Cet article propose une conceptualisation du deuil périnatal chez l’homme, sujet peu étudié jusqu’ici. Le deuil périnatal est particulier, du fait à la fois du manque de différenciation de l’objet perdu, de la force avec laquelle il était investi et d’une hémorragie narcissique renforcée. Dans la famille bouleversée, le deuil du « devenant père » présente certaines spécificités. L’article s’attache à développer la question de la symbolisation de la perte chez le père. Une réflexion sur (...) le continuum narcissico-objectal de l’investissement du bébé in utero est engagée, qui mènera à une proposition de conceptualisation du deuil périnatal centrée sur la notion de relation d’objet virtuelle – l’« enfant virtuel » n’étant pas à opposer à l’enfant réel, mais à l’enfant actuel. Ces considérations théoriques seront étayées et illustrées par les témoignages de deux hommes. (shrink)

Tout travail, y compris le travail psychique, demande de l’énergie. Pour Freud, cette énergie est fournie par la libido, l’énergie sexuelle. Mais celle-ci s’exerce bien sûr de façon différente selon la forme de sexualité qu’elle anime. L’auteur envisage ces formes une à une pour montrer comment elles interviennent, leur rôle exact et surtout les problèmes qui surviennent à la suite de blocages, de surinvestissements ou de conflits internes. La sexualité génitale joue un rôle déterminant dans les deuils de personnes proches. (...) La sexualité pulsionnelle s’en prend aux objets mis en place dans la relation. L’amour idéal est également déterminant, dans la mesure où certains des objets intériorisés dans le contact avec les proches ont acquis un poids psychique particulier : ils sont indestructibles, et c’est finalement en trouvant à les remettre en place dans d’autres circuits relationnels qu’on parvient à retrouver un équivalent adéquat à la relation disparue. Il faut toutefois veiller à ce que les tendances pulsionnelles primaires issues du ça ne viennent pas tirer le mouvement du côté de la mort. (shrink)

Cet article aborde la question du deuil et plus particulièrement du deuil d’un enfant dans une famille. Ce deuil traumatique vient bouleverser l’ordre générationnel. Il confronte l’ensemble du groupe familial à un impensable. Comment peut-on accompagner au mieux une famille frappée par un tel drame? Est-il pertinent de prendre en charge l’ensemble de la famille? La plupart des auteurs qui ont travaillé ces questions sont d’orientation systémique. Les auteures, psychologues et thérapeutes familiales psychanalytiques, se proposent ici d’aborder (...) cette thématique sous l’angle de la théorie psychanalytique individuelle et groupale. Elles illustrent leurs propos au travers d’une situation clinique afin de montrer l’évolution du travail de deuil au sein d’une famille confrontée à la perte d’un enfant. (shrink)

Les auteurs posent la question des retentissements du deuil d’une figure parentale dans l’enfance sur les remaniements liés à la construction psychique de la paternité. Elles formulent cette problématique théorique en s’étayant sur l’analyse du cas de Marc, futur primipère ayant vécu le deuil de son propre père dans son enfance. Les auteurs soulignent que devenir père nécessite, pour le sujet, de parvenir à s’identifier à ses imagos parentales et de s’étayer sur ses représentations de la fonction parentale, (...) et discutent du destin de l’objet interne lorsque le parent réel est décédé. En particulier, la nouvelle paternité implique le renoncement aux objets parentaux idéalisés, question à mettre en lien avec l’idéalisation du défunt qui intervient toujours dans le deuil, au moins dans les premiers temps. En outre, l’accession à la paternité réactive des angoisses de mort et de castration, processus entrant en synergie avec le réveil de ces mêmes angoisses dans le deuil. Cette étude clinique ouvre aux questions de la parentification du garçon orphelin et de l’impact de cette dernière sur la construction ultérieure de la paternité. (shrink)

La nostalgie, contrairement au deuil, ne s’adresse pas à un Objet à jamais disparu, mais à un Objet partiel, idéalisé, inatteignable dans l’immédiat, souvent exprimé comme une atmosphère rappelant des expériences anciennes. Elle se vit dans une relation imaginaire qui renvoie à des satisfactions beaucoup plus archaïques de l’ordre de la toute-puissance infantile. Un travail psychique de nostalgie ne conduit pas à la disparition de cet Objet idéalisé, pérenne, mais plutôt à sa transformation.

