Our nickname for the little girl I’m pregnant with now is Itsy Bitsy. She has two living siblings – Everett (5) and Imogen (3).
“Hug Itsy Bitsy!”
“I want to feel Itsy Bitsy dance.”
“I’ll sing to Itsy Bitsy.”
“When will Itsy Bitsy come out of your belly?”
These phrases are on repeat in our house. They are so excited to have a baby. It isn’t just excitement though.

Author’s Personal Collection/Elizabeth Thoma
“What if Itsy Bitsy dies?”
“Why will you be sad if Itsy Bitsy dies?”
These questions are on repeat as well. More from my 3-year-old, and I know she’s trying to make sense of her world. I do my best to reassure her, and truth be told it reassures me too.
I tell her, “I don’t think Itsy Bitsy is going to die.”
There is some power in saying it out loud. Of course (of course!), there is fear bubbling underneath. I don’t know that Itsy Bitsy will be born alive. I don’t know that if she is born alive that she will live and grow like my living children have.
“She’s growing bigger and stronger every day.”
This is true. Each day’s passing increases her odds of a healthy delivery and survival. The risk isn’t 0, but it gets smaller every day. It reassures my inquisitive small people, and it reassures me.
“If she dies, we will be very sad.”
Why do I even say it? Why do I make the possibility seem real to them at all? I don’t want to invalidate their fears, and I don’t want to confuse them regarding their older brother, Oberon, who did die. I let them take the lead from there, which is usually the follow-up, “WHY will we be sad?” I opt for a straightforward answer. “I love all my kids, and I would miss any of you if you weren’t here.” Then I try to change the subject gently. I don’t think it’s necessary to dig into what raw grief is like, but acknowledging the possibility of death and sadness feels right to me.
“Are you going to be a helpful big sister/brother?”
I talk with them assuming Itsy Bitsy will be born and need all the things we expect a newborn to need. We talk about ways to interact with a baby – sing to her, hold her, be gentle, diaper changes. I explain that no, you cannot push Itsy Bitsy off the couch onto a pile of soft blankets. We discuss ways to be a good example, ways to be helpful. It all assumes that everything will be fine, which is where I’d like them to be for now. Framing it this way for them, pushes it that way for me. I really do need to start washing the hand-me-downs!
“Do you want to feel Itsy Bitsy kick?”
I try to have my living kids interact with Itsy Bitsy, to internalize that she is real – even though she’s hiding in Mommy’s belly right now. It took a while to get here. The day we read books about the human body and heartbeats, we got out a stethoscope to hear everyone’s heartbeat. I retreated to my room to get the doppler out and find Itsy Bitsy’s heartbeat first – before even asking the kids if they wanted to hear it.
I can’t totally eliminate the fear, but I can do my best to work through it and focus on hope. Doing my best to set the example I want for my kids. I don’t want them to be constantly terrified that Itsy Bitsy won’t survive. I don’t want to share every terrifying symptom or not-so-good blood pressure reading.
I want to prepare them for the arrival of a healthy, needy, noisy little sister. That is (and it’s even hard to type now) the most likely outcome. I don’t want to shortchange them from the preparation that will help them during this transition because I’m afraid of tragedy striking again.
Balancing joy and grief. Hope and fear. Known and unknown.
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