HEALING THE GRIEVING HEART
Healing the Broken Bond: Mourning Pregnancy Loss
Host: Dr. Gloria Horsley
With guest: Irving G. Leon, Ph.D.
February 23, 2006

G: Hello. I?m Dr. Gloria Horsley. Welcome to Healing the Grieving Heart. There are no simple or quick solutions to dealing with loss. Each of us is unique and special as are our relationships and our responses to loss. This is especially true when we speak about perinatal loss or the loss of a child prior to birth or shortly after. Being sensitive to the grieving process of parents who have suffered a miscarriage is a fairly new concept in the medical community. Prior to 1980, there was according to our guest today, Dr. Irv Leon, a conspiracy of silence. Medical caregivers typically try to prevent parents from mourning a stillborn or neonatal death by prohibiting any contact with the dead child, disposing of the body unceremoniously and anonymously, prescribing tranquilizers for parents to dole any expression of grief, advising them to forget the experience and often suggesting another pregnancy soon. Fortunately, things have changed, and today we?ll discuss this most important issue of healing the broken bond. Please join us on our show today by calling our toll-free number 1-866-472-5792 with questions or comments regarding the losses in your life. And remember that just going about your day-to-day business is an accomplishment whether it?s working in the home or the office. You can also email me through my website, www.healingthegrievingheart.org, and remember that these shows are all archived on www.healingthegrievingheart.org as well as www.thecompassionatefriends.org website and www.health.voiceamerica.com. Again, today our topic is Healing the Broken Bond, Mourning Pregnancy Loss, and my guest is Dr. Irv Leon. Irv Leon is a clinical psychologist and adjunct faculty at the University of Michigan Medical School. He is the author of When a Child Dies, Psychotherapy for Pregnancy and Newborn Loss. He?s also written a chapter in a book of gynecology and obstetrics. It?s called ?Helping the Family Cope with Prenatal Loss.? He?s a bereaved sibling as well as a bereaved father in that his wife has had three ectopic pregnancies and has had unsuccessful attempts at in vitro fertilization. He has also had a very successful adoption. Welcome to the show, Irv. May I call you Irv?
I: You may call me Irv. It?s a pleasure to be here.
G: It?s so wonderful to have you on our show today. Before we get started, I wanted to read an email. My audience is so great to send me out some emails and if you want to email me, you can do it through www.healingthegrievingheart.org. I received an email from Howard from Tucson. Last week we did a show, The Bereaved Marriage, with Mel Erickson, and he said I really enjoyed your show called The Bereaved Marriage. I was glad you took on the difficult topic of sex and intimacy. With the loss of our daughter, it?s really been difficult. I?ve decided to pamper my wife in small ways such as checking to see if she?s comfortable, asking if she has enough light when she?s reading, and asking if she?d like something to eat or drink, and so on. This allows me to feel intimate with her. Each night, we give each other a kiss and say ?I love you? and that really means so much to both of us. Thanks again for devoting a show to the sensitive issue of intimacy and grief and for having the courage to talk about the subject with such frankness. I went to bed with a smile on my face. Well, Howard, I wanted to tell you, thanks for the email and certainly anytime that we can help a bereaved parent to go to bed with a smile on their face, we?re happy about that. Irv, again, welcome to the show, and it?s great to have you on. As I talked to you right before the show, I wanted to talk to people about what we?re going to talk about today because it?s such an interesting topic dealing with not only having a miscarriage, but the death of a child which is called the perinatal period. Can you tell our audience what exactly that is.
