Step 17a: Grieving and Healing

Grieving and Healing

Grieving is a key ingredient to positive birthing, yet it remains one of the least talked about subjects. Charlie Brown says grief is good in his expression, “Good Grief!” Yes, grief is good. In the words of Elisabeth Kubler-Ross, grief is a gift (Kubler-Ross. 1978-84). It washes through us in a cleansing and clearing way and needs to be viewed as a healthy process. The purpose of this step is to help you have a better understanding of birth related losses and provide ways in which to help men and women heal from them during the postpartum period and on into life.

Everyone experiences loss during their lifetimes. In birth, losses include death of a child or new baby, miscarriage, abortions, cesareans, the loss of a perfect birth, a less than perfect baby, a handicapped child, a premature or ill infant, or a traumatic delivery. There may also be loss of a dreamed experience, and separation of the mother and baby after birth. In fact, at the moment of birth, there is a powerful and instinctive need for the mother and baby to be together. The mother feels a need to protect her baby and the baby needs her mother for survival. When there is separation, grief goes to the core of the woman’s body and this is compounded if there is a complication in the baby.

It is essential that postpartum doulas view grieving as a healthy process. The more a woman is able to express her feelings, the sooner she can heal.

Recommendations for parents who have lost a baby

• See or hold their baby.
• Name the baby.
• Be alone for a time with the baby’s body.
• Follow religious beliefs and have the baby blessed or baptized.
• Save a lock of the baby’s hair and take footprints and handprints.
• Collect mementos, such as photos, ID bracelets, blankets, hats or other garments the baby has worn.
• Dress the baby in its own clothing.
• Plan a funeral service.
• Create a living memorial by planting a tree or garden.
• Write a special letter to their child.

Some women grieve the loss of fertility. PCBs in the environment are known to lower sperm counts. Twenty percent of the adult population is involuntarily childless. The loss of lifelong dreams and intense anticipation of birth and parenthood become a reality. Life is changed and the future must be reshaped. Suddenly, in the presence of loss of not being able to carry a child, there is vulnerability. Many such parents decide to adopt a child, a form of resolution in and of itself.

After birth, there can be a loss perceived with no longer being pregnant. Some women love feeling the creative life force growing within them. It is a time of great joy, fulfillment and caring attention from those around them. During pregnancy, a woman usually finds herself the focus of much attention. Her husband/partner may be more attentive, perhaps bringing flowers, being more affectionate and listening to her in a more openhearted manner. Her parents may reclaim her as their daughter, forgetting conflicts from the past. The pregnant woman is literally showered with gifts at baby showers. The baby is a topic of conversation such as in, “When is the baby due?” “Where are you having your baby?” and “How do you feel?” People may ask to feel the baby moving. Children often want to put their heads against her belly to feel/hear the baby. The pregnant woman exudes beauty and glowing radiance. Strangers often show courtesies such as offering bus seats and holding open doors. There is a simultaneous air of wonder and affection. The pregnant woman represents motherhood, family, strength, vulnerability, and femininity. The world appears to celebrate and honor her, as she is about to bring a new child into the world.

After giving birth, much attention is showered on the baby. Some women may feel left out. Others may feel so proud. However, her husband may no longer be the doting partner he was during the pregnancy, especially if he is not getting enough attention himself. It is a time when parents and in-laws are full of advice about how to raise children. The baby receives gifts. Questions shift to, “How old is your baby now?” “Is your baby smiling yet?” and “Is he/she a good baby?” A new mother may not find people asking how she, herself, is feeling. She will be experiencing loss of sleep, loss of time for herself, and loss of her body figure. The new mother experiences fatigue as her sleep patterns change and as she adjusts to her new body and her new baby. This is especially pronounced in women having their second, third or fourth baby. The stress can result in emotional upheavals affecting the entire family and even postpartum depression.

In our culture, women are expected to get back into shape and into a routine soon after birth. Other cultures have a six-week to six-month accepted period of adjustment, which is seen as normal and healthy for a new mother. In our fast-paced society, women often feel societal and economic pressure to return to their jobs within two weeks to a month after birth. Take for example a school teacher who gave birth prematurely and was told that if she left her job to be with her baby, she would also lose her insurance. The NICU costs were $10,000 per day.

Grief is a whole body experience. It touches every aspect of who we are. For ultimate healing, it must be approached through integration of the mind, body, and spirit. Since many people are not aware of the stages of grieving, they may be unable to recognize the symptoms when they, themselves, encounter a loss and begin grieving. Grief is also a relentless emotion that will keep surfacing in one’s life until it is resolved. When an event carries emotional impact, it demands resolution. Our innate drive towards good health and well-being seems to lead us to experience loss again and again until we learn how to heal ourselves and reach a place of resolution, acceptance, and peace.

Cesarean mothers may experience postpartum separation from their babies, and post-surgical pain. Regardless of how common cesareans have become today, it remains major surgery with the associated risks of invasive surgery. The body always suffers a violation in surgery with tugging and pulling on body tissues, and the cutting of nerves and vessels. Women who believe that having a cesarean is easier than having a vaginal birth may be surprised at how painful it is to cough, laugh, and move around after a cesarean. Many women who have cesareans experience various degrees of grief especially if it was not a planned cesarean.

