Resources

There is not a timeline for when you will feel better emotionally, and things may never truly “return to normal,” so it is important to be patient and loving toward yourself and your loved ones. Taking care of both your physical and emotional health is necessary for your overall healing process. Here are some recommendations for self-care:

• Focus on getting sleep every night.
• Keep hydrated by drinking water or juice. Avoid caffeine (in coffee, tea and soda) in the afternoon, as these items may make it hard for you to sleep.
• Eat healthy food, such as fruits and vegetables. Stay away from junk food, fast food and too many sweets.
• Avoid drugs and alcohol as a way to cope with the sadness and anger you may be feeling.
• Try to do something active every day once you have been medically cleared by your provider.
• Go for a walk. Get outside for a while. Feel the warmth of the sunshine on your face.
• Seek out quiet moments for meditation or prayer.
• Write your thoughts and feelings in a journal. Start a blog. Find ways to express what you are thinking and feeling.
• Practice deep breathing, taking in slow, deep breaths through your nose and then releasing the air slowly through your mouth.
• Read books and poems or listen to music that you like and find comforting.
• Practice progressive muscle relaxation: Lie on a bed or couch and simply be aware of your entire body.
• Begin by focusing attention on your toes and work your way up to the top of your head. Note any tension or physical discomfort. Contract your muscles in each of those areas and then, with a big exhale, let the tension drop away.
• Ask others for help and support. Tell them exactly what they can do for you. Ask them to help with childcare, pet sitting, grocery shopping, making meals, or just spending time with you at home.
• Talk about your thoughts and feelings with your partner, family members and other supportive loved ones.
• Join a support group of other parents or couples who have also experienced a pregnancy loss.
• Try not to make big changes in your life (like moving to a new place or taking a new job) right away. Wait a few months. Give yourself time to grieve the loss of your pregnancy.
• Consider creating a memory box with special mementos and meaningful items and/or find ways that are meaningful to you to honor your child. This could be in the form of planting flowers or a tree, or finding another ritual for your family, if you wish.

Grief is a natural part of coping and healing after loss. There is no right or wrong way to grieve, but stages of grief have been described to help people understand some of the thoughts and emotions they might experience.

These stages do not necessarily represent a step-by-step guide to grief; a person may move from one stage of grief to another, or may skip some steps entirely, only to experience them at a later time. You may find that you and your partner, two people experiencing the same loss, grieve in completely different ways and may not be in the same stage of grief at the same time. This is normal.

Common stages of grief

DENIAL is often described as a feeling of disbelief about a situation, or the thought that this just cannot be happening. Common thoughts people may have during denial:

• “There is nothing wrong with my baby. The doctors are wrong.”
• “This isn’t happening to me.”

ANGER following a loss may be directed at strangers, members of a healthcare team and even loved ones. The anger you may feel while grieving may disguise itself as anger about other things. It is possible that you may be more short-tempered than you usually are or find excuses to start arguments about things that wouldn’t normally bother you. Common thoughts people may have while experiencing anger:

• “You’re wrong. You don’t know what you’re talking about.”
• “I did everything right during the pregnancy. This isn’t fair.”

GUILT is characterized by assigning, or assuming, blame for what has happened. Common thoughts people may have include:

• “What did I do to deserve this?”
• “I must have done something to cause this.”

DEPRESSION is a time of great sadness following a loss. It is important to realize that depression is a stage of grief, but also can develop into a clinical problem (see “Recognizing Symptoms of Depression and Anxiety” resource page). Common thoughts people may have while experiencing depression:

• “I never knew I could hurt so much.”
• “No one understands what I’m feeling.”
• “I don’t know how I’m ever going to feel better.”

ACCEPTANCE is often described as the final stage of grief. Acceptance does not mean happiness or even accepting the situation you are facing, but rather it is a feeling of integration about your loss. It is the ability to hold on to your grief, while also taking steps to move through it. You may feel that you have reached acceptance only to flip back to one of the other stages of grief. Again, this is normal.

Grief does not have a timeline. It is typical for a person to relive or re-experience any of the above stages following a period of grieving. Anniversaries, the expected date of birth, holidays, and other events may trigger your grief after loss.

