Grief Counselling: A Soothing Balm for Bereaved Mothers

Grief Counselling: A Soothing Balm for Bereaved Mothers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Grief Counselling: A Soothing Balm for Bereaved Mothers Nellie Myburgh¹, Duduzile Ziqubu², Lunghile Shivambo², Lerato Ntsie², and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6890320/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Maternal grief has long been recognised as the most profound and unique of all grief, especially when a mother loses a young child. Knowing the cause of death is one way of beginning a long journey towards healing. Minimally Invasive Tissue Sampling (MITS) is a procedure used to determine the cause of death. Methods: An exploratory qualitative study was conducted at Chris Hani Baragwaneth Academic Hospital, Soweto, South Africa to understand bereaved mothers’ experiences of grief counselling after consenting to MITS conducted on their deceased children. Ten Key Informant Interviews (KIIs) were conducted with bereaved mothers (ages 18-32 years old) who had consented to the MITS procedure. Results: The study revealed that bereaved mothers experienced profound psychological and emotional distress following the death of a child, with dominant themes of pain, trauma, hopelessness, and self-blame. Mothers described their grief as overwhelming, prolonged, and physically and emotionally debilitating—often likening it to being choked or dying inside. Those who experienced Caesarean births or multiple child losses reported intensified suffering, and some resorted to harmful coping mechanisms such as alcohol use or expressed suicidal ideation. The sudden and traumatic nature of child loss left many in shock, disbelief, and existential despair, compounded by feelings of frustration, denial, and internalised blame. Despite these challenges, grief counselling emerged as a critical source of emotional relief and healing. Mothers reported that counselling, especially when integrated with prayer, provided comfort, strength, and a renewed sense of hope and coping. The sessions fostered spiritual connection, emotional reassurance, and the ability to begin envisioning a path forward. Many participants expressed appreciation for the emotional support received and reported diminished guilt and a greater sense of acceptance. These findings underscore the urgent need to integrate culturally and spiritually sensitive grief counselling into routine healthcare services for bereaved mothers. Conclusion: The findings from this study revealed that long-term professional grief counselling is an urgent intervention that should be offered at the primary healthcare level. As a recommendation, grief counselling should be included in the healthcare systems as a standard of care for those who are bereaved and failing to cope. South Africa bereavement grief counselling trauma children death MITS qualitative thematic analysis Figures Figure 1 Introduction Maternal bereavement following the death of a child presents a unique and deeply disruptive form of grief, with consequences that extend far beyond the immediate period of mourning. The enduring psychological vulnerability reported among mothers—sometimes persisting for years—demonstrates that child loss constitutes a grief experience of exceptional intensity and duration [1] . This form of grief is not a static emotional state but rather a dynamic, multidimensional process that touches nearly every domain of life, including physical health, cognitive functioning, social relationships, cultural identity, and spiritual meaning-making [2,3] While grief is a natural response to the loss of a loved one, its manifestation in bereaved mothers often challenges conventional clinical and cultural expectations. D’Antonio defines grief as an internal emotional response to the loss of someone loved and valued, and Hall aptly notes that while death ends a life, it does not necessarily end the relationship. This ongoing relational bond is particularly salient in maternal grief, where the severance of the maternal-child connection undermines a core part of the mother's identity [4,5]. The notion that mothers maintain continuing bonds with their deceased children contradicts grief models that expect resolution or closure within a predetermined timeframe. Traditional grief frameworks, especially those developed in Western or biomedical contexts, frequently underestimate the intensity and duration of parental bereavement. For example, Lindemann’s early model of grief framed bereavement as a short-term psychological response, typically resolving within weeks or months [6]. However, this view has been increasingly challenged by contemporary scholarship that situates grief as an enduring process—particularly in the context of child loss. Becvar proposed a more expansive timeline, suggesting a period of two years for meaningful adaptation, yet even this may be insufficient [6]. Empirical studies demonstrate that grief related to child death often persists beyond the bounds of clinical or culturally defined "normalcy", leading to what is now recognised as complicated or prolonged grief disorder [8,9,10,11]. Complicated grief, marked by persistent sorrow, emotional pain, and functional impairment lasting more than a year, challenges the health system’s ability to respond appropriately. In low-resource settings such as Sub-Saharan Africa, this challenge is compounded by systemic constraints. With fewer than one healthcare provider per 1,000 individuals in many developing regions [12] (psychosocial aspects of care—including grief support—remain critically neglected. Health systems prioritise acute care and disease management, while the chronic, emotionally laden experience of grief is often dismissed or misunderstood, especially when it does not conform to visible or measurable health outcomes. This disconnect reveals a profound gap in holistic care. Despite growing recognition of the impact of complicated grief on long-term mental and physical health, especially in mothers, grief support continues to be treated as a peripheral issue in maternal healthcare. The situation is exacerbated by cultural norms that may discourage prolonged expressions of grief or view maternal sorrow as weakness or failure. As a result, many bereaved mothers are left to suffer in silence, with minimal access to therapeutic spaces that validate their pain or support their long-term recovery. Recent global initiatives highlight the urgency of addressing this care gap. The U.S. Department of Health and Human Services Bereavement and Grief Services Report to Congress calls for inclusive, community-based grief services, particularly for underserved and structurally marginalised populations [13]. Zhang et al. similarly point to the heightened visibility of complicated grief in a post-pandemic world, where bereavement care must be reimagined as a critical component of public health [14]. These global perspectives support the relevance of this study in advocating for the integration of grief counselling into maternal health frameworks, especially within under-resourced healthcare systems. The implications are clear: maternal grief must be acknowledged as a legitimate, complex, and long-term health concern. Culturally attuned, trauma-informed, and sustainable models of grief care are not optional add-ons but essential elements of comprehensive maternal health. The failure to address grief as a healthcare issue is not merely a clinical oversight—it is a structural injustice that compounds the pain of loss with systemic neglect. Methodology Before the Child Health and Mortality Surveillance (CHAMPS) Programme implementation in late 2016, Wits Vaccines and Infectious Diseases Analytics (Wits-VIDA) conducted a pilot study between 2015 and 2016 at the Chris Hani Baragwanath Academic Hospital. The study aimed at establishing the cause of death of under-5 (U5) children in a high prevalence setting of Soweto, South Africa using the Minimally Invasive Tissue Sampling (MITS) technique. This pilot study registered 412 deaths of children between the ages of 1 to 14 years, with 240 deaths eligible for the MITS study [15] Before the MITS was conducted, bereaved parents were approached by a grief counsellor to voluntarily give informed consent. Grief counselling was given before and after the procedure to assist in emotional containment and the healing process. A trained grief counsellor conducted 240 grief containment sessions with bereaved mothers recruited from the paediatric, neonatal, and labour ward units. A minimum of three counselling sessions (i.e. short-term counselling) was offered, with some mothers receiving more based on the counsellor’s discretion. Mothers who required additional support beyond the initial sessions were provided with referral letters for long-term counselling—tailored to their individual healing trajectories—at a local non-governmental organization, LifeLine[1] Sessions were held either at the hospital in private rooms or at the mothers’ homes based on their preference. A qualitative exploratory study design was used, suitable for studying in-depth personal experiences. Ten bereaved mothers aged between 18 and 32 years were purposively sampled and interviewed using Key Informant Interviews (KIIs) approximately