We want to welcome Hannah Mirmiran back to ‘What’s Your Grief’ to continue our discussion about grieving after pregnancy loss. Hannah is a Licensed Clinical Social Worker who works as a Psychotherapist at Omaha Integrative Care in Omaha, Nebraska. She has a personal and professional link to grief work as it relates to pregnancy loss and she has generously poured some really awesome information into this post including:
Information on grieving in a meaningful way
Ways to support someone who has experienced a pregnancy loss
Books and online resources
Okay, take it away Hannah…
The fabulous Litsa posted an excellent weekend edition recently highlighting various resources and posts from around the web about miscarriage and stillbirth. Thankfully this is a subject that more and more people are speaking openly about.
To continue the momentum of speaking about this subject, this post is a continuation in our series about pregnancy loss. In my first post the feelings and experiences common after a miscarriage or stillbirth were identified. We focused on loneliness, anger, sadness, and guilt in particular. This post is aimed at providing some helpful suggestions and tools for grieving. Also included are some suggestions for how you can provide support to loved ones in your life who have experienced pregnancy loss.
As the first post discussed, pregnancy loss is unexpected and traumatic. It can be devastating. Unfortunately, it’s also fairly common with estimates that almost one in four pregnancies ends in loss. But just because it happens frequently, it doesn’t make it any less painful when it happens to you. Even if a miscarriage happens early in a pregnancy, it is painful. Pregnancy loss is a significant loss and like any loss, it necessitates a grieving process.
So how can you grieve a pregnancy loss? It’s so different than the death of a parent or grandparent and there are not many prescribed rituals, and yet it is important to grieve. No two losses are the same and no two people grieve in exactly the same way. There isn’t a right or wrong way to grieve, but there are some tools that may be helpful along the journey.
While a loss will obviously be different for a mother who suffers a stillbirth, perhaps just days before the expected due date, and a mother who miscarries days or weeks into the pregnancy, any mother who is pregnant and then learns that the pregnancy has ended unexpectedly and without the delivery of a healthy baby will go through similar feelings. This is about grieving the loss of a child and the loss of a dream, regardless of the circumstances of the loss.
For most people, the six months following the loss of a pregnancy are the most difficult. It’s normal to cycle through a roller coaster of emotions including sadness, denial, shock, guilt, anger, disbelief and depression over and over. The feelings may change day to day or even minute to minute. The important thing to know is these feelings are all normal and they are not constant. Usually, the intensity of the emotions tends to decrease as time progresses. While these emotions don’t last forever, they are incredibly real and can take your breath away.
If you have experienced a pregnancy loss, here are some suggestions about how you might grieve in a meaningful way.
- Acknowledge that this is a big loss. Women who miscarry early in a pregnancy may feel like they should be able to “get over” the feelings of disappointment and sadness because the loss was early in the pregnancy. Very common reaction, but not very reassuring since it just makes you feel guilty about feeling sad which you are feeling anyway. It’s important to acknowledge that regardless of how far along the pregnancy was, or what type of loss you’ve endured, this is a significant loss and you can give yourself permission to grieve. A baby has been lost. This baby may already have a nursery, a crib, a name, and a college savings fund. It’s a big loss.
- Allow yourself to feel all of your feelings. Be sad, be angry, be in shock. Just allow yourself to be where you are. Feel your feelings deeply and know that they won’t last forever. Many women find it helpful to allow themselves to cry. Many of the women with whom I’ve worked have found it incredibly useful to cry in the shower where they have the privacy, freedom and space to sob, weep, and really be with the sadness. Letting them out gives the feelings some space. Sometimes if you can give yourself permission to cry and feel sad, it makes space for other feelings. I like the analogy of the exploding refrigerated can of biscuits or cookie dough. Once the can pops open and the dough seeps through, you can’t ever stuff the biscuits back in there. If you carefully open the package within the expiration date, you can take out each biscuit in a thoughtful way. It’s way less messy.
