Slides on Mourning and Stillbirth -Elizabeth Kirkley-Best PhD

Emily was Born, But She Died, by Elizabeth K. Best

Emily was Born, But She Died, by Elizabeth K. Best

A Controversy

Normally, I do not address background issues in this blog. I have had to in a number of other blogs, dues to unscrupulous attempts to ruin the sites,  but with "The Forgotten Grief", I thought I would never have to since in almost 40 years, my work and reputation have been so well known.  An unfortuate amount of controversy has arisen, partly coming from that other direction, as some highly unethical folk have attempted to all but erase even my identity and early career history.  If it were not that serious, I would not address the following, but it seems necessary after so long a time.  As a Christian, I will not 'name names', nor get into gory details, but rather focus on a few facts about my own life and career, so that any one encountering unfortunate information, may have the 'other side.' My bio and cv may be found at elizabethkirkleybest.blogspot.com which may be all verified either online or by university indices.  If something cannot be found, it may be in a special index or archive, and one can easily write to me if there is any doubt, and I will be happy to provide the source, which is almost always 'checkable'.  Part of the problem has arisen, as several people have attempted to 'rewrite' my early articles and works, in some cases with politically and religiously charged motives.  In two cases, several articles have been 'reworked' and republished under a different name but this is unethical and illegal and in at least one case, the person was not even in the field.

When Dr. Kellner and I published several foundational articles many years ago, all the work behind our work was either based upon my dissertation and research, or his and Dr. Donnelly's Perinatal Mortality Counseling Program in OB-Gyn at UF.  As such, all of our work was done at the hosptial or in Psychology, carefully documented, monitored, approved and in some cases videotaped and signed. Every piece of research we did had to go through a process of several department's approval, and our team approach greatly benefitted us, in that we both had constant professional witnesses to our work.  Back then it was a very unique work, with few involved even nationally,  but even then, we encountered an occasional author who thought we should give him or her greater mention, etc, as the human ego is a frail thing.  However, Dr. Kellner and myself (he has recently passed away) had an M.D./Ph.D and a PhD respectively: his in Obstetrics and internship in Psychiatry, and mine in Psychology, in a research division.  Dr. Kellner had high level writing and publishing experience as well, and even in my early years, my training in research, statistics and writing was above what most graduate students had.  We published together for a few years, then each of us published independently, and successfully.

A few facts:

1. All of our research is verifiable and 'certified', obtaining back then multiple committee approvals, and other still proveable evidences.

2. My doctorate is in Personality Psychology (a research/academic degree) from University of Florida Department of Psychology, and I have taught at UNF, UF, NEOU Coll Medicine, a seminary and several other places over the years part time.   His obituary states the following:

Union College, where he was an Eliphalet Nott Scholar. Attending the State University of New York, Downstate Medical Center in the Combined-Degree Program, he received both a M.D. and Ph.D. degree in 1973 doing research in embryology. This was followed by a residency in Obstetrics and Gynecology at Jackson Memorial Hospital, Miami and a fellowship in Maternal-Fetal Medicine at the University of Florida. He was board certified in both fields and had been on the faculty of the University of Florida since 1977.

3. Both of us in the course of our careers received grants and our publications are accessible and well-known, including the most cited lit-review, "The Forgotten Grief" in American J Orthopsychiatry in 1982. (see Google Scholar)

4. "The Forgotten Grief" was a literature review in 1982, but had also been the title of the perinatal section of my dissertation which is available online, including on forgottengrief.wordpress.com and via the digital collections of George Smathers Library, UF.  I own the copyright to my dissertation.

5. One of the biggest challenges to my work, after we had ceased working together, was at NEOUCOM in 1984-86 when after years in the field, one woman there who had not received her doctorate at that time, and in a very different area, 'wanted in' on the work.  It was then an unqualified person, and my work was already established: I have since that time worked independently completely.

6.In 1985, though I had been completely secular before,  I became a Christian. Part of the conflict has been that, as some persons not aware of ethics in research think they can 'have' or 'rewrite' my early work, which is of course ludicrous.   The challenges are attempts at career ruin, and occasionally affronts to free speech as some early work shows developing maternal attachment in pregnancy.

7. One woman in the literature has developed what she calls the "Prenatal Maternal Attachment Inventory", but Kellner and I developed an instrument of that name in 1979-80, where it was validated in OB clinics.  This is verifiable: it is also mentioned back then in a significant legal brief. My field is also partly test development and I had used the instrument early.

8. My dissertation has the 'Grief Scale' developed for raters in Perinatal bereavement, which was also validated and checked for inter-rater reliability.  I included some of that data in the appendix of my dissertation, although several versions other than the originals, have shown up with one of the pages missing.  The original is available and was verified through my doctoral committee and via the graduate school office for Dissertations and Theses.

