recalled that “At
the time you will be too worried about (your wife) and the whole
situation… and support your wife as much as possible, she is the one with
the baby inside her”. David immediately thought of his wife and that “we
lix
were going to go through what we had been through before.” ( konna se
naddu min dak li ghaddejna qabel). Ian explained that “ she didn’t know
what was going on around her because she was so shocked. I was very
4.3.4 The need to re-gain control and remain strong to support their
partner.
All fathers (6) discussed how important it was for them to feel in
control of their feelings and the situation. They all (6) felt that somehow
they needed to gain control of a situation where there were helpless. It was
important for them to feel like they had a certain amount of control to be
able to provide support for their partners. They felt that, remaining strong
and dealing with the doctors, funeral arrangements (6) and children (3) was
The problem is, this is something which you cannot control”. Matthew
words resonated with most of the other fathers “I was trying not to make
things worse, you know, at least I didn’t want them to worry about me...I
David also spoke about gaining mastery by hiding his feelings from his
lx
wife behind a mask and joking as a way of being perceived as being in
control. He stated:
Most (5) of the fathers spoke about the differences in the way
they and their partner grieved. Their wives, in their opinion were more
emotional and felt the need to talk about it more .Only (1) father felt that
they “grieved in the same way”. All the fathers (6) felt that although they
had suffered greatly, their wives had in fact suffered more. Luke recalled
that “she was much, much worse than me” and Ian found that “she took it
much worse”. Many of the fathers (5) felt that they were misunderstood by
their partner, especially after the initial period of grieving when they were
ready to move forward before their wives. David recalled that “ Mark, on
the other hand found comfort in grieving with his wife although they found
lxi
moments, mostly we were not at the same time.” Ian spoke of how his
times, to be with their thoughts (5) or to cry away from people (3). Luke
spoke about how it was difficult to be left alone “I went out alone and I
find them (my wife and friends) there. I love them, don’t get me wrong but
I love to have moments alone, it’s better alone sometimes”. Matthew spoke
about the first time he felt he could release his emotions “I think I had
more water coming out of my eyes than out of the shower, I broke down,
this was the first instance when I was completely alone and I could break
down without worrying anybody.” Ian recalled that on his way to break the
lxii
A few fathers (2) spoke of the need to seek the comfort from
David said that he often “didn’t feel like his family” even though
talk about the experience with their wives in the early days that followed
the loss but unlike their wives, many fathers (3) stated that they preferred
not to bring up the subject and discuss it after the initial period of
mourning. David was the only father who expressed that he had mixed
feelings, and said that although he wanted to talk with his wife he didn’t
feel that it was healing, this was because he held back and did not
completely let go when talking to his wife so he felt he could not open up
and talk to anyone, even though he wanted to . Luke had similar feelings:
lxiii
“I wanted to be alone, alone, alone, I didn’t want to talk and be around my
wife or my mother, no one, and it was these moments that helped me.
Some (2) fathers found that talking about it with their partners
and family actually helped them. John said that talking to friends and
family about the experience helped even though “people may not like it to
show, but I talk about it and I’m sure it helped.” Mark explained that
“especially my sister, because with her I can really talk about these
things… she, her first baby was a miscarriage and she had miscarried a
twin also.”
family and friends to ease the pain often backfired. Matthew expressed
surprise at his colleagues reactions: They told me ‘We are so sorry that you
did so much for this baby and then you lost it.’ That had not even crossed
my mind. It hadn’t even entered my head. I’m not feeling sorry because of
that. I’m sorry because I lost a future with the baby…and I couldn’t
understand that. It wasn’t good.” Luke found that “a lot of people you
think are friends come over, not to support you but to find out how and
what really happened, typical Maltese. In a way we found out who our real
friends were.” John and Luke mentioned one close male friend each who
lxiv
Many fathers (4) found going to support groups useful as it helped them
realise they are not alone as well as provide information. Many (4) saw it
as a way of giving additional support their wives. Ian found going to group
meetings was a way of helping his wife: “I just go there to support my wife
and the other men” They could around people who understood their grief
as they had passed through a similar experience. Luke explained that “It
felt it was useful and necessary to go together: “Because, then one is trying
to solve the problem, while the other is sitting at home. You make the baby
together so you should go together when they die to solve your problems
together” A few fathers (2) felt very strongly that they found support
groups would not help them. One father even went as far as to state that
talking about it. I don’t like doing it, me personally. It wouldn’t have
All the fathers (6) spoke about their need to do things to keep themselves
busy after the loss. Some were more active cognitively (3) thinking and
up groups while others were active more active physically (3) doing things
lxv
such running, hitting, building and going out. Many fathers (5) felt this
helped heal their loss significantly. Luke explained that “emotions helped
me a lot, not crying though, how do you say, kicking things, physical
wanted to be perceived as coping well and usually (5) they had weaker
affect and shed fewer tears than their wives. Ian said that, “she never asks,
on the other had felt the need to express himself in an emotional way and
said, “I still break down every now and then and fall into a pot hole.” One
father spoke about his need to use alcohol during the early days to help him
lxvi
described it like a “stone on my chest” as well as being tense all over “ I
was all worked up, I was so tense that my muscles were aching and
literally tense” while John touched his chest and spoke of “a pain in here.
