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The Grief Ritual of Extracting and Donating Human Milk after Perinatal Loss
Abstract
Perinatal loss is a major life crisis involving multiple losses, including the loss of future hopes and dreams, of being pregnant, and of self-esteem, to name a few. In the present study I focus on mothers who experienced perinatal loss and chose to extract and donate their human milk to nonprofit milk banks. Through an analysis of 88 women’s personal testimonials, collected between 2017 and 2019, I uncover the ritualistic attributes of the extraction and donation process. The bereaved mothers in this study experienced ambiguous loss, comprising the combination of the physical absence and psychological presence of their baby. The process of extracting and donating their milk constitutes a grief ritual, allowing mothers to maintain and reconstruct the continuing bonds with their babies. The present study extends current understandings of organ donation in times of loss, highlighting the unique nature and consequences of the milk donation process through its conceptualization as a grief ritual.
... The concept of continuing bonds in the context of grief and bereavement is well known and developed (see for example: Klass et al., 2014;Oreg, 2020). This theory proposes that after the death of a loved one, individuals maintain a psychological connection with the deceased through various means, such as memories, rituals, and symbolic gestures (Klass et al., 2014;Oreg 2020). ...
... The concept of continuing bonds in the context of grief and bereavement is well known and developed (see for example: Klass et al., 2014;Oreg, 2020). This theory proposes that after the death of a loved one, individuals maintain a psychological connection with the deceased through various means, such as memories, rituals, and symbolic gestures (Klass et al., 2014;Oreg 2020). ...
... Continuing bonds can also be observed in the way individuals integrate the deceased person into their sense of identity and the narrative of their lives. Memories of the decedent may become a part of the individual's story, influencing their thoughts, feelings, and behaviors in various ways (Klass et al., 2014;Neimeyer, 2016;Oreg, 2019Oreg, , 2020Prigerson & Maciejewski, 2008). ...
This study explores the phenomenon of memorial stickers commemorating victims of the October 7, 2023, massacre and subsequent Israel-Hamas war. Analyzing 600 stickers collected across Israel, we examine how these artifacts shape personal and collective memories of these tragic events. Using content analysis, visual data analysis, and ethnography of texts, we investigate the stickers' distribution, textual content, and visual elements. Three key findings emerged: (1) The widespread distribution of stickers expands commemoration beyond cemeteries, creating a larger community of remembrance; (2) Diverse textual content, from personal traits to universal messages, aims to keep the deceased's values alive in social awareness; (3) Visual elements balance public recognition with private mourning through strategic use of photographs, colors, and barcodes. Drawing on theories of collective memory and continuing bonds, we argue that these stickers symbolically bring the deceased into daily life and public spaces, contributing to the processing of personal and national trauma.
... Recognizing that early physical bonding experiences can have formative impacts on parents as they navigate the uncertainty of their infant's prognosis, healthcare practitioners should attempt to support early experiences such as skin-to-skin contact, handholds, and other physical contact whenever safe and appropriate to do so to limit early physical separation and the associated burdens. Similarly, the appreciation parents felt for photographs and tangible mementos to maintain their child's legacy is one that has been well-described (Alexander, 2001;Cortezzo et al., 2015;Kymre and Bondas, 2013;Levick et al., 2017;Oreg, 2020). Parents' stories alluded to how the care they received in the NICU contributed to sense-making in the time following the death of their infants, and some explicitly described the importance of tangible items in assisting that healing process. ...
... Bereavement is a long-term process that benefits from tactful and compassionate communication, shared decision-making, and individualizing care to help parents grieve, find closure, and move toward acceptance after loss (Clarke and Booth, 2011;Cortezzo et al., 2015;Currie et al., 2019;Oreg, 2020). It is important to note that the stories told by parents did elicit some unexpected discrepancies in methods of support that have been previously identified in the literature. ...
... Though individualizing care is an essential component to providing effective bereavement care, parents' stories wholly illustrated the impact healthcare providers had on their bereavement in the short and long term. There are several supportive measures, as seen in the literature, that healthcare practitioners should generally provide that help support families-frequent communication with the healthcare team, encouraging parents to participate in daily rounds, involving ancillary services, and supporting parents to spend quality time with their infants (Clarke and Booth, 2011;Cortezzo et al., 2015;Currie et al., 2019;Oreg, 2020;Sigurdson et al., 2020). This study illustrated additional ways healthcare practitioners could enhance family-centered care and provide parents with other realms of support in their bereavement. ...
Death is no stranger to the neonatal intensive care unit (NICU). Extreme prematurity, congenital abnormalities, and other complexities can turn what was hoped to be a very exciting moment in a family’s life into one of despair and grief. There are many infants that not only do not survive but also have a medicalized death necessitating complex decision-making, weighing quality versus duration of life. We can learn from the stories of parents who chose palliative care for their children. In this narrative inquiry study, we elicited bereaved parents’ stories and reflections on the lives of their children and the care they received in the NICU. From a narrative ethics perspective, their stories speak to normative aspects of parenting, decision-making, and receiving medical care that affect their moral sense-making of their NICU experiences as well as their longer-term living with the loss of their children. Their stories express the importance of having had meaningful time with their children, maintaining direct and frequent communication, acknowledging uncertainty, and emphasizing compassion as methods of providing support to parents as they navigate their bereavement.
... In the absence of comprehensive lactation care, bereaved mothers may rely on their partners or other family members for assistance and support (Chen et al., 2015;Sereshti et al., 2016). For example, partners may play a critical role in supporting bereaved breastmilk donation practices (Carroll et al., 2014;Oreg, 2020). The paucity of research on lactation after infant death, however, renders significant gaps. ...
... The paucity of research on lactation after infant death, however, renders significant gaps. Research is required to elicit the perspectives of non-birthing parents on their experiences and involvement in bereaved lactation practices (Carroll et al., 2014;Oreg, 2020). ...
... The study findings provide unique insights into how bereaved breastmilk donation may assist fathers' meaning-making and coping following infant loss. Although recent research has established the benefit of breastmilk donation to bereaved mothers' identity and meaning-making following infant death (Oreg, 2019;Oreg, 2020;Carroll & Lenne, 2019;Welborn, 2012a), prior to this study fathers' views and experiences were unknown (Carroll et al., 2014;Oreg, 2020). Consistent with research findings from bereaved mothers, fathers reported donation provided significant meaning for them and their partner. ...
This exploratory study targets a significant gap in the lactation and bereavement literature by exploring bereaved fathers’ experiences, perspectives and practices in relation to their partner’s lactation after stillbirth, neonatal or infant death. Semi-structured interviews were conducted with seven bereaved fathers in two Australian state/territory jurisdictions. Purposive sampling ensured the partners of five of the fathers had been involved in bereaved breastmilk donation to a human milk bank. Thematic data analysis identified key themes that drew attention to the significant grief experienced by fathers and highlighted: (i) breastmilk and infant feeding holding significant meaning for some fathers especially within the neonatal intensive care or palliative care settings, (ii) the impact
of diverse lactation management options on the awareness and involvement of fathers in their partner’s lactation after infant death, (iii) fathers’ provision of significant care and support for partners participating in bereaved breastmilk donation, (iv) bereaved breastmilk donation positively impacting some fathers’ grief and meaning making,
and (v) bereaved families’ requirement for enhanced lactation care, information and support. Results indicate the need for an enhanced focus on family-centred bereaved lactation care and acknowledgement of the positive role that bereaved breastmilk donation may have for both mothers and fathers following infant loss.
... 14-16 Many women are not even aware of the option to donate expressed breast milk, which could provide a therapeutic option for coping with grief. 17,18 The donation of breast milk has been considered a component of grief rituals that may empower women in the grieving process. 17 In addition to the altruistic act of helping other ill infants, expressing and donating breastmilk may help women cope with loss. ...
... 17,18 The donation of breast milk has been considered a component of grief rituals that may empower women in the grieving process. 17 In addition to the altruistic act of helping other ill infants, expressing and donating breastmilk may help women cope with loss. [17][18][19] Some studies ✦ Perinatal loss results in a negative impact on women's well-being and mental health. ...
... 17 In addition to the altruistic act of helping other ill infants, expressing and donating breastmilk may help women cope with loss. [17][18][19] Some studies ✦ Perinatal loss results in a negative impact on women's well-being and mental health. ...
Introduction
Perinatal loss is a traumatic event for women with negative consequences for their well‐being and mental health. After perinatal loss, some women choose to not suppress lactation and to donate their breast milk. Donating milk can be a grief ritual to cope with the loss. The aim of this study was to explore women's experiences of donating their breast milk following a perinatal loss.
Methods
A hermeneutic phenomenology was carried out. Thirteen semistructured interviews were conducted. Data was recorded, transcribed, and categorized into themes and subthemes.
Results
Two main themes emerged from the data: (1) lactation after loss: a forgotten aspect of the care, with the subthemes “the silence surrounding grieving lactation” and “experiencing lactation amidst a sea of tears”; and (2) milk donation: a resource to alleviate pain and offer hope, with the subthemes “expressing and donating breast milk: a healing ritual” and “breaking the taboo of the grieving lactation.”
Discussion
Information about lactation options is not typically included in participants’ care plan. Women's experiences highlight the need for the support of health care professionals. Donating milk helps some women to cope with the loss and accept and integrate it into their daily lives. Milk donation is also an opportunity to educate society about options following a perinatal loss.