9. I presented in 1984 in Toronto at APA a paper called "Authenticity and Grief: Grief is Not a Disease", a Response to George Engel's "Is Grief a Disease".  Copies of the paper were distributed then, and abstracts are still available.  I believe the conference session was also recorded.

10. While several of my articles may be found online, a few require a trip to a university library, although I am trying to post copies on forgottengrief.judahsglory.com (forgottengrief.com is also mine, but currently awaiting the site being rebuilt.  Formerly it was(is) at angelfire.com/journal2/forgottengrief.

11. My last professional article in the field was "The Hidden Family Grief" at Kirkley-Best, E., & VanDevere, C. The hidden family grief: An overview of grief in the family following perinatal death .

 Journal International Journal of Family Psychology & Psychiatry1986 (7)Pp:419-437.Cited by 26 The journal has either become defunct or changed names, and I have not found the exact outcome of it.  This article was part of a two part study conducted at the Department of Psychiatry, Akron Children's Medical Center, and Dr. Van Devere was the past chair of the department, though he is now retired. He was added as he made the facilities available and contributed to the discussion.

12. Very early, I developed helps for parents as well as professional resources.  These included songs, poems and even things like burial blanket designs, and cross-stitch patterns for commemorating babies' deaths.  One poem was published in Best, Elizabeth Kirkley. Pharos: J Medical Humanities: 1985,48(2) p. 36

 13. Some of the resources were published in SHARE's earliest resource manual by Sr. Jane Marie Lamb, Springfield/Belleville Illinois.  

14. One of the current issues that keeps coming up is Counseling Parents Experiencing Perinatal Death: A Handbook for Parents & Professionals.  This was originally published in 1982-3, and was distributed nationally, and at the APA Convention in 1983 in Anaheim CA where I gave the first APA workshop to both physicians and psychologists.  This is still listed in APA records. The handbook in workshop form has been online for over 17 years on the site "The Forgotten Grief".  I revamped it to 'book' form in 2007,  but am still working on a 3rd edition.  I have never sold the rights to it, nor invited anyone to ruin it.  

15. Last but not least, "forgottengrief.com" (currently only for redirect) has been located several places on the net for years, most eminently at forgottengrief.com and angelfire.com/journal2/forgottengrief.   For the past 2-3 years I have been rebuilding the site on forgottengrief.judahsglory.com which I also own.  My registration is too well known.  The site was not to start a war, to go full time back into the field, to be an affront to any other project or person, but was a receptacle for basic comfort and information on the topic so that the very substantial work of those early years would not go to waste.  It is strictly for aid in mourning.   I am not affiliated with SHARE, HAND, or any other parent or hospital group currently.  In 1987-8 I redirected to ministry, then to Shoah Studies for the Church, but kept up this work part-time in the background.

I have to say in sum that I am utterly appalled at the unprofessional conduct emerging these days at universities, in churches, etc in which people attempt to 'bulldoze' another's career and work (particularly at the end) for the main purpose of getting ahead, or thinking they can just show up and take the place of someone who has worked in the area for 40 years.  The gesture is insane, and hurts everyone in the field,as well as parent care.  There is no competition here:  I started around 23 and I am now 63:  mostly I am finishing the last few things I meant to write or get in order, in order to aid in the foundation of a continuing work.  My last speech in the field was a keynote in NY at the national conference called "The Mourning After Death", a play on Emily Dickinson's poem, calling for honesty and authenticity in our approach to grief: to recognize that we are not there for anyone but the bereaved: our careers, reputations etc. can wait.  I also said then, that I had serious questions about research becoming an intrusion and an affront to care, as people were even in that field trying to get ahead and 'make their fortune' off the death of infants.  How sad!  How sad to have to write this 40 years later!   I have just said my 'goodbyes' to two old friends and influences on my career, and have had also to say goodbye in 2005 to Jane Marie Lamb.  My great desire for the field is that research and careers do not become the 'main thing' in Perinatal Grief and Mourning, but comfort, teaching and care to keep parents from despair.  I make that a challenge to the new generation moving up into all of our places.

The Passing of Friends

 It is with great sorrow, and belatedly, that yesterday searching the net for some minor detail, I ran across obituary notices for two old friends and valued people in my life.   Both of these people were central influences in my early career, and inspired me with information, kindness, and insight to follow the path that I followed early, in the Study and understanding of Mourning and Bereavement.

