Vol.1 No.10The Emotional Impact of Pregnancy Loss
When I was asked to write about the emotional impact of pregnancy loss I began outlining a rather lengthy, descriptive paper about phases of the grief process, stages of pregnancy, and how they inter-relate, It was to have been objective and informative without being too formal or academic. As I further considered the topic and reflected on my almost twenty years of experience as a clinical social worker in an inner city teaching hospital's obstetrics department my focus and goal changed. I decided to write about the people -- all the people-- who are affected by a pregnancy loss. In this way I hope to convey the deep and far reaching effects, impact and impression of this kind of a loss. The effects are at times unrecognized, at times invisible, and at times denied. This article is not intended to be a "how to cope" manual regarding pregnancy loss, but rather an exploration. of the complex, multifaceted dynamics that occur in pregnancy loss. It is MY hope that this article will serve to inform two different groups of people --- those who have and those who have not experienced a loss. By reading this article, bereaved couples who have suffered a loss will feel less alone, more connected and better able to cope. Readers with no experience of pregnancy loss will have an understanding of the extent to which the that loss affects its survivors. What is pregnancy loss. and who are the women that experience it? For my purposes, in this paper, pregnancy loss is all inclusive, It is: early first trimester miscarriages, ectopic pregnancies, second trimester genetic terminations and natural losses, the demise of one baby in a multiple gestation, a full term stillborn, the death of a baby soon after it is born. And who are the brave, courageous women who suffer these losses? The group is large, diverse and spares no one. All ages, religions, races, income levels and stages of life are represented. Imagine these women, united in loss, but as different from each other as one could expect: 12 year olds who aren't even clear how they got pregnant, "older" women who are pregnant for the first time, single-or married or divorced women, women with unplanned or unwanted pregnancies, women who have been trying to conceive for years. Each and every one of them utilizing her own life experience, support network, and understanding of the medical problems, will have to cope and move on. How does one understand the impact of a loss? In part, by assessing the value of what has been lost. The word pregnancy conjures up images of smiling, gurgling babies, tired, bleary-eyed adults and a "glowing pregnant woman". It is a word that epitomizes joy, hope for the future, dreams and relationships yet to be realized, and perhaps, the next step on the ladder of life-- parenthood, For some people, it represents the fulfillment of a lifelong goal. Expectant fathers share and experience this early emotional connection along with their partners. They often take great pride in considering their soon-to-be role, their contribution to society, and the mark their child will leave on the world. In Rogers and Hammerstein's "Carousel", the leading man sings "My Boy Bill', a song anticipating, savoring and worrying about his upcoming new role and responsibilities. Many health care professionals who choose to work in this specialty area do so because it is considered a "happy" job. For everyone involved in "pregnancy", there seems to be an abundance of positive energy invested in it, committed to it, expected of it. Pregnancy, from a non medical, societal perspective, is considered a simple and natural part of life. Getting pregnant, staying pregnant, and then delivering a healthy, bouncing baby is the way it's supposed to be. Undoubtedly then, we can understand the utter devastation felt by people when there is a pregnancy loss. Parents feel cheated out of a wondrous, natural experience that was to be theirs, Suddenly their dreams are shattered and their hope for a family, is lost, or temporarily put on hold. Instead of planning baby showers and decorating rooms, they are planning funerals and putting baby items away and out of sight. This is not what's supposed to happen., Your baby isn't supposed to pass on before you have had a chance to hold, love, care for it, and share in it's life. Mothers and fathers alike express: shock, numbness, sadness, emptiness, anger (at G-d, at life, at others who have healthy children), and confusion. "I keep thinking this is just a bad dream and when I wake up I'll still be pregnant.". They just don't understand why something so natural, pure, and simple has slipped out of their grasp, Bereaved parents sometimes allude to a loss of focus and direction, an inability to know what to do next. "I got the room ready and quit my job so I could be home with my baby. I was planning to spend my time raising my child. What do I do now?" Feelings of guilt, blame, and failure may also begin to surface. While these last few reactions have no basis in reality, mothers often feel ultimately responsible for the well being of their unborn child and therefore culpable. They review events leading up to the loss, seeking an answer, a cause, a reason. Sometimes they unfortunately settle on an action or lack of action of their own as the causative factor. Women often think: "If only I hadn't carried those heavy grocery bags." "If only I had rested more". "If I had eaten better and gotten more exercise." "If I hadn't been so nervous and worried so much." All these ruminations lead to the same conclusion-"I didn't take good enough care of my baby." Feelings of failure can arise out of comparisons--"None of my friends had any problems with their pregnancies. We went to the same doctor and exercise classes. She works too, and probably doesn't sleep any more than I do." All of which leads to-"What's the matter with me? How come I can't do this simple thing?" It is not uncommon for their partners to go through a similar process. Many men have shared these comments with me: "If I'd helped more around the house, she could have rested." "Maybe we should have waited longer. Maybe I shouldn't have pushed for a baby so soon." The context in which the loss is perceived by the mother and her ability to freely communicate how she is feeling may contribute to her long term adjustment. A not uncommon, although rarely discussed response to the ending of a pregnancy is a sense of relief Women don't readily share such "unacceptable" thoughts as: "This just wasn't the right time for me to have a baby, but I never considered abortion or adoption as alternative." For some women, now that a baby won't be coming, life can