Tara Shafer

To Begin Again

The Emotional Impact of Loss

Coping With Depression & Anxiety in Post-Loss Pregnancies and Beyond

Posted May 30, 2014

In December 2005, I gave birth to a stillborn son. While in the hospital, I experienced a grief so profound and transcendent, it almost lifted me up, after which waves of despair seemed to knock me to a kind of seabed -- as I struggled to return to my daily life -- before returning me mercifully to some undiscovered center. I tried to manage the tidal waves of pressing anxiety that were as intense to me as bouts of nausea, producing sweaty palms and shortness of breath. In these months, I began a frantic search for meaning. The idea of meaning rising from suffering then, as now, lacked definition, but did offer something resembling redemption.  By redemption I mean in the sense of "re-deeming" all that my life had been before, calling everything by a new name.

A year and a bit afterwards, I became pregnant again. 

I recall holding the positive pregnancy test, flooded instantly by the innumerable emotions that coursed through me all at once as if hundreds of little dams were bursting. I was seized with panic at the idea of having to actually gestate a baby again.  I was filled with relief at the possibility that I could.  How could these two things coexist? And for so long?

I kept my pregnancy secret from all but a few for far longer than I reasonably could. I wore loose-fitting clothing everywhere I went. I avoided most social situations. I felt that to tell people would be to jinx the pregnancy although, in truth, I longed to reveal it. As I tried to negotiate the polar opposites of true joy and a throbbing residual grief that are the hallmarks of a post-loss pregnancy, I struggled mightily with intermittent depressive symptoms such as difficulty sleeping.  I also frequently battled intense anxiety.

Simultaneously, I suffered tremendous guilt over my efforts to have another child, as if this emergent reality threatened what precious little memory remained of the baby who had died. I was scared to leave him behind. The novelist Marilynne Robinson writes, “[M]emory is the sense of loss, and loss pulls us after it.” I felt trapped in a moment remembering little, and yet afraid to imagine more. I was unable to move either backwards or forwards in time. There were good days too, and on these days I was able to permit myself to imagine a baby I could raise, as I let the seeds of joy creep in to my heart and flower and remain there for as long as I could nurture and grow them: sweet, sweet hope.

I was often deeply touched by the good wishes of people who rejoiced in my increasingly obvious pregnancy. I was often sustained by their efforts to convey their happiness for me; so many kind people seemed so relieved on my behalf. While I understood that they understood the complexity inherent in their good wishes, there seemed no good way to convey the central fact of this truth in normal, day-to-day conversation. The fear of possible loss was tacit and pervasive, and there was little I could do to tamp it down. Desperate though I was to share their relief, there was a part of me that felt as though accepting their unfettered joy could still doom my baby. And so I remained less demonstrative than, perhaps, I should have. I felt remote from myself and also from most others.

I wish I had known how common these responses are.  One in four pregnancies do not come to term; stillbirth occurs in one in 160 pregnancies. According to a 2011 study in the British Journal of Psychiatry, women who experience baby loss during pregnancy have elevated rates of depression and anxiety over the course of a subsequent pregnancy.  In addition, these symptoms are likely to persist in some measure for an average of three years even after the healthy birth of a baby. Said Professor Jean Golding: “[T]his study is important to the families of women who have lost a baby, since it is so often assumed that they get over the event quickly, yet as shown here, many do not.” Added Dr. Emma Robertson Blackmore: “If we offer targeted support during pregnancy to women who have previously lost a baby, we may be able to improve health outcomes for both the women and their children.” 

I was lucky in that the medical care I received had a mental health component. My doctors did all that they could to ease my path through a blessed, longed for pregnancy. Many women are not as lucky in this way. Health care providers who work with pregnant women following a loss may not realize how far even seemingly small efforts can go. Examples of these efforts are remembering the gestational age at which a loss occurred, checking in, and acknowledging the inherent stress that women may feel in this subsequent pregnancy. Therapists are in a position to address these issues, but so too are obstetricians, doctors who specialize in family medicine, midwives, doulas, and pediatricians to name a few. These considerations, which may seem small, can be the difference between intolerable stress and manageable stress. And slight though this may seem, they really can make all the difference.