Archives for December 2011

The following segments are derived from extremely helpful slideshows presented by credible professionals in the field of grief and loss.  I’ve put them in this written format to ensure that anyone can access them easily.   I’d strongly encourage you to please visit the links at the end of each section, as each slideshow has a tremendous amount of information regarding the NICU, loss, and grief experiences.

What is Grief? (27)

• Grief is a normal response to an abnormal life event.
• A grieving person may experience physical and emotional symptoms along with intellectual, social and occupational responses.
• Grieving people may also question their spiritual beliefs; many experience a crisis of faith as part of the grief response.

The Body’s Response to Grief (28)

• A person experiencing a loss may experience somatic (body) complaints that include: fatigue, aches, insomnia, gastrointestinal symptoms, nausea, chest pressure, palpitations, shortness of breath, back pain, stomach pains, anxiety and panic attack.

Stages of Grief (30)

• Stages of Grief – DABDA
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• These stages should only be viewed as a tool to help frame and identify what a grieving person might be feeling, not absolutes of what they should be feeling or experiencing.

Tasks of Grief (31)

• In the 1980’s, William Worden looked at grief as a series of tasks that one works through:
• Task One: to accept the reality of the loss
• Task Two: to work through the pain of grief
• Task Three: to adjust to a different type of environment
• Task Four: to emotionally relocate the loss (deceased) and move on with life

Key Facts about Grief (32)

• Pastor Bob Deits, author of Life after Loss, a classic in the field of loss and grief, describes four key facts about grief:
• The way out of grief is through it.
• The very worst kind of grief is yours.
• Grief is hard work.
• Effective grief is not done alone.

Companioning the Grieving (33)

• Alan Wolfelt, Ph.D. talks of companioning as:
• honoring the spirit.
• learning from others.
• being curious and being still.
• walking alongside.
• listening with the heart.
• bearing witness to the struggles of others.
• being present to their pain.
• respecting disorder and confusion rather than imposing order and logic.
• Companioning is NOT about thinking you are responsible for finding the way out of grief.

Intuitive (Emotional) Grievers (46)

• Intuitive grievers feel grief intensely and find expressing emotions by talking or crying is helpful.
• They are comfortable with expressing strong emotions, are sensitive to their feelings, and are aware of the feelings of others.
• Sharing feelings about the loss and providing support to others can be very healing for the intuitive griever.
• The intuitive grief style or emotional style is the one often associated with the typical female grief.

Instrumental (Physical) Grievers (47)

• Instrumental grievers experience grief, but it is less intense or emotional and more physical than the intuitive griever.
• Instrumental grievers like to think or problem solve ways of coping with the experience.
• For instrumental grievers the grief tends to be more private or hidden.
• They may be reluctant to talk about their feelings.
• The instrumental grief style or physical style is the one often associated with the male grief.

The above information is borrowed from the work of Kirsti A. Dyer MD, MS, FAAETS, NCBF Physician, Grief Educator, College Instructor from the Grief in the NICU: Identifying, Understanding and Helping Grieving Parents slideshow (marked by number)

Basics of Coping (34)

• Take it one hour at a time, one day at a time.
• Maintain a normal routine.  Keep doing normal activities.
• Get enough sleep or at least enough rest.
• Try to get some regular exercise; even walking helps relieve stress, tension and improve moods
• Maintain a healthy, balanced diet.  Limit junk food.
• Drink plenty of water.
• Avoid using alcohol or other drugs to mask the pain.
• Do those things and be with those who comfort, sustain and recharge you.
• Remember past losses and the coping strategies used to survive them.  Use these inner strenths again.

Remember TAKE CARE:

• Time is needed to handle the grief.
• Avoid alcohol or other medications.
• Keep to some routine or schedule.
• Eat a balanced diet.  Focus on healthy foods and water.
• .
• Converse with others, especially those who have “been there” and “survived that.”
• Art can help keep the hands busy, whether journaling, building, crafting, or other.
• Rest and sleep are important to help the body heal.
• Exercise to reduce stress and improve one’s mood.

Helpful Strategies (35)

Initial Minutes:

• Reassure parents that what they are feeling is normal.
• Listen to their story of loss.  It provides comfort.

Early Hours:

• Advise parents about available resources.
• Share information that others have found helpful.

Later (Weeks):

• If a parent remains distressed after several weeks or is profoundly affected, a referral to a professional grief counselor would be beneficial.

