Today, wanting to broaden the topic already discussed of the psychological needs of a woman who suffers an abortion, we are going to interview Monica Alvarez, psychologist specializing in Couple and Family Therapy. She is also, together with M. Àngels Claramunt, creator of the forum Overcoming an abortion, where she began by pretending to give support and listening to mothers and their families, but which she would also share personally when she lost a much desired pregnancy.
She is currently the mother of two girls and professionally attends online consultations trying to reconcile her profession with the upbringing of her daughters and we can read it on two fundamental pages to understand the emotional implications of abortion, gestational and perinatal grief and perinatal psychotherapy.
In our interview with the psychologist Mónica Álvarez we are going to deepen the psychological aspects of abortion and the moment to ask for help from a specialist, a topic that we talked with the psychologist Paz Ferrer and that we now complete with a second opinion to give our readers A vision as complete as possible.
What impact does abortion have on women?
For a mother to lose a child while she is pregnant can be a devastating experience that turns her mental-emotional-social house ... upside down. Like all vital crises, it is a moment in life to question many things that were believed immovable, it is an opportunity for emotional and spiritual growth that leaves an indelible mark on the person, whether taken advantage of or not.
In our society we are educated for life, we do not think that the other side of the coin of life is death and that it is not something that always touches others. When a woman becomes pregnant, the last thing she thinks is that she will lose it, in most cases. Even if you have close cases and consider them, finding out what is happening to her can be a huge shock even in the early stages of pregnancy. This is compounded because there is also little room to cry, say goodbye, honor a baby who only had life inside the womb.
Is the experience the same for all women?
Each woman is a world and each one can live it differently. There are other variables that also influence the way of processing it (whether or not there have been previous duels, how has your history been linking with the mother herself, the support she receives especially from her partner ...), but in any case, what What we usually say to moms who enter the forum Overcoming an abortion in search of information, support, comfort is that, almost anything that comes to mind, do not worry, it is normal for that person.
Does the emotional reaction depend on the time of pregnancy?
No. You can't compare pain. The forum includes women who have lost their babies in any month of pregnancy and all bring their pain, their anguish, their pain in tow. The pain of those who lost a baby in the 7th month cannot be compared with those who lost it in the 7th week of gestation. No one has the right to claim the title of "my pain is stronger" because we have no device that can measure it.The pain is very subjective and even the baby who weighed a few grams carries tons of broken illusions.
Is grief different in a perinatal loss?
The duel as a concept, the psycho-emotional phases that are going through are the same for all people in all types of losses. From losing a loved one, a job, a pet, an arm that has been amputated, the clock they gave you in communion ... all are losses and will entail their own duel, more or less intense depending on the characteristic of the loss. Although the duel as such is universal then everyone makes it their own, in their own way. In our society it is believed that the first quarter is the "dangerous", it is the stage of pregnancy in which more losses occur. Once this is past, many women forget that life and death often go hand in hand and that although statistically the number of losses that occur in the second and third trimesters is lower, it also occurs. It will be in a very small percentage, but to whom it is the turn, it is 100%. The shock, the surprise, are greater. Most women who become pregnant do not think they could lose it, it is always a surprise. But having felt the baby in the womb, having passed nine months of pregnancy, and losing it, makes the baby more real. As in those nightmares where you were almost ready to get your wish and escapes when you have it right at your fingertips.
Should they offer psychological help to all women who lose a pregnancy?
It would be very interesting to offer it yes, although in our society there is no culture to be treated emotionally, neither in these cases nor in any other.
Is emotional attention to abortion generally good in hospitals?
In hospitals they deal with the physical part of the loss. Then you have to be lucky and run into staff with a minimum of sensitivity. For the losses after week 28, there are protocols in a hospital to accompany the parents in a more humane way. But in general the treatment by medical professionals is quite aseptic and in many cases with a total lack of tact. It is true that, for example, the job of a nurse is to heal the physical injury, but there is also an emotional treatment that must be helped to heal, or at least not interfere or cause further damage. The problem is that to deal with a suffering being, one must be familiar with the pain itself, with the history of grief itself, and this is something that is avoided even accepting that it exists.There is very little training in general in emotional intelligence in hospital workers, at least in the area of obstetrics and gynecology.
Are women prepared for this? You are never prepared for a loss. We know that death exists, but it is always something that "happens to others." Although we have already been through it and we are on notice, one is never prepared to lose a child.
Neither women are prepared, nor, as I said, in many cases, the professionals who treat them in the hospital. In Overcoming an abortion many women come with a considerable traumatic burden as a result of the treatment received in the hospital.
Would it be necessary to prepare pregnant women for this possibility or is there no preparation possible?
