Pregnancy after loss is a psychologically complex and challenging journey. And it can be tricky to determine if what you are feeling is grief for your baby who died … appropriate fear about this new pregnancy … or a complicating mental health disorder, like perinatal anxiety or depression. Once you determine which of these you’re experiencing – how can you cope?
Pregnant after loss (PAL) moms have a higher incidence of perinatal anxiety and mood disorders.
When you are pregnant after loss, you may feel the followingMental Health After Loss and Supporting Mom Pregnant After Loss, Lindsey M Henke, MSW, LICSW, … Continue reading:
- A loss of innocence and trust in your body and a ‘good outcome.’
- Conflicting emotions of joy versus grief or hope versus fear.
- Isolation – feeling alone and different because you are changed forever.
- Ambivalence toward the pregnancy out of fear of getting attached and suffering loss again.
As if all of this were not hard enough, your mental health can be additionally affected by this new pregnancy. Your history of pregnancy or infant loss places you at a higher risk of anxiety, depression, PTSD, and complicated grief. And this is true even if you did not suffer a mental health disorder after the death of your child. You can experience these disorders during pregnancy (perinatal) or after birth (postpartum).
Why perinatal/postpartum mental health disorders are common after pregnancy loss.
Isolation and loneliness due to stigma and silence.
You may feel lonely or isolated for many reasons. Perhaps you do not have the emotional energy for socializing. Perhaps you have opened up about your loss and were met with silence or painful platitudes. And even if you share with a loved one, you know that no matter your words, no one can fully understand how you feel at the loss of your child. Loss is often isolating and lonely.
Invalidation of your loss.
Modern society is predominately grief illiterate. And part of that failure includes the inability to recognize the significance of the loss of a baby at any gestation or after birth. We do not talk about pregnancy and infant loss as a culture, thereby insinuating it is not worth talking about. Nothing could be further from the truth. And yet many loss parents report feeling like they were shamed for their grief and were told they should not grieve as hard or as long as they were.
Lack of support from significant people in their lives.
When you go through something significant in life, it is natural to want to share that event with the people you are closest to. But because pregnancy loss is such a taboo topic, many people do not know how to support you through your loss when you allow them into your grief. They may stumble for words (if they say anything at all). Often, they fail to recognize you are both a postpartum mom and a bereaved mom and need support for both things. Too often, support is lacking, even from those who love you.
Views loss as a major life event.
The loss of your child is a major life event. And it is incredibly challenging to function in a world that refuses to acknowledge this fact. This child and the loss of him or her changed your life. And there is no going back.
Psychologist and author Bessel van der Kolk, MD, says, “Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long-lasting scarsThe Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk, M.D., Penguin Books, 2014.” Pregnancy and baby loss are often traumatic experiences for parents because you cannot protect your child from death and yourself or your loved ones from grief. The amount of trauma involved does not necessarily relate to the gestation or age of the baby traumatic.
A shift in pregnancy hormones.
When you go from pregnant to not pregnant, at any gestation, in any manner of birth, your hormones go through a cataclysmic change. That hormone dump on your brain affects the way your brain operates and puts you at a higher risk for a mental health disorder. Even if you have an early loss, the hormone shift has the same effect on your brain as those with later losses or births.
Reasons why mental health disorders are common in pregnancy after loss.
Here are some additional reasons you may struggle in your mental health as a pregnant- or parenting-after-loss mom:
When you experience moments with your subsequent baby that you missed out on with your baby who died, your grief can resurface. Perhaps you made it past the gestation where you lost your other baby. From that moment on, you may feel a renewed sense of loss, recognizing that you never got to share this moment with that child. Once your baby is born, you may find incredible joy with your living child – and overwhelming grief at all you missed out on with your child who died. You may find that you spend time wondering who your child would have been and mourn that you’ll never know. You may also mourn the relationship you hoped your babies would have had with each other.