... Third sector scholars have found countless opportunities for new discoveries in the online world, through a variety of digital platforms. Recent studies in the field have explored online platforms such as personal and institutional websites, personal blogs, Facebook, Twitter, and Instagram (see examples in Campbell et al., 2014;Campbell & Lambright, 2019, 2020Ho, Chiu et al., 2015;Levine et al., 2019;Pallas et al., 2015;Scurlock et al., 2020;Zorn et al., 2013). These studies cover all levels of the third sector, from individuals and communities, to organizations and social movements, and are based on both quantitative, qualitative, and mixed methodologies. ...
... Coming from the fields of social work and anthropology, we explore human experiences in the third sector from a strong qualitative positionality. We used digital ethnography in our own research to study migrant workers (Babis, 2021a;Sabar, et al., 2021;Babis, et al., 2021;Golan & Babis, 2019a, b), indigenous nonprofit organizations (Babis, 2018), nonprofit human milk banks and (human milk donors (Oreg, 2019(Oreg, , 2020, and Grassroot international NGOs (Appe & Oreg, 2019, 2020 We first introduce the notion of digital ethnography methodologies, followed by two research examples from our own experience. We then propose combining digital ethnography with additional qualitative tools and conclude with a discussion of the advantages and limitations of using digital ethnography in third sector research. ...
... Coming from the fields of social work and anthropology, we explore human experiences in the third sector from a strong qualitative positionality. We used digital ethnography in our own research to study migrant workers (Babis, 2021a;Sabar, et al., 2021;Babis, et al., 2021;Golan & Babis, 2019a, b), indigenous nonprofit organizations (Babis, 2018), nonprofit human milk banks and (human milk donors (Oreg, 2019(Oreg, , 2020, and Grassroot international NGOs (Appe & Oreg, 2019, 2020 We first introduce the notion of digital ethnography methodologies, followed by two research examples from our own experience. We then propose combining digital ethnography with additional qualitative tools and conclude with a discussion of the advantages and limitations of using digital ethnography in third sector research. ...
Ethnographies involve the exploration of social phenomena in the field, typically for an extended period of time. Traditionally, ethnographers listen to, observe, and directly communicate with the subjects of their research. At its essence, ethnography is about storytelling, and the data are collected through human interaction. With the development of new technologies, and with the plethora of social media platforms, the manner in which many stories are told has become significantly more varied. Accordingly, digital ethnography has emerged as a new approach to conducting ethnographies. In the present study, we focus specifically on the use of digital ethnographies in third sector studies. Building on our own experience using digital ethnography, collecting data from Facebook pages and groups, blogs, and websites of nonprofit organizations and individual volunteers and donors, we describe two different ways of conducting digital ethnography: One, at the micro-level, explores human milk donations to nonprofit milk banks. The second, at the meso-level, explores a community of migrant workers. We aim to outline the potential, limitations, and ethical considerations of this methodology.
... Perinatal loss is regarded as a major life crisis that involves multiple losses, including the loss of future hopes and dreams, the loss of a pregnancy, and of self-esteem (Oreg, 2020). Although perinatal loss affects both spouses, it is often considered an emotionally and physically traumatic event especially for expectant mothers. ...
... Some studies have reported that persistent breast milk serves as a reminder of the baby's existence following their loss (Mcgee et al., 2018;Oreg, 2020). Mothers' bodies produce milk for a baby who is no longer alive in the physical sense, which may lead to an unclear definition of perinatal loss as opposed to other losses (Mcgee et al., 2018). ...
Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An interpretative phenomenological study was carried out between January 2021 and July 2022 with 6 parental pairs (12 people in total, 6 mothers and 6 fathers) who experienced a perinatal loss. Participants were reached by snowball sampling method. Data were collected using semi-structured audio recording interviews that were transcribed and analyzed using thematic analysis. The themes of this study were determined as “attributing meaning to loss”, “fragmented parenting roles and expectations”, “changing relationships”, “expectations from healthcare professionals”, and “emotional responses”. Five sub-themes were created from the emotional responses theme which included. These are sadness and pain, denial, anger, guilt and fear. In the study, it was concluded that the experience of perinatal loss may have negative consequences on the psychological health of the parents. Therefore, specific, professional, adequate nursing support and continuity of support are needed to help parents cope with perinatal losses.
... Recently we are seeing increased research on HMB donations following a perinatal loss (15)(16)(17), although there is a long tradition of looking at this topic in North America (18) and Ireland (19). In 2019 the non-profit PATH released "A Resource Toolkit for Establishing and Integrating Human Milk Bank Programs," with its final chapter dedicated to how to engage bereaved mothers in HMB services. ...
... Until recently, this topic has not been well-researched, and in some cultures, it has not even been discussed (21). Research shows, however, that donating breastmilk can have advantages for families, including helping with grief by acquiring a donor identity (15), and providing structure around bereavement (16). Yet, donating under these circumstances is not a decision that every person may choose or be able to make, or be offered. ...
There is a growing recognition globally that care regarding lactation following a perinatal death needs to potentially offer the opportunity for maternal donation. This article discusses this experience and perspectives from a human milk bank (HMB) in Vietnam. This is a descriptive exploratory case study that has a long tradition in both the social and health sciences. Triangulated data collection involved a review of video data, interview data with the donor, and data review for the Da Nang HMB, a Center for Excellence in Breastfeeding. We found that although it is common for mothers in Vietnam to donate breastmilk to HMBs, it is less common for this to occur following perinatal loss. We offer a descriptive case study of the maternal loss of twins and a subsequent choice to donate for approximately 1 month to the Da Nang HMB, the first HMB in Vietnam. We discuss four reasons derived from this case regarding donation following perinatal loss. (1) A strong motivation to donate breastmilk when aware of the service, (2) donating breastmilk helped her deal with grief, (3) family members supported her through this tough time and supported her decision, and (4) health staff supported her decision. While human milk sharing (e.g., wet nursing) has been practiced in Vietnam, breastmilk donation from bereaved mothers has neither been discussed nor well-researched. Because maternal grief is complex and individual, deciding to donate breastmilk is a personal decision that needs to be supported, without creating guilt for those who do not wish to donate.
... This happens also in the case of prenatal loss, often involving painful breast engorgement (Bar-Yam, 2005). Lactation after loss is a constant, painful reminder of the baby's absence (Oreg, 2019(Oreg, , 2020. Moreover, the mother's prenatal attachment to her dead baby creates a psychological experience of his/her presence alongside the reality of physical absence. ...
... Grieving people struggle to find meaning in their loss (Baumeister, 1991;Davis et al., 2000;Neimeyer, 2001); this is particularly salient and difficult when the loss is of one's newborn child (Davis et al., 2000) In the present study, we build on Oreg's earlier work, in which she suggested that milk extraction and donation constitutes a grief ritual that "helps bereaved mothers resolve the ambiguity of their loss and infuse new meanings into their bond with their lost child" (Oreg, 2020, p. 2). The continuing bond between the mothers and their deceased babies is represented in Oreg's (2020) study, primarily in reference to the embodied experience and symbolic nature of producing (through the process of lactating) and extracting (through repeated pumping) the milk. The "coproduced" nature of the milk contributes to its symbolic meanings, as bereaved milk donors often feel that something from the mother-baby dyad, and from their dead baby, nevertheless continues to live on within the recipients (Oreg, 2019;Welborn, 2012). ...
Most of the research on human milk donations after prenatal loss has focused on donations to milk banks in which donors and recipients are anonymous to each other. In contrast, in this Israel-based study, we focus on an ongoing, direct interaction between a bereaved donor and recipients who adopted a new baby. We conducted a relational autoethnogra-phy, wherein multiple researchers present their life experiences and interpersonal contexts and meanings. We suggest that directed, interactional bereaved milk donation allows both parties to assign symbolic meanings to the milk, which may help their grieving process and can create relational healing.
... 3 Oreg also reported that the process of extracting and donating their milk constitutes a grief ritual, which allows mothers to maintain and reconstruct the continuing bond with their child. 2 The methodology used precluded collection of demographic data from the online participants, and data obtained from interviews were from eight mothers whose loss in some cases was years earlier. 2 The paucity of lactation information available to women who experience perinatal loss has also been described in the literature. One study indicated that whether the infant survived or was stillborn, few parents were completely informed about the option and process to express and donate their milk. ...
... 2 The methodology used precluded collection of demographic data from the online participants, and data obtained from interviews were from eight mothers whose loss in some cases was years earlier. 2 The paucity of lactation information available to women who experience perinatal loss has also been described in the literature. One study indicated that whether the infant survived or was stillborn, few parents were completely informed about the option and process to express and donate their milk. ...
... 3 Oreg also reported that the process of extracting and donating their milk constitutes a grief ritual, which allows mothers to maintain and reconstruct the continuing bond with their child. 2 The methodology used precluded collection of demographic data from the online participants, and data obtained from interviews were from eight mothers whose loss in some cases was years earlier. 2 The paucity of lactation information available to women who experience perinatal loss has also been described in the literature. One study indicated that whether the infant survived or was stillborn, few parents were completely informed about the option and process to express and donate their milk. ...
