Preterm and Neonatal Loss: An Informative Interview

1.  Please introduce yourself and your work for our readers.

My name is Claudine Radford. I currently live and work in San Francisco, and am trained and licensed as a clinical social worker (LCSW) and psychotherapist. My private practice is located within Acupuncture Kitchen, a stellar integrative health care practice which focuses on prenatal and postpartum care, emphasizing fertility and reproductive health. I bring my clinical skills and understanding of the relationship between the mind, emotions, and body to this holistic setting. I am also a mother who lost my first daughter neonatally. I have been profoundly affected by both the precious time we shared, and my ongoing journey with grief and healing. It is through this lens that I approach my work with women and families who are experiencing challenges with fertility, during pregnancy, or who are navigating the loss of a pregnancy/baby.

2. I am seeing more and more women in my Boulder psychotherapy practice who are seeking out support around the loss of their infant- this loss being either in utero or shortly after birth.  Many of these moms feel very alone in their grief.  Can you give us a sense of how common infant/ pre-term loss is?

Losses in pregnancy occur across the pregnancy spectrum and include:

*miscarriages during the first 20 weeks of pregnancy stillbirth from 20 weeks through the end of the third trimester (sometimes days before or at the time of delivery)

*losses that are sustained neonatally (during the process of labor and delivery to within hours or days following, including ‘late neonatal death’ from 7-28 days after birth)

*the loss of a baby in the first year as a result of SIDS (sudden infant death syndrome).

In tandem with the sophistication of prenatal testing via first and second trimester blood work screenings, ultrasound, CVS (chorionic villus sampling) and Amniocentesis, many families also face complicated and often impossible decisions with respect to information discovered in early detection. This information will potentially lead to the termination of a pregnancy.

I also want to recognize the cycle of loss that is experienced monthly by women and couples who are working with fertility treatments for the purpose of conception.

Here are some statistics:

*Miscarriage is believed to occur in 1/3 pregnancies. It is also documented as %30 of all pregnancies which includes those that have not been detected or confirmed by a pregnancy test. Therefore, it is noted that 15-20% of confirmed pregnancies end in miscarriage.

*The rate of stillbirth is documented in the US as 1/160-200 pregnancies.

*The SIDS numbers in the US have remained consistent over approximately the past decade affecting between 5,000-7,000 infants every year (depending upon the statistical source).

3. You and I both know well that this type of loss has the additional burden of including the same postpartum issues that moms with living babies face.  Can you talk a bit about this?

Regardless of the point at which a baby is delivered (in the scope of loss we are talking about miscarriage, termination via DNC, delivery of a stillborn, and Neonatal loss, i.e. delivery of a child via a vaginal or c-section birth who does not survive), a woman’s body is pregnant beginning with day one of conception. Fertilization and implantation of an egg into the uterine wall (or fallopian tube in the case of an ectopic pregnancy) triggers a watershed of physical, hormonal, chemical, and emotional changes as the body prepares itself to grow and nurture another human being. In addition to the physiological changes which we experience that are not within our control, are the emotional changes which have a tremendous impact upon our relationship to ourself, our partner/family/loved ones, and to our growing baby. With the loss of a developing or ready to birth baby, comes the same reorganization of chemistry as that of a mother who has birthed a healthy living baby who survives.

In both cases (the extent of which depending upon the time of the loss), the uterine lining will be shed producing a release of blood that far exceeds a normal menstrual period. Without the release of oxytocin within the mother via nursing her baby, the uterus will not have the benefit of this encouragement to contract, and the process will need to take place independently. Depending upon the stage of gestation, milk will be released into the breasts to prepare for nursing which can create engorgement. Because this does not become the nourishment for a living baby, and is often quite painful, it can add another significant layer to the grief being experienced. For most women, the lustrous hair that is not shed during pregnancy will fall out within 2-5 months following delivery of a baby. Women who have lost a baby are often not spared this postpartum experience which can come as a surprise, after one is back into a regular menstrual cycle and moving through a healing process.

The loss of a baby triggers both chemical/hormonal and emotional components of postpartum which are compounded by bereavement and depression. This type of depression has some overlap with Postpartum Depression, yet the root cause is very different. One of the challenges is to understand, as the grieving process unfolds, whether a mother is experiencing ‘healthy’ grief that ‘moves’ or whether it develops into an unyielding depression that will require psychiatric support. The ability to sleep, eat, spend time with friends and loved ones, and maintain a physical fitness routine are inevitably affected by the loss of pregnancy/baby. This is very different from the challenging sleep deprivation and change in routine that comes with the care of a newborn.

4. All women go through a significant identity shift upon becoming mothers.  Can you talk about this with respect to those women who’s babies do not survive?