three months after the death of their children. In addition to in-depth interviews, the study incorporated 20 participant observations conducted by the grief counsellor. During these sessions, the counsellor systematically documented the emotional expressions, non-verbal cues, and behavioural responses of the bereaved mothers before, during, and after the counselling encounters. These observational field notes provided valuable contextual insights into the mothers’ grief experiences and coping mechanisms. By triangulating these observations with the transcribed interview data, the analysis was enriched with a nuanced understanding of both verbal and embodied expressions of grief. This methodological approach enhanced the depth and credibility of the qualitative findings by capturing the dynamic and often unspoken aspects of maternal bereavement.. The data were analysed using thematic analysis, a rigorous qualitative method that involves identifying, analysing, and reporting patterns or themes within the data. This approach enabled the systematic coding of interview transcripts and observational notes, allowing for the development of both primary and secondary themes that reflected the depth and complexity of participants’ experiences. Through an iterative process of reading, coding, and refining, recurring patterns related to grief, coping mechanisms, and the perceived value of counselling were identified and organised into coherent thematic categories. Thematic analysis provided a flexible yet robust framework for interpreting the data, ensuring that emergent themes were grounded in participants’ narratives and supported by rich, contextual detail. Ethical approval for the study was granted by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC), under clearance number 160614. All participants received a detailed information sheet, which was explained to them in a language they understood and provided written informed consent prior to participation. Participation was voluntary, and participants were informed of their right to withdraw from the study at any time without providing a reason. Confidentiality was ensured by removing personal identifiers and assigning pseudonyms during data collection and analysis. Participants were assured that the information gathered would be used exclusively for academic publications, the advancement of research, and to inform policies aimed at strengthening coping interventions tailored to the needs of bereaved mothers and their families. Findings Table 1: Participants socio-demographic characteristics Pseudonym Age (Yrs) Deceased child age (months) Education Religion Marital Status KII-#1-21 21 11 Grade 12 Christian Single KII-#2-30 30 2 Grade 9 Christian Married KII-#3-25 25 7 Tertiary education African/ Traditional belief systems Single KII-#4-27 27 30 Grade 12 Christian Married KII-#5-19 19 5 Grade 9 Christian Single KII-#6-18 18 15 Grade 10 Christian Single KII-#7-20 20 10 Grade 12 Christian Single KII-#8-29 29 18 and 19 (twins) Grade 8 Christian Single KII-#9-25 25 21 Grade 12 African Married KII-#10-23 23 15 Grade 10 African Single Pain “ Losing a child is a very painful thing” was a repeated theme expressed by mothers who participated in this study. Mothers described the pain of losing a child as "enormous, prolonging, overwhelming, indescribable, and sometimes it felt like one is being choked." Those who had Caesarean births or had lost several children described it as a “double blow.” Some resorted to destructive coping mechanisms such as using alcohol to numb the pain. Others reported suicidal ideation or feeling like they had died inside. One mother said, “… It was a very painful moment in our lives especially the hope we had when we saw that it was a male child… our hope was shattered …” [KII-#1-21] Ceaserian births were physically painful and the mothers experienced this pain and the psychological pain of losing after losing the children. “…Imagine going through C-Section and losing the baby. You are dealing with two wounds. My C-Section scar may heal, but I am not sure the wound of losing my baby will ever get better…” [KII-#2-30] From the participant observation data (notes), the study found that the bereaved mothers suffered a few psycho-social challenges that they were struggling to cope. One major observation was that some of the bereaved mothers were resorting to destructive lifestyles to cope. The interviews confirmed this finding. A young, bereaved mother reported that she turned to alcohol and drugs to help her cope with the unbearable pain she felt. “…I lost my baby, and my life is a mess. I drink every day to numb the pain. I don’t know what to do with trauma…” [KII-#3-25] Another observation was that some of the mothers looked very depressed, and the interviews revealed bereaved mothers became so desperate that some of them even contemplated suicide, while others felt lost. One mother said, “…I wanted to commit suicide after losing the baby…” [KII-#4-27] Another talked about feeling like she had died too. She said, “…I was lost… and the pain felt like I had died already…” [KII-#5-19] Trauma Mothers felt physically numb, psychologically disturbed, and emotionally overwhelmed. The sudden death of a child left many in shock and disbelief. Some mothers lost more than one child, compounding their trauma. One bereaved mother reported that she passed out when she was told that her child had died. She said, “…My child died in my hands, and they told me that [the baby] is no more … I passed out … and when I regained consciousness … it was like a dream…” [KII-#6-18] Another mother described the trauma thus, “Losing as a child is the most traumatic moment, I don’t wish it on anybody …” [KII-#7-20] In addition, a few bereaved parents who had lost several children were hard hit by the loss. A mother who lost twins explained, “… Losing two babies at different times is a very hectic situation. When the first baby passed, on the 1st of October 2015, it was very sad. The 2nd twin passed on the 18 th of November 2015, and I became numb…” [KII-#8-29] Mothers also mentioned feeling confused, disturbed, and in disbelief upon hearing about the death of their children. One mother aptly put it this way: “… I was still at sixes & sevens [confused, disturbed, disbelief, not knowing whether you are going or coming] not knowing what to do…” [KII-#9-25] Frustration, discouragement, hopelessness, denial and blame Mothers expressed intense frustration with themselves or the healthcare system. Feelings of hopelessness and denial were common. Some blamed themselves for not doing enough; others blamed external circumstances or individuals. “Losing a child is a not normal thing … the frustrations are too overwhelming…” [KII-#5-19] “… The knowledge of [me] being [HIV] positive, I also blame myself…” [KII-#10-23] The bereaved mothers frequently expressed feelings of discouragement and hopelessness, which emerged as central themes in their narratives. Statements such as “Our hope was shattered” and “I did not believe it when they told me my baby is no more [alive]” illustrate the profound emotional devastation experienced in the immediate aftermath of child loss. A mother who lost a set of twins expressed that she was in denial about the sudden death of her twins. This mother expressed a deep sense of denial after she heard that the second twin had also died. She could not accept the reality that both children had died. She said, “… When my baby [twin2] passed on, I was in denial. How can God take 2 babies away? What am I supposed to do? I still can’t accept that my babies are gone.…” [KII-#8-29] Grief Counselling and support Prayer emerged as a particularly meaningful component of the grief counselling process, offering participants a vital source of comfort, hope, and emotional strength. All participants reported that counselling provided reassurance and a sense of coping, but it was the integration of prayer that deepened their connection to healing. For many bereaved mothers, prayer served as both a spiritual anchor and a culturally resonant practice that affirmed their faith and offered solace in the face of profound loss. The act of praying during sessions helped to create a safe and sacred space, fostering emotional release and reinforcing a sense of divine support. This spiritual dimension not only complemented the therapeutic process but also aligned with participants’ personal beliefs and coping mechanisms, highlighting the importance of culturally and spiritually sensitive approaches in grief counselling. “… Prayers helped us so much as well. The comfort we received was like comfort from family members… it is rare to find someone outside family members who can give such warmth and words of comfort that can make you forget for a while of what was happening…” [KII-#10-23] Mothers appreciated having someone to talk to and expressed a desire to try for more children or return to normal life after the sessions. “… Having someone close at that moment when you are grieving and praying for you, really, it’s like bringing you back from that dream. Grief counselling made a difference, and I am looking forward to another chance again, to have another baby…” [KII-#4-27] The narratives of bereaved mothers highlighted the profound emotional