... 2 The methodology used precluded collection of demographic data from the online participants, and data obtained from interviews were from eight mothers whose loss in some cases was years earlier. 2 The paucity of lactation information available to women who experience perinatal loss has also been described in the literature. One study indicated that whether the infant survived or was stillborn, few parents were completely informed about the option and process to express and donate their milk. ...
Background: The second stage of lactation with copious milk production occurs after birth regardless of the infant's survival. Previous research indicates that milk donation following a perinatal loss may help some bereaved mothers come to terms with their loss. The purpose of this study was to explore the experience of women choosing to continue to express milk after a perinatal loss specifically for donation to a nonprofit milk bank governed by the Human Milk Banking Association of North America (HMBANA). Materials and Methods: Participants were recruited through HMBANA's milk bank directors' listserv, their bereavement committee, and through their website. Participants were eligible if they donated to an HMBANA milk bank and specifically continued to pump milk for the purpose of milk donation following a perinatal loss. Qualitative interviews were conducted with each participant using a secured web-based platform. Data collection and analysis occurred concurrently using qualitative content analysis until there was acknowledged informational redundancy. Participants' demographic and lactation data were collected and analyzed using descriptive statistics. Results: Over 10 months, 21 participants were interviewed. Donating after perinatal loss has been described as a positive, valuable, and nurturing experience. Diminished grieving, enhanced connection to the infant, establishment of legacy, and creation of a positive from a negative are highlighted in several themes that illuminate the phenomena of bereaved donation. Discussion: The findings of this research are consistent with published literature, but in this study, two subgroups were formed. This enabled the researchers to compare the experience of those with previous breastfeeding experience and those without, which adds to the knowledge about the phenomenon. It provides information for health care professionals (HCPs) to understand the experience of bereaved milk donors and serves as a call to action for HCPs to develop best practices and incorporate lactation management in enhanced, individualized bereavement care for these women.
... [5][6][7] While suppressing lactation may be the most common practice in bereavement, sustaining lactation, keeping milk as a memento, or donating breast milk can assist some mothers to cope with their grief, 2,3,6,8 thus indicating the emotional and social significance of lactation and breast milk in bereavement. 6,[8][9][10] At the center of safe maternal health care delivery is the premise that women have the necessary information, time, consideration, and respect to make decisions about their physical and emotional needs. 11 However, lactation care offered to bereaved mothers within hospital settings is currently limited. ...
... 1,35 Research with bereaved mothers has demonstrated that respect and understanding of their individual needs and wishes and social and cultural context is critical and that some women benefit greatly from discussing lactation more fully and pursuing options beyond suppression (e.g., keeping milk as memento, or donating breast milk) that can help to honor their motherhood status, maintain connection with their deceased infant, or make meaning in the wake of their death. 6,[8][9][10] Moving to more inclusive and comprehensive lactation care is no small task. Utilizing existing evidence-based lactation care guidelines 5-7 to enhance hospital policies and practice protocols would be an important first step for improving quality. ...
Objective:
The study aimed to identify and map the factors that shape the delivery of hospital-based lactation care for bereaved mothers to inform quality improvement initiatives targeting hospital-based lactation care.
Methods:
Focus groups and interviews were conducted at three large hospitals in Australia with 113 health professionals including obstetricians, neonatologists, midwives, neonatal nurses, lactation consultants, social workers or pastoral care workers, Human Milk Bank (HMB) staff, and perinatal bereavement nurses. Thematic and interactional data analysis identified the nature, scope, and pattern of bereavement lactation care.
Results:
A bereaved lactation care pathway was generated from health professionals' reports. Bereaved lactation care, if provided, was limited to brief encounters aimed at facilitating lactation suppression. The type of lactation care offered, and any exploration of the variable biopsychosocial significance of lactation after infant death, was conditional on (i) availability of health professionals with suitable awareness, knowledge, capacity, confidence, and comfort to discuss lactation; (ii) hospital culture and mode of suppression primarily practiced; (iii) mother's breast milk being visible to hospital staff; (iv) mother expressing interest in expanded lactation management options; (v) availability of, and eligibility to, donate to a HMB; and (vi) support beyond the hospital setting being facilitated.
Conclusion:
Mothers should be presented with the full array of lactation management options available after stillbirth or infant death. Inclusion of evidence-based, biopsychosocial and patient-centered approaches to lactation care is urgently required in health professionals' bereavement training and in the policies of hospitals and HMBs.
... Regardless, Hinton et al.'s (2013) study of dreams about the deceased and the Cambodian/Buddhist interpretation of these dreams to mean that rebirth has not occurred raises the possibility of new or delayed customary rituals being used as a way of helping people understand and perhaps avoid or otherwise manage triggered grief. Oreg's (2020) study of a helpful grief ritual among women of extracting and donating their milk after a perinatal child death is a clear indication of the personal relevance of grief rituals. Oreg (2020) identified this ritual as a way of "allowing mothers to maintain and reconstruct the continuing bonds with their babies" (p. 1). ...
... Oreg's (2020) study of a helpful grief ritual among women of extracting and donating their milk after a perinatal child death is a clear indication of the personal relevance of grief rituals. Oreg (2020) identified this ritual as a way of "allowing mothers to maintain and reconstruct the continuing bonds with their babies" (p. 1). In addition, Gamliel's (2007) study of wailing in a Yemenite-Israeli community revealed this to be a psychotherapeutic ritual for that community. ...
Grief is understandably severe in the first days, if not weeks or months, following the death of a beloved person. Unless the mourner develops complicated grief, which is prolonged severe and impactful grief, the initial acute grief lessens in severity over time, although waves of significant grief will still occur with grief triggers. A scoping research literature review was undertaken in early 2021 to determine how often grief triggers occur, what the most common grief triggers are, the impact of triggered grief, and what can be done (by those not diagnosed with complicated grief) to manage grief triggers and mitigate the effect of them. Nine academic library databases were searched for English-language research reports using the keywords “grief trigger(s)” and “research”: CINAHL, Directory of Open Access (online) Journals, Humanities Index, JSTOR, Medline (Ovid), Periodicals Index Online, PsychArticles, Scopus, and Web of Science. Six research papers relevant for review were published in the last two decades, with some evidence gained on how often grief triggers occur, what constitutes a grief trigger, and the impact of grief triggers. Major gaps in evidence were revealed, despite grief triggers being identified as a major consideration for grief in general and for grief recovery specifically.
... There is "fluidity" in the milk donor's identity: in some cases, milk donation is portrayed by milk banks as a gift from the "baby donor," who is generous to share his milk, and the mother who produced and pumped the milk from her own body, gave her baby's milk to other babies (Oreg & Appe, 2020). Such representation portrays the baby as the donor, thus make the female donor symbolically invisible (Oreg, 2019(Oreg, , 2020Oreg & Appe, 2020). Another scenario that is portrayed by HM banks is that the donation was made by both baby and mother, as a unique mother-baby donor dyad (mother and baby are donating their milk) which yet again, omits the role of the mother as the donor. ...
... Moreover, there is a subset of milk donors who are bereaved mothers who choose to donate their milk in memory of their babies who died in stillbirth or prenatal loss. For them, milk donor invisibility corresponds with the larger "silencing" of their grief and experience, due to the taboo and the discourse around infant loss, particularly in Western societies (see Hazen, 2006;Oreg, 2019Oreg, , 2020. ...
In this research note, we call attention to human milk donation being essentially omitted from the philanthropy literature and bodily gifting research. We focus here on human milk donations for infant feeding through nonprofit milk banks. We argue that its omission is due to two main factors: (a) the incoherence of defining human milk donation and the challenges to its regulation and (b) its consideration as care work and the characteristics of the milk donor identity. We end with avenues for future research in this area.
... Similarly, we suggest that getting memorial tattoos after October 7 serves as a personal ritual. Rituals are by nature transformative; they provide the individuals who perform them with a means of reclaiming control or equilibrium and enable the transition toward something new (Oreg, 2020). ...
Objectives: To delve into the phenomenon of memorial tattoos in Israel following the October 7, 2023, massacre, and the ensuing Iron Swords War utilizing Terror Management Theory. Methodology: A qualitative approach employing digital ethnography and visual content analysis was adopted to scrutinize 250 war tattoo images sourced from Israeli tattoo artists' Instagram pages and Facebook groups. Data collection spanned the initial four months of the war, from October 2023 to January 2024. Findings and conclusions: The analysis highlights existential anxieties stemming from the massacre and ongoing conflict, which are both reflected and addressed through the tattoos' content and meaning. Memorial tattoos serve as responses to mortality salience, depicting themes that adhere to the three anxiety-buffer mechanisms proposed by the theory: reinforcement of collective worldviews; enhancement of self-esteem; and seeking continued attachment relationships. Through these mechanisms, tattoo recipients invest efforts in giving meaning to the inconceivable events and their ongoing grief.
... At the same time, those with higher gestational weeks had higher levels of psychological pain. This result may be related to the increase in the level of mother-infant attachment in parallel with the increase in gestational age (Oreg, 2020). In this study, the history of abortion and number of abortions were other variables that affected psychological pain. ...