Grief Responses (36)

• Each person experiences grief in his or her own unique way.  People have very different grieving styles.
• It can be very helpful for parents to realize that each of them may respond quite differently.
• Parents can be encouraged to grieve separately as well as together; this enables each person to express grief in his or her own unique style and way.

Conventional and Masculine Grievers (37)

Conventional Grievers:

• Identify others as sources of support
• Openly expresses feelings
• Temporarily withdraws from responsibilities
• Allows time to experience inner pain
• Joins support groups
• Chooses ways to express feelings – journal, quilt, project

Masculine Grievers:

• Shelves thoughts/feelings to cope with present
• Chooses active ways of expressing grief – hobbies
• Uses humor to express feelings and manage anger
• Seeks companionship
• Uses solitude to reflect and adapt
• Writes – journals

Cultural Aspects of Grief (38):

• Language – use interpreters as necessary.
• Social Unit, Role of Elders – determine who makes decisions.
• Family History – consider possible prior discrimination or challenges.
• Gender Differences – how their culture regards men and women.
• Spiritual/Religious Beliefs – Role of Hope
• View of the Future
• Expressions of Grief – determine how their culture expresses grief.

Perinatal PTSD Questionnaire (45)

Have you had the following experiences within 6 months of your birth experience?  “Yes” answers are only those that you experienced for longer than 1 month, in that 6 month timeframe (a “yes” answer to 4 or more would be an indication of referral for further evaluation):

1. Did you have bad dreams of giving birth or of your baby’s hospital stay?
2. Did you have upsetting memories of giving birth or of your hospital stay?
3. Did you have any sudden feelings as though your baby’s birth was happening again?
4. Did you try to avoid thinking about childbirth or your baby’s hospital stay?
5. Did you avoid doing things that might bring up feelings you had about childbirth or your baby’s hospital stay (for example, not watching a TV show about babies)?
6. Were you unable to remember parts of your baby’s hospital stay?
7. Did you lose interest in doing things you usually do (for example, did you lose interest in your work or family)?
8. Did you feel alone and removed from other people (for example, did you feel like noone understood you)?
9. Did it become more difficult for you to feel tenderness or love for others?
10. Did you have unusual difficulty falling asleep or staying asleep?
11. Were you more irritable or angry with others than usual?
12. Did you have greater difficulties concentrating than before you gave birth?
13. Did you feel more jumpy (for example, did you feel more sensitive to noise or more easily startled)?
14. Did you feel more guilt about the childbirth than you feel you should have?
15. Would you like to talk to someone about your responses to these questions or feelings about this questionnaire?

The above information is borrowed from the work of Kirsti A. Dyer MD, MS, FAAETS, NCBF Physician, Grief Educator, College Instructor from the Identifying, Understanding and Working with Grieving Parents  in the NICU slideshow (marked by number)

“Childbearing losses may affect women and their families for a lifetime.  The affects of childbearing losses may occur well after the childbearing years have ended.”  -Wisconsin Association of Perinatal Care (2)

“Grief reflects the psychological and spiritual attachment to the baby that was lost physically and strongly resists abandonment of the baby.  It is based on the primeval energy of parental attachment, which is used, although there is no baby.” -Leena Valsanen, Author, Family Grief and Recovery Process When a Baby Dies: A Qualitative Study of Family Grief and Healing Processes After Fetal or Baby Loss.  Department of Psychiatry and Department of Nursing, University of Oulu, Finland, 1996. (3)

Perinatal losses need to be treated as unique bereavements that are different from other types of bereavements.  According to Leon, 1990, these losses: (4)

• disrupt a significant milestone (pregnancy, birth, infancy)
• cause isolation from peers
• cause inner conflicts for the griever
• reorganize self esteem

A 1995 study by Zeanah et al reported that stillborn and the deaths of infants are equally painful to parents and that the length of the gestation does not effect the extent of the parental attachment. (5)

Mothers and Grief (9)

• Mothers who experience the sudden death of a child (eg stillbirth, SIDS) tend to have more intense grief reactions than those mothers whose children die as a result of a chronic condition.
• Mortality rates are higher in mothers who have experienced the death of a child (2003 study conducted in Denmark).
• 20% of mothers who have experienced stillbirth, experience a prolonged episode of depression and one in five mothers suffers from post traumatic stress disorder (2002 UK study).
• Mothers who experience stillbirth are at risk of developing postpartum major depression.  The risk of depression is highest within the first six months after delivery.  The mothers who are at highest risk of becoming depressed are those who fail to show any signs of grief during the first two weeks after the stillbirth or those whose grief does not show any signs of diminishing six to nine months after the stillbirth.
• Thoughts of suicide are not unusual in the aftermath of stillbirth.  30% of mothers report having had such feelings.

