217. Pregnancy after loss with Clinical Psychologist Narelle Dickinson

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1:23 So what that does, it pushes it up the algorithm and it helps push it out to other people just like you that are looking for pregnancy information. That really does help our show. So today we are having uh Norelle Dickinson on the show. She's a clinical and health psychologist and she works very much in the pregnancy space.

1:46 And we have brought Norell on because it is infant and pregnancy loss awareness month. And uh Naurelle, with her wealth of experience, more than 30 years of experience, talks to me all about how it feels for someone that's going through pregnancy after a loss. So uh Naurelle, she and her team support individuals and families through fertility treatment, pregnancy, pregnancy loss, birth trauma, and transition to parenthood.

2:16 Uh, she helps people through face-to-face appointments as well as telehealth, and she's the director of Lotus Health and Psychology in Brisbane. She's also an educator, researcher, and advocate committed to improving reproductive and perinatal mental health care across Australia. We talk about some big topics.

2:37 So if you've picked up this topic because you're needing support, because you are either pregnant again after loss, or you are just somebody who wants to know more information, uh and you're not feeling quite emotionally resilient enough right at this moment, just hit pause. Come back when you're feeling a bit stronger, have a listen, because the information that Norrell shares will be very, very helpful for people that need this support.

3:05 Welcome, Norell. Thank you so much for giving up your time and joining us today. It's my pleasure. Thanks for having me. Uh, I want to start with the term rainbow baby. You know, we often hear that on social media, and the whole idea of a rainbow is joy. But a lot of women who have a rainbow baby coming don't often say that it feels very joyful.

3:27 It feels terrifying. Why is that?

3:31 Yeah, and I think even the term rainbow baby is not um a term some women particularly connect to. They they don't necessarily choose to use that language. So it's always um a phrase I'm quite cautious about using myself. Uh because I I think the reality is that for probably the vast majority of women after a loss, the next pregnancy is pretty terrifying.

3:58 Um, and so it it's it's an avalanche of emotions, really. So, you know, obviously they're delighted to have conceived again, uh, but the experience is very colored by what's gone before. And depending on when the the loss of the previous uh pregnancy occurred, that that might not um you might not get much pregnancy, which doesn't feel like it's been affected.

4:29 If it's been a stillbirth or a very late-term loss, then you know, really there's there there isn't a point where it feels safe, as it were, within the pregnancy. And it's that kind of um what has been seen cannot be unseen experience. You know, that I often I often talk about the fact it's like a curtain has been pulled back for people that they they they never realized that pregnancy loss that stillbirths happens or that it's so common.

4:56 But once you know it, you can't unknow it. And so pregnancy feels like a really scary thing and it might not have before.

5:05 And that's that feeling of, you know, I I can't imagine what it would be like to feel excited, but also devastated at the same time. Yeah. How do people cope with that feeling?

5:16 With great difficulty is probably the the um the answer. Um yeah, I I mean I I think sometimes it the the reality is two things can be true. You can feel excited for the new pregnancy, but also still terrified about how it feels and devastated for the loss of the previous baby. Um some women will talk about the fact they feel like they're almost um uh disrespecting the baby that's been lost if they're happy about the next one.

5:48 It almost feels like you're not allowed to be excited. And then a lot of the time, those women will also say when they get to the end of the pregnancy and they meet that baby, hopefully everything's gone well, that they look back and they're they feel really um, really guilty and really disappointed that they didn't enjoy the pregnancy more.

6:07 So it's a little bit damned if you do tempting. Yeah.

6:11 And you know, we we sort of, I don't know, is there an expectation in our society just to soldier on or to hope people aren't thinking this, but to get over it? Um, and you know, that person that's going through it, they're suppressing all that emotion because they can't feel big emotions. How how do we support women through that?

6:33 I'll I'll never forget the mum that I met many years ago who had had a stillbirth, and it was about six months after her baby had been born sleeping, and she um was talking to her own mother about the baby and talking about how distressed she was feeling. And her mum looked at her and said, Oh, are you still sad about that?

7:00 Oh wow. And I just thought, oh my goodness. I was so shocked that a a mother wouldn't have been able to reach into that and realise that that's probably not a loss that you ever get over. You you might feel like the pain is slightly less sharp as time goes by and you become more accustomed to it, but um, I don't I don't think it stops, I don't think you get over it.

7:30 There is a huge social expectation that uh women move on and uh a sense that the next baby is a healing experience from the loss. And I mean, there's probably a component of that. You've particularly if the first loss was um if the loss was the first pregnancy, that sense of I I have been able to now have a living child.

7:56 Um I I think for a lot of women they don't actually validate their own motherhood until they're parenting a child that is living. Um, it's almost like um the baby that died doesn't count, um, doesn't let them become enough of a mother. Um, and so those sorts of beliefs that sit within our society, I think, are incredibly difficult for women.

