Navigating the emotional journey of maternal loss

Transcript

Cheryl Martin (Host): On this episode of our podcast, we delve into an often challenging topic, maternal loss. It’s a deeply emotional and complex experience that affects individuals and families in profound ways. We’ll explore various aspects of pregnancy loss with psychiatrists, Dr. Jessica Obeysekare and Dr. Jeffrey Black, both with Prisma Health Center for Psychiatry. This is Flourish, a podcast from Prisma Health. I’m Cheryl Martin. Doctors, so glad you’re on to discuss this heartbreaking topic.

Jeffrey Black, MD: Thank you.

Host: When we talk about pregnancy loss, what is a terminology used?

Jessica Obeysekare, MD: That is a really good first question because the terminology can be kind of confusing and also different organizations or different countries use different terminology. But in general, we think of pregnancy loss or miscarriage as loss of pregnancy within the first 20 weeks of pregnancy. Sometimes you’ll hear early pregnancy loss, which is the most common type, and that usually refers to loss in the first trimester. And then we usually use the word stillbirth for a loss later in pregnancy.

Host: Is this common or uncommon?

Jessica Obeysekare, MD: Unfortunately, it is not rare. According to ACOG or the American College of Obstetricians and Gynecologists, first trimester pregnancy loss occurs in about 10% of all clinically recognized pregnancies, 80% of pregnancy loss occurs within the first trimester. And then when we’re thinking about stillbirth, in the US the rate of stillbirth in 2022 was 5 or 5.45 per 1000 births.

Host: I think that’s one of the reasons there are certain women who will wait until after that first trimester to announce broadly that they are pregnant.

Jessica Obeysekare, MD: Yes, exactly.

Host: So how does pregnancy loss affect a person, both emotionally and mentally? Dr. Black.

Jeffrey Black, MD: I think the loss of a pregnancy affects everyone different emotionally and mentally. There’s certainly some common factors, but everyone grieves in a different way and there’s no right way to grieve. It may impact both parents very differently, and especially if a parent feels ambivalent about the pregnancy, they can experience the loss very differently and that’s okay as well.

Host: So what kinds of support are most helpful for someone experiencing pregnancy loss?

Jessica Obeysekare, MD: I think it’s important to start by acknowledging that we are lacking societal rituals for this in the US and so holding space as family and friends is really critical, and some parents might prefer not to discuss the loss. We don’t need to force them to. There’s no right way to grieve, as Dr. Black was saying, but some parents do want to talk about it.

Maybe they’ve named the baby and they want to hear that name, and so I think trying to meet people where they are is important. When the parent wants to talk about the baby, but their family and friends are shying away from this, I think they can end up feeling in this sort of space where no one is acknowledging their loss or acknowledging the grief.

Host: So why is it important to talk about the emotional impact of pregnancy loss?

Jessica Obeysekare, MD: I think it can be very isolating, and by talking more about this, our patients realize that they’re not alone in going through this, and they can also understand when to seek help.

Host: So what are some simple steps someone can take to begin healing emotionally after a loss?

Jeffrey Black, MD: I think the three words that really encompass this, and to make it fairly simple is three words here, now and close, that people need those around them that love them and care for them, who are also experiencing the loss to be present, to be here, to be with them. Also encouraging the, the individual, the mom who’s lost the baby, the father who lost the baby, to be very present with themselves even though it seems counterintuitive because the pain is so great. And sometimes they want to push away from that, but to be as here as much as they can be now.

So fully in the present moment. And, the saying is to feel what you feel when you feel it. Allow for the feelings, feel them as they arise. And the biggest thing is a lot of people who grieve will push back against connections and isolation is one of the dangers of having a severe loss, a significant loss in life is to feel this need to isolate.

There’s a sense of wounding that happens and people will draw back a little bit. And so being with somebody close, so the here, now and close is may simply be to just maintain connections. Make sure they know that you’re there, that you are in the other room, that you’re in the house, that you’re present, you’re a phone call away, whatever the close may be for the individual because the social isolation is one of the major complications and causes of complicated grief, which really needs further assistance than just the grieving process.

Host: How can support groups or counseling make a difference for grieving families?

Jeffrey Black, MD: Support groups can be positive and negative for some people. Some people, the support groups have a tendency to want to share the death story, to share the story of the loss. And that can be very healing for some people. For others, it’s too much. And so some support groups center around not just the death story, but also the stories of promise.

