A doula asked if there were any workshops on mourning for doulas. It seems there is something out there, but thought this would be a good opportunity to discuss how a doula (or midwife) might attend to a mom who has lost a baby (or had a cesarean or, or, or…).
It seems some doulas can go through a career without having a mom lose a baby… and others who have one tragedy after another. The truth is, one day you will have a client (or more) that needs you as they mourn.
Mourning is not just when a baby dies, but also when a woman has an unexpected cesarean, tears her vagina, has an apathetic husband, etc. Many doulas have already helped women through those situations, so have a head-start on knowing how to support women through pain. Mourning the loss of a baby is on the grieving side of the spectrum, but much, much deeper.
Practical aspects must be addressed. She may need help drying up her milk supply. Be aware that not every mom wants to do that... some want to let the milk diminish naturally, so asking her preference is important. Let her know you can help whatever her choice.
If she chooses to dry her milk supply quickly, you will do the opposite of what you do to bring it in: Have her eat sage; use only ice packs and cabbage on the breasts, twenty minutes out of every hour; keep a tight bra or binding on at all times (except when the ice is on the breasts); NO PUMPING and as little stimulation as possible. She will still need to watch for mastitis though and if she begins to get an infection, don't hesitate to help her contact her OB for medication.
Letting mom know she is an “open vessel” as long as she is bleeding and her milk is flowing... to stick close to home and only surround herself with those that love her and have her best interests at heart. Going to the mall or even the grocery store can be too much of an emotional and spiritual toll on her; those activities will come back with time.
People tend to be very close to mom in the beginning, but as time passes, they get further and further away. Once everyone has stopped bringing her meals, once her bleeding has finished, it is then she will need your help as a doula.
If this is her first baby, letting her know the normal course of postpartum events can alleviate her surprise when they occur. On day three or four, the tears flow as the milk comes in (milk flows/tears flow) and even though she certainly has been crying, these days might seem especially devastating and to know that the despair will pass. Never tell her that time will lessen the pain or any of the other platitudes people say when they don’t know what to say. Time never lessens the pain; life just piles on top of it.
She is at greater risk for Postpartum Depression. Talking about it with mom and dad together is very important. Be blunt and clear that if she shows any signs of depression, one or the other MUST call. You are probably not a therapist, so do not attempt to do therapy with a mom, but you can be a loving ear and an attentive caregiver should she begin falling into the hole of PPD. Families can be immobilized by the sadness and depression, so it can be an enormous help if you are able to guide them towards qualified help should they need that. It's important for you not to diagnose the PPD, but allow a professional to do that for her.
I tell moms some of the major symptoms of PPD - the feeling of ants crawling on them, seeing things out the corner of their eyes or hearing whispers in their ears... the desire to sleep continuously or, conversely, an inability to sleep at all for several days at a time... if they feel jerks or "shocks" when there is a loud noise... if their mind cannot stop running, scenario after scenario... sometimes horrifyingly scary and graphic. These are signs she needs help immediately. Mourning is normal, but these symptoms are not.
Mainly, doulas can simply be there for the grieving client. Let her know there is no judgment regarding her thoughts and feelings. Remember, you are not a therapist, but you are a friend. She can say anything to you and you will hold her words close to your heart. She may need to tell the story over and over and over... and that is so helpful and loving to her lost child. Simply listen with an open heart, not trying to get her to forget or move on. She will thank you someday.
So, this is helping the mom care for herself. Now it is important for the doula to also do self-care. Do not cry on mom’s shoulders; find someone else to express your own deep sadness or helplessness to. If you find her taking care of your feelings, "It's okay, Leslie... It’s going to be okay" while you cry, that is a huge red flag to get a grip on yourself and attend to her. You did not lose a child (this child) and must find your own support people.
If you do find your issues coming up, take note of them, but suppress them while you are physically with her. It's not uncommon for our own issues to bubble up as we move through our birthing life. It happens all the time. What we do, though, is acknowledge it and find what we need from it and then assimilate/set it aside/delete it from our minds.
If you need to, get a therapist to help you through your own grief. Feeling empathy for someone who lost a child is appropriate, but finding yourself depressed and always thinking about it isn't normal after the first couple/few days. Doulas need doulas, too.
If doulas are able to settle their energy as they do in birth, allow a woman to move through her mourning stages just as she rocks and moans in labor, and remain open to the constant shifts of emotion and (energy) movement, she is doing exactly what a mother needs her to do… attend to her in her labor and birth. Even when that labor and birth include the passing of a blessed child.