8:21 Um, I mean, I think we all just have a responsibility to be incredibly gentle with people as as they are going through their loss experiences, and actually be gentle with pregnant women because you might be looking at a woman who's visibly pregnant and or you know is is carrying a newborn baby and thinking, oh, this is wonderful, you know, you must be excited, and is this your first?

8:48 And that's a really conflicting question for someone who's previously had a loss. Um, you know, what do I say? Uh no. Oh, how old's your other one? You know, it they they're they're such hard questions to answer for those those mums and dads.

9:05 How do you counsel people on how to answer that question?

9:10 Yeah, look, the the simple answer is whatever feels right for you. Um, and I I think in reality it's a different answer in different places. If you're doing your shopping and the lady serving you at the register says, Oh, is that your first? You might think, Oh, for goodness sake, I don't need to have that conversation right here.

9:29 And it might be that you do just say um yes. Um, and then in another circumstance, or if it feels better for you to say, um, yes, this is my first living child. I had another baby, but unfortunately they died. That might be the answer that you choose to give. Um, and there's there's not a wrong answer, and there's not a wrong answer for the circumstance.

9:53 It's just what feels right for you.

9:55 Do you have your your clients talk to you about the burden that they might feel by sharing that information and that they then have to be the person that that supports the person that they've just told? Uh we had a little while ago, quite a while ago, we had Priyanka Saha, her Instagram handle is the Lilyflower, and she talks about her the loss of Lily.

10:19 Um, and she says that often, like sometimes it's it's about whether that person kind of deserves my story. Um, but then it comes from the space of then I feel like I have to support that person, and that must be exhausting.

10:35 Yeah, I I usually say to women that um I mean, your first responsibility is to honour yourself and your baby. And if that feels like what you want to do today, if you want to use your baby's name, if you want to refer to them, that's that's for you and for them. And if it's a day where you think I don't actually have the energy to talk about what I've been through, or because I know that the person I say this to is probably going to give me the goldfish mouth of, you know, of shock, um, then that's also okay.

11:07 It doesn't mean you're dishonouring your baby, but it might mean that you're assessing your own energy levels or your own bandwidth that day. I personally think that anyone who asks the question, uh, anyone who inquires about a pregnancy, anyone who's starts asking those questions, um, how far along are you?

11:28 Is it a boy or a girl? Is it your first? You know, those things that seem socially quite normal. If they enter into your personal space, then you've got the right to answer personally. And if if they don't like how they feel because of the answer that you provide them, I don't know if that's your problem.

11:49 I think that's their problem. Um, you know, they chose to ask what is actually a very personal question. Um, it's not your fault that the answer's more complicated than they expected.

12:00 I love that. I love that. I think that gives people a lot of foundation on how they can be in a conversation with someone if if they're willing to share and that person wants to hear. Yeah. Um, I want to talk about, you know, this idea that you've finally got your little miracle or something like that, and and you know, the need to feel grateful all the time, and and how that might um also be a burden for that person when they don't tend to feel that grateful, but they're grateful that they're they're pregnant, but you know, they're still thinking about the baby that they lost.

12:30 And yeah. I I think it goes back, Bridget, to what I said before. Sometimes two things can be true. And um even when you haven't lost a baby, you are not grateful every moment to a newborn. You know, most of us are not grateful for sleep deprivation, most of us are not grateful for punamis, you know, that it's it's actually not normal to feel delighted in every single waking moment of parenthood.

13:03 And when we are missing a baby that's been lost, and thinking about that the reality that if it wasn't for my pregnancy loss, I never would have even met this baby that I'm now parenting. That's really conflicted. And um, I think it's inevitable that every day that you're loving the baby that's in front of you, you're also going to be missing the baby that's not there.

13:31 And having, you know, the gratitude for the living baby requires grief for the lost baby. You know, that the two things uh they're completely interconnected. And I I've sometimes seen this in in mums who've had twins where one has survived and one has not. And the complexity of that loss is just so difficult.

13:59 Uh, and it it's the same kind of confusion of if I if I'm excited to and grateful for my my baby who's survived, does that somehow mean that I'm it doesn't matter that my other baby died? Or if I'm grieving for the baby that died, does that mean I'm not doing enough for the baby that's here? No, it just means that two really complicated things have happened and they don't naturally fit together.

14:54 And so it it's hard to process.

14:58 I want to talk about people who are going through a pregnancy with pregnancy after loss, but also might be dealing with just normal pregnancy anxiety, uh, which the general pregnancy community would feel. So, how do we know that it isn't just normal pregnancy feelings or whether it's got to the point where that anxiety and uh that that grief is now overwhelming?

15:24 I I think that that is such an excellent question because you're right, pregnancy is weird and confusing and stress-provoking, even when it's going perfectly fine. Um, we know that the proportion of people during pregnancy and postpartum who experience anxiety into a clinical range is quite high. It's probably, you know, in that one in five or so women will experience perinatal anxiety.

15:54 And when there's been uh something very complicated, like a previous loss, that's a big risk factor to push you up into that group. Uh, and I think it is normal to have some anxiety in a subsequent pregnancy, even if it doesn't quite meet that clinical range. But I guess for me as a psychologist, what I'm always thinking about is how much is the anxiety affecting you?