father found that in the week leading up to the anniversary of his baby
girl’s death he could not sleep and his appetite became non-existent.
Some fathers (3) said they had vivid flashes of their child that sometimes
popped up. David spoke about how he had vivid dreams about his
daughter. He explained:
I used to dream a lot. I used to see a little girl, her being born as I
had seen her being born. But she was growing and going to school
in her uniform with pigtails and I see her, always got further and
further away. And, I dreamt this for a long time and I never told
my wife because she was crying everyday.
The fathers who faced a perinatal loss used two main adaptive strategies.
worldviews.
lxvii
Most of the fathers (4) used cognitive strategies to cope with the
experience. This is not to say that they did not feel anything, only that their
feelings were less intense than their partners. They could separate their
feelings from their thoughts. Ian, reflecting on what might have been
showed how he could separate his feelings of grief from his thoughts “I
miss her, even when I am in the car with the two kids, and I am taking
them to school I think, she would be over here, I think about it for a few
others, with most men (4) preferring to deal with their loss by thinking of it
and trying to come to terms with the loss by spending time alone and with
into work and doing other things to stop them from ruminating over the
loss was also found to be helpful. Mark spoke about focusing on the house
lxviii
Keeping myself busy helped me a lot. My grandma has a house
and it’s being demolished to make three flats and she told me to take care
of these things and that helped me a lot, it gets me out, going to the notary,
but I still keep a part thinking of the baby, I don’t want to forget.
Not all the men had been given a reason for the loss but all stated that it
would have been helpful to know, especially if there was something they
could do about it to prevent it from happening again. All the men spoke
about how they felt that perinatal loss was a terrible experience but that
they accepted it as one of those things; something that happens and part of
life, although the loss had changed them forever. John said that he felt “it’s
not meant to be” and Ian felt that “…nothing just happens, there is always
a reason for things to happen”. Two fathers used their medical knowledge
to help them cope with the loss and build up a protective barrier. Ian stated,
have happened but for the lay person, who knows how they will take it”.
There were mixed feelings about whether their faith in God helped. Some
fathers (2) found it useful, Mark who found it helped, though his wife felt
differently, he said that he felt “…you cannot blame God about it, about
why he took out child.” Matthew used it to explain to his son that his sister
was now an angel with Jesus. Luke however felt, “Not at all” (Xejn affatt).
David found that first, he found comfort in God, even naming two of his
lxix
children after religious figures, however after multiple losses he took it
After the last loss I took it very much against the church…I
didn’t want to know about anything .I didn’t want to see Santi
cards or even The Pope, poor man who has nothing to do with it, I
used to change the channel. Now I let it all go, it’s passed, but I
spent two if not three months, because I used to say “Four times!
You see women who don’t look after themselves at all and she
goes out and puts them in an institution and because you’d love
and you want to have a family, it’s like he is kicking you”
Maltese translation-?
however; a few fathers (2) found that sharing their feelings of grief to be
lot and “ had the opportunity to express my feelings” The pain of the loss
was expressed with tears that even emerged during the interview and re-
telling the story as a way to make sense of it and get in touch with their
feelings. They found that talking to their wives was the most beneficial
lxx
Don’t hide your feelings from your wife and don’t stay alone
with them because you will not cope with it. You push your
feelings away, but you are not really solving the problem…I know
that if you push it away even years after, it will come back and
resurface.