I: When I think of these losses, I like to think of it in the broadest context. That?s why sometimes I use the term reproductive losses. That includes perinatal loss and that?s a loss which occurs in the 20th week of gestation until the first month postpartum. But that?s actually a small percent of pregnancy losses. It?s only 1.2%, and other pregnancy losses, which are much more common, tend to be overlooked. Ectopic pregnancy, tubal pregnancy, occurs almost twice as much as a perinatal loss. Miscarriages occur in 10-15% of all pregnancies. Infertility, about one out of six of all couples. And if you expand it even a bit more in terms of pregnancy termination where there?s a fetal anomaly, giving birth to a disabled or special needs child, making an adopting plan, we?re talking about a lot of losses which interfere with making and parenting a healthy biologically-related child. And the reason I like to think of it in these broad terms is that often it?s the death, meaning the death of a baby, but sometimes when it occurs earlier, like a miscarriage, it?s not even experienced quite like that. For some maybe it?s not, but there?s a terrible blow to one?s self esteem and self worth.
G: Yes, I was really interested in reading your article about that and thinking about a blow to self esteem. I don?t think most people think of it in those terms, do they?
I: Well, they don?t. But if you think about it, particularly from the woman?s perspective, and this is a big difference between how a woman experiences it and how her partner, typically a man, experiences it. The loss is within the woman?s body. There is a sense of losing a part of one?s self. There?s a sense of feeling one?s body hasn?t functioned adequately or competently so there?s often a terrible sense of failure, a terrible sense of guilt. What if I would have done this or would have done that, would that have made a difference? To a woman?s grief, there?s usually much more guilt and self-blame than a prospective father is.
G: You?re really kind of the factory for the baby. You?re supporting the whole system.
I: And that happens with all pregnancy losses, and it could happen particularly when one talks about infertility, when one has to go through those very difficult infertility procedures which can go on for years and years, and we of course know about and are happy to hear about the miracle babies, which are common enough, but they?re not so much miracles. Children going through IVF, but a lot of those situations.
G: And IVF is in vitro fertilization. And a lot of hormones going on with that. That?s the other issue after having a miscarriage or having a child die and even after giving birth to them, you have a lot of hormones floating around there also.
I: That is true, although I?m going to say that generally from what we know, the hormonal effects why they can be intense with any pregnancy, you know, after delivery, you have the typical four or five day blues and that can happen 25 to 85% of all women. Those are what the studies indicate. Usually after the first week or so with most women, they?re kind of getting more back to normal but there?s a degree where there?s been some reproductive loss or trauma that they sit with.
G: Now would you call that postpartum depression with any of that or is that only if you have a viable living child?
I: No. I?m going to distinguish, because I think it?s important to distinguish these terms. Postpartum depression is a separate disorder that typically occurs one month to six months after birth and while it?s associated with a family history of depression, typically postpartum depression is due to what we call psychosocial environmental variables ? not having that much support, being overwhelmed with being a mother, stressors, difficulty in the relationship with one?s spouse. And that kind of depression often, not always, often can be benefited by medication, anti-depressants, as well as psychotherapy. When you were talking before, this is an aside in terms of how much procedures have changed in dealing with pregnancy loss, and it really is dramatic. If you had a text book from thirty years ago, whatever was said in that textbook of handling perinatal loss, one would do the opposite today, meaning that one would want to encourage grieving, for women to hold, see and touch the baby. The one thing that hasn?t changed unfortunately is sometimes our reliance on medication when we have a loss such as this. It used to be thirty years ago Valium was a rage and that was prescribed. Now antidepressants are a rage. You want to be careful. If someone has a clear, clinical depression, antidepressants can be a part of treatment, but too often after these losses, I?m not talking about postpartum depression, I?m talking about the kind of losses you just mentioned, people will resort to medication when what women need more than medication is compassion. Too often, we have a technological solution meaning give someone a pill as opposed to allowing a woman to sit with her grief. We find the same thing in terms of dealing with the death of an older child, of course.
G: Now let me say with our audience out there, I?m thinking they?re sitting out there thinking of the mistakes the medical community made with them or maybe they had a doctor that was trained thirty years ago that wasn?t as sympathetic with them as they felt that they should have been or whatever. What would you suggest for those folks out there?
I: Well, you know things are different.
G: What has changed? Let?s talk about what has changed.