Post cesarean surgery symptoms vary.

• Some women describe an increased sensitivity to pain, i.e., a small cut will hurt more.
• Others report an opposite reaction of being tougher. They find it difficult to receive affection, perhaps guarding themselves against further violation.
• Still others feel grateful for the cesarean, believing it helped them to have a healthy baby.
• Some women have pain in the area of their back where the needle was inserted for epidural or spinal anesthesia.
• Some women are left wondering whether their cesarean was life saving or not. The nagging question persists, “Could I have done anything different to avoid this?” It is important for BirthWorks instructors to reassure women with such feelings, saying they did the best they could at that time and what more can they ask of themselves than that?

Physical Aspects of Grieving

The mind and body are so interconnected that thoughts (emotions) affect the body even before the physical body is aware of the thought. People who are grieving have a multitude of physical symptoms that express the pain of their grief. Such symptoms tend to be either “too much” or “too little” in nature.

• Disrupted sleep patterns, either sleeping too much or not enough. This can lead to a constant state of exhaustion, disinterest, and depression.
• Eating too much or too little food.
• Short and shallow breathing that may lead to hyperventilation and a tight feeling in the chest. The voice can be affected and rise in pitch.
• Aimlessness and lack of sense of purpose, initiative, and a shortened attention span. This is observed as confusion and the inability to focus on anything.
• Severe hostility or marked apathy.
• Tendency towards illness and depression.

The following are the stages of grieving most commonly described. A postpartum doula needs to be aware of these stages so she can recognize them in a woman in the postpartum period. A grieving person may be in more than one stage at a time and also not in any particular order. Still, there is always a general progression from shock and disbelief to acceptance and forgiveness.

Stages of Grief

First Stage: Disbelief
Typically, this stage of grieving is characterized by mental shock and numbness. A nurse might say in amazement, “She just lost her baby and is not even crying!” It is a dream-like state, as if in a trance from which the person feels he/she will wake up. This is a healthy reaction and serves as a form of protection. At this time, the grieving person may be “listening” but not “hearing” information. It is a time when genuine support, not advice, is needed. Second Stage: Anger
Anger can be directed towards their doctor, nurse, partner or themselves. When allowed to be expressed it can be short lived. In this stage it is good for the grieving person to do little things for him/herself, starting with small things such as buying a new outfit in the store. Third Stage: Guilt
We have a profound capacity for self-punishment. This is the “if only” stage. “If only I had a different doctor.” “If only my husband would have said ‘No’.” If only I had the baby at home.” If only my childbirth educator would have told me…” Since the mind has a tendency to think negative thoughts, it is crucial in this stage to receive as much accurate information as possible. It is a good time for contact with others. Stage Four: Emotional—Healthy Expression
There are various names for this stage. In BirthWorks we like to use the term “Healthy Expression.”

This is a stage when the person having experienced a loss may be ready to explore possible reasons of why it happened. She may also be ready to talk about the loss over and over again with her family and friends. Someone might say, “But we already told her that.” However remember in the stage of disbelief, the mind is numb and the information was unlikely to register. Being able to talk and ask questions is an important part of healing and should never be discouraged.

A distinction needs to be made between suffering and expression of feelings. Suffering is an experience accompanied by prolonged guilt, resentment, and self-pity. Expression of feelings is merely a general release of sorrow.

Fifth Stage: Forgiveness and Acceptance
Great spiritual upheaval often follows loss. At a time of loss, we sense our own mortality, immortality, and spirituality in a different way. A way to begin healing from loss is to feel all the emotions as fully as possible and seek the deeper meaning and learning that comes from it. It is also a time to forgive those who need to be forgiven. Time is the great healer and offers a perspective that can then allow healing to happen.

Acceptance is the final part of the grieving process. A woman who has lost her child can never say she was not a mother. A woman who has experienced a traumatic birth can never say it didn’t happen. This is a time to settle up a relationship with God or whatever spirit or force a person believes and honors. It is a time for birthing families to hold the experience in their hearts in a way that brings calm and strength, not suffering.

This is also a time of realignment, a new beginning. When we have suffered a loss, life may never feel the same again. It is important that this idea be accepted. This is a time to let go of the hurt and pain and forgive those who hurt us so we can get on with our lives. Forgiveness is the key to peace of mind. We must forgive or else our own health may be affected adversely. Keeping emotions inside has cumulative effects. In time, minor stress becomes major stress and illness often results. It is essential to help people in your classes understand the importance of total forgiveness in terms of their own health.

Application & Understanding. Enter your answers to these questions via the Submissions link below.

• The mother you are caring for has had a traumatic birth and now in the postpartum period finds herself crying frequently during the day. Describe your conversation with her to help her with her emotions.
• Name five physical symptoms of grieving.
• Name the five stages of grieving. Describe an experience you have had yourself where you experienced the grieving process.
• A woman has lost her baby as it was stillborn. She is grieving the loss. Describe three things you could do to help her heal.