The problem is that this society of ours makes a total denial about death and specifically in this about the loss of a baby in the breast. It would be necessary to turn around all the way one has to live and treat it, something that after all is as normal as life itself. People learn by imitation, women learn to shut up and hide if that is what we have seen our mothers, aunts, grandmothers, neighbors ...
Ideally, it should be introduced in childbirth preparation classes, but I don't know what type of reception I would have. In addition, classes are usually done in the third trimester, so previous losses would not be treated. Maybe the midwife on the first pregnancy visit could talk about it, as one more possibility, inform what to do in case of, so that she does not catch without information of any kind. Anyway, I still think that the understanding of abortion is a problem of this society. In the moment in which it is possible to speak with normality of the physiological loss like another phase of the psychosexual development of the woman and we recover the right to give birth to our children are alive or dead…; when it is normal to lose a baby and be able to cry, take a low, be K.O. because that is what the body asks us without obstacles or demands to be well or to return "to normal life". Then we will know that the loss is a very hard blow, but that life goes on. Now for many women, abortion is a great black well that they do not even know if they will get out.
When is psychological care indispensable?
The duel includes a series of stages, according to Elisabeth Kübler Ross we would talk about shock, denial, negotiation, sadness, anger, acceptance. Each person lives them in a different way. Sometimes stages overlap or the order is changed, what is certain is that it goes from one to another. After a year it may have been done all the way, although there are people who need more time. If there is a fixation in any of the stages that blocks the progress there, we should see what is happening and how to “unclog it”. Our society is fixed on the denial of death in the womb, so that many people will remain fixed there also by not having reference models to rely on to move forward. I don't see it, then it doesn't exist, nothing has happened here.
In other duels the mourner has the opportunity to cry, take a casualty if he needs it ... He has the right to depress for a while. Not here. Many women who have been detected a malformation are going to have an IVE and the next day to work. And here nothing has happened.
What symptoms can we look at to detect the need for psychological help?
A clear symptom is denial, that someone tells you that you do not need it and you see it that it is made dusty, sad, maybe neglected, with physical symptoms (different diseases that can manifest on the physical level the inner energy imbalance), which leaves of going out, of relating, that slimming or fattening many kilos in a short time. All these symptoms can occur in a person or give only one. You have to be aware of the level of well-being that has been lost since the loss, the time elapsed (three months later it would be normal, two years later, no), the support you have.
Sometimes therapy is needed not only because of the issue of grief, but to neutralize the ill-fated influence that poorly informed friends and family can exert and not to mention medical services.
How to convince a woman who denies needing help?
You can't convince anyone who doesn't want to do therapy to do it. The therapy must be voluntary. The important thing is that women know that they can access this resource and do so when they feel they need it.
There is another problem and that is that most people increasingly have more knowledge of psychology, and that is good, it means that there is interest, that the information runs free. But there is a problem, which is intended to help those who need a professional. Or that the person in need of therapy self-convinces that theirs are arranged by talking with friends. There are things that can be solved, yes, but there are problems, such as traumas, that need professional help, because more harm can be done than anything else if you try to rummage without having the right knowledge.
What is wrong with the environment in these cases?
As I said earlier, the environment mostly does deny the pain of abortion. There are cases in which the family reacts great and supports and helps the parents, but the normal is usually the opposite.
The loss has always been experienced as a taboo, so that the couple who suffers it is usually seen alone when making their duel. The typical phrases that are said when you do not know what to say about “pregnant woman, pregnant woman,” “you have more children,” “now you have to be strong for your other children,” “you are already older,” “total, war that children give ”, etc. They do more harm than anything else. If you do not know what to say, it is better to remain silent, you really appreciate not having to listen to nonsense.
Is it normal to need help? Does that make us weaker?
What are the normal phases of a grieving process?On the contrary, asking for help makes us stronger. Or we are stronger when we ask for help. Another taboo and another myth: it is wrong to be vulnerable. We have sold the Superwoman movie and we have believed it so much that we no longer know how to take off our cape.
There are several ways to “count” the phases according to the psychological school or the author who does it. I like the one Elisabeth Kübler Ross said: Shock, denial, negotiation, anger, sadness, acceptance. Is the time to overcome an abortion variable?
A year is usually given to go through all the phases of the duel, although there may be people who cost them something more or something less. They are a whole school of growth, it is like the image of the snake that changes its skin. Grief also changes us and makes us different, stronger, safer people. And for that it takes time, everyone will know how much they need.
With this we finish the first part of this deep and enriching Interview with the psychologist Mónica Álvarez, specialist in gestational and perinatal grief, which has taught us a lot about the emotions of abortion and how to live this indispensable duel. There will be a second installment in which we will continue discovering more things about what a dueling psychologist and therapist can teach us.
