Grief After A Heartbreaking Choice

By Nancy W.

Common threads

I have read literally thousands of e-mails over the last two years and I see some common threads, common concerns and questions ... Am I crazy? Why does time move so slowly or stand still? How do I deal with depression? Why doesn't my spouse understand me? Does this grief get better? Or worse? When?

The classic grief process

I would like to talk about the grief process. Over twenty years ago Elisabeth Kubler-Ross wrote her first book, "On Death and Dying" She identified stages of grieving: shock and denial, sadness, anger, bargaining and acceptance. At first it was thought that people all went through them in some particular order ... time taught Elisabeth and many others that there is absolutely no order ... that a person can experience all of these things in the space of a few hours and over and over in different orders. No right or wrong way to experience grief, but some ways are healthier, and lead to more resolution. I have had the honor of knowing Elisabeth, and her work was instrumental to my healing after my first husband died.

What is known now, is it is very important to grieve, to do the grief work which has been put on your plate. What is grief work you say? Grief work is finding a way to put your loss into perspective and to weave your loss into the fabric of your life. It is allowing feelings, working through them, asking for and receiving comfort. It is remembering the good times and the bad and getting them in perspective. It is memorializing your lost loved one in your heart or in many other ways. It is honoring your lost loved one by going forward a better person for the gift of that person's life in your life, no matter how brief. Read on.

The loss of a dream

There are various kinds of losses. When an old person has lived a full life and they pass on, we are sad, we miss their presence in our lives, but their death is in the natural order of the universe, something which comes to us all someday, hopefully later than sooner. When a person dies before "their time" it is much harder to accept, for it is out of the natural order of things. It may seem much more tragic. But when a baby dies, before having the chance to live their life, it is completely out of order. The death of a baby is a death of a future, not the ending of a rich history. The loss is different, because it is the loss of a dream, of hundreds of dreams: First smiles, first words, first steps, first day in school, first tooth lost, the first report card, the first sports team, the first trick or treating, first religious holiday, school, sports, proms, boyfriends, girlfriends, college, jobs marriage, grandchildren, on and on. Every one of us has all these dreams and more for our children. The death of a dream.

Venus and Mars: Crucial differences in grieving

There are some crucial things to understand about the process you are embarking on.

First, no two persons ever grieve in the same way. This is because nearly every culture on earth ascribes different roles by sex and biology. Men protect, women nurture. Men are the breadwinners, while women bear the children. This is very important to grasp.

Consider this: Most men, especially in Western Culture, grow up believing it is their duty and role to be the breadwinner, the protector, the fixer. Men strive in usually very concrete ways to fix things when they are broken. They are action oriented. They have been taught to tough things out. They need to feel that things are under control, orderly and predictable. Very "yang."

Women are different. Brought up by culture to be nurturers and given the very biology to do that with caring hearts and unfailing stamina. Networkers who use often rather fuzzy logic and intuition to come at solutions to problems. Often willing to relinquish control for a greater good, willing to wait for solutions to reveal themselves. Softer, more emotional, less rational and more feeling. Very "yin."

When I used to teach Childbirth Education, way back when, I would have my husband come help me with the segment on Dads. Dads view pregnancy as a time for grasping the responsibility of fatherhood, and providing for a family, and for dreaming of the baby to come. Most Dads don't take any of this too lightly, so their mate's pregnancy can be a time of emotional upheaval, even if they don't share it with their mate. Afterall, they are supposed to be the protector and fixer. Nine months is a long time to get prepared.

But, for the mom, the entire experience is different. Beginning with the implantation of that tiny embryo in the wall of their uterus. From then on, nothing is ever the same.

Do you know that the placenta produces the equivalent of 100 birth control pills' worth of hormones, mainly estrogen, each day in order to sustain the pregnancy? Imagine popping over three months of medication every day! It would certainly alter how we feel. Did someone say emotional? There is no word to describe the crescendo of feelings which can overcome a pregnant woman. Pregnancy is absolutely intoxicating! And once the Mom feels the first quickening, there begins the symbiotic and loving dance, a yearning pas-de-deux which lasts a lifetime, in many ways.