This study was conducted to determine the relationship between psychological pain, spiritual well-being, and social support among Turkish women undergoing therapeutic or elective abortion. The cross-sectional study was conducted with 342 women who were hospitalized in the gynecology and obstetrics service of a city hospital between March 2021 and December 2022 in Turkey. The mean psychological pain, spiritual well-being and perceived social support scores of women undergoing therapeutic/elective abortion were 26.96 ± 11.21, 110.72 ± 13.09 and 64.09 ± 15.62, respectively. There were a significant negative correlation between psychological pain with spiritual well-being and social support. According to linear regression analysis, spiritual well-being, social support, age, employment status, economic level, history of abortion, number of abortion, current abortion type, and gestational week were statistically significant predictive factors of psychological pain. Therefore, healthcare providers can provide individualized psychosocial-spiritual care and counseling services that decrease psychological pain in women after therapeutic or elective abortion.
... The sociopolitical and ethical milieu within which a loss occurs significantly shapes the process of reconstructing meaning (Raskin & Debany, 2018). Furthermore, it is well established that organ donation serves as a meaningful response to loss, often providing solace to grieving families (Oreg, 2019(Oreg, , 2020Oreg et al., 2023). Research suggests that political ideology becomes a pivotal avenue for the reconstruction of meaning following a loss in the context of political conflict, where individual narratives intersect with broader cultural, political, and religious contexts (Neimeyer et al., 2014). ...
We explore the phenomenon of organ donation between rivals in time of war when a significant gift such as organ donation is given not just to a “stranger” but to a stranger who may be considered an enemy. This is a case study of a unique organ donation event that occurred in Israel during Operation Guardian of the Walls in May 2021. It involved a Palestinian boy killed by a Jewish policeman and a Jewish man killed by Palestinian youths. Both victims, lacking organ donor cards, had their organs donated by their families with the awareness that recipients could come from the “opposing” group. We ask: (1) How do families from rival groups construct meaning in their decision to donate organs? (2) How do they construct meaning in their experience of loss? The findings reveal that bereaved families imbue their actions with political and religious significance, framing the organ donations as a “universal gift” guided by religious commandments to save lives. While these acts initially transcend cultural and national boundaries, a lack of recognition and gratitude afterward can lead to disillusionment, reinforcing “us” versus “them” boundaries. This study underscores the intricate dynamics in organ donations during political conflict and the pivotal role of religious authorities in shaping perceptions and meaning. Moreover, it highlights the potential for organ donations to foster reconciliation and coexistence amidst conflict, provided mutual recognition in cases where compassion and understanding of loss are prioritized.
... Milk donation following bereavement is emerging as an important donation that may benefit both the milk bank and the bereaved parent(s) as it may be conceptualised as part of the grief ritual in some ways comparable to organ donation (Oreg, 2020). ...
Mother's/parent milk is the optimal way to feed infants and when unavailable, supplemental donor human milk is preferred. A safe supply of donor human milk should be available for all low birthweight infants for whom it has been shown to reduce morbidity. Human milk banking has been in existence for more than a century, although largely shut down during the 1980s, primarily due to fears of human immunodeficiency virus transmission. With renewed security in milk banking, has come an exponential growth in human donor milk use. Guidelines for milk banking have been published in many countries including Australia, France, India, Italy, Spain, Switzerland, the United Kingdom and the nonprofit organization PATH. The European Milk Bank Association and the Human Milk Banking Association of North America have also published recommendations for milk banks throughout Europe and North America, respectively. Although there is variability among these guidelines, there is general consensus on quality control measures required to provide a supply of safe donor milk. These measures include effective donor screening, safe collection, transport and storage of milk, standardized pasteurization and bacteriological testing. Operational considerations are also critical, such as appropriate training for staff, equipment maintenance and cleaning, protocol and record keeping and inspection and accreditation. Clearly delineating these key quality control measures provides an excellent foundation for establishing international guidelines. Acceptable modifications must be established for low‐ and middle‐income countries that do not have sufficient resources; overly burdensome guidelines may make establishing a milk bank unnecessarily prohibitive. This review presents a summary of current best practices for human milk banking.
... In addition, women may also grapple with the failure of their bodies and perceive a rupture of their femininity [13]. In some cases, they may report feelings of shame and guilt about their failure as caregivers [18]. Additionally, the loss of a child during pregnancy can strain the relationship with the partner [19]. ...
Losing a child is a traumatic event, disrupting life's natural cycle, profoundly affecting the family system, and causing enduring grief. Perinatal death, including ectopic pregnancies, miscarriages , stillbirths, and neonatal deaths, exacerbates this distress. Additionally, the COVID-19 pandemic has challenged healthcare systems and supporting services available to individuals in need. Thus, this research explores experiences of parents facing perinatal loss in 2020-2021, further focusing on the pandemic's impact. Using a mixed-methods design with self-reports and qualitative interviews, this paper presents results from the quantitative protocol, involving an update and follow-up of a previous study. It compares measurements across scales: COVID-19: The Impact of Event Scale-Revised; The Prolonged Grief-13; The Parental Assessment of Paternal/Maternal Affectivity; The Dyadic Adjustment Scale (short version); The Daily Spiritual Experiences Scale; and The Inventory of Complicated Spiritual Grief. In the baseline measurement, 45 parents participated (37 mothers and 8 fathers), with 20 (13 mothers and 7 fathers) contributing to the follow-up and 9 engaging in interviews. Baseline results showed higher scores for mothers compared to fathers, with effect sizes ranging from small to medium (ranging from −0.02 to 0.29), though statistical significance was limited due to the small sample size. Multiple regression analysis for distress measures at baseline identified two significant predictors: maternal/paternal affectivity and gesta-tional week. Additionally, positive support from healthcare professionals emerged as a mitigating factor, particularly in relation to Avoidance. A significant reduction in stress measures and parental affectivity was observed at the 6-month follow-up. Qualitative analysis revealed three themes: Shifts in Self-Perception and Post-Loss Growth; Conflicted Relationship with One's Body; and Negative Impact of COVID-19 vs. Unexpectedly Positive Aspects. In conclusion, the findings emphasize the significance of psychological and psychosocial interventions based on meaning-making processes, along with the importance of spiritual care and empowerment for those navigating perinatal loss.
... PL is one of the most traumatic events for women during childbirth, involving multiple losses such as hopes and dreams, selfesteem, expected parental roles, and anxiety about future fertility (Hernández-Padilla, 2022). Women who experienced PL reported negative emotions of pain, anger, emptiness, depression, shame, and guilt for not protecting the baby (Carroll & Lenne, 2019;Oreg, 2020). ...
Limited studies have been conducted on Chinese women's willingness to donate milk following perinatal loss. In this study, we explore the relationship among childbirth trauma, willingness to donate milk, and resilience in women following perinatal loss, and the mediating effect of resilience between childbirth trauma and willingness to donate milk. A cross-sectional study was carried out throughout 4 months. We used convenience sampling methods and recruited 241 women following a perinatal loss from eight tertiary hospitals in Sichuan Province, China. Participants completed four questionnaires during a face-to-face individual interview: the general information questionnaire, the Willingness to Donate Milk Scale (WMDS), the City Birth Trauma Scale, and the Brief Resilience Scale. SPSS 20.0 was used to analyze the collected data. In our study, childbirth trauma was negatively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience was positively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience partially mediated the relationship between childbirth-related symptoms and willingness to donate milk (β = -0.38, 95% confidence interval [CI]: -0.50 to -0.26), which accounted for 69.03% of the total effect. Resilience partially mediated the relationship between general symptoms and willingness to donate milk (β = -0.31, 95% CI: -0.40 to -0.21), which accounted for 66.89% of the total effect. Resilience partially mediated the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. Our findings suggest that resilience can play a significant role in mediating the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. These results could help healthcare professionals design interventions for physical and mental recovery after perinatal loss.
... • Biocultural Lactation (cf. Carroll 2015, Carter & Reyes-Foster 2020, Cassidy & Dykes 2019, El Guindi 2016, El Guindi & al-Othman 2013, Falls 2017, Fioole 2015, Hewlett & Winn 2014, Kramer & Veile 2018, Malcolm 2021, Naef 2017, Nita 2018, Oreg 2020, Oreg & Appe 2020, Palmquist 2015, Rahbari 2020, Rock-Singer 2020, Ross & Waltz 2016, Wellman 2017, Wilson 2018. Finally, Van Esterik & O'Connor (2017) argue that centering breastfeeding as nurture offers a path forward that resists dominant, reductionist, or romanticized models and refocuses the importance of lactation as a relational practice that, when structurally supported, has powerful potential to reclaim and restore cultural histories that were broken by extractive colonial and neocolonial capitalism. ...
This review examines anthropological contributions over the past decade into the biocultural processes and practices of lactation via the analytical pillars of colonialism, racial capitalism, and medicalization. The nexus of these three processes has been foundational to the profound disruption and decline of breastfeeding in the mid-twentieth century and is still impacting ongoing efforts to restore and facilitate breastfeeding. Anthropologists have helped expose and challenge biocapitalist, medicalized conceptualizations of lactation that undermine breastfeeding often even when they claim to support it. Moreover, they have highlighted how ethnocentric cultural ideologies shape biomedical categories of “normal” infant feeding and lactation and have demonstrated the variability of these processes and practices. While these efforts have yielded important interventions into anthropology and a range of other disciplines, significant work remains to integrate efforts across the subfields and to challenge racist, oppressive systems that continue to shape both the study and the practice of lactation.
Expected final online publication date for the Annual Review of Anthropology, Volume 52 is October 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... These understandings have been confirmed by research that has sought the perspectives and experiences of bereaved donors. 2,5,[9][10][11] Regardless of these advancements, international research consistently reports that bereaved mothers receive limited lactation care and inadequate guidance to manage or make decisions about their lactation or breast milk, 3,[12][13][14] with the option of milk donation remaining unavailable to many bereaved families. 15,16 In response, researchers have called for health settings to adopt evidence-based bereaved lactation care policies and practices that promote a biopsychosocial and patient-centered approach and support bereaved mothers to make informed decisions from the full array of lactation management options that may be available to them. ...
Objective: The study aimed to identify how, from the perspective of bereaved parents, hospital-based health professionals can better meet their lactation care needs. Methods: In-depth interviews were conducted with 17 mothers and 7 fathers bereaved by stillbirth, neonatal death, or older infant death. Participants were recruited from three large hospitals in Eastern Australia including two with human milk banks. Qualitative thematic data analysis identified bereaved parents' lactation experiences, needs, and how parents wanted lactation care to be provided. Results: Participants experienced lactation after infant death as hard and challenging, while at the same time they received limited lactation care. The negative impact of lactation, however, could be mediated by anticipatory guidance, assistance to make sense of lactation, support to make decisions from available lactation and breast milk management options, and support with breast care for as long as required. Bereaved parents explained lactation care was best provided by health professionals they had come to know and trust rather than by a particular professional role. Care should be provided with compassion, in a manner respectful of individual circumstances, inclusive of partners, and supplemented by quality written information. When bereaved parents felt supported to manage their lactation in a manner consistent with their unique needs, lactation for some could have a positive impact on grief. Conclusion: Bereaved parents have demonstrated that comprehensive lactation care is critical to their health and well-being. Such care should be more fully incorporated into hospital-based bereavement care policies and practices.
... Diversos estudios muestran que la donación de LM requiere un gran esfuerzo y tiempo por parte de las madres (44,45), que disponer del tiempo necesario influye en la frecuencia de la extracción de leche (40), por eso constituye una barrera para la donación (45). ...
Resumen Fundamentos: Colombia mantiene una reducida práctica de lactancia materna, lo que demuestra la necesidad de fortalecer estrategias como la de los Bancos de Leche Humana (BLH). Esta investigación propuso como objetivo identificar las representaciones sociales (RS) sobre donación de leche humana de madres lactantes residentes en cinco ciudades de Colombia donde funcionan BLH. Métodos: El estudio se abordó desde la teoría de las RS, se utilizaron métodos mixtos y diversas técnicas, como: la evocación jerarquizada, encuesta, entrevista semiestructurada y diario de campo. Resultados: se presentan los resultados de las 83 entrevistas realizadas a madres lactantes, clasificadas en cuatro grupos según su experiencia y conocimiento del proceso de donación de leche humana. Conclusiones: la principal motivación para donar es la empatía y el deseo de ayudar a otros bebés, el principal factor favorecedor tiene relación con la gestión de los BLH, y la principal barrera para dejar de donar fue la falta de tiempo de las madres.
This study was designed as a two-group pre-test post-test comparative experimental study to examine the effects of grief counseling on perinatal grief levels in women who underwent pregnancy termination before discharge from the clinic. This study was conducted with 70 women who underwent medical termination of pregnancy. The intervention group ( n = 35) received perinatal grief care, while the control group ( n = 35) received only routine hospital care. In this study, the Introductory Information Form, Perinatal Grief Scale, and evaluation form of the care received were completed. While the perinatal grief level of the intervention group decreased after the application of grief care, a significant difference between the groups was detected only in women with a history of medical termination according to obstetric characteristics ( p < .05). The findings obtained from this study showed that perinatal grief care support decreased grief scores on perinatal grief instruments and their sub-dimensions in the intervention group.
Receiving donor human milk for a baby can have a protective effect upon parental wellbeing. A growing body of research also finds that being able to donate milk to a milk bank, particularly after infant loss, can also boost maternal wellbeing through feelings of altruism and purpose. However, most studies are qualitative, with small sample sizes outside the United Kingdom, and often do not include the experiences of those who have been unable to donate. Our aim was therefore to examine the impact of being able to donate milk, as well as the impact of not being able to do so, using a survey containing open and closed questions in a large UK sample. Overall, 1149 women completed the survey, 417 (36.3%) who donated their milk and 732 (63.7%) who did not. Most women who donated found it had a positive impact upon their wellbeing, feeling proud, useful and that they had achieved something important. Conversely, those unable to donate often felt rejected, frustrated, and excluded, especially if they received no response or felt that restrictions were unfair. Thematic analysis found that being able to donate could help women heal from experiences such as birth trauma, difficult breastfeeding experiences, neonatal unit stays, and infant loss; however, being unable to donate could exacerbate negative emotions arising from similar experiences. A minority of women who donated experienced raised anxiety over following guidelines. These findings further extend the impacts of milk banking services beyond infant health and development and support expanded service delivery.
In the tender space when a baby is born and parents have to say both hello and goodbye, care providers in hospital and community settings seek to support families, foster their parenting, and make meaning. This chapter will focus on how to facilitate and co-create ritual and meaning-making activities with families experiencing perinatal or neonatal death. In keeping with the broadest definition of “ritual,” we will include small moments that hold special meaning, especially those done with intentional purpose, and not just the more traditional rituals such as a funeral.
In the pages ahead, experts including labor and delivery nurses, palliative care nurses, advance practice providers, physicians, a professional photographer, a child life specialist, bereavement counselors, researchers, and a loss doula will offer ideas and choices. Some of the authors are also bereaved parents themselves; their collective experiences (personally and professionally) are reflected in the recommendations for ritual during pregnancy, after birth and after death.
Midwifery is not just about life and joy; unfortunately, at times it also involves death, sorrow and grief. The death of a baby and subsequent grief is complex, and involves grieving the baby's life as well as the life that parents have imagined with their child, including their role as parents. Pregnancy and baby loss have devastating effects on women and their families; expecting life and meeting death leave a profound emptiness. Perinatal death can include miscarriage, stillbirth and neonatal death. Lactation in these circumstances has been described by bereaved mothers as a healing therapy, and although there is some published evidence on this topic, further research will be necessary. This article was written based on the author's personal and professional experience, combined with current evidence, following Gibbs' reflective cycle, which provides a structured approach to learning from experiences. The aim is to create awareness of the importance of giving women the opportunity to decide how to manage their lactation and to speak about a topic that, unfortunately, is still taboo.
Background:
Parental bereavement after the death of an infant in a neonatal intensive care unit (NICU) is a complex and nuanced experience. Support from healthcare practitioners can have a significant impact on bereavement experiences in the short- and long-term. Although several studies exist exploring parental perceptions of their experience of loss and bereavement, there has not been a recent review of beneficial practices and common themes in the current literature.
Objective:
This review synthesizes empirical research to identify considerations that ought to guide the caregiving practices of healthcare professionals to support parental bereavement.
Settings/subjects:
Data was collected from studies identified in MEDLINE, Embase, and CINAHL. The search was limited to English-language studies describing parental bereavement in the NICU population from January 1990 to November 2021.
Results:
Of 583 studies initially identified, 47 studies of varying geographic locations were included in this review. Various themes surrounding healthcare support in parental bereavement were identified including ensuring the opportunity for parents to spend time caring for their child, understanding their perception of infant suffering, recognizing the impact of communication experiences with healthcare providers, and offering access to alternative means of support, all of which have been described as suboptimal. Parents generally want the opportunity to say goodbye to their infant in a private and safe space, be supported through their decision-making and be offered bereavement follow-up after loss.
Conclusion:
This review identifies methods of support in parental bereavement based on first-hand parental experiences and routine implementation of these strategies may be beneficial in supporting parents through their bereavement after the loss of a baby in the NICU.
Introduction:
Mother's own milk has long been accepted as the best source of nutrition for the newborn. In those cases where mother's milk is not available, the best choice is the human milk provided by selected donors. Human milk banks are the most institutionalized method of milk sharing and play a vital role for neonates that cannot be breastfed. This study aims at systematically reviewing factors influencing donation to human milk banks.
Materials and Methods:
A systematic review of the literature was performed on authentic electronic resources, including PubMed, Scopus, Embase, ScienceDirect, and Web of Science with no time limitation. To increase the sensitivity and to find additional studies for systematic review, the reference list of the published studies was examined as well. Data extraction and quality appraisal were carried out by two independent reviewers. The study was qualitatively summarized to generate descriptive and explanatory themes that emerged from the literature.
Results:
From a total of 1,157 articles, 31 met the inclusion criteria in which 64 factors are extracted. From these, 26 factors act as barriers and 38 factors act as facilitators of milk donation. Having excess milk, altruism, and helping other babies are found to be the most important facilitators of milk donation, while the most important barriers are religious and cultural concerns.
Conclusion:
Developing practical strategies to attract milk donors are crucial for successfully establishing human milk banks. These include providing reliable information regarding the milk bank goals and functions and developing breastfeeding polices with regard to differences in countries' contexts and trying to resolve any uncertainties regarding milk donation, especially those arising for religious concerns.
