Q&A with Kelley Kuchinov
1. Is the loss of a baby in pregnancy or shortly after birth an unusual occurrence?
First, I want to start by saying, this is a difficult subject and I’m glad we’re taking about it. Part of a therapist’s job it to talk about taboo topics; break down the fears/judgments and create a supportive space for grief, acceptance, and encouragement. Experiencing loss can be very lonely and it doesn’t have to be.
Working with women's perinatal concerns, the term “loss” can include pregnancy loss, embryo loss, miscarriage, termination, ectopic pregnancy, stillbirth, perinatal loss, and neonatal loss. Miscarriage is the most common type of pregnancy loss. It’s estimated that 25-50% of all pregnancies end in miscarriage. The exact number is unknown because it may occur before a woman even knows she is pregnant. Miscarriage is defined as the loss of pregnancy in the first 20 weeks of gestation.
The loss of a pregnancy after 20 weeks is referred to as stillbirth. A stillbirth (Intrauterine Fetal Demise) can happen before or during delivery. In my Perinatal Mental Health Advanced Psychotherapy Training through Postpartum Support International, it was noted that intrauterine loss can be due to issues with the placenta, it can be due to preeclampsia, a birth defect, chromosomal disorders, or growth restrictions. According to the CDC, stillbirth affects 1 in 160 births. Those statistics are more than 10 times as many deaths that occur from Sudden Infant Death Syndrome (SIDS). While these numbers are eye-opening, they have actually decreased over the years due to advancements in medical technology, prenatal care and educational awareness.
I’ve worked with several women who’ve experienced these devastating losses. For some, realizing how common pregnancy loss is can be shocking as it’s not frequently or openly discussed. So, my focus with clients is to break the stigma & silence and build support & strength.
2. What are some of the normal feelings mother(s) and/or father(s) experience after a loss?
Most commonly, people experience depression and anxiety after the loss of a pregnancy/baby. Sadness and fear can persist for up to one year after the loss, for one or both partners. As you can imagine, the range of emotions is long and complicated, such as shock, confusion, denial, sadness, guilt, shame, fear, anger, and loneliness. There may be a sense of loss of control, distrust within the self and the body, decreased self-compassion. Even jealousy and resentment towards others may be experienced. Yet, through the grief process, healing occurs and eventually there may be a sense hope.
Even though individuals/couples may not share their experiences freely, they are entitled to all their emotions, no matter when the loss occurs.
3. Why is it difficult for couples to heal from the loss of their baby?
Everyone knows how hard it is to let go of someone you loved and cherished, we all have a natural tendency to want to hold on. Not only have couples lost their baby, but expectations and plans of pregnancy and parenthood are suddenly taken away too. It’s a loss of what could have been; visions of the future fade away. The loss is emotionally devastating and can be physically traumatic as well.
The physical, mental, emotional, and spiritual impacts can leave someone feeling like life will never be the same. A person’s world can feel unsafe and unpredictable, losing a sense of trust. Loss forever changes you. This is not something you "get over" more so, you move through the pain. Knowing that it will never be gone or forgotten AND believing the pain will be eased and accepted as part of the reproductive story. I know women, particularly those who’ve gone through failed infertility treatments, that carry the pain of the loss(es) with them, in lesser degrees, even though they’ve gone on to have children.
4. Do fathers and mothers respond differently to a pregnancy loss or neonatal loss?
Generally, yes due to social expectations. Often, men may feel like they must be 'the rock' for their partner, as she is in a vulnerable state, so they may not grieve openly. Men may feel that because they did not carry the baby, they do not have the right to be as upset. While men want to be a main support, they’re encouraged to preserve time and space for their own experience with the loss as well.
It’s been reported that men identify with powerlessness and a loss of identity in these difficult times, unsure about their future role as a parent. While one partner may have urges to withdraw or hide their emotions, recognizing that the willingness to share in the experience can actually strengthen the relationship.
There tends to be less social recognition and support for fathers around pregnancy/neonatal loss. Postpartum Support International, hosts online groups specifically for fathers, among many other support groups focused on loss.