Fathers and Grief (14)

• Because fathers tend to be less verbal about their grief, their grief has been underestimated in grief research.
• Grief in fathers tends to peak around 30 months after the death of the baby, whether that baby is stillborn or whether that baby dies shortly after birth (2002 study, University of Queensland, Australia).
• Study conducted by Swedish researchers (2001) concluded that fathers’ “general trust in life and the natural order was suddenly and severely tested by the death of their child, which they perceived as a terrible waste of life.” Being able to protect their partner and grieve in their own way was important to the fathers interviewd by this group of researchers.
• Fathers initially grieve by doing – by caring for the mother.
• They may try to mask their own grief in an effort to protect her.
• Father’s can have a difficult time separating their own grief from the mothers grief.
• Father’s can experience both physical and emotional pain in response to their grief.
• The father’s grief feelings may not be validated to the same degree as the mother’s grief feelings.

Children’s Grief (16)

• Children who have lost a sibling through stillbirth may tend to minimize or delay their own grief symptoms in order to avoid “upsetting” their parents.
• Girls who are age 7-12 and who had strongly identified with their mother’s pregnancy are especially likely to want to “fix” their mother’s grief.
• Children don’t have the same support systems as adults to help them cope.
• Children who have lost a sibling through stillbirth suffer in other ways as well.  At the very time they need their parents most, their grieving parents may be emotionally treading waters themselves.

Grandparents and Grief (18)

• Grandparents grieve a stillbirth on two levels: they grieve the death of their grandchild and they hurt because their children are hurting.
• Sometimes a bereaved grandmother will try to “shut down” her daughter’s grief – an indication about her own feelings about the power of grief and the fact that women are vulnerable to suffer losses like stillbirth.

The Unholy Trio: Grief, Trauma, and Guilt (21)

• Trauma can freeze or delay grief, but it doesn’t make grief go away.
• Complicated Grief is believed to occur in 21% of cases of perinatal bereavement.
• The loss of one or more multiples can take a particularly long time for a parent to process.  One study found that it took three to five years to be able to incorporate their loss without significant sadness or depression.  Part of the challenge is having the language to label surviving children (eg two surviving triplets are not twins).
• Dealing with guilt (in most cases, unwarrented guilt) and regret about difficult decisions that were made with regard to their baby’s stillbirth only adds to the pain.

A study by researchers at Millersville, Pennsylvania (2001) found that the majority of parents describe their child’s death as precipitating a crisis in meaning that resulted in stronger connections with other people, desire to engage in activities that would give their child’s life and death meaning, enriched beliefs/values, personal growth, and feelings of connection with the child who had died.

The above information is borrowed from the work of Ann Douglas, Author, Speaker of Canadian Foundation for the Study of Infant Deaths Converance from the Still Unanswered, Always Remembered slideshow (marked by number)

This article begins, by serving to provide support specifically to mothers who’ve endured the loss of their child or children, after enduring the struggle of medically assisted conception (or Assisted Reproductive Technology – ART).

There are many forms of medically assisted conception, as well as many forms of pregnancy loss or reasons for grief following this support.

Regardless of the method(s) of assistance you endured to conceive, it has likely been an expensive, emotional, painful, seemingly isolating journey that challenged your marriage, your understanding of motherhood, and even your identity.  After enduring all of that, to finally have conceived – to likely have been able to bond sooner with your baby than most other mothers because you may have found out about your pregnancy sooner than most, and may have even been given a photo of your embryo – to have experienced that amazing and profound joy, and then to have it end in loss, is devastating.  Please know, that you are not alone.