and psychological benefits of grief counselling, underscoring its critical role in facilitating healing. Participants consistently described experiencing a renewed sense of hope, gratitude, courage, and emotional comfort as a result of their engagement in counselling sessions. Many expressed feelings of closure, strength, and relief, along with a sense of assurance and reassurance that helped them begin to cope with their loss and envision a path forward. The counselling process was described as empowering, enabling mothers to gradually recover from their grief, feel encouraged, and start to rebuild their lives. “… Losing a child is a very painful experience. You really feel helpless but receiving grief counselling helps us. We realise that we are not alone, and the prayers really helped…” [KII-#8-29] Some of the mothers who were blaming themselves for the death of their children reported that after the grief counselling, the guilt started to abate. One mother said, “… It [grief counselling] was helpful because I was blaming myself that perhaps there is something I did not do well…” [KII-#6-18] [1] https://lifelinesa.co.za Discussion The emotional landscape navigated by bereaved mothers in this study underscores the profound and often disenfranchised nature of maternal grief, particularly following the loss of a child in a clinical setting. The intensity of the grief expressed points to a complex interplay of psychological trauma, disrupted maternal identity, cultural expectations, and systemic health inequities. Central to this discussion is the recognition that maternal grief cannot be adequately captured through linear models or decontextualised frameworks; instead, it must be understood as a layered and deeply embodied experience shaped by individual, relational, and structural dimensions. A recurring theme in the mothers’ narratives was the depth of traumatic grief—a form of bereavement that extends beyond conventional mourning to encompass the psychological shock and existential rupture triggered by the unexpected death of a child. Traumatic grief in this context is intensified by the suddenness of the loss and the disruption of culturally significant rituals, which are often essential for achieving closure and meaning-making [ 16 ] The death of a child not only violates the normative life course but also profoundly destabilises the maternal identity, fracturing a mother’s sense of purpose, selfhood, and imagined future [ 17 ]. This fragmentation reflects the complex dual mourning experienced by bereaved mothers: grieving the child and simultaneously grieving the self that existed in relation to that child. These findings resonate with contemporary models of grief, such as Neimeyer’s constructivist approach, which conceptualises bereavement as a disruption of the narrative self that demands a reconstruction of meaning to restore coherence and psychological stability [ 18 ]. As such, grief counselling plays a critical role in supporting this reconstruction process, especially in settings where traumatic loss is compounded by systemic and cultural barriers to mourning. The embodied nature of grief emerged prominently, particularly among mothers who experienced multiple losses or medicalised births, such as Caesarean sections. The phrase “double blow,” repeatedly mentioned by participants, reflects not only the emotional devastation of losing more than one child but also the physical trauma associated with invasive birthing processes. Here, the mothers' pain is not simply psychological—it is lived through the body, through surgical scars, lactation without a baby, and the bodily memory of pregnancy. Such expressions resonate with existing scholarship on embodied grief, which argues that maternal bereavement is not only psychological but also somatic [ 19 ]. These experiences challenge grief models that emphasise emotional processing over physical reality, and they call for holistic approaches that acknowledge the full spectrum of suffering. Denial and disbelief surfaced as significant coping responses. While traditionally conceptualised as an early phase in the grieving process [ 20 ]. This study suggests that denial may function as a recurring and protective mechanism rather than a linear stage to be surpassed. In contexts where grief is too overwhelming to integrate—particularly when losses occur in rapid succession or under traumatic circumstances—denial serves to temporarily shield the psyche from collapse. Palmer suggests that disbelief may persist as a way to preserve psychological continuity, allowing individuals to maintain functioning in the midst of incomprehensible loss [ 21 ]. The findings here affirm that such responses should not be pathologised but recognised as contextually adaptive strategies within a broader grief trajectory. The issue of guilt—both internalised and externalised—further complicates the grief process. Many mothers blamed themselves for the deaths, often citing delays in seeking antenatal care or accessing medical attention. Others assigned blame to healthcare providers or family members. These responses mirror Stroebe et al.'s findings that bereaved individuals frequently engage in counterfactual thinking, imagining alternative outcomes had different decisions been made [ 22 ] Camacho et al. also highlight that guilt is particularly pronounced in cases of unexpected loss, where the absence of closure exacerbates self-scrutiny and regret [ 23 ]. However, in the South African context, these feelings of guilt are not solely intrapsychic—they are entangled with systemic issues such as healthcare access, socio-economic inequality, and institutional neglect. Mothers’ feelings of culpability, therefore, reflect broader structural failures that are unfairly individualised. Taken together, these findings call for a re-examination of grief counselling models and their applicability to mothers who have experienced child loss under complex and traumatic conditions. Western-derived models that prioritise emotional processing or stage-based recovery risk marginalising the experiences of mothers for whom grief is compounded by cultural, systemic, and bodily factors. A more culturally sensitive, trauma-informed approach is required—one that situates maternal grief within the lived realities of loss, acknowledges the legitimacy of prolonged or complex grieving, and resists medicalising grief responses that are in fact reasonable and contextually grounded [ 24 , 25 ]. Moreover, grief counselling in this context must also function as a form of advocacy, helping bereaved mothers not only to process their loss but also to make sense of it in relation to the social and medical structures that failed them. This integrative approach aligns with recent calls for socially attuned grief support, which foregrounds both the personal and political dimensions of bereavement [ 26 ]. Ultimately, maternal grief cannot be addressed in isolation from the systems that shape it, and effective interventions must honour both the depth of individual suffering and the broader socio-cultural context in which that suffering occurs. Recommendations and implications for maternal health Based on the findings of this study, several key recommendations emerge for improving care following child loss. First, while the MITS procedure provides valuable insights into the cause of death and contributes meaningfully to medical and public health knowledge, its implementation must be accompanied by comprehensive psychosocial support for bereaved families. The process of requesting consent from mothers to conduct MITS, and subsequently providing them with the results of the cause of death, can be emotionally overwhelming and retraumatising if not handled with sensitivity and care. These critical moments present opportunities for healthcare providers to offer immediate grief counselling, which can support mothers in processing complex emotions such as guilt, shock, or helplessness. Therefore, it is essential that grief counselling is not viewed as an optional service, but as an integral part of post-mortem care. Healthcare systems must ensure that diagnostic objectives are not pursued in isolation from the emotional needs of grieving families. Formal integration of grief counselling into routine hospital-based services, particularly in settings where child mortality is prevalent, is necessary to promote compassionate, holistic care that recognises the full impact of bereavement. Second, while recognising the cost and staffing constraints within many healthcare systems, grief support services—such as those provided by the CHAMPS program in South Africa—should be strategically expanded and gradually institutionalised across healthcare facilities. To ensure sustainability, integration should begin with low-cost, scalable models such as basic grief counselling training for existing healthcare workers, community health workers, or lay counsellors. These services should not be limited to study participants but made available to all mothers who have experienced child loss, irrespective of the cause of death or medical setting. Prioritising equitable access to grief support, even within resource-constrained environments, acknowledges the critical role emotional care plays in maternal well-being and reinforces