The stories of even allowing a person to go to what could have been. Even though it kind of acknowledges even a stronger form of grief, but also allows them to talk about those stories and to dream a little bit and to be able to grieve those things and make manifest those things that they’re considering part of the grieving process.

I think a support group and even counseling, and that may be a formal counseling through a mental health provider, if a person has a faith community, a counseling through a faith oriented counselor would be simply to hold space. Grieving is a normal process. It’s a usual process. It’s an inevitable process for all of us that isn’t pathological, but it can become problematic if people isolate and disconnect.

And the other thing is recognize that the family is there to support. One of the biggest things I have people do is to list those people that they know are there for them. And then the other thing that I found really true is a lot of people will cover people up with love and concern and compassion for the first month or so after a great loss, such as losing a child; and they, they don’t check back in the six weeks, the eight weeks, the three months. Having people in your community that would be willing to check in with you, being very intentional. How are you doing? Just calling you, especially on anniversary times. I know this would’ve been your child’s first birthday.

Just wanted to check in with you, see how you’re doing. That can go a long way to really help the process of accepting the world without this child in it and the integrating that loss into their life.

Host: That’s some great advice there. Now, what should someone know if they are supporting a loved one dealing with maternal loss?

Jeffrey Black, MD: I think that has a lot to do with timing in the initial loss. First of all, keeping their own grieving in mind, and recognizing their own grief. Secondly, be fully present with a person and let go of this desire to make things better. You can’t make this better. You can’t fix it. And just being with them, being present, being fully connected, being here now and close can make all the difference in the world and making sure that continues for weeks and even months afterwards. There’s no getting over it. There’s no like deciding you’ve gotta go through these certain stages and then you’re done. Grief is the, is the actual event itself of bereavement and grieving is that process that evolves over time.

Host: Are there certain things a person who’s there to support should not say, and either one of you may want to address this? That’s kind of a no-no.

Jessica Obeysekare, MD: I think one example that you hear a lot about is, everything happens for a reason. There’s actually an entire podcast, and book titled by Kate Bowler about people saying everything happens for a reason to her after she experienced a really significant diagnosis and how that made her feel and sort of the implications of that where the person grieving might be tempted to say something like, really, tell me the reason that I lost this baby. What is the reason for that?

Host: It could actually set you back.

Jessica Obeysekare, MD: Yeah, yeah.

Jeffrey Black, MD: Another one is you can have another child. Please just let me be with this grief and this loss, without trying to make me feel better. I think people are well-meaning, but yeah, that’s especially one. What, what’s been said.

Host: And I think that’s why you said earlier, Dr. Black, it’s important just to be present.

Jeffrey Black, MD: People have a tendency to want to talk when they’re uncomfortable, especially around grieving and death because they don’t know what to say and I always say it’s okay if you don’t know what to say, not to say anything. Just a hug, or a I love you or I’m here, or a squeeze of the arm. That’s a very powerful thing, especially in the acute phases in the first couple of months, especially.

Host: Your thoughts on how hospitals and communities can work together to provide better emotional care after maternal loss.

Jeffrey Black, MD: The research really demonstrates the importance of allowing families if they so choose to do this, to participate in holding the child, naming the child, a way to plan to honor the child. And of course there are families that choose not to do that. Most of the research shows though, that there are very few families that feel that holding, naming and honoring the child was not helpful.

I haven’t read anywhere where people felt like that was not helpful. And I think also allowing time to do this. Most places, including Prisma Health and departments, they give time for this to occur and hold space and have people who just allow the family to have the time and space that they need.

Jessica Obeysekare, MD: I would also add to this. We’re talking about grief, but we’re not talking about some of the conditions that can occur at the same time. And so I think that identifying depression, or anxiety, or bipolar disorder or any other sort of mental health illness at the same time, and getting treatment for that is really important because I think if you are grieving and severely depressed simultaneously, it makes both much, much more difficult.

So I would also add that we can as a community, as doctors, we can try to make sure that we’re also diagnosing other illnesses at the same time.

Host: Dr. Jessica Obeysekare and Dr. Jeffrey Black, thank you both for sharing your expertise on this topic. Just some great insights and sensitivity. Thank you so much.

Jeffrey Black, MD: Thank you, Cheryl.

Jessica Obeysekare, MD: Thank you.

Host: For more information, visit prismahealth.org/flourish. If you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. This is Flourish, a podcast from Prisma Health. Thanks for listening.

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