Baby Loss Awareness Week runs every October, and now is in its 22nd year of highlighting the often-silent journey of those who have experienced pregnancy and baby loss. 

1 in 8 known pregnancies end in miscarriage according to the NHS (this is a very conservative figure). Many more happen before people even know they are pregnant. These losses come with unique emotional and physiological challenges that require a nuanced understanding of grief, mental health, and the body's response, yet are not commonly spoken about in public. 

This Baby Loss Awareness Week, we’ve consulted a fertility therapist to dive deeper into the coping mechanisms, psychological impacts, and the role of biological stress responses during the healing process. Tracey Sainsbury is a specialist fertility and bereavement counsellor. Whether you decide therapy isn’t for you for whatever reason, or if you’re looking to speak to a therapist about loss, we hope these questions help provide support through a difficult time. 

Understanding Grief

Can you explain the unique nature of grief when it comes to pregnancy or baby loss? How does it differ from other types of grief?

There’s a uniqueness when it comes to the grief around pregnancy or baby loss; the physical and hormonal changes can intensify the feelings of sadness and despair for anyone later in the pregnancy. The body may continue to undergo postpartum changes, such as lactation, for some time, reinforcing the absence of a much-wanted child. 

I also acknowledge a disenfranchised grief; I call it FLO - Fantasy Loss Ownership, our hopes, dreams and fantasies about the life of a child, but also of the next stage in life you hope to embrace.   This doesn’t just apply to those without children; processing the loss for any child you have, for their sibling you hoped would be with them, promotes further enduring grief. 

Frustratingly, for some, there can be an invisible or silent grief; pregnancy and baby loss can feel less tangible to others. For the death of a friend or family member, there can be space to reflect, share memories and mourn together the helplessness of those close, not knowing what to say or how to be supportive, can promote a desire to ‘move on’ further intensifying a sense of lack of understanding, compassion and support and a sense of isolation. 

Both parents can process grief. Differently, partners can often put additional pressure on themselves to be supportive, and in being unable to reassure sufficiently, can feel more helpless; a mother's experience may be more visible, but if there is a lack of compassion for yourself as well as each other, there can be an increase in misunderstanding, increasing emotional distance. 

There are also often so many triggers and anniversaries, a recurrent grief cycle. I don’t believe we heal but rather learn to carry this better. If you go on to have another pregnancy, it doesn’t fix grief. Instead, an increase in fear and anxiety can be the norm. It’s so important to know there is support and people who understand - even when things are going well. 

Alongside pregnancy loss, life goes on, which can feel quite unbelievable in the early days, unimaginable that you will regain the strength to keep pace. Still, when you do, it can feel as if you’ve done something wrong, so we go around the grief cycle again, acknowledging life shouldn’t be this hard. 

Neurobiology of Grief

Research suggests that grief activates neurological pathways similar to physical pain. How do these brain responses manifest in individuals who experience pregnancy or baby loss, and what impact might this have on long-term emotional well-being?

Thankfully, the brain has remarkable plasticity, meaning it can adapt and heal over time; it’s important to remember this at the start as more research raises awareness of the neurobiological impact of trauma and grief. 

Emotional pain also activates the areas of the brain associated with physical pain, and the overlap explains why emotional pain from loss can feel all-consuming. Disenfranchised grief, where others don’t see the realities of loss, impacts on areas of the brain that intensify feelings of rejection and isolation. The sense of aloneness is sadly commonplace even when there is support.

The abrupt ending of the increased oxytocin produced during pregnancy and early motherhood to promote attachment and bonding can also intensify the emotional void. 

Chronic grief, Prolonged Grief Disorder, can cause lasting alterations in brain function, an inability to make decisions and lack of ability to concentrate and struggling to recall information from memory can all add to both physical and emotional exhaustion. 

There are many ways to engage the brain's plasticity towards recovery; self-compassion is often so important, little steps in claiming the reality of loss and finding the proper emotional support to promote emotional scaffolding as you regain strength to move forward. 

Coping Mechanisms

What are some practical ways individuals and couples can cope with the immediate aftermath of a pregnancy or baby loss?

Shock is often the first stage in a grief cycle. We often don’t recognise how impactful it is until we are out of it. For that reason, the greatest gift you can give yourself and each other is time. It can feel safer to get back to normality, to what is known too quickly, which can increase the potential to experience emotional overwhelm. 

Taking a break from responsibilities, accepting help and support from others with the practical tasks that need doing, having time and space for yourselves individually and as a couple if you are in a relationship. 

Communicating openly, without expectation, and being available for each other promotes time in, not time out. Routinely, people process grief differently; even in the closest relationships, one may need to talk more and one favours distraction. Being honest and open promotes you both being able to share your needs and understand each other's grieving style. 

Opening up to friends and family can help validate how you’re feeling. They may or may not be helpful with the support they can offer, but talking about the loss of your pregnancy or baby can help to alleviate feelings of isolation. Speaking more openly can help identify who you want to be closer to as you move forwards, finding your inner circle of support who don’t give unsolicited advice. 

Seeing a counsellor and/or joining a support group can provide a safe space to pause; sometimes, having someone or a group can help to navigate complex feelings, but it’s not a quick fix. 

Engaging in self-compassion means moving at a pace that works for you; it is so very easy to be self-critical, a back-to-basics approach of staying hydrated, eating balanced meals regularly, and resting and nourishing. Not rushing, but finding gentle movement and/or exercise that puts more energy in than it takes out, stimulating the release of the hormones that promote you feeling aware of the strength in your body and your capacity to be upright and keep going. 

