Perinatal Loss Keynotes

Across the Rainbow: Multidisciplinary Approaches to Perinatal and Infant Loss

Friday 25 October 2019

Our inaugural conference gives you access to multidisciplinary leaders in the perinatal loss space.  You have opportunity to hear from each and every one of our impressive keynotes as we have designed the program as a single stream.

The program addresses perinatal loss across the rainbow of experience, from assisted conception, through miscarriage, genetic termination, stillbirth and pregnancy following loss. Our speakers will knit together knowledge from psychiatry, psychology, obstetrics, midwifery, social work, grief therapy, relationship therapy and lived experience.

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Considering perinatal loss within a developmental framework of pregnancy

Pregnancy represents a time of immense transition, adjustment, and change for parents-to-be with emotional and psychological transformations characterising the perinatal period. Psychological work is required in which individuals consider themselves in the emerging role of ‘the parent’, and the idea of the baby as a real person surfaces.  Holding in mind the immense psychic and relational reorganisation that occurs during pregnancy, on the background of the formation of an early attachment to the unborn child, the establishment of a parental image, and emerging hopes and dreams for the future, clinicians are charged with the task of considering the complex developmental processes that occur during pregnancy. Perinatal loss disrupts the developmental processes of pregnancy and transition into early parenthood.  This presentation will invite participants to consider pregnancy within a developmental context and to reflect on what happens when these normative developmental milestones are disrupted by a perinatal loss.

Dr Charise Deveney is a Clinical Psychologist.  She founded Let’s Talk Psychology Practice, a private psychology practice, in 2008 on Sydney’s upper North Shore.  Charise heads a team experienced of psychologists.  Charise and her team are well known in the field for providing focused perinatal and infant mental health services to the community.  Having completed a postgraduate diploma in perinatal and infant mental health with the NSW Institute of Psychiatry, Charise has a solid theoretical understanding of the clinical issues faced during the perinatal period and into parenthood.  For the past 8-years Charise has facilitated a group program, Managing Motherhood, that provides support for women transitioning into parenthood.  Charise is co-creator of Bearing the Unbearable: a relationship-based training program for perinatal loss, co-creator of Together with Baby: an evidence-informed eclectic group program that uses baby massage and mindful awareness to support healthy parent-baby relationships, and a proud Member of the Centre of Perinatal Psychology.  Charise advocates for perinatal and infant mental health issues in the medical field, providing lectures to medical students on perinatal and infant mental health through the Sydney Adventist Hospital.  Holding a holistic framework Charise is currently completing a PhD the Department of Medical Sciences at the UNSW and Australasian Research Institute investigating the aetiology of perinatal depression. Perinatal loss is perhaps one of the most challenging clinical presentation to work with as a therapist and Charise is keen to support other clinicians in their work with this very vulnerable client group.  Charise is a mother of three beautiful children and an adventure enthusiast; always on the look-out for a new challenge!

The true impact of early pregnancy loss and infertility

This session will delve into the emotional and mental health impact of early pregnancy loss and infertility. Samantha will share the support services they offer through The Pink Elephants and the plans they have for the future; inclusive of their 2019 launch of Fertility in the Workplace Support. She will address the successes and challenges of this program, highlighting the importance of shining a light on the mental health impacts of early pregnancy loss and infertility. Covering the need for better support of men walking the journey of loss with their partners and how organisations need to reach this audience too.

Samantha Payne is a Co-Founder and Director of The Pink Elephants Support Network. After her own experience of miscarriages she identified an unmet need in terms of support specific to that of early pregnancy loss. Together with Gabbi Armstrong they created a charity The Pink Elephants Support Network and in just over 3 years have supported over 10,000 couples through miscarriage. Samantha is on a mission to ensure that no couple faces the journey of pregnancy loss alone and that they receive the support they need and deserve.

Get comfortable with uncomfortable – caring for families with extreme complex pregnancy’s with uncertain outcomes.

Melanie McKenzie the Founder and Director of Harrison’s Little Wings will discuss the unique service Harrison’s Little Wings provides and what women and families are saying.

Caring for Families with complex pregnancies, who have uncertain outcomes can be difficult and at times it can be uncomfortable to give distressing news to families. Melanie McKenzie wants to get comfortable with uncomfortable.

What do undergraduate caring professionals need to know about stillbirth?

The Australian Government has recently identified stillbirth education and training for health professionals, as an important strategy for reducing stillbirth. A key recommendation arising from the national stillbirth roundtable of Australian experts held in February 2019 was:

… all health professionals involved in providing antenatal care need to have up to date knowledge in relation to stillbirth prevention. They also need to have skills to communicate these risks to pregnant mothers and help them to identify and address personalised risk factors

This presentation will outline what undergraduates who are studying for a caring professional qualification needs to know and why.