- Try not to compare your grief. It’s so easy to compare your grief with the grief of others. This goes both ways. You might try to convince yourself that because your loss was early, you don’t deserve to feel as sad as a woman who has experienced a later loss. Or perhaps you’ve had a stillbirth and find yourself feeling as though your loss isn’t as substantial as the death of a two year-old. Or maybe you have experienced the death of an infant but you can’t fathom why mothers who have had miscarriages would even feel sad. It isn’t the same. No two losses are the same. Your loss was traumatic and you are sad and that is what matters.
- Take care of your physical needs. When a woman experiences a pregnancy loss, there are many things that happen to her body. While the emotional impact of a pregnancy loss is clearly painful, the physical pain is also significant. Bleeding, cramps, pain, and discomfort accompany nearly every miscarriage and pregnancy loss. Depending on how far along the pregnancy had progressed, you may have delivered the baby or undergone a D&C procedure to remove the fetus. Your body may begin to produce milk, and the hormonal changes that occur as pregnancy ends have a tremendous effect on mood and emotions. Post-partum depression is something that can happen as well. After a pregnancy loss it is very important to take care of yourself. You may find it helpful to take some time off from work, and depending on your company’s policies, you may be entitled to maternity leave or family leave. It’s important to drink lots of fluid, rest as much as possible, and follow-up with your medical provider for after-care.
- Know you are not alone. Unfortunately, there are many other people who have experienced the loss of a pregnancy and there is a whole community of women who self-identify as “baby loss moms”. Most cities have support groups for pregnancy loss and infant death and these can be a wonderful resource. If your community doesn’t have a group up and running, there is a lot of support on-line. Look for a list of on-line resources at the end of this post.
- Know that everyone grieves differently. Each of us needs support in different ways. Some people need privacy and others need to talk through the experience with many, many people. Some people find it helpful to journal or even start a blog of their own, and others don’t have the patience to write anything. There isn’t a right or wrong way, the important part is knowing what feels best to you and then doing it.
- Reach out for support. Eleanor wrote an excellent post about seeking support (http://www.whatsyourgrief.com/support-system-superlatives-a-journaling-exercise/). If you share the loss with others, chances are that they will ask you what you need or they may say, “let me know if there’s anything I can do.” It’s good to have a few suggestions for letting others know exactly what they can do that will be supportive. Suggestions might include help with groceries or dinner, assistance entertaining other children, joining you for a walk or a movie, contacting other friends for you, returning maternity clothes, or just sitting with you while you cry.
- Try and let go of guilt. Guilt is not productive and it’s often a dangerous spiral. It’s very common to try to figure out why the loss has occurred. It’s also common to blame yourself, maybe for drinking that glass of wine before you knew you were pregnant, or for taking an Advil or working out too strenuously. Most likely, there is nothing you did to contribute to the loss. Know that you did all you could do.
- Expect some bumps in the road. One of the most inspirational clients I’ve ever worked with lost her son when she was 28 weeks pregnant with him. She so wisely coined the term, “train wreck moments” which she described as “moments when a barrage of uncontrollable thoughts, that you don’t see until the last minute, are approaching but you’re already traveling so fast toward them you can’t find the brakes. And in the end, you know they are going to cause more damage than what you know what do with at the moment, but there is nothing you can do to stop it.” These “train wreck moments” may happen when you find out that a friend or relative is pregnant soon after your loss, or when you see your favorite grocery checker or hairdresser who knew you were pregnant and then asks how many weeks are left in the pregnancy without knowing about the loss. Or when you open your e-mail to discover a message from a pregnancy website congratulating you on making it to the next milestone in the pregnancy. You may be able to avoid some of these moments by unsubscribing from certain websites, notifying professionals in your life, and avoiding certain interactions, but there are often unavoidable train wreck moments. It can be incredibly logistically difficult to make yourself “unpregnant”. Sometimes just expecting that there will be some bumps helps to make them a little easier to endure when they do happen.
