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Wednesday
May052010

Doulas and Mourning

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.

References (1)

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  • Response
    Response: www.awnet.com.au
    Hello everybody, This website is high-quality and so is how the issue was developped. I like some of the comments too even though I would rather we dont err from the main point in order add value to the message. It will be also encouraging to the one who penned it ...

Reader Comments (15)

Barb, I had to stop reading when you wrote, "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. Most doulas have already helped women through those situations; mourning the loss of a baby is similar, just deeper.".
Wow that shocked me. I think if you spoke with woman that have lost a child who also had had these other "losses" you will indeed find they are in fact, NOT the same. No way no how! Burying a child & planning a funeral is a much different grief than a birth process that did not go as planned. I need to head out to clinical, I will come & read the whole thing later, but knowing you & knowing me, I had to let you know how shocked I was when I read that. :(

May 5, 2010 | Unregistered CommenterCristina

There is a wonderful womyn from Israel named Miriam Maslin who travels the world teaching doulas, midwives, doctors and anyone else interested about perinatal loss. I have personally taken two classes with her and as a doula who has assisted clients with complicated births and the death of a baby, I have found them to be very informative, rewarding and special. They are also very healing. Her website is http://www.miriammaslin.com .

May 5, 2010 | Unregistered CommenterBeth

Cristina - in NO WAY was I minimizing the pain you know. I clarified what I meant... that a doula who has helped women with other painful losses in birth has a head-start in understanding how to support a woman through grief. If I still didn't clarify right, please let me know.

You *know* I would never minimize the pain of a woman losing her baby. I absolutely want to honor you through this piece.

May 5, 2010 | Registered CommenterNavelgazing Midwife

This is a subject I've been wanting to write about recently. Thanks for bringing it up.