But for us, when it was time for us to deliver our children, our deliveries were a time of travail, and for us, incredible, unspeakable loss. A loss of not only all the dreams, but the loss of the miracle of pregnancy itself. It is utterly devastating! And, no matter how wonderful a Dad is, he will never be able to completely comprehend the enormity of that loss, the totality of the devastation - physically as well as emotionally.

So, what now?

And so there you are. Bereft. Adrift in a dark sea of grief. Crazed. Unexpected. Alone. Scorned by society. Torn with emotions. Feeling, perhaps, unsupported by your mate who is also dealing with their grief. What now?

Back to where I started. First you must understand that no two persons grieve alike, or on the same schedule. This is very hard for most couples to fully grasp. Men may seem to be in denial. Afterall, society has put it on them to be "macho", strong, protective, but please understand that to be in denial is to be grieving, just the same! And remaining in denial takes enormous energy. It is exhausting! And how frustrated our partners must be when they cannot find an easy "fix" for our pain. Thus we may see and feel their anger. No wonder we don't often see tears! How sad, but how true for many partners, especially men!

Women, on the other hand are adrift in a sea of hormones, immediately post partum. Their bodies still feel pregnant, but in their minds they know the terrible truth. That there is no baby in their womb any more. Their milk comes in, but there is no baby to suckle. Their empty arms literally ache to hold the infant who is forever gone. No wonder we curl up in a fetal position and want to die! No wonder we wail and howl!

I would take my puppy, Rover, out in the middle of the night and I would cry so hard, rail at the stars, howl at the moon! Poor little Rover would gallantly lick my tearstained face. He loves me that way to this day. He grew up suckled on my tears, poor pup. I was simply inconsolable for weeks. My husband was at a loss to help me.

It will always be this way. Men and women will grieve differently. Even when we have had some two mommie couples here, each partner's experience with the grief process is different. And here is the most important aspect of losing a child: when one person in a couple loses, say a grandparent, or sibling, the other member can be strong and supportive. But when there is the loss of a baby or child, the loss is shared. Neither parent may have the energy to support the other. As a result, we must both attempt to understand when our partner can't be there for us.

It is this disparity which shakes the very foundations of a relationship following the death of a baby or child. Remember this, and try to cut each other some slack, for the sake of your relationship. Give yourselves time to heal, at least a year by most standards. Do your grief work. Each of you!

The grieving year

The second thing is to understand the timetable of grief after AHC, for we do see a pattern. Remember this is not set in cement, but most folks would concur that these are the landmarks:

  1. The immediate postpartum period - intense, overwhelming emotions, nearly continuous grieving, poor sleep, poor appetite, shock and disbelief, bargaining, constant second guessing of the decision, physical aching to hold the baby, mom's milk comes in, setting off grief anew, Mom may still feel the baby's "kicks," arms literally ache to hold the baby, she may "hear" the baby's cries. Can last up to a month or so. Also characterized by dads feeling very helpless and overwhelmed by the intensity of the mom's reaction. Much of the intensity of the emotions is governed by the still present hormones of pregnancy and post partum.
  2. At roughly 6 weeks to 3 months, once the pregnancy hormones are mostly gone and there is relative hormonal balance, grief, for the mom, may actually get worse. In this period the reality sets in. The body can no longer fool the mind. The pregnancy experience is not so close and the challenge of trying to conceive may be real for many women. Many moms on AHC have struggled through this period, surprised that anything could be worse than the initial period.