Luke was the only father who mentioned that he used alcohol as a
Hospital
Most fathers (5) expressed their wish for more privacy during
the birth and just after. One father explained that “we were surrounded by
couples there we knew who were going to deliver.” Half the fathers (3)
lxxi
different area from the labour ward full of expectant parents. Matthew
stated “We even had staff come in to say ‘Congratulations, we are really
happy for you’ and I have to speak up and say listen, we have nothing to be
almost all (5) of the men were extremely satisfied with the immediate after
nothing to complain about, and I will be grateful to them for my life”. Ian
who was in hospital in London said the staff were incredibly professional.
One midwife came in on her day off to make sure his wife did not deliver
have experiences a loss of this nature. This midwife steered him through
situations, like registering the birth, which could have caused more trauma
and to which, being a visitor in the country, he was unaware of at the time.
Their professionalism helped him heal. The one father who found it
traumatic experienced his loss ten years ago, well before any standards of
care were implemented at the local hospital. The person who delivered the
news of his child’s death ignored John and spoke only to his wife, the
doctor told him the sex of his baby and “that it was best if I did not tell (my
wife) and…till this day I didn’t tell her”. The level of the support these
lxxii
fathers received had a huge impact on how the men felt about the whole
experience.
way they were treated outside the hospital. A few fathers (2) expressed
anger at the way shop owners did not acknowledge the loss when asking to
She phoned where we had got the cot and everything from
(name of shop), he’s very, I don’t want to use bad words but he asked us
for the death certificate before he would give us a voucher. Can you
All men (6) found their family and friends gave good support, however at
times they were insensitive to their loss. Mark explained that it was hard
for him and his wife to talk openly in the family about their loss since his
sister-in-law was also pregnant at the time of their loss. “It makes you
wonder how it would have been even seeing her sister pregnant, now she is
really showing… because it would have been only two weeks difference.
John spoke about the fact that he felt “totally forgotten, you are there to
support your wife, that is something that is defiantly lacking, that they give
lxxiii
all the attention to the wife.”, however he did find that his family and one
close friend in particular could understand him. Matthew found it hard that
they don’t actually go up to the mother and tell her “listen how do
you feel? What is it? How are you feeling? Do you need any help?
No, they ask me and to some extent, they take me for granted. At
one point, they were discussing the funeral, when we had not even
cope. I told them I don’t want to think about that now, I’m not
Workplace
sympathy, although most (5) men felt they did not want to go into the
details of their loss with them. John for example said that, “over there I
didn’t express my feelings that much over there…I had spoken to them
about it but I didn’t go deep into in. They work for us, so, I didn’t, it was
Partners support
lxxiv
All fathers felt that their wives had offered them various levels
Matthew felt that now his wife realises what he did for him and is a lot
more tactile with him, whereas before his wife and son were taking him for
granted “…now they are not taking me for granted absolutely. She is
asking me when I come home from work “Listen, do you need some rest?”
Not like before, you know, assuming I was available… she is going out of
their wives and children, if they had any, during the first few weeks. They
felt it was important to grieve privately and talk about it within the family
to make sense of what had happened together, before letting other people
in. Ian and his wife found themselves in a different country and he
explained:
lxxv
4.7 The Pathway to moving forward
Men found several ways that helped them move forward and look to the
future.
All the fathers had seen their baby on the advice of the hospital
staff. Most men were apprehensive at first, as they did not know what to
expect. All the fathers were happy that they had done this even though they
may have initially expressed otherwise. Seeing and holding the baby made
was pink and born alive and the other was born dead. He
lxxvi
described the little girl as “perfect” and “pretty and fair”. The fact
that she was born alive and lived for a few moments made it
asking him why he couldn’t help her. His son was born dead, but
he felt that at least he did not suffer as much and he did not regret
seeing him. David and Mark’s partners did not see one of their
children after they were born as they felt it would make things
worse.
