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The risk of losing a baby during pregnancy ranges from 10% to 20%, particularly before weeks 12 and 13. According to the latest data from Spain’s National Statistics Institute, the country’s perinatal mortality rate is approximately four to five deaths per 1000 births. Each year, an estimated 1200-1500 families in Spain experience the loss of a baby during pregnancy, childbirth, or within the first days of life. These losses generally fall into three categories according to gestational age and timing of death: early pregnancy loss before week 22, intrauterine fetal death from week 22 onward, and neonatal death within the first 28 days of life.

The recently released Versa, a short film from The Walt Disney Company, has drawn attention to perinatal grief among clinicians and patients. Directed by Malcolm Pierce, who has worked in Disney Animation for 16 years, the film was inspired by a personal experience shared by Pierce and his wife, Keely Tateossian. In Versa, the film follows a young couple hoping to start a family, as they embark on an emotional journey that moves from excitement and hope to loss and grief through a cosmic, ethereal, and imaginative exploration of life. The short film portrays perinatal grief through symbolic imagery and visual metaphors that reflect the emotional experiences of pregnancy and loss.

“Versa” has attracted widespread attention on social media across healthcare and patient communities in both the US and Europe. The film has been widely shared and discussed in grief support forums, baby loss groups, and family support communities, as well as in professional settings related to obstetrics, neonatology, perinatal psychology, and primary care, among other specialties.

Carlos De Bonrostro Torralba, a gynecologist in the Unit of Maternal-Fetal Medicine, Department of Obstetrics, Miguel Servet University Hospital, Zaragoza, Spain, is among the healthcare professionals who have shared the short film on social media. His Instagram account, drcdebonrostro, has more than 60,000 followers.

Speaking with El Médico Interactivo, part of the Medscape Professional Network, De Bonrostro explained that audiovisual tools can play a significant role in raising awareness about experiences that remain poorly understood and heavily stigmatized. He noted that films such as Versa may help people better understand the emotional process patients and their families experience after such a diagnosis, while also encouraging greater empathy toward perinatal loss. He added that a well-developed short film could serve as a valuable educational tool when addressing an issue that is both complex and deeply painful.

Another example of how culture reflects this reality is Hamnet, Maggie O’Farrell’s 2020 novel, and its forthcoming film adaptation. The story traces the death of a child and the quiet yet overwhelming sorrow that settles over the family in its aftermath. Through this intimate portrait of grief, O’Farrell gives voice to an experience that is often left unspoken and unseen.

Clinical Recognition

De Bonrostro noted that perinatal grief historically has been underestimated and, at times, rendered invisible. Some experts classify it within the concept of “unacknowledged grief,” referring to losses that are not always socially or institutionally recognized as legitimate bereavement, potentially complicating emotional processing, and expression.

“Scientific evidence shows that pregnancy or neonatal loss can be linked to anxiety disorders, depression, posttraumatic stress, and even effects on subsequent pregnancies if not effectively managed. Therefore, from a healthcare perspective, addressing this issue is essential because we professionals are often the first and primary point of contact following the loss. The way the news is communicated, the support provided, and the care given — such as allowing contact with the baby, facilitating memories, or respecting each couple’s timeline — have a direct impact on the grieving process,” he noted.

He added that there have been significant advances in how professionals address perinatal grief. “There are clinical guidelines, protocols for humanizing care, and greater sensitivity. However, there are still areas for improvement,” he said.

From a clinical standpoint, the approach does not end with the loss but extends to subsequent pregnancies, known as “rainbow pregnancies.” These require specific monitoring, which includes increased ultrasound surveillance not only for medical reasons but also as a measure of emotional support to reduce maternal anxiety. Likewise, multidisciplinary coordination between obstetrics and perinatal mental health teams is recommended starting in the first trimester, with the goal of providing comprehensive care that addresses both physical and emotional aspects.

National Protocols

In Spain, care for perinatal bereavement is increasingly structured through clinical guidelines, protocols, and manuals. These documents are not uniform across the country; in many cases, they vary by autonomous community and by individual hospitals or health services that have developed their own procedures to standardize care.

The Generalitat de Catalunya Perinatal Grief Guide, the Extremadura Health Service Guide, the Murcia Region Perinatal Grief Guide, and the Sergas Perinatal Care Documenta are some examples, in addition to other initiatives such as the Madrid region’s guidance on gestational and neonatal grief and respectful maternity support.

Several hospitals in Spain have implemented dedicated perinatal grief protocols, including the Vall d’Hebron Hospital in Barcelona, regarded as a pioneer in this area. Other institutions with specific perinatal grief guidance include Hospital General Universitario Gregorio Marañón, Marqués de Valdecilla University Hospital in Santander, Hospital del Vinalopó in Elche, and Dr Peset University Hospital in Valencia. Additional reference materials have been developed by organizations including the Menudos Corazones Foundation, Umamanita, Crisálida, and the “Let’s Talk About Grief” initiative from the Mario Losantos del Campo Foundation.

