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Navigating Pregnancy After Loss (PAL)

Another question I am very frequently asked is about how to manage pregnancy after loss, and in particular the emotional impact of what is an incredibly difficult, and often traumatic, process. There are no quick fix solutions, and what worked for me might not work for everyone, so I am hesitant to make specific recommendations. So again, I will share some more general thoughts and ideas I have had through my own experiences and from what I know about anxiety and trauma professionally:

Clarify your professional support network and have a plan

Knowing who will be looking after you and who to contact when was key for me. I was lucky that I had a Case Loading Midwife, which meant that I saw her for each and every appointment and I could call her as and when needed (ask if your local maternity service provides this). I also had a couple of appointments booked to see the Consultant for guidance and had a plan in place for additional scans as the pregnancy progressed. Because no cause of death was found for Orla, to a certain degree I had ‘treatment as usual’ that was midwifery led, but with much more emotional support and reassurance monitoring. However, I knew that my midwife was very involved in my care and the threshold for seeking any additional advice and guidance was low.

Although I couldn’t believe that we would even get to that point, I did find it helpful to have a provisional plan in place for birth. This gave me an aim and a ‘finish line’ so to speak and took away the additional anxiety of uncertainty.

Peer support

I would not have managed those nine months if it wasn’t for other women who were going through the same process. Having people to share your thoughts, your worries and your hopes with was priceless. I found my support through social media, but I know others have found theirs through support groups, online support forums or local groups within their hospitals.

It is like the NCT group you never knew existed until you needed it.

Try not to fight the anxiety

Despite knowing that this was never going to be possible, I had a fantasy that if I did certain things, I would alleviate myself of all anxiety in pregnancy after loss. Accepting that anxiety is a normal and expected aspect of pregnancy after loss helped me considerably, and undertaking regular mindfulness practice supported me with this. What it taught me was to become more aware of, and connected with, my anxiety; noticing when it increased and how I experienced that physically and mentally, noticing what helped and acknowledging when I was unable to manage it myself and needed extra support.

As a psychologist, we might term certain strategies ‘safety behaviours’ (i.e. things we do to alleviate anxiety in the short term, that actually perpetuate it in the long term). However, PAL is a very intense and finite period of time – and the fears that we have are very real, because the worst thing has happened to us already. Therefore, it is important to find strategies that work for you – however, you mustn’t feel like you need to do this alone and always use the support you have around you, both personally and professionally.

And always remember, if you notice your mood dipping or your anxiety becoming very hard to manage, speak to your midwife, GP or consultant about the possibility of additional support. For example, perinatal mental health teams (or specialists that work in other mental health teams) can work very well with women who are experiencing mental health difficulties in pregnancy – and this may include therapy of medication.

Find what works for you

PAL will throw up different challenges for everyone – don’t compare your journey to anyone else’s and find what works for you. And remember that what works at the start, may not be helpful later on. It is all trial and error.

Be aware of your own personal triggers

Weekends were hard for me because Orla died on a Sunday, and as pregnancy progressed I found that I couldn’t function on these days without some form of reassurance. Therefore, my midwife arranged for me to go to labour ward for monitoring every Sunday (as well as two other days in the week from 32 weeks until birth). The staff became familiar with me and my situation, and where this wasn’t the case, my midwife or her team would call the staff of shift to give them a handover before I arrived.

It is important that you become aware of what is difficult for you and that you share it with those caring for you. They may have suggestions that you wouldn’t have even considered.

Early intervention

And linked to the above is intervening early. It was better for me to seek advice and reassurance before my anxiety completely spun out of control. If I woke up already feeling wobbly, then commuting to work and continuing with a jam-packed day was only going to worsen it. So, I would do what I needed to in order to alleviate some of my anxiety before getting on with my day, such as calling my midwife, visiting the Maternity Assessment Unit or spending some time focussing on baby’s movements.

Have down time every day

I know that I survived pregnancy after loss in a flurry of distraction and relative busyness. However, I knew that I needed to schedule some time each and every day just to sit and connect with myself and my baby. This might have been 10 minutes here or there throughout the day and then a full evening at home, or maybe even a whole day that I kept my diary clear. Essentially, I needed time to focus on movements and my breathing.

Embrace what you can

And don’t beat yourself up for what you can’t. Pregnancy after loss is bittersweet and full of complex and conflicting emotions and it is about learning to live alongside them. I wanted to try and do all the things I regretted not doing in Orla’s pregnancy, like having a maternity photo shoot. However, I couldn’t embrace shopping for our baby. Accepting this and taking opportunities to do ‘normal’ things as and when I could was a helpful process.

Communication

With the shift between handwritten and electronic notes, I found that communicating my situation, needs and care plan wasn’t always easy. I had a Sands sticker on my notes, but people often didn’t see or read it, or even if they had, they may have needed to ask certain questions for their own clarification.

Being clear about what you feel and need in that moment may not always work miracles, but I found that when I did that from the outset of an appointment (rather than expecting the other person to assume or know), I often had a more positive experience.

Think holistically

Outside of the professional care I received, I also tried to look after my overall wellbeing by attending regular pregnancy yoga classes, acupuncture and practicing mindfulness. I treated myself to some nice new pyjamas, an amazing pregnancy pillow and tried to go to bed at a reasonable time and maintain a healthy diet.

I found going out very hard after Orla died, particular at night in London, so I did spend a lot of my pregnancy at home in the evenings. Reading good books, finding a decent boxset and generally nurturing myself was a really important aspect of PAL.

Where possible, think beyond these nine months

This was something I didn’t do, and maybe it is impossible when you’re immersed in PAL. However, the shock of bringing home a baby was just so overwhelming because I hadn’t really allowed myself to believe that it was going to happen.

I don’t think I could have faced another antenatal course so soon after the one we took with Orla, and I know that being in a room full of potentially naïve and excited first time parents would have been excruciating. However, the other loss mums I have met who manged this seem to have done so with some very positive outcomes, so don’t necessarily rule it out.

Take each day as it comes

Each day is a step closer to meeting your baby. You may have a countdown (or count up) checklist in your diary, or on an app that helps you to feel as though you are moving forwards – or this may seem like too much. But even if you feel as though each day is an uphill battle, it is one small step closer. And if today is extra hard, tomorrow may be easier.

Mantras

Some people find mantras helpful, such as ‘today I am pregnant’ or ‘I believe that my baby is safe’. Some days they may work, others they don’t – it’s about what fits for you. And if they are helpful, having them as a note or voice memo on your phone can be a discreet but helpful reminder.