NATAL X NPR LIFEKIT: NAVIGATING LIFE AFTER PREGNANCY LOSS

 
 
 
 
Final Illustration - Credit Bee Harris_NPR.png

Despite how common pregnancy loss is, families often suffer in silence. In honor of Black Maternal Health Week (#BMHW21), we teamed up with NPR's Life Kit to share stories from parents who have experienced loss, and expert advice about how to support loved ones through grief.

Episode Summary

Despite how common pregnancy loss is, families often suffer in silence. In honor of Black Maternal Health Week (#BMHW21), we teamed up with NPR’s Life Kit to share stories from parents who have experienced loss, and expert advice about how to support loved ones through grief.

Episode Notes

In this episode you'll hear from:

  • Marilyn Abrahams, Episode Five

  • Yvonne McCombs, Episode Five

  • Dr. Jamila Perritt, Board Certified OBGYN and NATAL Advisory Board Member

  • Asha Tarry, Licensed Psychotherapist and NATAL Mental Health Advocate

  • Erica McAfee, Founder of Sisters in Loss

Resources for grieving families mentioned in this episode:

For continued reading and listening, we suggest:

DIGITAL PIECE

This piece was originally published on npr.org/lifekit.

“Everything was hush hush. No one spoke of loss, at least not in my circle. You know, there was no support system.”

That’s how Marilyn Abrahams of New Jersey described her pregnancy loss, which happened back in 1993. Even today, it’s a deeply painful and traumatic experience that as a society, we don’t talk about nearly enough. 

Between 10 and 15 percent of known pregnancies end in miscarriage, according to March of Dimes -- and it’s likely that number is even higher when unknown pregnancies are taken into account. And the National Institutes of Health estimates that Black women are twice as likely to suffer both early pregnancy loss and stillbirths than white women.

Yet, despite just how common pregnancy loss is, so many parents and families suffer in silence and don’t get the support they need. And their partners, loved ones, coworkers, and even medical providers might also feel unsure of what to do with their own grief, let alone how to show up for the birth parent during this time. 

If you or someone in your life has experienced a pregnancy loss, here’s some advice for the journey ahead.



Acknowledge the loss

Marilyn’s story highlights a much larger culture of silence - and even shame - that surrounds pregnancy loss. A big part of that silence stems from the fact that we don’t  have a shared understanding of what pregnancy loss is, and why it happens. 

“Typically in the way that I talk about it with people that I care for, it’s nature’s way of ending a pregnancy that wasn’t going to be able to continue on its own,” says Dr. Jamila Perritt, an OBGYN in Washington D.C., and president and CEO of Physicians for Reproductive Health.

Pregnancy loss is often classified by when it occurs: A miscarriage, also called a spontaenous abortion happens before 20 weeks of pregnancy. However, a loss at or after 20 weeks is defined as a stillbirth. 

Beyond explaining the medical side of pregnancy loss, Dr. Perritt also makes it a point to remind her patients that the burden of shame is not theirs to carry. “Almost the first or second thing that I always say for someone who is experiencing this, is there is nothing that you did to cause this, and there's nothing you could have done to prevent it. Because even for folks who don't articulate that internalized feeling of shame and struggle around it, sometimes it's there,” she says. 



Make space for grief and grace

Grief looks differently for everybody. 

“When there's a loss, we could see daily function being interrupted, which includes the inability to sleep through the night,” says Asha Tarry, a New York City psychotherapist who specializes in trauma and mood disorders. For others, grief might show up as uncontrollable crying, or the complete opposite: feeling like you have to cry even when you are unable to. 

The other thing about grief is that there are no hard and fast rules about who is impacted or who is allowed to grieve. Tarry reminds us that “not only is the person who was carrying the child grieving, but also the people who supported that parent at the time of the pregnancy and the loss.” This group might include significant others, relatives, other children in the household, co-workers, neighbors, or even the neighborhood grocery clerk. And regardless of their relationship proximity to the birth parent, their grief (often referred to as disenfranchised grief) is valid.

