Emotional Support
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
Most couples enter the path towards parenthood expecting that it will occur without too much problem. After all, they spend most of their lives trying not to get pregnant and assume that when they consciously start trying, pregnancy will soon be achieved. As the months or even years go by without a baby, and efforts to achieve pregnancy are increased—from intrusive testing to high technology treatments—the path turns into the emotional roller-coaster of infertility.
Infertility can be a real test of a couple’s relationship and shake the foundation of a marriage. It can make a solid relationship stronger and weaken the core of a troubled one. Because infertility is a crisis, it is out of the realm of experience of most couples and thus challenges them to develop new strategies and coping mechanisms to deal with this life crisis. The good news is research has shown that, for most infertile couples, the experience strengthens their marriage by teaching them life-long skills to deal with problems. Since infertility is one of many challenges couples may face in their life together, the skills learned can be adapted to use at other difficult times.
Relationships, like anything you want to grow and thrive, have to be tended to flourish. They are like a garden that must be carefully planted and then receive adequate amounts of nutrients such as sun, water, fertilizer, and cultivation to blossom. If the garden is neglected too long or receives too much of these nutrients, the plants will wither and die. Relationships are also like a bank account—you can’t continue to make withdrawals without depositing something back or you will end up overdrawn. Infertility can be like a “withdrawal,” draining intimacy from your marriage and depleting your emotional resources. It can cause you to neglect your relationship, focusing all energy on the baby quest. In effect, infertility can create a life of its own in a marriage, causing you to lose sight of what brought you together in the first place and what is necessary for a healthy family to grow in the future.
For a marriage to survive the crisis of infertility, couples have to learn to continue to make “deposits” and “tend the garden.” Understanding the ways in which the stress of infertility can strain a relationship, couples must make special efforts to put positive energy into a marriage during this time. If you are an infertile couple, there are steps you can take to enhance your relationship so that it grows and thrives. The following are some suggestions to help you along the way:
Work as a team. No matter who is identified as “the patient,” infertility is a couple problem. Always approach the issues as a team, working together and finding ways to share responsibility regarding treatment. Avoid finger-pointing as nobody ever wins the blame game.
Plan playtime. Since dealing with infertility can feel like a full-time job, it is important to “take time off” by consciously make time for each other. Have regular dates where you can have fun and take a break from infertility. Vacations are also playtime, and having things to look forward that are under your control is positive. Look for ways to put nurturing energies in the relationship, making your partner a priority.
Separate baby-making from love-making. Infertility often puts strain on a couple’s sexual relationship and what was once fun has now become a tedious job. You may want to designate different rooms in your house for your intimate work versus play. Remember the ways you enjoyed sex early in your relationship and find ways to recreate it. Plan romantic encounters at non-fertile times, such as a bubble bath together or giving a massage. Understand that sexual intimacy does not have to mean intercourse and use your imagination to plan recreational sex.
Build a support system. Couples often have an unconscious expectation that their spouse will be able to take care of all their emotional needs. This is a daunting task during infertility and an impossibility for any relationship. Infertility can be an isolating experience and put undue pressure on a partner for providing all emotional support. Support from others can strengthen relationships, especially during times of stress. Encourage friendships for yourself, your spouse, and as a couple. Work towards balance in your support network by having friends both in and out of the infertility world.
Identify individual coping styles under stress. Know your own and your partner’s styles for dealing with stress. Learning how to accept differences in the way each of you handles and deals with your feelings can lessen conflicts. Like many things in life, men and women will feel and deal differently with infertility. However, different doesn’t mean better or worse; it only means not the same.
Allow breathing room in your relationship. Realize that marriages are fluid and in a constant state of change due to the many external and internal factors in your life, including infertility. During times of stress, try to give each other some space and distance to allow for transition. Understand that couples are seldom at the same place, at the same time, when at treatment crossroads.
Communicate the positives. Often we neglect to communicate our positive feelings to our partner, and all he or she may hear are negatives. Changes in behavior come more from positive reinforcement than from negative. Also, infertility may consume your life and engulf all your conversations. It may be necessary to put limits on the time you talk about infertility to designated periods, such as 20 minutes in the evening, so that it does not overtake all your communication.
Keep a sense of humor. No matter how tough things get, being able to find something humorous about the situation helps to relieve the tension. Laughing together is good for the health of your relationship.
