Best practices for helping women after a miscarriage.

A miscarriage is pregnancy loss before twenty weeks. Early pregnancy loss is estimated to occur in 1 out of 4 women. Most miscarriages happen between 6-12 weeks gestation. Early pregnancy loss is considered a loss but also a trauma. I recently was asked by Kat Schuknecht to give a presentation to the Madison Postpartum collective on best practices in helping people through early pregnancy loss. Here is a summary of my presentation.

Miscarriage is an invisible loss. It is the loss of your baby but also the loss of your dreams to come. Many people wait until the second trimester to share pregnancy news. When pregnancy is unknown by others it can feel invisible to the couple that is grieving. There is no one asking how you are doing or checking in with you. It can be difficult to share your news with others because of the sense of shame and guilt that surrounds the stigma of miscarriage. Many women blame themselves even though it is not their fault. In most cultures there are no rituals or ceremonies to help people grieve. It is normal to grieve with others, you may grieve miscarriage alone or with only a few people and you may feel very isolated.  It can also feel very abstract. If you do decide to share the news of a miscarriage it can feel abstract to the people you are sharing it with. It can even feel this way for your partner. Women tend to connect with their pregnancy and baby early on while partners often connect later in the pregnancy or once the baby is born. This type of loss can feel very uncomfortable for people and you may find them shying away or not knowing what to say.

If you have had a miscarriage you have experienced a major loss. An earlier loss does not equal less grief. Grief does not go away, it becomes part of a new normal that you carry with you. Grief is not linear it is actually quite messy and make look different every day. Grief is different for each person. You have a right to your grief. Your partner's grief will be different from your own.

Miscarriage can lead to feelings of shame, guilt, anxiety, depression, isolation, emptiness, failure, feeling disconnected from your body and sadness. No two people feel the same way. We cannot assume that we know how someone is feeling.

Miscarriage can lead to women feeling disconnected from their bodies. It may lead to difficulties with intimacy. Because women may be feeling disconnected they can be unaware that they are holding trauma in there body. It is important if you do bodywork with people that you are taking a trauma informed approach.

A miscarriage is a loss but also a trauma. Having a miscarriage can trigger post traumatic stress disorder. Symptoms of PTSD to look for our: fatigue, trouble sleeping, hyperarousal, nightmares, lack of concentration, anxiety, depression, loss of appetite and frequent crying. Pregnancy after a loss can be triggering for people.

Women who experience a miscarriage can have postpartum depression or anxiety. Anytime a woman goes from pregnant to not pregnant there is a shift in hormones that can affect brain chemistry.  It can be difficult to identify what is grief and what is anxiety or depression.

How Can Professionals Help

Holding Space - Professionals can help by holding space for clients. Holding space is being present with clients. Starting where a client is and remaining non judgmental. It is providing an environment that honors your clients needs.

Communication - How we communicate with people about early pregnancy loss can greatly impact our work. By opening dialogue about early pregnancy loss we can normalize and help reduce stigma. Ask. Include questions about early pregnancy loss in your assessment.  Take cues from clients when addressing early pregnancy loss. Refer to it as your client does. Whether they call it a pregnancy, a baby or even a name. If you meet with couples acknowledging a partner's grief.

Advocacy - Advocate for your client's needs on different level. At a micro level address their needs within your office. Are there pictures you may want to take down in your office or waiting room? Does this client have to wait in a room full of pregnant women? Is it possible for them to wait in the office? If you have someone that needs support validating and normalizing that it is okay to need support. Connect them to resources in the community. Therapy and Support groups are a few sources of support.

What do clients want us to know? I surveyed a group of women that had experienced early pregnancy loss and this is what they wanted providers to know.  They wanted providers to:

• Be present with the client and loss

• To listen

• To validate

• To understand that grief is a lifelong process

• To be told they are a mom

If you are a provider or someone that has experienced miscarriage and our looking for resources Kull Counseling provides therapy and a free monthly miscarriage support group. Contact Julie at 608.239.4807 for a free 15-minute consultation.

The guilt of miscarriage

It is estimated that 1 in 4 women will experience a miscarriage.  For many, having a miscarriage is a devastating loss that leads to a roller coaster of emotions. One common emotion many women hesitate to talk about is guilt. When you have a miscarriage there is a large amount of guilt associated with it because you feel like you did something wrong.  

Different types of guilt with a miscarriage:

1. The Guilt of It was my job. You may feel that that having a baby is part of your role as a woman and a wife. You might feel guilty that this is your job and since this is your job and you did not give birth to a healthy baby you have failed your job. You might have been taught that pregnancy and motherhood come naturally (and easily might I add) so when you are not able to maintain a healthy pregnancy there are strong feelings of guilt.

2. The Guilt of I did something wrong. If you believe #1, that it was your job to get pregnant and have a baby, than this is usually where the second layer of guilt sets in. If you could not do "your job" than you must have done something wrong. Did I drink too much caffeine? Was I exercising too much or not enough? Was it that glass of wine I had before I knew I was pregnant? You probably have come up with a dozen things that might have caused your miscarriage and concluded that is was your fault. 