I: As I was saying, everything has changed. It really used to be, let?s say back in the late 1960s, it began to change in the 70s, but it really didn?t become hospital uniform policy until the 80s that if a baby died in still birth, that baby was whisked out of the room. No one would allow the parents to see the baby. They were told to forget the baby, not talk about it. Usually sedated with a tranquilizer. Told to become pregnant as soon as possible. That has changed completely. There?s encouragement now to hold the baby, get to know the baby, because the woman has attached to the baby before the baby was born but she needs to see what she has lost. The medical community and hospitals are really so much better at this now than they used to be because when the baby is born and if it?s a baby who?s died, we in fact see women bond to their babies like live babies. They begin to touch them with their fingers and they move to their palms and they first touch the extremities and they move to the trunk and what they do is they notice the family resemblance. She looks like mom or dad or an uncle. They identify that not just as a baby but a specific member of the family to be grieved. Now if the woman hasn?t had that experience because it occurs thirty, forty years ago, people are resilient. You can find your own way of trying to
G: Yeah, what about the people who didn?t hold their babies and now obviously it?s too late. Sometimes family members suggest that they don?t do it and I?ve seen a lot of experiences where particularly male members of the family sometimes don?t want their wives, mothers or whatever to experience that traumatic experience, and they?ve said to them, you really don?t want to see the baby. And then you also had something in your article which I thought was very interesting about some people may choose not to see it for reasons maybe it?s a birth defect or maybe they just don?t want to do it and the nursing community is into this protocol that now we all see our babies and maybe we don?t want to see our babies.
I: This is a good question. Let me try to answer it. I?m all for individualizing how people respond to these losses. No one should be told how to grieve, whether to see their baby or not. Having said that, it is almost universal that when a woman who has given birth to a near-term, late-term, perinatal loss with some gentle encouragement, not saying that you should, but that many women can find it helpful to see and to get to know their babies. That?s a very valuable experience. It really allows them to grieve that loss.
G: And also to say good bye in a way.
I: Right. Now where it gets more complicated is when talked about a different loss that I?m going to bring up which is when there?s a pregnancy termination for fetal anomaly. One has an amnio in the second trimester, one discovers a major fetal anomaly, it may be Downs, it may be an anomaly which is fatal and one chooses to end the pregnancy, and if one chooses, it?s a difficult choice often to have the labor and induction, then one has a very difficult decision. Do you choose to see the fetus/baby that you decided to end and for some women it is too painful, understandably, because the guilt can be enormous, but I?ve worked with a lot of women with this loss and many women do choose, even under those circumstances, to see the baby in a pregnancy they?ve ended. Because for them, too, it allows them to embody their grief, to connect it with a person, a baby that they get to know. But that?s a more complicated loss and one needs to be very careful not to be pressuring women to see their babies in those instances.
G: It?s time for us to come up on break now and my guest today is Dr. Irv Leon and our topic today is Healing the Broken Bond: Mourning Pregnancy Loss. Coming up with us on the show after break is Dr. Heidi Horsley. She?s adjunct professor at Columbia University School of Social Work. She works as a clinician and researcher for the FDNY Columbia University Family Assessment Guidance Program which provides therapy for the children of firefighters killed in the World Trade Center disaster. Heidi is a bereaved sibling and has suffered pregnancy loss and she has recently adopted. Heidi is my daughter and sometimes my co-host on the show and so she?ll be on with us after break. If you want to call in, our line is 866-472-5792. Please stay tuned for more on Healing the Broken Bond.
I think you both have some personal commonalities and professional and also the adoption thing so we?ll get into all that as we move on to the show. Heidi could you tell us about your experiences?
