How to Support Your Clients Through Miscarriage and Infant Loss

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Miscarriage, stillbirth, elective termination, failed IVF, childbirth, SIDS — these are all examples of pre-term and neonatal loss.

Pregnancy loss is often defined by how far along the pregnancy was when the loss occurred:

• Miscarriage (or spontaneous abortion) happens before the 20th week.
• Stillbirth is loss that occurs after the 20th week.

An elective termination (abortion), can happen for a myriad of reasons, and just like any other kind of loss, deserves deep compassion. The fact that the word elective is part of the name does not make this a less difficult experience, nor does it mean the procedure was a simple choice or a decision made flippantly and without close considerations.

To offer the best coaching possible, it is important that you support your client’s decisions, regardless of your own personal beliefs and values. You must trust that your client is making decisions for herself in whatever way she needs to, and it is not your place to judge any decision she makes, especially one that is incredibly sensitive such as this. If you do not feel that you are able to support your client’s decision because of your own personal beliefs, you have a professional responsibility to refer her to another coach who can.

Death during birth (a variation of stillbirth), losing an infant after a NICU stay, infant loss as a result of congenital defects and other complications, and a number of other variables make each situation a deeply unique and personal one.

Pregnancy loss is much more common than most people imagine. According to the Mayo Clinic, in the U.S.:

• Approximately 10 to 20 percent of pregnancies end in miscarriage [1].
• Approximately one in 160 pregnancies end in stillbirth [2].

As for infant loss:

• SIDS accounts for 15 percent of all infant deaths in the US [3].
• Globally, over one million newborns die within the first 24 hours post-birth, with the US ranking highest over all other industrialized nations for first-day deaths in babies [4].

While pregnancy and infant loss may be statistically common, it is not easy to navigate or overcome.

In understanding the spectrum of prenatal and postpartum loss, it’s important to avoid comparing “levels” of loss (for example, assuming that a mother who lost a month-old baby must be hurting more than one who lost a pregnancy at 17 weeks). Grief is subjective and dependent on many variables, and we cannot assume what women are experiencing.

Making remarks, purposefully or casually, or comparing which situations are more deserving of sympathy and condolences, sends a potentially deeply hurtful message to those whose loss is not considered as impactful as another: that they must continue to suffer in silence since their suffering is “not as bad” as others’.

There Are No Rules for Grief

The level of grief and suffering a woman will experience as a result of loss cannot be quantified by any social parameters. There is no quick or exact formula that outlines how a woman will move through her grief depending on the characteristics of her situation. Her experience is unique to her.

Who Can Experience Grief After a Loss

• Those who did not know they were pregnant until the miscarriage occurred.
• Those who do not want to have children.
• Those who are in abusive relationships.
• Those who drink alcohol, smoke cigarettes, use drugs.
• Those who partake in risky physical activities.
• LGBTQIA individuals.
• Those who have miscarried before.
• Those who have never miscarried.
• Those who were pregnant as a result of rape or incest.
• Those who miscarried very early in the pregnancy.
• Those who lost the baby late in the pregnancy.
• Those who lost the baby at birth or shortly after birth.
• Those who lost the baby they were seeking through IVF.
• Those whose loss happened decades ago.
• Those undergoing an abortion.
• Those who are poor, overwhelmed, or without any support system.
• Those who have had an abortion before.
• Those whose life is at risk because of the pregnancy.
• Those who were not planning a pregnancy.
• Teenagers who got pregnant accidentally.
• Those who get pregnant at an older age than recommended.
• Those of varied physical abilities.
• Those of varied cognitive ability.
• Those struggling with their mental health.
• Individuals of all races, ethnicities, shapes, sizes, socioeconomic backgrounds, education levels, religion or belief systems, career paths, etc.

Anyone who has carried and/or birthed a baby or who may be close or connected to a person who has carried and/or birthed a baby can feel the grief of loss.

The degree of a client’s loss cannot be graded or quantified. What she needs from her coach is support to the best of your ability and scope of practice.