If you’re currently grieving, show grace for yourself, but also towards those around you who might be processing the loss in their own way. Tarry encourages those in community with a grieving parent to continually ask, “How can I show up for you today?” -- because a parent’s needs might change over time. 


Be present

Grief calls on all of us to be more tender in our words and actions with one another, even when we might not know exactly what to say to someone who has recently experienced pregnancy loss. From dropping off a meal, to babysitting older siblings, to assisting with bereavement paperwork, there’s a full range of what being present can look like -- and it doesn't have to cost a lot of money. 

Yvonne McCombs, a mother, wife, and birthworker in California, deeply treasured visits from her own mother after her eight consecutive pregnancy losses. “My mom would just come and just sit down on the bed with me, and she wouldn't say anything,” says McCombs. “She would sit there and she would pray for me. She'd hug me. She would rub my shoulder. Even when she didn't know what to say, just her presence -- she was just there.” 



Explore your care options

Whether or not you have a huge support system, everything from processing emotions, to explaining what happened, to returning baby items can feel incredibly overwhelming after a pregnancy loss. Knowing what kind of care resources are available, such as support groups and doula services, can make a world of difference.

After experiencing two consecutive losses, Erica McAfee knew that she did not want other parents to go through the same journey alone. In 2017, McAfee founded Sisters in Loss, a digital community and podcast for Black parents coping with pregnancy and infant loss, and infertility. 

Based in the Washington, D.C. area, McAfee is also a full spectrum doula - a non-clinically trained support person that works with families before, during, or after birth - with a focus on bereavement. In this capacity, she helps families transition from “welcoming this baby into the world [to] then having to say goodbye and preparing for a funeral.”

While awareness and demand for doula services are growing in the U.S., there is still a huge exposure and insurance coverage gap. If paying out of pocket is not an option for you, in some cases, doulas might be covered through your insurance. They might also offer sliding scales and payment plans, or even barter services. If you or someone you  know would benefit from working with a doula, there are a few places to connect with one, including the National Black Doulas Association, Sisters in Loss, and even doula groups on Facebook. 


For medical providers and birthworkers: work collaboratively to connect families to holistic care options

Of course, so much of what we’re talking about varies greatly depending on who and where you are. And too often, barriers to care present a unique challenge to pregnancy loss survivors who are people of color, queer or trans, uninsured, and/or living with a disabiilty. So this takeaway is specifically for all the care providers out there: think about ways that you can work collaboratively within and outside the hospital to connect families to holistic care options during this bereavement period. 

For Dr. Perritt, “integrated care means really putting the person experiencing pregnancy loss at the center of the care model and building out from there. So it falls upon us as the health care providers to seek those services out in our communities because they exist.” 

***

Following their pregnancy losses, Yvonne, Marilyn, and Erica each eventually gave birth again to healthy babies, commonly referred to as rainbow babies. But the babies they lost will always hold a special place in their hearts. Their stories are a reminder that navigating life after loss is not only possible, but that it can oftentimes result in new joy, new hope, and new life, too. 

EPISODE TRANSCRIPT

MARTINA ABRAHAMS ILUNGA, HOST:

Just a heads-up, you should know that this episode deals with the trauma of pregnancy loss.

GABRIELLE HORTON, HOST:

This is NPR's LIFE KIT.

MARILYN ABRAHAMS: I always knew I wanted to be a mom. I'm a planner by nature.

YVONNE MCCOMBS: As a woman, I just in my head was like, I'm going to be able to have kids. As we are conditioned as we're younger, you get married. You have kids. You get married. You have kids.

MARILYN: Never in my mind that I entertained the thought of losing a baby, having a miscarriage, having a stillbirth. The doctors didn't mention it. No one mentioned it. So I went in like a schoolgirl. And, of course, my first pregnancy was perfect.

YVONNE: So then when I had my first daughter, I'm thinking, like, OK, let's try again.

MARILYN: But my second pregnancy, I lost that baby for miscarriage - and then my stillbirth.

YVONNE: And then it kept on continuing. I was just like, oh my goodness, I am failing as a woman. And I felt all I was good as was birthing death.