a more holistic approach to health service delivery. Third, training for healthcare professionals involved in child mortality cases should include components on respectful bereavement care, trauma-informed communication, and cultural sensitivity. This would enhance professional conduct and reinforce the importance of empathy, altruism, and emotional support during some of the most difficult moments families face. Finally, policymakers should recognise grief as a public health concern and allocate adequate resources to support grief counselling services at the primary healthcare level. Institutionalising grief support within national health policies will help bridge the existing gap between medical procedures and emotional recovery, ensuring that bereaved mothers receive the holistic care they deserve. Conclusion The findings from this study illuminate the multifaceted value of the Minimally Invasive Tissue Sampling (MITS) procedure—not only in advancing medical understanding of child mortality but also in supporting bereaved families’ need for answers and closure. While MITS provides crucial diagnostic clarity and contributes to research, policy, and ethical medical practice, its implementation must be accompanied by a parallel commitment to psychosocial care. The experiences of bereaved mothers reveal a significant gap in current healthcare systems, where the pursuit of clinical knowledge often overshadows the emotional, cultural, and psychological needs of those most affected by child loss. The integration of long-term grief counselling into the CHAMPS program in South Africa represents an important and commendable shift toward holistic care. To build on this model, grief counselling should be formalised as a core component of maternal and child health services at the primary healthcare level. Doing so not only honours the profound emotional journey of bereaved mothers but also aligns with global best practices in compassionate, patient-centred care. Declarations Acknowledgments The authors would like to thank the study participants who were willing to share their stories even at the most difficult time of their lives. The authors would also like to acknowledge the amazing work of the grief counsellor. Furthermore, the authors express their gratitude to the Child Health and Mortality Prevention Surveillance (CHAMPS) Network in Soweto, Johannesburg, South Africa, for their valuable technical support in conceptualisation and implementation of this project. Authors’ contributions Nellie Myburgh conceptualised the idea of the study, managed data collection activities, analysed data and wrote the first draft of the manuscript. Duduzile Ziqubu assisted in data collection and provided grief counselling. Lunghile SHivambo and Lerato Ntsie assisted in data collection and transcription of the data. Maria Maixenchs and John Blevins made inputs and reviewed the manuscript. Ziyaad Dangor reviewed the manuscript. Shabir Madhi was the principal investigator on the overall CHAMPS Programme at the Soweto site - which part of a multi-site programme. All aithors contributed to the discussion of the study findings and approved the final manuscript, and agreed to be accountable to the work presented herein. Funding information This study is part of the Child Health and Mortality Prevention Surveillance Network in Soweto, South Africa, and it was funded by the Bill and Melinda Gates Foundation (Grant Reference number: SDGF/VDE4/670/2021-803). The funding agency had no role in the studyThe authors therefore express their appreciation to the Bill and Melinda Gates Foundation for providing the funding. Data availability The data supporting the findings of this study and article are available from the corresponding author, Nellie Myburgh upon reasonable request, subject to potential restrictions. All participants in your study were informed about the research , and they all voluntarily agreed to take part . All participant provided consent to participate in the study – to this written informed consent was obtained from all participants prior to their inclusion in the study. Participants were provided with detailed information about the study objectives, procedures, and their rights, including the right to withdraw at any time without consequence. Ethical approval Ethical approval for the study was granted by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC), under clearance number 160614. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their participation in the study. Consent for publication Not applicable Competing interests The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article. Disclaimer The views and opinions presented in this article are solely those of the authors and are derived from their professional research. They do not necessarily represent the official policies or positions of any affiliated institutions, funders, agencies, or the publisher. The authors take full responsibility for the article's findings, conclusions, and content. Conflicts of interest None. References Kark SM, Adams JG, Sathishkumar M, Granger SJ, McMillan L, Baram TZ, Yassa MA. Why do mothers never stop grieving for their deceased children? Enduring alterations of brain connectivity and function. Front Hum Neurosci. 2022;16:925242. 10.3389/fnhum.2022.925242 . Buglass E. Grief and bereavement theories. Nurs Stand. 2010;24(41):44–7. 10.7748/ns2010.06.24.41.44.c7807 . Cerdán MG. 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Bereavement theory: Recent developments in our understanding of grief and bereavement. Bereave Care. 2014;33(1):7–12. 10.1080/02682621.2014.902610 . Harper M, O’Connor RC, O’Carroll RE. Factors associated with grief and depression following the loss of a child: A multivariate analysis. Psychol Health Med. 2014;19(3):247–52. Additional Declarations No competing interests reported. Supplementary Files IDIToolCHAMPSGriefCounsellingStudy070725.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6890320","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495618720,"identity":"5d95117b-ba17-4a9d-9721-2ba6bc05d4bd","order_by":0,"name":"Nellie 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18:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6890320/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6890320/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88414824,"identity":"284408d8-d7ae-43fc-901e-b7e6e5f73612","added_by":"auto","created_at":"2025-08-06 08:50:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":322052,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiagram 1: Flow Diagram showing how the participants were recruited\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6890320/v1/98ef6d503a7bc5ef2f0ee8e6.png"},{"id":99308275,"identity":"248ebb74-e6f4-4ad5-b380-0b0a56c07a5c","added_by":"auto","created_at":"2025-12-31 16:08:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864434,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6890320/v1/f4333147-3a64-49d4-9c15-deb984c99c23.pdf"},{"id":88414816,"identity":"3b52f821-4f7f-4734-bb51-4a04ad4bcfd9","added_by":"auto","created_at":"2025-08-06 08:50:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29705,"visible":true,"origin":"","legend":"","description":"","filename":"IDIToolCHAMPSGriefCounsellingStudy070725.docx","url":"https://assets-eu.researchsquare.com/files/rs-6890320/v1/d147795e5d7a3642e499e87b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Grief Counselling: A Soothing Balm for Bereaved Mothers","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMaternal bereavement following the death of a child presents a unique and deeply disruptive form of grief, with consequences that extend far beyond the immediate period of mourning. The enduring psychological vulnerability reported among mothers—sometimes persisting for years—demonstrates that child loss constitutes a grief experience of exceptional intensity and duration \u003cstrong\u003e[1]\u003c/strong\u003e. This form of grief is not a static emotional state but rather a dynamic, multidimensional process that touches nearly every domain of life, including physical health, cognitive functioning, social relationships, cultural identity, and spiritual meaning-making \u003cstrong\u003e[2,3]\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile grief is a natural response to the loss of a loved one, its manifestation in bereaved mothers often challenges conventional clinical and cultural expectations. D’Antonio defines grief as an internal emotional response to the loss of someone loved and valued, and Hall aptly notes that while death ends a life, it does not necessarily end the relationship. This ongoing relational bond is particularly salient in maternal grief, where the severance of the maternal-child connection undermines a core part of the mother's identity \u003cstrong\u003e[4,5].\u003c/strong\u003e The notion that mothers maintain continuing bonds with their deceased children contradicts grief models that expect resolution or closure within a predetermined timeframe.\u003c/p\u003e\n\u003cp\u003eTraditional grief frameworks, especially those developed in Western or biomedical contexts, frequently underestimate the intensity and duration of parental bereavement. For example, Lindemann’s early model of grief framed bereavement as a short-term psychological response, typically resolving within weeks or months \u003cstrong\u003e[6].