- Expect some people to say some stupid things. Unfortunately, in their attempts to make you feel better or to alleviate their own anxiety, some people might say things that don’t feel great to you. You may hear that “this is nature’s way,” or “it was for the best,” or “you can always try again,” or “at least you already have one child” or “at least the baby is in a better place now,” or “at least you know you can get pregnant.” Usually, the person who is making the comment isn’t being intentionally cruel, but just doesn’t know what to say or do. These comments can sting. In addressing your own grief, you probably won’t have the energy to provide a lot of education or counseling to others about why these comments don’t make you feel better, so it’s usually helpful if you just say, “thank you” and then decide whether you’d like to address it at a later point.
- Limit your exposure to Facebook. After you’ve experienced a loss, a glance at Facebook can be like looking at a perfectly airbrushed album of the picture-perfect lives of others and a glaring reminder that others have exactly what you don’t have and desperately want. Sometimes just seeing a pregnancy announcement or ultrasound picture can send you running for the ladies room while sobbing. If many of your Facebook friends are expecting children, might be likely to announce pregnancy, or frequently post baby pictures, you may want to temporarily block those friends so you don’t have to see pictures that might be upsetting. Some people find it helpful to take a social media sabbatical for a period of time until the painful feelings begin to decrease in intensity. It can also be helpful to apply the old adage that we often “compare our insides to others’ outsides” and to remember that we never really know what is going on for another person based on their Facebook wall. Chances are that even that perfectly-airbrushed friend has experienced loss or a hardship at some point.
- Say goodbye: There isn’t really an official protocol on how to appropriately recognize the loss of a pregnancy. And yet, at some point in your grieving process, it may be helpful to do something to recognize the loss. Deciding to honor your loss with a ritual is a very personal decision and there are many possible options. Some parents choose to hold a funeral or memorial service for the baby. Others choose to send out birth announcements with information about the loss. For parents who experience an earlier miscarriage, they may find it helpful to recognize the loss in a more personal way, perhaps purchasing an ornament or piece of jewelry or releasing a balloon. Others may choose to plant a tree or flower in memory of the baby, offer a monetary donation to a meaningful organization, or provide a book or other gift to a church, library or school. Such rituals are concrete actions that can help give the loss meaning and serve as a way to honor your own grief. Many people also find it helpful to create a memory box filled with memories from the pregnancy. These might include pictures, ultrasound images, a pregnancy test, a list of potential names, and perhaps a letter each parent writes to the baby. I’m a huge proponent of writing. Journaling and letter writing can be very effective tools in the grief process.
- Take care of yourself. Self-care is critical for physical, emotional, and spiritual healing. Physically, it’s important to take care of your body and ensure you are healing. Follow-up with your healthcare provider as needed, drink water, walk, rest. When you are ready, you may find it helpful to try yoga or other gentle exercise. Or you may find it very helpful to engage in more strenuous activity like running when you have been cleared by your doctor. I know that as a therapist, I’m biased, but I truly believe that everyone can benefit from counseling and support from a third party. Especially if you are struggling with sadness, guilt, and anger and these feelings aren’t seeming to decrease with time, working with a grief counselor, therapist, chaplain, and/or psychiatrist can be very helpful. Depression is common after pregnancy loss and it’s important to address it early.
Perhaps someone close to you has experienced a pregnancy loss and you’re wondering how you can be supportive. Maybe you were also connected to this pregnancy as a grandparent or aunt or uncle. Or maybe you and your best friend were pregnant at the same time and now one of you has experienced a loss. These are all tough positions and it’s important to acknowledge that you may also be grieving. What are some ways you can offer support?
- Acknowledge the loss. If you learn that someone you care about has experienced a pregnancy loss, the first step is to recognize it. Reach out and let the person know that you are sorry for the loss and then offer something that you know you’ll be able to provide. Try to offer something specific that is doable for you. That could be taking your friend out for tea, bringing over dinner, or just sitting and listening.