Dr. Jane Warland (RM, PhD) is a registered midwife and associate professor in Nursing and Midwifery at the University of South Australia. Since suffering the unexplained full term stillbirth of her daughter Emma in 1993, she has been a passionate researcher into preventative and modifiable risk factors for stillbirth as well as promoting public and maternity care provider awareness of stillbirth. Her program of research is STELLAR (stillbirth, teaching, epidemiology, loss, learning, awareness and risks). She is regularly called upon to present her research at national (Australian) and international conferences. She has more than 90 publications, including books and journal articles: many in the area of stillbirth.

Love and Loss: The impact of grief on a couple’s relationship

At a time when parents expect to be happier together than ever, the losses of parenthood can sideswipe a couple. There are different types of losses and each is likely to have a different impact for mothers, fathers and partners: some losses may not even register and others can ravage a relationship. In this presentation, practitioners will be introduced to different types of perinatal loss, the impacts of these on mothers, fathers and families and a number of different models of approaching loss. Participants will go away from this session with some new understanding and ways to support couples, even if only one parent is in the room, through this immensely challenging time.

Elly Taylor is an internationally recognised perinatal relationship expert, award winning author and founder of Becoming Us, an organisation grown to prepare and support parenthood professionals to prepare and support parents. Elly has served on advisory panels for a number of Australian university research projects and is currently on the board of the International Forum for Wellbeing in Pregnancy. Elly lives in Sydney with her firefighter husband, their three children and a bunch of pets.

Grief in the 21st Century

Although grief is a universal experience, it is not a process we are officially taught (in first world Western cultures), nor a topic that is discussed a lot (apart from the media continually talking about ’closure’). In this presentation, I will briefly discuss the change in approaches to grief over the last 20-30 years, and the tensions that can result from these changes; I will explore some of the reasons why we want to ‘make things better’ for the bereaved, and suggest how futile this is; and finish with a discussion on the power of words in relation to perinatal and infant loss.

Vicki Culling, PhD is the Director and Principal Educator for Vicki Culling Associates. She is a bereaved parent whose first daughter died in 1998, which led her to utilise her education and social work skills in the area of perinatal and infant loss bereavement support and training. Vicki was a founding member of the NZ Perinatal and Maternal Mortality Review Committee, and is currently a member of the NZ Maternal Fetal Medicine Governance Committee and on the NZ National Perinatal Pathology Service Committee. Vicki has been involved with Sands NZ, both nationally and locally, for over 15 years. At present, she is working with government agencies in NZ to explore how we might better support bereaved parents, families and whānau when a baby or infant dies.

Understanding and supporting infant loss

Supporting families after the death of a baby is often challenging. Mothers report feelings of guilt and shame that seem immovable. Fathers, often report a sense of helplessness and hopelessness in supporting their partners; whilst at that the same time trying to navigate their own grief experience.  Within the supervision setting clinicians have shared feelings of inadequacy and ineffectiveness in really creating shifts in this cohort of bereaved parents. In order to best support the perinatally bereaved, clinicians need to understand and acknowledge that people grieve differently. One’s grieving style will determine the most effective therapeutic interventions for that individual.

Keren Ludski is the CEO of Red Nose Australia.

Keren graduated with a degree in psychology from Monash University in 1988 and has spent the last 18 years supporting bereaved parents and families, providing clinical supervision and educating other professionals in the field. She has worked with community-based organisations and corporates nationally.

Keren’s experience as a counsellor has spanned both private and corporate sectors, with a dedication to upskilling those within the corporate and healthcare system to better support their clients in grief.

As CEO of Red Nose, Keren is focused on achieving Red Nose’s mission to save the lives of babies and children and support people impacted by the death of a child.

Heartfelt – Giving the gift of photographic memories

Heartfelt is a volunteer organisation of professional photographers from all over Australia and New Zealand dedicated to giving the gift of photographic memories to families that have experienced stillbirths, premature births or have children with serious and terminal illnesses.

Heartfelt is dedicated to providing this gift to families in a caring, compassionate manner.

All services are provided free of charge.

Founder and President of the volunteer charity Heartfelt, Gavin Blue is a 2019 Order of Australia Medal recipient.

A successful commercial photographer based in Melbourne, Gavin works with clients in Australia and around the world.

As founder and President of Heartfelt, Gavin leads a team of over 320 volunteer photographers and retouchers across Australia and New Zealand. The charity is dedicated to providing professional photography to families who have experienced stillbirths, premature births or have children with serious and terminal illnesses.

Parenting while grieving a perinatal loss

This paper will specifically look at the emotional challenges faced by parents grieving a perinatal loss when they are already parenting a toddler or pre-schooler.

