Pregnancy after loss
I was that “crazy client1.” You know; the kind that can’t really make up her mind about what choices she wants and doesn’t want. The kind of client that says she wants less intervention but then opts for extra ultrasounds and monitoring. The kind of client that really confuses you, the doula and makes you question why you do what you do. You may even consult with your peers or your doula group about a pregnant mother like me. I know my doula did. Because, I was “crazy,” I later learned.
I am not upset with my doula for this particular label. I didn’t learn that I earned this label until well after my birth. I was with my doula one day when her friend came over and I was introduced to her. Her friend said, “Oh, this is your crazy client?” I giggled but later, began to think about this new title. I didn’t want to be considered a crazy client so how did I earn this title?
Pregnancy after a loss is complicated but let me preface all this with a little background information. In 2003 I gave birth to my first son after years of fertility treatments. His pregnancy and birth was very medicalized. He was likely conceived in an exam room and not in our bedroom. I saw his egg on the ultrasound screen the day I was inseminated and watched him grow every other week until I was released to my OB. He was referred to as a “Clomid” baby which was offensive to me.
I was traumatized by his swift birth (4 hour labor and delivery) and began studying about birth. Then I became certified as a labor doula and began my journey into the more natural realm of living as well as pregnancy and birth. It was a wonderful transformation and one that has served me and my family well. I knew the next time we were to have a child, that child would be delivered into my husband’s loving arms, hopefully in a pool full of warm water with a wonderful midwife in attendance.
After five years of trying for another baby, we were unsuccessful on all Eastern and Western medicine attempts and I left my career as a doula to become a police officer. During that journey however, I discovered I was pregnant. Mixed emotions and a fear that I would lose this baby turned into a reality at just eight weeks of pregnancy when we discovered our baby no longer had a heartbeat. We lost her in April 2010. It was horrifying and devastating.
Even though I had read books about pregnancy loss on my doula journey, I did not fully comprehend just how horrible miscarriage could affect a woman and yet to be discovered was how complex a subsequent pregnancy would become.
We didn’t try for another baby until over a year had passed and I had uterine surgery to correct Asherman’s Syndrome2 which my D&C caused within my womb. December 31, 2012 was our “end date.” This was the date we gave ourselves where we would stop attempting pregnancy. This was a foolish date where we judged our age and our capabilities to parent a child into adulthood.
By mid-2012, I made one last attempt at pregnancy and asked the doctor to perform exploratory surgery to ensure nothing internally was impeding a pregnancy. All was fine and the disappointment set in but no sooner than two weeks after the surgery did I notice a change in my body and it looked like I was fertile. My husband and I jumped at the opportunity though we were not holding any hope that we would conceive. A positive test two weeks later revealed all the hope we had previously lost.
And here I was, faced with wanting little to no intervention with a beautiful homebirth, yet I was absolutely scared to death that I was going to lose this baby too. The first few days were exciting days but those were the only truly “worry-free” days I had. Each day following was a nightmare full of toilet paper checks and questioning everything I had previously learned.
Instead of ogling over the size of the baby, “Is the baby the size of a poppy seed or a blueberry?” I found myself Googling if the size of the baby measured appropriately for its gestational age. I thought that if I could find anything to prove this baby wasn’t growing correctly that it too was doomed to fail. I felt it was doomed to fail from the beginning.
I was faced with struggling between, “I know I shouldn’t have another ultrasound” and “I feel like my body is going to explode not knowing if the baby is okay.” I rushed out and bought the next best thing for me, a Doppler because I felt foolish going to the doctor for reassurance.
Then there was the anxiety about doctor’s appointments. Before I had a miscarriage, I was excited to see the doctor and hear the baby. “Maybe I would get a peek at the baby today?” But in pregnancy after a loss, the excitement faded and was replaced with anxiety. “What if I learn today that my baby died, again?”
As the baby grew and my pregnancy progressed, birth workers and doulas told me to bond with my baby. This just brought along guilt. Their message was that if I didn’t bond in pregnancy, my baby would be broken. My baby would grow up “messed up,” “untrustworthy of others,” and worse, “not bonded to the mother.” If they only knew how desperately I wanted to bond with my unborn baby.
I didn’t want to see the doctor as often as I did but it was the only moment that would bring some relief to my anxiety. But those moments were short-lived. I would leave the doctor’s appointments feeling empty. The brief moments of relief I experienced while there quickly changed back to the anxiety of not knowing if the baby was fine. “Sure, the baby was okay five minutes ago, but what about now?”
My husband did the best he could but even he grew tired of hearing about my fears. When I began to lean on my doula, she was confused. She was caught between, “I thought you didn’t want that test,” and “Here is information on the risks and benefits of that test.” But what was so difficult was the feeling of judgment. Disappointment in choosing the “wrong procedure” or one that “carries heavy risks.” The confusion of “I know this isn’t good and can lead to another intervention but I need to know more.”
I knew this would be confusing to my doula. It was difficult for me to decipher as well but I realize now that I had lost the naivety3 that comes with most first pregnancies; that feeling that nothing can or will go wrong; that once we make it past a certain point, all will be well; the complete trust in the process.
I didn’t realize that pregnancy after a loss destroyed that comfortable feeling and would bring about intense anxiety. This is the reason I assist families through pregnancy after a loss as a mentor. Pregnancy after a loss is another silent syndrome.
So as a doula, do you ask about pregnancy loss during your prenatals? If you are confused about some of the choices your client is making, probe a bit.
Ask them what is making them feel this way. Is there something they experienced, heard, felt, thought, read, were told, saw, etc that is leading them towards that test?
Help her to probe her intuition. My doula did this. She would ask me how I truly felt and tried to get me to dig deep to see if this was just anxiety or a real feeling that something was wrong.
Instead of telling her what she should be doing, show her how to do it. Offer ways to bond with her baby (bathing, journaling, music, scents, affirmations, etc) and help her with the potential guilt she may feel.
Share ways to help reduce the anxiety many women feel following pregnancy after a loss. It may help for her to get a massage, mani/pedi, acupuncture, long walks, yoga, or attend a support group4 for pregnancy after a loss.
Don’t tell her that everything will be okay, that she is past a certain point and now it will work out. If she shares with you she is past where she lost the baby, celebrate that milestone with her but do not tell her all will be okay now. Because it might not be.
But most importantly, listen to her. Be a shoulder for her to lean on. This may go beyond your comfort level so be sure to refer her to a mentor or another woman who has been through this for support. She is struggling inside too and just wants to bring home a living baby, even if it means an early induction or c-section.
What have you done to help a loss mother through pregnancy after a loss?
Elizabeth Petrucelli, SBD, CCCE ((http://elizabethpetrucelli.com)) is the author of All That is Seen and Unseen; A Journey Through a First Trimester Miscarriage and “It’s Not Just a Heavy Period; The Miscarriage Handbook.” She is a childbirth educator, birth & bereavement doula and owner of Dragonflies for Ruby; an organization dedicated to serving families through the loss of their baby. When she is not educating birth professionals on pregnancy loss, she is an advocate who raises awareness for first trimester loss. She lives in Parker, CO with her husband and two living sons.