continue on it's originally intended course--a continuation of school, beginning a new job, getting out of a bad relationship, struggling to balance existing parental and child care stresses. Relief may equally co-exist with feelings of sadness and grief For some women the situation is even more complex. "I used to think about how much easier it would be if I weren't pregnant, if somehow it would just disappear and things could go back to normal. Now my wish has come true, and I feel like I killed my baby." It's vitally important for parents to have the opportunity to talk, without hesitation, to their partners and to supportive family, friends and health care providers about their conflicting feelings regarding the loss of their baby. Parents are not alone at the time of a pregnancy loss. The members of the health care team who are caring for the patient often experience a similar flood of reactions and emotions. After all, isn't it their job and commitment to safely guide a woman from the beginning to the end of a pregnancy, to check and recheck to make sure there aren't any problems, to anticipate problems that might occur and resolve medical complications that do arise? However, sometimes even all their caring, attention and use of modem technology can't stave off the inevitable. We can certainly comprehend why they may not want to be the ones to confirm a bad diagnosis, a poor prognosis or the absence of a fetal heart beat. But it must be done. They have to communicate the news, answer the questions if possible, and watch the looks of shock and despair overtake the faces of their patients. It would be foolhardy to think that this does not take a toll. Caregivers may (and do): cry along with the parents, feel upset, feel responsible, wish they could take away the hurt, review their work to see if there's anything they could have missed, wonder how much longer they can do this kind of work, talk with colleagues for support, or they may busy themselves with work and move on--pushing away the feelings. After all they're only human, For everyone involved --patient, partner, medical provider-- there may be a sense that the situation is out of their control, that in spite of everyone's best effort this pregnancy, this life, was lost. As time goes on, bereaved parents may be viewed as being at the center of the crisis of pregnancy loss and it's impact on daily life. Just as a pebble dropped into water generates infinite concentric circles, the effect and impact of pregnancy loss spreads out to touch many people in more ways and for longer periods of time than one might imagine. Having already discussed the reactions of the mother and father, I want to look at the first circle. The parents, children, family and close friends of the bereaved come to mind. These are the people who would have been the grandparents, siblings, aunts, uncles, cousins, pals of the baby. They have already shared with the parents in the growth and development of the unborn child, have seen the ultrasound pictures and have felt the baby move and kick. Some may have offered to loan cribs and baby clothes, offered to baby-sit, begun to knit a blanket or sweater, or have offered to share their toys and even their room. Now they have to shift gears and direct their efforts to providing comfort, support, a listening ear, a calming touch--to helping in whatever way they can, While the expectant mother or couple eagerly accepted previous offers of services and goods, how will they now respond to offers of emotional support and to being taken care of? Over the years f have found that people strive to be independent, capable, and self-sufficient and want to be so considered by others especially in times of crisis. Will the bereaved parents accept help from those who want to give it? What about the children who would have been siblings or cousins? What do you say? How do you explain the passing of a baby to a youngster eagerly awaiting its arrival. If there is a funeral should the older children attend? Is there a way to be clear and truthful about the loss without making it sound too frightening? Although in the midst of their own grief, parents are concerned about the other children at home, who want to know that mommy is OK and when the baby is coming home. Parents have to continue in the role of caregiver while requiring care themselves. Parents generally want to discuss these questions and are open to suggestions. Often the family pediatrician who is familiar with the child can be very helpful in framing answers to the questions children inevitably ask. Continuing the flow out from the center, you next encounter neighbors, coworkers, classmates, the people from your congregation, local shopkeepers, etc. A whole new set of concerns arises. How many of them knew about the pregnancy, are pregnant themselves, or have young infants? How does one explain what happened to concerned and curious associates? How much should you say and how much do they really want to know? How will you face it when their due date arrives? Should you go to the baby shower you've been invited to next week? Your daily acquaintances are undoubtedly as unsure as you are.. They don't want to upset, ignore, or anger parents by anything they might say or do. These are delicate situations and we all have to act or respond as best we can, There are no simple answers. On the outer perimeter and on a more global scale, pregnancy and babies are everywhere. So, just when bereaved parents feel composed and ready to face the world, they are bombarded by TV commercials for Pampers, pregnant women in the supermarket, and babies in the park.. One can't escape the realities of birth and death, pregnancy or its loss. Each day women, their partners, and their families move ahead and hopefully grow stronger as they recover from the complexities of pregnancy loss. Many may connect with local support groups. Support groups and books on pregnancy loss are excellent ways to increase one's understanding of the topic and to receive ongoing encouragement, motivation, and strength. A few clinical snapshots dramatically illustrate the depth and breadth of the impact of pregnancy loss: In closing, it would be difficult and unfair to define, catalogue, or quantify, the emotional impact of pregnancy loss in any standardized way. The reactions to loss are as unique and special as are the people themselves. Loss touches people in many different ways and at times for years into the future. There is a fluid process of adjustment, reflection, and acceptance--at times easier, at times more difficult. The child is gone, but never forgotten, and often the subject of continued fantasies about what might have been. |