Honour your feelings, especially when planning for significant dates, due dates, and anniversaries of your loss, can all re-traumatise strong emotions/plan how you want to acknowledge those days; there are no rights or wrongs, just what feels right for you. 

Your coping skills will be unique to you. Remember the adult outer you lived through at every age before, and each developmental stage will have had hopes, dreams, and fantasies about how life would be now. Nurture yourself at the age you are feeling. Your inner 4-year-old may need a hug, and your inner 8-year-old may seek reassurance that you did nothing wrong, though the desire to make sure you are working hard can drive you to seek answers. Your inner teenage self may be rageful; we can be so easily triggered as our senses are so hyper-vigilant after loss, we can flip that to find sensory ways to help self soothe too. 

Navigating Guilt and Blame

Feelings of guilt and shame are common post-loss. From a cognitive-behavioural standpoint, how can individuals challenge distorted thinking patterns that perpetuate these feelings, and how can you help someone healthily process these emotions?

Within my work supporting people after pregnancy and baby loss, I embrace the strategies shared in Acceptance and Commitment Therapy (ACT) and Dialectical Behavioural Therapy (DBT) 

After loss, there can often be distorted thinking, such as ‘I caused this’ or ‘I should have done something differently’. Rather than exerting energy and time challenging, instead of accepting these thoughts as truths or exerting energy challenging or distracting, we instead work towards accepting them as thoughts, background noise, and we work to lessen the impact of the thought.

Thoughts might be around emotional pain, having acceptance to sit with it. We don’t need to ‘feel better’. It's OK not to struggle with the feeling; instead, responding with compassion builds our strength to cope with all of our thoughts, including the negative ones, and those of hope for the future too. 

Professional Help

At what point should someone consider seeking professional help from a therapist, and what kind of support can therapy provide that differs from personal support networks?

After a pregnancy loss, seeking professional help from a therapist can be incredibly beneficial, especially if certain emotional or psychological signs arise. It's important to remember that grief from such a loss is deeply personal, and the intensity or duration of it varies for everyone. However, there are key moments when professional help might be particularly valuable:

If prolonged feelings of grief interfere with daily life for prolonged periods without improvement, therapy can provide a safe restorative space with a focus on grief, where you can express all of your feelings that may feel uncomfortable when sharing with others close to you

Physical symptoms of grief may be helped by a GP. Still, support around insomnia, loss of appetite, and fatigue can all be physical symptoms of grief and be alleviated by therapy; specific therapeutic approaches such as Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR), or mindfulness can help to build resilience as you move forwards.

As couples often process grief differently, therapy for couples can help to ease tension and emotional distance in their relationship; friends and family, though supportive, may offer advice based on their emotions or experiences. A therapist provides an objective perspective, free from personal biases, which can help you gain clarity and offer strategies to help individually and together.

Subsequent Pregnancies

How can parents manage anxiety and fear when trying to conceive again after a loss? What advice would you give those afraid to hope for a positive outcome?

Understanding that it’s normal to feel fear and anxiety when trying to conceive again and with the subsequent pregnancy is so important to promoting resilience; parents can often feel torn between the desire for a child and the fear of experiencing another loss. Managing this complex emotional landscape is essential to navigating the journey forward with hope.  Hope has to be there 51% of the time to feel ready to try again, but hope is often quiet. A negative bias is often noisy, so we hear the negatives more, but hope is strong and so when it feels right to try again, we head in that direction. 

Frustratingly, the more we try to hold emotions in the middle ground, the more exhausted we can feel; the emotional highs are so much higher when you have known the highs of a much-wanted pregnancy, and the lows so low when you have known loss. The reality is an emotional rollercoaster, an appropriate one. Instead of trying to battle it, I suggest embracing any thought or feeling as appropriate and responding with compassion and retaining energy rather than using it to battle negative thoughts.

Finding Closure and Moving Forward

Is finding closure possible after pregnancy or baby loss, and what does that process look like for most individuals?

I mentioned before that I don’t believe we heal, rather learn to carry loss in a more manageable way; however, the concept of kintsugi, the Japanese art of repairing broken pottery with gold, creating something beautiful from its imperfections, offers a profound metaphor for healing after a baby loss. In Kintsugi, rather than discarding a broken object, the cracks are carefully mended, highlighting the beauty of its history and increasing the value of the scars it bears. 

It’s okay to feel broken, and it’s okay for your healing to be visible. The cracks and scars from the loss, like the golden seams in kintsugi, become a testament to your strength and resilience. Grief doesn’t have to leave you permanently broken. You can rebuild and transform into a new version of yourself—different, but no less valuable, and more resilient and whole in many ways.

Message for Baby Loss Awareness Week

What would be your overriding message to those who are grieving during Baby Loss Awareness Week?

Acknowledge the importance of self-care, not just soon after loss, but as a lesson for life. You know you best; your emotional rollercoaster will be as high as your highest high and as low as your lowest low. Any situation in life can be re-traumatised by loss, and triggers can often be found years later, promoting loss from the past feeling very present, even when you’ve processed well and worked hard to be in a good place. 

Support around pregnancy loss can often be as helpful after many years down the line as it can be soon after; if things feel hard, don’t sit with it, promote self-care and seek support. 

Key Takeaways for Baby Loss

• Grief from pregnancy loss is unique and often invisible to others.
• Self-compassion and time are essential for coping.
• Professional support can provide valuable guidance.
• It’s normal to feel fear and anxiety when trying to conceive again.

For support, consider contacting organisations like SANDS, Tommy's, or The Miscarriage Association.