Book Review

Loss during Pregnancy or in the Newborn Period: Principles of care with clinical cases and analyses

N Engl J Med 1998; 338:1552-1553May 21, 1998

Article

Loss during Pregnancy or in the Newborn Period: Principles of care with clinical cases and analyses
Edited by James R. Woods, Jr., and Jenifer L. Esposito Woods. 546 pp. Pitman, N.J., Jannetti, 1997. $34.95. ISBN: 0-9655310-0-7

The loss of a baby, whether by miscarriage, stillbirth, or postnatal death, is as profound a loss as anyone could expect to experience. Anyone involved in the care of pregnant women and their families can attest to the intensity of these experiences. For physicians in particular, training programs have paid inadequate attention to teaching the expected course of bereavement and modeling the skills of counseling for grieving families. This lack of instruction and guidance promotes the discomfort many physicians experience when dealing with pregnancy loss and does little to dispel the notion of the physician as an uncaring technician.

Loss during Pregnancy or in the Newborn Period is a welcome addition to the limited number of textbooks addressing this subject. The scope of this book is broad; the editors have chosen to address pregnancy loss from many angles: loss at the various stages of pregnancy, the medical causes of loss, methods of preventing fetal death, the roles of various care providers, and issues of counseling and ethics. The book encourages a broad definition of pregnancy loss by including such information as the feelings of loss experienced by birth parents who give children up for adoption. The authors represent many disciplines and include a funeral director and parents who have experienced pregnancy loss.

In each chapter an overview of the topic is followed by one or more case analyses written by professionals other than those who wrote the chapter. The case summaries are often poignant examples of the issues raised in the chapters. The more helpful ones relate to the overall issues and relay advice based on the commentator's experience rather than discussing the details of recommendations about the specific cases. Some of the comments seem overly biased by the opinions or the particular research interest of the commentator, which detracts from the generally balanced views presented in the chapters.

The editors state clearly that they intend their book to interest a wide variety of professionals, including physicians, nurses, psychotherapists, clergy, and funeral directors. One consequence of this broad approach is that not all chapters will be of interest to all readers. The chapters on the more technical aspects of the problem, such as the biologic aspects of loss, the teratologic aspects of loss, and the technologic approaches to antepartum surveillance, are well written but are overly detailed for paraprofessionals and provide little new perspective for physicians. Likewise, some of the details of the models of mourning processes will be less helpful to physicians than an overview and may seem oversimplified to psychotherapists. A few chapters are hampered by the paucity of research in the area of interest. This applies to the chapter on adolescent pregnancy, in which there is a detailed account of an unpublished study, and the chapter on birth parents' grief about relinquishing their babies for adoption. One aspect of perinatal loss that is touched on in several chapters but that may have deserved its own chapter is the loss experienced by families when a pregnancy is complicated by a severe fetal abnormality that does not end in termination or fetal death.

Overall, this book provides a wealth of information and advice from professionals who are clearly dedicated to improving the care of families in crisis over pregnancy loss. It can provide a framework within which those in training can begin developing their skills in this area and can give valuable help to those who had inadequate training in this challenging aspect of medical care. Implementation of the skills and knowledge gained from this book will improve the quality of care we provide to patients and the satisfaction our patients feel about our care.

Emily R. Baker, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756