- Listen. Often, parents who have lost a pregnancy want to talk about the loss, to talk about the baby. In the early stages of loss, it can be incredibly important to have someone sit with you, listening attentively and acknowledging your feelings.
- It’s okay to say that you don’t know what to say. None of us are born knowing exactly how to support a grieving friend. Sometimes the most honest thing is the most helpful. Saying, “I know you are hurting and I feel helpless. I know I suck at this, I want to help but I don’t have a clue of what to say or do” might incredibly well received.
- Don’t give unsolicited advice. When your loved one hurts, it is only natural to want to make her feel better. I think our natural inclination is to want to make it better, stop the hurt, put on band-aids and take away the pain. Unfortunately, after a pregnancy loss, there isn’t anything anyone can do that will take away the pain. The pain will subside with time, but it needs space. The hardest but most important job of supporting someone in pain is to just sit with the pain. It’s common to want to offer some suggestions like “you guys should try again soon”, or “I think if you come to church more often you’ll feel better”. A grieving person may hear those words and interpret them as advice that they are doing something wrong, and that’s not a great way to feel in the midst of a loss.
- Don’t try to give meaning to the loss. In the same vein of unsolicited advice is unsolicited meaning. Trying to find meaning in any loss is normal. Chances are that your loved one is searching for meaning and asking many why questions. She may want to talk about these with you and that is great. But it can be hurtful if someone else tries to suggest some answers without prompting. These might include, “the baby is in a better place”, “I’m sure there was something wrong with the baby”, “sometimes this is nature’s way”, “God needed another angel”. These sayings can be hurtful and frustrating because they may not be true and they don’t tend to address the hurt and pain that the parent is feeling right after the loss. Yes, there might be another baby someday and this baby might be in a better place, but right now, that parent only wants this baby here on earth and is grieving the loss of this baby.
- Understand if there is distance. If your loved one isn’t responsive to your attempts to reach out, give her a little time and space. The parent who has lost a baby often goes through a period of shock and may be experiencing some post-partum depression. Also, if you are pregnant or have a new baby, it might be very difficult for your loved one to be around you because she may be experiencing real feelings of jealousy. This is very normal and it’s okay to acknowledge that this might be happening. If you are blocked, defriended or unfollowed, it’s okay—it’s usually not about you and about the other person taking care of herself.
- Don’t disappear. Even if your friend doesn’t seem receptive, keep reaching out. Send regular notes, texts, or e-mails, or call every few weeks to check in.
- Know that there isn’t a timeline. Everyone grieves differently and there isn’t an end date when the feelings go away. The loss is forever, but the feelings change. For many women who have experienced pregnancy loss, the physical healing happens before the emotional processing, and the grieving process can take many weeks and months. Be patient and be prepared to settle in for the long haul.
- Ask about the baby. Many bereaved parents want to talk about the baby and find it comforting to share the hopes and dreams they had for this child.
- Remember the big days. Recognize Mother’s Day and Father’s Day. Make a note of the anniversary of the loss to recognize it in future years. If you are aware of the expected due date, recognize the day when it approaches with a card or phone call.
- Take care of yourself. Supporting someone through grief can be draining and overwhelming. Make sure you are doing your own self-care and getting your own needs met.
Here is a list of additional resources that may be helpful:
“Empty Cradle, Broken Heart: Surviving the Death of Your Baby” by Deborah L. Davis
“Grieving the Child I Never Knew: A Devotional Companion for Comfort in the Loss of Your Unborn or Newly Born Child” by Kathe Wunnenberg
“What Was Lost: A Christian Journey through Miscarriage” by Elise Erikson Barrett
“Empty Arms: Coping After Miscarriage, Stillbirth and Infant Death by Sherokee Ilse
“Surviving Miscarriage: You Are Not Alone” by Stacey McLaughlin, PhD
For family or friends:
“How can I help? Suggestions for People Who Care About Someone Whose Baby Died Before Birth” by Martha Wegner-Hay
“Stuck For Words” by Doris Zagdanski