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A Loss Out Of Time

As October is Pregnancy Loss Awareness Month, I felt compelled to write about the ubiquitous but often not discussed loss of a pregnancy or baby. This is such an important conversation for those who have experienced a loss, those who want to better support someone who has experienced a loss, and for everyone embarking on their reproductive journey. I am so grateful to the women with a public platform who are open and vulnerable enough to share the stories of their loss and the grief that is too often experienced silently and alone. I read Chrissy Teigan’s blog post about the loss of her baby boy at 20 weeks of pregnancy and the public reaction to her posting pictures of her with the baby. I read Meghan Markle’s op ed in the New York Times about her miscarriage. I have read the stories on social media of countless other less famous women who have been brave enough to use their voice and their story to create awareness and help other women feel less alone. Often women need to tell their story to help heal and be able to process their experience as well. I support and embrace every mom who shares their story, and I also support and embrace those who do not yet feel ready or able to do so.

The loss of a pregnancy or baby most commonly happens very early, after a positive pregnancy test but before a heartbeat is even heard. It may occur at any point in the pregnancy from the first trimester until prior to birth, or even after the baby has been born and gone home seemingly healthy. There are other situations that some people may not even think about as falling into the category of pregnancy loss but that count just as much: ectopic pregnancies, elective terminations due to genetic or structural abnormalities, elective terminations due to mom being so sick from medical complications that she would likely die if she continued the pregnancy, or even preterm births prior to when the baby could survive on the outside which may be due to preterm labor, abruption, or preterm rupture of membranes. All of these situations and countless others I have not mentioned also end in the loss of a baby.

I have been lucky to never have suffered the loss of a pregnancy or baby. I have however cared for many women and their families as they have gone through the experience of their loss. I have subsequently cared for these women as their gynecologist and during future pregnancies as their obstetrician. I have also spoken to many friends and family members who have experienced losses, some losses that occurred many decades ago but are still remarkably clear and ever present to those who experienced it. Some of my most difficult yet impactful times as an OB/GYN are when I am caring for a woman who has lost her baby. Often I am the one giving these women and their families the bad news that they have lost or will lose their baby. I am the one holding their hand as they cry prior to performing the procedure to remove the pregnancy from their uterus. I am the one delivering their stillborn baby or their baby that dies hours or days after delivery. I have comforted moms and taken turns holding their tiny babies who were born breathing but are too small or too sick to resuscitate. Even though it is so painful to bear witness as these little lives experience their first and last breaths almost simultaneously, we honor them as best we can and in the way that feels right to the mother.

I always feel helpless and at a loss for the right words. I have learned to accept that there will never be the right words that can take away someone’s pain and grief, however I do my best to make sure that I do not use the wrong words. I never want my patients to remember the painful and traumatic experience of loss and recall that I used a word or said something that was insensitive and made their experience worse. Sometimes this means sitting in silence and just holding space for them. I always try to bear witness, comfort, reassure, and provide compassionate care. When the time is right I make sure to offer to connect them with other resources to help them through their grieving process. I let them know I am there for them and they can reach out for anything I can do to ease their journey. I always make sure to let them know that there was absolutely nothing they did to cause the loss or anything they could have done differently to prevent it. I never want women who are already suffering to think back over the course of their pregnancy and blame themself in any way. Sometimes I am so devastated and heartbroken with them that it is hard to stay in my role. Sometimes I try to absorb the pain and grief to lessen their burden even though I know it is not possible to take on someone else’s grief.

I recently completed a training in Perinatal Loss and Grief through the Seleni Institute so that I am better able to understand and provide holistic care and support to my patients who experience pregnancy loss. The Seleni Institute is a wonderful center in New York for women where they receive maternal mental health care from psychiatrists and therapists who specialize in areas of mental health care specific to women in the perinatal period such as perinatal loss and postpartum depression. One of the most important distinguishing factors of perinatal loss that I learned from this training is that the grief experienced by women and their families when they lose a pregnancy or baby is a different kind of grief called disenfranchised grief. In the words of Christiane Manzella, PhD, senior psychologist and training instructor at the Seleni Institute, a disenfranchised griever is not viewed as someone entitled to mourn. This term was coined during the AIDS epidemic when families would shut out the gay partners from the grieving process. Theirs was a loss that was not acknowledged or socially supported. Women who lose babies experience a similar disenfranchised grief, a grief that is very often quiet and isolating. Some women may not have even told those close to them that they were pregnant when they experienced their loss. Others who are further along or who had delivered their baby may encounter friends, family, and coworkers who do not even acknowledge their loss as it is too uncomfortable for them to ask how they are doing, they don’t know what to say, or they are afraid their own personal happiness will be too much for their grieving loved one to bear. Our culture and society is just starting to acknowledge these losses, the losses of lives not yet lived.

Everyone experiences and moves through grief differently. Some women may feel judged even by their friends and family members as the way they grieve does not line up with others’ expectations. Grief in itself is a normal process and everyone deserves to be able to grieve and honor their pregnancy and baby in the way that feels right to them. We also must acknowledge that the grief associated with the loss of a baby is the grief of a death that occurred much too soon, a grief that includes loss of hopes and dreams. A mom may start to fantasize about their baby and bond with their unborn child from the moment they see a positive pregnancy test. All of this is lost, along with an innocence that comes from the assumption that everything will go as planned. Pregnancy and motherhood is depicted as a joyous time, one full of love and hope for the future child and thoughts of bringing home a perfectly healthy baby. All of this is taken away from the mom when she loses her baby.

Some losses and the stories of the families who experienced them will always stay with me. There are some families that I stay in contact with because we are forever inextricably bound by a shared experience of trauma and heartbreak. Many times I have been one of the few people who ever touched, held, or met their baby and therefore one of the only people that can honor their baby and keep their story alive. Sometimes we have cried together, sat in silence, or made light conversation to ease the gravity of the situation. With all of my patients that experience a loss I desperately hope that I will be able to help them have a healing experience. If they want to have another baby I support them and do everything in my power to make sure they have the physical, mental, and emotional, resources they will need throughout their next pregnancy. Sometimes I have had the privilege of handing them a warm, squirming, healthy baby after previously handing them a cold, limp, lifeless baby. Their loss will always be a part of their story but I feel a shift, a sense of newfound joy that becomes more prominent in their energy than the weight of the previous loss and grief. Sometimes we pay homage to the lost baby at the next delivery. When I follow up with patients who have experienced a loss I tell them that the loss will always be a part of their story, but over time it will become a smaller part of their story as their life becomes filled with more joy and happiness. I hope this thought provides even a small amount of solace.

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