MARILYN: Everything was hush hush. No one spoke of loss, at least not in my circle.

MARTINA I'm Martina Abrahams Ilunga.

GABRIELLE: And I'm Gabrielle Horton. We're the hosts of NATAL, a podcast docuseries about having a baby while Black.

MARTINA On our show, we pass a mic to Black parents like Yvonne McCombs and my own mom, Marilyn Abrahams, who you heard at the top of the episode. We invite them to share their stories about pregnancy, childbirth and postpartum care in their own words.

GABRIELLE: Today, we're partnering with LIFE KIT to have a real conversation about something that can be really difficult to talk about. And that's losing a baby.

MARTINA You know, Gabrielle, last year when we were doing research for our episode on pregnancy loss, I couldn't believe that between 10 and 15% of known pregnancies end in loss. And it's likely that number is even higher when unknown pregnancies are taken into account.

GABRIELLE: I remember that. I also remember how the National Institutes of Health estimates that Black women are twice as likely to suffer both early pregnancy loss and stillbirths compared to white women.

MARTINA But despite just how common pregnancy loss is, so many parents and families suffer in silence and don't get the support they need.

GABRIELLE: So our hope is that this episode can be a real resource for folks. So if you're a parent who's recently lost their baby, you'll hear about ways that you can ask for and access the support you need but also how the rest of us, whether you're a friend or a nurse or an auntie like me, can show up for the parents in our lives when they need it most.

MARTINA The silence around losing a baby that my mom mentioned at the top of this episode is not only common. But for some cultures and households, pregnancy loss can also be a taboo subject. So our very first takeaway - and that goes for everybody - is to acknowledge the loss, acknowledge that a family is hurting.

To help start our conversation, we wanted to speak with Dr. Jamila Perritt, a board-certified OB-GYN in Washington, D.C., where she's also the president and CEO of an organization called Physicians for Reproductive Health.

DR. JAMILA PERRITT: Now, I have a little bit - is my voice coming through OK? 'Cause my video has been, like, delayed intermittently during the day.

GABRIELLE: You look fine so far.

DR. PERRITT: Good.

GABRIELLE: A big part of the silence around pregnancy loss, the failure to acknowledge that loss is that we don't always have a shared understanding of what it is or how it shows up.

DR. PERRITT: There are lots of ways that people describe pregnancy loss. We're using that phrase here, but some people describe it as a miscarriage. For an example, in the medical field, we describe it as a spontaneous abortion. All of those mean the same thing, that pregnancies, stop growing typically in the first trimester but not always.

GABRIELLE: Dr. Perritt says that most of the time, it's unclear why pregnancy loss happens.

DR. PERRITT: That's why we call it spontaneous. Typically, in the way that I talk about it with people that I care for, it's nature's way of ending a pregnancy that wasn't going to be able to continue on its own.

MARTINA My mom - well, she's all too familiar with what Dr. Perritt is describing.

Hello.

MARILYN: Hello. Who said hello?

MARTINA Me. Hi, Mommy.

MARILYN: Marty (ph), Martina.

MARTINA How are you?

MARILYN: I'm fine.

MARTINA Two years after having me, my mom suffered a miscarriage. She and my dad tried again. And in January 1993, they gave birth to my twin sisters, Britney (ph) and Briana (ph). But Briana - well, she was born sleeping. I'm sure you might have heard this term before or even sleeping baby to describe a stillbirth, which is another form of pregnancy loss that can typically happen after 20 weeks. The thing that always sticks out whenever my mom and I talk about this is how she remembers how her friends, our family and even my dad completely avoided talking about Briana. Everyone was so focused on my surviving sister, Britney, it was almost as if Briana never existed. But in reality, my mom just wanted someone to acknowledge her pain, her loss and the fact that one of her girls wouldn't be coming home.

DR. PERRITT: There's a lot of shame attached to pregnancy loss. And so the - almost the first or second thing that I always say for someone who's experiencing this is there is nothing that you did to cause this, and there's nothing you could have done to prevent it - right? - because even for folks who don't articulate that internalized feeling of shame and struggle around it, sometimes, it's there.