    By this time, everyone else, including partners are often losing patience, longing for equilibrium in the relationship. Coworkers who might have been supportive have long since moved on, some may be involved in their own pregnancies. Extended family may assume all is well, and demand normal behavior at family functions. This can be a period where anger finally surfaces for the Mom and can be reflected in her partner as they struggle with their relationship. Other children in the family may voice their need for some attention, well aware that their moms haven't been doing too well, but needing her comfort, just the same.
  3. The next big landmark is the due date. As this time approaches, the couple's dreams for this time resurface and are mourned again. If the due date coincides with a holiday, or a birthday, or other important date, it will be all the tougher. Many moms say that the period leading up to the date can be worse than the actual day. Many parents feel some relief when the day finally passes. Most of us have found it helpful to make plans for something special to mark this day or time. A get away, a memorial ceremony, something nurturing, a gift in honor of the baby to a favorite charity, endless possibilities. Anticipate and be proactive. It will help with getting closure.
  4. The next set of landmarks are holidays, birthdays and anniversaries. Each of these special times has unique meanings, and may be laden with grief over unrealized dreams. We imagined delivering twins at the birthing center less than a block from our home and walking them home to a home merry with the Christmas Season. Instead Christmas was so painful in our house, two blocks from the hospital where our AHC occurred, that I could almost not bear it. Again planning and proactively setting up something, perhaps different from the plans envisioned on some earlier day, which can honor your baby, yet provide comfort, or at least distraction, is in order.

Then there is the one year anniversary of your AHC. Again, plan and do something to mark this special time in a commemorative or nurturing way.

And beyond

The subsequent year, you will often remember everything from the previous year and review every little anniversary with added grief. This is normal after every loss. Remembering when you got pregnant, when you found out you were pregnant, and then all the difficult times you would rather not remember.

Usually, after a year, give or take, you will be able to put most of the events around your baby's life and death in perspective. We see a pattern here of parents coming initially and usually staying through the due date, or until they are actively trying to conceive, at which point parents may move to the subsequent pregnancy loop. Parents reappear on the list, if they have left, near the due date, holidays, and again at the anniversary of the AHC. Folks, like me, who don't find the list until long afterwards, usually stay long enough to be able to get out their whole story and all their feelings, basking in the love and confirmation which is everpresent here.

We all need to know we are not alone, not crazy. We all learn the hard lesson that you usually need to walk a mile in another's shoes before you can fully understand their pain. It felt great to me, and I shed my share of tears, to share Brewster and Cary and Katie with all of you. Writing about our beloved children, seeing their names in print, and having others speak of them, as moms might do over coffee together, or dads might do watching a game, is indeed a very healing thing.

Our babies were not figments of our imaginations! They were real, beloved members of our families and we were parents to them. We made perhaps the biggest and most generous decision any parent ever has to make for their child, that of sparing their child from pain and suffering. Many are the parents I saw in my daily work at the children's hospital who begged God to let them bear their children's suffering, only to know that they could not do it.

The big D, depression

Now to deal with the topic of depression. First of all, since you are reading this, you are online. Choose a search engine, like Google or Yahoo and search under depression and you can instantly find lots of information and resources about depression. But let me do a quick summary of some important distinctions.

Research is finding out more and more about the biochemistry of depression. We know that depression is linked to a faulty mechanism for regulating various neurochemicals in our brains, like Serotonin, which regulate our feelings of happiness or satisfaction. New "designer" drugs (SSRIs) such as Zoloft, Prozac, and others help to regulate these chemicals. Some other, older, antidepressants can be very helpful too. But, I am getting the cart in front of the horse here.

Depression has been found to run in families, and often a major depressive diagnosis can be made without a precipitating episode; some of us may have had this tendency long before our loss. Other people may become depressed after a major loss in their lives. This is thought of as a "situational" depression, and all of us certainly qualify for this one! Then there is the whole topic of post partum depression.

Let's digress and talk about PPD. Because of the tremendous hormonal shifts at the end of pregnancy, nearly all women encounter some degree of "baby blues." These are self limited, lasting two to four weeks, and usually consist of intense emotionality, even when the outcome of the pregnancy is normal and happy. Post partum moms cry more, and are more emotional for usually up to a month, or as long as it takes for their hormones to balance out. We all can relate here. This is a major contributor to our crazy feelings after we lose our babies.