Kenneth R. Kellner, MD, PhD: Professor Emeritus, Department of Obstetrics, Shands Teaching Hospital, University of Florida

In 1978 or just into 79, while a graduate student 'up the hill' working in Studies of the Self, and beginning to dabble in death and dying, and related topics, a faculty member stopped me and told me of a marvelous opportunity 'down the hill' (The J. Hillis Miller Health Center, the UF School of Medicine, was 'down the hill' from the Psychology Building).  They were looking for a graduate student who might be able to aid with developing research on the topic of Perinatal Bereavement, or Grief and mourning with stillborns.  I immediately said 'yes': it was just what I had wanted to do: for my Masters, and up till then, my studies were dry and scientific, theoretical, and as both a researcher and young mother,  this opportunity appealed to me as precisely what I had hoped for.  From 1978 until 1982, and years afterward, the work that Ken Kellner, Dr. Donnelly (Pathology) and myself would do, would help set the groundwork in America for research in the area.    None of us knew that at the time:  Dr. Kellner, with Dr. Donnelly's advice and aid had established Perinatal Mortality Counseling Program, an interdisciplinary team approach to onsite, inhospital, compassionate and informed intervention and counseling for parents at Shands experiencing prenatal loss and stillbirth. (Kellner, KR, Kirkley-Best, E., Donnelly,W. et al,1981)  This team approach, rather unique at the time, coordinating pathology, OB-GYN, Psychology & Social Work) would later serve as a template for hospital programs all over the world.  It was an exciting time, though very sad, as we listened to the mourning and sorrow of so many mothers, whose infants had died at or before birth.  Dr. Kellner's death has added a wistful end to his work, as his full and busy life stands next to those small lives, who because of 'fate and The Fall' came only to change lives.

I did not know that Ken was sick with cancer: we lost touch over the years, had some minor 'spiffs', but how they pale the moment someone who was significant in your life is gone!   The last time I saw him face to face was in the 80s:  we wrote a note or two, one at his retirement regarding time for him and his wife to travel, but how fast the time went:  he had a great sense of humor and when I worked with him, I remember he had a wooden carving of his name on his desk: one day while we were talking, I took my finger and absent mindedly ran it across the dusty 'name carving' and he started to to tease about whether I was accusing him of bad housekeeping!  In graduate-student flustering, I assured him not, and he laughed, but that was what he was like.  Back then he looked like Howie Mandel.  I hardly recognized him late.

Everyone who knew him, the hundreds of interns, medical students, co-workers, could agree on one thing: he was hard working and excellent at what he did.  God graced me with several people like that in my early training:  I learned to care about detail and accuracy,  about always attributing credit where credit is due, about care and patience with families and about listening: that was an odd lesson from a clinician, as I have worked with many who despite their strengths, often fail at that trying occupation.  I was gone from the team for 30+ years, though kept some of my own research going and developed "The Forgotten Grief" website, based upon an article he and I co-authored, that became a foundational literature review in the area.  My early work was much better because of Dr. Kellner: he was a careful editor and thinker, and wrote well.

I know he loved his wife and children, speaking of them often.  I don't recall meeting Mrs. Kellner, but know her life as a physician's and professor's wife must have been very trying, I will remember to pray for her and his family.  While Dr. Kellner was not only known for his work in Perinatal Bereavement, our early work, as that of others such as Glen Davidson (SIU), Sr. Jane Marie Lamb(SHARE) and others went so far:  back then, we were surprised at how many people would listen: there was so little intervention.  Now,  even with those early seeds of research, counseling and care,  there is almost not a hospital even abroad, that doesn't at least have referrals and support groups.   What you plant, grows.  So many people die, having led full lives, but leaving nothing behind.  While his secularism might not agree with this thought: how great the grace of God, to allow us to plant those seeds in life that lead to a healing work.  How comforting it is, not to think of where we went in our careers, but of how many people now are comforted by the work.  Here is one of his last lessons to me, unintended: never let the minor distractions of life, or the pursuit of career or achievements overshadow a far better great work, of healing and comforting other people in pain.

In my mind, I will always remember the young doctor who looked like the one on "St. Elsewhere".  A stalwart and dignified family man who taught me to be a better psychologist and human being.  May his family be comforted in knowing that their sacrifices through the years, were just as critical in the work as his: they share in the comfort of many worldwide.

Dr. Hannelore Wass, Department of Education, 

Foundations of Education, U of Florida

In the same day I learned of Kellner's death, I found quite belatedly, that Hannelore Wass had died in 2013, though no one had told me.  Hannelore was on my doctoral committee: I chose her because she taught my first college course in Thanatology, or Death and Dying.  She was warm and friendly, and though even then nearing retirement,  engendered many students into the field or related fields.  Hannelore was a founding member of what is now ADEC, but then National Forum for Death Education and Counseling, and the editor and founder of Death Education and Dying: Facing the Facts: an annual publication of research and theory in Death and Dying.