MARILYN: I felt alone in my pain. I was alone in my pain. All it takes is one - one person to acknowledge that you did have a second baby. That baby was real. And it was enough. It was enough. So imagine what a community would be, right?

GABRIELLE: It may seem really simple or even obvious, but as you've just heard, that's not always the case. Without acknowledging the loss, well, how can parents or loved ones start to grieve and even heal through the pain?

ASHA TARRY: As a professional, helping clients to grieve is really very sacred work because there's no limit to how the grieving process will unfold.

GABRIELLE: That's Asha Tarry. She's a New York City-based psychotherapist who specializes in trauma and mood disorders. She's a perfect person to help us understand what grief might look like for parents and tender ways we can all respond to it, which leads us to our second takeaway - make space for grief and grace.

ASHA: So there are various signs that we see in terms of how grief manifests both psychologically and physically. When there's a loss, we could see daily functioning being interrupted, which includes the inability to sleep through the night. Sometimes, people experience dreams, dreams of their child, dreams of being pregnant, even the fantasies in their wakefulness as to what it would have been like had their child survived. And so there could be a lot of things that mentally go on that feel like intrusive thoughts.

MARTINA That constant mental replay can be really hard to deal with, especially if you have to continue on as if everything is normal, like showing up for work or raising other children. But the thing is, grief looks different for everybody.

ASHA: And so some of it could look like uncontrollable crying. Sometimes, for other people, it could feel like they want to cry, but they can't actually cry. And that could be very frustrating for individuals because it may seem like they don't feel the loss if they're not physically showing the signs of loss.

GABRIELLE: something that I feel like we can all relate to, especially in the middle of a global pandemic, is that no matter how hard we might try, grief doesn't fit neatly in our Google calendars. Grief has a schedule of its own. And not only is that OK. It's absolutely normal.

MARTINA One idea for parents might be to establish a support word with loved ones or even co-workers to let them know when you could use extra support or space.

ASHA: Sometimes, when people are grieving pregnancy loss, not only is the person who was carrying the child grieving, but also the people who supported that parent at the time of the pregnancy and the loss. So that impacts the co-parent. That impacts, at times, the other children in the household.

GABRIELLE: That was the case for Yvonne, a wife and mother out in California. Back in 2009, Yvonne was looking forward to having her second child. But at around four months, she lost the baby. Over the next 10 years, she would suffer seven more miscarriages back to back. And the thing is it wasn't just Yvonne mourning by herself. She also had a young daughter who was grieving, too.

YVONNE: So I have to not only take care of myself and my mental health but take care of my daughter's, as well, and then knowing how to navigate with her. Like, sometimes, she may want to talk about it. She may want to draw a picture. She may want to write a letter. She may want not to say anything. Or she may want to talk to my sister.

MARTINA These situations can be so nerve-wracking and make you wonder, am I saying the right thing? Or will saying something make things worse? We asked Asha if there is such a thing as saying the wrong thing.

ASHA: Unhelpful language would sound like this. Aren't you over this by now? Didn't you tell me you've already grieved? You know, the ways in which people probe sometimes comes in the form of a question that sounds like judgment.

MARTINA However, Asha does have advice for more helpful, loving language that we can use instead.

ASHA: So I would ask people to ask less questions. But if you're going to ask anything, just ask, how can I show up for you today? And let that be the thing that maybe you repeat ongoing because it may look different over time. Be the one who initiates contact with the person who's had the loss.

GABRIELLE: And if the words aren't coming to you or you're still nervous about saying the wrong thing, our third takeaway is to be present. And there isn't just one way to be present or show up, you know? It can be dropping off a meal or offering to babysit. Or for your mom, Martina, it was as simple as a really thoughtful card.

MARILYN: I have to say I did receive a condolence card from a good friend at the time. I literally still have that card. It meant the world to me. Somebody is acknowledging my loss. Somebody is acknowledging that I did carry two babies because, you know, everybody around me - it was like I wasn't pregnant with twins, right? So that card was everything to me.