Most loss mothers experience a subsequent pregnancy within 18 months of their loss. This means that your hormones are yet again on a wild roller coaster of rising and dropping, and with the onslaught of hormones comes increased opportunity for your mind to struggle to operate as usual.
Pregnancy after loss or infertility is psychologically challenging.
When you find yourself on the wrong side of statistics, it can feel impossible to hope for the best again. You may be more hypervigilant. Anxiety from your loss can carry over into this pregnancy and through birth to parenting. You may constantly wonder if you will lose this baby too. This uncertainty and fear can take their toll.
Lack of good sleep is a common complaint among pregnant and postpartum women. And for good reason. Not having enough (or good enough) shut-eye can cause significant challenges for your brain to function as it should, and can cause or exacerbate mental health disorders.
What can put you at increased risk of mental health disorders in pregnancy.
Here are some things that put you at higher risk of developing a mental health disorderList of risk factors is a compilation based on the following resources: “Screening for Perinatal Depression,” Committee Opinion Number 757, Committee on Obstetric Practice, The American College … Continue reading:
- Pregnancy or infant loss.
- History of infertility.
- Previous mental health diagnoses.
- Lack of proper social support.
- Low income.
- History of substance abuse.
- Pregnant after loss.
- History of recurrent pregnancy losses.
- Previous mental health history.
- Lack of support from a partner or domestic violence.
- No living children.
- Termination for medical reasons.
- Unintended pregnancy.
- Traumatic birth experience.
- Your baby spent time in the NICU.
When to question if you have a mental health disorder.
Lindsey Henke says there are a few indicators that you are dealing with more than grief. If your feelings are keeping you from operating in day-to-day life after six months or more, it is probably time to talk to a licensed counselor or medical doctor. If you are seeing or hearing things that are not there, you are likely experiencing psychosis, which is a medical emergency and needs immediate treatment. If you are relying on substances to cope, have disturbing intrusive thoughts you can’t get rid of, cannot experience any joy, or want to self-harm or dieIt is natural for a mother to want to be with her baby. When your baby is dead, the desire to be with them can seem morbid to others. This feeling of longing to connect with your child is different … Continue reading – these are indicators that it’s time to see a professional to help you navigate your grief.
Postpartum or perinatal anxiety.
Anxiety is a nervous fear of what is to come. Anxiety can be a completely normal and appropriate emotion. It also can be a disorder when it is disruptive to your everyday life. As you can imagine, PAL moms report high levels of anxiety in a subsequent pregnancy. When you’ve been on the wrong side of statistics, life itself does not feel safe – let alone pregnancy.
It is helpful to note that anxiety is a biological response to your fear. To help you “prepare” for worst-case scenarios, your brain creates these scenarios, forcing you to mentally navigate your way out of them. Anxiety is a cry for felt safety. The problem with your mind’s natural response to that fear is that anxiety doesn’t make you any safer. Instead, it drains the joy out of your present moment.
Anxiety, like all mental health disorders, is not a failure. It’s a sign that you need more support than what you can create through grit and determination.
Depression … when it’s more than sadness.
How can you know if you’re depressed – or you’re just in the pit of grief? The American College of Obstetricians and Gynecologists say that depression is one of the most common pregnancy complications, affecting up to one in seven women during pregnancy or in the months following birth“Screening for Perinatal Depression,” Committee Opinion Number 757, Committee on Obstetric Practice, The American College of Obstetricians and Gynecologists, October 24, 2018, … Continue reading.
The following symptoms indicate depression if they last more than two weeks: Low mood, sluggishness, not getting out of bed, not feeling pleasure or interest in things, intrusive thoughts, irritability, anger, insomnia or too much sleep, change in appetite, feelings of worthlessness, withdrawal from family and friends, recurrent thoughts of death or suicide, and more“Postpartum Depression,” Mayo Clinic Staff, Mayo Clinic, September 1, 2018, https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617.
You may think – well that sounds like grief.