Most fathers (5) were given photographs, hand prints, foot prints
and locks of hair as a way of remembering their lost children. They all
expressed that these were a positive thing in retrospect although one father
still found it hard to look at them. Another father had his daughter
cremated and her urn had a special place in his bedroom so in a sense “she
is still with us”. Half of the fathers carried a picture of their child in their
wallet which they took out to show people. They found this helped them
and a source of comfort. The father who did not have any physical
evidence said that he was not given the option of keeping or recording the
event but expressed his hope that practices had changed and that this was a
good idea as it may have helped him and his wife if it had been available.
lxxvii
4.7.3 Looking for the silver lining and Generativity.
All fathers (6) initially found nothing positive about the whole experience
emerge was that they were closer to their wives, both physically and
emotionally and felt that their marriage was now stronger. Half the fathers
(3) wondered about the future and what they could do to keep their child’s
memory alive. One father set up a support group as a way of keeping his
daughters memory alive. Another positive thing that emerged was the
fathers understanding of others losses. All the fathers (6) felt that now they
were better able to provide support to others who have lost someone.
4.7.4 Weaving the experience and memory into the fabric of the
family.
All fathers stressed that their lost children were indeed a member
of the family even if he or she did not survive. Most fathers (5) included
their dead babies when counting the number of children they had and liked
it when others acknowledged their lost children. Fathers who’s losses had
occurred more than a year ago found ways of remembering the child on
their anniversary, especially in the first two years after the loss. Most just
spent the day alone with their wives or visiting the cemetery. Ian went as
far as to introduced a system where every year he and his family celebrate
lxxviii
his daughter by going out for a meal with the rest of the family. He
explained, “She hasn’t left us, she is still with us and that has helped me
cure myself.”
Introduction
perinatal loss. In doing this, various themes with different textures and
structures emerged. Here I will discuss the findings that were consistent
lxxix
Fathers in the study reported a profound sense shock at the loss as well as
that showed fathers reaction’s to be less intense and their grief resolved
means of coping, one more cognitive in style and one more affective in
style. These findings are consistent with Martin and Doka’s (2000) theory
style strategies to cope exhibited tears, expression of feelings and the need
to talk and retell their story. In fact, during the interviews, fathers who
were later identified as being more affective in style, shed tears and
have been beneficial and cathartic. Most fathers in the study used thinking
as predominant to feeling and noted that their feelings were less intense
lxxx
than their wives were. This reflects Martin and Doka’s (2000) ideas on
strong and set one’s grief aside (Henley & Kohner, 1991). The fathers in
the study felt a need to take on the supportive role and to show their
feelings less. They felt the need to control themselves and their
that men may score lower due to the way they express their grief.
Martin and Doka, 2001), ideas about society norms that regulate behaviour
and experience. Men exhibited severe reactions during the labour were
offered pills to calm them down but declined as they wanted to calm
themselves down and take it like a man and be strong. Grief is an emotion
that is usually not associated with masculinity. Those men whose feelings
stronger feelings of anger than the other men. For example, one father
lxxxi
Perhaps a direct result of suppressing affective emotions, lead them to be
Another strong theme to emerge from this study was the heavy
speaks about fathers finding comfort and sometimes blaming and showing
anger towards God. This study revealed what a powerful social agent the
Roman Catholic Church is on this island and how all the Maltese fathers
about. The three top priorities Abela speaks about are : family, work and
religion. Religious rituals associated with death were usually adhered to,
chosen, even though a perinatal loss was not considered a proper death in
terms of the law or the church.Those fathers who chose to have a burial or
ceremony were usually afforded dignity and recognition of the loss. Many
due to Malta’s strong family ties ( Sultana & Baldacchino, 1994), which
they did not always find helpful, as they wanted to be alone. The church
performed some sort of ceremony, which was not the case in other findings
contrast to other countries. The religious element could also be seen in the
lxxxii
use of Santi (cards with a picture of a saint) which were often placed in the
casket with the child. Several fathers still visited their child’s grave
regularly and one father had plans to build a religious shrine to place the
baby’s urn in. God was also used as a way of justifying and rationalizing
the loss. The only person who did not bring up religion until probed, and
had reactions consistent with literature, was the only father in the study
was foreign. This leads one to believe that Maltese men use and rely more
heavily on religion than men in the United Kingdom, North America and
those by Lasker & Toediter (2000) and Kavanaugh, Trier & Korzec (2004)
which have shown that couples who support each other, come out of this
tragic even with a much stronger bond and ultimately have a stronger
physically present and talking about the loss only made it harder for the
fathers in the study who needed to be alone to grieve. Those fathers who
specifically told their family to back off and give them time alone with
their partner first, claimed that this made them heal faster.
lxxxiii
Intimacy is, according to Sultana and Baldacchino (1994), one of
almost impossible not to bump into people you know on the bus or at the
supermarket for example and since many people belong to many networks,
Malta are therefore afforded even less privacy and time alone than abroad.
unannounced. While this was beneficial for men who found speaking about
the loss useful, those who didn’t, found it even harder to find the space
they required to grieve. The need for others to find out the finer details of
the loss is especially typical of small tightly knit communities. This was
found to be hurtful especially when this was all that was asked about.
