As a kid, a popular playground activity was the see-saw: a simplistic device that promotes relationships and excitement. We would take turns going up and down in either a rhythmic way or erratically to promote the most thrills. I loved the metronome-like quality of it as it was almost hypnotic for me. Recently, I began thinking about how similar a pregnancy after loss is to this metaphorical see-saw.

Almost by definition, a pregnancy after loss is a study in the ups and downs of emotions. The first sign of a positive pregnancy begins the see-saw: feelings of exhilaration and fear simultaneously enter the picture. Many are overjoyed that they were, in fact, able to become pregnant again. There can be a sense of responsibility and concern about not being able to protect this tiny being-to-be as it grows. (It is a nearly universal thought in my practice that any loss was somehow the mother’s “fault”.)

I want to focus on this one aspect of the see-saw: the parent (most typically the female or partner with a uterus) has a sense of acute responsibility. This begins with pregnancy, and is imbued within our language for loss. For example, a “miscarriage” states within the word that someone didn’t carry the pregnancy correctly—they miss carried it. It implies (again, within the actual word describing loss) that somehow, the pregnant person is at fault for the loss. Rarely is this the reality—a person cannot control chromosomes, uterine factors, immune responses, or viruses that are the typical causes of a pregnancy loss prior to 20 weeks (the defined period of time of a “miscarriage”). This loaded sense of responsibility impacts all pregnant people, irregardless of loss history, but is compounded for those that have lived through loss.

Often, a pregnancy after loss can feel like a type of redemption: a chance to recreate past events with a different outcome. Just getting through pregnancy and delivering a living child can feel like an Olympic moment and a Herculean task. The dawning (whether it occurs during a pregnancy or after) of the realization about the level of responsibility for not only bringing a tiny human to life, but also having to continuously keep it alive, can feel overwhelming. This can play out in many types of seemingly banal situations like: how do I feed my baby? How will I know if my baby is comfortable? How do I give my baby a bath? It can also extend to questions that are of more import, like How do I choose childcare for my baby?

Picking daycare, a nanny, a babysitter, or a family member to watch a rainbow can feel like Sophie’s Choice, in that there is no good answer. Many people desire to be home with their baby, especially after having to endure trauma to experience living motherhood. For many, this isn’t economically feasible. Choosing childcare, in the best of circumstances, is deeply personal. It can help to narrow down what potential options you have (should those options exist in your area) and then sharing your journey with your would-be provider. Enlisting empathy can be useful as you might have specific ideas about what your Rainbow might need that might differ from how a provider sees things with other infants that they have worked with. For example, you might have a lot of questions about how your baby regulates (again, you might assume that if he or she is fussy, that somehow this reflects on your parenting). You might have ideas about sleep or feeding that are important to you given the context of your baby being a child born after loss. Being able to provide a potential caregiver with this information can assist in the relationship that you form with him or her.

The see-saw of feelings and questions that come with a pregnancy (and postpartum) after loss can be inundating. It might be important to try to slow your see-saw down as you manage each piece one by one, rather than try to speed up the ride. The biggest part of a see-saw is that it only works in conjunction with another person, so shoring up your relationships (whether it be with your partner, family or friends) is essential to navigating the ups and and the downs.

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