16:22 Is it disrupting your life? Is it causing you distress on a day-to-day basis? Is it making it hard for you to go about your day? Are the anxious thoughts really intruding and interrupting on you? Um, if the answer is yes, then it's probably in into that range where it's problematic. And I think a lot of women are very much dismissed by other people saying, oh, it's normal to worry during pregnancy.

16:50 Um, and yes, it is, but if you're worrying so much that it is really starting to interrupt just what your days look like, it's okay to at least just go and talk to someone and to a GP even and say, Is this too much? Um you don't have to figure it out by yourself.

17:09 No. We're a big fan of people seeking support. And sometimes we see it in our own clinic that maybe it's just one or two visits to our psychologist. Yep. That is enough to put people back on track that that have just pregnancy anxiety or pregnancy concerns. Um, somebody that's in this situation, how how how often would you recommend that they see somebody if they've gone to the point where they've they've either they're pregnant after a loss or they've got overwhelming feelings?

17:42 Yeah, I I think what you just said then is really right. Often, quite often I will see people come in because they're feeling very anxious in their pregnancy. And when I meet them, I think, yeah, no, you're having a rough time, but it this is not like we need weekly sessions for the next nine months.

17:57 That's not what this is about. I might um we might provide some information about what anxiety is and how it affects you. We might have some simple strategies that might not take a great deal of time, that might only be a couple of sessions. Um, some people need a little bit more, and we need to uh, you know, to really work on helping to manage the strategy.

18:20 So, I mean, the answer is how long is a piece of string? Um, I guess I always like to check in on people, even if I think they're probably doing pretty well. Um, I'll usually say let's check in around, you know, if it's an early term uh anxiety presentation, they're coming in. I might say, let's check in again around the 20-week scan, you know, because that that's a tricky time for a lot of mums.

18:45 Or I might say, let's check in towards the end of the pregnancy as you're approaching the birth and getting ready to meet your baby. Let's see how you're feeling then. And I'm definitely going to ask to have a little bit of a check-in on them, maybe four to six weeks after the baby's been born, you know, once that crazy four-week time has settled down a little bit where you don't even know which day of the week it is.

19:05 Um, but I want to see how they're traveling in the postpartum because I want to see whether that anxiety might have followed them through. Um, because I know that if we can catch it at those points, if it's starting to bubble, we can get it back under control again. I don't want it to be really bad before we start to intervene.

19:22 It's a lot more work when you don't have a lot of bandwidth to do the psychological strategies.

19:29 I want to ask what a psychologist like yourself with so much experience feels about social media. Does that help or hinder somebody who's trying to um grow another baby after a loss?

19:45 Yeah, it's a million-dollar question, I think. Um I have very mixed feelings about social media, probably like a lot of people. Um I think it serves a useful purpose. It can certainly help people feel connected and less isolated. There's some wonderful support networks out there and some really wonderful organizations that do a lot of really good education and information providing online, and I actually think they're invaluable.

20:16 But a lot, like a lot of things, it's good until it's not. And I do find that sometimes people will find that the forums and the groups uh start to feel quite triggering. Um, and of course, involvement in any of those kinds of groups trigger off your algorithm and tend to fill your feed with scary things, um, which doesn't necessarily help.

20:45 I also tend to find people probably outgrow some of the groups. You know, they might have been in a pregnancy loss group and now they're in a pregnancy after loss group, and it it might feel like I've graduated out of something and something that was useful to me a couple of months ago isn't useful to me anymore.

21:05 It's okay to acknowledge that and just mute it or you know, unfollow for a while. Um, I think you just really have to tune into the question of is this serving me today? And if it's not, if it's if you think no, I actually feel worse because I was in that group, it's probably time to get out of it.

21:30 I feel conflicted with people that have perhaps built a brand around pregnancy after loss, um, because they themselves must be moving through that cycle. In some cases, I'm sure people are moving through that cycle. So, you know, I often wonder where do they get to that point and think, okay, well, it's now time for me to be moving into a different stage of my brand influencing.

21:55 Um, that must be a complex decision for them. Um do people in this situation, I don't know. I like I lots of my friends are into crime podcasts and crime uh stories. And I don't know, I think my life is fairly full of of uh trauma in terms of the news cycle and everything else. So I choose not to go down that path of consuming media like that.

22:21 But do you think people get to the point where they're seeking it out? They they want to identify with other people that have had uh pregnancy loss, or you know, they they're in that cycle of over catastrophizing or or looking for the worst case scenarios. Um, do you think that's what brings people into those forums?

22:39 Yeah, I I I mean I think most people start with them because it's a it's a place to get support and to feel like I'm not the only one. Um, but it it can turn into something a a little bit different and um you know it yeah, it it can certainly switch and and become yeah really pretty unhelpful. Um and it's I think anxiety has this really strange mechanism that uh it the purpose of anxiety is to keep us safe, right?