Seek help before problems get too big. Infertility can put terrible strains on relationships and couples need to consider counseling as a resource of support and information to deal with problems. If you find that you are at an impasse or your usual coping strategies aren’t working in the relationship, counseling may help. Don’t wait until things get critical. Ask your doctor or visit the American Society of Reproductive Medicine website for a listing of mental health professionals specializing in infertility.
Contributed by:
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services
Written by: Patricia Sachs, LCSW-C
They’re at the mall. They’re in your neighborhood. They are your friends and your family. They’re everywhere! When you have been struggling with infertility, it suddenly seems like everyone around you is getting pregnant. Everywhere you go you see pregnant women and big bellies. You can be out enjoying yourself and then you are unexpectedly confronted by this traumatic event. You feel as if you want to “flee” the situation. Especially if you are at an age when your friends and relatives are also getting pregnant and starting their families, it may seem as if everyone else is getting pregnant quickly and easily, and can’t understand why you have not.
The reality is that it is extremely painful to be faced with the visible success of others when you want this so much for yourself and feel so vulnerable and helpless. Seeing or even hearing about pregnancies can be a stimulus that triggers feelings of anger, sadness, and jealousy. You may be left feeling out of control and overwhelmed.
Strategies to Help Cope Around Others Who are Getting Pregnant
There are some strategies you can do to help with coping with other people who are getting pregnant or who are already pregnant that allow you to regain control of the situation and your emotions. Here are some questions to ponder and some possible solutions:
- Have you told any of your close friends or family members about what you are going through, even if not in a lot of detail? Letting a few close allies in on your situation can sensitize them to how difficult seeing/hearing about pregnancies can be for you. Think about what you may want from them. Do you want them to tell you about pregnancies right away, or to wait, or have someone else be a “reporter?” Would you prefer NOT to receive baby shower and birth announcements? Chances are if you can speak privately with a friend/relative about these issues they will understand and there will be fewer hurt feelings. If you simply cannot go to a baby shower, tell your friend that it is just too difficult for you to be in that kind of group setting. Maybe there will be another way to have some special time with your friend in the future. It may seem as if these relationships will be strained, but once your situation changes (and it WILL, one way or another) they can be repaired. You are not a bad person because you can’t “be there” for your friend’s pregnancy and most likely, if you express these feelings, she will understand.
- Take notice of when mothers and young children are most likely to be at the mall, for example (mornings, daytime, not at night!) and don’t go then. This will cut down on unexpected encounters with pregnancy.
- Recognize that jealousy is a normal feeling associated with infertility. Chances are you are not typically a jealous person, but this situation is bringing out these uncommon emotions in you. It is normal to feel frustrated when faced with infertility, especially as getting pregnant seems to come so effortlessly to others. These feelings of jealousy towards your friends and family members will ease in the future when your own situation has been resolved.
- If you are going to a party or family gathering where you know there will be a pregnant person, enlist the help of a partner, spouse, or friend. Agree on a signal or cue you can give if you are starting to feel uncomfortable and want to leave. There is no reason why you have to suffer through an experience that will set you back emotionally and leave you feeling depressed and defeated.
- It may seem like your newsfeed on social media is full of pregnancy announcements. We recommend joining Shady Grove Fertility’s community of hope of over 28,000 SGF Sisters. SGF’s Facebook community offers women and men facing infertility a space to share their struggles and successes. Receive support, resources, and reassurance.
- Last but not least, consider joining a support group of others experiencing infertility. You will find that many people face similar emotions and concerns as you and that your feelings are completely normal. Having a safe place to share and strategize about coping with infertility will help you to feel empowered to deal with the “outside world.” You may even make some new friends, which can help you feel less lonely and isolated, knowing that you are not alone in this struggle.
About Patricia Sachs, LCSW-C: Ms. Sachs has been on the psychological support team at Shady Grove Fertility for 25 years. She does infertility counseling with individuals and couples, and has led support groups and workshops for patients on many infertility-related issues including IVF treatment, secondary infertility, adoption, and families formed through gamete donation.
To learn more about Shady Grove Fertility’s support groups for individuals or couples experiencing infertility, or to schedule an appointment with a physician, please call and speak with one of our New Patient Liaisons at 877-971-7755.
Editor’s Note: This post was originally published in March 2016, but was updated in May 2019.
Seeking and accepting support is like weaving a safety net for yourself—the more connections or stands of support you have the stronger your net becomes. A strong support network lifts us up when we get low and can provide the strength we need to keep moving forward in the direction of our dreams.
