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Tara Shafer

The Emotional Impact of Loss

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

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.


About the Author

Tara Shafer is the co-founder of Reconceiving Loss, an online resource center for pregnancy loss and healing.