This study aims to explore miscarriage through the theory of ambiguous loss. The sample consisted of 10 females currently seeking support services related to their miscarriage experience. From the data, six primary themes emerged from the miscarriage experience, including: Emotional Toll; Stolen Dreams; No One Understands; He Loves Me in a Different Way; Why? I Don’t Understand; and In the End, I Have My Faith. The findings in the current study suggest ambiguous loss theory may not fully capture the experience of miscarriage. Clinical implications and future research directions for this population are discussed.
This paper examines how gender dynamics shape human tissue donation for research and for human health. Drawing on research investigating the donation of different types of bodily tissues including blood, plasma, breastmilk, cord blood, foetal tissue and placentae we consider how and why women and men are viewed as different kinds of donors. We situate these donation practices within a broader understanding of gender difference to explain why any sociology of donation needs to take account of gender. In so doing we explore how tissue derived from the bodies of women acquires value in distinctive ways and for distinctive purposes and reasons. Within these gendered bioeconomies of donation, the supply and demand for tissue is structured by social understandings of maternity, parental responsibility, and risk, which in turn affect the experiences of donors.
Traditionally, ritual has been studied from broad sociocultural perspectives, with little consideration of the psychological processes at play. Recently, however, psychologists have begun turning their attention to the study of ritual, uncovering the causal mechanisms driving this universal aspect of human behavior. With growing interest in the psychology of ritual, this article provides an organizing framework to understand recent empirical work from social psychology, cognitive science, anthropology, behavioral economics, and neuroscience. Our framework focuses on three primary regulatory functions of rituals: regulation of (a) emotions, (b) performance goal states, and (c) social connection. We examine the possible mechanisms underlying each function by considering the bottom-up processes that emerge from the physical features of rituals and top-down processes that emerge from the psychological meaning of rituals. Our framework, by appreciating the value of psychological theory, generates novel predictions and enriches our understanding of ritual and human behavior more broadly.
Personal grief rituals are beneficial in dealing with complicated grief, but challenging to design, as they require symbolic objects and actions meeting clients' emotional needs. The authors reported interviews with 10 therapists with expertise in both grief therapy and grief rituals. Findings indicate three types of rituals supporting honoring, letting go, and self transformation, with the latter being particularly complex. Outcome also point to a taxonomy of ritual objects for framing and remembering ritual experience, and for capturing and processing grief. Besides symbolic possessions, the authors identified other types of ritual objects including transformational and future-oriented ones. Symbolic actions include creative craft of ritual objects, respectful handling, disposal, and symbolic play. They conclude with theoretical implications of these findings, and a reflection on their value for tailored, creative co-design of grief rituals. In particular, several implications for designing grief rituals were identified that include accounting for the client's need, selecting (or creating) the most appropriate objects and actions from the identified types, integrating principles of both grief and art/drama therapy, exploring clients' affinity for the ancient elements as medium of disposal in letting go rituals, and the value of technology for recording and reflecting on ritual experience.
With this paper we aim to understand the motivations that lead women to donate their milk to milk banks. We've made an integrative review using articles collected from PubMed, considering as an inclusive criteria they having defined as an object of study social or motivational aspects of the mothers that have donated milk; we found and analyzed eight articles. There is great variability in the sociodemo graphic characteristics of the mothers. The main motivations for donating are an altruistic feeling and an excess of milk, being important training and informing health professional surrounding the birth process as well as social and familiar support and institutional involvement accompanied by a collection infrastructure to facilitate the convenience of the mothers in the donation.
This study explores possible therapeutic benefits derived from imaginal relationships with deceased loved ones. Using grounded theory methodology, triangulation of the qualitative data was attained through analysis of three data sets: responses from experts, interviews with elders, and a search using LexisNexis. Replicated findings or “global assertions” indicate that imaginal relationships with the deceased are common, “normal,” and therapeutic. Reported therapeutic benefits include feeling cared for and loved, experiencing resolution of grief and relationship conflicts, and experiencing increased confidence in problem solving and decision making. The discussion focuses on applications in counseling.
A cross-culturally valid conception of marriage must begin with a definition of husband-wife and with a distinction between spouses and lovers. From this perspective we find that marriage is an institution by which men are provided (socially supported) rights to women. Typically, this institution is embedded within a domestic group wherein a multiplicity of other rights and responsibilities are assigned. Hence, the definition of marriage attributable to E. R. Leach confounds domestic rights (which may exist in the absence of marriage) with marital rights. Notes and Queries and Kathleen Gough define marriage by reference to the legitimacy of children. However, legitimacy is a construct oriented toward restricting access to resources on the basis of parentage. In particular, characteristics of parentage are used strategically as a basis for delimiting the set of offspring admissible into the corporate groups to which their fathers or in matrilineal systems their mothers belong. The extent to which legitimacy is tied to marriage is a strategic variable in the control of dominants within a social system. It is often associated with marriage but sometimes not.
Suggests that the creation of rituals in therapy for the bereaved offers methods of addressing grief work and constitutes an adjunct to traditional forms of counseling and psychotherapy. Nine specifically therapeutic properties of rituals are discussed. Psychological, social, physical, cultural, religious, and philosophical characteristics specific to the loss should determine the design of the therapeutic ritual. Case vignettes are included. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of the present chapter is to provide a comprehensive framework for understanding caregiving as a behavioral system in its own right—that is, as an organized set of behaviors guided by a representation of the current parent-child relationship (George & Solomon, 1989, 1996; Solomon & George, 1996, 2000). A unique contribution of this chapter is to emphasize the importance for the parent of making a shift away from seeking protection and proximate care from attachment figures (the function and goal of attachment for the child) to providing protection, comfort, and care for a child (the function and proximate goal for the parent). This shift is fundamental to understanding the meaning of and motivation underlying critical aspects of parental behavior, cultural differences in providing care, the development of the child's quality of attachment, and the mechanisms of intergenerational transmission. The first section of this chapter outlines the components of a behavioral systems approach to caregiving. We next describe the caregiving system in relation to interactions and competition among behavioral systems. This discussion leads us to define the construct of "flexible care." We next discuss what little is known about the ontogeny of a mother's caregiving system, including potential influences in childhood, adolescence, and the transition to parenthood (pregnancy and childbirth). The final major section discusses representational models of caregiving. The predominant focus of caregiving researchers to date has been on describing the representational mechanisms that underlie maternal sensitivity. We complete our caregiving model by contrasting these approaches with our own, which defines caregiving representation in terms of flexibility and of organizing and disorganizing forms of defensive exclusion. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The loss of an infant through stillbirth, miscarriage, or neonatal death is recognized as a traumatic life event. Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. Risk of complicated grief was found to be especially high after termination of a pregnancy due to fetal abnormality. Studies have revealed that men and women show different patterns of grief, potentially exacerbating decline in a relationship. Although it is clear that prenatal loss has a large psychological impact, it is concluded that there is a substantial lack of randomized controlled studies in this field of research.
This paper introduces the concept of “altruism born of suffering,” and provides a review and integration of relevant research
and theories from various disciplines. In contrast to the well-supported notion that prosocial behavior is rooted in positive
experiences, whereas violence and adversity often contribute to further violence and antisocial behavior, it is proposed that
suffering may actually enhance the motivation to help other disadvantaged members of society, including outgroups. A motivational
process model is presented that includes a typology of altruism born of suffering, integrates clinical and social psychological
perspectives on underlying processes, and proposes potential mediators and moderators. Relevant empirical studies are reviewed
that provide initial support for this model. A particular emphasis is placed on victims of group-based violence, and implications
for intergroup relations and social justice.
Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between "meaning-making efforts" and "meaning made," and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research.
An historical sketch of the manner in which evidence has accumulated showing the ill effects of separation, loss, and maternal deprivation during the early years, and of how, in the light of this evidence, a new conceptual framework, often referred to as attachment theory, has been formulated for understanding personality development and psychopathology. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
This is a study of bereaved mothers' donation of human milk to nonprofit human milk banks following their baby's death. Whereas much has been written about the biological and medical aspects of milk donations in times of loss, much less attention has been given to the psychosocial aspects of this phenomenon. I build on research of motivations for philanthropic giving in times of crisis and loss, and focus on the role of donor identity for explaining bereaved mothers' milk donations. Through a content analysis of 80 bereaved donors' personal testimonials, I demonstrate the role of a donor identity as a transformative identity in these women's process of coping with their loss. Taking on a temporary milk donor identity helped the women in this study reconstruct their shattered identities as mothers and healthy females and served to enfranchise them as bereaved mothers.
This comparative study examines the way Israeli Holocaust descendants and Cambodian genocide descendants differentially reconstitute “discontinued” descendant‐ancestor relations with the genocide dead they never knew. Empirically examining the way distant bonds “discontinued” in contexts of warfare and mass suffering are restored in everyday life, this study fills a lacuna in the scholarship on genocide legacies, continuing bonds, and person‐dead contact. Descendants depict channels of engagement with the dead entailing person‐ person‐dead contact, person‐object interaction, and imaginal conversations, constituting copresence and intersubjectivity. Contrary to trauma theory, Holocaust and genocide studies, and the anthropology of absence that reduce relations with the dead to maladaptive identification or the burdensome presence of voided absence, the data points to normalized and empowering relations. Comparative findings contribute to our understanding of the way cross‐cultural meaning making differentially conceptualizes the porous border between the living and their ancestors and informs the restoration of (dis)‐continued bonds.