Shady Grove Fertility offers a range of complimentary fertility support groups throughout Washington, D.C. and Baltimore, MD Metropolitan regions, designed to guide and help patients cope with any challenges they may face along the way.
Unsure about what to expect from a support group? Hear from our patients. Thousands who have attended once or attend regularly have found an invaluable community of love, hope, and healing.
“I am someone who handles stressful situations by talking them out with other people in the same situation. Being able to attend the support group at Shady Grove Fertility and talk through issues with people in similar circumstances was an invaluable outlet for me. It was the additional services that SGF offered that I think was the “selling point” of moving to a larger clinic that can sometimes feel like a factory of baby making. Services like this group make the experience much more personal and allowed me to be more comfortable that I had made a good decision coming to SGF.”
“My husband and I cannot say enough about how much this group has meant to us. The ability to share with people who not only sympathize, but who have been there, has been invaluable. We just don’t feel so alone anymore. So thankful Shady Grove Fertility puts value on not only their patients’ physical, but mental health as well. It is intrinsically part of this process, and all too often overlooked.”
“I attended the group counseling one time and found it very comforting in this extremely painful journey of infertility. To be able to sit in a room with people who can relate, understand, and help in giving insight is extremely beneficial to me emotionally.”
“The SGF support group has been a lifeline as we have pursued our goal of starting our family. Infertility and its resulting treatment has been an incredibly isolating journey, and has often left us feeling misunderstood and uncomfortable with our friends and family. The support group offers a safe place to process these interactions with a group of people who understand and empathize with that struggle. It is also offered at no cost, which has been invaluable throughout this expensive process. We feel fortunate that we live only an hour away from one, as there are so few resources that adequately address the emotional and psychological aspects of this life crisis.”
“Infertility support group has helped a great deal. I was reluctant to go to one, but once I did it, I never regretted it. The support group helped me to realize that I wasn’t alone in this journey, that there are many people like me out there and I am not the defected or unlucky person I thought I was. Infertility is just like any other disease and this group helped me to understand that I should not feel any shame because of my condition, it is just like having diabetes or cancer or any other disease. I think the most helpful part of this group is I can talk to others in the same language of infertility and they understand me and know what I am saying, unlike many of our friends or family members who have not gone through infertility or know about the topic, and that is huge! Imagine yourself expressing your feelings of sorrow and pain in English to somebody who does not speak English at all or only speaks a little? It would be frustrating, right? That is how I felt before I joined this group.”
“I am new to the infertility counseling group, but it has been a tremendous help to me and my husband already … just to have an outlet during this extremely difficult time in our lives. Group support and counseling sessions are amazing!!”
“These support groups played a big role in making me feel comfortable transitioning over from IUI to IVF. It is really helpful to hear other patients’ experiences, especially with the meds and injections. I actually just started my first day of stims last night. It’s also nice to have a place to go where you can relate to and talk to others going through similar experiences.”
“My husband and I absolutely love attending the support group. I wish they were more frequent. I can’t say enough positive things about the group. It helps us tremendously cope with our infertility struggle, it gives us hope and encouragement.”
“My husband and I didn’t think we had any insurance options to pursue IVF. One of the support group members had similar issues through her employer and offered guidance on other pathways to explore. We were able to undergo IVF treatment at SGF as a direct result of her recommendations.”
“The support group facilitated by social workers at SGF has been very helpful. The group helps us not feel so alone. It is very helpful to meet with the group in person. In the waiting room and appointments, things are so lonely despite being surrounded by other couples who are going through something similar. The group has changed that for us. We now don’t feel so alone. “
“The SGF infertility support group has been helpful to me during this process to sit with other men and women who are navigating the same path, even though we are at different stages or our roads may vary. There are rarely safe spaces out in my own community to talk about the fears, doubts, frustrations, challenges, and sadness of infertility and the invasive, expensive, low-yielding treatment process. And even less opportunities to talk judgement or ‘helpful comment’ free. ‘Just relax, it’ll happen’ or ‘maybe you two just aren’t supposed to have kids’ are two phrases I’ve never heard at the support group or in any of the following exchanged emails between group members. The group doesn’t offer solutions to our infertility problems, but it offers a community where we can sit, cry, wail about how unfair this is, and leave the group a bit lighter.”
“I want my husband to know he is not the only one using donor sperm.”
