Elisabeth Kübler-Ross introduced a framework describing the emotional journey individuals often experience when facing terminal illness or catastrophic loss. While originally developed for dying patients, midwives encounter these exact psychological responses in obstetric and gynecological settings. This occurs during events such as sudden fetal loss, neonatal death, receiving a congenital abnormality diagnosis, or experiencing a sudden hysterectomy. Midwives must recognize that these emotional reactions are not rigid boxes. People move back and forth, skip steps, or experience them out of order. Understanding this framework helps you provide compassionate, non-judgmental care rather than rushing a grieving mother or family to 'move on.'
The first reaction to devastating news is often denial, serving as a temporary psychological shield. When a pregnant woman is told her baby has died in utero, she may act as though everything is normal, insisting the ultrasound machine must be broken. This numbness protects the mind from absorbing too much pain all at once.
Once the shock of denial fades, the underlying pain and helplessness often transform into intense anger. Patients may lash out, asking questions like, 'Why did this happen to my child?' or 'Why didn't you check me sooner?' This anger can be directed at spouses, relatives, God, or the attending midwifery and medical staff.
Remember that this anger is rarely about you personally. It represents masked pain, fear, and a deep sense of injustice. Taking insults or aggressive complaints personally will damage the therapeutic relationship. Instead, practice active listening, maintain clear professional boundaries, and let the patient vent without arguing back or becoming defensive.
During the bargaining phase, individuals attempt to regain control or reverse the reality of their loss through secret deals or negotiations, often with a higher power. A mother facing a terminal diagnosis or mourning a sick newborn might pray, 'If only my baby survives, I will dedicate my life to charity,' or 'Take me instead, Lord.'
This stage is fueled by guilt and the illusion that we can somehow alter an unchangeable outcome through good behavior or promises. Midwives should listen respectfully without feeding false hope, gently guiding patients back to present reality while honoring their spiritual coping mechanisms.
As the reality of the situation fully sets in, bargaining fails, and anger subsides, the individual enters a profound state of sadness. In midwifery, this is where the full weight of a lost pregnancy, a dead infant, or a life-altering diagnosis hits home.
Patients may withdraw from social interaction, lose interest in daily activities, cry uncontrollably, or express feelings of emptiness and hopelessness. While this resembles clinical depression, in the context of grief, it is a natural and appropriate response to a major loss. Midwives must distinguish normal grief-related sadness from severe postpartum depression or suicidal ideation, offering gentle comfort and reassuring the patient that it is okay to mourn.
Acceptance does not mean the person is happy about the loss or has forgotten their baby or diagnosis. Instead, it means they have learned to live with the new reality. The frantic searching, angry outbursts, and paralyzing despair give way to a quiet, steady acknowledgment of what happened.
In this final stage, mothers and families begin to reorganize their lives. They can talk about the lost child with a calm sorrow rather than raw agony. They start making plans for the future while carrying the memory of their experience. Midwives witness this when a patient returns for postnatal checks, able to engage constructively in discussions about future family planning and emotional healing.
Providing compassionate care in Nigerian hospitals requires blending clinical competence with deep cultural and spiritual awareness. Grief is heavily influenced by societal expectations, religious beliefs (Christian, Islamic, and traditional practices), and family dynamics.