Supportive provider care is an essential piece of pregnancy after loss. To help, we at Pregnancy After Loss Support compiled these evidence-based tips for healthcare providers when treating the mom experiencing pregnancy after loss.

pregnant woman with doctor - tips for healthcare providers treating the mom experiencing pregnancy after loss

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1. Understand the Unique Emotional Experience of Pregnancy After Loss

Many women feel alone and confused when pregnant again after loss (PAL). They often feel like they no longer fit into the loss community, but they also feel uncomfortable in the mainstream pregnancy world. Encourage them to reach out to others who have been through pregnancy after loss[1]Gold, K., Boggs, M., Mugisha, E., Palladino, C., (2012). Internet message boards for pregnancy loss: Who’s on-line and why? Women’s Health Issues. 22-1, e67-e72. (PAL) and consider referring them to Pregnancy After Loss Support’s online community.

2. Remember the Loss Mom’s Need for Reassurance

Women who are pregnant again after a loss often need a great deal of reassurance. Extra doctor’s visits, extended time during these visits, and understanding care from the hospital’s labor and delivery department/emergency room will help reduce some anxiety in the mom, as well as provide attentive care with the added level of reassurance that the pregnant after loss mom needs[2]O’Leary J, Thorwick C, Parker L: The baby leads the way: Supporting the emotional needs of families’ pregnant following Perinatal loss. 2nd edition. Edited by Ragland, K. Mpls, MN; 2012.

3. Help Reduce Anxieties

Doctors’ appointments and ultrasounds can provoke high anxiety for the PAL mom. Most PAL moms received the news and confirmation that their baby had died during a past doctor’s visit or ultrasound check. Taking into consideration that these visits can be stressful and even bring back past traumas for the mom is vital. One way to reduce this anxiety is to begin by reassuring the mom that the baby is alive, either through a Doppler check in the doctor’s office or during an ultrasound.

4. Provide Concrete Medical Information

PAL parents need truthful and concrete medical information about the development and health of their baby. PAL parents might need information repeated or explained further. Please remember to be patient with their questions, as they are not questioning your professional training; they are insecure about this pregnancy and the health of their baby.

5. Understand that the Relationship between a Loss Mom and Her Body is Complex

A woman pregnant again after a loss often has a hard time trusting her body to do what it is supposed to do during the pregnancy and birth of her baby. Her trust in her body has been broken after the loss of her previous baby, and sometimes that lack of trust is accompanied by guilt. Understanding this loss of trust can help medical doctors advise a woman on her birth options, as well as direct the PAL mom to further mental health services if needed.

6. Know That Risk of Mental Health Disorders are Increased for PAL Parents

PAL moms and dads are at an increased risk for mental health disorders, including perinatal and postpartum mood and anxiety disorders[3]Blackmore, E., Cote-Arsenault, D., Tang, W., Glover, V., Evans, J., Golding, J., O’Conner, T., (2011). Previous prenatal loss as predictor of perinatal depression and anxiety. The British Journal … Continue reading. Research shows that women who are pregnant again after a loss report having higher symptoms of anxiety and depression during their subsequent pregnancy compared to those who have not experienced a previous loss. Keep this in mind when assessing if parents need further mental health support and a referral to a mental health therapist or a support group during this pregnancy.

7. Acknowledge Their Grief and Their Fears

PAL parents are often afraid that this baby will die too. Acknowledging their fears with phrases like, “It makes sense you would feel this way,” and “This must be very difficult for you,” can help the PAL parents realize you are empathetic towards their loss and haven’t forgotten how they have arrived at this place of pregnancy after loss.

8. Know that it’s Normal for PAL Parents to be Hesitant to Attach During Pregnancy

Couples who are pregnant again after a loss may struggle with making plans for the baby’s arrival. They often have restrained expectations and use language like, “if the baby lives.” PAL parents may resist attending prenatal and childbirth classes. It is also quite common for PAL parents to refuse celebrations such as baby showers as well as purchasing any items for the baby until he or she arrives. Parents struggle with attaching due to fear of this baby dying too. Remember to normalize this experience for the PAL parents if they question their actions.

9. Realize One Baby Does Not Replace the Other

Sometimes PAL couples admit to having a hard time realizing that this is a different baby. Encourage the couple to continue to find ways to connect with their child who died in order to differentiate between this baby and the one(s) they lost. Parents need healthcare providers to acknowledge the loss of their child who died and understand that a new baby does not take away the pain of losing the other.

10. Use the Child Who Died’s Name in Conversations

When working with the PAL parents, if you don’t know the name(s) of the child/children who have died, then ask them gently. If you do know the name(s), use them in conversations with the PAL parents when appropriate. Using the child’s name will validate the significance of the loss and build trust between the parents and provider.

11. Understand that Detachment After the Birth Can Be Normal

Feelings of detachment from the baby born after a loss is quite normal at birth. PAL parents report having a hard time coming to terms with realizing that this is a different baby. Like during pregnancy, they also struggle with attaching after birth due to fear of losing this baby too. This detachment should dissipate over time. However, if attachment issues arise that are of concern, consider referring the PAL parent to the appropriate resources for support to help build a secure attachment for both baby and parents.

12. Educate Yourself and Your Patient on Emerging Resources for Support

Studies have shown that peer-to-peer relationships have been a significant source of support[4]Mills, T., (2014). Improving support in pregnancy after stillbirth or neonatal death: IMPs study. School of Nursing, Midwifery and Social Work at the University of Manchester. 1-10. for women who experience perinatal and postpartum mood disorders as well as bereaved parents (specifically for those who have lost a child during pregnancy or within the first year of that child’s life). Encourage the PAL parents to connect to other PAL moms and dads through in-person support groups or reputable online support communities such as Pregnancy After Loss Support.

13. Anticipate Anxiety During Early Parenting of This New Baby

Providers working with PAL parents should expect the parents to experience anxiety over the health of a baby born after a loss[5]Giannandrea, S.A.M., Cerulli, C., Anson, E., & Chaudron, L., H. (2013). Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. Journal of Women’s Health. … Continue reading. Be patient and understanding. Acknowledge their concerns and gently remind them that this is a different baby, constantly reassuring them about the health of the baby, as long as the baby is healthy. Also, be mindful of the PAL parents’ history of loss and use your professional judgment to determine if all that is needed is extra reassurance. If the PAL parents are suffering with larger underlying issues, including postpartum mood and/or anxiety disorders, for which they are at higher risk, refer them to the appropriate resources[6]Ross – White A. (2014). Pregnancy following a loss, Once the baby arrives. PAIL Networks Facilitator’s Handbook..

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