Because of Hannelore, I was greatly inspired to go into the study of Grief and Mourning:  before, I studied Depersonalization, a component of Grief and other experiences, and her early influence and help got me started publishing.  She was always animated and cheerful, though at the same time dignified.  She told the story in her class, which met one summer in her home, about growing up in Nazi Germany,  and at 9 experiencing a bomb blast which hit their apartment home.   Later in life, Hannelore would go on to study the fascination of youth with Nazi culture in the post-Columbine climate in an effort to understand and circumvent future occurrences.

One of my favorite stories though about Hannelore, was one that occurred after I left Psychology for ministry-related efforts.   Shortly after I made the difficult decision to leave, around 1987,  me and my children travelled down to Orlando to visit family, but we stopped on the way to 'checkin' and say hello to some folks from UF.  I had become a Christian, and the interchange was a bit stressed because not all of my former faculty members understood.  By coincidence, that evening, Hannelore was sponsoring the Peterson lecture, and annual endowed lecture on topics in Thanatology, and she invited me to stay for the talk.  The talk was by the professor from Rutgers, Myra Bluebond-Langner, who wrote: The Private Worlds of Dying Children.  As she spoke, she made a statement, off the cuff, about how, at least in her research, they never spoke of heaven or an afterlife!   As I sat there that night,  I thought to myself "Well of course they don't, no one ever tells them about heaven!"  The more I thought about it, the more it became clear that this was a serious untapped need for both dying and bereaved children, that they might know they are loved and to have hope.  When I returned home, I started the ministry which would become Judah's Glory,  though the first name of it, in 1987, was 'Hope to Heaven', which provided coloring and workbooks for Christian children.

I have learned in my life so much from Hannelore (I'm not being 'cheeky': everyone by her permission called her that).  Here was a woman who early in life knew Nazi Germany and bomb blasts, but instead of developing bitterness, taught people indeed, to 'face death' with hope and strength.  Later, she would work to fight the roots taking hold again in the young:  this is among the greatest achievements I see in her, a victorious life.  She, like Kellner, and like many, also have plenty of awards, honors, degrees, etc, but it was in the semantics of her life that she gave the rest of us meaning.  She taught me about death:  but by doing that she taught me about life,  and I did not become a 'death-denier'.  When I came into faith,  it helped me to understand faith better. Faith and Hope.

She was one of the people who gave me many opportunities, always without fanfare: she had a knack for seeing who was good at what: she was one of the most welcome additions to my doctoral committee.   I have left researching most thanatological issues,  over the years in an effort instead to learn to love people better, to be more sincere in my faith, more authentic in belief.  That crossroads, that night that I 'randomly' stopped into see some old friends and mentors, led me teach more eternal lessons.  I will greatly miss Dr. Wass: she may be one of the last of a kind. 

OCTOBER 15th WALK TO REMEMBER

While there are 'Walks to Remember' all over the country between now and October 15th (a few after),  the National S.H.A.R.E. and a related walk will occur in Naperville Illinoise,  and St. Charles, Missouri (closer to National SHARE).  Visit their websites for times, locations and details, and plan to attend.  

I began my work in this area in 1978,  which is now 38 years ago.  At that time, SHARE was just beginning to take off under Jane Marie Lamb,  and the most popular books were Peppers and Knapp Motherhood and Mourning,  Kotzwinkle's Swimmer in a Secret Sea, and Glen Davidson's Death of the Wished for Child.

Thirty eight years later, it is astounding how far everyone has come and what has been accomplished:  many dissertations and significant research projects, the Missing Angels Bills in a number of legislatures, support now available in almost every hospital worldwide, and SHARE even fared just fine after the very sad death of Sr. Jane.  IF there were one irreplaceable person in the field it would have been her,  and I know she would be so pleased to see what became of the Walk to Remember, Memorial Services, and in-hospital care.   

I counted her as a friend though we did not know each other well,  we have some long conversations about grief and mourning, God, and the world back then:  she was always a welcoming and edifying person.   Blessings to all of you who followed in her footsteps, and continued the great work once started:  So many parents with a listening ear now, so many lives saved and healed.  Be blessed on October 15th.

She was Born,But She Died 2nd edition coming soon

Upgrading the artwork: look for 2nd edition soon of "She Was Born, But She Died".

The Forgotten Grief: New Feature

Until the main site is on again,  I am going to feature pages from the old site here, as well as page posting of some former articles.  Many of my former articles may be accessed via google Scholar at scholar.google.com,  but I will try to post full versions of the more significant articles online.  Starting today I have posted the first:

On Stillbirth: An Open Letter to the Clergy

from a number of years ago.  Hope all find these useful.   

Many blessings, 

Dr. Elizabeth K. Best

note

there is currently appearing online a wattpad blog calling itself forgotten grief.

I am NOT associated with them and know nothing of their work.  THE FORGOTTEN GRIEF has been around since 1980 when i first published the title and has always been associated with my 32 years of research writing and conferences.  