Rituals are argued to be transformative in the literature. However, a psychological understanding of transformative ritual has been lacking. Moreover, in contemporary society, meaning-making processes are more complex and uncertain, and the practice of ritualising leads to more individualised and dynamic rituals. This article explores the question how to understand ritual transformation from a psychological perspective. In this theoretical review, insights from ritual studies are combined with psychological theories to build a theoretical framework on ritual transformation. Ritual is found to be transformative in terms of (1) aesthetic distance, (2) structured performance and (3) social collaboration. Ritual is considered in this article to be a culturally scripted event that cultivates emotions and thoughts through symbolic action in a social setting. The article ends with suggestions on how to study this framework in future empirical research.
Aims and objectives:
To explore the meaning of rituals that women and their families perform after a stillbirth.
Background:
A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened.
Design:
Qualitative descriptive study.
Methods:
In-depth interviews, which were transcribed and content analyzed, were conducted with a purposive sample of 16 women discharged from 2 teaching hospitals in Taiwan after they had a stillbirth.
Results:
Families engaged in rituals for 2 underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) Sending the baby's spirit to a safe place, (ii) protecting it from suffering, and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) Releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral, and (iv) praying for a successful subsequent pregnancy.
Conclusions:
Death-related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt, and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy. This article is protected by copyright. All rights reserved.
In this chapter, I compare and contrast three different kinds of death. The first I term traditional and it corresponds to Ariès (1981) ‘tame death’ which he illustrates in the death of an old French peasant in times past:
She contracted a summer cholera. After four days she asked to see the village priest, who came and wanted to give her the last rites. ‘Not yet, M. le curé; I’ll let you know when the time comes. Two days later: ‘Go and tell M. le curé to bring me Extreme Unction’.
(Ariès 1981: 10, quoting Guitton 1941: 14)
This chapter discusses the religious meanings of blood and milk in Christianity and Islam. It is demonstrated that these meanings matter in the construction of men and women as differently and hierarchically placed religious and social subjects. Whereas male blood, as in the passion of Christ or Islamic blood sacrifices, has historically been valued as holy, female blood, in particular that of menstruation and childbirth, was considered impure and polluting and an argument to exclude women from religious leadership or certain religious practices. Milk, another bodily and quintessentially female fluid, mattered differently. In early Christianity Mary's milk was sacralised as a symbol of passing on the Word of God and adored in the Maria Lactans. But whereas the religious values attached to blood only increased in Christian history, that of milk declined. In Islam however, the high value attached to mothers' milk still can be seen in the ideas on milk kinship.
Purpose:
Concern for the grieving family can moderate the intentions of critical care staff to advocate deceased organ and tissue donation. Conversely, benevolent actions may provoke distress through missed opportunities to save or transform lives. This article provides insight into the perceived benefits of organ and tissue donation for grieving families who experienced end-of-life care in the intensive care unit.
Methods:
Data were collected via semistructured, face-to-face or telephone interviews with 43 participants from 31 donor families. Audio recordings were transcribed verbatim and subjected to qualitative content analysis.
Results:
The study findings affirmed the importance of person-centered end-of-life care. Donor families shared examples of good-quality care and communication that contained the hallmarks of compassion, respect, dignity, and choice. We uncovered a trajectory of hope and despair in which the option of organ and tissue donation appeared to give meaning to the life and death of the deceased person and was comforting to some families in their bereavement.
Conclusions:
Our study findings underlined the significance of donation decision making for grieving families. Organ and tissue donation has the potential to balance hope and despair at the end of life when the wishes of the dying, deceased, and bereaved are fulfilled.
In jurisdictions where the sale of body tissue and organs is illegal, organ transplantation is often spoken of as a gift of life. In the social sciences and bioethics this concept has been subject to critique over the course of the last two decades for failing to reflect the complexities of organ and tissue exchange. I suggest that a new ethical model of organ donation and transplantation is needed to capture the range of experiences in this domain. The proposed model is both analytical and empirically oriented, and draws on research findings linking a series of qualitative sociological studies undertaken in New Zealand between 2007 and 2013. The studies were based on document analysis, field notes and 127 semi-structured in-depth interviews with people from different cultural and constituent groups directly involved in organ transfer processes. The aim of the article is to contribute to sociological knowledge about organ exchange and to expand the conceptual toolkit of organ donation to include the unconditional gift, the gift relation, gift exchange, body project, and body work. The rationale for the proposed model is to provide an explanatory framework for organ donors and transplant recipients and to assist the development of ethical guidelines and health policy discourse.
© 2015 The Author. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
A major barrier to meeting the needs for organ transplantation is family refusal to give consent. This study aimed to describe the perspectives of donor families on deceased donation. We conducted a systematic review and thematic synthesis of qualitative studies. Electronic databases were searched to September 2012. From 34 studies involving 1035 participants, we identified seven themes: comprehension of sudden death (accepting finality of life, ambiguity of brain death); finding meaning in donation (altruism, letting the donor live on, fulfilling a moral obligation, easing grief); fear and suspicion (financial motivations, unwanted responsibility for death, medical mistrust); decisional conflict (pressured decision making, family consensus, internal dissonance, religious beliefs); vulnerability (valuing sensitivity and rapport, overwhelmed and disempowered); respecting the donor (honoring the donor's wishes, preserving body integrity) and needing closure (acknowledgment, regret over refusal, unresolved decisional uncertainty, feeling dismissed). Bereaved families report uncertainty about death and the donation process, emotional and cognitive burden and decisional dissonance, but can derive emotional benefit from the “lifesaving” act of donation. Strategies are needed to help families understand death in the context of donation, address anxieties about organ procurement, foster trust in the donation process, resolve insecurities in decision making and gain a sense of closure.
Despite the scholarship on continuing bonds with the dead and the critique of pathologizing paradigms in trauma theory, little is known of the engagement between trauma descendants and relatives who perished prior to their birth. A sample of 55 Holocaust descendants was recruited in Israel to participate in semistructured ethnographic interviews. Descendants reported on the normalized presence of and engagement with the dead and the restoration of previously "discontinued" bonds. Findings were consistent with the scholarship on the therapeutic role of continuing bonds and with meta-analyses normalizing descendant psychosocial legacies. Jewish-Israeli paradigms of memory facilitated therapeutic bonds with the dead.
This article summarizes the author's original research, which sought to discover the elements necessary for using death-related ritual as a psychotherapeutic technique for grieving people who experience their grief as "stuck," "unending," "maladaptive," and so on. A death-related ritual is defined as a ceremony, directly involving at least 1 person and the symbols of the loss, and usually directly and indirectly involving others. Suggestions for counselors and psychotherapists are discussed.
Counseling psychologists face many approaches from which to choose when they conduct a qualitative research study. This article focuses on the processes of selecting, contrasting, and implementing five different qualitative approaches. Based on an extended example related to test interpretation by counselors, clients, and communities, this article provides a detailed discussion about five qualitative approaches— narrative research; case study research; grounded theory; phenomenology; and participatory action research—as alternative qualitative procedures useful in understanding test interpretation. For each approach, the authors offer perspectives about historical origins, definition, variants, and the procedures of research.
This article is designed to explore ideas in the recent sociology of morality about the conjunction of ethics and embodiment in everyday life. While it draws on an interpretation of the ethical encounter as a relation of moral proximity, it extends this conception of ethics beyond the dyad to include a discussion of gift giving and generosity in the present context. This is done in order to analyse a concrete empirical event in terms of the web of moral and social codes that inform it. The event in question is a well-known New Zealand breastfeeding case in which a woman breastfed another woman's baby `without her consent'. As well as drawing attention to the ethical risks in encounters between strangers and others in contemporary social life, this particular breastfeeding case also brings to the fore the invisibility of breastfeeding as an embodied ethical practice.
Stillbirth, or sudden intrauterine death, is in many ways an invisible death. A stillborn infant is one mature enough developmentally to have lived outside the womb but for some reason, or perhaps multiple reasons, was born dead. Stillborn infants are often demarcated from other types of child death and are rarely legitimized as a real loss. When a baby is stillborn, mothers, fathers, surviving siblings, and grandparents may struggle for years to find answers to a series of complex and inherently unanswerable questions. The family members' profound feelings of grief and ambiguity loss are borne in a social environment that denies this reality because the child's death was invisible to most of the world. Boss's framework for understanding ambiguous loss proves quite helpful in thinking about stillbirth.
The article is a cross-cultural study of continuing bonds to the dead as an aspect of bereavement in Japan and North America. Japanese ancestor rituals, rooted in Buddhism, are well-developed cultural forms for managing continuing bonds. North American material is from a study of continuing bonds among bereaved parents in a self-help group. Cultural differences create very different ways of experiencing and managing the thoughts and emotions modern psychology calls grief. In both Japan and North America, the transformation of the relationship from living to a continuing bond is accomplished by embedding the attachment to the deceased in a network of social bonds. In both, bonds to the dead connect survivors to larger attachments, to religion, and to nation. The level of abstraction ranges from how relating to the dead functions in individual lives to how grief and continuing bonds are shaped by the culture's economic and political power arrangements.
