Abstract

Continuing bonds theory suggests that bereaved parents can adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents’ everyday lives and support systems. Few studies examine continuing bonds following stillbirth, and little is known about the potential mental health benefits of expressing continuing bonds. Most studies focus on parent-baby contact and memory-making activities in the immediate aftermath of the loss. Findings are inconclusive although there is evidence that sharing memories of the baby is related to better maternal mental health. Therefore, this project explored how parents continued bonds with their stillborn baby longer term, and investigated any association between key aspects of the relationship, parents’ perceptions of social support for the relationship, and bereavement adaptation.
A mixed methods design was employed. In Study 1, 12 parents were interviewed. Data analysis was informed by grounded theory and the constant comparative method applied. In Study 2, parents (N = 170) completed an online questionnaire examining engagement in continuing bonds expressions over time; characteristics of the relationship and parents’ experience of sharing it; social support, and meaning-making. Measures of anxiety, depression, posttraumatic stress, and posttraumatic growth were also included to quantify bereavement adaptation. Results showed the creative strategies employed by parents to maintain connections with their baby; the affective depth and potentially interactive nature of bonds; and the enduring, pervading influence of the relationship on parents’ ongoing lives. How the relationship was expressed changed over time. Parents appreciated sharing their relationship with their baby with compassionate others. Generally, partners, family members and friends understood and supported parents’ relationship with their baby. However, over half of parents stated that some family members and friends did not support the relationship. Few parents believed the relationship was expected or widely understood in society, and social support for it tended to fade over time. Most parents thought the relationship aided coping. Regression analyses showed that time since death, meaning-making, engaging with nature and legacy building are positively linked to parents’bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. For the first time this project shows that key aspects of parents’ ongoing relationship with their stillborn baby, and parents’ perceptions of the social context in which they experience the relationship are related to bereavement adaptation. A social context that fails to fully accommodate parents’ relationship with their baby may be contributing to poorer outcomes. Moreover, results indicate the therapeutic potential of nature following stillbirth. Recommendations for care and the development of a nature-based intervention are proposed.