One complex piece of identity shift is particular to mothers who experience a loss and are not parenting other living children that support and maintain their identity as a parent. (Note: This is not to minimize the experience and challenges of a loss while parenting other living children, but to highlight a specific difference.) Depending upon the stage of pregnancy at which the loss has occurred, women have either identified to themselves and loved ones as pregnant, and have begun parenting via self care and Ob/midwifery care, or they have additionally become visibly pregnant to the outside world.

The loss of a baby holds a tremendous internal experience of grief, and yet there is also an identity that begins to form as one begins to be seen and sees oneself differently to the outside world. Most painful to this identity shift is the invisibility of one’s parenthood following the loss of a child. Mothers (fathers/partners) who have lost babies do not wear the evidence of their status as parents in an Ergo, a Baby Bjorn, nor are they able to evidence their baby in a stroller. There is an emptiness of belly, heart, and arms. Socially, there is a tremendous loss as well. Many to-be parents have made connections with other pregnant parents, look forward to shared time parenting along side of other family members, and have begun to build their lives around the anticipation of a child. It is a daunting place for parents when community and commonality transforms to the support of other parents who have experienced the similar loss of a pregnancy/baby. The tunnel of grief also creates an isolation that is so different from the quiet nesting of pregnancy and solitude in the postpartum care of a newborn.

I also want to mention here that no two women feel the mother-child bond in the same way, and I hold space in this understanding for the parents who were taken by surprise, were not trying to conceive, or struggle with a family history/personal life experiences that make this life transition complex in unique ways. We all come to the table as a unique self, and this becomes part of the journey of becoming a parent as well as a journey through loss, even of an unexpected baby.

5.  While everyone’s experience is unique, are there some specific things that moms who have lost their babies might expect to experience in their postpartum year?

The postpartum year for parents who have experienced a loss holds many layers of challenge, and these layers often parallel the stages of postpartum. As the body begins to heal, the heart will continue to break. There are decisions no parent ever wants to make with respect to saying goodbye to a baby, and depending upon the stage of loss creating a ritual/ceremony, and burial that provides comfort will be part of the early stage of bereavement. Relationships to ones spouse, family, friends, work will be impacted as a result of the loss, and there will likely be a challenge to not become lost in isolation. Finding an ongoing relationship to one’s lost baby and an understanding of the loss will be a feature of this year. Learning to take care of oneself while not growing a baby inside can become complicated since pregnancy requires self-care that revolves around baby. Many mothers (fathers/partners) will experience depression, feelings of responsibility, some will experience feelings/thoughts of suicide which requires medical/psychiatric attention, desire to be with the lost baby, doubts about one’s body, fantasies of reliving all decisions leading up to the loss. Regaining a sense of self, faith, hope, optimism, trust, a religious or spiritual map, a routine, can become daunting tasks when these features of previous life have been shattered. I remind parents who have lost a baby that this loss is unlike any other.

6.  Can you suggest some things that might be helpful for a mom who is going through the grieving and healing process?

Seek and accept support that feels nurturing to you. Believe that it is possible to heal, and remind yourself that healing isn’t forgetting. Find healthy rituals that celebrate and remember your baby. Take care of yourself. In the early weeks/months try to take time outside to walk, move, be in nature or the outside world for a short time each day. Try hard to eat and nourish yourself, and find ways to heal your body. I strongly recommend individual/couples therapy, groups for bereaved parents, and body work/acupuncture with trusted professionals. Find what your religion, culture, spiritual orientation has to offer you. Books/websites about the loss of a baby with stories from other mothers/parents can help to break isolation if you are unable to leave your home. Recognize that family, friends, acquaintances, co-workers will likely be very clumsy or unskilled, not always say the right thing, or know what to say. Most people mean well, but are not comfortable with death and specifically, the death of a baby. Some don’t see an early pregnancy as a baby, and this could lead to feeling discounted and invisible. You will inevitably have your feelings hurt. You will educate others about how to be with you. It is an added burden, yet it can bridge relationships that could otherwise be lost. Be with your partner and people who feel good to you as an antidote. Your surviving children and pets are healing. You may or may not be able to be with other parents/babies/pregnant friends for a period of time. Honor yourself and your needs. You will know when you are ready to try again for a baby. You will receive much unsolicited advice around when others think you should start ‘trying again’ and how healing this will be. You get to heal at your own pace, and be with the loss of this baby first. Follow up medically with your OB/midwife as recommended for your postpartum care.

7.   What are some things that spouses, partners, families, and friends can consider in their efforts to support a mom through this incredibly difficult journey?

This journey is a roller coaster of grief, loss, and healing. Be there unconditionally for your loved ones, and with patience. Reassure mother, father/partner that they have done the best they could, that no parent causes the loss of a baby willingly or intentionally. Recognize the parents as parents. Support them with food and supplies in the early months. Listen. More often than not, comforting with statistics, ‘silver linings’, or other ‘comparable’ stories of loss is not helpful. Bereaved parents will and will not always know what they need. Try to read between the lines, and ask if you are unsure. Be respectful of their need for space, and be there to fill the unwanted emptiness. There are also books, websites, and groups for you as you are inevitably dealing with your own grief and sadness. Take care of yourself. Do not assume that the pregnancy/baby will become less important, forgotten, or ‘gotten over’. Hold space for baby over time, and take the lead from the parents. Talking about the pregnancy/baby is healthier than pretending to forget. Healing is not the same as ‘moving on’.

