The Overlap Between Miscarriage, Perinatal Loss, and PPD: 13 Things to know about Grief
By Kate Kripke, LCSW
Losing a baby though miscarriage, elective termination, stillbirth, childbirth, after a NICU stay, SIDS, or any other time is, without a doubt, one of the most difficult experiences that a parent will ever endure. There are no words to explain the depth of despair that a parent goes through when attempting to understand the shift that occurs when all hopes and expectations suddenly drop out from underneath anything stable.
It is an experience that many will never need to make sense of and also one that many others will swim through unexpectedly. It is tragic and drastic and totally and completely unfair and yet thousands upon thousands of families find themselves in this position each year. Here is what we know:
- Approximately 15-20% of confirmed pregnancies end in miscarriage.
- In the US, the rate of stillbirth is documented as 1 in 160-200 pregnancies.
- In the US, the rates of SIDS affects between 5,000-7,000 infants every year.
- In the US, approximately 11,300 infants die within 24 hours of their birth each year.
I give these statistics not to scare you, but because it is important for those mothers who have lost their children to know that they are not alone; to know that there are many others out there who are needing to navigate this loss too.
I have worked with countless women in my office as they try to manage the unfamiliar emotions that surround loss, and I have learned a great deal from these phenomenal moms. I also have a dear friend and colleague who lost her daughter hours after birth and she, too, has honored me with her insight, pain, and eventual healing.
With the information gathered from both my clients and my dear friend (who is now a clinician in San Francisco specializing in perinatal loss), this post is written for all of the moms out there who are trying to navigate the unfamiliar postpartum experience while also grieving the loss of a child that never made it home or past that first year mark. For these moms, postpartum distress is complicated by the process of grief, and sometimes it is hard to make sense of what goes where in this unimaginable puzzle.
So, if you are one of these women, here is what I want you to know:
Some women who lose babies through miscarriage are able to move through this loss freely, while others feel deep despair at this loss. There are no “shoulds” in this. No right way to feel. If you feel strong and grounded and ready to move forward after a miscarriage that is totally valid. If you feel deep loss and grief then that, too, is appropriate. No one gets to tell you how you feel except you.
Any time a body goes from being pregnant to not being pregnant, there is a significant shift in hormones that can affect brain chemistry. Postpartum depression, anxiety, and other mood disorders can affect a mom regardless of the point at which a baby is delivered. You are likely in a position where you need to process through grief while also having a vulnerable brain chemistry. This can make the experience of healing feel impossible for many.
Grief is a normal process and includes a shifting of emotions such as denial, anger, bargaining, depression, and acceptance. Grief felt after the loss of a baby from miscarriage or other event is not necessarily depression and while there may be some overlap, it should not be treated as such. If you feel angry one day and dissociated from your loss the next, this is normal.
If you are not aware of a shifting through the stages of grief and continue to feel debilitated by your suffering, there may be an element of clinical depression or anxiety that needs to be addressed. “Healthy” grief moves, but sometimes it can develop into relentless depression that requires more specific treatment. Many moms will experience depression that includes feelings of guilt, shame, self-doubt, and sometimes suicidal ideation. Regaining a sense of self, hope, and trust is important to one’s healing after a loss such as this.
Identity shifting is a huge piece of the postpartum experience for every new parent, and yet moms who lose their babies are not able to show the world their mother-ness. If you feel like a mom, and yet are not able to participate in the experiences that the mothers around you are included in, know that this is a shared experience and that, whether or not the world can see this, we value you as a mother too.
Loss can often beget feelings of loss. Many women who lose their babies become suddenly afraid of losing everything else, be it their sanity, other relationships important to them, their faith in the world, or any hope for the future. Many, many women who go through this loss feel a deep need to grab onto other things in their life for fear of losing those, too. If this is happening to you, let those close to you know.
Relationships with spouse/partner, family, and friends will be impacted by your loss. It is important to be aware of the tendency to isolate during this time. Receiving appropriate support will be imperative in your healing and there may be work to do in relearning your relationships given this new reality. If you are unable to get the support that you need from loved ones, reach out to a therapist who can help.
While you desperately want your spouse/partner to understand what you are going through, he/she may not. People grieve differently. Often, losing a baby is a very different experience for a mother than it is for her partner, as she was the one who felt the development of this baby and feels, still, the physical loss as her body adjusts to no longer being pregnant. Give space for your own process as well as your partner’s.
You are likely to learn who your truest friends are during this time. Some people’s insecurities and fears around loss and tragedy may interfere with their ability to be there for you. It is entirely appropriate for you to spend time with those who are able to give you what you need, and to take distance from those who do not.
It is normal to feel triggered into sadness and despair when you least expect it. You may find reminders in the places where you least intend them to be. Seeing other pregnant women, babies, holidays and anniversaries, playgrounds, doctor’s offices, advertisements for baby-related items all may bring you to tears even when you feel strong. This is normal.
People don’t always know what to say. Many of you will want desperately to talk about your babies, to bring them to life through your words and memories, to make room for them in conversation and in your experiences. Some people will worry that bringing your baby and your loss in conversation will be upsetting to you. It is helpful to let the people in your life know what you need.
Just because you are ready to feel whole again, are healing, and may decide to have more children, this does not mean that the baby who you lost is forgotten. Regaining strength does not mean that you have “moved on” and will no longer think of what might have been. Your pregnancy and your baby will always be a part of you. However, you deserve to be well and the feeling that you must keep grieving in order to stay faithful to your baby will not serve you. Finding a way to honor your pregnancy or your baby through ritual or event is often a lovely way of incorporating that being into your life as you move forward.
And finally, find others who have experienced something similar. As mentioned so many times on this blog, community is imperative and I am certain that there are others out there who can offer you the kind of solace, strength, and integrity that you will need as you continue to heal.