23:19 You know, it's we if I'm about to cross the road, if I wasn't anxious enough, I wouldn't look both ways before I stepped out. If I wasn't anxious, I would, when I was cooking the dinner tonight, I would put my hand on the hot saucepan without being careful about whether it was hot enough or I needed oven mitts.

23:39 So anxiety serves a really, really useful function. But when anxiety is starting to move into something unhelpful, it tells us more is more. And so it says, look for all the things. You know, you got to be more careful, you've got to understand more of what could go wrong. You have to look for every single possible threat, and and then you have to be able to set up all the contingencies and figure out all the solutions that you're gonna use when all these various catastrophic things happen.

24:14 But anxiety lies. That's actually not helpful, and it's not even possible to come up with all of the things that you need to think about and protect yourself about. All it actually does is just overactivate our flight and fight system. So I think a lot of the time it's that false feedback loop that people are getting into that if I know everything that could possibly happen, I'll be safe.

24:42 But it it doesn't really work that way.

24:45 And we do get that. We we see that in our clinic, or we see it from our listener messages. If they have had a pregnancy loss, some women might spend years searching for answers if they don't have any answers. Does that sort of vigilance have any impact on a subsequent pregnancy? Or is it made better if that person actually knows why the let loss occurs?

25:08 Again, I think that's a very individual reaction. And unfortunately, as you know, that for a very large number of losses, even very late-term losses, it doesn't matter how many tests we do, it doesn't matter how um well understood the the pregnancy has been. We might not be able to fully identify what the cause of the loss was.

25:35 And the no amount of searching and testing and checking will will turn up an answer for people. And that I think that contributes to a lack of sense of control. Um, I think the one thing about knowing provides is a okay, well, I can look for that problem. Um, but even that I guess the difficulty is a lot of the time if you know, okay, this was the problem, it doesn't mean there's particularly much chance of that happening again.

26:03 It's it's it doesn't necessarily translate to that. So again, it's a bit like the anxiety cycle I was just describing. It's false control. It doesn't particularly help. Um, but yeah, people can feel really adrift if they're if they really don't understand why. And you know, that means their the need for reassurance and checking in a subsequent pregnancy can really accelerate.

26:27 That's where I see people wanting to buy home Dopplers and get scans all the time and you know, really, really high frequency of medical reviews. Um, but again, that reassurance cycle doesn't work for long, it's very, very short term, and then it tends to um, you know, very quickly, we we're not confident enough again.

26:49 We definitely see that in the clinic, and I know that our obstetricians actually offer that as well because they see that if a scan is needed, if if one of the patients calls up and and we know that they've had, I don't know, either recurrent uh miscarriages or they've had a um late um pregnancy loss, we know that the best thing that we feel we can do is have them in, have them in for reassurance.

27:17 But understanding that that reassurance is temporary as well. Why do you think, speaking of scans, why do you think that scans in themselves can be quite triggering and people can, you know, hold their breath until the scan is done. And uh, you know, are we are we doing the right thing by even offering reassurance through scanning?

27:40 The answer to are we doing the right thing to reassure people is yes, of course, if they if they feel like they need it. Is incessant repetitive scanning helpful? In my humble opinion, no. Um there's I think people who've had um particularly later term losses probably do need a higher frequency of reassurance than um maybe someone who hasn't gone through that.

28:08 Uh but like I said before, more is not always more. Um why is a scan so triggering? Uh I think there's lots of reasons for some fair proportion of parents, that's the moment they realize their baby had died. Um, they may not have had any idea that there was a problem, but um, that's when someone says, I'm sorry, I have bad news, you know, the the words nobody wants to hear, the worst words in the world.

28:40 Uh sometimes that's you know, there's a sense that if I'd had the scan sooner, it would have made the difference. And, you know, those sorts of if only, if only, what if sorts of questions. And for anyone who's had to experience the distress of of seeing a scan where a baby has died, it's it's the it's the most awful thing to have to witness.

29:08 Um, and so that fear that I'm gonna see that again, fear that I don't know, fear that I haven't done enough to prevent that from happening, makes scans feel very, very difficult in the lead up.

29:21 What can someone do to prepare, if they can prepare? If they know, say it's a 20-week scan and the last time that is when something was identified. How does a person prepare for that big milestone?

29:37 Uh I think it's probably having to do some uh reality testing and sitting with the uncomfortable feelings of that are coming with it, but you know, the reassurance that uh there, you know, that because something has happened in a previous pregnancy doesn't automatically mean it's going to happen again and trying to use that settling.

30:02 I guess in most instances where someone has had a previous loss and that raises concerns about future pregnancies, those those parents have usually had very different obstetric care. Um, you know, there there's been probably a lot more um testing and reviewing and uh you know focused seeking if there is anything to be looking for.

30:30 So remembering, I I tend to ask people to remember what's been different during this pregnancy from what's what happened last time. Um, again, as a as a form of reason. Um to some degree it's it's getting to the day, doing the best you can, knowing that um that whatever is happening, you're doing the best in your pregnancy.

