The moment you see the blue line of your pregnancy test, you see yourself as a parent. You imagine yourself holding a baby, pushing a baby in a pram and start planning how your life will be. Do I need a new car? When shall I stop work? And a myriad of other very exciting thoughts. Fortunately for most of you, that dream will become a reality, and you will give birth to a healthy live baby.
For a small percentage of parents, that hope and excitement ends in devastating loss. The statistics are:
- In the UK, it is estimated that 1 in 4 pregnancies end in loss during pregnancy or birth.
- An estimated 1 in 5 pregnancies ended in miscarriage
- There were 2,763 stillbirths in 2019 (2,522 England & Wales; 174 Scotland; 67 Northern Ireland)
- 170 unexplained infant deaths occurred in England and Wales in 2019, a rate of 0.27 deaths per 1,000 live births: a decrease from 0.32 deaths per 1,000 live births in 2018
These look like small statistics, but when you are on the wrong end of that number, it is shattering. For those of you for whom this is a brutal reality, there is nothing any of us can do that can make it better, because only having a live baby will do that, but there are many ways you can be supported in your loss.
Often the level and depth of your loss is misunderstood, particularly when your friends and family have not seen the baby, it is almost ‘out of sight out of mind’ ‘how can you miss a baby you barely knew?’ This is absolutely not the case, nor can the level of the loss be determined by the gestational age of the baby when it died. It is the emotional investment in the pregnancy that will predict the level of the loss, and for most parents it is unquantifiable. It feels like their present and their future has been snatched away from them, it is utterly shattering, and their trust in life is ruptured. It is crucial that the parents and those around them acknowledge this loss, a simple “I am so sorry” is a good beginning. Giving the baby a name is an important acknowledgment too.
Focus for your Grief
When a baby dies you may have very few memories, so the hardest and most crucial task of grieving, which is facing the reality of your loss, is made harder. How you adjust to this new reality, that you absolutely don’t want to be true, is by allowing yourself to experience the pain of your loss. Having a focus for your grief, helps with this; so a memory box with mementos of your baby, photographs, foot and handprints, and locks of hair all help you to remember the baby who has died. As you do this, you experience the pain of grief, and incrementally adjust to this new reality. With all psychological aspects, this is a process over time, and something you can allow yourself to move in and out of.
Grief feels like you are going mad, but let yourself know it is not the case. It is normal to have extreme feelings, images, urges, thoughts. You may also feel numb, and worry that is abnormal, it isn’t. Grief is a small word that describes a deeply complex painful process and the important thing, I know I’m saying it again, is to find ways to support yourself in it. You cannot escape it.
Grief is embodied, you feel it in every cell of your being, and it can feel like fear. Taking regular exercise, ideally 25 minutes a day, when you raise your heart rate, helps release your natural endorphins, and can help you manage the pain.
Writing has been well researched to be as therapeutic as speaking, and buying a book where you can write down all that you feel, in any way that works for you can be very helpful. Putting in images, drawing, scribbling anything that helps you express what is often inchoate in your body. It is also very helpful as a reference for yourself over time of your process.
Dual Process Theory
The most useful theory I have found is something called The Dual Process. As you can see from the image, at the moment of the loss all of us, men and women have two instinctive responses Loss Orientation and Restoration Orientation, and we oscillate between the two. Doing one allows you to do the other. So having a focus for your grief, supports you in the loss orientation, and then getting out and exercising supports you in the restorative aspect. You may move in and out of the different states many times throughout the day. At the beginning, you are likely to feel overwhelmingly loss-oriented, but doing things that distract you, and being restoration-oriented can help you manage that level of loss. Men tend to be restoration oriented and women tend to be loss oriented, so it is helpful to recognise that we are wired differently; it doesn’t mean we feel the pain less, but what we tend to do with it, is different.
It is also psychologically vital to recognise the equal importance of both states. Being wholly restoration-oriented, which is a form of denial, that old-fashioned view of ‘what I don’t see won’t hurt me’, is actually where madness lies. Equally not giving yourself permission to move away from loss orientation, because there is this feeling of guilt about being ‘ok’ and also the pain keeps the baby close, can lead to complex grief.
Talking about baby loss
Finding ways of talking about what has happened, telling your story in microscopic detail is helpful, filling in every piece of the jigsaw until you have a clear picture is essential. Putting your feelings with your words as you tell your story helps you to adjust to the enormity of this loss. You may need to do this over and over. Walking and talking is helpful. The best thing your friends and family can do is listen, with sensitivity, kindness and compassion.
Choosing to do things that you know comforts you is helpful, whether that is watching a box set, having a massage, cups of tea – whatever you know soothes you. Doing this consciously and regularly helps you manage the internal disruption and chaos that grief brings. And remember grief is like the weather, you are not in control of it, it has its own momentum. As awful as it is, it is a natural process where pain is the agent of change, forcing you to find a way of living with this new reality. Finding ways to comfort you in this is very important. Also important to know that you are all different, and there are absolutely no rights or wrongs in grief, so be informed, but also listen to your own instincts about what works for you.
We will each have our ‘default mode coping mechanism’ that jumps into action the moment we receive bad news. This will be our learned way of coping with difficulty. We all need defence mechanisms, and it is useful to be aware of what yours is, and also work out for this situation whether you need to build other mechanisms too.
Our history of loss will be triggered by this loss, as it takes us to the same place, so a new loss is likely to bring back previous losses. It isn’t you going mad, it is normal.
The level of the pain does change over time, and that time is usually longer than any of you would choose; but that doesn’t mean you forget and move on. Your baby that has died will always live on in you, and be a part of you. It will change you. Your perception of what matters in the world will change, your knowledge of yourself and your friends will change, and some of that learning may over time feel like growth. Not growth you would ever have chosen to have, but growth nevertheless.
There are many organisations where you can get much more detailed support and information:
Julia Samuel is a UKCP registered psychotherapist. Over more than two decades she has worked in this field as Founder Patron and Trustee Child Bereavement UK, Counsellor for Paediatrics at St Mary’s Hospital Paddington. She is Vice President British Association Counselling and Psychotherapy and Honorary Fellow Imperial College.