\u003c/strong\u003e However, this view has been increasingly challenged by contemporary scholarship that situates grief as an enduring process—particularly in the context of child loss. Becvar proposed a more expansive timeline, suggesting a period of two years for meaningful adaptation, yet even this may be insufficient [6]. Empirical studies demonstrate that grief related to child death often persists beyond the bounds of clinical or culturally defined \"normalcy\", leading to what is now recognised as complicated or prolonged grief disorder \u003cstrong\u003e[8,9,10,11].\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComplicated grief, marked by persistent sorrow, emotional pain, and functional impairment lasting more than a year, challenges the health system’s ability to respond appropriately. In low-resource settings such as Sub-Saharan Africa, this challenge is compounded by systemic constraints. With fewer than one healthcare provider per 1,000 individuals in many developing regions \u003cstrong\u003e[12]\u003c/strong\u003e (psychosocial aspects of care—including grief support—remain critically neglected. Health systems prioritise acute care and disease management, while the chronic, emotionally laden experience of grief is often dismissed or misunderstood, especially when it does not conform to visible or measurable health outcomes.\u003c/p\u003e\n\u003cp\u003eThis disconnect reveals a profound gap in holistic care. Despite growing recognition of the impact of complicated grief on long-term mental and physical health, especially in mothers, grief support continues to be treated as a peripheral issue in maternal healthcare. The situation is exacerbated by cultural norms that may discourage prolonged expressions of grief or view maternal sorrow as weakness or failure. As a result, many bereaved mothers are left to suffer in silence, with minimal access to therapeutic spaces that validate their pain or support their long-term recovery.\u003c/p\u003e\n\u003cp\u003eRecent global initiatives highlight the urgency of addressing this care gap. The U.S. Department of Health and Human Services Bereavement and Grief Services Report to Congress calls for inclusive, community-based grief services, particularly for underserved and structurally marginalised populations \u003cstrong\u003e[13].\u003c/strong\u003e Zhang et al. similarly point to the heightened visibility of complicated grief in a post-pandemic world, where bereavement care must be reimagined as a critical component of public health \u003cstrong\u003e[14].\u003c/strong\u003e These global perspectives support the relevance of this study in advocating for the integration of grief counselling into maternal health frameworks, especially within under-resourced healthcare systems.\u003c/p\u003e\n\u003cp\u003eThe implications are clear: maternal grief must be acknowledged as a legitimate, complex, and long-term health concern. Culturally attuned, trauma-informed, and sustainable models of grief care are not optional add-ons but essential elements of comprehensive maternal health. The failure to address grief as a healthcare issue is not merely a clinical oversight—it is a structural injustice that compounds the pain of loss with systemic neglect.\u003c/p\u003e"},{"header":"Methodology ","content":"\u003cp\u003eBefore the Child Health and Mortality Surveillance (CHAMPS) Programme implementation in late 2016, Wits Vaccines and Infectious Diseases Analytics (Wits-VIDA) conducted a pilot study between 2015 and 2016 at the Chris Hani Baragwanath Academic Hospital. The study aimed at establishing the cause of death of under-5 (U5) children in a high prevalence setting of Soweto, South Africa using the Minimally Invasive Tissue Sampling (MITS) technique. This pilot study registered 412 deaths of children between the ages of 1 to 14 years, with 240 deaths eligible for the MITS study \u003cstrong\u003e[15]\u003c/strong\u003e Before the MITS was conducted, bereaved parents were approached by a grief counsellor to voluntarily give informed consent. Grief counselling was given before and after the procedure to assist in emotional containment and the healing process. A trained grief counsellor conducted 240 grief containment sessions with bereaved mothers recruited from the paediatric, neonatal, and labour ward units. A minimum of three counselling sessions (i.e. short-term counselling) was offered, with some mothers receiving more based on the counsellor\u0026rsquo;s discretion. Mothers who required additional support beyond the initial sessions were provided with referral letters for long-term counselling\u0026mdash;tailored to their individual healing trajectories\u0026mdash;at a local non-governmental organization, LifeLine[1] Sessions were held either at the hospital in private rooms or at the mothers\u0026rsquo; homes based on their preference.\u003c/p\u003e\n\u003cp\u003eA qualitative exploratory study design was used, suitable for studying in-depth personal experiences. Ten bereaved mothers aged between 18 and 32 years were purposively sampled and interviewed using Key Informant Interviews (KIIs) approximately three months after the death of their children. In addition to in-depth interviews, the study incorporated 20 participant observations conducted by the grief counsellor. During these sessions, the counsellor systematically documented the emotional expressions, non-verbal cues, and behavioural responses of the bereaved mothers before, during, and after the counselling encounters. These observational field notes provided valuable contextual insights into the mothers\u0026rsquo; grief experiences and coping mechanisms. By triangulating these observations with the transcribed interview data, the analysis was enriched with a nuanced understanding of both verbal and embodied expressions of grief. This methodological approach enhanced the depth and credibility of the qualitative findings by capturing the dynamic and often unspoken aspects of maternal bereavement.. The data were analysed using thematic analysis, a rigorous qualitative method that involves identifying, analysing, and reporting patterns or themes within the data. This approach enabled the systematic coding of interview transcripts and observational notes, allowing for the development of both primary and secondary themes that reflected the depth and complexity of participants\u0026rsquo; experiences. Through an iterative process of reading, coding, and refining, recurring patterns related to grief, coping mechanisms, and the perceived value of counselling were identified and organised into coherent thematic categories. Thematic analysis provided a flexible yet robust framework for interpreting the data, ensuring that emergent themes were grounded in participants\u0026rsquo; narratives and supported by rich, contextual detail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC), under clearance number 160614. All participants received a detailed information sheet, which was explained to them in a language they understood and provided written informed consent prior to participation. Participation was voluntary, and participants were informed of their right to withdraw from the study at any time without providing a reason. Confidentiality was ensured by removing personal identifiers and assigning pseudonyms during data collection and analysis. Participants were assured that the information gathered would be used exclusively for academic publications, the advancement of research, and to inform policies aimed at strengthening coping interventions tailored to the needs of bereaved mothers and their families.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Participants socio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePseudonym\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Yrs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeceased child age (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#1-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#2-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#3-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eTertiary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eAfrican/ Traditional belief systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#4-27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#5-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#6-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#7-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#8-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e18 and 19 (twins)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#9-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eAfrican\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eKII-#10-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGrade 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eAfrican\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003eLosing a child is a very painful thing\u0026rdquo; was a repeated theme expressed by mothers who participated in this study. Mothers described the pain of losing a child as \u0026quot;enormous, prolonging, overwhelming, indescribable, and sometimes it felt like one is being choked.