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in populations, (...) (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage. (shrink)

In this article, the theme of introductory engagement is developed through the conversational interviews and participatory observations I carried out with perinatal nurses and birthing women in the context of a feminist phenomenological methodology. Positioned against the landscape of hierarchical health care practices embedded with power dynamics and disembodied practices, this research explored the ways in which perinatal nurses related to birthing women in the context of relational care. The focus of attention in this article is to describe the theme (...) of introductory engagement by way of a storied phenomenological text. (shrink)

Le deuil a été largement étudié par la psychanalyse. L’aptitude à la séparation mère-bébé l’est également par les spécialistes du développement infantile. Nous souhaitons former des ponts entre ces deux épistémologies pour démontrer que l’aptitude à la séparation permet la prédisposition au deuil. L’aptitude à la séparation résulte de la cessation de l’état fusionnel mère-bébé qui permet l’établissement de l’intersubjectivité puis de la subjectivité. Le rythme des interactions mère-bébé donne accès à la temporalité. Ces étapes sont essentielles pour (...) le travail de la pensée nécessaire au deuil. Le bébé dont la mère est déprimée dès la naissance ne pourra pas développer son aptitude à la séparation dans une perpétuelle attitude de stimulation. L’enfant qui connaît la dépression maternelle aura les plus grandes difficultés à accepter son ambivalence. Nos illustrations thérapeutiques témoignent qu’il est possible maintenant de proposer une prévention de la dépression maternelle en maternité ou en pédiatrie. (shrink)

In this paper it is argued that questions in perinatal medicine concerning treatment or non-treatment of severely handicapped children, after or before birth, cannot be answered solely by referring to the general aims and objectives of medical treatment and its specific deontology. Justifications of decisions about treatment and non-treatment need to be placed in a broader context of discussions about social justice and the social significance of medical practice as a whole.

Perinatal experience is posited as generative of psychogenesis: the psychological birth of the infant. The process involves a sentient human being rather than a nonconscious tabula rasa fetus. That birth experience is only traumatic is reductionist. The origins of positively colored affects as well as sexual feelings and even ecstasy may be intrauterine. The importance and complexity of the birth experience can better be described in terms of phases of being that parallel the physical stages of labor. These phases are (...) immanence, obstruence, descendence, experience, ascendence, emergence, and transcendence. Each of these phases encompasses a unique state and dynamic process. Birth as such is shown to be a rich multidimensional experience that is also transformative. (shrink)

Childbearing trans and nonbinary people are confronted with the heteronormative and cisgender frameworks that underpin “maternity” services. We explored the educational needs of 108 perinatal staff in the United Kingdom as related to the needs of trans and nonbinary service users. Participants were most confident in formulating care plans and least confident about the provision of colleagues’ perinatal care in this context. While the majority of participants were positive toward the trans and nonbinary communities, they considered that those communities remain (...) marginalized in perinatal services. Transphobic, anti-trans, and nonbinary attitudes were highlighted by our respondents. Our findings suggest that caregivers witnessed transphobia among colleagues and were apprehensive themselves about providing care to childbearing trans and nonbinary people. They reported a cisheteronormative model of care that lacked awareness of trans and nonbinary issues. The educational needs identified included information about the practicalities of childbearing as a trans or nonbinary person, how to use inclusive language effectively, and creating policies and processes for supporting childbearing trans and nonbinary people. These caregivers’ preferences included hearing from trans and nonbinary people and sharing best practices among themselves, with open discussions about how to be inclusive. (shrink)

Habituellement le processus de deuil suite à la mort d’une personne significative évolue favorablement vers une fin, marquée par la réorganisation de la vie et la capacité de réinvestissement chez l’endeuillé. Mais le deuil peut se compliquer. L’absence de deuil ou le deuil-non-fait en est une complication grave à l’origine de désordres somatiques et psychologiques et d’une entrave au bon développement psychique chez l’endeuillé et même sa descendance. L’auteur présente deux observations cliniques de deuils-non-faits qui illustrent (...) d’une part, le concept de crypte avec l’identification d’un enfant épileptique à un « double » mort tenu au secret, et d’autre part, celui d’absence symbolique de sépulture où le mort reste « accroché » au vivant. Ces observations montrent aussi qu’un deuil peut n’être pas définitivement gelé et s’enclencher bien des années plus tard, avec même, une surprenante facilité, pourvu que le deuil soit entendu. (shrink)

Ample evidence from various quarters indicates that the perceptual-cognitive competence of the pre- and perinatal human being is significantly greater than was once thought. Some of the evidence of this emerging picture of early competence is reviewed, and its importance both as evidence of the biogenetic structural concept of “neurognosis” and for a theory of enculturation is discussed. The literature of pre- and perinatal psychology, especially that of developmental neuropsychology, psychobiology, and social psychophysiology, is incorporated, and some of the implications (...) of these data for a theory of enculturation are suggested. (shrink)