Important Things to Know About a Grieving Mother

There Is No Right or Wrong Way to Grieve

Some women move very quickly through the grieving process, to the point that their grief may have seemed nonexistent. Others take a long time (sometimes years or decades). There is no one right answer. Each woman will follow her own path.

Allow your client the space to grieve in any way she needs to. Follow her cues, including talking about her baby, if that is what she wants to do. It doesn’t have to be uncomfortable or awkward. Some mothers report feeling comforted by the people in their support system leaving that door open: “I’m here, if you ever want to tell me about your baby. I’ll be happy to listen.”

Their baby existed. Allow them to speak freely and know that some clients may just need a listening ear and may or may not be interested in deeper discussion with you about what happened.

Her Body Is Still Changing

When a pregnancy ends, there is still a series of hormonal and physiological changes that must take place. These could add to the emotional turmoil of the already devastating situation.

In stillbirth or infant loss, oftentimes the brain will prompt the body to produce and release breastmilk, as if the baby was alive and needed to be fed. Some women find this a difficult reminder that their baby is gone. Others find it sweet and comforting. Again, there is no right or wrong way to feel.

Work with your client at the level that her recovering body dictates. Listen actively and ask questions when pertinent to her safety or your programming. Offer gestures of support when appropriate.

It May Be Difficult to Be Around Pregnant Women or Babies

A woman who just lost her pregnancy or baby may find herself suddenly hating to see other pregnant women or women with their babies. She may resent the ultrasound pictures shared on social media announcing another woman’s happy news while she is so submersed in her own pain.

None of this makes her selfish, self-centered, bitter, or inconsiderate. In fact, there is a chance she is feeling deeply ashamed of her strong negative emotions and wishes she didn’t feel this way. This is one more aspect of grief, and it may or may not take a very long time before she feels at peace with another woman’s happy pregnancy and delivery.

Be understanding. Don’t make the mistake of taking it personally if she suddenly doesn’t want to come to your facility or classes anymore. If she’s avoiding seeing reminders of pregnancy and babies, this may be the case. Let her know you care about her and you appreciate her regardless.

She May Want to Dive Right Back Into Activity

Some women desperately want to find a new focus, something to take space in their mind to keep them from ruminating over the events of their loss and the sadness that accompanies those thoughts. They may want to undertake a new project, dive into a new fitness program, or tackle a new challenge as soon as possible.

Follow your client’s cues, always keeping her safety in mind (for example, if creating a new training program, make it appropriate for the needs of her recovering body.)

In the Name of Healing

The following are some actions a mother may take in her healing journey while seeking peace and resolution. Only a basic introduction to each is presented to help you become familiar enough to know what a client might be talking about, were she to take any of the following actions:

Pictures

For mothers who know they will be having a stillbirth, or whose baby will pass away shortly after birth due to congenital problems, the few moments they will spend cradling their baby in their arms are the only moments they will ever have. The memories they make in the very short moments they get to have their baby near, are all they will ever have.

This is why many mothers choose to have a photographer present at the hospital to have pictures taken with their baby. Many mothers report feeling gratitude and relief at having this option of a visual reminder of their baby.

Some women keep the pictures and rarely or never look at them again. Others choose to display and show them to everyone they know — and this isn’t weird or morbid. This is a mother sharing the beauty of her child.

If you have a close relationship with your client and she chooses to share those images which she finds invaluable with you, it is appropriate for you to share in the moment by commenting and thanking her sincerely for letting you into this piece of her heart.

Also, just in case you need to hear it from us: it’s OK to cry with her.

Having emotions when faced with a heartbreaking situation like this one will not make you look unprofessional — far from it. We are human, and this is a moment of deep connection.

Mementos

Some mothers keep mementos of their babies. This could be the baby’s footprints or handprints, a cast mold of the baby’s hands or feet, or a lock of their hair, for example.

Much like above, consider yourself trusted and valued if a grieving mother chooses to invite you into this painful space of her life. Show your empathy and support along with your gratefulness.