Please note the difference.   Elizabeth Kirkley Best Ph.D

Not an Endorsement

http://www.citymomnow.com/wp-content/uploads/2013/03/Little-Spirits-Garden-Brochure-24SEP2012-web.pdf


A short time ago,  I found that a quote of mine from The Forgotten Grief regarding the grieving of parents was being used on the front page of amemorial garden called "Little Spirits Garden".    The quote was correct,  and was not used in any wrong way,  but its prominent feature on the site of the page made it look like an endorsement of the Vancouver "Little Spirits Garden" a place where stillborn babies are laid to rest.
While it may seem insensitive to write this I feel that I must, since the quote, which while legally used in some respects (any one can quote anything up to 400 words),  in other ways appears far too much like an endorsement.

I know very little about Little Spirits Garden except that the premise of the place is based upon a philosophy and semi-religious, 'new age' base, which I do not share, and cannot endorse.  I have asked them three times to consider the use of other material rather than mine which has a Christian worldview,  though many people from many walks of life use the material.   They have agreed but never take it down,  so I feel that I have no choice but to express my non-endorsement of the project:   my work in the Christian community and my faith in God necessitate integrity and a knowledge of where I stand on certain issues.

Whether the very little babies should be buried in separate sections or in family sections is of course a matter of private choosing:  there are positive and negative points to both:  this is not really the issue.   My particular feeling is that a family is a family and should be buried together, and the identity and integrity of the child's life should be preserved in death.   Not all people though have family plots, and there are many other reasons for making another decision which are perfectly legitimate:  it has to do with parental choice,  of which I have always been an advocate.

However,  the occultic nature of the approach to this particular memorial garden,  would cause me never to offer an endorsement based upon my own work, and knowledge of the Word of God.  While they may keep the quote against my will on the front page of their site,  I likewise feel free to write this post acknowledging my displeasure at it.   In this way no one's choices are hampered.

In professional work with perinatal bereavement we seldom admit or acknowledge our faith or beliefs, but that is in some ways a form of hypocrisy and not objectivity because dealing with parents and the death of infants inherently involves beliefs and doctrine.   This was one of the reasons I left psychology for more ministerial concerns,  to better aid parents since most of their most troubling questions were about their infants well-being in eternal life.    It is for this reason,  that this post is written,  and not to dissuade any one from making other choices, but to make clear, that the position of the above memorial garden, is not mine.

Elizabeth (Libbie) Kirkley Best, PhD
Director, THE FORGOTTEN GRIEF

My new book is out on Kindle.   She was Born, but she Died is a child's story of speaking with her grandmother about the death of her stillborn sister Emily.   Written from a Christian point of view, the Grandmother reassures the child that death is not the end, and that there will one day be a joyful reunion, although their grief is great.  Written and Illustrated/graphics by Elizabeth Kirkley Best.

Note: From Elizabeth Kirkley Best PhD

Still around, folks, and The Forgotten Grief has not changed hands nor added any other authors. Until forgottengrief.com is back online, I will on occasion feature pages from the main site. The work on The Forgotten Grief is still soley mine unless noted otherwise, and no one else may edit or write on the site. This is to assure the quality of the site. Over the years several people have tried to waylay this and other sites for their personal views, or to sell what has been offered for free all these years. My aim is to make materials from my early career and a few other new offerings available to aid and comfort, not to merchandise. Please help keep this site free. Many blessings, Dr. Elizabeth Kirkley Best , Director.

The Forgotten Grief: Questions Mothers and Fathers Frequently Ask: Frequently Asked Questions: I was just wondering if a baby stays a baby when God takes it to Heaven? Or does it automatically become of a certain age? Or does it grow up in Heaven to a certain age. I miscarried about 22 years ago at about 12 weeks. My niece just miscarriage at 7 months. When we get to Heaven will our babies be babies or adults? The Bible does not give complete details of how we will look or be in heaven, but it does give a few ideas. Age will not matter: there is not the same sense of time we have here as in eternity. The saved of God are given a new body fit for life in eternity (I Cor 15), and there we are "known as we are known". 1Cr 13:12 For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known. When a Christian 'walks' in the Holy Spirit, we are given understanding and can 'see' what we cannot 'see' at other times-- clarity in an idea, the needs of another etc, and although it is not a literal seeing , more often than not, it is with understanding and assurity. We will know each other in Heaven. A well known radio pastor, Chuck Smith, in response to a similar question once noted that we will 'not be more stupid in Heaven than we are here". ---we will know one another but not bare the same relationship to one another: one may discern this by the answers Jesus gave regarding marriage and re-marriage in which he noted that in heaven none are given in 'marriage': it is a real place, Heaven, but it is not of the same nature as earth, nor will our bodies be. You will have full joy in reunion with the children you have lost: you will rejoice when you see them, and will live with them in the presence of a Loving Lord and Savior if you are dwelling in Him, and He in you. Heaven is for the saved of God, those who come His Way, through the atoning work of the Lord and Savior, Jesus Christ, the Way, the Truth and the LIfe. When we have received Him and walk in Him, Heaven is assured for us, and we will have that joy of reunion with those who have gone on before. We often draw pictures of Jesus holding a baby to give an idea of the Love of the Savior for the little ones, and the site explains on the page God and Your Baby , that they go fully to Heaven with the greatest assurance we can have from Scriptures. God is more merciful than we are: our journeys can be from a a few minutes or less to up to 100 or more years, but each life counts and is precious to God, and each is used in the plan of His reign and Kingdom. Your baby is held in His love and care. You will see them again. Cordially,Elizabeth Kirkley Best PhD forgottengrief@gmail.com Back to HomeContact Us &copy 1981, 2004 Elizabeth Kirkley Best PhDTitle taken from "The Forgotten Grief" published in American Journal of Orthopsychiatry, 1982.

