Emotional responses & Support

The societal view of pregnancy and babies tends to be one of excitement and joy. This can exacerbate feelings of isolation when parents have more complex feelings towards pregnancy. In pregnancy after loss a person’s response may be surprising to those who have not been through this experience but the vast majority of the time their responses are reasonable given their experience. Below are some feelings people may have:

• Worry vs excitement – a level of excitement but often this is alongside or overshadowed by worry; 
• Conflicting emotions – some joyful thoughts of bringing this baby home (they also may not be able to think about or imagine this) alongside all the things their baby who died missed;
• Anger and guilt – parents may believe that if they had received the same level of care in their previous pregnancy as in this one then their other child/children would be alive. They may feel guilty as perhaps they have had more babies than they would have planned to have if they had not experienced loss; 
• Others’ reactions – it can be hard to share how you truly feel when you feel pressured to be excited or happy about it, often those who haven’t experienced loss can’t truly understand how scary it is; 
• Numbness – people may feel numb, this can be a protective response for when we feel too overwhelmed to function; 
• Disconnected – some parents may not relate a pregnancy to bringing a baby home and may struggle to connect with the baby; 
• Rapidly changing emotions – quick cycling emotions are common in grief and this may be exacerbated by pregnancy hormones and the anxieties of PAL listed above; and
• Trauma responses – understandably revisiting the places, spaces and meeting people again where our biggest traumas and tragedies played out will have a huge emotional, and physical impact on us. This can manifest in trauma responses which include things like shaking, sweating, uncontrollable crying, lots of fight/flight responses. 

As people experience different emotions in pregnancy after loss, this can also manifest as different behaviours which can include:

• Announcements – people may change when or how they announce a pregnancy, on one hand some people prefer to wait until they feel, ‘safe’ to announce a pregnancy whereas others know there is no safe point and announce earlier than is commonly ‘expected’ in society. How people announce may also change. For us we told people via text or social media because we found it less intense emotionally;
• Buying and preparation – parents may be reluctant to buy items or discuss preparing for their baby’s arrival; 
• Disconnecting – for some people their fear may be so intense that they struggle to bond with the baby, if you feel this way then there may be some people who could support you;
• Avoidance – some people may be so anxious about revisiting a particular place, person or headspace that they avoid addressing concerns or worries – if your anxiety around hospital visits etc is so intense that it you feel unable to attend medical appointments related to your pregnancy then please seek support from your midwife, contact Tommys or ask if there is psychological support available in your area. 

What does support look like? 

• Listening, acknowledging and validating – often what the parents are feeling in these contexts is completely understandable given their experiences. Of course you may be unable to predict or understand exactly how they are feeling but you can listen to how they are feeling, acknowledge their thoughts and validate them. It is powerful for people to hear, “what you are telling me is really understandable,”
• Practical support offers – everyone is individual and their needs will change over time but often asking grieving people to tell you what they need can feel like an additional task. Instead, it is useful if support people can suggest practical help, eg “I can cook you a meal for Friday and drop it off at x time.” Ideas include cooking meals, dog walking, childcare of any older children, attending appointments with them etc. Be specific and realistic about your capacity;
• Comfort and safety – the anxiety is around feeling unsafe and out of control. If you are a clinician you may be able to talk through clinical plans or use psychological techniques to support. If you are a support person you may be able to drop a meal round, offer transport to an appointment, accompany them on a walk, gift them a pregnancy massage if it is safe to do so etc. 
• Self care – you can make use of yoga, breathing techniques, grounding exercises and anything else which is safe during pregnancy and you find supportive. 

When to seek professional emotional support?

For some people their own self-care, support from family and friends and midwifery support feels like enough to get them through a very difficult time. For others they may need further support. Specialist midwives may be able to offer some support and may be trained in trauma informed practice but if the trauma responses mentioned above are interfering with your ability to engage with appointments in relation to this pregnancy you may wish to consider some support from a Psychologist. 

Professional support 

• Specialist midwives – some NHS trusts have specialist midwives for pregnancy after loss who may guide you through your pregnancy and offer an extra level of emotional support;
• Tommy’s clinics – Tommys charity runs Rainbow clinics which are run by people with specialist knowledge in caring for women who have experienced loss; 
• Psychological support – increasingly NHS trusts are offering specialist psychological support for the perinatal period