Pregnancy and Infant Loss: Moving Through the Grief

“Let everything happen to you: beauty and terror. Just keep going. No feeling is final.”

~ Rainer Maria Rilke

I love this quote for 2 reasons. The first is because it reflects what I tell all my patients: allow yourself to feel all your emotions, good and bad. This exercise is especially important when it comes to grief, and particularly for a perinatal loss.

A loss that happens in or around pregnancy (including miscarriage, termination for medical reasons, stillbirth, or infant death) is often accompanied by a variety of emotions: sadness, anger, frustration, anxiety, despair, guilt, and loneliness. Sometimes the grieving parent is numb right after the loss and disconnected from the grief, but eventually the rollercoaster of feelings seeps through even the best armour. It’s important to allow yourself to move through the grief and not around it. No feeling is wrong or bad or shameful.

Not everyone will understand your grieving process; many people are uncomfortable talking about death, especially a perinatal death, and they may not know how to comfort you or have the right words to say. Often, couples grieve differently and at different stages. Many men tend to “compartmentalize” their feelings; for example, they may prefer to return to work as soon as possible to be distracted. Sometimes there is pressure to “get over it and move on,” and not wallow in sadness. Couples must recognize that the most important thing is to respect how the other is grieving. Good communication is essential during this time. Let your partner know what your needs are — maybe you don’t want someone to tell you what activities you should be doing to feel better; maybe you just need a hug and some kind words.

Similarly, it’s helpful to let your friends and family know how to help. For instance, asking your boss to send an email to your co-workers may help when you return to work, so you aren’t bombarded with awkward questions. Or, let family know how you want the baby to be remembered — whether it’s by using the baby’s name, remembering the delivery/loss date, or sharing photos — it’s up to you to guide others along your grief journey. This may be a frustrating process and you may think “it’s one more thing that I need to do; it shouldn’t be up to me to educate others; friends should just know how to help me.” But telling others what your needs are will save a lot of anger and disappointment during the mourning process. And when people say unhelpful or hurtful comments, think of a phrase you can say to shut them down gently. Remember their words are often said with naivety and not with malicious intent.

The second reason I love this Rilke quote is because of the encouragement to keep going and move beyond the pain. In other words, the raw, open wound will heal with time.
 

Closure does not mean forgetting the loss

I often say “you need to close one door before opening another,” and I do believe there needs to be some closure and healing before planning another pregnancy. Closure does not mean forgetting the loss; you will never forget this indelible experience and there will be many reminders and moments of sadness that pull you back into the grief. But it’s important to continue forward on a positive path, and to begin to have moments of joy and laughter by getting back into the activities that give you pleasure.
 

There is no time limit on grief.

Emotions may be raw and unrelenting in the acute phase, but you should be gradually feeling better with improved daily functioning. So how do you know when you are “stuck” in your grief, or when grief becomes depression? How do you know when you need to get help for your mental health?

Here are some questions to ask yourself (and please be honest!):

• Am I feeling sad, lonely, irritable, and depressed most of the day?
• Am I crying more than usual?
• Do I have things to look forward to?
• Am I genuinely able to take pleasure in moments during the day?
• Am I avoiding people for fear that they will ask me about the loss?
• Am I having trouble sleeping because I wake up in the middle of the night, my mind starts racing and I can’t shut it off?
• Am I distracted by looking up negative things on the Internet?
• Am I consumed with irrational thoughts or guilt?
• Do I have constant anxiety buzzing in the background so that it’s difficult to truly enjoy anything?
• Am I having episodes of shaking, chest pressure, trouble breathing, and feeling like I’m going crazy?
• Are these negative feelings familiar to me and remind me of my past episodes of depression or anxiety?
• Do I have any thoughts of running away or escaping?
• Do I have any thoughts of not wanting to live (or being with the baby I lost)? *

If you have any concerns about your mental health, please see your primary care provider — there are many treatment options available, even medications that are safe if you plan to conceive again. If you feel stuck, an experienced therapist may also be able to help you through the grieving process. And if you conceive again, it’s common to have anxiety and trepidation in that pregnancy. But remember, no feeling is final, so be mindful of your mood, look for appropriate supports, and find the strength to move forward.

*If you are having any thoughts of self-harm, please go to the nearest ER, call 911 or call the Canadian Suicide Hotline at 1-833-456-4566. Help is available.

Dr. Bev Young is a psychiatrist and co-founder of BRIA, a comprehensive virtual mental health clinic for women across reproductive life stages (trying to conceive, pregnancy, postpartum and perimenopause).