October 15 marks Pregnancy and Infant Loss Remembrance Day. For any bereaved mother dragged under by grief, the traumatic reminders of their longed-for child come thick and fast. From being served baby-related Facebook ads, to the pile of pregnancy books, prenatal supplements, organic skincare swaps, and health scans, everything serves to remind you of the life you almost had. In this dark place, even the act of escaping via social media becomes fraught. Nobody can brace you for the deluge of sonogram birth announcements on Instagram. Photos of baby showers and gender reveal parties become aftershocks that undermine the mental health of the most resilient of grieving parents.
“Pregnancy and infant loss is the loss of a child at any stage, from as early as five weeks into the pregnancy, to stillbirths and infant loss,” explains Shumin Lin, co-founder of Fertility Support SG. “Losing a child, one that you have hoped, dreamed and prayed for, is one of the most painful experiences in life. This pain can be worse when the child was conceived after years of waiting and fertility treatments.”
Fertility Support SG was founded in 2020 by a group of Singapore-based mothers whose experiences span the spectrum of infertility, IUI, IVF, PCOS, miscarriage and other family planning issues. In Singapore alone, a whopping 20 to 25 per cent of pregnancies end in miscarriage, usually up to 12 weeks gestation. Stillbirth is defined as the death of a baby before or during delivery, after 24 weeks of pregnancy.
For some, falling pregnant itself feels like an insurmountable hurdle: there’s anxiety brought on by medical tests, not to mention financial strain—all set against the backdrop of COVID-19. There’s also near-obsessive ovulation tracking and for some, the need to hack and overhaul one’s lifestyle, diet and psychological landscape in preparation for baby. And after hoping against hope, the overwhelming rip tides of grief felt with the loss of a pregnancy is often compounded by well-meaning yet harmful words by loved ones and friends.
“When you’re the person carrying the child, and you lose that child, it inevitably makes you feel like you have failed. Maybe you shouldn’t have gone for that walk. Or had that cup of coffee. Maybe you didn’t go to the right temple, or you didn’t say your prayers the right way.”
“Because we feel like we have failed, it is sometimes hard to be honest and open about our experiences. It’s hard also because we see other people giving birth with no issue, despite drinking a glass of wine daily! And sometimes, when we do open up to close friends and family, they do not know what to say. It’s not easy when it is such a delicate and sensitive topic,” says Lin. Here Vogue Singapore explores the best ways to support the grief and healing journey of parents of pregnancy and infant loss.
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The best ways to support someone who has experienced pregnancy or infant loss
When it comes to the sensitive topic of grief and helping your loved one process pain and loss of a baby, knowing what to say is as important as when and how to say it.
ACKNOWLEDGE THE LOSS, VALIDATE THE PAIN. “The best thing to do is to respect that the grief is valid, and that it will take time. Simple phrases like ‘I’m so sorry for your loss’, or ‘I’m here for you’ can be helpful,” says Lin. “Another important point is to follow up. It’s easy to forget the issue after a week, a month, or even a few months. But the pain lingers. Continuing to check in with a simple, ‘Hey, how are things?’ even after others have forgotten, can go a long way.”
Sueann Yao, 33, experienced pregnancy loss following her fourth IVF transfer, “after going through three retrievals and knowing that finally! A positive pregnancy test! However during the scan, the doctor saying that there was no heartbeat was the most devastating news after going through so many failures. We did a D&C and sent it for karyotyping. We found out it was a boy with chromosomal abnormalities. It gave us closure, as when an embryo is chromosomally abnormal, most of the time the body recognises and the pregnancy will not proceed leading to a miscarriage. But that’s head knowledge. Going through a loss was painful, I felt like I was a failure for not being able to sustain a pregnancy. Time heals all wounds, however the scar remains. I think grief is like a huge ball occupying a whole room, and over time the ball gets smaller. It’ll still be in the room, but in a corner, meaning the loss will still be a part of me.”
“‘I am here if you need someone to talk to, I might not understand but I will listen’ and ‘What can I do to make you feel better? Let me know if there’s anything I can help with’ are some words of comfort that Yao found most healing.
Potentially more hurtful than saying the ‘wrong’ thing would be to not acknowledge that any death occured. Bypassing loss by being indifferent, downplaying, or not recognising that it occured—ignoring the elephant in the room so to speak—can feel like a violation of another level.
Rohaida Rahmat, 33, experienced a natural miscarriage followed by two ectopic pregnancies at weeks eight to 10 before doing IVF and giving birth to two beautiful boys. She explains that constant questions made her isolate herself further. “Personally I’d rather they ask an honest question whether or not they mean it, than try to sweep it under the rug and made it seem like the loss never happened. There is no right way to handle this, both reactions can invoke sad responses to us nonetheless but at the very least, knowing that our loved ones know how we feel, even if they don’t know how to handle us, makes a difference. They probably are just as awkward and at loss to react to us too.”
RESPECT BOUNDARIES. Feelings of guilt and failure are common and acutely felt by grieving mothers. Avoid posing questions or ‘what if’ statements that directly or indirectly place blame on the bereaved. While it’s human nature to dissect the hows and whys of what ‘went wrong’ including asking questions relating to genetic abnormalities, how many weeks the mother was when it happened, or if they plan to try again, recognise that these questions may come across as interrogatory to vulnerable parents. Instead of adding pressure to an already tenuous situation, hold space for your grieving friend. Abandon the impulse to come up with ‘helpful’ solutions or fact finding. Your grieving loved one will voluntarily share information if and when they’re ready to process their feelings.