Here are some methods of conception assistance, and you may have utilized any of these:

• Ovulation Induction
• Ovarian Drilling
• Intrauterine Insemination
• Female Surgery: Laparoscopy
• Female Surgery: Tubal Sterilization Reversal
• Female Surgery: Hydrosalpinx Removal
• Male Surgery: Testicular Biopsy
• Male Surgery: Testicular Sperm Aspiration (TESA)
• Male Surgery: Percutaneus Sperm Aspiration (PESA)
• In Vitro Fertilization (IVF)
• Embryo Freezing
• Embryo Donation and Adoption
• Embryo Adoption Awareness
• Blastocyst/Embryo Transfer
• Traditional Surrogacy / Gestational Surrogacy
• Other

Pregnancy loss, or reasons for grief, can occur at any point after conception takes place, and can include any of the following:

• Any of the types of pregnancy loss listed here at stillbirthday
• One or more of the implanted blastocysts/embryos did not continue into a complete and vital pregnancy
• Grieving the loss of multiple blastocysts, either by medical discarding, selective reduction, freezing expiration, embryo adoption or any other situation
• In traditional surrogacy, the “intended mother” grieves the biological experience that the father has
• In either traditional or gestational surrogacy, you are the surrogate mother and you grieve the “loss” of the child as the baby is welcomed by their family
• In either traditional or gestational surrogacy, you are the surrogate mother and you experience pregnancy and infant loss and experience a grief that can feel complicated in your situation.
• Discovering that implantation never took place after transfer

For surrogate mothers, the grief of loss can feel complicated because:

• You stand to validate the decisions and journey of surrogacy.
• You have prepared your heart and mind for the understanding that you are not “relinquishing your child” but that you play an integral role in growing someone else’s family.  Yet experiencing pregnancy and infant loss as a surrogate can feel very personal and deeply grieving.
• You can be faced with feeling as if your body failed you, and failed the family you intend to honor with your surrogacy commitment.  This can be compounded with a suspicion that somehow the family may accuse you or suspect some kind of negligence or fault, when in fact this is not true.
• You can be faced with feeling that the journey of surrogacy is pushing too far, that experiencing pregnancy and infant loss is proof of that, when in fact this is not true.
• It is your blood that you see, it is your very intimate obstetrical experience, including birth planning and birth methods in the experience of miscarriage or stillbirth that you are witnessing.
• You have the painful privilege of bearing sacred witness to this loss the family is experiencing, and this may or many not be the first time their fertility struggle is shaped by loss after conception – via miscarriage or stillbirth.
• You have the painful privilege of inviting the family to experience the miscarriage or stillbirth by allowing them to bear sacred witness to your labor or in some way be involved in the welcoming or the farewell.
• Because you are surrogate, if it is medically necessary to have a medically assisted birth – in the case of D&C, D&E or later in which an autopsy may be requested or in any instance in which the physical form of the baby may be received by medical staff, it is best to articulate very clearly who the parents are and what their wishes are.  If you do not know what those wishes are or if they are not yet sure, please consider the options that will give you the most options later – meaning, it is best to articulate very clearly to medical staff prior to their receiving the physical form of the baby, that you will like to have the physical form of the baby returned to you.  Having this expressly written, read and understood by all involved can help clear up any possibly confusion or hospital policy issues later and can potentially expedite the process of having the physical form of the baby returned to you.  If this turns out to be an impossibility, seeking to retrieve any photocopies of any microscope slides can be a tangible, visual way that the parents can have their baby’s physical form.  This, in addition to any medical records, reports and information.  Please see the birth plans that would be the most appropriate to your circumstances.

All of these reasons for hurt or grief deserve to be validated.

You are invited to see our library of personal stories shared by parents (visit the right sidebar), which include:

• Snowflake Babies
• Living Grief (grieving aspects of parenthood, related to children who are alive: includes birth trauma, adoption, surrogacy, menopause)
• Selective Reduction
• Ending Fertility with a Loss

You are also invited to share your story.

Some supportive resources for any of these concerns:

• Information for emotionally preparing for surrogacy
• Information on state laws regarding surrogacy
• Information on grief after selective reduction
• Online contact form specifically for grief after ART
• Information for men on the emotional aspects of pursuing ART
• Information on emotional aspects of embryo freezing
• An SBD Doula may support you through a specialized surrogacy birth plan

Additionally, if you are experiencing a pregnancy loss while utilizing medical assistance for conception, you may wonder what the best birth method for your pregnancy loss might be, and if there is any difference in your choices when your pregnancy loss relates to ART in any way.  Your birth methods are, for the most part, still the same for pregnancy loss.  You can view the birth methods for pregnancy loss here.