Only one father supported the literature that states fathers are
not being a bereaved person in their own right (Weaver, 1996). The
majority of fathers spoke highly of the hospital staff that treated them as
mourners in their own right. They also confirmed the findings in literature
encouraged by staff to hold the baby for the first time but once they did
they looked upon the experience as positive. This shows what a long way
the Maltese medical profession has come within the last ten years when
lxxxiv
dealing with standards of care and perinatal loss. This study highlighted the
usefulness of hospital staff and how they helped in resolving in the fathers
Father’s views on support groups was consistent with literature in this area.
aware that some men may not be comfortable disclosing their emotions
and should not be pushed, as this may do more harm than good.
support, even though they preferred not to go into details of the death with
colleagues. Many fathers also though the type of support was not always
helpful.
them beneficial and this was consistent with recent literature on the subject
(Lane, 2000). Keeping the child’s memory alive by helping others and
weaving his or her story into the fabric of the family was also backed up
lxxxv
the literature (Johnson & Puddifoot,1996; Kavanaugh,2001; Radstad et al,
2001)
Chapter 5
lxxxvi
Limitations of this study
This study is limited in size and scope. The biggest setback was
the limited length of this project. I found that the more engrossed I became
in the subject matter, the more I felt it impossible to limit or summarise the
experience. I believe that being able to explore fully each part of this
researchers.
all fathers who experience a loss of this type. The results are therefore
this study. Since five out of the six interviews were carried out primarily in
lxxxvii
English, the interviews may not be an accurate sample of the Maltese
the two languages. Finally, due to the sensitivity of the topic, the co-
findings in this study are consistent with a larger proportion of men. The
study could also look at the differences between fathers who are still
childless and those who are not. It may also be useful to determine if
multiple losses effect paternal grief reactions or not. Another issue which
emerged and was not touched upon by the researcher was the issue of grief
in the siblings of the families going through a perinatal loss. Several fathers
in this study spoke of their concern for their sons and daughters reactions
to the loss. Future research may want to focus on the children or family as
lxxxviii
Most fathers in this study received support through S.A.N.D.S. It
would be useful to compare these men to fathers who were not given the
same level of hospital and group support. Finally, future research may find
it useful to further explore the role of local culture and how this colours
Conclusion
lxxxix
References
xc
Doka, K .A. & Martin, T. (2001). Take It Like a Man: Masculine Response
to Loss. In Dale A. Lund (Ed.), Men Coping with Grief. (pp. 37-47). NY:
Baywood Publishing Company, Inc.
Fathers Bond With Their Unborn Babies, Study Finds. (2003, February
12). The Age, Australia.
Ilse, S. (2002). Empty Arms: Coping with miscarriage, stillbirth and infant
death. Burnsville, NC: Compassion Books, Inc.
xci
Johnson, M .P., and J. E. Puddifoot.(1996). The grief response in the
partners of women who miscarry. British Journal of Medical Psychology
69, 313-27.
Kavanaugh, K., Trier, D., Korzec M.( 2004). Social Support Following A
PerinatalLoss. Journal of Family Nursing, 10(1), 70-92. Sage Publications
Inc.
Kohner, N., & Henley, A. (1991). When a baby dies: The experience of
late miscarriage, stillbirth and neonatal death. London: Pandora Press.
xcii
Layne, L.L. (1992). Of Fetuses and Angels: Fragmentation and Integration
in Narratives of Pregnancy Loss in D. Hess and Linda L. Layne (Eds)
Knowledge and Society, 9:29-58.Hartford, CT: JAI Press.
Layne, L.L. (2000). He Was A Real Baby With Baby Things: A Material
Cultural Analysis of Personhood, Parenthood and Pregnancy Loss. Journal
of Material Culture. Vol 5(3): 321-345. Sage Publications Inc.