English summary: Abdication may be the renouncement of power, but it is also an ultimate act of personal power, one that can only be made by an individual imposing his own choice to abandon the body politic. This collection of articles follows up on Jacques Le Bruns 2009 study of abdication, with analyses of abdications by Christine of Sweden, Celestine V, Charles de Gaulle, as well as abdication as treated in the films Habemus Papam and King Lear. French description: Au (...) debut de 2013, deux abdications souveraines se sont produites: celle de Beatrix, reine des Pays-Bas, annoncee le 28 janvier et celle du pape Benoit XVI, proclamee le 11 fevrier. L'actualite prenait en echarpe les huit siecles que nous parcourons ici. L'abdication, ce renoncement au pouvoir, constitue l'etat pur d'un acte de volonte dans la sphere politique ou religieuse. Une instance souveraine, qui ne depend de rien d'autre que de soi-meme, decide de s'abolir. L'abdication apparait alors non comme le simple abandon du pouvoir, mais comme un acte de pouvoir - celui de l'individu imposant son choix, se repliant sur son corps et abandonnant le corps politique - ou, du moins, comme une autre facon de le manipuler et de s'en saisir. Ce livre entend donner un echo et un prolongement au texte fondateur et magistral de Jacques Le Brun, Le Pouvoir d'abdiquer. Essai sur la decheance volontaire, paru en 2009. Notre entreprise a etendu ces variations aux cas mentionnes par Jacques Le Brun sans qu'il en traite, soit dans l'arc temporel premier, pour l'abdication de Christine de Suede, soit dans les temps anterieurs pour la renonciation du pape Celestin V, placee dans la perspective globale du XIIIe siecle, ou posterieurs, quant aux departs de De Gaulle. Pierre-Antoine Fabre, pour sa part, a ajoute au dossier le cas doctrinal de l'abdication du superieur jesuite en faveur de son collateral dans les Constitutions de l'ordre. Et Jacques Le Brun s'est attache a reperer les echos contemporains de l'abdication dans le film Habemus Papam de Nanni Moretti et dans Le Roi Lear. (shrink)

This paper engages in the ongoing dialog on "justice and the health care 'industry"'1 and addresses the question of whether market strategies are consistent with an ethical distribution of resources in health care. As it pertains to the development of perinatal services over the past twenty-five to thirty years in the United States, my short answer to this question is "no." Business organization and market-oriented strategies have contributed to the creation and extensive growth of perinatal intensive care centers located in (...) large medical centers. This growth, which has aggravated the neglect of primary care, has been incongruent with known health needs and represents an ethically questionable distribution of resources. (shrink)

Advocacy has been positioned as an ideal within the practice of nursing, with national guidelines and professional standards obliging nurses to respect patients' autonomous choices and to act as their advocates. However, the meaning of advocacy and autonomy is not well defined or understood, leading to uncertainty regarding what is required, expected and feasible for nurses in clinical practice. In this article, a feminist ethics perspective is used to examine how moral responsibilities are enacted in the perinatal nurse—patient relationship and (...) to explore the interaction between the various threads that influence, and are in turn affected by, this relationship. This perspective allows for consideration of contextual and relational factors that impact on the way perinatal nursing care is given and received, and provides a framework for exploring the ways in which patient autonomy, advocacy and choice are experienced by childbearing women and their nurses during labour and birth. (shrink)

In the past four decades, obstetric and neonatal care practices have changed dramatically throughout the western world. As a result, humans now confront unprecedented situations for which they have no biological preparation or cultural experience. In these special issues, an integrated view of the evolving practices of birthing and infant care are discussed from a variety of perspectives. Contributors attempt to show how understanding of the biomedical and psychosocial issues can be informed by cross-cultural and cross-species evidence concerning birth management, (...) neonatal care, and early development. The individual contributions are summarized in this introductory article. (shrink)

Pope Francis beautifully describes how the perinatal journey starts in mystery. Doctors may forget this. We focus on the science that may partially explain how conception and implantation occur, how the placenta functions, and the gradual development of embryo and fetus. But science cannot address that meta-physical—or spiritual—reality. The question of “why?” is never too far away from the minds of expectant parents. Why now? Why me? Why did my baby develop these terrible problems? Why is my life being challenged (...) in this way? Maternal-fetal “cross-talk” is a reality that cannot be denied. It occurs both when the fetus is quiet and when the fetus is active. It may be facilitated by fetal imaging—an ultrasound of... (shrink)

Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen was used to assess fear and (...) violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 ]. Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not. (shrink)

This paper reports on recent regulations and guidelines in the Federal Republic of Germany bearing on perinatal medical ethics, embryo research and trophoblast biopsy. Some of the regulations are defensive responses to new moral opportunities. In contrast, this paper calls for a more aggressive moral cost-benefit assessment of high technology medicine, which would include large-scale research on embryos prior to the fiftieth day post-menstruation. Keywords: abortion, embryo research, moral triage, prenatal diagnosis, withholding treatment CiteULike Connotea Del.icio.us What's this?

