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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Perinatal loss and trauma

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Physical danger or acute psychiatric crisis

Heavy bleeding, syncope, severe abdominal pain, fever, sepsis, hypertensive or neurological symptoms, suicidal intent, psychosis, severe dissociation, inability to care for self or a living infant, or violence after loss requires immediate medical and mental-health action.

Action: Assess ABCDE and urgent obstetric or neonatal complications, provide analgesia and privacy, ask directly about suicide and safety, involve emergency obstetric, gynaecological, paediatric and crisis teams as indicated, and ensure the bereaved person is not left alone when current risk cannot be safely managed.

Synopsis

Provide compassionate, trauma-informed care after miscarriage, ectopic pregnancy, termination for fetal anomaly, stillbirth, neonatal death or traumatic birth; recognise when grief is complicated by PTSD, depression or acute risk and offer evidence-based support without coercive debriefing.

  • Use the person's own terms for the pregnancy and baby, acknowledge what happened directly, and do not rank losses by gestation or assume the expected emotional response.
  • First confirm that physical follow-up is complete: bleeding, pain, infection, lactation, hypertensive symptoms, investigations and future obstetric questions can sustain psychological distress.
  • Grief may involve waves of yearning, numbness, anger, guilt, relief or avoidance; diagnosis depends on syndrome, danger and impairment, not whether emotion fits a timetable.
  • Assess PTSD through re-experiencing, avoidance, negative beliefs, hyperarousal and dissociation, while also checking depression, psychosis, mania, substances, sleep and suicide.
  • NICE recommends offering advice and support to people who want to discuss traumatic birth or miscarriage and considering the effect on partners and family.
  • For PTSD after traumatic birth, miscarriage, stillbirth or neonatal death, offer trauma-focused CBT or EMDR in accordance with NICE PTSD guidance.
  • Do not impose a single-session intervention focused on reliving the traumatic birth; supportive listening and practical information are different from compulsory high-intensity debriefing.
  • Choices about seeing, holding or photographing a stillborn baby and keeping mementos should be sensitively revisited by an experienced practitioner, without pressure in either direction.
  • Offer a follow-up appointment that covers physical recovery, investigation results, future pregnancy, anniversaries, work, relationships and mental health, with a named route back into care.

    • Key red flags

    Soaking bleeding, shoulder-tip pain, collapse, severe unilateral pain, fever or offensive discharge after pregnancy loss may indicate haemorrhage, ectopic pregnancy or infection and needs emergency physical assessment.

    Current suicidal intent, preparatory behaviour, psychotic guilt, command hallucinations or stated inability to survive the loss requires same-day specialist mental-health care.

    Flashbacks with dangerous dissociation, panic that prevents essential medical care, profound sleeplessness or escalating substance use indicates a need for urgent trauma-informed assessment.

    Persistent inability to eat, wash, leave bed, attend follow-up or care for a surviving infant may signal severe depression or physical illness rather than grief alone.

    A controlling partner, blame, threats, forced decisions about seeing the baby or mementos, or fear of returning home requires private safeguarding enquiry.

    Investigation priorities

    01
    Urgent physical reviewFirst step

    Identify haemorrhage, retained tissue, ectopic pregnancy, infection, anaemia, hypertensive disease, lactation problems or postnatal complications.

    Management branches

    Immediate careStabilise and communicate without coercion

    Pregnancy loss, neonatal death or traumatic birth has just occurred or the person presents with an unresolved physical concern.

    1. Address pain, bleeding, infection and other medical priorities while providing privacy, clear explanations, interpreting and a chosen supporter where possible.
    2. Acknowledge the loss, check what language the person uses and offer information in small repeatable parts without demanding detailed emotional processing.
    3. Assess immediate suicide, psychosis, dissociation, domestic abuse and ability to return safely, then arrange physical and psychological follow-up with named contacts.
    Open full textbook →Answer 2 questions
    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • NICE CG192 perinatal recommendationsSupport after traumatic birth or miscarriage, PTSD treatment, avoidance of single-session reliving and memory-making choices.
    • NICE NG116 PTSD recommendationsTrauma-focused CBT and EMDR indications, components, duration and monitoring for adults.
    • NICE NG126 ectopic-pregnancy warning signs and referralRecognition of haemodynamic instability, pain, bleeding, syncope and shoulder-tip pain, with urgent referral routes for possible ectopic pregnancy.
    • NHS miscarriagePhysical recovery, emotional effects, support and when to seek further clinical help after miscarriage.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom