Kayce Hodos 10/15/18 Kayce Hodos 10/15/18

5 Tips For Supporting Women Who Have Lost A Pregnancy

I’d like to offer some guidelines to help you navigate the murky waters of supporting someone who has experienced the loss of a pregnancy or infant.

October is Pregnancy and Infant Loss Awareness Month (and the 15th day of the month is Pregnancy and Infant Loss Remembrance Day). The US Department of Health and Human Services reports that as many as 10-15% of confirmed pregnancies are lost, so you probably know a woman who has been through it.

This kind of loss is unique in that mothers who have experienced a miscarriage, stillbirth, or saying goodbye to an infant who only lived a short time often feel that the people in their lives just don’t get it, and they’re right.

There is no way to completely understand another person’s grief, even if you’ve experienced something similar. Please know that you don’t have to get it in order to be supportive.

Our culture is really good at setting aside months to acknowledge different causes, decorating our cars with magnets expressing how woke we are, framing every social media post with the hashtag du jour, but we are not even close to being good at actually supporting the people who need it, especially mothers.

(I am not saying don’t do those things; I’m saying do more than those things.)

Grief Is Scary

We don’t know what to do with grief. It terrifies us, especially when the loss is of a pregnancy or infant (infant mortality is defined by the CDC as death of an infant before his or her first birthday) because in these cases, there may be no funeral or wake or memorial service to attend.

And we suck at being with someone who is in emotional pain. We like to fix things. Instantly. Relax, grief doesn’t need fixing. Grief is painful and messy and horrible and confusing because it’s supposed to be. And it doesn’t really stick to any kind of schedule.

The death of a baby checks all the boxes for stuff that activates our brain’s fight, flight, or freeze state.

What To Do (and Not Do)

Now for the comforting part. You can learn how to face your fear of emotional discomfort. You can be present with another human being whose life experience doesn’t resemble yours in the least. It doesn’t cost a dime, but you will feel things that aren’t comfortable.

You may be reminded of losses of your own.

You may not know what to say.

You may feel the urge to say something you think might be helpful just to break the silence (because silence is another thing we don’t do well).

But before you speak, I’d like to offer some guidelines to help you navigate the murky waters of supporting someone who has experienced the loss of a pregnancy or infant.

Show her you remember. Put the date of her loss on your calendar, and when that anniversary date rolls around, send her a message letting her know you are thinking of her.
When a woman miscarries, there is no ritual to publicly acknowledge her loss. She has not only lost a child, but also the hopes and dreams she had for her child. Her future as a mother. What she was going to look like as her baby bump grew. Her baby’s name. Her baby’s room.
Whether she was weeks into her pregnancy or months into it, she will grieve. Whether she was 100% sure she was ready to be a mom or not quite there yet, she will grieve.
Whether she has a loving partner or is going through it on her own, she will grieve.
And as the days go by, she will feel as if everyone has forgotten her loss. You get to show her that you did not forget. And now that you know October is Pregnancy and Infant Loss Awareness Month, you have a separate occasion to let her know you care.
Don’t say any of the following things (even if you have convinced yourself you’re being helpful).
By the way, each one of these statements has multiple variations, so as a rule of thumb, if what you’re about to say sounds in any way similar to the following phrases, skip it:

“Your baby was so special, God wanted them with him in heaven.”
Religious or not, I guarantee you this mom will not be comforted by this statement. Even if she believes in a god, she wants her baby with her, not in heaven. If she has other kids who overhear this statement, imagine how they may feel.
“You can always have another baby.”
First of all, you don’t know if this is true.
Secondly, so what if she can? She wanted THIS pregnancy. THIS baby is the one she is grieving right now. And if she does move forward to have another baby, it will not replace the one she lost.
“It just wasn’t meant to be.”
What in the world does this even mean? This is completely useless filler.
You may as well say, “I am so uncomfortable with this situation and have no clue what to say right now.”
In fact, say that instead. It would be way more helpful.

3. Instead of the empty and hurtful remarks I just mentioned, say something like, “I have no idea what you’re going through. It must be awful. I don’t know what to say, so just know that I care about you.”

4. Ask her if she wants to talk or grab a cup of coffee or go for a walk. If she says she isn’t up for seeing anyone right now, assure her that it’s ok. Let her know you’ll check in with her later, and then do just that. Don’t harass her, but don’t disappear from her life either — even if she doesn’t respond. Especially if she doesn’t respond.

This isn’t about you. She isn’t being rude. Grief doesn’t care about manners. This is about showing her you’re there now, and you aren’t going anywhere.

5. Ask her what she needs and then listen. If she says she doesn’t know, that is completely ok. Offer to come over and sit with her, listen to her, cry with her, run her errands for her or with her, tidy up, make her a meal, screen her mail for baby-related marketing material (check out this helpful article).

This one can be tough because you may feel like you aren’t compassionate enough to anticipate what should be done, but my professional opinion is that moms who have lost a baby feel like they have no control.

They also may be experiencing hormonal fluctuations (but DO NOT tell her she’s “just hormonal” EVER) or health concerns from the complications that led to the loss.

Going through the postpartum time period without an infant to care for is absolutely horrible.

She may be feeling like her own body has betrayed her, that her healthcare providers couldn’t provide answers, that people are now avoiding her, and many, other frustrating and often conflicting emotions.

You could be the only person who is paying attention to what she needs! And that may be exactly what she needs — to be heard, to be seen, to be met right where she is at this moment.

Both Scary And Doable

I challenge you to face the unknown, the scary, the gray. Show up and be ok with not knowing exactly how to help.

And don’t forget about the professional helpers out there. Mothers who have experienced loss do not have to get through it alone.

Counseling with a professional who is trained in maternal mental health and pregnancy loss can be extremely helpful.

Mothers are underserved, overlooked, and undervalued, so the more we can care and pay attention to them, the better our world will be.

If you’re looking for support as you process your loss, I’d love to help. Please reach out to get started.

Let's Talk About Maternal Mental Health

When you are training to be a mental health professional, you learn about the dangers of self-disclosing, or sharing information about your personal life with clients. After many years of being a therapist, I have realized that, as with most things that matter, discernment is the key. Your focus remains on helping the client and doing no harm, and there are instances when sharing a personal story can do just that, particularly for experiences that leave people feeling alone. Mental health issues related to childbearing definitely fit into this category.

After participating in a two-day workshop presented by Postpartum Support International, I feel more strongly than ever that we need to be talking openly about perinatal mental health and educating everyone. As many as 1 in 7 women are affected by postpartum depression and anxiety. I’m sharing my own experience with you on World Maternal Mental Health Day, in hopes that doing so will help move us towards the goal of eliminating the stigma of asking for help.

Pregnancy

From the instant I learned I was pregnant back in 2011, I felt the pressure to make the “right” decision about, well, everything. Even though in my professional life, I regularly help people change their right/wrong, black/white, all/nothing thinking in order to be more rational, I sometimes fail to apply this valuable skill to my own circumstances. A few of the first challenges I encountered during pregnancy included reading the most popular books, registering for the safest baby items, selecting the best pediatrician, and deciding on the healthiest birthing method.

What better way to kick off a pregnancy than sitting down with the father of your child for a viewing of Ricki Lake's anxiety-inducing documentary, The Business of Being Born? We then managed to catch our breath and proceeded to begin interviewing doulas while getting to work on our birth plan. As my expectations piled up, I pretended to remain open-minded about the very real possibility that things may not go exactly according to our wishes. After attending childbirth and breastfeeding classes, I managed to confidently hold onto my intention of delivering a healthy baby and breastfeeding him for at least one year, per AAP recommendations.

Throughout my pregnancy, I exercised (both cardio and prenatal yoga), maintained a healthy weight, had all the precautionary tests (as you do when you are of “Advanced Maternal Age,” a label that was stamped on every single page of my medical record), avoided alcohol, and at the prescribed time, began logging my baby’s kicks. As I approached my due date, I downloaded the most highly reviewed apps to track feeding, diapers, and sleeping. I was all set. Or was I?

Childbirth

Let’s not dive too deeply into this part. It was a long, strange, painful, and horrifying trip. While it is certainly a significant piece of this whole journey, and the trauma (in a non-near-death-but-still-never-wish-to-experience-again kind of way) most definitely impacted the emotional kickoff to motherhood, I’d like to focus on the postpartum aspect of the saga.

Postpartum

I am pretty sure my experience with postpartum depression and anxiety began the moment the nurse wheeled me out to the car 1.5 days after I had my son. I felt sheer panic rush over me as I tearfully told her, “I’m scared to leave you.” I could not imagine why a tiny person would be allowed to be strapped into a vehicle and whisked away by two people who had never done this before. Even with the help of my mother and husband, the next few days at home only confirmed my fear. I was not producing enough breast milk to nurture my baby boy. He was losing weight at a rate that would rapidly lead to what the medical community horrifyingly refers to as “failure to thrive.”

NOT THE BABY BLUES

For the first two weeks of my son’s life, we visited the pediatrician’s office daily to check his weight, took him to have a liver ultrasound (a procedure for which he had to be fasting! Right, explain that to a newborn), and began learning the art of supplementing my meager breastmilk supply with (gasp!) formula. Do you know what we were not doing? SLEEPING!!!! The lack of sleep was, seriously, more evil than vaginal childbirth itself. Well, ok, just as evil, but its impact over time is deadly and makes everything feel exponentially more awful than it actually is. In fact, the CIA regularly employs the use of sleep deprivation as an enhanced interrogation tactic (i.e. TORTURE), but all new parents know it as simply part of the blessed process of loving and caring for their brand new tiny person who cries, pees, poops, demands to be fed, and spits up constantly.

Intrusive Thoughts

Of all the experiences of early motherhood, one memory stands out as the most disturbing and terrifying: It was probably the second or third day since we’d brought our son home. I was standing by the car in the crowded parking garage of the hospital, where we’d just had to subject our baby to some kind of diagnostic torture (probably a heel prick to measure bilirubin, high levels of which mean the liver isn’t functioning properly) watching my supportive, also sleep-deprived, incredible husband secure our newborn boy into the car seat. In a complete fog of overwhelming exhaustion, guilt, fear, and frustration, I began to wonder what would happen if a car came speeding around the corner. What if the driver didn’t see me? My husband and infant were safely in the car by now, but I was still standing there. I could simply step out in front of an approaching vehicle and get some relief from this barrage of perceived endless misery.

Those thoughts are not the same as intent and are actually a very common symptom of postpartum depression. It was not about leaving my husband and new baby behind. It was about feeling ill-equipped to cope with this intense helplessness and fear. Giving birth is part of the natural circle of life, but nothing about it came naturally to me. I felt like I didn’t do the labor part right because it took so long, I was not able to feed my baby because my breasts weren’t up to the task, and I couldn’t figure out why I wasn’t dealing more gracefully with the lack of sleep. Was I weak? How do women do this???? And why would anyone do it more than once?!?

I can look back on those first few weeks after giving birth and recall funny moments, too. My husband somehow can always manage to make me laugh no matter the circumstances, but I recognized that my laughter was not quite as full as it usually was, and my sense of humor felt like a forced and stunted version of itself. I recall laughing and crying as I nervously attempted to ‘wear’ my baby using a Moby wrap, a stretchy piece of fabric, oh, about 20 feet long (not really but seems that way and feels longer and longer the more you wrap it around yourself), the purpose of which is to securely hold your baby close to you while freeing you up to take care of all the other domestic chores that still need tending to. My experience looked nothing like those smiling new moms pictured on the web site gallivanting around with their bundles of joy, living their fabulous hands-free lives! After about a dozen tries and countless youtube tutorials, I felt the Moby pulling me further and further down the path to complete failure. Right then and there, I resolved to not leave the house until my child was ready for kindergarten.