May 6, 2010 | Unregistered CommenterSummer

Barbara,
I immediately thought of you when this crossed my in box!
;)
Ruth
NYC
~~~~~~~~~~~~~~~

SQUAT is a new anarchist birth journal and we are currently looking for
submissions for our first ever publication due to be released at the end ofMay. Our publication is aimed at providing a forum for midwives, doulas and friends of radical midwifery to share information, opinion and show support.

We will be accepting submissions until MAY 19th, 2010. Please send all
submissions to squattingbirth@gmail.com. We are looking for writing,
artwork and photography. Please give us the following information
along with your submission:

NAME - To be published with your submission, pseudonyms and anonymous submissions are A OK with us.

EMAIL - A way to contact you to let you know the status of your submission and to get further info so we can arrange to send you a copy.

BIO - A short description of who your are and what you do. Keep it down to a few sentences or less.

TITLE OF SUBMISSION - If you have a title for your writing or visual image make sure we know about it.

LOCATION (optional) - If you wish to identify yourself by city, state,
country or region here would be the place to do so. This information will be published with your name.

ARTWORK (optional) - If you have specific artwork that you would like to include with a specific piece of writing please submit both together and make sure to tell us that they go together.

Anything you submit will still belong to you and you may continue to use
your writing for whatever you'd like, but we may make small corrections to grammar and spelling before publishing. If you wish for your writing to NOT be copy edited or if you wish to have special misspellings or formatting please let us know with your submission.

PHOTOGRAPHS/ARTWORK: Please submit original photos and artwork. If you have ideas for art/photos that someone else created that you think we'd like then tell us about it and we will see if we can use it.

Thanks again for you interest! We look forward to reading your submission(s) and creating a bad-ass radical birth journal with your help.

Much obliged,
Your friends at SQUAT

May 7, 2010 | Unregistered Commenterdewi

Crista,
I do not know your situation, but I understood Barb's words in the role of the "Doula,” not that she was equating a clients unexpected cesarean, vaginal tears, or an apathetic husband, with the same gravity and tragedy when a clients baby dies.

As a Doula that has attended families postpartum when a child has died in birth, as well as a family where the women died during childbirth. I did not read what she wrote as if it was at all the same situation; without needing first hand experience everyone knows that it’s incomprehensible, and not on par with any other grieving or mourning the tragedy when a child dies.

However, Doulas commonly help women when they are experiencing something that the client perceives as “grieving” and it is real for her when she has the unexpected birth experience or outcome, for whatever reason that women is “grieving” doulas are by her side.

Not to be cynical but maybe if those women had experienced the death of her child during birth it would put it into a different perspective her mourning because she had a cesarean. People are funny that way; they cannot imagine a worse tragedy.

It is never the same type of grieving, but as a compassionate person the doula is in the business of being reassuring, and emotionally available to for all levels of grieving and mourning.

May 7, 2010 | Unregistered Commenterdewi

My son died shortly after his birth last August, at 21 weeks gestation following the perfect storm of issues (unidentified damage to the cervix at the internal os from a previous cervical ectopic pregnancy and probable membrane breaking, placenta previa and possible abruption following weeks of bleeds, an uncaring and unconcerned hospital staff who refused to treat pre-term labor while there might have been hope).

I was seeing a midwife and planning homebirth throughout the pregnancy, though when the bleeds continued, she sent me to her OB for review. Previa diagnosed, bleeding dismissed. I saw her the day I went into labor to check and see if my water had broken. The order to go the hospital was delayed for over 2 hours while she waited on the OB to return her call. We only spoke once afterwards and exchanged two emails.

I was frankly upset by her manner in talking to me following his birth and death. She said things that upset me, like thinking I was in early stages of labor when she sent me home to rest and saying she suspected my water had broken. After hearing about my hideously traumatic hospital experience, she said she should have just come out to my house so I could have delivered him here, as if that ever would have been an option for me when there may have been a chance to save him.

Abiding with someone is hard work, and it wasn't something she was good at in any way. It's important to stress how badly a woman who has been so shattered will need people just to sit with her and let her feel whatever she feels without judging or trying to guide.

And it's also worth noting that some women may feel anger directed at their birth attendants which may be misplaced (or not, as in my case), and likewise may not be able to handle being around reminders of that time and place. I would not go back to that midwife and birthing center if you paid me, regardless of the anger I feel towards the midwife.

Beyond that, it's good that you've noted that when she often needs someone the most is after the sympathy has ceased pouring in. I'm nearly 9 months out and this week has brought me to my knees, keening in grief once again, but it's been hard to deal with because many people I see expect me to be over it or think I am over it already.

May 9, 2010 | Unregistered Commentereliza

Eliza, I am so, so sorry for you loss. And you are right, it does come back in waves... sometime drowning you and sometimes with you sitting gently on the top of them; yet, they are always there. Whoever says, "It gets better," is lying. It gets different, but never better.

What a horrible birth you seemed to have had. I cannot fathom your grief, but know you do have at least some/most of the information/clues as to what happened. Have you gotten your chart to see what they said in it? Those of us who look at charts a lot know they can be grossly incorrect at times. I've seen at least 2 charts with the wrong gender of the baby. So, even if you have your chart, it doesn't necessarily mean it will validate your experience. But, it can be power-full to see what was said. When you are ready. When you aren't so raw, this might be a consideration.

As a provider, one of the hardest things to do is stay close to clients who had shitty births (in their eyes). They do often push us away, but I force myself to squish in the pain and uncomfortable-ness, to stay as close as she'll let me, answering questions, helping her process. If she refuses to see me, I send a short card that says I am there, waiting until she is ready. And when she calls (and she always does), I go to her right away, as if she's in labor (which she most certainly is).

The longest separated from a woman was 5 years before she was ready to talk. Another, it was a year.

I try to let other midwives, students and apprentices know that just because a woman pulls away does not mean she (the midwife) did something wrong (necessarily), but that she just needs to cocoon to process things. When she is ready, she will come back.