H: I really appreciate the opportunity to share my experience because I don?t think that women that have had miscarriages have that opportunity very often. I have one biological son and he is now almost eight years old and several years ago, my husband and I decided we wanted to have another child and give him a sibling. I tried to get pregnant and I found out that I had something called secondary infertility which I actually knew nothing about because I just assumed because I had had my first child and that was very easy that this would happen again. So in the process, I ended up having two miscarriages and they were both during the first trimester, and I went through infertility and had surgery, etc., and was not able to get pregnant again. What was interesting about my own experience and from what I?ve read about in Irv?s article, what I think is common, which I didn?t know at the time, is many did not recognize my miscarriage as a significant loss and people really interrupted my grief, and the way they did that is they said things like, well, at least you know you can get pregnant, and at least you already have a child, and at least you were only in your first trimester, and so not only was my grief interrupted, but I almost felt like I didn?t have the right to my grief, and so I really kept it to myself and didn?t talk about how I was feeling. Irv, you mentioned something earlier which really struck a chord with me, and that is I really felt like my body had let me down and that somehow it was my fault, and I felt a lot of guilt. I would go through what had I done? Did I have too much stress? Had I not eaten healthy enough? Did I not exercise enough? Was it that diet coke I had?
I: So much of what you?re saying rings true with the couples and women I work with who have had miscarriage. Miscarriage so often is used, unfortunately, as a medical non-event. It happens. Women go to the ER, as long as it?s not an ectopic, which can be a life-threatening event, are told to go home, wait what develops, and one just doesn?t get the recognition of what this loss means, and it?s interesting. Studies have looked at how people feel about their caregiving after a later term loss, a perinatal loss, like a still birth, and usually the evaluations are glowing. When they talk about miscarriage, they?re not. Medical caregivers really let couples down by not acknowledging how for many women this is a tremendously difficult loss, especially, especially when this is a very-wanted pregnancy. What?s complicated with miscarriage is sometimes women, it?s an unplanned pregnancy and they may be shocked to learn that they?re pregnant and then their reaction to a miscarriage can be very confused because they?re not clear as to how much they wanted it, but especially for a wanted pregnancy. The other thing I want to quickly add is that these days, technology being the way it is, once you have that first ultrasound, usually it?s seven or eight weeks, and once you see the heart beating, that is no longer a fetus for many women. You start referring to it as a baby and when that happens, the depth of the loss becomes that much greater. Our technological advances means that earlier and earlier we are experiencing pregnancies not as a fetus but as a baby.
G: So we have our audience out there and they?ve had a miscarriage or they?ve had a baby die shortly after birth or whatever and they?re out there sitting thinking, okay, I didn?t get the support, now what? What can they do now? Is there some way I?m thinking as a parent and certainly of Heidi, what could I say now? What could people ask of health caregivers now? What could I ask of my family now to support me? What do I need to do?
I: Want me to try to take a shot at that? With miscarriage, particularly earlier, there?s not the opportunity to see the baby the way there is with a later loss. But what I?ve seen with many women who have had a miscarriage, and this doesn?t have to happen right at the time of loss, is they find some way to memorialize their loss. For many women, just to echo what Heidi was saying, there?s a loss of mother nature. There?s a loss of that creativity. One that wasn?t able to make a baby which one identifies with being a woman. And I?ve seen women after loss like this make a sculpture, write a poem, make a quilt. Finding some way to put their creative energy.
G: That could also be a way to bring your family in. If you?re doing that, then your family members say what are you doing and a way for them to realize that you are doing something that there is something going on.
I: The challenging thing with miscarriages, not always, but often because again it?s within the woman?s body, she may be quite a bit ahead of everyone else in terms of attaching to it so the husband may not feel that kind of loss. There?s a term, incongruent grieving, that describes the differences between them.
G: What resonates with you in this, Heidi?
H: I really identify with what Irv is saying as far as women and men grieving a little differently, especially during a pregnancy loss and especially during one that?s early on because your body changes fairly quickly when you?re pregnant and you do start to bond and attach to this fetus and this unborn baby and I didn?t feel like my husband was very attached to the process yet because he couldn?t physically see that I was pregnant whereas I felt attached. I grieved not only the loss of the pregnancy, but I grieved the loss of the future with this unborn child. What would she look like? Or him? What would their personality be like? What would the sibling relationship be like?