\u0026quot; Those who had Caesarean births or had lost several children described it as a \u0026ldquo;double blow.\u0026rdquo; Some resorted to destructive coping mechanisms such as using alcohol to numb the pain. Others reported suicidal ideation or feeling like they had died inside.\u003c/p\u003e\n\u003cp\u003eOne mother said,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; It was a very painful moment in our lives especially the hope we had when we saw that it was a male child\u0026hellip; our hope was shattered\u003c/em\u003e\u0026hellip;\u0026rdquo; \u003cstrong\u003e[KII-#1-21]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCeaserian births were physically painful and the mothers experienced this pain and the psychological pain of losing after losing the children.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Imagine going through C-Section and losing the baby. You are dealing with two wounds. My C-Section scar may heal, but I am not sure the wound of losing my baby will ever get better\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[KII-#2-30]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the participant observation data (notes), the study found that the bereaved mothers suffered a few psycho-social challenges that they were struggling to cope. One major observation was that some of the bereaved mothers were resorting to destructive lifestyles to cope. The interviews confirmed this finding. A young, bereaved mother reported that she turned to alcohol and drugs to help her cope with the unbearable pain she felt.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I lost my baby, and my life is a mess. I drink every day to numb the pain. I don\u0026rsquo;t know what to do with trauma\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[KII-#3-25]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother observation was that some of the mothers looked very depressed, and the interviews revealed bereaved mothers became so desperate that some of them even contemplated suicide, while others felt lost. One mother said,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I wanted to commit suicide after losing the baby\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[KII-#4-27]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother talked about feeling like she had died too. She said,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I was lost\u0026hellip; and the pain felt like I had died already\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#5-19]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTrauma\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eMothers felt physically numb, psychologically disturbed, and emotionally overwhelmed. The sudden death of a child left many in shock and disbelief. Some mothers lost more than one child, compounding their trauma.\u003c/p\u003e\n\u003cp\u003eOne bereaved mother reported that she passed out when she was told that her child had died. She said,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;My child died in my hands, and they told me that [the baby] is no more \u0026hellip; I passed out \u0026hellip; and when I regained consciousness \u0026hellip; it was like a dream\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[KII-#6-18]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother mother described the trauma thus,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Losing as a child is the most traumatic moment, I don\u0026rsquo;t wish it on anybody\u003cstrong\u003e\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e[KII-#7-20]\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, a few bereaved parents who had lost several children were hard hit by the loss. A mother who lost twins explained,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; Losing two babies at different times is a very hectic situation. When the first baby passed, on the 1st of October 2015, it was very sad. The 2nd twin passed on the 18\u003csup\u003eth of\u003c/sup\u003e November 2015, and I became numb\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;[KII-#8-29]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMothers also mentioned feeling confused, disturbed, and in disbelief upon hearing about the death of their children. One mother aptly put it this way:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; I was still at sixes \u0026amp; sevens [confused, disturbed, disbelief, not knowing whether you are going or coming] not knowing what to do\u0026hellip;\u0026rdquo;\u003c/em\u003e\u0026nbsp; \u003cstrong\u003e[KII-#9-25]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eFrustration, discouragement, hopelessness, denial and blame\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eMothers expressed intense frustration with themselves or the healthcare system. Feelings of hopelessness and denial were common. Some blamed themselves for not doing enough; others blamed external circumstances or individuals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Losing a child is a not normal thing \u0026hellip; the frustrations are too overwhelming\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[KII-#5-19]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u003cem\u003e\u0026ldquo;\u0026hellip; The knowledge of [me] being [HIV] positive, I also blame myself\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#10-23]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bereaved mothers frequently expressed feelings of discouragement and hopelessness, which emerged as central themes in their narratives. Statements such as \u0026ldquo;Our hope was shattered\u0026rdquo; and \u0026ldquo;I did not believe it when they told me my baby is no more [alive]\u0026rdquo; illustrate the profound emotional devastation experienced in the immediate aftermath of child loss.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA mother who lost a set of twins expressed that she was in denial about the sudden death of her twins. \u0026nbsp;This mother expressed a deep sense of denial after she heard that the second twin had also died. \u0026nbsp;She could not accept the reality that both children had died. She said,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; When my baby [twin2] passed on, I was in denial. How can God take 2 babies away? What am I supposed to do? I still can\u0026rsquo;t accept that my babies are gone.\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#8-29]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eGrief Counselling and support\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003ePrayer emerged as a particularly meaningful component of the grief counselling process, offering participants a vital source of comfort, hope, and emotional strength. All participants reported that counselling provided reassurance and a sense of coping, but it was the integration of prayer that deepened their connection to healing. For many bereaved mothers, prayer served as both a spiritual anchor and a culturally resonant practice that affirmed their faith and offered solace in the face of profound loss. The act of praying during sessions helped to create a safe and sacred space, fostering emotional release and reinforcing a sense of divine support. This spiritual dimension not only complemented the therapeutic process but also aligned with participants\u0026rsquo; personal beliefs and coping mechanisms, highlighting the importance of culturally and spiritually sensitive approaches in grief counselling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; Prayers helped us so much as well. The comfort we received was like comfort from family members\u0026hellip; it is rare to find someone outside family members who can give such warmth and words of comfort that can make you forget for a while of what was happening\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#10-23]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMothers appreciated having someone to talk to and expressed a desire to try for more children or return to normal life after the sessions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; Having someone close at that moment when you are grieving and praying for you, really, it\u0026rsquo;s like bringing you back from that dream. Grief counselling made a difference, and I am looking forward to another chance again, to have another baby\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;[KII-#4-27]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe narratives of bereaved mothers highlighted the profound emotional and psychological benefits of grief counselling, underscoring its critical role in facilitating healing. Participants consistently described experiencing a renewed sense of hope, gratitude, courage, and emotional comfort as a result of their engagement in counselling sessions. Many expressed feelings of closure, strength, and relief, along with a sense of assurance and reassurance that helped them begin to cope with their loss and envision a path forward. The counselling process was described as empowering, enabling mothers to gradually recover from their grief, feel encouraged, and start to rebuild their lives. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; Losing a child is a very painful experience. You really feel helpless but receiving grief counselling helps us. We realise that we are not alone, and the prayers really helped\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#8-29]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the mothers who were blaming themselves for the death of their children reported that after the grief counselling, the guilt started to abate. One mother said,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; It\u0026nbsp;\u003c/em\u003e[grief counselling] \u003cem\u003ewas helpful because I was blaming myself that perhaps there is something I did not do well\u0026hellip;\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e[KII-#6-18]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e[1] https://lifelinesa.co.za\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe emotional landscape navigated by bereaved mothers in this study underscores the profound and often disenfranchised nature of maternal grief, particularly following the loss of a child in a clinical setting. The intensity of the grief expressed points to a complex interplay of psychological trauma, disrupted maternal identity, cultural expectations, and systemic health inequities. Central to this discussion is the recognition that maternal grief cannot be adequately captured through linear models or decontextualised frameworks; instead, it must be understood as a layered and deeply embodied experience shaped by individual, relational, and structural dimensions.\u003c/p\u003e\u003cp\u003eA recurring theme in the mothers\u0026rsquo; narratives was the depth of traumatic grief\u0026mdash;a form of bereavement that extends beyond conventional mourning to encompass the psychological shock and existential rupture triggered by the unexpected death of a child. Traumatic grief in this context is intensified by the suddenness of the loss and the disruption of culturally significant rituals, which are often essential for achieving closure and meaning-making [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The death of a child not only violates the normative life course but also profoundly destabilises the maternal identity, fracturing a mother\u0026rsquo;s sense of purpose, selfhood, and imagined future [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This fragmentation reflects the complex dual mourning experienced by bereaved mothers: grieving the child and simultaneously grieving the self that existed in relation to that child. These findings resonate with contemporary models of grief, such as Neimeyer\u0026rsquo;s constructivist approach, which conceptualises bereavement as a disruption of the narrative self that demands a reconstruction of meaning to restore coherence and psychological stability [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. As such, grief counselling plays a critical role in supporting this reconstruction process, especially in settings where traumatic loss is compounded by systemic and cultural barriers to mourning.\u003c/p\u003e\u003cp\u003eThe embodied nature of grief emerged prominently, particularly among mothers who experienced multiple losses or medicalised births, such as Caesarean sections. The phrase \u0026ldquo;double blow,\u0026rdquo; repeatedly mentioned by participants, reflects not only the emotional devastation of losing more than one child but also the physical trauma associated with invasive birthing processes. Here, the mothers' pain is not simply psychological\u0026mdash;it is lived through the body, through surgical scars, lactation without a baby, and the bodily memory of pregnancy. Such expressions resonate with existing scholarship on embodied grief, which argues that maternal bereavement is not only psychological but also somatic [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These experiences challenge grief models that emphasise emotional processing over physical reality, and they call for holistic approaches that acknowledge the full spectrum of suffering.\u003c/p\u003e\u003cp\u003eDenial and disbelief surfaced as significant coping responses. While traditionally conceptualised as an early phase in the grieving process [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study suggests that denial may function as a recurring and protective mechanism rather than a linear stage to be surpassed. In contexts where grief is too overwhelming to integrate\u0026mdash;particularly when losses occur in rapid succession or under traumatic circumstances\u0026mdash;denial serves to temporarily shield the psyche from collapse. Palmer suggests that disbelief may persist as a way to preserve psychological continuity, allowing individuals to maintain functioning in the midst of incomprehensible loss [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The findings here affirm that such responses should not be pathologised but recognised as contextually adaptive strategies within a broader grief trajectory.\u003c/p\u003e\u003cp\u003eThe issue of guilt\u0026mdash;both internalised and externalised\u0026mdash;further complicates the grief process. Many mothers blamed themselves for the deaths, often citing delays in seeking antenatal care or accessing medical attention. Others assigned blame to healthcare providers or family members. These responses mirror Stroebe et al.'s findings that bereaved individuals frequently engage in counterfactual thinking, imagining alternative outcomes had different decisions been made [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Camacho et al. also highlight that guilt is particularly pronounced in cases of unexpected loss, where the absence of closure exacerbates self-scrutiny and regret [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, in the South African context, these feelings of guilt are not solely intrapsychic\u0026mdash;they are entangled with systemic issues such as healthcare access, socio-economic inequality, and institutional neglect. Mothers\u0026rsquo; feelings of culpability, therefore, reflect broader structural failures that are unfairly individualised.\u003c/p\u003e\u003cp\u003eTaken together, these findings call for a re-examination of grief counselling models and their applicability to mothers who have experienced child loss under complex and traumatic conditions. Western-derived models that prioritise emotional processing or stage-based recovery risk marginalising the experiences of mothers for whom grief is compounded by cultural, systemic, and bodily factors. A more culturally sensitive, trauma-informed approach is required\u0026mdash;one that situates maternal grief within the lived realities of loss, acknowledges the legitimacy of prolonged or complex grieving, and resists medicalising grief responses that are in fact reasonable and contextually grounded [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, grief counselling in this context must also function as a form of advocacy, helping bereaved mothers not only to process their loss but also to make sense of it in relation to the social and medical structures that failed them. This integrative approach aligns with recent calls for socially attuned grief support, which foregrounds both the personal and political dimensions of bereavement [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Ultimately, maternal grief cannot be addressed in isolation from the systems that shape it, and effective interventions must honour both the depth of individual suffering and the broader socio-cultural context in which that suffering occurs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations and implications for maternal health\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBased on the findings of this study, several key recommendations emerge for improving care following child loss.\u003c/p\u003e\u003cp\u003eFirst, while the MITS procedure provides valuable insights into the cause of death and contributes meaningfully to medical and public health knowledge, its implementation must be accompanied by comprehensive psychosocial support for bereaved families. The process of requesting consent from mothers to conduct MITS, and subsequently providing them with the results of the cause of death, can be emotionally overwhelming and retraumatising if not handled with sensitivity and care. These critical moments present opportunities for healthcare providers to offer immediate grief counselling, which can support mothers in processing complex emotions such as guilt, shock, or helplessness. Therefore, it is essential that grief counselling is not viewed as an optional service, but as an integral part of post-mortem care. Healthcare systems must ensure that diagnostic objectives are not pursued in isolation from the emotional needs of grieving families. Formal integration of grief counselling into routine hospital-based services, particularly in settings where child mortality is prevalent, is necessary to promote compassionate, holistic care that recognises the full impact of bereavement.