Supporting folx during pregnancy loss
[CW: This article addresses pregnancy loss, including miscarriage, stillbirth, and abortion. Additionally, there is some gendered language in quotes and statistics taken from other resources.]
Full-spectrum doulas honor and support all types of reproductive experiences, including pregnancy loss. Pregnancy loss can be experienced as miscarriage, stillbirth, or abortion. Doulas can show up for families experiencing loss by providing physical, emotional, and informational support throughout their transition.
Honoring All Pregnancy Losses
Miscarriage is the loss of a fetus from the uterus before it is able to survive independently, especially spontaneously or as the result of accident. ~10-15% of pregnancies end in miscarriage, per March of Dimes.
There are several types of miscarriages, each of which may occur at a different phase of pregnancy and may be caused by varying complications, circumstances, or choices. The majority of miscarriages happen before the 12th week of pregnancy. ~1-5% of miscarriages take place during the second trimester (weeks 13-19). Some miscarriages require medical or surgical management, so it’s important for clients to check in with their care providers to understand their unique situation.
Stillbirth is the death of a baby in the uterus before birth. Per the Center for Disease Control and Prevention (CDC), stillbirth impacts about 1% of all pregnancies, and each year about 24,000 babies are stillborn in the United States.
Pregnant people who experience stillbirth will need medical and sometimes surgical management. When and how a person gives birth depends on how far along they are in their pregnancy, their medical condition, and their personal preferences. Birth options include the surgical procedure called dilation and evacuation (or D&E), labor induction, and cesarean birth.
Abortion is the intentional choice to end a pregnancy. There are different types of abortions, again dependent on personal preference, stage of pregnancy, and health conditions. Options include medical abortions-- the most common combination of medications is Mifepristone & Misoprostol, aspiration, Dilation & Evacuation (D&E), and induction abortion. Check out our blog about abortion doulas here, and take our self-paced, prerecorded Abortion Doula Continuing Ed training here! You might also enjoy this article about abortion after care.
A Doula’s Role
A person experiencing loss will have a range of needs, and the way a doula shows up will be individualized. However, there are some overarching areas of support that many people experiencing loss will need. The doula’s role is to validate and affirm the client’s big (and little) feelings, questions, and concerns; this process can support the client in feeling stronger in their ability to advocate for themselves throughout their loss journey.
Physical Needs:
Pregnant people who experience loss will often have a range of physical symptoms, including fatigue, vaginal bleeding, abdominal pain, breast/chest discomfort, engorgement and/or leaking. They may need support planning for and using comfort measures. Additionally, they may simply need or want the physical presence of a loving, caring person while they go through their loss experience.
Emotional Needs:
A person going through loss may experience feelings of guilt, shame, emptiness, fear, jealousy, and so on. They may feel lonely, tired, depressed, or experience suicidal ideation. It can be helpful to keep the six stages of grief in mind when working with bereaved clients, and you may directly talk about this process with them (remembering that the stages aren’t linear and can ebb and flow). Clients may need help anticipating the waves of emotions (or lack thereof) they may experience, as well as a plan for how to cope with the uncomfortable feelings if or when they arise. Oftentimes, clients appreciate having an open, non-judgmental listener to process with before, during, or after a loss.
Logistical and Informational Needs:
While experiencing loss, clients may need referrals to other professionals, from mental health professionals to pelvic floor therapists, to lactation consultants, and so on. Clients may also need support in preparing logistics for their postpartum or healing time-- things like food, childcare, time off, etc.
Specific Ways a Doula May Show Up During Loss
All of these are options, and not all clients will desire support in all of these ways. There may be additional needs that clients express.
Attend appointments with client to confirm the miscarriage.
Be present with the client in the emergency or birth room, or at home.
Offer emotional support via text, phone and email before, during, and after loss.
Present bonding options for client and baby.
Explain options and final disposition for the baby’s body.
Hold space for the client as they go through the stages of grief.
Support them in creating and practicing rituals for grief or loss-- ideas include memorial services, creating art, writing poems and letters, planting a tree, making an altar, taking photos and/or creating a scrapbook, and religious or spiritual activities.
Support them in planning for longer term grieving.
Join Us in this Important Work
If this work of witnessing and supporting someone through loss speaks to you, we would love to see you in class. We touch on bereavement and loss in our 12-week Full Spectrum Doula Training, we offer a 4-week Abortion Doula Continued Education Course, and our friend Molly Dutton-Kenny also offers an online course that we love.