Grieving the Loss of a Baby in the Womb

By Meredith Resnick, LCSW

Perinatal loss encompasses various traumatic events that can occur any time during the gestational period. About 1 in 4 pregnancies ends in miscarriage; approximately 1 in 160 ends in stillbirth. Perinatal loss includes first- and second-trimester miscarriage, missed (silent) miscarriage, ectopic pregnancy, stillbirth, neonatal death, and complications from molar pregnancy, blighted ovum, and preterm delivery.

These clinical terms define the medical aspect of loss yet fail to address the grief-filled psychological space a woman inhabits after the body has recovered.

In a 2006 study, researcher Lynn Clark Callister, PhD, wrote, “Perinatal loss engenders a unique kind of mourning since the child is so much a part of the parental identity. Societal expectations for mourning associated with perinatal loss are noticeably absent.”

Intersectionality
A concept first coined by Kimberlé Crenshaw in 1989, intersectionality examines how race, class, gender, and other individual characteristics “intersect” with one another. Huong Diep, PsyD, recommends clinicians utilize an intersectional lens to heighten their awareness to discern the myriad ways in which these and other social identities converge to create unique forms of oppression and disparity with which the clinician may be unfamiliar.1

Begin with acceptance of the potential underlying layers that the clinician may know less about than they would prefer. “Since the social worker may not know how a patient self-identifies ethnically, culturally, racially, [or] religiously, utilizing an intersectional lens is vital,” Diep says.

Cultural Humility
Generational and collective trauma of being marginalized and denied services and care amplifies the grief associated with pregnancy loss, says Nicole Alston, MSW, an associate at the Columbia Center for Complicated Grief.

Alston, who specializes in perinatal loss and its subsequent grief, says that the loss of a baby in the womb may exacerbate the present-day and ancestral pain for a person who is Black.

When visiting clients, Alston recommends social workers “listen to what’s being said, listen to understand. If there was ever a time to check your ‘clinical temperature,’ it is now.”

However external events constellate, including the loss of a baby, each person’s experience is unique. “One person’s story cannot be used as a gauge to help understand the next client,” Alston says.

Countertransference
In The Myth of the Perfect Pregnancy, Lara Freidenfelds, PhD, wrote that “early pregnancy losses are part and parcel of childbearing.” She notes that the majority of miscarriages are caused by chromosomal abnormalities that render the embryo incompatible with life.

“Sometimes social workers try and remain purely clinical because it feels safer, but failure to witness suffering thwarts the capacity to be present,” says Traysi Chong, LCSW, an adjunct lecturer at the USC Suzanne Dworak-Peck School of Social Work at the University of Southern California, who urges clinicians to avoid clinical terminology, which can be cold and impersonal. “Say ‘baby,’ not ‘fetus,’” Chong says. “Use the baby’s name if one was given and especially if the mom does.”

Keisha Wells, LPC, calls the experience of pregnancy loss “altered motherhood,” noting that losing one’s baby in the womb is a “forced and out-of-order loss.” The pain can be stifling and hard to talk about. Having a clinician who can listen and be present is essential, she says.

Diep encourages clinicians to “examine their need to ‘fix’ a patient’s emotions instead of sitting with and bearing witness to their pain. Most of the time, a patient just wants someone else to say, ‘I see your pain, and I see how much it hurts you.’”

In the Face of Grief
“People, social workers included, ask question after question when they are anxious,” Chong says. Allotting ample time for visits, particularly in the hospital at bedside, can reduce the pressure of trying to find the perfect thing to say. Allow the conversation to evolve organically. Be a witness to their pain—and the pain of their partner.

“Prepare for the level of grief,” Chong continues. Conference with the bedside nurse and read the chart to best understand family dynamics and assess the scope of the loss. “Never walk into the LDR [labor, delivery, recovery room] or ED [emergency department] unless you’ve talked to the nurse first to understand the patient’s unique situation. Do not reinjure a patient by asking questions that are already answered in the chart,” Chong says.

Become familiar with the effects of postpartum and comfortable with the educational aspect. When social workers understand the medical aspects of pregnancy loss, they can be helpful in normalizing the grief a patient feels without being overly clinical.

By being fully present, social workers model the sensitivity that the patient can then gift upon themselves in the days to come.

Social Media
Social media can provide a global view of how individuals are talking about pregnancy loss, and how they are framing and entering the conversation. It also can act as a means of feeling part of a community while enduring what many describe as a lonely and isolated experience. This can help “lessen stigma, connect people to resources, and to quickly search through hashtags and other search engines to find other like-minded people,” Diep says.

Nevertheless, clinicians should “caution patients against using the internet and social media as their sole source of information,” Diep says. “Search engines control results, and a great deal of content has not been vetted by health or mental health professionals.”

Also, there is the risk that “if someone doesn’t find what they are looking for or a pregnancy loss story that resembles theirs, the automatic belief may be, ‘I’m even further alone in this. No one else on the internet or in the world has gone through what I have gone through,’” Diep says.

“For some folks, reading through message boards and other blogs was enough. For others, they needed a group process session via video. Others required one-on-one counseling,” she continues. “I would encourage people not to judge themselves for being stronger or weaker than someone else based on their level of need. It is, indeed, a sign of self-trust to acknowledge what you need and then seek it.”

— Meredith Resnick, LCSW, worked in health care for two decades and maintains a strong interest in the expressive arts. She is the coauthor, along with Kim Hooper and contributor Huong Diep, PsyD, of All the Love: Healing Your Heart and Finding Meaning After Pregnancy Loss.

Reference
1. Wilson Y, White A, Jefferson A, Danis M. Intersectionality in clinical medicine: the need for a conceptual framework. Am J Bioeth. 2019;19(2):8-19.