This article is the third 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.

Childbirth Education After Loss Part Three

Why do childbirth classes after a loss?

All birthing couples need birth preparation. Classes covering all aspects of pregnancy, birth and postpartum are important as each birth is different. Classes should reduce birth fear and explain best practices for the whole family. These parents have an intimate knowledge of how stacking the odds in their favor could make a big impact on the birth outcome. It is critical that they have the information and freedom to make informed choice about their care and their baby’s care. Parents are the best decision makers for the baby but learning how to advocate for one self and children is something that is learned.

Due to the additional stress of pregnancy after loss, these parents may require significant medical assistance through out the pregnancy and birth. Some of the more common forms of assistance include genetic testing, early and frequent ultra sounds, and extra growth monitoring. These extra opportunities to check on the baby reassure families. Also scheduling an induction is often desired and recommended as it can balance stress and help to control fetal outcome. So focusing on reducing interventions may not be helpful for couples after loss. These families need a balance between being ‘normal’ and appropriate medical care. Most importantly they need compassion as they are not ‘just another mom’.

As seen above, unlike other new parents, loss parents have additional fear of unknown outcome. Their loss is upfront and they cannot get away form the idea that they will or will not have a baby to take home, bond with and breastfeed. They may exhibit a lack of excitement over the current pregnancy. The pregnancy itself may lack joy and just be something they have to suffer through. The may be afraid of bonding with the baby inside of them incase they have a repeated loss. Every new sensation is something to be worried about, every similar sensation might be a trigger for what when ‘wrong’ last time. There can be obsession over symptoms, testing and potential outcomes. These families may also be defensive of their choices and concerns as it is challenging to grieve fully while in a current pregnancy.

What type of class is best for loss parents?

Group classes have several advantages for the instructor. It maximizes time usage and encourages classmates to learn from each other. It can foster a sense of bonding and develop long-term last relationships in and out of the classroom.

However it may not be practical as loss parents did not have a positive warm experience the first time. If the classroom is made up of both loss parents and new parents, the loss couples can feel left out and neglected despite the instructors best efforts. It also can be uncomfortable for the ‘normal’ parents as pregnancy is supposed to be a time spent on bonding, loving and planning. Have a loss family in the classroom can bring up fear, doubt and anxiety in normally progressing pregnancies. The loss family may feel left out in the classroom or that they do not belong as the other couples cannot/do not want to relate. Loss couples can also experience jealously over the living children if the other couples already have living children minimizing the effectiveness of group classes.

However, depending on the clients, a group class can be beneficial. A miscarriage loss can fit into a group class with more ease than a stillborn couple, especially if the instructor covers early warning signs and miscarriage statistics as part of class. Sometimes they also can fit in to a birth refresher class with parents who have living children but may have not had ideal birth experiences. Remember birth trauma can be perceived to be equally traumatic as loss. I personally have had success with both group and private classes as long as the loss couple if given then option of choosing the class that best suits their needs.

What do I need to know as an instructor?

When working with loss couples make sure to be compassionate, sincere and honest. Be fair and truthful with your knowledge of loss. Know your limitations and areas of expertise. When in doubt reach out to seniors birth workers and mental health professionals in your area for assistance as needed. Avoid adding disinformation and creating additional harm. Loss couples need simplicity and sincerity. They typically do not desire piles if information and options.

Create time or allow time to grieve over their pregnancy loss or guilt over previous loss/trauma. If loss comes up in class give it the time and space it deserves; have tissues handy and make an effort to create balance in the classroom. Pay respect to what was lost, what was never experienced, and listen with open ears and compassion. Speak from your heart. Do not gloss over the loss or feelings of everyone in the classroom.

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