Two hidden predisposing factors in child abuse

It is in the nature of stillbirth that it is very difficult to mourn. The psychological characteristics of stillbirth that give rise to the difficulty with mourning also tend to lead to its mismanagement. This exacerbates the problem so that stillbirths are often very inadequately mourned. Furthermore, the quick replacement pregnancy which frequently follows a stillbirth, and is unfortunately so often encouraged by others, impedes the mourning of the stillbirth. In the puerperium the mother, though preoccupied with her live baby, is haunted by the unmoumed stillbirth. This can result in profound difficulty with the mothering of a baby born subsequent to a stillbirth. Often the baby screams. In addition, as a stillbirth can lead to marital difficulty, the mother often feels undermined by her husband. If there is a family difficulty with containing violence, the child may be battered. Pregnancy tends to inhibit the normal processes of mourning. It is particularly difficult to mourn a dead baby during pregnancy. However, with all bereavements which occur during, or shortly before or after pregnancy, mourning tends to be inhibited. Once delayed by pregnancy and the maternal preoccupation with the new baby, the work of mourning may never get properly under way again. A case will be described of a woman who murdered her eldest child eight months after the birth of a baby, her husband having died suddenly during the pregnancy. It is important to be aware of the difficulty of mourning during and around pregnancy in the understanding and prevention of child abuse. Methods to facilitate the mourning of a stillbirth and other bereavements during pregnancy and in the perinatal period will be described.