I: Absolutely. This is critical, and this is true of all pregnancy losses where it?s the death of a dream. If I could say, timing being the way it is, a couple of hours ago, I was meeting with a woman who had a perinatal loss and she was hearing the minister talk about sometimes we think of a road that we haven?t gone down and it would be useful to explore what would have happened if we went down that road, and she asked me, would it be healthy to go down that road in terms of imagining what would have happened if her child had lived. I don?t tell people how to grieve, but I said it is the most natural thing in the world to go down that road, and imagine because that?s where a lot of the grief is. It?s not a grief over the past, it?s a grief over the future that you?re never going to have, and you have that in a different way when you have a child who?s born with a disability. You have the pleasures of what they can do, but there?s also some grief over them not being able to reach the milestones and doing some of the things that you may have wished them to do. That happens with infertility where you don?t have the wished for biological child. It?s really grieving for a dream that didn?t come true.
G: And I?m thinking what a wonderful thing for our audience to think about. If you?re a writer, you could write a wonderful story about what they would have been with their life.
I: The thing of writing, it?s almost like you?re reading my mind, there actually is a wonderful book that I?m going to put in a plug for, not that I have any contact with the author, I?ve never met her, but it?s a novel. It?s called Luscious Lemon, and it?s written by Heather Swain. I don?t know if you?ve come across this, Heidi, or not. But it?s just the story of a couple who ? I don?t think this gives it away ? it?s not intended to be a story of a miscarriage but it documents so beautifully a way that a miscarriage is experienced that I think it?s kind of her way of dealing with and expressing this loss. She doesn?t say if she actually had one, but my bet is that she did because it shows such a personalized awareness. What I did in terms of the losses I had, ironically, I started writing this before I had the loss of the ectopic but after I had the loss of the ectopic, I stayed in this area and did writing. My approach was to write a book. My wife?s approach was to write a poem, which actually was the beginning of the book.
G: Do you have that poem? Do you want to read it to us when we come back from break? Okay. It?s time for us to go to break now.
I wanted to read an email. We were talking to Irv about talking about male female and he?s also going to read us a poem, but Lisa from Bangor, Maine, sent us an email. She said that she had heard that Dr. Leon was going to be on the show and that she has a friend who had twins die five months ago before their birth. They were supposed to be born in three more months, I think she says, so they were six months in utero. She has two children, 8 and 5, and she has cut off all her friends and doesn?t want to talk about the twins. If I do see her, what would you recommend?
I: That?s a tough one and I am going to say that?s not the usual reaction because what usually happens is the other people don?t want to talk about the twins or if one of the twins dies, just wants to talk about the live twin. But my view of this is that people grieve in different ways and I would respect her wishes. I would not put upon someone that they should talk about it. Now this happened five months ago. How someone reacts in the first month, in the first half year, the first year, things can change, but I think people need to respect how the griever chooses to deal with it. We all assume, not accurately, that there?s one way of grieving. In fact, there are studies that indicate that a large chunk, I?m not talking about 5 or 10%, but 20 or 30% of people who have a major loss, don?t grieve in the usual way and don?t seem to have major problems later, and we really need to recognize there really is variability in this and to not assume that the way you grieve is the usual yearning and pain and crying. That may be the typical way, but it?s not the only way.
H: Plus she may be grieving alone and not in public and people may not see her grief. They may assume she?s not grieving and maybe she just has a different way of grieving.
I: And just to kind of piggyback on that, there are real cultural differences. I?m not saying this woman belongs to a different culture than the usual mainstream one, but particularly in a place like the U.S., there are some cultures that really do not grieve openly. It is a much more private thing. That?s a thought for counselors and therapists to be aware of because there are some people who just are not that comfortable showing that grief. One important subculture where that?s true is the gender called male. Many men do not feel comfortable grieving in public and will tend to do it in a much more solitary way. So there are real differences among people and genders.