30:54 There's nothing more that you can change. We just have to wait till you get the scan.

30:59 What about attachment? Do some women avoid being too attached to the pregnancy or to the baby um during that pregnancy because that's their best protective mechanism?

31:12unknown Yeah.

31:13 And does that have any sort of future impact on their attachment with the baby?

31:17 Yeah. Yeah, there's no doubt that a lot of women will suspend attachment as as long as they can. Um, definitely uh until after the time gestational stage of the previous loss. So if someone found out their baby had died at 10 weeks' gestation, they will try very, very hard not to connect to the baby until into the second trimester and so on.

31:43 That's really tricky for people who had a stillbirth because that sense of again, I can't connect to this baby because I can't feel confident that this this baby will be born alive and well makes that feel too difficult. I think it's a very, very common defense response and it's really understandable.

32:02 Um, the good news is it seems to have a very poor predictive quality in terms of how well you're going to attach to the baby afterwards. So not being able to attach during pregnancy or feeling too scared to attach during the pregnancy does not mean you're not going to be able to have a good connection to your baby afterwards.

32:21 It just means you're probably going to have a pretty bloody awful pregnancy in terms of how you feel.

32:27 But that's good news. Like if someone's listening to that and thinking, oh my God, have I done the wrong thing by my baby? Am I being a bad mum already as I grow this baby? Yeah. That's good. Hang on to that. Yeah.

32:39 Baby does not know that you're you're not really believing that they're in there. Baby does not know they are not listening to your thoughts. And and in my experience, we can definitely turn that around. And normally, you know, for a for a lot of mums, it's uh it's quite often as soon as the baby is born, it's like that defense just crumbles because we don't need it anymore.

33:01 Agreed. What about uh some of the psychological tactics that people play in their in their brains? I mean, I'm an um just an eternal optimist, and sometimes that makes me fall on my face a little bit. But what about people who um just go, well, if I expect the worst, then I avoid disappointment. Like what are these, what are good psychological tactics?

33:25 Is that a good psychological tactic?

33:27 Yeah, um, oh look, it probably doesn't do any harm. I I I work a lot with women in the fertility space as well, and it's it's a that's a popular choice when when women are going through IVF as well. Uh if I just don't get too excited, then you know I won't get disappointed. Um look, I I think the answer is the same as what I just gave.

33:48 Baby's not listening to you and your superstitious thinking. Yeah. Uh so baby doesn't care what you're thinking. And you can you can think the best, you can think the worst. The baby's going to do what the baby's going to do. The pregnancy is going to progress irrespective of what mind games you're playing with yourself.

34:06 I just um I just think it it's a really hard way to be pregnant if you're telling yourself to expect the worst all the time. It's it's pretty depressing, so and it's anxiety provoking. So I I tend to talk about um I I call it realistic optimism, which is looking at, you know, what what are what does what does the data tell us?

34:29 You know, what what's the the chance of the pregnancy proceeding? Now I really understand that for people who've had, you know, a one in a thousand chance and they were the one that is not reassuring. Uh but telling yourself, oh well, what's the point? It's all going to be terrible anyway, is also not reassuring.

34:48 So um uh, you know, I I think it's just trying to come back to um remembering that because something has happened before does not predict it's going to happen again. And trying to kind of snap those protect uh predictive links that we've created in our brains.

35:08 Dr. Pat talks a lot about uh roll of a uh new dice, you know, like the some of them there you might be predisposed to the same thing happening again, but for many issues it's just a roll of a new dice.

35:20 So yeah.

35:21 What about people that have already had uh health issues diagnosed such as anxiety or depression or OCD or any of the mental health issues? Do they have a better or worse, or how do they fare in pregnancy after loss?

35:40 I I really feel like with any pregnancy, irrespective of past loss, unfortunately, uh the perinatal period is our most high risk time uh for us to experience mental health complexities. And um if we have had previous uh difficulties, it's a very high risk time for recurrence. Uh past losses simply add to the risk factors there.

36:11 So uh unfortunately, if you have previously had uh mental health conditions, be they anxiety, depression, OCD, eating disorders, whatever, um, unfortunately we see you as someone who is at higher risk of having those difficulties again. And as I said, a pregnancy loss would simply add to that. My my um advice would be: this is a really good time to reconnect with your past mental health team if you've got one, or to find yourself a good perinatal psychologist who understands how these conditions can emerge during pregnancy and postpartum and to get some support.

36:55 You don't have to do it by yourself, um, and you probably need someone who's able to keep an eye on you, watch your baseline, mental health, and see if things are getting a bit wobbly. Because, like I said before, early intervention is the key. That's how we keep people as well as possible, and there's plenty of things we can do.

37:15 Um, for some people, that does include medication. A lot of women don't want to take um psychiatric medications during pregnancy because they're fearful about the effects on baby. The reality is the risk to you and baby of being unwell and unmedicated massively outweigh the risks of being well and medicated because we have some great options that we can use that we know are very, very low risk to Bub.