MARTINA And even though she doesn't remember what the card said word for word 28 years later, my mom still remembers how it made her feel, which is what matters most. For Yvonne, being present looked like her mom and sister, coming to spend time with her and her daughter.

YVONNE: Like, a lot of times when I didn't want to talk, I just wanted to cry. My mom would just come and just sit down on the bed with me. And she just - she wouldn't say anything. Then I finished crying. And then she'll leave. And that was the best for me that time. She would sit there, and she would pray for me. She'd hug me. She would rub my shoulder even when she didn't know what to say. Just her presence - like, she was just there. And with my daughter, I didn't have to ask them to do anything for her. She was already taken care of. Even if they can see on my face, like, mommy needs some time, they take her to the park or take her shopping or take her out. Like, I just - I had that time in space when I needed them to be near and then when I needed them to be a little further from me.

GABRIELLE: I really love the range of what being present can look like. And it doesn't have to cost a lot of money, either. Asha also reminded us about all the administrative work that has to be done after a pregnancy loss occurs that, to be quite honest, I had never even thought about before this episode.

MARTINA She mentioned things like returning baby items to the store or planning a small memorial or even creating a death certificate, which might be too much for the surviving parents to bear. So when we say there's a range of what being present can look like, we really do mean it.

GABRIELLE: And, parents, don't feel like you always have to wait for a loved one to offer this support. If there is a certain type of way that you want your village to show up and be present for you, this is your time to be specific in your ask.

MARTINA For someone like my mom, knowing what resources were available would have made a world of difference. When we talked, she opened up about the kind of support she wished she had after losing my sister, things like...

MARILYN: Therapy, a community of support in terms of, you know, talk groups. Support groups would have been so helpful.

MARTINA Fortunately, there are resources out there for people to tap into. That's our fourth takeaway. Explore your care options, including therapy, support groups and doula services.

GABRIELLE: And we should say that these options are by no means a comprehensive list and are in addition to medical care. To help walk us through some of these options, let's bring in Erica McAfee. She's the founder of Sisters in Loss, a digital community and podcast for Black parents navigating life after pregnancy and infant loss and infertility.

ERICA MCAFEE: I experienced two losses, a loss at 39 weeks and a loss at 18 weeks, both consecutively. They happened right after each other. So I knew then I didn't want anyone to experience a stillbirth or a second trimester loss like I did.

MARTINA Erica wanted to create a space where she could have that community among Black women. So that's when Sisters in Loss was born. She's also a bereavement doula.

ERICA: I get a call every day. Every single day, there is a baby who dies in the hospital.

GABRIELLE: And can you just tell us a little bit about, like, what a bereavement doula is? 'Cause I have a feeling that some of our listeners may not actually know.

ERICA: Absolutely. Well, a doula in general is a nonclinically trained support person that supports clients, families before, during and after birth. But a bereavement doula steps in and supports clients in any trimester. So if they lost the baby in the first trimester, if they experienced an abortion or elective termination or if they actually have a stillbirth and they want to walk through and have someone to navigate through welcoming this baby into the world and then having to say goodbye and preparing for a funeral.

MARTINA Doulas like Erica can really transform a family's overall care experience regardless of a pregnancy's outcome. They can connect parents to online and local support groups, therapy and other services you might need during the bereavement period. And the good thing is families can choose to start working with a bereavement doula at any time, even if it's been months since your pregnancy loss.

GABRIELLE: And while awareness of and demand for their services are growing in the United States, there's still a huge exposure and coverage gap. And if you're like me and thinking about price tags right about now, know that there are options. Some dealers might offer sliding scales and payment plans or even barter services.

ERICA: A lot of the work for a lot of bereavement doulas is pro bono work. You know, we do this out of the kindness of our hearts because we know what it feels like to be in those situations where we don't know what options that we have.

GABRIELLE: If you think you were someone you know would benefit from working with the full spectrum of bereavement doula, there are a few places you can go to connect with one. Of course, good old Google is a great place to start.

MARTINA And there are several doula directories, including the National Black Doulas Association, sistersinloss.com. There, you can search for and join doula groups in your local area and ask for recommendations.