“People always ask ‘why did this happen to you again, did you eat or do something wrong?’,” shares Rahmat. “Hearing this from close people in my life got to the point where I stopped explaining what actually happened and stopped meeting anyone for a few months. I’m sorry for blocking out many people in my life at my point of grief but thank you for giving me time to come to terms with my loss and overcome my grief. Thank you for letting me take my time to recover emotionally and mentally.”
Bereaved mothers and partners may feel the need to put a moratorium on social events and be even more rigid with their ‘digital hygiene’, temporarily muting potentially triggering content on social media—which to you could be as benign as photos of your child’s first day of school or baby’s bento box. Respecting their grief means also respecting their digital boundaries.
PUT LOVE INTO ACTION. Aside from words of support and affirmation, sending care packages especially in this time of social distancing, is a gentle way to lend strength to parents of baby loss. “I think the best support I received was when friends didn’t compare my loss to someone else, instead they asked, ‘can I send you a box of cookies’ or ‘let’s go out for a meal’,” says Yao. For newly bereaved mothers whose hearts and bodies have been stretched to the brink, consider sending flowers, books, healing TCM, ayurvedic herbs or confinement food plans. At-home self-care and grooming services may be of help down the line. Small, heartfelt gestures of kindness goes a long way.
KEEP CHECKING IN. “My immediate family and loved ones, including working colleagues always checked in on me to see how I was coping emotionally and mentally,” Rahmat reflects. “They made sure I did not develop any self-blaming behaviour and sent me loads of care goodies to make me feel better.”
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The most invalidating responses to pregnancy loss, and why they hurt
“‘Everything happens for a reason'” makes us think, ‘well, I can’t think of any good reason why I’m suffering this pain’. Try ‘I’m sorry, but I know you are going to make it through this’ instead,” Lin recommends.
“‘At least you already have children doesn’t diminish our longing for another child. In fact, we may be more motivated to try for a sibling for our child. Try ‘I know it’s not easy, even though you already have a child. I really hope your dreams will come true’ instead,” says Lin.
“‘You were too stressed! Just relax next time!’ makes us feel like you’re blaming us for the loss. Try ‘I know you did everything you could, but sometimes some things are just out of our control’ instead,” says Lin.
Rahmat shares: “People need to stop saying ‘it’s okay. It happens.’ Because yes, it happens but for every individual who’s gone through each loss, they experience it differently. A loss is still a loss and no one should ever have to explain how empty they feel from that.”
Yao says, “The difference with someone else who conceived naturally and me who experienced loss after IVF and that I conceived by medical methods. So when people know that I miscarried, they say ‘because it isn’t natural’, ‘because you went against God’s will’.”
Yao also experienced friends offering glib statements such as, “‘Maybe God doesn’t want you to have children’, or ‘actually just adopt, it’s the same’. At the beginning of the year, I went through another miscarriage at eight weeks, and I received people saying, ‘at least you have one already!'”
Holding space when a bereaved parent is triggered and withdraws
“When a friend invites me for a full month/full moon or birthday party, I will reject the invitation giving a valid excuse and a red packet instead,” says Yao. “I struggled a lot after the loss; when personal friends who gave birth at the same estimated date of delivery as mine, should my pregnancy not fail. I do ask, ‘why am I not the one who is also giving birth?'”
Yao explains that in choosing to bow out of invitations to baby showers, birthday celebrations and opting to send her wishes in a traditional Chinese angpow instead, she’s ensuring to safeguard her mental health. “I don’t want to pretend that I am happy. Talk to friends who will understand or even counsellors on how you feel.”
“It is normal to feel happy for your loved ones and then sadness and disappointment for yourself,” empathises Rahmat. “I made sure I shared those feelings with my partner. He supported me to distract myself so I filled my time with part-time studies, work and travelling. Looking back, it was definitely a great coping mechanism that worked out for the best for me!”
Yao also cautions against telling your grieving friend about other loss mums who have since gone on to start a family. “You don’t need to tell your friend that so and so lost a pregnancy and subsequently got pregnant. It doesn’t help any way. Just be there for them, and don’t sweep it under the carpet afterwards. Do drop them messages after asking them how are they, even if they don’t respond.”
Healing tools that grieving parents use to cope with pregnancy and infant loss
“Sharing your pain with trusted friends can help, because you won’t be alone in shouldering this grief. It’s important to know that your grief is valid, and justified. Even if you’re still grieving after weeks and months: grief doesn’t have a deadline,” says Lin.
“On @fertilitysupport.sg, we have a #TTCSecrets section where we let people share their story anonymously. We wanted to create that safe space for people to share their struggles and pain. It’s also useful to mark the date on which your child should have been born, and the day on which you lost your child. I marked it by releasing a balloon in the night, and by praying that it would reach her in heaven,” Lin says.
“For me, I painted my embryo to remember the pregnancy. Other ways will be getting a necklace, engraving a pendant with the name or a word that signify that pregnancy and with the date the pregnancy ended,” Yao suggests. “There are support groups like Fertility Support SG, which I’m part of it, we do talk about pregnancy loss and also have talks on it.”
Support is closer than you think. “It’s important for you to seek help from a trusted, trained professional. Your struggles are real, and there is no shame at all in getting the help you need to cope with these problems. We’ve all been there before. You are not alone,” assures Lin.
You are not alone. If you think that you are experiencing poor mental health, contact NUH’s Women’s Emotional Health Service, which offers emotional assessment and support during and after pregnancy, fetal loss support, and individual and couple’s counselling. Support is also available at KK Women’s and Children’s Hospital or your doctor. Your GP can recommend you to a therapist or counsellor. For ongoing social support alongside parents who have been in your shoes, contact Fertility Support SG.