G: I hope that helps you, Lisa, and thank you. For me, I would say to you just hang in there as a friend and keep inviting her out for lunch or maybe you can take her kids to the zoo or something maybe to give her a little time off but it?s great to have friends who care enough to email in about these issues. Irv, when we went to break, we were talking about male and female issues and you were saying that your wife wrote poetry and your?s was to think about going directly to a book and you did write a book.
I: I wrote about 200 pages of what she was able to in her own way more poignantly describe in one page and I?ll read it. It?s just a brief poem. It?s called ?First? and this was written after our first ectopic pregnancy.
You were my first
A July baby to be born in the hot sun
When the river glistened and trees are full
Fruit ripe and ready to drop
But I lost you in cold December under operating lights
In a river of blood
I lost you when you?d just begun before the July river
Saw the first light of day
And with you I took one step closer to death.
I don?t read that poem that much, but in some ways it shows some important differences.
G: Irv, you?ve to stop for a minute. You?ve taken us back.
H: That was beautiful.
I: Let people digest that first, huh?
G: Whoa, whoa, that?s an incredible poem. Really incredible.
H: It is. I think that really captures it.
G: An ectopic pregnancy is a tubal pregnancy so it?s the very beginning because as the cell divides, the tube cannot tolerate that much dividing and so there?s pain and the tube generally has to be removed and just to think of the energy that your wife had behind that cell, it only divided how many times? And amazing.
I: The thing that really strikes me is she was able to experience this obviously as much more of a baby than I did. It?s described as a baby. But when I read the poem, tears come to my eyes because vicariously through her, I experience it more as a baby and that?s actually true, I think, in a lot of men. I will sometimes when I?m with a couple ask a man what his grief reaction is and he talks about it in not an unfeeling way but not with that much emotion. Then when his wife talks about it, tears come to his eyes. They begin to well up. For many men, they do vicariously grieve through their wives. The grief experience is different but that can be a way that brings them closer together and many couples are afraid after a loss like this that the marriage is going to be in danger. If the marriage is solid before, it?s probably going to be stronger after. It does not tear couples apart even though as we spoke earlier, the grief reaction among men and women is different. A man?s grief tends to be shorter or not as intense, not as much filled with self blame, guilt.
G: Now remember audience when you hear Irv say that, these are pregnancies that maybe were pre-birth and also shortly thereafter because I don?t want men to feel like they don?t grieve as long for older children.
H: I think also that men, I?m generalizing, but oftentimes men want to fix the problem, they want to take care of it, and in this situation they can?t and it?s very frustrating. They just need to sit with the grief and and sit with their wives with the grief but they want to make it better.
I: That?s a big part of it and for them, for some men, what is really traumatic is the helplessness they feel. Many young men and without stereotyping too much, engineering types, have the sense of if there?s anything that?s wrong, I can fix it, and if they?re in their early 20s and they?ve been able to fix everything, this is something they can?t fix and it hits them right in the face and it takes them awhile to develop a different image, a different kind of schemer of the world, I can?t fix everything, and that?s very painful.
G: But I like what you said about that they do grieve through their wives because I?ll give presentations at The Compassionate Friends and, by the way, in July Irv?s going to be our plenary speaker for the professional day at Compassionate Friends and we have a great conference that will be in Dearborn, Michigan. I believe it?s the 14th, 15th, and 16th of July. You can go on The Compassionate Friends website and hear about that. At Compassionate Friends, I will give presentations and I will see husbands and wives sitting and oftentimes a young couple, the man will have his arm around his wife and he will look so sad but she?ll be crying and he?ll be kind of holding her and I always thought he was trying to protect her but I think he was grieving through her now when I hear you talk that way. He?s experiencing the grief.
