When a baby dies: grief and infertility, miscarriage, early neonatal loss and stillbirth
By Dina Goldstein Silverman, Ph.D.
Infertility is an extremely taxing journey. Emotionally, physically, financially, whether undertaken with a loving, supportive spouse or partner or as a single-parent-by-choice, infertility can seem like an overwhelming trail with no endpoint in sight.
Often, one may rejoice at a positive pregnancy test only to be sent into the depths of despair with a low beta at the next bloodwork appointment or no heartbeat at the next ultrasound. The physical stress of an early term miscarriage is taxing for any family, but for one that has struggled with infertility; the magnitude of a loss can seem devastating in its enormity. Early neonatal loss, defined as fetal mortality after 20 weeks of gestation, or a stillbirth of a much-desired pregnancy is truly tragic, although in modern Western culture, discussing such losses has been seen as taboo until fairly recently. Many couples who have suffered miscarriages, early neonatal losses or stillbirths, find themselves feeling alone in their grieving, as family members, friends and associates, struggle to provide support for such an exceptional loss. Many women grapple not only with sadness, grief and anger but also feelings of guilt and self-reproach as well as fears about their abilities to carry a subsequent pregnancy to term. If you have or a loved one has suffered a miscarriage, early neonatal loss and stillbirth, here are some strategies that may help to begin the healing process:
– Give yourself permission to feel a myriad of emotions, sadness and anger, guilt and fear. A loss of much-desired, much-hoped for child is a devastating tragedy. You may feel betrayed by your body or your partner’s body. You may feel like the medical system has failed you. You may worry about whether you will ever be able to carry a pregnancy to term. You are never wrong to feel what you feel. Practice self-compassion in allowing yourself to experience these emotions in the service of healing.
– Give yourself permission to feel resentful, jealous or anger towards others who are pregnant and give yourself permission to not attend triggering social events, such as baby showers or children’s parties for the time being. It may be helpful to discuss your options with a therapist about how to communicate about your miscarriage, early neonatal loss or stillbirth to extended family members, friends and acquaintances and co-workers, particularly co-workers who may not have known that you were pregnant. While attending to one’s social obligations is important, part of practicing self-compassion is minimizing exposure to triggering events. You may choose to send a present or a gift card but not attend a baby shower, and you may find it easier to write a thoughtful note rather than visit a new mother of a healthy newborn in the hospital.
– Give yourself time to heal your physical body. Reproductive loss can result in considerable physical pain and discomfort and may even be life-threatening in certain cases. The physical changes associated with reproductive loss can be similar to the post-partum physical changes, which can serve as a particularly aching reminder of the loss. A woman’s breastmilk may come in, so a consultation with a thoughtful lactation specialist regarding how to stop lactation would be important. A woman may still appear pregnant, so dressing in loose, comfortable clothing may help her feel more comfortable physically. When a woman is cleared to resume her exercise or wellness routine by her physician, returning to exercise can be particularly helpful in re-establishing confidence and a sense of security with one’s body. Strenuous exercise also helps the brain generate dopamine and endorphins that help produce positive emotions.
– Acknowledge the loss of your baby. Creating a ritual or following an established religious, spiritual or cultural practice for mourning can help a distraught couple begin the healing process. Some couples or families may find it healing to name the baby or to have formal funeral arrangements made for their infant. Others may find it comforting to have a remembrance photography session with their deceased child through Now I Lay Me Down To Sleep, a non-profit nationwide organization that trains and mobilizes volunteer professional photographers to provide tasteful photographs to help facilitate grieving and remembrance. If a professional photographer is not available, oftentimes NICU and other hospital personnel will create memory boxes of the infant’s foot prints and hand prints, photographs, locks of hair and other mementos, such as hats, booties and blankets. Even gathering ultrasound photos and hospital bracelets in a special album can serve as a healing ritual and help make meaning of the terrible tragedy.
– Ask questions. It is normal to feel anxious following a sudden unexpected loss of a baby. It may be helpful to discuss expected physiological changes, the cause of perinatal loss, implications for future reproductive plans, and possible medical and genetic testing going forward with your reproductive endocrinologist, your obstetrician-gynecologist and your high-risk pregnancy specialist. A consultation with a compassionate, patient and thoughtful physician can go a long way in providing comfort in times of grief and security and confidence in your ongoing reproductive decision-making.
– Ask for help in maintaining closeness to your partner or spouse. Your spouse or partner may experience the same intense grief, coupled with anxiety about your physical and emotional well-being. He or she may grieve alongside with you, express his or her grief differently or internalize his or her grief. In the aftermath of such an immense loss, it may help to seek couples’ counseling in order to facilitate ongoing intimacy. In particular, licensed psychologists with specialty areas in clinical health psychology, as well as licensed marriage and family therapists, may have additional expertise in addressing couple communication issues in the aftermath of a pregnancy loss or a stillbirth. Some couples find it helpful to join a support group through RESOLVE, the National Infertility Association, or Share, a National Pregnancy and Infant Loss Support organization or other national and local pregnancy and infant loss organizations. For those who appreciate social support from their peers, leaning on other couples that have lived through similar losses, can be immensely helpful. Your NICU social worker or the practice manager of your ob/gyn, RE or MFM office, may be able to direct you to resources in your area.
– Discuss the loss with your other children honestly, simply and age-appropriately. Children may feel overwhelmed and distressed by the loss of the baby and may need reassurances about their mother’s health and their own, as well as questions about their own mortality. It would be important to be concrete and use age-appropriate language to help explain to your other children what had gone wrong. It is also important to let them see your emotions, so that they learn that their sadness and worry are normal and valid. Avoiding or minimizing what happened may serve to make the child more anxious, and they would benefit from being included in the memorial service to attain their own closure. If a child asks about death, do NOT tell the child that death is like going to sleep, as that may serve to make the child anxious about bedtime. If you are hospitalized, it may be helpful to have your children visit you in the hospital to reassure them that you are in the process of recovery.
– Be careful about how you utilize social media and online resources. Social media and the Internet can be extremely powerful tools and provide a wealth of information and a lot of support. It can also be a disheartening, discouraging and downright disparaging environment. Multiple studies have shown that extensive use of social media can worsen existing depression. The perceived anonymity of the Internet oftentimes disinhibits behavior, and in a vulnerable emotional state, you can be easy prey for unscrupulous individuals. Your physician, your therapist, Resolve, Share and other national organizations can link you to reputable online tools. Limit your time on social media and try to find time to see your friends face-to-face for some invaluable in-person social support.
Losing a baby is devastating. However, with coping strategies and support, you can find healing and peace. You will never stop mourning the child that you lost, but you can learn to enjoy life again, and you will even find hope.
About the Author
Dina Goldstein Silverman, Ph.D., is an Assistant Professor of Psychiatry and Psychology in the Department of Psychiatry at Cooper University Hospital and Cooper Medical School of Rowan University in Camden, NJ. She is the author of numerous publications and has presented both regionally and nationally. Dr. Silverman is a member of the American Psychology Association and the Society of Behavioral Medicine.