\u003c/p\u003e\u003cp\u003eSecond, while recognising the cost and staffing constraints within many healthcare systems, grief support services\u0026mdash;such as those provided by the CHAMPS program in South Africa\u0026mdash;should be strategically expanded and gradually institutionalised across healthcare facilities. To ensure sustainability, integration should begin with low-cost, scalable models such as basic grief counselling training for existing healthcare workers, community health workers, or lay counsellors. These services should not be limited to study participants but made available to all mothers who have experienced child loss, irrespective of the cause of death or medical setting. Prioritising equitable access to grief support, even within resource-constrained environments, acknowledges the critical role emotional care plays in maternal well-being and reinforces a more holistic approach to health service delivery.\u003c/p\u003e\u003cp\u003eThird, training for healthcare professionals involved in child mortality cases should include components on respectful bereavement care, trauma-informed communication, and cultural sensitivity. This would enhance professional conduct and reinforce the importance of empathy, altruism, and emotional support during some of the most difficult moments families face.\u003c/p\u003e\u003cp\u003eFinally, policymakers should recognise grief as a public health concern and allocate adequate resources to support grief counselling services at the primary healthcare level. Institutionalising grief support within national health policies will help bridge the existing gap between medical procedures and emotional recovery, ensuring that bereaved mothers receive the holistic care they deserve.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings from this study illuminate the multifaceted value of the Minimally Invasive Tissue Sampling (MITS) procedure\u0026mdash;not only in advancing medical understanding of child mortality but also in supporting bereaved families\u0026rsquo; need for answers and closure. While MITS provides crucial diagnostic clarity and contributes to research, policy, and ethical medical practice, its implementation must be accompanied by a parallel commitment to psychosocial care. The experiences of bereaved mothers reveal a significant gap in current healthcare systems, where the pursuit of clinical knowledge often overshadows the emotional, cultural, and psychological needs of those most affected by child loss. The integration of long-term grief counselling into the CHAMPS program in South Africa represents an important and commendable shift toward holistic care. To build on this model, grief counselling should be formalised as a core component of maternal and child health services at the primary healthcare level. Doing so not only honours the profound emotional journey of bereaved mothers but also aligns with global best practices in compassionate, patient-centred care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the study participants who were willing to share their stories even at the most difficult time of their lives. The authors would also like to acknowledge the amazing work of the grief counsellor. Furthermore, the authors express their gratitude to the Child Health and Mortality Prevention Surveillance (CHAMPS) Network in Soweto, Johannesburg, South Africa, for their valuable technical support in conceptualisation and implementation of this project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eNellie Myburgh conceptualised the idea of the study, managed data collection activities, analysed data and wrote the first draft of the manuscript. Duduzile Ziqubu assisted in data collection and provided grief counselling. Lunghile SHivambo and Lerato Ntsie assisted in data collection and transcription of the data. Maria Maixenchs and John Blevins made inputs and reviewed the manuscript. Ziyaad Dangor reviewed the manuscript. Shabir Madhi was the principal investigator on the overall CHAMPS Programme at the Soweto site - which part of a multi-site programme. All aithors contributed to the discussion of the study findings and approved the final manuscript, and agreed to be accountable to the work presented herein.\u003c/p\u003e\n\u003cp\u003eFunding information\u003c/p\u003e\n\u003cp\u003eThis study is part of the Child Health and Mortality Prevention Surveillance Network in Soweto, South Africa, and it was funded by the Bill and Melinda Gates Foundation (Grant Reference number: SDGF/VDE4/670/2021-803). The funding agency had no role in the studyThe authors therefore express their appreciation to the Bill and Melinda Gates Foundation for providing the funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study and article are available from the corresponding author, Nellie Myburgh upon reasonable request, subject to potential restrictions.\u003c/p\u003e\n\u003cp\u003eAll participants in your study were \u003cstrong\u003einformed about the research\u003c/strong\u003e, and they all \u003cstrong\u003evoluntarily agreed to take part\u003c/strong\u003e. All participant provided consent to participate in the study \u0026ndash; to this written informed consent was obtained from all participants prior to their inclusion in the study. Participants were provided with detailed information about the study objectives, procedures, and their rights, including the right to withdraw at any time without consequence.\u003c/p\u003e\n\u003cp\u003eEthical approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the University of the Witwatersrand Human Research Ethics Committee (Wits HREC), under clearance number 160614. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their participation in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.\u003c/p\u003e\n\u003cp\u003eDisclaimer\u003c/p\u003e\n\u003cp\u003eThe views and opinions presented in this article are solely those of the authors and are derived from their professional research. They do not necessarily represent the official policies or positions of any affiliated institutions, funders, agencies, or the publisher. 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Psychol Health Med. 2014;19(3):247\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"South Africa, bereavement, grief counselling, trauma, children death, MITS, qualitative, thematic analysis","lastPublishedDoi":"10.21203/rs.3.rs-6890320/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6890320/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Maternal grief has long been recognised as the most profound and unique of all grief, especially when a mother loses a young child. Knowing the cause of death is one way of beginning a long journey towards healing. Minimally Invasive Tissue Sampling (MITS) is a procedure used to determine the cause of death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An exploratory qualitative study was conducted at Chris Hani Baragwaneth Academic Hospital, Soweto, South Africa to understand bereaved mothers’ experiences of grief counselling after consenting to MITS conducted on their deceased children. Ten Key Informant Interviews (KIIs) were conducted with bereaved mothers (ages 18-32 years old) who had consented to the MITS procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study revealed that bereaved mothers experienced profound psychological and emotional distress following the death of a child, with dominant themes of pain, trauma, hopelessness, and self-blame. Mothers described their grief as overwhelming, prolonged, and physically and emotionally debilitating—often likening it to being choked or dying inside. Those who experienced Caesarean births or multiple child losses reported intensified suffering, and some resorted to harmful coping mechanisms such as alcohol use or expressed suicidal ideation. The sudden and traumatic nature of child loss left many in shock, disbelief, and existential despair, compounded by feelings of frustration, denial, and internalised blame. Despite these challenges, grief counselling emerged as a critical source of emotional relief and healing. Mothers reported that counselling, especially when integrated with prayer, provided comfort, strength, and a renewed sense of hope and coping. The sessions fostered spiritual connection, emotional reassurance, and the ability to begin envisioning a path forward. Many participants expressed appreciation for the emotional support received and reported diminished guilt and a greater sense of acceptance. These findings underscore the urgent need to integrate culturally and spiritually sensitive grief counselling into routine healthcare services for bereaved mothers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings from this study revealed that long-term professional grief counselling is an urgent intervention that should be offered at the primary healthcare level. As a recommendation, grief counselling should be included in the healthcare systems as a standard of care for those who are bereaved and failing to cope.\u003c/p\u003e","manuscriptTitle":"Grief Counselling: A Soothing Balm for Bereaved Mothers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:49:58","doi":"10.21203/rs.3.rs-6890320/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0152ca94-7c9c-40a0-ba8a-c1ac096aa50e","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T05:54:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:49:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6890320","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6890320","identity":"rs-6890320","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}