“I was pretty upset about having to use donor egg when I came to my first group last year, but here I am 22 weeks pregnant because the group helped me through the grief and decision making. Now I can offer my experience to others to help them get here too.”
“You feel so alone in this that it is amazing to have a safe place to share ALL my feelings and fears, since I have to put on a happy face to others who either don’t know, maybe disapprove, or tell me to be grateful for this option. I feel that I CAN do it when I leave.”
“We just wouldn’t have had the strength to continue without the support of the group.”
“I have learned tips about such things as using needles, insurance/grant resources, and all kinds of things from those who have done treatment before. I also learned new treatment information that I can ask my doctor about to see if it might help me.”
Not in the area or can’t make the support groups? Check out our Facebook page to connect with over 27k Shady Grove Fertility current, past, and potential patients. Join us today!
Read: 25 Patient Stories of Triumph E-Book
To learn more about SGF’s support resources or to schedule an appointment with a physician, please contact the New Patient Center at 1-877-971-7755 or complete this brief online form.
By Carol Toll, LCSW-C
Infertility is a life event that creates high levels of stress that may impact important areas of your life. Feelings about self, intimate relationships, friends, family, work, and financial decisions may be affected by infertility. Before you know it, fertility issues have become your world, taxing your emotional and material resources while evading your control.
What to do? Develop a support plan. A support plan is a personal game plan or “roadmap” that you create to help move from feeling powerless and isolated to in charge and connected. Changing how you perceive yourself and your situation paired with experiencing the understanding of others can go a long way to easing the challenges of fertility treatment.
Set the Stage for Support
Work individually or with your partner and start a support plan by assessing your current situation. Set aside a quiet time to take stock of your current feelings, treatment plan, and expectations, including both emotional and practical considerations. Make a list of “Things I Wish I Could Change.”
Next, decide that you are in control. Feeling out of control is especially distressing in infertility, where a major life goal is at stake. Determining what you can still influence or act on may bring back a sense of power. While it is true that predicting the outcome of treatment is not possible, you can decide how to think about it and what you choose to do during a treatment cycle. Rewrite your “Things I Wish I Could Change” list using empowering language. Rename it “Things I Will Change.”
Put power into your vocabulary. Reframe your situation by starting to speak about decisions, choices, and opportunities. Become informed and participate, rather than helpless and powerless. Label actions and thoughts in more positive terms. Make plans to begin doing the items on your “Things I Will Change List.”
Create Your Support Plan
Find a Support Group
Energized by your newly empowered outlook, explore support opportunities and choose to become an active participant in a support group or activity. Knowing you are not alone and that others share your concerns is gratifying. Sharing treatment tips and coping ideas lead to feeling in control and a sense of belonging. Support groups also help patients persevere in treatment giving every opportunity to achieve a positive outcome.
- Shady Grove Fertility offers free monthly support groups on a variety of topics throughout the region. Check out upcoming support groups and other events.
- RESOLVE, the national infertility association, offers:
- Opportunities to participate in peer-led as well as professionally led support groups. Click here to see the RESOLVE support groups by state
- Online support communities
- Patient education about stress and infertility
Participate in a Support Activity
- Join Shady Grove Fertility Facebook Group of more than 18,000 followers and discover a new community of support.
- Investigate online support resources geared to your fertility interests.
- Find a cycle buddy to share your treatment experience with.
- Start or continue with appropriate exercise, yoga, acupuncture, or other pleasurable activities unrelated to fertility to feel better emotionally and physically during or between treatments. Learn more about these services offered at Pulling Down the Moon.
- Consult with a mental health professional with expertise in fertility issues if you need more individual/couple support.
Follow-up on Your Support Plan
Give yourself a pat on the back for taking initiative and becoming actively involved in developing a support plan that ultimately leads to creating a support network from which you can draw strength from. As your needs change, adapt your plan to current challenges. Keep your “Things I Will Change List” up to date. You may even find you have become a leader and an inspiration for others who are in need of support. After all, you are now in charge.
Carol Toll, LCSW-C, has over 20 years of experience working with individuals, couples, and groups with fertility issues. She is a licensed clinical social worker in Maryland and Virginia and sees patients in Shady Grove Fertility’s Rockville and Columbia offices.
Shady Grove Fertility’s team of dedicated New Patient Liaisons are available to answer your questions and schedule a consultation with a physician. Call 877-971-7755 or click to schedule an appointment.