Specific options that may be discussed between you and your care provider might include:

• If your hormone levels are a factor that could inhibit the process of natural delivery, or you are eager to begin the next cycle, level, phase, or ART attempt and time is a factor, a more medically assisted delivery of your pregnancy loss may prove to be better for your situation. For example, miscarrying naturally can take several weeks to complete, but a D&C wouldn’t-but could come with additional risks.
• If you are Rh-negative, your provider may suggest getting the Rhogam shot to protect you against Rh incompatibility, which could affect future pregnancies.  If you experienced a miscarriage under approximately 12 weeks gestation, your provider may suggest the micrhogram shot.
• Your provider might suggest IVIg therapy.  It would be important to know why this is being suggested, what the potential risks and potential benefits could be, and any alternative therapies available depending on the already stated variables (these might include Intralipid, Lovenox, other medications or natural therapies that a holistic healthcare expert could possibly provide suggestions for).
• Any of these topics and all specific issues pertaining to your pregnancy and pregnancy loss experiences need to be discussed with your care provider, and they should be apprised of all ideas and suggestions you are evaluating.

Articles related to ART (these will be updated as often as they are submitted and deemed to have possible relevence)

• Twin embryo IVF success rate
• stillbirthday’s Recurrent Miscarriage section may prove useful for emotional support as well as alternatives and other parenting options

Please know that you can share your story, or any helpful resources with us here.  You can access yours and others stories related to loss after ART here.

This article serves to provide support resources for mothers and families who are currently pregnant after having endured a previous pregnancy or infant loss.  Please also visit our Rainbow Birth Plan for information on planning the birth of your “subsequent/rainbow” baby.

It is extremely important to be aware that a subsequent pregnancy can likely bring with it heightened fears and anxieties.  Having a Sacred Circle or blessingway can be a treasured way to celebrate this pregnancy.

If you are not yet pregnant with your subsequent pregnancy after loss, you might fill this time with love and rich healing.  We have resources in our fertility challenges section on such subjects as conscious conception and pre-conception planning and bonding.

As you read this article, you can also listen in on a radio show with Heidi Faith (the founder of stillbirthday and author of The Invisible Pregnancy), Franchesca Cox (the founder of Still Standing magazine and author of Celebrating Pregnancy Again) with radio show host Gena Kirby (founder of Progressive Parenting):

 Please join us at our sister website, run by our doulas, at www.stillbirthday.info.

Many mothers consider subsequent pregnancy after loss to be a “rainbow” pregnancy, or they wait until this live baby is born and then refer to him or her as a “rainbow” baby.  We talk about ways of incorporating special keepsakes and meanings into your Rainbow Birth Plan here at stillbirthday (see the end of this article for the link).  Having a Boudoir Maternity photo session that includes rainbows, a memorial tattoo or other keepsake can be a way of facing challenges of discovering our inherent beauty and joy in a subsequent pregnancy.

Some things to consider in subsequent pregnancy:

• While there seems to be variability in professional opinion on the best time to try to conceive again following a pregnancy loss, many professionals recommend allowing one subsequent menstrual cycle to pass, to help ensure the uterus is clear of any fragments, possibly from the placenta.
• Researching the best prenatal vitamins for you is an empowering and healing choice.  Our facts/stats is a delicate page, but which may have helpful information for you.
• Parents need to be empowered to make pregnancy decisions on their own timeline.  They already feel like they have lost so much power over what has happened to them.
• Mothers who conceive quickly may have a tendancy to believe (and/or have loved ones who believe) that the new baby will help to repair a lot of the expectations lost with the previous baby’s death.  Moms who are due around the time of their previous baby’s anniversary (stillbirthday) are at particular risk of experiencing such feelings (1995 Child Bereavement Trust, UK).
• Other studies suggest that getting pregnant right away may allow the strongest of grief feelings to dissipate sooner.
• Guarded emotions, heightened anxiety, a tendency to mark off time by waiting for particular pregnancy milestones to come and go, and a need to seek out or avoid particular behaviors are common ways of coping with pregnancy after a loss (Syracuse University, 1999).  This is true whether or not the mother has sought out, learned, and has attempted to or is working through medical reasons for her losses.
• Pregnant, bereaved mom can feel more suspicious to trust her instincts, overly compensating with anxiety and fear.  Calming techniques can be valuable in pregnancy, including breathing techniques, light music, pregnancy-appropriate massage, and quiet reflection.  As counter-intuitive as it might sound, integrating the baby not alive into your family story in some ways – perhaps one family photo with a teddy bear or other symbol of your baby, can be a healing, validating experience.
• Support groups can be very helpful in providing support to women going through pregnancy after a loss.  They can help them to recognize that the others are going through the same experience, remember the babies who have died, learn new coping skills, and begin to relate to their living babies.  Please see our article on various websites, including online groups.
• Bereaved parents who subsequently give birth to living children need to consider the place of the stillborn or miscarried child in the family and the relationship of the children who were born before the stillborn/miscarried child to those who arrive afterward.
• Loved ones may respond differently to the subsequent pregnancy than the mother.  While the mother may be anxious and fearful, loved ones may pressure her to move on, forget her deceased child, and only celebrate her current pregnancy.  Alternately, the mother may be feeling joyful at a subsequent pregnancy, only for loved ones to feel weary and blame the mother for getting pregnant again.
• Fear can present itself in many ways in subsequent pregnancy: fear of losing another child, fear of announcing the pregnancy, fear of betrayal toward the deceased child, fear of celebrating pregnancy, fear of the experiences of childbirth.  Fear of the experiences of childbirth can include: remembering the last time her body gave birth, fear of contractions, fetal heart monitoring, crowning, and the moments immediately after birth.
• The challenges of balancing bereavement with joy often don’t end with the birth of a live subsequent pregnancy, but just as in NICU grief, mothers of subsequent living children can face many experiences and seasons that remind them all over again of what all was lost at the death of their child: the same is true for fathers.  Our Rainbow Birth Plan also includes information about our Rainbow Milk campaign.

