Saturday, October 17, 2015

The Heart of Grace: Pregnancy and Infant Loss

October is Pregnancy and Infant Loss Awareness Month.

As a doula with over two decades experience, an inter-spiritual minister, and one who supports the dying, I have held space for the grieving of early and late pregnancy loss.  

There are times my support has been in the moment and in person, emotions ranging from disappointment and sadness to the keening of shock and soul shattering grief as a baby lies still in its mother's arms.  It has at times been over the phone because a doctor referred someone to me for emotional support.  It has been at times listening to a friend, student, or client discuss a recent or long ago loss.  

Each story of pregnancy loss is woven into the intricate patterns of the exquisite fabric of women's reproductive lives, into the stories of Family.  Each is a reminder, some poignant, some resentful, and some unreconciled, of the Mystery of life's unfolding.

It is always humbling to be invited to bear witness to an account of a parent's experience of loss. Loss expresses itself in a myriad of ways.  Sometimes it is quiet and gentle.  Sometimes it is fierce and raw.  I have found it best to be with exactly how it is for that parent, and to simply breathe into the moment, hollowing out my being, so that I may serve as a vessel of compassion and empathy.

When sitting with someone who is losing or who has lost the child they've conceived, there is little to say.  I have given up trying to find the words that will heal.  Because there aren't any.  There are no pretty words to ease a grieving mama's heart.  The space we hold for the unburdening of these maternal feelings is best filled with our listening presence.

"Listening is the oldest and perhaps the most powerful tool of healing.
It is often through the quality of our listening and not the wisdom of our words that we are able to effect the  most profound changes in the people around us.  When we listen, we offer with our attention
an opportunity for wholeness.  Our listening creates sanctuary for the homeless parts within the other person.  That which has been denied,
unloved, devalued by themselves and others.  That which is hidden."

-Rachel Naomi Remen

The loss that occurs in late pregnancy, during birth, or just afterwards is an unspeakably painful thing for the parents, as well as for those who love them.  Even for those who are just acquaintances or have heard of the loss through the grapevine, feelings can be complicated and uncomfortable. Eyes are lowered, we often don't know what to say, and we are generally quite unskilled as a society at communicating with bereaved parents.

I heard it once said that there are terms for people who have lost partners ("widow" and "widower") and for children who have lost their parents ("orphans"), but there isn't one widely known word for a parent who has lost a child...perhaps because it is a grief society can little bear to even think of.  But our not addressing loss keeps us unskilled, to the detriment of the parents.  

A few years ago, a wonderful woman I see regularly for self-care services was pregnant, and we would talk animatedly about birth whenever I went for a visit.  Then one day I learned from one of her co-workers that she had lost that baby very late in her pregnancy.  

I am a doula, for Pete's sake, with experience of loss support, and even I found it hard to go back to her place of work again knowing this elephant would be in the room between us, and would grow more insistent with each passing moment it was left unacknowledged.  But how to acknowledge it?  Leave it on her shoulders?  Bring it up myself?

 I experienced a deeper understanding of how those who are frightened of this kind of encounter could squirm with discomfort at the idea of having to talk to a grieving mother and not know what to say.  I could imagine what might go through their minds if they were in my shoes. "What if I open the floodgates of pain and we all get caught in the deluge of overwhelming emotion?"  "What if she gets mad at me for saying anything?  Or worse, for NOT saying anything, even though it it clear she doesn't have a baby in her belly anymore?"  "What if I say the wrong thing?" "I just can't deal with her, so it's best to ignore her and tell her I've been busy if I run into her." "Maybe I should just change service providers." 

Staying away from the grieving is something some people choose, because they just can't deal with the potential for intense and overwhelming emotions and the fear of messing up.  While I can understand that impetus, knowing it comes from fear and not a lack of caring, it certainly doesn't help to ostracize grieving parents. 

I made an appointment and went to see this woman as usual.  She walked into the room, appearing pale and subdued.  It was clear she was uncomfortable too.  I was a doula she had shared intimate details of her pregnancy with, and she was no longer with child. She knew that her clients had been informed about what had happened, according to her own instructions, but that didn't make encountering people any easier.  I took her wrist, looked her in the eyes, took a deep breath, screwed up my courage to take the risk and said, "I heard you lost your baby.  I don't have words for how sorry I am."  I am sure there are some mothers who would have preferred to not have me bring up the baby and announce the death themselves themselves.  But because the "rule book" is so complicated and conflicting, at some point we have to listen to our hearts for the answer how to approach and take a risk.