I: Yeah. That is a part of it. Another part of it is that there is ?man?s role to be strong? as if to grieve is to be weak. There?s a wonderful book written by Tom Lynch. He wrote a book called The Undertaking. And this is for all grief. What he said is, ?Grief is a tax we pay for love. It is not weakness to grieve, it is strength. It?s just a measure of how much we love.? But many times, men have the idea if I have to be strong and if I show my feelings, then who?s going to pick up the pieces? Any time I?m with a couple, and again there are a few universals just to be talking male and female, and a man says gee I can?t grieve because it would bring her down too much. If I just look at his wife and say is that true? If he shows his feelings, would that bring you down? And never have they said yeah, that?s true. The response in one variant or another is always no because then I will know that I?m not alone in my grief. Then we can grieve together. Then I can connect and reach out to help him. So even if there are times where there are opportunities to grieve together, if men can get over that kind of tough masculine role.
G: However, together isn?t always together as we always talk about on the show about the ups and downs of grief.
I: The other thing because you were making a very important distinction over reproductive loss and the death of an older child and I want to underscore that which is that grief is grief is grief. I don?t think one can measure, if you will, grief based on how old the child lives.
G: And all circumstances around it. Like Heidi was saying, she realized she wasn?t going to have more children. There?s a whole grief around that. Right, Heidi?
H: Absolutely and one more thing is seeing friends and family members pregnant or with children triggers ongoing waves of grief and loss and you?re not sure when those waves are going to overtake you. Both my sisters went on to have healthy baby boys and I couldn?t do that so there are constant reminders around you.
I: I couldn?t agree more. You?ve probably experienced this, Heidi, in the scheme as well, and this universal. Any woman going through a loss like this, when they see a pregnant woman, they just want to run out of there.
H: Absolutely and for some reason, all of a sudden everybody around you is pregnant. You?re just noticing it all the time.
G: And now people are showing their bellies and everything so it?s really right out there. We?ve got to go to break right now again. One of the things we were talking about earlier on in the show was how our audience out there who have suffered the loss of a child, the loss of a pregnancy, some of the things they can do to help them. Irv was talking about that it?s great to maybe do a quilt or we were talking about writing a story. And also wanted to talk to the audience again and remind you about the Library of Life. This is our last break so I wanted to ask both of you if you had some things that you wanted to talk about that we?ve missed on the show. Somebody want to go for it.
I: Well, one of the things, we?ve talked about some, but I can?t emphasize enough that what really makes all these losses unique is how powerful a blow it is to a woman?s self worth. I remember being at a wedding for a good friend and the priest was saying how they were going to become co-creators with God in terms of forming a family and that is the kind of blow to one?s self worth. One can really feel close to the divine when one makes a child, and as in my wife?s poem, one can feel one?s taking a step closer to death when one doesn?t give birth to a live child so the sense of pain, there?s also a sense of feeling omnipotent, all powerful as a parent. I?m supposed to do this. Even cows can do this. Why can?t I? That kind of really painful evaluation, feeling lousy about oneself, can really make one feel more down than in other kinds of loss. We know during the death of all the children, that the parent will always feel guilty, but there?s a particular, another threat of guilt in terms of feeling like their body didn?t work in the way that it was supposed to. And I find that just sort of talking about that stuff, playing it out, it tends to subside for most women after awhile.
H: I have something on my refrigerator that helped me because I really felt like why can?t I do this? Like you said, anybody can get pregnant. Animals get pregnant. It doesn?t take a brain surgeon to get pregnant and I have something that Joseph Campbell said and he said, ?We must be willing to let go of the life we have planned so that we can embrace the life that is waiting for us.? And there are many wonderful ways to bring children into your lives, and Irv and I have both adopted and have wonderful children so there are ways you can bring children into your lives eventually if pregnancy is not an option.
G: And you don?t even have to adopt. You can adopt your neighbor?s kids. There are big brother/big sister programs. All sorts of things that you can get involved in. That?s one of the things that we haven?t gotten into. I think we can do a whole show on it is how about the siblings?