37:49 Uh, but spending nine months of your life um with elevated adrenaline is not really doing anyone any good. So um, yeah, get get your mental health team on track.

38:02 Great. Um, when we are in this situation, and we talked a lot about the woman, but you know, let's say she's got a partner. Um how do they fare as a couple during this time?

38:17 It's hard work. Um, yeah, I mean the partners also had the loss in the previous pregnancy. Uh, it may not have been experienced the same. They may not have gone through the physical experience, but they definitely went through the emotional experience. And they've also had to witness someone that they love go through something that's probably one of the worst things they've ever had to deal with in their lives.

38:42 And they're probably also really scared when the next pregnancy comes around. Uh, but again, they aren't feeling the physical effects, they don't have that sense of direct personal responsibility. One of the hardest things about being a caring parent is that no matter what you've been told was the cause of the baby um not surviving, still think my body did that.

39:10 So um, you know, there's that sense of personal responsibility is really strong. Partners don't tend to have that, but that also makes them feel quite helpless. Um and I I think when when a pregnant person is feeling really anxious, they're often not feeling um their best versions of themselves. They're not they're not feeling very friendly, so it can put a lot of strain on relationships.

39:38 People experience grief in different ways as well. So uh for the pregnant person, they might be going through and feeling scared and terrified for the for the non-pregnant partner, they might be especially in the early stages of pregnancy, it almost sometimes feels like it's it's not really happening, it's very surreal.

39:59 So you might not be connecting into it in quite the same way.

40:04 And for maybe the mum and the partner, how do they both feel? What do you see after the baby's born? Does the anxiety and the fear disappear, or is it still there?

40:17 Uh sometimes. I I probably I probably find that partners tend to have the anxiety evaporate a little bit more easily. Um, again, I think it's probably not having had that very direct personal responsibility to to um bring this little human into the world. Unfortunately for some people, that pregnancy anxiety will turn into a postpartum anxiety.

40:45 Um, and it's I mean, it's really a form of health anxiety where we become, we have a an overestimated sense of risk that uh something else is gonna happen. And it almost feels I mentioned superstitious thinking before. It's almost like, oh, okay, well, I got the baby born healthy, but that's not a guarantee.

41:08 Now I've got to figure out all the other things that um so that anxiety is still playing its nasty little games in their head and never letting them feel very safe. So sometimes that anxiety actually continues, unfortunately.

41:23 So how much does the cause of loss matter psychologically? We've just talked about recurrent miscarriage right up to stillbirth, but does it impact differently?

41:37 I think the experience of loss is incredibly personal and individual. And the the complexity of taking a pregnancy all the way to term and then not being able to bring a live baby home is uh just you know, the it's just the literally one of the worst things I think anyone can go through in the world.

42:08 For another person, a pregnancy loss at a very early stage of pregnancy may feel just as catastrophic to them. Uh and I I certainly see people who even I mentioned that I do a lot of work in the the fertility space, people who've had a an embryo transfer that hasn't worked will experience that as the most catastrophic experience.

42:35 Um and I think we have to be extremely careful not to invalidate somebody's loss because to us it doesn't seem bad enough. Um, there isn't a grief Olympics, you don't win a gold medal for the worst bad thing. Uh and it I think this is very important for partners and support people to remember as well.

43:02 We we shouldn't be rating grief. Um that happens a lot. Um if that person experienced the grief as or the loss as horrific, then it's horrific. The nature of how the loss occurs, I think um can also really influence if it feels like it was something preventable. So I'm not sure if someone's involved in a motor vehicle accident and subsequently has a loss, they're going to go through the if I'd gone a different way, if I hadn't gone to work that day, you know, if if if if if if if and all of the the what ifing that goes through that, and how could I have possibly prevented that?

43:51 If someone has a spontaneous bleed at home, um then the the feeling of that is going to be um extremely difficult as well. If if someone is in a late stage of pregnancy and they haven't noticed that Bub was not moving so much for a few days, and then they suddenly, or if even a few hours, and then suddenly think something's different that I should have done and I could have done's and what ifing is going to come through as well.

44:26 So, and I'm I talked before about having an an ultrasound diagnosis of a loss. There, there's guilt that goes with that. How could I have not known? How could I have not felt my baby die? Um Know what kind of mother am I? Gee, we're good at asking ourselves that question, aren't we? Um so I think all of those things can really influence the experience of the loss and then also how we see ourselves as capable and competent as a parent, how much we can trust our body, and how that's going to make us feel in the next pregnancy.

45:02 On one of your bios that I read, you talked about um TFMR or termination for medical reasons being a unique type of grief. And I know we'll be having people listen to our podcast that have had a TFMR. Um can you describe whether their experience is the same or different? From what you just said, it's it's it's similar, but you know, I I think it's worth mentioning people with TFMR.

45:30 Yeah, I'm really glad you did because um I I think they get left out of these conversations frequently. And I really do feel like it's a unique grief because they often don't feel like they have the right to grieve their baby uh or even to acknowledge that it was a termination as opposed to a miscarriage.

