1. Is the loss of a baby in pregnancy or shortly after birth an unusual occurrence?
Perinatal loss (miscarriage, stillbirth, infant death) is a far more common experience than people realize. More than one million families are affected by this tragic event every year. One of every five pregnancies ends in a miscarriage (before 20 weeks of pregnancy). Approximately, two babies are stillborn for every 100 live birth (between 20 weeks and term). And of every 100 live births, one baby will die in the first 28 days of life (neonatal death).
2. What are some of the normal feelings a mother and father experience after the loss of a baby?
The death of a baby, whether early in pregnancy or after birth, triggers a grief response similar to other deaths and losses. The feelings occur in a somewhat unpredictable and repetitive sequence. Initially, there is a phase of shock and disorganization. There is a feeling of numbness, disbelief, and a sense that this can’t really be happening. These feelings can last for a few hours or for a few weeks. Then there is a period of volatile emotions that occurs as the couple tries to understand why this has happened. They may experience intense feelings of anger, sadness and guilt. The anger may be directed towards those closest to them (spouse, family and friends) or those seen as having power and control over them (such as their doctor or God). Guilt can be overwhelming at times for, in trying to find answers, they often blame themselves. As intense emotions start to subside, a phase of loneliness and depression occurs. The reality of the loss sets in, along with feelings of sadness, fatigue and powerlessness. These feelings may peak between three to nine months following their baby’s death. Finally, reorganization occurs as their baby’s loss has become accepted—not in the sense of being right or fair, but only in that it happened. The loss is no longer consuming all their energy and emotion. Now only shadow grief remains. Feelings of sadness can be rekindled around significant days or events, such as their due date, conception date, and anniversary of their baby’s death. Special holidays, events, places, music, changes of seasons, and so on may also trigger memories of their baby and rekindle grief. Shadow grief is a reminder that their baby will always hold a special place in their hearts and will never be forgotten.
3. What makes it so difficult for couples to grieve the loss of their baby? 
The loss of a baby early in pregnancy can be particularly difficult to mourn, primarily because the grief is prospective rather than retrospective. What this means is that parents are grieving over the hopes, dreams, and wishes for the future with their child rather than over real experiences and memories when someone older dies. With earlier pregnancy losses, there may be no tangible evidence of their baby’s existence, which adds to the sense of unreality. Other people may not have known they were pregnant and thus are not aware of the loss or the significance. In addition, when a baby dies during pregnancy or at birth, traditional mourning rites and rituals are not encouraged, as the baby is “know” only to the parents. There may be no viewings, funerals, or other religious services that help in the grieving process. Parents at times are encouraged to repress their feelings, forget their baby, and “move on”. Thus, couples can find themselves suffering intense emotions in virtual isolation.
4. Do fathers and mothers respond differently to the loss of a baby? 
The loss of a baby can be a devastating experience for both mother and father. However, mothers and fathers have bonded to the baby in different ways and thus often experience feelings of loss differently. Women frequently feel that they are the ones hurting and feeling the greatest pain over the loss of their baby. Husbands often are put into the role of the strong protector, decision maker, and/or caregiver. Thus, men may not be encouraged to grieve and can fear that it will make things worse if they allow themselves to feel the pain. It is important for husbands and wives to understand that will feel and deal differently with this loss. They need to be patient with each other and keep communication open.
5. What are some suggestions for supporting couples and helping them cope after a pregnancy loss?
Mourning the loss of a baby can be hard work that takes time and drains energy. Further, grieving this loss takes far longer than most people recognize, from months to years. Couples need to know that their feelings are normal and there will be many ups and downs while they grieve. To help in the healing process, couples will first need to find ways to acknowledge the death of their baby as a significant and real loss. To acknowledge this loss, they may want to name their baby; give a donation or gift to a special charity; have a memorial service or funeral; or maybe plant a tree in their baby’s memory. You can help by taking similar actions that memorialize this life. Secondly, couples need to have the opportunity to talk about their experience, not only immediately following the loss, but for many months later. Research has shown that a couple’s ability to satisfactorily resolve their grief is in direct proportion to their finding suitable avenues to express their feelings. Give mothers and fathers the chance to talk about their baby and their grief, if they chose to. Know that if they cry it is not because you made them cry, but rather allowed them the chance to share emotions that are close to their heart. Lastly, couples need to be given adequate opportunity to grieve. They need to understand that they may feel worse before they will feel better. They also need to give sufficient time for physical and emotional healing before attempting another pregnancy.
6. What can friends, family, and colleagues do to help someone who has experienced a pregnancy loss? 
As mentioned, you need to help the couple find ways to acknowledge the loss as significant, real, and worthy of grieving. Expressions that tend to diminish the loss, however good intentioned, are best avoided. For example, statements such as “it was for the best”, “you can have another baby”, “at least you didn’t really know the baby”, “maybe this happened because you were under too much stress” or “you can always adopt”, only cause pain and hurt. Simple heartfelt expressions of sadness and emotions such as, “I am so sorry that this happened and can only imagine your sadness, but want you to know I care” are often most appreciated. In addition, you can communicate your sympathy by sending notes or through thoughtful gestures like preparing a meal or giving a small gift such a book on perinatal loss. Remember that special events in this couple’s life, like their due date, anniversary of their loss, or even holidays are often difficult times. Helping the couple talk about their feelings and finding meaningful ways to remember their baby at these times can be helpful. Last and most important, couples need to know that they can talk about their baby and this experience long after the event has occurred. Knowing that other people care and understand this tremendous loss is a gift and can help in healing.
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services