I: Yeah, I have done some work in seeing that when this doesn?t get addressed that siblings can have very strong reactions. I?m happy to say that generally this is more out in the open so the kinds of reactions the siblings had, at least in the book that I wrote, are not as extreme now as I think they had been when these losses weren?t dealt with.
G: I wondered Heidi, did you think your son, was he impacted by all of this and not knowing or did you think about it?
H: I didn?t think he was until I heard him talking to his friend. Children know a lot more than you give them credit for and they make up things and have magical thinking if they are not told about what?s going on. I heard him say to his friend, God would only put one baby in mommy?s tummy and that was me so we have to go to China and get my sister but we have to hurry and get there before someone else gets her first. So I basically had to talk to him about that we were going to get her regardless but it was interesting what he understood because I thought he didn’t know anything of what was going on but he had overheard some things.
I: I?m glad you brought up the sibling stuff because it?s very common for parents to believe, particularly with young children, I?m talking about 2 or 3 year olds but they don?t know what?s going on. They may not be able to talk about what?s going on but they know things are going on more than we realize. They?re like little scientists. They want to piece their world and understand it and we need to give them the facts of what did happen and it can be explained in simple terms about the baby died in mommy?s uterus and kids can understand it. But it has to be parents willing to talk about it.
H: And if we don?t give them age-appropriate information, they will fill in those facts with information that?s not accurate.
I: Right. I remember I was giving a conference once and a little girl, she was probably three years old, when she touched her bereaved brother and she got afraid because her hands were so cold, ?Mommy, mommy, my hands are cold.? What was she afraid of? She was afraid that death was contagious. She was afraid that if you touched a dead baby, that baby was going to harm her. So just to know that this is not contagious, it?s not going to hurt you, and death is two things. It?s permanent. This baby?s never coming back and nothing worked. There?s no feeling, there?s no thinking, so that the child, the sibling doesn?t have to worry that the baby?s in the graveyard, but the baby feels cold at night. There?s no feeling. There?s no hurt.
H: How does our audience know if they need therapy?
I: Well, I have a kind of gentle approach to that. If you?re feeling you?re not getting the support you need, it really is useful to meet with somebody who is experienced in this area.
G: Important point ? experienced in the area.
I: Yeah, I would say that. And as I said before, while I am not against medications for those people in clinical depression, soon after a loss like this, one certainly has depressed feelings but it wouldn?t necessarily be a clinical depression and just being able to sit and work with someone and helping them work out those feelings can go a long way. Sometimes that?s two sessions, sometimes it?s twenty sessions, depending of what other stuff comes up, it could be much longer although for these losses, and this is different. This is different than the death of an older child, and again, I?m not weighing one grief is worse or better than another, but the cost of grieving for perinatal loss in my experience tends to be, and I don?t want to be too hard and fast with time frames, is six months to a year. Most people by a year after they get over the anniversary, are feeling much more on their feet. Do they ever completely get over it? Of course not. But there?s not the acute grief. With the death of an older child, as we all know, much, much longer than that. So if one is in acute grief and it keeps going on and on and on and there?s no relief, that would be a sign. If one is having serious suicidal ideation, what I mean is really thinking of killing themselves, many times when there?s a loss like this, one might wish that one was no longer alive. That?s not the same as really beginning to think more seriously. One is doing things like getting into substance abuse. Those are the kinds of significant red flags. If one is so depressed after a number of months that one is unable to get out of bed, one is unable to function. Those are the kinds of things that I think it?s crucial. But I think anybody who feels they?re not getting support, can go to a professional if they are still in that area. I quickly want to add support groups.
G: I was going to say that or support groups, Compassionate Friends or also through your hospital, you can find some support groups. Well, it?s time for us to close our show and do you guys have any quick parting words? Thank you for being on the show. If people want your article, can they email you? Where would they email you at?
I: irv.leon@prodigy.net. If they have any questions, too, I?d be happy to answer.
G: You can get a hold of Dr. Heidi Horsley or me at my website, www.healingthegrievingheart.org.

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