Pregnancy loss affects the entire family system. It may seem like most of the focus and attention is on the woman who experienced the physical loss; however, your loss experience is just as important to acknowledge.

As her partner, you may feel the need to be “the strong one” in order to care for her physical and emotional well-being. As a result, this may not leave you with the opportunity to express your own unique feelings of grief within your shared loss. It may also make it challenging to ask others for help during this difficult time.

It is important to understand that this experience of loss is a shared loss; something that has happened to both of you. You may be surprised to find that you are experiencing similar feelings of disappointment, anger and sadness as those of your partner. You may believe that expressing your sadness may make things worse for your partner, but this is rarely the case, as she needs to know that she is not in this alone.

You may be pulled to continue to try to “keep things together” and take care of business as you always have, such as returning to work or managing the household duties. Grieving styles between you and your partner will be different which can lead to misunderstandings or a disconnection with one another about the level of sadness you both feel. Sometimes loss, however, can bring you closer as a couple and as a family.

While there are no specific guidelines for grieving, there are some tips that can be helpful for the unique situation in which you find yourself. Some considerations may be:

• Take some time off of work or your regular activities, despite the possible desire to return right away.
• Let your family know that you may need some extra help, even if you don’t know exactly what you need.
• Allow yourself to feel the full range of your emotions. Try not to delay or distract yourself from them.
• Seek professional help if and when you think you may need or want it.
• Consider journaling and/or reaching out to other bereaved parents for support.
• Let your partner know how you are feeling.
• Avoid drugs and alcohol as a way to cope with the sadness and anger you may be feeling.
• Explore other outlets to express your grief, such as physical exercise.
• Pay attention to any physical symptoms you may be experiencing (e.g., headaches, stomach upset, restless sleep) and see your medical provider if these symptoms worsen.

The journey through grief can be a long and painful process. There is help along the way. Identifying that you are also grieving is the first step in beginning to take care of yourself and one another.

Sometimes you may think that all you want is to get pregnant again, while at other times you may feel that you could not possibly survive another pregnancy. This kind of uncertainty, combined with intense feelings of grief, and perhaps guilt about your loss, is normal. You are not alone.

Some couples decide to try again as soon as they are medically cleared, some wait years, while others never try again. The best way to decide what is right for you is to consider your physical and emotional readiness, and then listen to your heart about whether you are ready to move ahead.

Some women become focused on the idea of getting pregnant again shortly after their loss. During this period, you may fear that you will never be able to have another baby or that something will go wrong again. This decision is intensely personal.

If you are still struggling in your grief (crying a lot, with disrupted patterns of eating and sleeping, and frequent mood swings), it is probably not yet time to become pregnant again, especially since the hormonal changes of pregnancy could deepen your sadness. If you get pregnant soon after your loss, the birth of your next child may coincide with the anniversary of your loss. While some women do not consider this a problem, others find this potentially upsetting. Some women feel that they do not want to consider getting pregnant again until after the due date of their previous pregnancy.

Talk with your healthcare team about risks for future pregnancies. If you opted for an autopsy or any additional genetic testing, it is recommended that you wait until you have the completed test results back before trying again. These results may give you the most complete information about recurrence risk and can provide helpful pregnancy management information for yourself and your care team.

You should not expect to be completely over your loss before you consider another pregnancy. As you mourn the loss of your child and begin preparing for another, it is normal to have complex and often conflicting feelings.

Some couples find it difficult to be physically intimate after a loss. The best way to resolve these differences is to talk openly and honestly with each other about your thoughts and feelings. More importantly, listen to what your partner has to say. Some couples find it helpful to seek out professional support from a therapist or clergy, or to identify a support group for families who have experienced pregnancy loss in order to work through the strain within the relationship that a loss can sometimes cause.