There are also reference documents developed by organizations to improve the quality of care and emotional support for families. These include the Perinatal Grief Guide by the Fundación Menudos Corazones, the guide by Umamanita, and the guide by Crisálida and the “Let’s Talk About Grief” (Hablemos de Duelo) initiative developed by the Mario Losantos del Campo Foundation.

In this context, and from the perspective of evidence-based-medicine, validated clinical assessment tools have also been developed, such as the Perinatal Grief Scale, the most widely used international instrument for measuring the intensity of grief and for the early detection of the risk for major depression or posttraumatic stress disorder in parents.

Family Support and Role of Healthcare Professionals

Finally, scientific societies, such as the Spanish Society of Gynecology and Obstetrics, have published guidelines that help standardize clinical approaches to perinatal bereavement within the Spanish healthcare system.

The gynaecologist believes that healthcare professionals play a central role, “far beyond clinical management,” one that “requires a range of skills.” She stressed the importance of clearly communicating the diagnosis and the next steps, as well as acknowledging the grief of the patient and her family.

Similarly, Speaking with El Médico Interactivo, Laura González, a volunteer and supervisor of the support team at Umamanita — a pioneering Spanish association dedicated to supporting mothers, fathers, and families coping with perinatal and neonatal death — discussed the essential role of healthcare professionals in perinatal grief. “They are the first to deliver the terrible news and to accompany families throughout the process. In many cases, these moments are relived repeatedly, and what remains is not just what happened, but how it happened: the words chosen, the silences, the looks, and the gestures. That is why training in perinatal grief, along with empathy and humanity, makes a real difference. If we can look back on our time in the hospital or clinic with some sense of comfort, despite the pain, we can begin the grieving process from a more advanced starting point. That initial support cannot erase suffering, but it can prevent additional suffering and help families move through grief more healthily,” said González.

It is important to help families make decisions about whether to see the baby, preserve memories, or choose how to say goodbye. “Optimal care reduces the risk of complicated grief, while negative experiences can make it more difficult,” said De Bonrostro “It is essential to offer choices without imposing them — and to re-offer them later. In my experience, when they suggested that we take our daughter or keep mementos of her, we initially said no. I am so grateful that they gently suggested it again. At first, you just want the nightmare to end; you are in shock and make decisions without thinking, which you may later regret — especially the things you did not do,” said González.

In her experience, it is vital to acknowledge the baby’s existence and the identity of the parents. Healthcare professionals should ask whether there is a chosen name and, if so, use it, refer to the baby as a son or daughter, and address the family from that perspective. “These are small gestures, but they are deeply healing,” she said. “When a team member has gone through a similar experience, it can help families realize that, even if it does not seem possible at the time, life goes on, and that fosters a greater sense of understanding. That is why the members of the support team introduce themselves as mothers, to convey closeness and show that they are there not only as professionals but as people who have lived through perinatal grief,” she added.

Memories and Farewell Rituals

When grief intensifies, memories become an anchor — the only tangible traces left of those sons’ and daughters’ existence. “Their four little footprints, a blanket, a hat, or a stuffed animal take on immense value. Photographs too offering the family the chance to take them, even if they initially say no because they will only have that one moment to see their baby’s face,” said González.

In this context, some hospitals have introduced technological resources such as the CuddleCot or cooling cot, a temperature-controlled cooling system that slows the body’s natural decomposition process and allows parents to hold, cuddle, and spend meaningful time with their baby after death. This enables families to stay with their child for as long as they need in the hospital room, fostering a more peaceful farewell and helping them create memories in a calmer, more intimate setting.

“Being able to hold them, talk to them, or even dress them are moments that stay with you forever and help you come to terms with the existence of your son or daughter and their passing. It is important for healthcare staff to offer families these opportunities to spend time with their baby and to create the memories they feel able to form,” she added. In this regard, other resources such as memory boxes and informational brochures are invaluable, both for families and healthcare professionals who request materials from different regions of Spain.

“Anything that helps bring perinatal death and grief into the open and makes them visible ensures that families do not feel isolated or invisible. Talking about it through film, literature, music, or the media allows this reality to become part of the wider social conversation.” She said, referring to Versa.

The short film also becomes a valuable resource for explaining to children what has happened to their brother or sister because they too need to process their grief and understand what happened in their own way. “Sometimes families contact us asking for resources to explain their sibling’s death to their other children, and Versa will certainly join the materials we already provide on our website,” concluded González.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.