Counselor Education for Serving Individuals Seeking Mental Health Care after Perinatal Loss in the United States
College
College of Education & Professional Studies (Darden)
Department
Counseling & Human Services
Graduate Level
Doctoral
Graduate Program/Concentration
Counseling
Presentation Type
Poster Presentation
Abstract
There are approximately 3.6 million births yearly in the U.S., but the general fertility rate is declining (Hamilton et al., 2024). Miscarriage risk, pregnancy loss prior to 20-weeks gestation, is about 15% in known pregnancies, suggesting this number could be significantly higher given losses occur prior to confirmation testing (Quenby et al., 2021). Additionally, about 5.7 stillbirths occur per 1,000 births annually in the U.S. (Gandhi & Page, 2024), meaning there are about 20.5 thousand babies lost after 20-weeks gestation during birth every year. Ely & Driscoll (2023) reported 3.58 per 1,000 deaths occurred in the neonatal period (within 28 days of birth), and 2.02 per 1,000 deaths occurred in the postneonatal period (between 28 and 364 days after birth). These statistics highlight the prevalence of perinatal loss in the U.S. and the heightened likelihood of counselors working with individuals seeking mental health care after such losses.
Counselors have the ethical professional responsibility to practice only within their competence boundaries and must monitor and improve their effectiveness, when necessary (ACA, 2014). Medical research surrounding perinatal loss is abundant, but study is sparse on mental health challenges and counseling competencies for this population. These individuals often experience severe distress, such as anxiety, depression, grief, and post-traumatic stress disorder (Karaahmet & Bilgiç, 2024; Quenby et al., 2021). Therapeutic interventions can aid in grief adaptation and reduce mental health symptoms (Karaahmet & Bilgiç, 2024). Although, there are about 1 million professionals in the U.S. behavioral health workforce, only around 9 thousand are perinatal mental health certified and of these only 2.6 thousand specialize in perinatal loss and/or grief/bereavement (National Center for Health Workforce, 2024; PSI, 2024). The Council for Accreditation of Counseling and Related Educational Programs requires programs to address the “effects of crises, disasters, stress, grief, and trauma across the lifespan,” but this is only briefly mentioned in a subsection of the accreditation standards (CACREP, 2024). Grief education is rarely prioritized in counseling programs. There is a shortage of mental health providers, and there is a need to increase educational opportunities for counseling professionals serving populations who have lost a baby at various stages of gestation and infancy.
Due to cultural norms of silence and societal taboos, there is misinformation and minimization of the impact that results from perinatal loss (Rogers et al., 2019). The purpose of this advocacy project was to increase counselors’ awareness and provide considerations for counseling populations through perinatal loss. Through reviewing literature and conversing with members in the community, recommendations are offered. Counselors should approach clients with empathy, asking specific questions and repairing empathic failures. Counselors can be knowledgeable of support resources in their areas, as well as establish both in-person and telehealth groups that meet at least biweekly to increase access to care. Careful consideration should be given to group admission criteria, as some are restricted to only non-pregnant parental figures. Counselors could also expand accepted payment options, offering sliding-scale and pro bono services for uninsured individuals. Furthermore, counselors should engage in ongoing training and consultation.
Keywords
Bereavement, Counseling, Counselor competencies, Counselor education, Grief and loss, Infant loss, mental health, Miscarriage, Perinatal loss, Stillbirth
Counselor Education for Serving Individuals Seeking Mental Health Care after Perinatal Loss in the United States
There are approximately 3.6 million births yearly in the U.S., but the general fertility rate is declining (Hamilton et al., 2024). Miscarriage risk, pregnancy loss prior to 20-weeks gestation, is about 15% in known pregnancies, suggesting this number could be significantly higher given losses occur prior to confirmation testing (Quenby et al., 2021). Additionally, about 5.7 stillbirths occur per 1,000 births annually in the U.S. (Gandhi & Page, 2024), meaning there are about 20.5 thousand babies lost after 20-weeks gestation during birth every year. Ely & Driscoll (2023) reported 3.58 per 1,000 deaths occurred in the neonatal period (within 28 days of birth), and 2.02 per 1,000 deaths occurred in the postneonatal period (between 28 and 364 days after birth). These statistics highlight the prevalence of perinatal loss in the U.S. and the heightened likelihood of counselors working with individuals seeking mental health care after such losses.