Parents may be able to negotiate leave from work but not from parenting. Responsive parenting to their child’s immediate and long term attachment and emotional development needs may conflict with their own grief needs and default responses. If their pre-schooler was also looking forward to having a baby sibling, their pre-schooler may need help understanding the concept of death, and adjusting to their own experience of loss. This may add multiple layers of distress- such as witnessing their toddler’s distress, and potentially regressed behaviour, and perhaps being triggered by innocent but difficult questions for which they may be unprepared. This may be exacerbated in the context of limited societal scaffolding.

Julie King is a Brisbane based Psychologist and a Member of the Centre for Perinatal Psychology.  Julie has dedicated much of her 30-year career to the field of perinatal and infant mental health, and holds a long-standing clinical interest in perinatal loss. Julie is co-creator of Bearing the Unbearable: a relationship-based training program for perinatal loss facilitated through the Centre for Perinatal Psychology.

Mercy Hospital for Women STAR clinic:  Decision-making, clinical management and care during subsequent pregnancies

Presented by Dr Gaynor Blankley, Dr Elizabeth McCarthy and Mary Klasen

  1. Introduction

Grief following pregnancy loss is profound and far reaching. It differs in some ways from grief after losing a loved one who has shared a longer, child or adult relationship with a bereaved parent. One distinguishing feature is that pregnancy often occurs again, mixing ideas of life, hope, death, sorrow, joy, guilt and birth. About 65% of couples worldwide conceive another pregnancy within 1 year of perinatal loss.  Whenever it occurs, the next pregnancy presents biopsychosocial challenges.

  1. Description

Biological tasks include phenotyping the previous loss, identifying causes, risks, predicting and preventing recurrence. Many currently used tests, surveillance and interventions lack high level evidence for benefit. In trying to help, we must strive not to make women’s experience and outcome worse.

Psychosocial tasks include validating the woman’s experience, range of emotions and providing individualised care. Excessive attention on biomedical factors can detract from normal parenting tasks, joys and challenges. Excessive emphasis that the next pregnancy will probably result in livebirth (97+% overall) can seem to invalidate the woman’s ongoing bereavement and love of her lost baby and detract from efforts to reduce stillbirth for this women and others.

Multi-disciplinary care which includes obstetrician/perinatologist, midwife, pastoral care/bereavement workers, mental health and ready access to other clinical, laboratory and research specialists aims to balance these emphases.

Those of us caring for women during pregnancy after loss need to be responsive to (a) the woman and (b) research. Encourage and explore women’s questions: they have thought about pregnancy loss a lot and might be the catalyst for stillbirth-preventing research.

  1. Summary

The STAR clinic at Mercy Hospital for Women provides care which is individualised, responsive, multi-disciplinary, evidence-guided, (despite a currently imperfect evidence-base) offers balance, safety and usually, good biopsychosocial outcomes for women who are pregnant after loss. This session will provide an overview of how the STAR clinic responds to these issues and needs.

Dr Gaynor Blankleis a psychiatrist with 25 years of experience working in perinatal mental health. She is the clinical head of Perinatal, Mercy Mental Health and has a particular interest in integrating mental health services into maternity care. She has worked extensively with women with borderline personality disorder, substance use disorders and who have suffered from stillbirth, neonatal and pregnancy losses.

Dr Elizabeth Anne McCarthy (known as Liz) is an obstetrician /maternal-fetal medicine (MFM) subspecialist at Mercy Hospital for Women and Northern Hospital, and Senior Lecturer in the department of Obstetrics and Gynaecology, University of Melbourne.

Her clinical work includes outpatient consulting, obstetric ultrasound, early pregnancy assessment, and inpatient care of women with antenatal, birth and postnatal problems. She also teaches and examines medical students in University of Melbourne Doctor of Medicine. EAM’s research includes 2 randomised controlled trials, and several cohort, cross-sectional surveys and audits and has authored over 30 peer-reviewed articles. She is an associate Editor for the Australian and New Zealand Journal of Obstetrics and Gynaecology and reviews manuscripts for several other journals.

EAM has provided obstetric care for women who have experienced Stillbirth and Reproductive Loss (STAR) at Mercy Hospital for Women since before 2010. Beginning as an MFM led clinic, it is now multi-disciplinary with midwives and liaison psychiatry, led by Dr Gaynor Blankley since September 2016.

EAM has represented RANZCOG at a SANDS workshop on Perinatal Loss 2018. She is a current working group member developing the Smoking Cessation component of the Safe Baby Bundle (SBB) with the Stillbirth Centre for Research Excellence (CRE) based at Mater Hospital, Brisbane QLD. In 2019, EAM has been an invited speaker about pregnancy after loss at The Northern Hospital – February, Perinatal Society of Australia and New Zealand (PSANZ, Broadbeach QLD) – March  and the International Stillbirth Alliance (ISA, Madrid) – September.

Mary Klasen is Director of Pastoral Care at The STAR Clinic, Mercy Hospital for Women, providing emotional and spiritual support for families.