One helpful distinction is whether you are capable of experiencing any joy whatsoever. When you are deep in grief, you should be able to experience a moment of joy, laughter, or appreciation. While you are likely not the picture of happiness right now, you can still smile sometimes, even if it feels wrong to do it because you’re grieving.
When you are depressed, you are unable to experience joy or happy emotions. You are numb to them all.
If you are experiencing these symptoms more than six months after your loss, and they are impacting your day-to-day, it can be helpful to talk to a therapist to help you delineate what is grief and what is depression. Depression, like anxiety, has significant consequences for you and baby and should be addressed.
When it’s trauma: Post-Traumatic Stress Disorder.
Trauma happens when you feel a threat to your life, or a threat to the wellbeing of someone you are close to, that is beyond your ability to cope. For many people, the loss of their child in pregnancy or shortly after is a traumatic experience.
Postpartum Support International says the following are symptoms of postpartum PTSD“Postpartum Post-Traumatic Stress Disorder,” Postpartum Support International, https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/:
- Flashbacks (feeling like you are transported back to the event and are re-experiencing your trauma).
- Avoidance of anything associated with your trauma.
- Feeling anxious or having panic attacks.
- Persistently feeling “on” and hyper-alert (e.g., irritability, difficulty sleeping, hypervigilance, exaggerated startle response).
You may wonder what the difference is between a grief trigger and a flashback. While there is no medical definition of a grief trigger, you can think of it as something that causes a wave of grief to hit. This grief may cause sadness or any other emotion you may come to expect from grief. When a flashback hits, you reexperience the traumatic event, as though the past is your present. It will cause you to feel fearful and unsafe and will likely trigger your fight/flight/freeze response.
Studies have shown that grief typically peaks around six months after the loss. This is true for pregnancy loss as well. This does not mean grief ends or that you never experience intense grief around the loss of your child again. Rather, it means that you can begin to engage back in your life, even if in baby steps.
If after six months, you are completely unable to function in everyday life due to your grief, you may be suffering from complicated grief.
The Center for Complicated Grief explains, “Grief continues to dominate life and the future seems bleak and empty. Irrational thoughts that the deceased person might reappear are common and the bereaved person feels lost and alone… Acute grief is typically highly emotional. Most people have a range of ways to regulate these emotions. They balance the pain with periods of respite, giving themselves permission to set the grief aside for a time. People with complicated grief have trouble doing this; instead, they often focus on things that increase emotional activation. Regular routines including adequate sleep, nourishing meals, adequate exercise, and social contacts may be disrupted, making emotions more difficult to manage“Complicated Grief,” The Center for Complicated Grief, Columbia School of Social Work, 201, https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/.”
Think of depression as a total inability to experience joy and a loss of interest or pleasure in things you normally enjoy. Complicated grief, on the other hand, is an unhealthy preoccupation with the loss of your baby.
How to cope if you have a perinatal or postpartum mental health disorder.
There are ways to help you cope and heal.
Get help from a mental health professional.
Talking to a licensed therapist can be beneficial whether you are “just” grieving or if you are suffering from a mental health disorder. They also can help determine what extra supports you might need at this time. If you do not already have a therapist you trust, try to see a therapist who is specially trained in perinatal issues or grief. Visit Postpartum Support International to find a provider near you.
Get support from peers.
Few understand your grief like those in the pregnancy loss community. According to one study, “it is essential that PAL moms find a place where they can feel free to express their distress, anxiety, fears, their sometimes ambivalent feelings between expecting a child and grieving for the previous child“Mental Health After Loss & Supporting Mom Pregnant Again After Loss,” Lindsey M. Henke, MSW, LISCW, … Continue reading.” Online or in-person support groups are equally beneficial.
Studies have shown that writing for even 15 minutes on three occasions about your experience can help you work through the trauma of your loss and promote healing.
Self-care is especially important in pregnancy after loss. Nurture yourself the way you would nurture your child. Eat good food. Sleep. Allow others to comfort you.
