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Navigating Life After Pregnancy Loss

Photo: Bee Harris for NPR
Photo: Bee Harris for NPR

"Everything was hush hush. No one spoke of loss, at least not in my circle. You know, there was no support system."

That's how Marilyn Abrahams of New Jersey described her pregnancy loss, which happened back in 1993. Even today, it's a deeply painful and traumatic experience that, as a society, we don't talk about nearly enough.
In honor of  Black Maternal Health Week, Life Kit teamed up with the hosts of the podcast docuseries NATAL to share this story about coping with pregnancy loss. Listen to NATAL  here, and follow them  here.

Between 10 and 15 percent of known pregnancies end in miscarriage, according to March of Dimes — and it's likely that number is even higher when unknown pregnancies are taken into account. And the National Institutes of Health estimates that Black women are twice as likely to suffer both early pregnancy loss and stillbirths than white women.

Yet, despite just how common pregnancy loss is, so many parents and families suffer in silence and don't get the support they need. And their partners, loved ones, coworkers, and even medical providers might also feel unsure of what to do with their own grief, let alone how to show up for the birth parent during this time.

If you or someone in your life has experienced a pregnancy loss, here's some advice for the journey ahead.

Acknowledge the loss

Marilyn's story highlights a much larger culture of silence — and even shame — that surrounds pregnancy loss. A big part of that silence stems from the fact that we don't have a shared understanding of what pregnancy loss is, and why it happens.

"Typically in the way that I talk about it with people that I care for, it's nature's way of ending a pregnancy that wasn't going to be able to continue on its own," says Dr. Jamila Perritt, an OBGYN in Washington D.C. and president and CEO of Physicians for Reproductive Health.

Pregnancy loss is often classified by when it occurs: A miscarriage, also called a spontaneous abortion, happens before 20 weeks of pregnancy. However, a loss after 20 weeks is defined as a stillbirth.

Beyond explaining the medical side of pregnancy loss, Dr. Perritt also makes it a point to remind her patients that the burden of shame is not theirs to carry. "Almost the first or second thing that I always say for someone who is experiencing this, is there is nothing that you did to cause this, and there's nothing you could have done to prevent it. Because even for folks who don't articulate that internalized feeling of shame and struggle around it, sometimes it's there," she says.

Make space for grief and grace

Grief looks different for everybody.

"When there's a loss, we could see daily function being interrupted, which includes the inability to sleep through the night," says Asha Tarry, a New York City psychotherapist who specializes in trauma and mood disorders. For others, grief might show up as uncontrollable crying, or the complete opposite: feeling like you have to cry even when you are unable to.

The other thing about grief is that there are no hard and fast rules about who is impacted or who is allowed to grieve. Tarry reminds us that "not only is the person who was carrying the child grieving, but also the people who supported that parent at the time of the pregnancy and the loss." This group might include significant others, relatives, other children in the household, co-workers, neighbors, or even the neighborhood grocery clerk. And regardless of their relationship proximity to the birth parent, their grief (often referred to as disenfranchised grief) is valid.

If you're currently grieving, show grace for yourself, but also towards those around you who might be processing the loss in their own way. Tarry encourages those in community with a grieving parent to continually ask, "How can I show up for you today?" — because a parent's needs might change over time.

Be present

Grief calls on all of us to be more tender in our words and actions with one another, even when we might not know exactly what to say to someone who has recently experienced pregnancy loss. From dropping off a meal, to babysitting older siblings, to assisting with bereavement paperwork, there's a full range of what being present can look like — and it doesn't have to cost a lot of money.

Yvonne McCombs, a mother, wife, and birthworker in California, deeply treasured visits from her own mother after her eight consecutive pregnancy losses. "My mom would just come and just sit down on the bed with me, and she wouldn't say anything," says McCombs. "She would sit there and she would pray for me. She'd hug me. She would rub my shoulder. Even when she didn't know what to say, just her presence — she was just there."

Explore your care options

Whether or not you have a huge support system, everything from processing emotions, to explaining what happened, to returning baby items can feel incredibly overwhelming after a pregnancy loss. Knowing what kind of care resources are available, such as support groups and doula services, can make a world of difference.

After experiencing two consecutive losses, Erica McAfee knew that she did not want other parents to go through the same journey alone. In 2017, McAfee founded Sisters in Loss, a digital community and podcast for Black parents coping with pregnancy and infant loss, and infertility.

Based in the Washington, D.C. area, McAfee is also a full spectrum doula — a non-clinically trained support person that works with families before, during, or after birth — with a focus on bereavement. In this capacity, she helps families transition from "welcoming this baby into the world [to] then having to say goodbye and preparing for a funeral."
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While awareness and demand for doula services are growing in the U.S., there is still a huge exposure and insurance coverage gap. If paying out of pocket is not an option for you, in some cases, doulas might be covered through your insurance. They might also offer sliding scales and payment plans, or even barter services. If you or someone you know would benefit from working with a doula, there are a few places to connect with one, including the National Black Doulas AssociationSisters in Loss, and even doula groups on Facebook.

For medical providers and birthworkers: work collaboratively to connect families to holistic care options

Of course, so much of what we're talking about varies greatly depending on who and where you are. And too often, barriers to care present a unique challenge to pregnancy loss survivors who are people of color, queer or trans, uninsured, and/or living with a disability. So this takeaway is specifically for all the care providers out there: think about ways that you can work collaboratively within and outside the hospital to connect families to holistic care options during this bereavement period.

For Dr. Perritt, "integrated care means really putting the person experiencing pregnancy loss at the center of the care model and building out from there. So it falls upon us as the health care providers to seek those services out in our communities because they exist."

Following their pregnancy losses, Yvonne, Marilyn, and Erica each eventually gave birth again to healthy babies, commonly referred to as rainbow babies. But the babies they lost will always hold a special place in their hearts. Their stories are a reminder that navigating life after loss is not only possible, but that it can result in new joy, new hope, and new life, too.

Martina Abrahams Ilunga and Gabrielle Horton are the hosts and executive producers of NATAL. Listen here.

For more Life Kit, subscribe to our weekly newsletter.

The audio portion of this story was produced by Clare Lombardo. Patrick Murray and Josh Newell provided engineering support.

Danielle Prieur covers education in Central Florida.