Then there is post partum depression. This diagnosis is made when the feelings are generally more intense and longer lasting. The Mom may feel unable to get on with her life. Medication and counseling are usually in order here.

There is one further diagnosis which can be made, but it is very rare. That is of post partum psychosis. In this case, the Mom loses all touch with reality, and needs intensive psychiatric help.

All three are points on a continuum which is loosely called post partum depression. It is now recognized that the hormonal shifts after weaning may also trigger depression.

Okay. You have lost your precious baby. You are experiencing grief. You are postpartum. Your emotions overwhelm you. Your spouse may be struggling in his own way. Your relationship is stressed, and provides more of a challenge than a comfort some of the time. It is hard to get up in the morning. Hard to go to work. Hard to be there for your other children. Hard to be "up" for your extended family. Are you depressed? Probably. Do you need help? Maybe. Medication? A good question, but one I can't answer over the net.

There are more questions to ask, things which you should discuss with your doctor, or your counselor. Like: Are you sleeping? Are you sleep deprived? Are you eating too little? Are you eating too much? Are you able to control your emotions or are they controlling you? Are you having trouble functioning in your daily routine? Is your work suffering? Are you able to leave the house? Are you suffering additional problems like anxiety or panic attacks? Are you feeling irritable? Are you able to experience pleasure in the things you used to? Are you feeling overwhelmed by guilt? Are you having trouble concentrating? How is your memory? Are you having trouble making decisions? Are you feeling restless, or are you much less active than you usually are? Do you feel hopeless? And finally are you having thoughts of suicide or death? All of these are important things for a professional to understand.

The way that I respond to the questions people on this listserv ask about whether their depression is "normal" or not and whether to go for help is this: Can you function? In other words, are you able to do the things you need to do in your daily life? Are you seeing any pattern to your feelings? Are you getting gradually better? Or are you spiraling down? Or are you absolutely stuck? If you answered yes to either of the last two questions, I would say that it would be good to talk to a licensed counselor, or a mental health professional like a psychologist or psychiatrist. Please know that there is no shame in needing help!

If you are put on medication, try and avoid addictive medications like barbiturates or tranquilizers which may actually compound your depression. Antidepressants are not addictive, however you must take them for a period of time for the blood level of the medication to reach a therapeutic level. They are definitely not a quick fix, usually taking from one to three weeks before any effect is felt and up to 6-8 weeks, or more, to reach a truly therapeutic level.

It is not wise to cold turkey antidepressants, as that can precipitate a sudden onset of significant depression. It is really important to dialogue with the prescribing physician, about your response to the medication, or if you have any side effects. Not every drug is right for every person, and it is not unusual to have to try another type of antidepressant before the right one is found.

An AHCer recently told me that she was so relieved to be on the medication, saying it allowed her to function for the first time in months. Antidepressants don't make you high. They just bring you up from the basement to the ground floor, so you can get on with the business of your life.

Another AHCer recently wondered if antidepressants would get in the way of trying to cconceive, or harm the baby. This is a question for your doctor to answer. But the way I look at it is this: if you can't even function, how are you planning to get pregnant? I have known of women who had severe problems with postpartum depression who were able to work out a plan for management with their docs. So, if you need them, talk with your doctor and then use them and heal from your loss enough that you can be fully prepared to undertake the process of trying to have another baby again, or just simply healing your grief.

Dads, listen up here, you too can be depressed

Dads, while we are talking about depression, some of you would probably benefit from help too. Please get it! You do not have to live your life in pain, suffering silently, while trying to be strong for your wife and family.

Substance abuse

One more little "momily" while I am on this subject. Bereavement is not the time to take up drinking or substance abuse. Avoiding your grief through "self-medication" can be very self-destructive.