Breast Milk Donation

Upon delivering a baby, the body’s cascade of hormonal reactions will send the signal for breastmilk production to initiate. Some women choose to make honor the memory of their child by using this as an opportunity to help others.

Depending on the laws where she lives, a woman may be able to collect her breast milk and donate it through programs that could benefit premature babies in the hospital, babies who lost their mothers, or whose mothers are undergoing treatments that make it unsafe to nurse. For some grieving mothers, this is a way of turning indescribable pain into something beautiful.

All in all, be respectful and encouraging of your client’s efforts in addressing her pain and healing, even if it is something you would never do yourself.

At a Loss for Words

In situations involving the loss of a pregnancy or baby, most people feel ill-equipped to offer support and condolences in a genuine and sincere manner.

There are certain phrases that, though well-intentioned, can be problematic when speaking with a grieving parent. These phrases have been used ad nauseum and now result in trite expressions, platitudes, and clichés.

“Everything happens for a reason.”

… and its variations, such as:

“There was probably something wrong with the baby.”

“Your body/Mother Nature is so wise, it’s probably for the best.”

These are not helpful nor are they comforting. Plenty of times there is actually no clear, medical explanation as to why the loss occurred. The not-knowing can make closure even more elusive for the suffering mother.

“You can have other children.”

… and other equally nocive variations:

“At least you already have other kids.”

“You can try again.”

These phrases do little more than invalidate a woman’s pain. The chance of having other children does not magically erase the pain she is feeling right now. For a grieving mother to properly heal, her current feelings must be honored and given a space to exist. The magnitude of her loss must be recognized. Having other children does not automatically cancel an individual’s right to suffer through their current loss.

Besides, a grieving mother is probably not ready to start thinking about trying again. She may be so lost in sorrow over this loss that the simple idea of making herself vulnerable to this pain once more might be overwhelming and frightening.

Finally, one child will never cancel out another one. We should never speak of someone’s children as trading cards. It’s hurtful and insulting.

“It’s God’s will.”

Yes, some women find deep comfort in their faith and their religious community. That’s a wonderful source of support when applicable and available to her.

However, regardless of whether a mother practices a faith or not, chances are she will not find solace in this phrase, at least not early on in her grieving process. Feelings of unfairness, despair, betrayal, disappointment, and even rage could occur.

Remember all scope of feelings is acceptable. Now is not the time to censor or doctor what a grieving mother “should” be feeling or how she “ought” to be expressing herself. Difficult emotions need to be acknowledged in order to be overcome.

“It’s better it happened now, before you got too attached.”

This line is equally offensive in cases of miscarriage early in the pregnancy or when a mother loses her newborn.

This insensitive comment stems from the assumption that a mother could not have had already an emotional connection with her baby, since the baby was not in the mother’s life long enough to warrant the mother’s devastation.

Nothing could be further from the truth: gestational age or how long a baby lives after birth are not parameters by which we can measure how deserving it is of a grieving process.

Most women who have experienced pregnancy or infant loss have had one or more of these phrases directed at them. Because they are so frequently used, they do not result in the intended effect of offering comfort or creating connection; the opposite transpires, often leaving the the mother feeling alone and misunderstood.

We must remain mindful of our words and how we communicate with grieving mothers.

How to Truly Be There For Your Client

Don’t Just Offer Help — Be Helpful

There is a world of difference between saying “I’m here for whatever you need,” and bringing her a meal you made so she doesn’t have to worry about cooking for herself or her family.

There is a marked stretch between saying “Let me know if you need anything,” and organizing the other members of your group class so that she receives one thoughtful care package each week, or doing something to help her ease back into her daily life.

If it were you in this situation, so emotionally drained and exhausted you can’t even verbalize your needs, which do you think you would appreciate more: the vague offers of help, or concrete actions that benefit you without you having to muster the energy to think about and express your needs?

You may be wondering if this goes beyond the scope of a coach-client relationship. Our view on this it that it is well within the boundaries of basic human care and connection; this is community at work, caring for one who is vulnerable and deep in sorrow. That said, if you are not comfortable or capable of extending yourself or organizing others to help your client, that’s OK too. You know your relationship with your clients better than we do. Let that knowledge guide how you choose to support her.