45:55 They often feel they have to kind of hide the truth of the termination. And in in my view, the decision to end a pregnancy that you wanted, that you loved, that you were looking forward to, but there's something about that baby where you've made the decision that that that is that you do not want your child to live the life with whatever condition it is that's been diagnosed, or you as a parent do not feel like you have the capacity to parent a child with those difficulties.

46:30 That has got to be one of the hardest decisions a parent can ever make. You know, that that's like deciding to turn off a life support machine. And that they are they are just horrific decisions. Um, and the questions those parents ask themselves about, you know, can I be sure? Did I, you know, was it right?

46:49 Did the doctors really know what they were telling me? You know, did I make the right decision? They're horrendous. Um, and so they're grieving and they're guilty and they're not sure if they have the right to be grieving. And you know, it's so complicated, and they often don't get the support they need because they don't feel like they're allowed to talk about um what that loss actually represented.

47:14 But it is it's a huge loss.

47:17 We recently um went to a twin funeral, um, and the parents uh the mum had a catastrophic CMV infection early on in her pregnancy and um yeah, went through a TFMR. Um the the twins wouldn't have been viable after birth, anyway, which is is a terrible sort of medical speak. But um it was beautifully done.

47:45 This funeral was a uh not a a set funeral that we would think where people get up and spoke. It was just that each person there at the um funeral home could go in with the mum and the dad and the twins and just sit with them for a bit. It was very beautiful.

48:03 I'm so glad for those parents that were able to do that. It's to me, um the greatest privilege I get in my work is the occasions where I've been able to sit with parents in the hours or days after the the death of their little one and just sit um with them and with their baby, and the days where perhaps I haven't had an opportunity to meet the baby personally, but where they've been prepared to share a photo of their baby, share their name of their baby, to talk about the baby, to describe how beautiful their little one was, you know, it is the biggest honor in the world to be brought into that.

48:43 And for anyone who is at that that funeral, that is such a privilege to be included in that that experience of mourning those little people.

48:54 Yeah. And then, you know, I'm even thinking about this family. So from then on, you know, they want to go on and have their next pregnancy. People who are listening to this podcast are listening because they're thinking about either being pregnant after a loss or they are currently pregnant after a loss.

49:16 How do we help them uh move from grief and loss being their defining lens in this pregnancy? What are the some of the best tools that you think you can offer?

49:27 Yeah, I I think it it's actually allowing grief to still be there. Grief, you know, that that's not gonna stop. Like I said before, you're there isn't a day where you're gonna get over it. So you're you're allowed to continue to br to to grieve and to to miss that baby that you didn't get to meet, or you know, you're not getting to parent.

49:51 Uh but it's the end. It's the and we are also preparing for this next stage of our life. But it it's like for people who have more than one living child, that you don't have a second kid because the first one's not good enough. Well, most people don't, hopefully. Um so you don't. I'm one of four, so I really hope that's not true.

50:16 I'm one of six, so I was a fourth, so um obviously my parents stopped at four, so I must have, you know, I must have met all the needs. Um, but it's not why you have more kids. It's not because some some, you know, the the other ones uh and you don't stop loving the first one because you have another one.

50:35 And so to imagine that that's what you have to do when your first baby or your second baby, whichever it is, has not survived is kind of just, you know, it's insane, really. It's crazy. Um, so knowing that you can love both of your babies, even if we're only going to get to parent one in real life, but it doesn't mean the other one doesn't stay with you.

51:01 Um, sometimes it's about finding those little rituals and finding ways to celebrate that little little person. I remember um I also, whenever I talk about these things, I often think of parents. And one of my favorite um stories I have ever heard was a beautiful family who um they had a son uh who was about four, and um their daughter was stillborn at term.

51:32 And um, so the little boy was old enough to understand, and he'd been really excited about getting to meet his little sister. He knew it was going to be a little girl and all the rest. And um after she was still born, he was incredibly distressed, and and his mum was really trying to figure out how to help him grieve while she was, as you can imagine, just beside herself.

51:58 And so they decided to set up a little ritual of lighting a candle every night at dusk. Um, and it was their way of saying goodnight to the baby. And and sometimes she would forget, which she, you know, talked about feeling guilty about, but her son would always say, Hey, we haven't, we haven't lit the candle for baby girl.

52:21 And so it was this, you know, sort of giving her a kiss goodnight every night. But she also told me the story of um she went, she took her son to childcare. Um, it was a couple of weeks after the the little girl had died, and um he was looking sad, and one of the other little boys in the playground came up to him and said, What's wrong?

52:45 And he said, Uh, my baby sister died. And the other little boy said, I had a little baby sister who died as well. Oh. And so these two boys, I know, right? It's this is quite a while since this happened, and it still gets me in the feels every time. But it, yeah, this these two kids embracing each other in the playground over this shared experience, and they shared their little sisters' names, and they both talked about how sad it was, but it it just it was such a beautiful way of honouring these little girls.

