I see many individuals and couples who are pregnant again following the loss of their baby due to miscarriage, stillbirth, or termination for medical reasons (TFMR). During sessions, we talk extensively about their fears and anxieties. They lose sleep over the many potential ways in which a new pregnancy can go wrong. The most common fear is a recurrence of the same problem.
Watching the calendar and counting each week becomes a ritual and in some cases, a compulsion. The dread sets in as the parent approaches significant weeks of the pregnancy. The most important week for many is the week the loss occurred or the week the baby was discovered to have a problem.
What can clinicians do to be helpful to their clients who understandably, fear the worst?
We can gently remind them that this is a new pregnancy and help them to do what they can to take care of themselves during those difficult pregnancy milestones. We can encourage them to be as hopeful as they can stand to be. We can be with them in their fear. The only thing we can’t do is make promises about what will or won’t happen in a new pregnancy.
If a particular ultrasound was the occasion on which they found out bad news, a parent can prepare for this milestone by acknowledging how challenging the day might be.
If it’s a new practice or new ultrasound tech and the mother is comfortable doing so, she can let the providers know that she may struggle and ask them to communicate with her as directly as possible about what they are seeing on the screen. Other parents might wish to explain why they are more emotional or why they might not look at the screen during the scan. All of these strategies are fine but not everything feels right for all parents. Some parents need extra reassurance from care providers while others prefer direct communication and very little hand-holding. Furthermore, some parents will switch practices following a loss to minimize reminders in a new pregnancy. Talk with your clients about what might feel right to them and do so in advance of these important appointments.
Waiting for test results (such as first trimester screen, CVS, or amniocentesis) can be excruciating if a particular test in the last pregnancy revealed a finding that led to a negative outcome.
Encourage your client to ask for results to be expedited if possible. Client also may need to speak up and let their care providers know that they are anxious due to a previous loss. Sometimes results do get delayed when a busy practice is not well-organized. If someone in the practice understands why it is so important to report results in a timely manner the wait time (and therefore, anxiety) may be reduced for your client. Clients may need reassurance that they are not “bothering” their doctor and assistance in harnessing their ability to advocate for themselves.
Anticipating an upcoming loss anniversary may trigger the need to mark the day in a special way.
This is challenging regardless of whether or not the mother is newly pregnant. For some, being pregnant will make the loss anniversary easier and for others it will be more of a challenge. How does one grieve for a baby who died while pregnant with a different one? Some parents may express guilt about feelings of happiness and connection to a new baby and this may impede their ability to grieve the baby who died. Encouraging them to acknowledge the entire range of their feelings can be helpful. Some parents may need to hear that it’s okay to be sad on a loss anniversary even if they are subsequently pregnant.
Finally, I try to encourage parents to utilize their support network and to seek out those individuals who were most supportive in the immediate aftermath of their loss.
The individuals who were the most connected then are likely to be the same people who will now understand the parents’ feelings of sadness alongside happiness and hope about a new baby. The more parents can share their feelings with others, the more they will be able to work through the complicated feelings that arise around reminders of loss in a new pregnancy.