Avoid Asking Questions Simply to Satisfy Your Own Curiosity

She will offer the information she wants you to have. Don’t ask for details just because you really want to know. Sometimes curiosity gets the best of us, and it’s hard to hold back from asking intrusive questions like:

“So, what do they do with the body if it was a miscarriage?”

“This congenital defect, does it mean she was deformed?”

Trust us, any question you ask out of pure curiosity is most likely completely inappropriate and invasive, no matter how innocent they may seem. Just, don’t.

Let Her Feel What She Is Feeling

“Don’t cry.”

“Don’t feel guilty.”

By telling her how not to feel, you are effectively invalidating her experience. It’s like implying she doesn’t know how to do this “grief” thing right. Well, who does? Each of us will be thrown into difficult situations in our lives, and will react differently. Different is not bad, please remember that.

Include Her and Let Her Make Her Own Decisions

Keep including the grieving mother in the normal activities she would usually be a part of at your gym or in your classes. Let her decide for herself if she’s up for it or not. Let her know you’ll be ecstatic to have her join you, but completely understand if she’s not ready or willing just yet. Keep that door open.

Some women desperately want a sense of normalcy in their lives after the devastation, and avoiding including her in the usual activities only adds to that feeling of alienation and loneliness. Don’t make the decision for her; let her decide if she’s up for it or not.

Forego the Quest for the Deep Words of Wisdom and Comfort

Sometimes (most of the time) there truly is nothing you can say to make things better.

This is OK.

It is OK to admit that you don’t know what to say because words aren’t enough.

It is OK to hug her, hold her, cry with her, hold space for her. Sometimes sitting in silence can be the most powerful healing experience we can offer someone.

All we can do is listen, be, and respect the pace and rhythm of her process.

Refer Her to Someone Who Can Help Her Through This Process

You may not have the right thing to say, but you can refer her to a mental health professional who has experience in working with women and couples who experience miscarriage and infant loss. If you noticed your client is still struggling weeks or months after her miscarriage or loss, refer her to a mental health professional who can help her work through her grief.

Training and Creating Reassurance After Loss

All pregnant clients want reassurance that what they are doing in the gym is safe and that their coach is keeping their changing body and the safety of their baby in mind when planning their training program. A woman who has experienced miscarriage or infant loss may need additional reassurance that the exercises you are programming for her are safe and beneficial for her when she returns to the gym.

If she voices concerns about her training routine, take the time to listen to her concerns, to answer her questions, and to explain your exercise selection and the purpose or function of each movement. Be prepared to offer suggestions for modifying certain exercises. Make her part of the process and let her know that she can be an active participant in developing her program. Listening to her concerns, providing explanation, and discussing the goals of the program will give her a sense of control and confidence in her fitness routine.

A New Normal

At the end of the day, there is no going back to the way things were. The bereaved mother’s life is now forever changed. There is no “getting over it” or being “fine” now. Mostly, the grieving individual will eventually find a new normal, with time, patience, and compassion.

The memories of that child and the pain of the loss will stay present for a long time, possibly forever. Yet, they will learn to continue forward. She isn’t broken or permanently wounded. In fact, she is likely one of the most resilient humans you will ever meet.

References

1. Miscarriage – Overview [Internet]. Mayo Clinic. 2016 [cited 2017 Aug 3]. http://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/home/ovc-20213664
2. Harmon K. U.S. Stillbirths Still Prevalent, Often Unexplained. Scientific American [Internet]. 2011 Dec 13 [cited 2017 Aug 3]; https://www.scientificamerican.com/article/stillbirth-risk-factors/
3. National Center for Education in Maternal and Child Health Georgetown University [Internet]. [cited 2017 Aug 3]. https://www.ncemch.org/suid-sids/statistics/
4. State of the World’s Mothers 2013 [Internet]. Save the Children UK. [cited 2017 Aug 3]. http://www.savethechildren.org.uk/resources/online-library/state-world%E2%80%99s-mothers-2013

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