Grounded-theory analysis was used to generate an explanation of the phenomenon of meaning reconstruction in the experience of 10 bereaved mothers. The theory that emerged included three phases in the process of meaning reconstruction: discontinuity, disorientation, and and adjustment. The participants reinterpreted the meaning structures they had held prior to their child's death in order to give meaning to the death. The nature of the prior meaning structure emerged as the core variable. The ability to restore meaning after the death of a child was clearly linked to the prior existence of a meaning structure that could account for and “place” the child's death. The findings suggest that the process of meaning reconstruction is a unique aspect of the grieving experience that cannot be explained by existing thories of grief Recognition of the complexity of the process has implications for community members and professsionals who interact with the bereaved parent.
This study explores the facilitative aspects of postfuneral rituals in the grief process. Participants included 50 adults who evaluated symbolic activities (rituals) in terms of helpfulness, aspects of those activities, and outcomes of performing such activities. Results confirmed (a) that appropriate rituals can facilitate adjustment to bereavement, (b) that some factors are particularly important for success of rituals, and (c) that performing rituals can have significant positive outcomes for participants.
Context
Individuals needing lifesaving (heart valves, skin grafts for repair of critical burn injuries) and life-enhancing (corneas, bone and tendon grafts, skin, and veins) tissue donations outnumber the tissues available for transplant.
Objective
To describe the grief family members experienced 6 months after donation and to learn how family decision makers gained meaning from the decision to donate a loved one's tissues. This is phase 1 of a longitudinal study in which family decision makers will be surveyed again at 13 and 25 months after donation.
Design
Qualitative descriptive.
Participants
One hundred seven family decision makers whose family member died a traumatic sudden death and who authorized donating tissues for transplant.
Data Collection and Analysis
Data were written responses to the questions, “If you could ask or tell your dead family member something, what would it be” and “What meaning does donating tissue to others have for you” Data were analyzed by using content analysis procedures.
Results
Concepts derived from the first question represent the context of family members grieving the sudden death of a loved one. Concepts were (1) feeling empty, (2) missing and loving, (3) being grateful, and (4) having regrets. The concepts derived from the second question were (1) fulfilling their family member's wish, (2) doing the right thing, (3) believing something good came from the death, (4) helping others, and (5) living on. Reasons for donating were based, in part, on honoring the legacy of their loved ones who had given of themselves to others in life and now continued to give to others after death.
Conclusion
The results of this study provide a basis for health professionals and donation staffs to better understand the context within which families grieve and give meaning to tissue donation.
This article points out the criteria necessary in order for a qualitative scientific method to qualify itself as phenomenological in a descriptive Husserlian sense. One would have to employ (1) description (2) within the attitude of the phenomenological reduction, and (3) seek the most invariant meanings for a context. The results of this analysis are used to critique an article by Klein and Westcott (1994), that presents a typology of the development of the phenomenological psychological method.
This article explores the nature of "the phenomenological attitude," which is understood as the process of retaining a wonder and openness to the world while reflexively restraining pre-understandings, as it applies to psychological research. A brief history identifies key philosphical ideas outlining Husserl's formulation of the reductions and subsequent existential-hermeneutic elaborations, and how these have been applied in empirical psychological research. Then three concrete descriptions of engaging the phenomenological attitude are offered, highlighting the way the epoché of the natural sciences, the psychological phenomenological reduction and the eidetic reduction can be applied during research interviews. Reflections on the impact and value of the researcher's stance show that these reductions can be intertwined with reflexivity and that, in this process, something of a dance occurs—a tango in which the researcher twists and glides through a series of improvised steps. In a context of tension and contradictory motions, the researcher slides between striving for reductive focus and reflexive self-awareness; between bracketing pre-understandings and exploiting them as a source of insight. Caught up in the dance, researchers must wage a continuous, iterative struggle to become aware of, and then manage, pre-understandings and habitualities that inevitably linger. Persistance will reward the researcher with special, if fleeting, moments of disclosure in which the phenomenon reveals something of itself in a fresh way.
Abstract Symbolic meaning and representational and reflexive perspectives remain dominant orientations in the analysis of ritual. While these must be crucial, this essay argues that a focus on the perceptual dynamics of rite, especially as these are located in ritual aesthetics, may expand an understanding of the force of rite. The discussion develops critically upon Victor Turner's seminal work, suggesting ways in which ritual analyses may be redirected. The related concepts of dynamics and virtuality (distinguished from the cyber-technological kind) are developed, indicating that these may be critical for understanding how rites change or transform the situations to which they are directed. Ritual as a dynamic in virtuality that has no essential or necessary relation to the ordinary realities that surround it may, because of this fact, be greatly empowered as a force that can pragmatically intervene in ordinary realities.
This article is a comparative elaboration of Eugene Hammel's pioneering analysis of “fictive kinship,” Alternative
Social
Structures
and
Ritual
Relations
in
the
Balkans
(1968). In place of godparenthood, I examine the structurally similar institution of fosterage or “milk kinship” as documented in former mountain kingdoms of the Hindu Kush in northern Pakistan. Comparable structures of interdomestic allegiance and tributary patronage organized through milk kinship are attested more fragmentarily elsewhere in the Middle East and Central Asia, and there is further evidence that such hierarchized foster relations also extended into many peripheral regions of premodern Europe (E. Goody 1982:280–1; Parkes n.d.). Hammel himself mentioned Serbian “kinship by milk” (srodstvo
po
mleku)—“meaning the fictive kinship relationship between two children suckled by the same woman, but otherwise unrelated” (1968:31 n.27)—with reference to Filopovich's (1963) earlier survey of South Slavonic ritual kinship. Yet Hammel did not pursue the possible analogies of such fosterage ties with kumstvo godparenthood: as structurally equivalent institutions of constructed kinship, once orchestrating transitive chains of interdomestic allegiance and tributary governance in peripheral polities throughout Eurasia.
When social ties are put to the test, proverbs affirm, those of consanguinity usually prevail: “Blood is thicker than water”; or as Arabs put it, “Blood is thicker than milk” (Lane 1893:1097). These enigmatic adages refer to former institutions of adoptive kinship in western Eurasia, contrasting the blood of natal kinship with the water of baptism or “spiritual kinship” in Christendom, and with infant fosterage or “milk kinship” in Islam. Other sayings, cited as epigraphs above, argue that the nurture of such adoptive kinship may match or supersede natal kinship, just as baptismal sponsorship was supposed to create a spiritual cognation superior to that of mere flesh and blood (Gudeman 1972; Guerreau-Jalabert 1995).
Background:
The continued ability for a mother to produce breast milk following the death of her baby in utero, at birth, or during the postpartum period is an aspect of perinatal loss that is rarely acknowledged.
Objective:
To explore the lived experience of bereaved mothers who chose to express and donate their breast milk to a milk bank to feed premature and sick babies following the loss of their own babies.
Methods:
Twenty-one bereaved mothers who donated their milk between January 2003 and December 2006 to the Mothers Milk Bank in San Jose, CA or Columbus, OH participated in an in-depth, semistructured interview process about their experiences expressing and donating their milk.
Results:
Each transcribed interview revealed 4 essential themes, as follows: (1) identifying as a mother, grieving the loss of motherhood; (2) meanings associated with the experience of pumping milk; (3) finding meaning in and integrating the experience of perinatal loss; and (4) the importance of addressing lactation with bereaved mothers. Various subthemes were explored within each essential theme.
Conclusion:
The experiences of these participants reflect the importance of addressing lactation more thoroughly with bereaved mothers who have lost their babies in utero, at birth, or during the postpartum period and providing them with adequate support and education during the healing process.
Ambiguous loss is a newly identified type of loss that occurs when a loved one is physically present, but psychologically
absent. Dementia is just one example. Because the lost person is here, but not here, grief is frozen, life is put on hold,
and people are traumatized. With no official verification of death, no possibility of closure, and no rituals for support,
there is no resolution of grief (Boss 1999). Clergy, especially pastoral counselors, can witness and provide comfort for such uncanny loss because people rely on them
for support, not just from the clear loss of death, but from the ambiguous losses, catastrophic and ordinary, that inevitably
will occur across the life course.
KeywordsAmbiguous loss-Traumatic loss-Complicated grief-Resilience-Self-reflection
Recent social science commentary on the donation of body tissues and organs typically invokes Richard Titmuss\'s work on altruism and the gift relationship as a way of framing donative processes. Much of this discussion, however, has neglected to consider how altruism and body gifting is structured and promoted by organisations and institutions that make such processes possible. In this article I suggest that the accounts people give of their body gifting practices do not always fit orthodox notions of tissue donation as unconditional. Rather, people\'s perceptions of body gifting and donation depend very much on the kind of tissue being donated and who the tissue is being donated to. Given these complexities, we need more thoroughgoing discussion of the rituals associated with specific donation practices.
We observed the reactions of mothers to the loss of a newborn infant and explored the strength of the affectional ties between mothers and their infants before the first physical contact. Twenty women were interviewed after the death of the infant; every mother mourned even when her baby was nonviable and lived for only an hour. There were no unduly upsetting effects of early tactile contact in emotionally healthy mothers. A high degree of mourning was most often found in mothers who were pleased to be pregnant and who had previously lost a baby. There was also, possibly, a higher degree of mourning in mothers who had touched their baby before its death, and who had not talked with their husbands about the loss. Strong affectional bonding appears to begin before physical contact and caretaking but is enhanced by these activities.