The perinatal necropsy is an important investigation following fetal or neonatal loss. Legal requirements on registration decree that consent is needed before necropsy can proceed in some of these babies. However, there are ill-defined grey areas which are open to legal and ethical difficulties. This paper discusses the problems that can arise with consent for a necropsy in the perinatal period. Some of these problems are clearly legal or ethical but all can cause distress to parents at a time of (...) grief and bereavement. The issues may not be readily resolved but public debate and ad hominem decisions on each perinatal loss may help to alleviate the problems. (shrink)

In May 2019, an international conference on perinatal palliative care entitled “Yes to Life! Taking Care of the Precious Gift of Life in Its Frailty” was held in Rome. It was organized by the Italian nonprofit foundation Il Cuore in Una Goccia and the Vatican’s Dicastery for Laity, Family and Life. Pope Francis greeted the participants personally and delivered an address describing the goals and practices of perinatal palliative care as being in keeping with the teachings of the Roman Catholic (...) Church and the pastoral care of families. His endorsement represents a new pastoral development, a renewed focus on supporting families and infants who are affected by genetic... (shrink)

Dans cet article, l’auteur émet une réflexion sur la question du deuil et la difficulté du travail de séparation-individuation chez les adolescents. Dans cette période de la vie très riche mais aussi douloureuse, l’adolescent règle ses comptes avec son passé, interroge ses propres idéaux, comme disait Piera Aulagnier, et cette position nécessaire est pour les parents difficile à supporter. L’auteur développe ce problème particulièrement vif en Turquie où des exigences paradoxales peuvent se jouer en termes de séparation-individuation.

Il y a plusieurs manières de penser la mort : en«s’exerçant à mourir », c’est-à-dire en acceptant notre finitude, ou bien en promettant d’« en finir avec la mort », en affirmant une vie plus originaire que l’opposition entre vie et mort. Afin de comprendre quelle conception défend Derrida, l’on interroge ses analyses portant sur le deuil et la survivance. L’on montre que, pour échapper à la fois à l’aporie de la relève et à celle de la finitude, il (...) a recours à la littérature ; notamment aux écrits de Blanchot qui esquissent le motif d’une « mort sans mort », de la « demeurance » d’un survivant qui resterait en instance de mourir, dans un interminable deuil de soi. De cette expérience auto-bio-thanatographique, se distingue cependant celle d’autres écrivains comme Artaud qui affirment l’entrelacement de la vie et de la mort sous le primat de la vie. (shrink)

Perinatal palliative and hospice care (hereafter, perinatal hospice) is a novel approach to addressing a family’s varied needs following an adverse in utero diagnosis. Christian defenses of perinatal hospice tend to focus on its role as an ethical alternative to abortion. Although these analyses are important, they do not provide adequate grounds to characterize the wide range of goods realized through this compassionate form of care. This essay draws on an analysis of the Christian virtue of humility to highlight the (...) ways a Christian virtue-based defense of perinatal hospice can account for these goods. I argue that humility can play an important facilitating role in helping Christian physicians to meet the needs of families in profoundly difficult circumstances. (shrink)

Perinatal hospice is a novel form of care for an unborn child who has been diagnosed with a significantly life-limiting condition. In this book, Aaron D. Cobb develops a virtue-based defense of the value of perinatal hospice. He characterizes its promotion and provision as a common project of individuals, local communities, and institutions working together to provide exemplary care. Engaging with important themes from the work of Alasdair MacIntyre and Robert Adams, he shows how perinatal hospice manifests virtues crucial to (...) meeting the needs of families in these difficult circumstances. As a work of applied virtue ethics, this book has important normative, social, and political implications for the creation and development of structured programs of care. It grounds the view that communities ought to devote resources to ensure that these programs are widely available and to develop social structures that promote awareness of and accessibility to these forms of care. A Virtue-Based Defense of Perinatal Hospice will be of interest to philosophers working in bioethics and applied virtue ethics, as well as scholars in the fields of neonatology, nursing, palliative and hospice care, and counseling who are interested in the study of perinatal hospice. (shrink)

Background and ObjectivesUp to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to (...) identify useful information on key implementation strategies, if any, that increase the engagement of men.MethodsWe drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both.ResultsEleven studies satisfied search criteria. The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms.DiscussionThere was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology. (shrink)