Martin, T. L., & Doka, K (2000). Men don’t cry... women do:
Transcending gender stereotypes of grief. Philadelphia, PA:
Brunner/Mazel.
xciii
Miller, J.E., & Golden, T. R. (1998). A Man You Know Is Grieving.
Indiana: Willowgreen Publishing.
xciv
Radstad, I.,Samuelsson, M., & Stegesten, K. (2001). A Waste of Life:
Fathers Experience of Losing a Child before Birth. Birth. 28, 124-130.
Blackwell Science, Inc.
xcv
Weaver, J. (1996). What’s a Father to do? In P. Schwiebert (Ed.), Strong
and Tender (pp. 9-15). Burnsville, N C: Compassion Books.
Zeanah, C., Danis, B., Hirshberg L, & Dietz, L. (1989). Initial adaptation
in mothers and fathers following a perinatal loss. Infant Mental Health
Journal 16(2), 80-93. Sage Publications, Inc.
Appendix A
Consent Forms
xcvi
Consent Form English Version
xcvii
Elizabeth Camilleri
Flat 4
15, G. Howard st
Sliema, SLM 09
Tel: 21320473
Consent Form
Dear Mr_________
I am currently following a Bachelor of Psychology Honours course at the
University of Malta. As part of the course requirement I am conducting a
research study on the experience of stillbirth on fathers. The results of this
study will contribute to the understanding of those who work with
bereaved parents.
At any point during the interview you may withdraw from the study should
you feel the need to.
xcviii
I would like to thank you for considering my request
Signature
( Initials only)_________
Date_________
Yours Sincerely
Elizabeth Camilleri
xcix
Consent Form Maltese Version
Elizabeth Camilleri
Flat 4
15, G. Howard st
Sliema, SLM 09
Tel: 21320473
Ittra ta’ Kunsens
Ghaziz ______
Qieghda nsegwi kors tal- Bacellerat fil - Psikologija fl- Universita ta’
Malta. Bhala parti essenjali mill- kors qieghda naghmel ricerka dwar l-
esperjeza ta’ ‘stillbirth’ fuq il-missier. Ir-rizultati ta’ dan l- istudju ser
jghinu lil dawk li jahdmu ma’ genituri li telfu tarbija.
Din il- ricerka tikkonsisti f’intervista ta madwar hamsa u erbghin minuta
fejn nitolbok titkellem fuq l - esperienza tieghek ta’ l - istillbirth’ u fuq in-
niket li garrabt wara din it- telfa. L- intervista ser tigi rrekordjata u mnizzla
kelma b’kelma bil-miktub. Kopja ta’ l - intervista u tat- tezi shiha jigu
mibghut lilekh. Nassigurak li l-materjal kollu ser jibqa kunfidenzjali u
jintuza biss minni ghall din ir- ricerca.Ismijiet u d- dettalji personali ser
jinbidlu biex tinzamm il-kunfidenzjalita.
Fi kwalunkwe him waqt din l – intervista tista tirtira minn dan l- istudju
jekk tixtieq.
c
Jien __________,(firma) naghti l- kunsens tieghi minn jeddi sabiex niehu
sehem f ’dan l – istudju hawn fuq deskritt.
Firma_______
(Inizzjali biss)
Data_______
Dejjem Tieghek,
Elizabeth Camilleri
ci
Appendix B
Interview Guide
cii
Demographic details
ciii
Questions in English
1 Can you describe in your own words your experience of this event?
٭How did you react initially to the news?
2 Can you describe in detail your thoughts, feelings and reactions through
this time ?
In what ways did you grieve the loss?٭
civ
٭What kind of emotions did you feel?
٭How did thinking help in all this?
7 Did you feel the support of your partner during all this?
12 Looking back, is there anything you wish you had done differently ?
14 Is there anything you feel would have helped you during this time?
15 Is there anything else in regard to this experience that you would like to
add?
cv
Questions in Maltese
cvi
3 Ir - reazzjonijiet tieghek, kif kienu bhal, jew differenti minn dawk tal-
partner tieghek?
٭ X’ kien l- ewwel inkwiet taghom ?
٭Esprimew ruhhom differenti minnek ?
cvii
11 U fuq il – post tax- xoghol ?
٭ L’ imghallem eghnek, u l- kollegi tieghek ?
14 Hemm xi haja li thoss li kieku kienet tghinek matul dan iz- zmien ?
Appendix C
cviii
Initial
Reactions
cix
cx
4