These practices have proven to be beneficial in helping to calm your mind. See our article on yoga and mediation to find out more.
Ground yourself in nature.
Being in nature has a way of calming our bodies and our minds. Engage your senses.
Deep, controlled breathing can help you regulate your autonomic nervous system, and calm your fight, flight, or freeze response. Here are some breathing exercises you can try. Please note that for some people, deep breathing can have the opposite of the desired effect, so do what feels right to you.
Continue your bonds.
Find a way to continue to mother your child who died. Even though they are no longer with you, your love and need to mother them is still strong. Keep building the bond with your baby in whatever way feels right to you.
Mental health disorders are biological disorders and may need a biological response. Medication can be a helpful part of your treatment. Remember that medication is not to fix grief – but rather, it is to help you have better access to your grief so you can process your loss. Medication should always be taken under the supervision of your doctor. Be sure to tell them if you are pregnant or breastfeeding.
Postpartum mental health struggles are not failures.
If you are struggling in your mental health in your pregnancy after loss, know that you are not alone. This is a common experience and there is help. Second, know that this does not mean you failed in any way – not in your grief and not in your pregnancy. This is not your fault.
While mental health struggles can complicate the grieving process, there are ways to help ease your suffering. You are worth the support … and so is your baby.
- 6 Coping Skills for Managing Stress During Your Pregnancy After a Loss
- Mental Health Medications During A Subsequent Pregnancy: What to Consider
- The Proven Benefits of Meditation and Yoga in Pregnancy
- My greatest fear during my pregnancy after loss wasn’t that my baby would die
- The Case for Seeing a Therapist During Pregnancy after Loss
- Why Aren’t We Talking About Mental Health After Loss?
|↑1||Mental Health After Loss and Supporting Mom Pregnant After Loss, Lindsey M Henke, MSW, LICSW, https://docs.google.com/presentation/d/1D34FpPDnJR6Jj0rCNULa6O8y6wJfY6J3vhxU2ItiFac/edit?ts=5ec6d922#slide=id.p|
|↑2||The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk, M.D., Penguin Books, 2014|
|↑3||List of risk factors is a compilation based on the following resources:
“Screening for Perinatal Depression,” Committee Opinion Number 757, Committee on Obstetric Practice, The American College of Obstetricians and Gynecologists, October 24, 2018, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression
“Mental Health After Loss & Supporting Mom Pregnant Again After Loss,” Lindsey M. Henke, MSW, LISCW, https://docs.google.com/presentation/d/1D34FpPDnJR6Jj0rCNULa6O8y6wJfY6J3vhxU2ItiFac/edit?ts=5ec6d922#slide=id.p
|↑4||It is natural for a mother to want to be with her baby. When your baby is dead, the desire to be with them can seem morbid to others. This feeling of longing to connect with your child is different from thoughts of wanting to hurt yourself or take your own life. If you are at the point where you are struggling to keep holding on, there is hope. Call 800-273-TALK (8255) to immediately talk with someone who can help you.|
|↑5||“Screening for Perinatal Depression,” Committee Opinion Number 757, Committee on Obstetric Practice, The American College of Obstetricians and Gynecologists, October 24, 2018, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression|
|↑6||“Postpartum Depression,” Mayo Clinic Staff, Mayo Clinic, September 1, 2018, https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617|
|↑7||“Postpartum Post-Traumatic Stress Disorder,” Postpartum Support International, https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/|
|↑8||“Complicated Grief,” The Center for Complicated Grief, Columbia School of Social Work, 201, https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/|
|↑9||“Mental Health After Loss & Supporting Mom Pregnant Again After Loss,” Lindsey M. Henke, MSW, LISCW, https://docs.google.com/presentation/d/1D34FpPDnJR6Jj0rCNULa6O8y6wJfY6J3vhxU2ItiFac/edit?ts=5ec6d922#slide=id.p|