On Santorum and Mourning a Stillbirth

A response to the 'weird' criticism of Santorum

http://www.commentarymagazine.com/2012/01/05/partisan-politics-santorum-stillborn-baby/

I worked with families grieving stillborns for many years in regional care facilities and in the community. Each parent and family grieve very differently and in a society bereft of understanding regarding death and mourning, it is little surprise to find no understanding regarding the mourning of a stillborn son or daughter. Parents need closure and time to say good bye, a feat usually briefly accomplished in a hospital's cold and clinical setting: if the Santorums had the great grace of quietly saying good bye in their home, then they are the blessed ones: our society cannot possibly address in its hardheartedness the enormous strength of character it takes to live through the death of a stillborn, and to go on to maintain a healthy and strong marriage and family, and then even contend for the highest office of the land: it is a sign of character and fortitude. The decision to see and hold and say quiet good byes to the smallest member of the family is healthy, expected, and waylays later possible emotional problems: it is called 'closure' and is not weird nor odd, but an expression of love with tears and in my estimation a clear sign of a strong candidate who values life at all ages. Many blessings to a fine candidate.

September 6th : Stillbirth Remembrance Day

Over the years, so much has been accomplished in the remembrance of the little ones who died at birth, and to comfort their parents and families.  "The Forgotten Grief" joins in the official day of remembrance,  in honoring the tiny lives and the impact they have made in their deaths, on the nation, the heart and their families. As we enter in to the new school year, the High Holy Days for the Jewish community, the Commemoration of the 911 tragedy,  and the fall season,  let us always keep in our hearts, that in God's sovereignty even the lives cut short,  or as scripture denotes them "the infants of days"  had purpose and meaning.  Many blessings to all those who have loved and lost their stillborn sons and daughters, and many congratulations to those who have tirelessly worked over the past 30 years, that they not be forgotten.

Elizabeth Kirkley Best PhD

The Forgotten Grief
www.forgottengrief.com

Grief at Prenatal Loss: An Argument for the Earliest Maternal Attachment: Online version

Dr. Kirkley-Best's 1981 Dissertation on the Psychology of Grief at Stillbirth and Prenatal Maternal Attachment

Notice: Terra Coggin's Group Announces Infant loss Awareness day

I am passing along the following information from the facebook page of Terra-Lynn Coggins regarding Pregnancy and Infant loss Awareness Day on Oct. 15,2010:

Terra-Lynn invited you to "Lights of Love International Wave of Light 2010" on Friday, October 15, 2010 at 7:00pm.

Event: Lights of Love International Wave of Light 2010
What: Ceremony
Start Time: Friday, October 15, 2010 at 7:00pm
End Time: Friday, October 15, 2010 at 8:00pm
Where: everywhere (Worldwide)

To see more details and RSVP, follow the link below:
http://www.facebook.com/n/?event.php&eid=171146237060&mid=21c504cG251bdeeaG4420e24G7&n

New Studies on Subsequent Children: Revisiting the 'Replacement Child Syndrome': The Studies did not find 'no effect'.

Recently in the news, there was widespread coverage of a research study by Dr. Penelope Turton in the Journal of Child Psychology and Psychiatry regarding the effects on the next child following a stillbirth.

A summary article appears at Stillbirth Not an Issue for Next Born in Forbes.com

Some are misreading both the study and misapplying the findings to suggest that there is no risk in the pregnancy subsequent to a stillbirth for the child born later. This seemed to negate the observation of hundreds of researchers and counselors who have noted for 50 years the existence of what has been termed the 'replacement child syndrome', a phenomenon in which many feelings about the 'ideal' child that died are overlaid on the feelings regarding the next child who survives. Many historical examples have been noted of pathological examples in which the 'new' child cannot live up to the expectations of what the previous child would have been like.

The actual findings in the new 2009 study in Journal of Child Psychology and Psychiatry, and a previous article in Attachment and Human Behavior, included the following statements in the two abstract:

We report that in this population there was no significant correspondence between U and PTSD scores or caseness and no association between maternal PTSD and infant D. We discuss possible interpretations of these findings.

Recent Study: Results: There were no significant between-group differences in child cognitive or health assessments, or in teacher-rated child difficulties. However, mothers with history of stillbirth (the index group) reported increased child difficulties, in particular peer problems, and more adverse interaction was observed in respect of higher levels of maternal criticism of the child's actions, more overall controlling behaviour by the mother, a less harmonious emotional atmosphere and a lower level of maternal engagement with the child. Some of these effects appeared to be mediated by maternal perinatal psychological symptoms and family breakdown.

Two major issues of are deep concern to the research and comfort community in Perinatal bereavement:

1. The study in no way says there are no differences at all: the study says there are no differences in teacher rated child difficulties, but that there are a number of differences in maternal reports! Serious differences contrary to the way the study was reported.

2. A fundamental error that is made in the social sciences among those who are doing field research is that when we find no significant difference between groups or measures, in this case, no difference between subsequent children following stillbirth vs regular children in teacher-ratings, we cannot say at all that there are no differences, only that we cannot support the 'Null' hypothesis.

In research especially field research (research that takes place in a natural setting, and not in a lab), countless variables and possible errors may confound our results. These natural 'errors' may exaggerate our data, or cause it to look like there are no differences when there really are. It is a common and deadly error over the years in Perinatal Bereavement research and must be heeded. Even those in their first quarter of college statistics learn that when we do not see a statistically significant difference, it does not mean that there was not one, only that it did not appear given our methodology and choice of statistical test. There can be many reasons that there appears to be no difference:

1. Raw Error
2. Unknown factors
3. Faulty methods such as poorly designed rating scales or assessments
4. The wrong statistical test, or the right one, lacking power or enough data
5. Confounding factors such as nonrandom selection, a common problem in field research, historical factors, meaning that either during the study an event happens which changes the data, or for example a difference in parity, maternal age, or time since loss which might not have randomized out.
6. Design facts

and others.

For this reason, virtually all Statisticians and trained researchers know that they cannot draw conclusions and say there are 'no differences' just because a statistically significant difference was not found. Two studies which did the same thing, concluded 'no differences' when they should not have, were that of Peppers and Knapp in the early 1980s who claimed to have found no difference in grief between women who lost babies in the first, second or third trimester, (which is not logical to those who have worked with many mothers) or a study by Kellner et. al[: Links
Kellner KR, Donnelly WH, Gould SD. Parental behavior after perinatal death: lack of predictive demographic and obstetric variables.Obstet Gynecol. 1984 Jun;63(6):809-14. ]

in which a less powerful statistic found 'no differences' when all they should have said was that they were unable to detect one. They used a chi square instead of a multivariate design, and seemed to contradict the earlier study of Kirkley-Best (1981), the first prospective and controlled study, which yield a significant difference with the highest predictive variable being length of gestation, followed by maternal parity. The Kirkley Best study has been replicated twice, by an extensive Swedish study [5], and another stateside.

The reason for this caution is that

1. The study actually did find a difference in maternal report, supporting all earlier observations (See The Forgotten Grief: A Review of the Psychology of Stillbirth-section on 'Replacement Child Syndrome' and
2. Designs out in the field can almost never conclude 'no difference'.

The reason this is so significant is because the study rapidly hit the news services and appeared to negate the warning of so many researchers and counselors, including myself of the insidious effects of perinatal mourning on subsequent children and family relations. It is not that healthy families cannot compensate for their feelings in later births, nor does it indicate that the effects are always severe, but even 'face validity' tells that the feelings about a child that died will affect feelings about the child who comes next! The example is often given of Vincent Van Gogh, whose mother even named him after the deceased sibling and had him visit the grave on a regular basis. While that is an extreme and pathological example, it indicates that the process does attend future children, and needs to be addressed.

This is not to say it is a poor or unimportant study, but the more appropriate question to be asked, how to get at the variables affecting the severity of the 'carry over' feelings, so as not to hamper the child's development later, and to avoid such traumatizing issues as using the same name or 'suspending' a name for a later child, or any thing which causes each child, living or dead not to retain a God given identity.

A last note quickly so that I do not slip into my old moronic psychology professor self: I have no vested interest any longer in research issues or diagnostic issues,as I left the research a few years back since in this particular field, research yield almost nothing that careful observation could not, with out reducing grief and sorrow over the loss of an infant to yet one more problem of clinical pathology. My greater concern is that healthy happy wholesome children and families find their way through despair and mourning, while retaining the dignity and unique 'glory' of each child, including the one who died. Just a passing note:

1Cr 15:41 [There is] one glory of the sun, and another glory of the moon, and another glory of the stars: for [one] star differeth from [another] star in glory.