3. The Guilt of what if I can't get pregnant again. If it was your job and you did something wrong than you might be feeling it is quite possible that you cannot get pregnant again. You may fear that you have already lost a baby and now you feel the guilt of what if I already lost one baby and I will never be able to have another. You might feel that this was your only chance and you did something wrong to cause this. You might feel that this is punishment for something else that happened in your life.

Guilt is an intense emotion and a very real part of the healing process of losing a baby in early pregnancy. There is help working to challenge these negative thoughts and normalize these feelings. If you have experienced early pregnancy loss it is not your fault, and  you are not alone. To learn more about guilt and other common feelings after a miscarriage or more information about the free monthly miscarriage support group please contact Julie at 608.239.4807 or julie@kullcounselingmadison.com

When pregnancy after a loss doesn't feel like a rainbow

You've experienced a perinatal loss and now you are pregnant again. The response of some people may be "I am so excited" or "I feel so lucky to be pregnant after a loss" but what if that isn't your response?  What if your response sounds more like "I am terrified or nervous" or "what if it happens again?". 

A rainbow baby is defined as a baby that is born after a miscarriage or stillbirth. In life a rainbow appears after a storm. The storm is perinatal loss and the rainbow is your beautiful baby that has emerged from the darkness (Urban Dictonary). While being able to get pregnant after a loss can be a relief and joy, it can also bring about a mixture of emotions.

Here are some common emotions that you may experience during a rainbow pregnancy:

Anxiety- Many couples experience intense anxiety during a pregnancy with a rainbow baby. After a loss your sense of security is gone. You may worry constantly about the health of your pregnancy. Women can have difficult times attaching to their pregnancies depending on physical symptoms for reassurance or worrying at the absence of them. You may feel like you will jinx the pregnancy if you start to plan for a baby; telling family and friends you are pregnant, buying items to bring the baby home, picking out names or even just getting excited about the pregnancy. Simple check-ups at the doctors office can turn into anxiety and nightmares. Even every day tasks can seem daunting as you worry about how it will effect the well being of your pregnancy.

Depression- You may feel intense feelings of sadness about your loss. You may have guilt about feeling happy or sad. Some couples wait until they have processed their loss before they start trying again, while others may start trying right away. Whether or not you waited to start trying again, getting pregnant again can bring such a sense of relief but it can also bring up feelings of sadness that you may have thought were gone. 

Grief- While you might have felt that you processed your grief from your loss, a pregnancy after a loss may bring up some of your grief again. It can feel like this pregnancy is supposed to replace your loss. You may struggle with honoring the child you lost while also honoring the child you are pregnant with. It may be an internal struggle to sit with your feelings of grief while also being happy for the new life inside of you.

If you are feeling mixed emotions about being pregnant again, you are not alone. How you feel about your pregnancy may change each day if not each hour. Anxiety, Depression and Grief are common emotions but so are Happiness, Relief and Hope. 

If you experiencing intense emotions during your rainbow pregnancy you are not alone. For counseling services please contact Kull Counseling, LLC at 608.239.4807 or email julie@kullcounselingmadison.com. For information on support groups please contact Bereaved Parents of Madison,

How to support someone suffering from anxiety

Anxiety is our body's natural response to a perceived threat. We all experience anxiety now and again when dealing with the stressors of life. However, many people experience such severe anxiety that it interferes with daily life and makes it extremely difficult to perform at work, maintain relationships; or start/finish tasks.   

The following highlights some common signs of anxiety and some questions to ask yourself to determine if your friend, family or loved one may be exhibiting those signs.

Common signs and questions to ask yourself to determine if a loved one has anxiety

1. Worry - Do they worry a lot? Do they worry about things they have little control over? Are they uncomfortable in situations that they cannot control?

2. Irritability - Do they feel keyed up, sometimes on edge?

3. Stress - Do they have a hard time feeling calm or an inability to relax?

4. Rumination - Do they have a hard time letting go of things- ruminating on something that was said or done a while after the incident occurred.

5. Negative thinking - Does this person have a lot of negative self talk or view of the world?

If these symptoms sound familiar, your loved one might be suffering from anxiety. The good news is you can help! Below are several Important tips to being a helpful and supportive ally, including several things to avoid when trying to support someone with anxiety:

1. Be a support person. Let this person talk to you about their feelings and emotions. Try not to judge what they are saying. 

2. Learn about about anxiety. The more you know the more you can be supportive. If you find anxiety frustrating, imagine how this person might feel. Think about a time when you felt anxious and how that felt. Imagine feeling that way every day or for prolonged periods of time.

3. Encourage the positives. Suggest positive coping skills such as: regular exercise, meditation, mindfulness, balanced nutrition, avoidance of caffeine and alcohol. Reinforce rational thinking and  help them try to avoid thoughts that are irrational.

Are you worried you may say the wrong thing? To help guide your conversation below are some hurtful phrases along with some more encouraging ones.

Hurtful-

"You should try to relax." "Don't worry about it." "Please try to calm down."

Helpful-

"How can I help?" "I am here to talk if you need someone." "I noticed that you did x even though you were really worried about it, I am proud of you."

Lastly, don’t be afraid to reach out because you won’t say the ‘right” thing. By talking to someone who is struggling with anxiety, you are already taking an important first step in making them feel heard, supported, and understood.

If someone you love is suffering from anxiety and needs help please contact Kull Counseling, LLC at 608.239.4807 or julie@kullcounselingmadison.com.