Grief like people can look differently. It can carry itself differently. Oftentimes, grief can show itself in ways that are surprising too. There are many varying factors to processing grief through perinatal loss; these include but are not limited to miscarriage, stillbirth, medical or elective termination, infertility related grief, and trauma.

The Kubler -Ross Stages of Grief identifies 5  stages of grief and mourning that are experienced universally. Stages are processed in varying orders, often complicated with guilt in the process. The distinguishing difference in perinatal loss is that the death is of someone who has not been born yet. Grief can be not only the physical loss of a pregnancy or baby, but an emotional loss of an envisioned life or future of change. So as a clinician you will be dealing with a physical loss of a pregnancy and baby, as well as the emotional grief of the expected life events (Weddings, college graduations, first steps, etc.).

Greif can show up in many ways, and some symptoms that are associated with perinatal loss can look like—

Isolation- Staying inside, not talking to friends that they once called on frequently, socially distancing themselves from gatherings, or family events.

Severe Depression- Excessive Sleeping, Lethargy, Decrease in motivation to do usual daily activities, change in hygiene, appetite changes.

Anxiety – Social anxiety and isolation. Fear of being in crowds, including stores, grocery shopping. Running thoughts about ‘what if’s’ or fixating on specific events/thoughts. Irritability with a partner or other children. 

Anger- Anger can show up in ways related to the loss or irritability with partners or other relationships. Lack of tolerance to things that may have been acceptable before. 

Fear- fear of subsequent pregnancies. Fear of becoming pregnant may impact relationships and intimacy with a partner or spouse. Fear also can be related to seeing babies in public spaces.

Grief related to Type of loss- Miscarriage ro Stillbirth can lead to guilt and grief regarding betrayal from their own body. Medical or elective termination may also be associated with grief and in cases where the termination was related to a health anomaly or  

Stoic affect. Not having any emotion. “I feel empty”, hopelessness about having or finding joy in anything again. 

Avoidance.Occasionally a client may present with minimal symptoms and may be relieved that they did not have to carry to full term. Often this may present as a protection from emotional reactions. With support a client may find validation or uncover underlying emotional reactions.

Remember, grief can be experienced differently and there is no right or wrong way to travel through the process. Remind yourself and your clients about this. There may be expectations to move on or be ‘ok’ by a certain time, but the fact is there are no roadmaps to grief, we have to forage on our own through the underbrush. We can get stuck in brambles and trip on roots, but as a partner in the journey, we are not there to be the waymaker, they have to find their own way through the stages. We are the hand that reaches out to help them up, or the lantern in the darkest parts of night or forest, reminding them that they are not alone, that someone cares and has been through this journey before with other travelers. The therapeutic relationship can be a valuable tool in supporting, guiding and processing the stages of grief. And it is an honor to be let in.

About Teresa M Eltrich-Auvil

Teresa M Eltrich-Auvil MS, NCC, LMHC Teresa is a perinatal mental health specialist, the WA state Climb Out of the Darkness Lead and has specialized training in infant mental health, infant loss, and equine assisted psychotherapy.

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