Expected recovery

• It is normal to have vaginal bleeding for one to three weeks after a pregnancy loss. The bleeding can range from very light to more like a heavy period. It is also normal to pass blood clots in the first one to two weeks.
• Most women experience slight cramping, similar to menstrual cramps. Cramping is usually worse in the first few days after the birth and should gradually resolve over the next two weeks. Applying a heating pad and taking an anti-inflammatory medication can help with the cramping.
• You may resume normal activity when you feel able, usually a few days to a week after the loss.
• Avoid strenuous activity or heavy lifting for at least a week or two.
• Most women will have a period about four to eight weeks after a pregnancy loss. Your fertility can return immediately, so you must use birth control when you start having intercourse following a loss if you do not wish to become pregnant.
• It is very important to see your provider for a follow-up visit about two weeks after the loss to make sure that you are healing well.
• Depending on the gestational age at the time of birth, you may experience breast engorgement (swelling) and leaking of milk. Wearing a tight-fitting bra, applying ice packs to the breasts, and taking anti-inflammatory medication will help these symptoms resolve within a few days to two weeks.

Signs of complications

Please call your healthcare provider if you have any signs of a complication, which include:

• Passing blood clots bigger than a golf ball
• Heavy bleeding that soaks through a large, overnight menstrual pad in an hour, for two consecutive hours
• Pain or burning with urination, or a sensation of having to urinate all the time
• Headache, muscle aches or a general feeling of unwellness
• Fever of 100.4˚F or higher that lasts four or more hours
• Severe pain in the abdomen that is not improved with pain medication, rest or heat
• Vaginal bleeding or discharge that has a foul smell
• Vomiting lasting more than four hours

Children who were expecting a new baby may ask where the baby is or why the baby is no longer in your belly. The thought of talking to your child/children about losing your baby may seem overwhelming, but giving them no explanation for the loss may cause more fear and confusion.

Children need clear and honest information. Questions and reactions may vary depending on a child’s age and personality. This guide is meant to provide some suggestions for talking to and supporting your child/children following a loss.

Younger children

• Young children may not understand what is going on, but they may sense that something is different at home.
• If your child asks about the baby, provide a simple answer. For example, you could say something like, “Our baby did not grow big enough to be born, and he/she has died.”
• Provide reassurance that no one did anything wrong and that you, as their parents, are both OK.
• Young children may ask you the same question over and over. This is their way of trying to better understand what has happened. Reply with the same clear answer each time and make sure that all other caregivers (e.g., grandparents, babysitters, daycare providers, etc.) are using your same language to avoid confusion.
• Storybooks can help you talk about the loss as well as help your child identify the feelings and emotions they may be experiencing.

School-age children and adolescents

• Children in this age group are able to think more logically, but they still need clear explanations.
• Start with a simple explanation such as, “Our baby did not grow big enough to be born” or “Our baby did not grow big enough in mom’s belly, and because of that our baby died.” Then listen to what questions or thoughts they have.
• Provide reassurance that no one did anything wrong and that you and your partner are both OK. It is OK to say, “Sometimes this happens with babies and we don’t know why.”
• They may not respond right away and may come back to you at a later time with questions.
• Your children may demonstrate different behaviors as a result of the loss. Keep the communication open and let your children know that they can always come to you with questions, thoughts or worries.

Emotions and feelings

You can also support your children by putting words to the emotions that they may see you exhibit or that they experience themselves. It is OK if your children see you cry; you can say, “Mommy is sad right now because the baby died and I miss him/her, and sometimes when we are sad, we cry.”

Again, provide reassurance that even though you are sad, you love them very much and they have done nothing wrong. Reading children’s books about feelings and emotions can also help.

If you have questions or need further support, your children’s pediatrician is also a good resource.

• Here are just a few ideas on ways to memorialize your baby. The list is endless and as unique as your baby!
• Create a website or blog
• Remember and celebrate birthdays
• Create a shadow box of the physical mementos of your baby
• Tattoos of handprints, footprints, name, birthdate, or image
• Attend Remembrance Walks and Events
• Help other families who have experienced a loss
• Stuffed animal in the weight of your baby
• Plant trees or flowers
• Start a foundation or fundraiser in your baby’s name
• Make blankets, clothes, diapers for hospitals to give to parents
• Donate to organizations in baby’s name