Aspects of the above information are borrowed from the work of Ann Douglas, Author, Speaker of Canadian Foundation for the Study of Infant Deaths Converance from the Still Unanswered, Always Remembered slideshow (22)

Other helpful ideas:

• Read other stories from stillbirthday, including subsequent pregnancies AND subsequent “rainbow” BIRTH stories!
• You might also decide to include your baby who died in your subsequent pregnancy announcement.  Here is one idea of how to do this.  You might include the names of all of your family, a special keepsake, or a rainbow somehow.
• Read our article “Your Subsequent Pregnancy” which has an invitation for you to share your experiences here at stillbirthday
• Some mothers feel reservation about sharing the news of their subsequent pregnancy for fear that either she or others will be waiting for “bad news” to follow.  Consider if it is more important to prevent having to retract the good news, or if it is more important to have support around you to reinforce the joy and encouragement of the pregnancy and to have “just in case” for emotional support if you do experience another loss.  This is a personal decision that needs to be discussed with your husband.
• Consider purchasing an iBirth app, Positive Pregnancy app, Sprout app or other similar device to give you updates on your pregnancy and other helpful features like an app-to-keepsake-book.
• Consider using a fetal heart monitor at home.
• Visit Count the Kicks
• Consider using a fetal kick count chart.
• Discuss your fears with your provider (midwife or OB).
• Because of health concerns related to Dopplers and ultrasounds, consider asking your provider about MaterniT 21 testing as a possible alternative.
• If you are considering purchasing or renting an at-home Doppler, there are organizations that can help you, such as Beats for Bristol.  Please, consider discussing the use of one with your provider, including any possible risks of harm or health to your baby, by misusing or overusing the product.
• our threatened miscarriage has some tips that may be helpful
• facts/stats on pregnancy loss can be assuring
• there are some natural fertility items such as stones, charms, and books in our keepsake list.
• MotherPrayer is a spiritually diverse and supportive book.
• Many mothers feel more comfortable in their subsequent pregnancies after they’ve reached two milestones: reaching the second trimester, and reaching the same gestational age at which they previously experienced a loss.  Finding comfort and joy even during this “waiting” is important.
• For mothers who have previously experienced miscarriage, the above may be true in the first trimester.  However, mothers who experienced later loss may find that it is toward the end of the subsequent pregnancy that fears mount.
• The hormones of pregnancy can serve to magnify hidden feelings.  Pregnancy can also serve to magnify the feelings of grief.  If you feel that you are experiencing heightened loneliness, anger, or dread, consult your provider along with your doula, and consider utilizing our long term support resources or joining our mentorship program.
• Some mothers prefer to plan a more medicalized birth for susequent pregnancies, in an effort to prevent a loss.  Please discuss these plans and your reasons for them with your provider.
• Some mothers experience emotional dystocia during the labors of their subsequent children – an otherwise unexplainable delay during the birthing process, which may be contributed to fears or memories of delivering a miscarried or stillborn baby.
• Even the hard feelings can be valuable to you, if you are wrapped in support and love.  Go slow, and remind your heart that the hard feelings are a normal reaction to an impossible devastation.  You are a beautiful mother.
• Consider using the Farewell Celebrations suggestions at any time after your loss and the Long Term Support resources to work through any residual fears and anxieties.

