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Beyond all the “medical” steps taken in the wake of stillbirth or perinatal death due to fetal defects are critical matters important to the family and its future. Active, mature, and informed management is necessary in these difficult and frequently poignant situations. Regardless of the cause of the child's defect(s), maternal guilt is almost invariable and sometimes profound. Recognition of a definitive cause unrelated to a maternal origin should be explained in early discussions and reiterated later. For autosomal recessive disorders or with even more problematic X‐linked disorders, maternal “culpability” is real and not easily assuaged. The fact that we all carry harmful genes, some of which we may have directly inherited, while others may have undergone mutation, will need in‐depth discussion. Mostly, it is possible and important to reassure mothers that the outcome was not due to something they did wrong. Where the converse is true, much effort will be needed for management of guilt¹⁰³⁰ and shame, and for planning actions that promise a better future with ways to avert another adverse outcome.

Attention to details that have a very important role in the mourning process (see Box 1.4 checklist) include ensuring that the child be given a name and, in the case of the death of an abnormal fetus in the third trimester, that the parents' wishes for a marked grave be determined. As noted earlier, most caretakers feel that parents are helped by both seeing and holding the baby.^{1000, 1001, 1031} Although some may experience initial revulsion when the subject is mentioned, gentle coaxing and explanations about the experiences of other couples may help grieving parents. Even with badly disfigured offspring, it is possible for parents to cradle a mostly covered baby whose normal parts, such as hands and feet, can be held. Important mementos that parents should be offered are photographs,¹⁰³² a lock of hair, the baby's name band or clothing.^{1027, 1028} Ultimately, these concrete emblems of the baby's existence assist parents in the mourning process, although the desperate emptiness that mothers especially feel is not easily remedied.¹⁰³³ Photos may also be helpful in providing comfort for other children and for grandparents. Parents will also vary in their choice of traditional or small, private funerals. Physicians should ensure that parents have the time to make these various decisions and assist by keeping the child in the ward for some hours when necessary.

Both parents should be encouraged to return for continuing consultations during the mourning period.¹⁰³⁴ Follow‐up contact after pregnancy has ended includes calls, condolences cards, and recommendation for further bereavement counseling. This appointment will also enable further discussion about causation, future risks, and options, as well as coping strategies. Parents confirm that anxiety blocks the assimilation and comprehension of facts and recommendations. Vocalizing the realization is helpful while repeating information provided previously. Mourning may run its course for 6–24 months. These consultations will serve to explore aspects of depression, guilt, anger, denial, possible marital discord, and physical symptoms such as frigidity or impotence. Impulsive decisions for sterilization should be discouraged in the face of overwhelming grief. Advice should be given about safe, reliable, and relatively long‐term contraception.¹⁰³⁵ Similarly, parents should be fully informed about the consequences of having a “replacement child” very soon after their loss.^{1036, 1037} That child may well become a continuing vehicle of grief for the parents, who may then become overanxious and overprotective. Subsequently, they may bedevil the future of the replacement child with constant references to the lost baby, creating a fantasy image of perfection that the replacement child could never fulfill. Such a child may well have trouble establishing his or her own identity.