Counselors have the ethical professional responsibility to practice only within their competence boundaries and must monitor and improve their effectiveness, when necessary (ACA, 2014). Medical research surrounding perinatal loss is abundant, but study is sparse on mental health challenges and counseling competencies for this population. These individuals often experience severe distress, such as anxiety, depression, grief, and post-traumatic stress disorder (Karaahmet & Bilgiç, 2024; Quenby et al., 2021). Therapeutic interventions can aid in grief adaptation and reduce mental health symptoms (Karaahmet & Bilgiç, 2024). Although, there are about 1 million professionals in the U.S. behavioral health workforce, only around 9 thousand are perinatal mental health certified and of these only 2.6 thousand specialize in perinatal loss and/or grief/bereavement (National Center for Health Workforce, 2024; PSI, 2024). The Council for Accreditation of Counseling and Related Educational Programs requires programs to address the “effects of crises, disasters, stress, grief, and trauma across the lifespan,” but this is only briefly mentioned in a subsection of the accreditation standards (CACREP, 2024). Grief education is rarely prioritized in counseling programs. There is a shortage of mental health providers, and there is a need to increase educational opportunities for counseling professionals serving populations who have lost a baby at various stages of gestation and infancy.
Due to cultural norms of silence and societal taboos, there is misinformation and minimization of the impact that results from perinatal loss (Rogers et al., 2019). The purpose of this advocacy project was to increase counselors’ awareness and provide considerations for counseling populations through perinatal loss. Through reviewing literature and conversing with members in the community, recommendations are offered. Counselors should approach clients with empathy, asking specific questions and repairing empathic failures. Counselors can be knowledgeable of support resources in their areas, as well as establish both in-person and telehealth groups that meet at least biweekly to increase access to care. Careful consideration should be given to group admission criteria, as some are restricted to only non-pregnant parental figures. Counselors could also expand accepted payment options, offering sliding-scale and pro bono services for uninsured individuals. Furthermore, counselors should engage in ongoing training and consultation.
Comments
References
American Counseling Association (ACA). (2014). ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Council for Accreditation of Counseling and Related Educational Programs (CACREP). (2024). Section 3: Foundational counseling curriculum. 2024 Standards. https://www.cacrep.org/section-3-foundational-counseling-curriculum/
Ely, D. M., & Driscoll, A. K. (2023). Infant mortality in the United States: Provisional data from the 2022 period linked birth/infant death file. National Center for Health Statistics: Vital Statistics Rapid Release Reports, 33.
https://doi.org/10.15620/cdc:133699
Gandhi, C., & Page, J. (2024). Stillbirth risk factors, causes and evaluation. Seminars in Perinatology, 48(1). https://doi.org/10.1016/j.semperi.2023.151867
Hamilton, B. E., Martin, J. A., & Osterman, M. J. K. (2024). Births: Provisional data for 2023. National Center for Health Statistics: Vital Statistics Rapid Release reports, 35. https://dx.doi.org/10.15620/cdc/151797
Karaahmet, A. Y., & Bilgiç, F. S. (2024). The effect of psychotherapy interventions after stillbirth on the grief process and depression: Systematic review and meta-analysis. Journal of Death and Dying. https://doi.org/10.1177/00302228241272686
National Center for Health Workforce. (2024). State of the behavioral health workforce, 2024. National Center for Health Workforce Analysis. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/state-of-the-behavioral-health-workforce-report-2024.pdf
Postpartum Support International (PSI). (2024). Perinatal Mental Health Provider Directory. https://psidirectory.com/listing/perinatal-loss,griefbereavement/w:united states
Quenby, S., Gallos, I. D., Dhillon-Smith, R. K., Podesek, M., Stephenson, M. D., Fisher, J., Brosens, J. J., Brewin, J., Ramhorst, R., Lucas, E. S., McCoy, R. C., Anderson, R., Daher, S., Regan, L., Al-Memar, M., Bourne, T., MacIntyre, D. A., Rai, R., Christiansen, O. B., Sugiura-Ogasawara, M., … Coomarasamy, A. (2021). Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet (London, England), 397(10285), 1658–1667. https://doi.org/10.1016/S0140-6736(21)00682-6
Rogers, J. L., Crockett, J. E., & Suess, E. (2019). Miscarriage: An Ecological Examination. Professional Counselor, 9(1), 51–66. https://doi-org.proxy.lib.odu.edu/10.15241/jlr.9.1.51