This article is the first of three in a series directed towards Childbirth Educators, working with couples pregnant after a loss. Part one provides important language and understanding about the many different experiences of loss. Part two discusses creating an empowering birth team. Part three describes why couples should complete childbirth classes after a loss, what classes are appropriate, and what the instructor needs to know.
Hope is born with a loss. And loss is interpretational, to be determined by those who experienced the event. When discussing loss in childbirth classes, it usually falls into one of three categories: stillbirth, miscarriage, and abortion.
It is important that the childbirth educator have the same language of the loss couple. This language helps to make for better communication and less misinformation. The term stillbirth is used when a baby dies after twenty completed weeks of pregnancy. Miscarriage is the proper term for when the baby dies prior to twenty completed weeks of pregnancy, typically during the first trimester of pregnancy. Miscarriage is reported to occur in one of four pregnancies and up to 1% of all women have reoccurring miscarriages. Both stillbirth and miscarriage are a loss of a child.
Miscarriage can occur due to a blighted ovum. Also called an embryonic pregnancy this is when the egg implants but never develops. An ectopic pregnancy is when an egg implants in a fallopian tube or a similar non-desirable location. And a molar pregnancy is when a genetic error occurs with or with out an egg that causes uterine changes.
Abortion can be a sensitive topic for many childbirth educators. The elective nature of the loss might be harder for an instructor to isolate or to process. Abortion also carries a social stigma even if the abortion was for medical reasons. A childbirth educator needs to understand that women who have chosen abortion often have a lack of community and do not feely share their stories for fear of peer judgment or social persecution. Their loss is unique and there are no rituals to help process their loss.
All three types of loss can be equally traumatic for the couples involved. The loss and their feeling surrounding it are very real and traumatic. Other forms of birth trauma that are perceived similarly might include: medicalized births (interventions, epidurals), cesareans, and NICU stays. As trauma and loss are both unique and isolating experiences, so is grief.
Everyone grieves differently. Some individuals are very public and upfront when sharing their grief. Facebook and other public media forms can make it easy to give your friends and family a quick glimpse into your life. Other people prefer to seek out professional help in both private and group grief settings. And yet some cannot face sharing their innermost thoughts with anyone and sit privately, all alone. I have even had experience where a mother was thankful for her loss as it drew medical attention to condition that ultimately saved her life. As a childbirth educator, you should not try to be a therapist but rather be able to supply her with professional recommendations.
Just as unique as loss can be, couples that have experienced loss can have a multitude of reactions and needs. Women might report a loss of feminine power or a loss of trust in their ability to birth. They may find that their maternal autonomy was undercut. That they lacked the ability to make decisions about their care, freedom of movement was restricted, or that the birth was violent or traumatic. They might mourn the loss of maternal wisdom, the concept of ‘do not disturb’. Partners may report sadness, grief and shock over the loss however about one quarter of partners do not share their feelings with their partner or peers and are often ignored or forgotten in the grief process.