8.  Is there anything that is helpful in negotiating the inevitable challenges that might occur in marriages where a child is lost?

Seeking support is incredibly important either with a trusted therapist, a group for both bereaved parents, or with clergy/spiritual guidance if this applies. The loss of a pregnancy/baby/child is one of the most stressful experiences that can affect a marriage/partnership, but it is important to remember that this loss does not inevitably end a marriage. The challenges to communication that existed prior to the pregnancy will be amplified, and new tools for communication will likely be necessary. Women and men tend to grieve differently (as with partnerships in which one partner has physically carried the pregnancy/baby), and support around this can be very helpful. Many relationships carefully and delicately tended to will not only survive the loss of a child, but will be significantly strengthened. Keep alert to any increases in addictive or self-harm coping behaviors that are destructive to either partner and to the relationship, and seek immediate help in these instances.

9.  Can you provide some resources for mothers and families who are faced with preterm and infant loss?

Helpful resources can feel very personal. I suggest when one is ready, looking on-line for local groups, see what books resonate in their description, seek out blogs/websites cued by your particular version of loss. I assume much of the early recovery is happening at home, and this is where the internet can truly feel like a lifeline. In most cities/towns groups are offered through hospitals and birthing centers. If it is too painful to make this call, ask a trusted friend or family member to gather the information for you. Trust that you will find or create what you need when you are ready. While some parents benefit from support groups immediately, others may wait. There are usually groups offered both for the immediate loss, the stage at which the loss has occurred, and for pregnancy after loss. These are ways of involving a husband/partner who is less inclined to seek couples or individual therapy.  You can find a few websites and books listed below.

10.   Is there anything else that you would like to mention?

I want to emphasize once again, that the loss of a pregnancy/baby is unlike any other loss, and it challenges many of the assumptions and foundations upon which we live. Modern medicine has unfortunately not eradicated this type of loss, and if you have survived this experience, you have become connected to many previous generations of women, and current women and families around the globe. There is a worldwide community of mothers who have lost children. Some cultures and communities are better equipped to talk about and be present with the loss of a pregnancy/baby than others. You may feel very alone, and will slowly discover that you are not. In many ways your capacity to love, and your ability to understand the depth and range of human emotion has been exponentially expanded. You are in touch with a wide range of sadness, anger, love, and the true unpredictability of life. Perhaps you have a deeper connection to, or understanding of death, and beliefs around ‘afterlife’. ‘Living in the moment’ may no longer sound like a cliche. You are strong, you will heal, and you will need support. I often remind myself and my clients that the parts of us that break and tear are often stronger for the healing than they previously were.

I also want to acknowledge, once again, that there is a huge range in response to/experience of the loss of a pregnancy/baby. While touching on generalities, I recognize that there are important experiences that I have not included or addressed in the context of this interview.

A few resources:

Two of my favorite healing websites:

http://namesinthesand.blogspot.com

http://www.sweetpeaproject.org

(Note: There are many additional websites that allow for sharing via postings as well as National and local groups dedicated to providing resources in your area)

Books:

About What Was Lost, 20 Writers on Miscarriage, Healing, and Hope
ed. Jessica Berger Gross

Empty Cradle, Broken Heart, Surviving the Death of Your Baby
Deborah L. Davis, Ph.D.

Help, Comfort & Hope, Losing Your Baby in Pregnancy or the First Year

Hannah Lathrop

Pregnancy After a Loss: A Guide to Pregnancy After a Miscarriage, Stillbirth, or Infant Death
Carol Cirulli Lanham

Grieving Mindfully, A Compassionate and Spiritual Guide to Coping With Loss
Sameet M. Kumar, Ph.D.

The Tibetan Book of Living and Dying

Sogyal Rinpoche

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About katekripke

I am a Licensed Clinical Social Worker LCSW) with a practice specializing in prenatal and postpartum wellness, including the prevention and treatment of Perinatal Mood Disorders. I am also a Colorado State Coordinator for Postpartum Support International.
This entry was posted in guest blogger, infant loss, mom-to-mom, Postpartum PTSD, resources, self care. Bookmark the permalink.

4 Responses to Preterm and Neonatal Loss: An Informative Interview

  1. Dennes says:

    Awesome! Thanks for the info!

  2. Pingback: Previous Prenatal Loss and Subsequent Episodes of PPD |

  3. Pingback: Support for Families After the Death of a Baby |

  4. Jj says:

    Thank you for these words- they have put into black and white Everythng I have, we have been feeling.
    Thank you

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