I pray your midwife will make herself available to you someday. It takes a great deal of humility to be able to sit in the anger someone else has for you, but it is the adult, mature and responsible thing to do.

I pray I am able to hold myself to this ideal when (not even "if") this happens again.

Please accept my apology, as a midwife, for your pain.

May 9, 2010 | Registered CommenterNavelgazing Midwife

Another option instead of "drying up quickly" or "letting the milk go away slowly" is the option of milk donation. I know that, were I to lose a baby, milk donation would be tremendously therapeutic for me. (Although I understand not for all women).

The chance to give the milk intended for a baby, to a baby, and to help babies be healthy and live.. Would likely be the life raft that I would cling to.

May 10, 2010 | Unregistered CommenterSara

Sara while I respect what you have said about donating milk when there was a baby lost... please know that as a woman who has lost two babies one at 23 weeks and one at 21 weeks 6 days... donation of milk was really for me the absolute LAST thing on my mind. My little girl lived for two days and I pumped like crazy for her, but once she passed over I wanted that milk gone DOUBLE time. I allowed it to naturally diminish with both of my babies but it was a reminder that I really didn't need while I was trying to figure out how the heck I was going to put my life back together.
This was a post that I really wish so many people in my life had read. Perhaps still could read to know how to be helpful and just let a mom mourn and grieve. My little girl would be 4 and my little boy would be 3 and I still am brought to my knees at times thinking about them. Even just a song that was on the radio a lot during that time can bring on a certain melancholy. There are so many people who just think it should be over after a certain point... but the first mother's day... the first birthday, the first christmas. So many firsts where you were planning to have a baby. And set aside the first, seconds and thirds can be hard too. A mommy whose arms are empty can face many things that set her off. There are so many times I wished that I had someone who would come to me at the drop of a hat. But the thing is that everyone else in the world goes on with their life and they kind of expect that you do too. So thank you for this post. I hope that more than doulas and midwives read it. Because every mommy who goes home with empty arms needs someone who understands this.

May 14, 2010 | Unregistered CommenterMelissa

I was going to say this too, I know that like you I would cling to the possibility of being able to help a baby, I would feel like it was the least I could do at a time when i felt useless, betrayed by my body, and like a total failure, at least i could succeed at donating my milk.

May 14, 2010 | Unregistered CommenterSara

I followed a link to the Ink Birth post and was totally blown away by the beauty of the images there. Then I started looking through your archives and found this post. As a mom battling PPD after the stillborn of my son just shy of 22 weeks gestation, reading this post spoke to me in ways that I will never forget.

Like Sara, I pumped and donated my milk after my son's death. I was able to meet a family who was fortunate enough to adopt a baby boy and directly contributed to their determination to have him breastfed for the first year of his life. Donating milk that was meant for my son was an extraordinarily difficult thing to do, but ultimately it was a significant part of my healing process that I am so grateful to have embraced. At the time, with this loss, it was the right decision for me and my family. Had circumstances been even a little bit different, it may not have been right, and that would have been okay too. We all have to navigate the awful path of perinatal loss in our own ways, and your clients are fortunate to have a committed advocate helping them start finding their own way.

Thank you for articulating so many things that I wish the people in my life understood. This passage especially should be a part of standard literature distributed whenever there is a loss of any loved one: "...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." I'd like to quote you in my own journal, linking back here, if that's okay. This is such a beautiful post and I really feel like it needs to be shared with some of the grieving families that I've encountered on my way through this ocean of grief.

Again, thank you,.

May 16, 2010 | Unregistered CommenterCeleste

Thank you for writing about this.
Any time somebody opens this door, and causes anybody to think about the unthinkable, I believe it will help a family down the road.
I had a postpartum doula who would come for 4 hour stretches following the death of my newborn daughter; she would sit and listen to me for the whole time. I loved speaking to her more than anyone, because she was uninvested in my sadness. My sadness could crush my mother, and it was ruining my sister. But I could sit with my doula and cry and cry, and while she empathized beautifully, I didn't worry about her. It was a true gift.
carol mcmurrich
www.happy-sadmama.blogspot.com

June 16, 2010 | Unregistered CommenterCarol McMurrich

Hey there. It took me a long time to decide to write a response to this post. I beg forgiveness, but I didn't read all of the responses up to mine.

My very first doula client was my best friend, who was expecting twins, and ended up experiencing fetal demise of one twin due to TTTS and birthing her babes at 23 weeks.

It was such an odd and beautifully horrible mix of emotions. Heart-hurt, hallowed and sacred silence, the wailing of mom over her first baby and then her fearful, yet powerfully brave stare when her second babe decided to be born immediately afterward.

I did cry, I cried with the family, I held her hand, whispered strength and honesty to her, and was honored when I was asked to step back from my role as birth-doula for the birth of their second babe and, instead, hold their babe that was born still.

Their preemie babe fought hard, but also left this earth only 9 days later... again, I was called to the hospital in the middle of the night, again to hold her hands, again to whisper strength and honesty, again to cry.

But I only allowed myself to hold her up in their presence... when I was away from them, I relied on the ability to talk openly and candidly with my pastor, husband, and fellow professionals in review. And I allowed myself to grieve.

Every anniversary of their birth, I find myself moody, distant... but I know why and simply send mama a card, or note, as I know she is reliving it herself, to let her know she is not alone and there is someone else who remembers.

That is what a doula is at a loss-birth: we are testaments, bearers of the short story of these dear little one's lives... that so very VERY few people ever come to know - we are torches, testimonies to their presence here on earth.

July 9, 2010 | Unregistered CommenterCole Deelah

There is a network to support families thru miscarriage: The Amethyst Network. They offer some kind of training and a network of women who are available, like doulas, to support loss. See their website for more info. BTW, loving your blog! Thank you for writing.

November 16, 2010 | Unregistered CommenterSiabird

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