Get Connected

• Consider partnering with one of our mentors who can provide emotional encouragement through this time.
• Any of our highly trained SBD doulas would be honored to work with you through this pregnancy and birth as well.  Our doulas know how to work with medically involved births, can lower the chances of unnecessary interventions, and can help you work through fears that may be prompting you to seek a more medicalized birth.  SBD doulas can also help you incorporate very special, personal and meaningful ideas into your Rainbow Birth Plan.
• Hosting a Mothers Workshop can be a great way to address the complex feelings of pregnancy after loss.

Please join us at our sister website, run by our doulas, at www.stillbirthday.info.

Additional Links

• Relaxation During Pregnancy script

Special books to help bring encouragement during this time

• The Invisible Pregnancy – a helpful book prior to getting pregnant again
• What am I Thinking? written by Karen Kleiman
• Celebrating Pregnancy Again written by Franchasca Cox.
• Finally, if it is needed, we have special information on having multiple losses

Rearing Living Children SBD Resources:

• Holding Umbrellas

Please join us at our sister website, run by our doulas, at www.stillbirthday.info.

All bereaved moms feel the emptiness of platitudes from well-meaning loved ones, but they can be particularly painful for the mother who has never birthed a live baby, and who, through various circumstances, possibly never will.

From people who do not know what you have endured, come callous questions such as:

“When are you going to start having children?” 

“Don’t you want to have children?”

“Are you just being selfish and focusing on your career instead of a family?”

“A good woman would provide her man with children.”

If you have experienced multiple losses, you may feel unworthy of grieving each child.

If you haven’t experienced multiple losses, you may feel unworthy of grieving.

If you have older, living children, but this will likely be your last pregnancy, you may feel unworthy of grieving.

Then, on top of the hurtful comments above, if there are people who know of your losses, these are some of the responses you might have experienced:

“You should just adopt.”

“You shouldn’t give up – keep trying.”

“You should have started trying sooner in life.”

“You already have children.  You should have stopped trying after your last one.”

“Maybe this is:

-punishment for something.”

-a good thing.  After all, parenthood is really hard.”

-a sign that you wouldn’t have been a good parent.”

All of these things are cruel and unnecessary. 

While having a subsequent “rainbow” baby doesn’t take the pain away of losing a child, when you do not and likely will not experience the joys of a “rainbow” baby, you face enduring the pain of your loss(es) in addition to the pain of knowing that the last birth experience you had, the last birth experience you may ever have, is one that was tragic.

Yes, there are additional fertility and parenting options that you could consider, and stillbirthday does have a list of many of these options at our recurrent losses section.  However, just focusing on what you should do next in your fertility journey is terribly unfair.

Your loved ones would be wise to consider these thoughts:

You may be done trying, and just want to find peace with childlessness.  Telling you that you “should” do anything could pressure you in ways you don’t want to be pressured, and make you feel uncomfortable with trying to find peace in your decision.

You may have already tried some of their suggestions but didn’t tell anyone about it (adoption isn’t like grocery shopping, for example.  It’s not a quick fix, and it takes a lot of careful and prayerful consideration).

There may be more to your situation than you have shared with others.

Even if you have older, living children, ending your fertility with a loss can be extremely painful.  It can make you want to “try again”, and cause a great deal of inner conflict.  Knowing that the very last birth you ever experienced was a tragic one can be a heartbreaking burden to carry, and this burden can actually feel compounded by the sense that you don’t deserve to grieve because you have older, living children.

You are still a mother, and your loss is still your baby.

If you have experienced a loss at the end of your fertility, please know that while you are ending your fertility with a loss, you are not “ending in a loss”.  You are still a mother.  Please know that your pregnancy loss is still a birthday.  Please know that your baby is still, in fact, your baby.

Please visit our Farewell Celebrations for ways to honor your baby.

If you would like to share your experience of ending your fertility with a loss, you can share your story here, and you can read stories shared in the special category for ending fertility with a loss.