Perinatal Grief Scale

Learn about the Perinatal Grief Scale used in assessing grief after perinatal loss. Understand its use, scoring, and how to support grieving parents.

By Nate Lacson on Aug 2, 2025.

Fact Checked by Ericka Pingol.

Use Template

What is the Perinatal Grief Scale?

The Perinatal Grief Scale (PGS) is a psychological assessment tool developed by Toedter, Lasker, and Alhadeff in 1988. It is primarily used to measure emotional and psychological responses following perinatal loss, including miscarriage, stillbirth, and neonatal death. The scale helps healthcare professionals, and researchers assess the depth and nature of grief experienced by bereaved parents after such a loss. While the scale is predominantly used for research purposes, it can also serve as a diagnostic tool to help clinicians identify the risk of conditions like major depressive disorder or anxiety that often accompany the loss of a child during the perinatal period.

Perinatal grief refers to the intense emotional pain and sorrow felt by parents following pregnancy loss or the death of the baby within the first few weeks after birth. This grief can manifest in various ways, such as sadness, anger, guilt, or physical symptoms like exhaustion and headaches, severely impacting both mental and physical health. Perinatal loss includes miscarriage, stillbirth, and neonatal death, each of which may trigger a different intensity and pattern of grief depending on personal circumstances and support systems. Further research on perinatal grief is essential to enhance mental health interventions, inform healthcare policies, and improve the support offered to individuals coping with such losses.

The PGS offers healthcare professionals a structured way to assess the emotions surrounding perinatal grief. By identifying the emotional and psychological aspects of grief, the PGS provides insights that can guide personalized care plans, whether for therapeutic interventions, support groups, or follow-up treatments for physical health concerns linked to grief. It also enables researchers to measure the prevalence and severity of grief in various populations, contributing to better resources and policy changes.

It's also important to differentiate the PGS from the Perinatal Bereavement Grief Scale (PBGS), developed by Ritsher and Neugebauer. While the PGS measures the overall emotional impact of perinatal loss, the PBGS was specifically designed for distinguishing grief from major depressive disorder following miscarriage. The PBGS focuses on clarifying the overlap between grief and depression, whereas the PGS takes a broader approach, assessing grief across a range of perinatal losses, including neonatal death.

Perinatal Grief Scale Template

Use Template

Download

Download PDF Template

How to measure Perinatal Grief using the scale?

The PGS is a commonly used tool for assessing emotional responses to perinatal loss. Our template provides the 33-item short version, the most accessible due to its brevity while maintaining comprehensive coverage of grief dimensions. It can be applied in both research and clinical settings to gather important data on the emotional well-being of individuals affected by perinatal grief.

Step 1: Access the template

To get started, access the Perinatal Grief Scale template by clicking the "Use template" button, which opens it in the Carepatron app. This app allows customization, sharing, printing, and filling out the form digitally. Alternatively, you can download a fillable, non-customizable PDF version by clicking "Download."

Step 2: Administer the survey to the respondent/s

Once the template is ready, administer the survey to the patient or respondents. Ensure they understand the instructions, emphasizing that there are no right or wrong answers. The PGS is designed to capture current emotional states, so respondents should reflect on how they feel. If used in a clinical setting, provide a comfortable environment and allow enough time for completion.

Step 3: Calculate the responses

After the respondents have completed the survey, calculate the scores. Each item is rated on a 5-point Likert scale, with items 11 and 33 scored directly and all others requiring score reversal. The summed scores provide an overall grief score and individual scores for the three subscales: active grief, difficulty coping, and despair.

Step 4: Compile and analyze the data

Once scoring is complete, compile the data. Depending on the context, this could involve analyzing scores for individual patients to monitor emotional health or aggregating data for research purposes. Analyze trends or emotional patterns that emerge from the subscale scores.

Step 5: Use the data for patient care or research reports

For healthcare professionals, use the data to create individualized care or therapy plans that address the patient's specific grief needs. The results can guide conversations about mental health interventions and provide tailored support. For researchers, the compiled data can be utilized in reports to further understand the scope of perinatal grief and its impacts, contributing to the broader understanding of mental health post-loss.

Scoring

Scoring the PGS involves summing up responses to the 33 items, with certain items reversed to accurately reflect the intensity of grief. The scale provides an overall grief score and three subscale scores: active grief, difficulty coping, and despair. Each subscale consists of 11 items. Scores range from 11 to 55 for each subscale, while the overall score ranges from 33 to 165.

The first step in scoring is to reverse the responses for all items except items 11 and 33 so that higher numbers consistently indicate more intense grief. Once reversed, add the scores to obtain the total PGS score and individual subscale scores.

There is no universally accepted cutoff score for the PGS, as the scale is flexible depending on the research or clinical context. Generally, higher scores across the subscales and the overall scale indicate more severe grief reactions. In clinical settings, a higher total score may suggest the need for psychological interventions, such as counseling or therapy. If used for diagnosis, combining the PGS results with clinical judgment and other assessments is important to fully understand the patient’s emotional state.

These are the three subscales in the PGS:

Active grief

This subscale assesses the immediate emotional responses to perinatal loss, such as sadness and yearning. A higher score indicates a more intense emotional reaction to the loss.

Difficulty coping

This subscale measures how well the individual manages their daily life following the loss. Higher scores suggest greater difficulty coping with the loss and maintaining routine activities.

Despair

The despair subscale evaluates feelings of hopelessness and low self-worth after the loss. Higher scores point to a deeper sense of despair and helplessness in navigating traumatic grief.

Next steps after using the scale

After completing the Perinatal Grief Scale, healthcare professionals and researchers can take several key actions:

Analyze the data: Use the scores to evaluate the intensity of grief and identify patterns that may require further intervention or support.
Develop a care plan: For individual patients, integrate the PGS results into a personalized care plan, including counseling or therapy to address intense grief reactions.
Policy development: Researchers may use the survey data to inform policies and programs aimed at improving emotional and physical health support for those experiencing perinatal grief, such as forming support groups, counseling, bereavement leave, community outreach, and even health programs that reduce risk factors of perinatal death.
Monitor progress: Regularly reassess patients or study participants to track changes in grief intensity over time.

Commonly asked questions

The three C’s of grief are Coping, Change, and Connection. These represent how individuals manage grief, adapt to life changes, and maintain emotional connections after a loss.

Perinatal loss includes miscarriage, stillbirth, ectopic pregnancy, neonatal death, and infant death. Each type refers to the death of a baby during pregnancy or shortly after birth.

Grieving the loss of an unborn baby involves seeking emotional support from loved ones, counseling, joining support groups, and allowing oneself time and space to process the loss. This complicated grief is especially important to address, especially as it affects a mother's overall physical health, the parents' marital relationship, and any subsequent pregnancies.