GABRIELLE: And I got to admit I actually completed doula training last year. So I know firsthand that Facebook is a great way for families to connect with droolers in their area. But, you know, Martina, all of this is reminding me of something we've talked about a lot on NATAL, and that's the fact that exploring these different care options varies greatly depending on who and where you are.

DR. PERRITT: The challenge, of course, is that when we're talking about a care model that is really occurring within a capitalistic system, coverage for these services can be challenging. So if we're talking about folks who are uninsured or underinsured, folks who are coming from communities that are historically marginalized and separated and have poor access to quality, community-centered culturally grounded health care more broadly, then thinking about what it means to access doula support services or mental health support services makes it even more challenging. Not impossible - right? - but challenging.

MARTINA These barriers to care are real for a lot of families and can make it that much harder for families dealing with a recent pregnancy loss to get the kind of support they need and deserve. So for all the clinical providers and birth workers out there, our final takeaway is for you. And that's to work collaboratively within and outside the hospital to connect families to holistic care options. Here's Erica again.

ERICA: I believe bereavement doulas need to be integrated into every hospital system, every OB-GYN practice, as well as every birth center.

GABRIELLE: For Dr. Perritt, working collaboratively with other birth workers and providers means that unions aren't the only ones making decisions about a patient's care.

DR. PERRITT: For me, integrated care means really putting the person with that experience, the person experiencing pregnancy loss at the center of the care model and building out from there. So it falls upon us as the health care providers to seek those services out in our communities because they exist.

MARTINA I know we're coming up at time, but we've really learned some valuable things today.

GABRIELLE: I agree. And I hope all of you listening feel the same because, really, what we've been talking about today boils down to different ways that you can advocate for yourself or for those you love or care for when a pregnancy loss does happen.

MARTINA And while it's in no way an easy thing to do, we want to remind you that it is possible, and you don't have to do it alone. So remember, start by acknowledging that loss and the weight of what that parent or family is feeling.

GABRIELLE: which is also a great reminder to give yourself the space and grace to grieve. And keep in mind that for many family and friends, they'll also be grieving, too, just in a different way. So be tender in your words and actions with one another.

MARTINA And if you are a loved one, find a way to be present, whether it's sitting by their side, assisting with paperwork or sending a card.

GABRIELLE: And remember, there's resources out there, too, like working with the bereavement doula or attending a virtual support group like Sisters in Loss.

MARTINA For the providers out there, think about ways that you can work more collaboratively with others in your field to connect grieving families to valuable resources.

Following their miscarriages and stillbirths, Yvonne, Erica and my mom each gave birth again to healthy babies. They're what's commonly known as rainbow babies.

GABRIELLE: But the babies they lost will always hold a special place in their hearts. So we leave you with their words. If you're a parent or family grieving, may they offer you some comfort in your journey ahead.

ERICA: It may be simple as a ritual, like lighting a candle on on the day or the date that the baby passed, releasing some balloons in a social-distanced-style style gathering.

MARILYN: Just by calling her her name, that's honoring her.

YVONNE: I would say to do something that honors your babies that you lost and then that honors yourself because the fact of the matter is whether you have a baby in your hand to rock or if your baby is not here, you're still a mom.

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MARTINA If you liked this episode and want to hear more stories from Black birthing parents, check out our podcast NATAL. It's available wherever you get your podcasts.

GABRIELLE: For more episodes of LIFE KIT, go to npr.org/lifekit. We have episodes in all sorts of topics, like how to find a therapist, how to advocate for yourself at the doctor or how to sleep better when you're coping with anxiety. And if you love LIFE KIT and want more, subscribe to our newsletter at npr.org/lifekitnewsletter.

MARTINA This episode was written by us, Martina Abrahams Ilunga and Gabrielle Horton. It was produced by Clare Lombardo, who is also our digital editor, along with Beck Harlan. Meghan Keane is the managing producer. Beth Donovan is our senior editor. And Clare Marie Schneider is our editorial assistant. I'm Martina Abrahams Ilunga.

GABRIELLE: And I'm Gabrielle Horton. Thanks for listening.

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