Two months into my life as a mother, I returned to work and was functioning at a decent-ish level, thanks to getting more sleep. I remember the panic we felt when our infant son finally met the developmental milestone of sleeping four hours in a row. We seriously considered calling the pediatrician because nothing this wonderful could be normal. The elation was, however, short-lived, and I soon slipped back into despair. Everything was still mostly covered in a fog of overwhelming sadness, even though I was pretty good at pretending I was “just tired.” I recall no matter what I was doing, I didn’t want to be there. I didn’t want to be at work, but it wasn’t because I missed being at home. I didn’t want to be getting a manicure, but not because I felt guilty. And I didn’t want to be at home, even though it used to be my safe place. That’s what was most unsettling. I didn’t want to die, but I also didn’t want to be anywhere. I know my husband felt helpless. He did all the right things: cared for the baby while I rested, came home from working all day and took over so I could shower, purchased a Massage Envy membership for me, and declared Saturdays as my day to do whatever I wanted. Nothing was enough.

Asking For Help

At my husband’s urging, I called my therapist, whom I had not seen in years. It was the best decision I could have made. (Yes, therapists need their own therapist. Doctors go to the doctor, don’t they?) I told her about that day in the parking garage, and she did not judge me, nor did she conclude that I was suicidal. I was adjusting to a new role, a new identity, and new responsibilities. I needed to learn how to somehow include a little bit of Me Time in this new roller coaster of a life. Self-care would no longer look like spending a rainy day curled up on the sofa with a good book. But it could look like having my husband care for our son while I read a few chapters or took a nap. I started spending Saturdays working for a few hours and taking some time for myself. I found that I resisted leaving the house due to anxiety, but if I pushed myself to do it anyway, I never regretted the decision.

My primary care doctor and OBGYN collaborated to find an effective antidepressant dose, and I had to work on finding ways to cope. If I could go back and do one thing differently, I’d spend more time looking for a support group. The only one I came across didn’t work out for me because I showed up on what was, unbeknownst to me, Bring Your Partner Night. The courage I had summoned to attend this group instantly vanished as I walked in and saw several male faces staring back at me. I simply turned around, walked right back out to my car, where I cried for a half-hour before driving back home.

Support groups (online or in-person) are wonderful and extremely helpful, and I highly recommend them, especially in conjunction with individual therapy. Just remember to ask questions and do some research before you choose one. I wish I’d been in a healthier emotional place at that time because I am certain I could have found another group, or I could have returned to that particular group the next week. I could have even stayed that night and benefitted from the discussion. But that’s incredibly difficult when you are at your most vulnerable and physically and emotionally drained.

If I’d only known about PSI, I could have connected right away with someone who would have walked me through the process of finding the right group for me.

Now

That little baby did indeed thrive, and so did I. Of course, there have been, and still are, moments when I question my capabilities and wonder how I’ve survived this madness. Motherhood rarely involves clear cut perceptions of our world or hard and fast rules of the road. It’s mostly both/and. I love BOTH kissing my son’s sweet little face AND putting him to bed at night. I look forward to BOTH Sundays hanging out at home with my family AND when they go back to school and work on Monday (I have Mondays off — self-care at its best!).

Life as a parent gets better as you adjust and your child grows. Babies start sleeping more than two hours in a row, they don’t need bottles or breastmilk forever, they grow into children who can go to the bathroom by themselves, and a little at a time, mothers figure out how to nurture both themselves and their offspring.

Whether you have been diagnosed with PPD, suspect that you are depressed, or simply would like someone to talk to about how freaking hard it is to be a mother, visit PSI to find local resources.

If you’re ready to talk with someone who gets it, please take a look at my counseling and coaching services to see if we might be a good fit. All you need is an internet connection to get started.

Until we meet again, remember PSI’s message:

You are not alone. You are not to blame. With help, you will be well.