 The elephant in the room shrank and shrank as I simply listened to the story that wanted to come out in a presence that was committed to only listening.  There were tears of sorrow from both of us.  She told me her child's name, told me about the birth experience, told me the things people said to her she didn't like ("Your baby is in a better place," "God wanted your baby back as an angel," "You're young and healthy, you can have another baby."), expressed her anger that her place of work was holding a baby shower for a co-worker who was pregnant and that she couldn't take it... and so many other things.

To this day, years later, she tells me little things about her child, about the box she has of keepsakes she hasn't yet opened.  It hurts to talk about that baby.  But for her and for many, it hurts more not to.

One of my favourite books on late pregnancy loss is a memoir called An Exact Replica of a Figment of My Imagination by Elizabeth McCracken.  It was given to me by an amazing client of mine whose first baby was born still, and whom I supported throughout the pregnancy and birth of her beautiful Rainbow Baby.  This woman and this author provided me with such insight into the uniqueness of the experiences infant loss.

Early pregnancy loss is an experience many women go through.  And it saddens me how little honour there is for the time it can take for many to heal from these losses.

For one, many people assume that just because it's an early-ish loss, it's not a big deal compared to a later loss.  That is certainly not the case for a lot of women.  A women discovering she had a blighted ovum can experience tremendous grief, because once the dream of a baby has infused a woman's heart, she has often identified herself as a mother-to-be.  The loss of the dream of a baby can be profoundly heartbreaking.  It is not for anyone else to prescribe how long a grief "should" last with regards to an earlier loss or the loss of what she thought was a conceived life.

Another example of the general lack of honour our culture has for early pregnancy loss, is with regard to what miscarrying women experience in the hospital, which I've often heard described as a nightmare.  When she starts bleeding and/or cramping and goes to the hospital, she often has to wait for many hours in emergency to be seen.  An early loss is not generally considered a medical emergency, but for the parents can definitely be an emotional emergency of epic proportion.  Coping with terror, shock, grief and raw vulnerability as she bleeds and hurts in a room full of people waiting to see a doctor is traumatizing for many women and their partners.

If, during a routine ultrasound it is discovered the little heart has stopped beating, mothers are often given medication to get the process going after a certain amount of time has gone by.  I cannot tell you how many times I have heard women say this was one of the most painful, distressing experiences of their lives.  In my experience a lot of women are not told about this possibility, and suffer not only from the pain itself, but from the terror that something might be terribly terribly wrong with them as they rush to emergency.

Many women these days don't tell people about their early pregnancies, waiting for them to feel more established because they perhaps don't want to have to deal with the often insensitive comments well meaning people might make if the pregnancy miscarries ("it wasn't meant to be" "Nature knows best" "at least it was early"), and the painful explanation she has to make if someone asks how far along she is now.  Others tell people about their new pregnancies right away, not because they are expecting with blind faith all will be well, but because they feel like they would be very open to explaining about their loss and receiving support from their friends, family, and coworkers if loss were to happen.  The point is, these are very personal choices, to be supported without judgement.   

The demands of work and life can press upon women who have had early losses with oppressive force.  Many women grieve profoundly, and are met with a lack of understanding of the depth of their grief. 

I have had several women call me after an early loss who wanted reassurance they were going to be able to go back to work and function normally in a couple of days, worried their grief would overwhelm them and make their productivity at work suffer, thus leading to the potential loss of their job.  The fact that there is a worry about a lack of understanding and a potential penalization for grief over the loss of a pregnancy is saddening.

Everyone has such unique needs and concerns to unburden, all of them valid.  To be able to express them is often more important than any answer the listener can provide.  These women's questions about the length of their grieving and its impact upon their work life were certainly not anything I could answer for them.  To try to have interpreted or shaped their experiences would have been inappropriate. But I could listen as they worked it out themselves, and that seemed to help.

I have experienced more than once a mother who has lost a child at some stage of pregnancy have a strong desire to share, when she felt safe with the people in her presence, an image she had captured of her lifeless baby (whether it looked like a developed baby or not).  I cannot tell you how deeply I have been moved by witnessing a group of women passing around the image, and kissing it with the blessing of loving hearts and mama tears, not looking upon death with shock or  horror, but with honour for that mother for having carried that very child.

In my experience, I have seen some of the most profound healing emerge from within a circle of compassionate women providing peer support for each other.  This is why pregnancy and infant loss support groups can be such powerful resources, which I highly recommend for those who are grieving loss.  

There is a softness which binds us gently together in moments of heart shattering empathy when we come together in community with an intention to heal.  When we trust that all of our feelings are welcome into the circle, courageously expose the soft underbellies of our grief to the loving, listening hearts of those who hold us without judgement, acceptance being mirrored back to us in every pair of eyes we look into, we discover the meaning of grace.

"I tell you this
to break your heart,
by which I mean only
that it break open and never close again
to the rest of the world."
-Mary Oliver