March is Pregnancy After Loss Awareness Month. And because becoming pregnant again after losing a baby is complicated, it can be hard to understand, specifically if you haven’t experienced loss yourself. In an effort to bring awareness to an often misunderstood experience, here are 10 things unique to pregnancy after loss that you might not realize.

1. Becoming pregnant after experiencing a loss takes courage, plain and simple.

Knowing firsthand that your baby could die, but choosing to try again anyway? Forging ahead in the face of fear? Trudging the lonely path of grief and deciding to take a turn into the unknown, fully aware you might just be going in circles? Choosing hope when heartache is about to swallow you? That’s bravery at it’s finest. The mom who is pregnant after loss is truly a warrior.

2. The mom who is pregnant after loss is still grieving.

With a new baby on the way, it might seem like her cup is full, but I can assure you it doesn’t feel that way to her. She is still grieving the baby who died—and forever aware of the child who is missing from her life. The sweet taste of a subsequent pregnancy is diluted with the bitterness of sorrow. The pregnancy after loss experience is truly a cocktail of grief and gratitude.

3. Pregnancy after loss isn’t your average pregnancy, no matter how normal it seems.

It’s tainted by the aftermath of loss. Clouds continue to hover, the shadow of loss ever-present as you wonder if the storm will ever truly pass—if this is the baby you’ll get to bring home. It calls for extra care, both physically and emotionally. For the mom who is pregnant after loss, gentle words and validation from friends and family are needed—remember, it’s likely that this new baby was conceived primarily because another baby died. A mental health professional might be called upon to help with feelings of intense grief and anxiety to cope with one loss and the fear of another. Additional doctor’s appointments, even in-home healthcare, might be required to give this baby the best outcome possible. But it’s important to remember that even the best doctors and mental health professionals cannot guarantee that this baby will survive. And that reality hovers over each day of a subsequent pregnancy.

4. It’s appropriate to offer the pregnant after loss mom congratulations as well as condolences.

Trust me. She will appreciate it. By congratulating her for the baby growing within her and sympathizing with the loss of her gone-too-soon baby, you are truly validating her experience and conflicting feelings. Yes, it’s important to celebrate the presence of a new life—and just as important to recognize the loss of one.

5. There might not be a pregnancy announcement.

You may not find out that a loss mom is expecting again until her pregnancy becomes a healthy, living baby who is cradled in her arms. The thing with pregnancy announcements is that they come with an assumption that life is being brought into the world. But the mom who has lost knows it’s sometimes death that is born instead. There is a very real concern that a pregnancy announcement will result in a loss announcement. For that reason, it’s not uncommon for the mom pregnant after loss to share her pregnancy news until much later in pregnancy or even after the baby is born.

6. When you ask a pregnant after loss mom if she’s excited, the answer might be “no.”

Sure, she might force her lips into a cautious smile, or nod her head. She might even tell you, that yes, she is excited, but mostly because it isn’t socially acceptable to say no. While the pregnant after loss mom certainly may be excited at the prospect of bringing another baby into this world, be prepared to hear about the less talked about side of pregnancy when loss is involved. Instead of excited, she is likely scared that another of her precious babies will die. She may have PTSD related to her loss experience, because really, is there anything more traumatic for a mother than losing her child? The bottom line is that when you ask a PAL mom how she’s doing, be prepared to hear a real, messy answer instead of a blanket response.

7. All things baby are still hard to be around

A friend’s baby shower. The pregnant family member. The sweet newborn at church. Any and all pregnancy announcements. The baby department at Target.  For the mom pregnant again after loss, these things can trigger grief, as well as unwelcome emotions like envy and anger. It’s confusing because she herself is pregnant, but while she’s grateful and hopeful, she’d give anything to experience pregnancy with the naivety she once had. She’d give anything to not have the weight of loss on her shoulders. She’d give anything to be 100-percent joyful and oblivious to all that could go wrong. And she’d give anything to have her baby safely in her arms. Anything related to babies reminds her of the pain involved in her own motherhood story, and frankly, it still hurts.

8. Pregnancy after loss is riddled with guilt

It’s quite possible that the pregnant after loss mom is still dealing with intense feelings of guilt related to her loss. No, it wasn’t her fault. But it’s hard for a mother who has lost her child to accept that truth as fact. Additionally, it’s likely that she feels a sense of guilt for “moving on” in becoming pregnant again and hoping for a new baby. She may feel guilty for feeling any joy at all over a new pregnancy, because how can she in good conscience be joyful when her other baby died? Or she may feel guilty for still grieving her loss when she’s carrying a new life. On top of that, guilt may be felt if she needs additional care or help, say, during a high-risk PAL. She might be able to rationally tell herself there is no need to feel guilty over such things, but her emotions tell her otherwise.

9. There is no when, only if.

There isn’t much talk of “when” for the pregnant after loss mom. Instead, you will hear her saying “if” when she refers to the future. Whereas a woman who hasn’t experienced loss will say “when we bring the baby home…,” the mom pregnant after loss says “if we bring the baby home.” “When we finally meet our baby…” becomes “if we get to meet our baby.” She knows she can’t be certain about anything and that plans don’t always work out. If her pregnancy ends with a living child, then perhaps she can start thinking of the future in such terms as “when.” But if her pregnancy ends in another loss, the only thing she’ll be wondering is “when will it be my turn to bring a baby home?

10. Pregnancy after loss requires understanding and lots of grace.

The pregnant after loss mom isn’t your average pregnant lady. From minute-to-minute, she is experiencing every emotion imaginable. Joy. Fear. Excitement. Anxiety. Grief. Gratitude. Hope. Doubt. Peace. Jealousy. The process of growing and carrying a baby is a beautiful experience, but being pregnant after loss has an ugly side that can leave a mom pregnant after loss feeling paralyzed. She needs grace—and lots of it. Please don’t judge her for harboring angry thoughts towards a peacefully pregnant woman. Or for seeming pessimistic in what is generally seen as one of the most optimistic times during a woman’s life. Trust me—she doesn’t like feeling the darker feelings. But they are real and they are valid and they come from a place of deep, deep hurt. Please try to understand the pain she has experienced in losing a child and offer her help and understanding as she cautiously awaits the birth of a new baby.

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