Suicidal thoughts

On the subject of suicidal thoughts. Is it normal to have them after an AHC? Maybe. Many of us have said the classic statement to ourselves, "I just wish I could die!" But, as a mental health clinician myself, I want to be straight with you: If you entertain serious thoughts about suicide, AHC is not the forum for that discussion. You need professional help immediately. Please share with your spouse, or someone else responsible, your thoughts and let them know if you are serious in your intent. Ask for help. And to you spouses who suspect or hear such ideas, take it seriously and get help for your mate, please! Call a mental health center, a mental health professional, call your doctor, go to the emergency room, or even call 911.

The loss we have suffered is devastating to be sure. Some of us are dealing with multiple losses in a short period of time. These losses do not help us to be rational about what matters in our lives. Please get help! Please keep the lines of communication open!


I have tried to deal with some of the big issues in the grief process after AHC. I absolutely understand your feelings, the crazy ones, the guilty ones, the ones where you hate your body for betraying you, the frustration with family and coworkers and their callous remarks and attitudes, your fear and ambivalence about trying to conceive again, not to mention your cravings to be with child again, your ambivalence about what comes next, your grief with subsequent fertility problems. Oh boy, what a predicament!

Many people voice the thought, "I will never be the same person again" as if that is so terrible. Let me offer a reframe for that comment. No, you will never be the same again. All of you babyless mommies and daddies are, nonetheless, parents to a child who did live, and whose short life has had a profound impact on your lives. You must believe that there is now a greater purpose in your life, like one dad speaking of his son "being with him" while surfing on the Outer Banks, your babies' spirits are with you always!

Honor that spirit by living well. Seek to grow in compassion and understanding for others. Renew your faith in your Creator. Reach out and give back! The love you felt for your baby will always be with you, and you can turn that love around and with it, be there for others in this sometimes heartless world. Find the message. I guarantee it is there waiting for you!

I came to AHC several years ago to give back what Katie has brought into my life: love, understanding, compassion. My life is fuller, richer because she lived! I shall love her to eternity. Nothing can shake us apart! And I thank God for her presence in my life! Yes, nothing has been the same in my life since I experienced the deaths of my first husband, and my babies, Brewster, Cary and Katie . . . but how rich is the tapestry of my life!

Have faith. Do the work you need to do to grieve your losses. Believe that you will find joy in your life again ... speak it into reality with all of us right here. I am here to tell you to keep moving from the darkness to the light - for there is light, glorious light out there for each one of you as you complete your healing journey.


Books on Loss and Grief

Our Heartbreaking Choices: Forty-Six Women Share Their Stories of Interrupting a Much-Wanted Pregnancy

The Dive :: A Memoir

A Time to Decide a Time to Heal: For Parents Making Difficult Decisions About Babies They Love

Precious Lives Painful Choices: A Prenatal Decision-Making Guide

Sunshine After the Storm: A Survival Guide for the Grieving Mother

Empty Cradle, Broken Heart, Revised Edition: Surviving the Death of Your Baby

Empty Arms: Coping With Miscarriage, Stillbirth and Infant Death

A Silent Sorrow: Pregnancy Loss

Unspeakable Losses: Healing From Miscarriage, Abortion, And Other Pregnancy Loss

Surviving Pregnancy Loss: A Complete Sourcebook for Women and Their Families

Difficult Decisions: For Families Whose Unborn Baby Has a Serious Problem

Books for Fathers, Family, Children and Friends

Couple Communication After a Baby Dies: Differing Perspectives

For Better or Worse: For Couples Whose Child Has Died

How to Say it When You Don't Know What to Say: The Right Words For Difficult Times

A Guide For Fathers: When A Baby Dies

When Your Friend's Child Dies: A Guide to Being a Thoughtful and Caring Friend

When Pregnancy Fails: Families Coping with Miscarriage, Stillbirth, and Infant Death

What You Can Say When You Don't Know What to Say: Reaching Out to Those Who Hurt

Books about Trying Again and Pregnancy after Loss

Journeys: Stories of Pregnancy After Loss

Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss

Pregnancy After a Loss: A Guide to Pregnancy After a Miscarriage, Stillbirth, or Infant Death