________________________________
1. Forbes.com
2. Penelope Turton 1 , William Badenhorst 1 , Susan Pawlby 2 , Sarah White 1 , and Patricia Hughes "Psychological vulnerability in children next-born after stillbirth: a case–control follow-up study" Division of Mental Health, St George's University of London, UK ; Institute of Psychiatry, King's College London, UK
Correspondence to Penelope Turton, Division of Mental Health, St George's University of London
3.Penelope Turton; Patricia Hughes; Peter Fonagy; David Fainman
journal Attachment & Human Development, Volume 6, Issue 3 September 2004 , 241 - 253
4. Kellner KR, Donnelly WH, Gould SD. Parental behavior after perinatal death: lack of predictive demographic and obstetric variables.Obstet Gynecol. 1984 Jun;63(6):809-14.
5.Ingela Radestad, Gunnar Steineck, Conny Nordin, Berit Sjogren, associate BMJ 1996;312:1505-1508 (15 June)Papers Psychological complications after stillbirth--influence of memories and immediate management: population based study
6 Peppers LG, Knapp RJ. Psychiatry. 1980 May;43(2):155-9.
Maternal reactions to involuntary fetal/infant death.
7. Kirkley Best E. Grief in response to prenatal loss: An argument for the earliest maternal attachment EK Best - 1981 -Doctoral Dissertation, Department of Psychology, University of Florida

Forgotten Grief: Update

Due to a great deal of computer difficulties, not many updates have been added lately to forgottengrief.com. I will begin to add weekly or biweekly blurbs to this blog on suggestions, ideas, and informal discussions of aspects of grief and mourning at stillbirth and the perinatal period. Two new poems soon to be posted, entitled, "The Petite Dress", and "








The Petite Dress

I would have clothed you
I want you to know
In this hour of despair
In my weeping
With the Satins and Silks
And Luminous Linens
Of Fairy Tales

I would have held you
Cradled in attendant arms
In Holy Dedication
Promising Our God
A Life for Him

I would have sung you
Tales of paradise
Of the Heaven where none die
And there are no more infants of Days
As He promised

My lullabies would have been hymns
Or treasonous little limericks
To force an infant smile
The soft whispers
That define Mornings
And give us back our names.














Instead I stand in
this shuddering moment
Purchasing an eternal garment
This Petite Dress.

I have chosen the white cotton
With the demure satin roses
White as fuller’s white
To dress you for your King
Surrendering what was not ours
To love but for moments
Choosing not to rage
At least for moments
At the small Garden
At the heart
We were not allowed to tend

At the heart, loved in distances
Yet ever near
Sung to in dreams and visions
Do you hear? As we hear?
Those hymns as tiny dresses
Thundering in our souls
When weeping pauses
And we hold you in a vision
The prisons of mourning
The dungeons
Where mourning mothers
Choose fierce Manacles
To remain at love’s door
A moment more?













And though my fingers grasp and ache
The baby garment strewn with
The fine embroidered smocking
Before it becomes
A bridal veil,
And the end of my heart
Before I must relinquish
Even my own garment
The tormented iron shackles of mourning
Before I let go

Here is my hymn,

I have already loved you
And will never cease
The breaking crescent of a thousand waves
Will be the counterpoint
Rushing into heaven
Where you have gone before
Dressed in His Glory
In Edenic Mercy
He already encompasses you
In Love greater than mine
(Though for the moment
I cannot embrace that wisdom)

My heart cry
Is Little One in the Petite Dress
Shining in the Holy Presence
Where small souls cry Abba, Father













I sing of your beauteous gown
And the one I shall wear
In Reunion soon,
When mourning flees
And we will recount in Joy
The wisdom of Eternity
Which escapes me
In this hour
Of the Petite Dress.


©2009 Elizabeth K. Best

-----------------------------



Mourning has a finer Thread




Mourning has a finer thread
Than mourners ever see
Runs contrary to the suffering Soul
And hides beneath the weave
Receiving blankets bathed in pale
Golden, pink and blue
Conceal the thread that none can bind
Yet pierce the heart straight through

That threaded shroud
That mocked the heart
A briared bassinet
It should have called to comfort rock
It called with Sorrow’s net
To fasten unsuspected there
The thorn which pierced His brow
The Crown that mocked
All Heaven’s King
Sits aching on mine now



Elizabeth k. best ©2009


Hope you like these. For general info, you can follow this blog, with an RSS feed.
Blessings this Spring day, although yesterday we still had snow in Wisconsin!.

Libbie Best

Welcome to Forgotten Grief

Notes of interest coming soon. Sorry the news update is so
delayed: will catch up shortly after the holidays.