5. What can friends and family do to help someone who has experienced a tragic loss?
A woman may feel emotionally attached early in a pregnancy, while this is natural and healthy, it can also intensify difficult emotions after a miscarriage. Therefore, acknowledging her pregnancy and her pregnancy loss are important. As well as encouraging her to share thoughts and feelings. Always affirming that the loss is not her fault. It's reported that 60% of miscarriages happen because of chromosomal issues.
For partners and families, it's important to remember that encouraging a woman to conceive again right away is not the solution for grief. The advice may have good intentions but can unintentionally cause her to feel isolated. Allow time for healing to occur.
For a woman who's experienced a perinatal or neonatal loss, acknowledging the loss in a way that feels meaningful and honest to her can be a healthy way to grieve. She may do so privately or surrounded by her support system. This can be through prayer, writing a letter to the baby, by having a memorial, or planting a tree/garden, or donating to an organization. Best thing to do is ask her how she wants to grieve and remember.
Let's also acknowledge that sharing the news can be overwhelming and draining for the couple. Having a family member who is willing to be responsible for sharing the news and suggestions for ways others may be helpful, can ease the emotional burden on bereaved parents. To offer support at a family after a loss, you may offer to cook meals or care for their other children.
If your partner, friend, or family member is struggling, encourage her to find a counselor who specializes in perinatal issues or join a support group. Finding a safe, supportive space is less isolating and she’ll feel comforted and understood by others.
6. How can therapy help those who are grieving the loss of a baby?
Therapy is highly recommended if there’s a prior history of depression and/or anxiety. Therapy can help to rebuild core beliefs, rebuild trust with self, others and the world. The process is very individualized, as everyone's experience is different. It's important to identify your needs, be patient and self-compassionate with the process that could take some time. Grief is not linear; it can be a little messy.
After a loss, a women may feel they cannot trust their body, like it could turn on them at any moment or it's "broken." It can be helpful to express negative thoughts and fears, through talk therapy, art therapy or journalling. Freeing the self from blame and negativity.
Additionally, I often encourage women to start with finding ways that prove the body is functioning and can be trusted, for example being mindful of the heart and breath; parts of the body that function naturally/involuntarily. Then bring awareness to the body and its structure by engaging in mindful walking exercises or mindful eating; giving back a sense of control, strength, and healing. Then with time, we work on rebuilding trust with the reproductive system.
In my work, I incorporate DBT, so it's a balance of validating all emotions AND challenging judgmental thoughts toward self and others. My clients are free to express thoughts around unfairness and know that it’s a space to be open, honest, and not judged for sharing. The therapeutic space to grieve creates an internal space to heal.
7. How do you create a safe environment for these parents?
First, we start with awareness, awareness of what going through their minds, what emotions are being experienced, and what beliefs about themselves, others, the world are being formed. If you can observe and describe what’s happening, you gain a deeper understanding and therefore a better opportunity for healing.
Again, looking for opportunities to balance opposites and constantly moving between shock/denial and acceptance/recovery. This dual process holds space for emotional processing around loss and coping strategies for healing.
Reframing experiences and beliefs can also provide comfort. Looking at a loss through another lens or with a different perspective - loss might've been a way of preserving a life. The trauma of the loss is so overwhelming and "loud" that individuals/couples may miss the quiet connections to life.
8. Are there any special techniques you utilize when treating clients who are grieving a pregnancy loss or loss of a baby?
As an art therapist, I offer clients a space to be creative, curious, and experimental. I encourage clients to use various art materials and even non-traditional art materials for expression. For some this can be a new experience, so if needed, I offer more structure and/or guidance. For instance, mandala making provides that balance of containment and exploration, planning and uncertainty.
As I mentioned, I incorporate DBT in my work, specifically Mindfulness Skills and Techniques. Certain skills help to increase awareness of emotions and thoughts, acceptance strategies and engagement in positive activities as well as reconnection with the self.
Other skills that may assist with regulating emotions encourage clients to practice daily activities for self-care. So, outside of the therapy space, my clients focus on taking care of their bodies in ways that are essential for emotional healing and trauma recovery. Such as, staying hydrated, eating balanced, physical movement, and sleeping well. Also, identifying pleasant events that they can do alone or with others.
I also offer my clients access to many books, podcasts and online support groups that can support the healing process after loss. There are worksheets, journal prompts and art directives that are very effective as well. Through the engagement in various forms of expression, grief is processed and healing happens!
