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December 19, 1990

When a Baby Dies: Psychotherapy for Pregnancy and Newborn Loss

JAMA. 1990;264(23):3074. doi:10.1001/jama.1990.03450230110042

As a basis for his suggestions for psychotherapy for women who have suffered perinatal loss, Dr Leon begins with a discussion of the psychology of pregnancy. The approach is primarily a psychoanalytic one with emphasis on Freudian concepts including oral incorporation, penis envy, and oedipal conflicts. These basic concepts are said to play a large role in the pregnant woman's identification with her own mother.

Dr Leon does not neglect the tenets of self psychology such as object seeking, the idea of the conceptus as an intimate part of the mother's own body and that of her husband, and the sense of narcissistic damage that occurs with the death or malformation of the fetus. The narcissistic injury impacts on the mother's body image, sexuality, and feeling of competence as a mother.

The remaining 110 pages of the book deal with individual cases, suggested interpretations, and therapeutic emphases. These 20 persons