53:20 I just I thought it was divine.

53:23 I want to talk about um something that we see a little bit on social media, and it's a term that I know, and that is post-traumatic growth. Is this is this actually a psychological term, or is it just something that's bandied about?

53:38 No, no, it's definitely a thing. So people are probably a lot more familiar with the concept of post-traumatic trauma or PTSD, which is a disorder, and I guess that is where as a result of a traumatic incident, um, we uh uh we become traumatized. And we all might carry trauma, but to what degree does it affect us and interrupt our lives again?

54:03 Post-traumatic growth doesn't deny the fact of the trauma, but it talks about the fact that we might be able to change as a person or emerge in ourselves in a positive way or in a helpful, healthy way. So sometimes, probably one of the more common ways that people grow post-traumatically is to get a different sense of perspective that things that seemed important before probably just don't, you know, kind of matter anymore.

54:37 So it might be something like I was always so preoccupied with work and deadlines and and you know, getting being the highest achiever. But after having had this incredibly significant event and this trauma in my life, I realize that work is not the most important thing to me. These other things have become more important.

54:59 I now understand the value of family and I'm I want to commit myself to that more. Um sometimes people uh will do it by uh honouring the the baby or other person who's died through legacy initiatives, so it might be setting up foundations and um funding um fundraisers and such. So something I see a lot within the the infant loss space is people funding for cold cots in hospitals or other support mechanisms for parents.

55:30 And there's some beautiful examples of that. Some of the support organizations like Bears of Hope and and Precious Wings, and those those sorts of organizations uh have grown out of that. So they're they're actually beautiful examples of post-traumatic growth and that opportunity to turn something awful into something extraordinary.

55:51 Um, we don't all have to do those sorts of big things, but um, you know, we're all capable of them.

55:58 So I want to finish with um support mechanisms. So you've talked about Bears of Hope and um Precious Wings. Precious wings.

56:06 There's there's so many different ones that um yeah, yeah.

56:10 Who are your go-to? Who do you recommend your people um touch base with?

56:15 Yeah, look, a lot of the hospitals have excellent bereavement services, some better than others. Um, but the the ones that have established bereavement services, those those bereavement workers are amazing. Um, you know, they're they're next level. Uh Red Nose, of course, is an incredible organization, um, and they've done a really extraordinary job over the years of expanding their services to uh include miscarriage, TMFR, um, and uh they're doing some great stuff for dad, um, dads who've experienced losses as well.

56:56 Um there's um I I'm in Brisbane and um I know that Red Nose here has an amazing uh bereaved dad who does a crazy amount of work um with other bereaved dads, and um he he's he's just an incredible guy. Um so some of the services there have been amazing. Bears of Hope also do some great stuff there. They have they have this great fundraiser every year called Beards of Hope, where the guys all grow grow their beards, um, which personally I think is possibly a crime against humanity, having these big raggedy beards where they don't shave for about three months.

57:32 But anywho. Um uh obviously Pink Elephant Support Group is amazing. Sam has done such a great job of um attracting funding to her organization, and it's allowed them to um build so many resources and online support networks and such. They're just their most incredible advocates. The Glimmer project has done some beautiful work over the years.

58:01 Um there's a few others around, but I'm not 100% sure about the funding that's sitting on them at the moment. So uh unfortunately, a lot of these organizations are very vulnerable to government funding. They're charity-based, and so sometimes they come and go with their energy. Um, but on my website I do keep a um a big list of them as well.

58:25 So um you can uh have a look at the resource page there, and there's there's a there's a whole list of organisations which provide free support and great.

58:35 Do you mind if we link to that in the show notes? We'd love to get a link to that. Right, we'll do that so people can go there and and sort of have a look through. And I I'm assuming a lot of people, if they've picked up this podcast, perhaps they've already gone to lots of these places. But you know, for those people that have have just gone through a um are pregnant again after a loss or whatever, they might just be at the start of this journey.

58:57 And I I think also for anyone, maybe it's a partner or a family member or a friend who's thinking, I don't know how to help my loved one. Um, they're great organizations to get some tips. They often have special pages for how to support someone through loss. So um, yeah, I think there's some really good hints there, not not only for the bereaved person, but the village that sits around them.

59:20 Perfect.

59:20 Great. Well, Noelle, thank you so much for your time. Um, I said it was going to be half an hour, it isn't, it's nearly an hour. Uh but that it's a big topic. So I'm I'm I'm glad that we got the chance to sort of really explore it.

59:34 Yeah, thank you. It's been lovely. And sorry, I I do I I can talk the hind leg off a dog, so we can talk all day about this.

59:42 That's great. All right, thank you very much for joining us. Thank you everyone for listening to the Kick Pregnancy Podcast and our conversation with Norrell. If you have loved this episode and you think that you know somebody that would also love this episode, please share. That is a great way of getting our information out there.

1:00:01 All right, I hope you are feeling well and keep growing those babies will be in your ears next week. Bye for now. Hey, even though Dr. Pat is, well, a doctor, and we get lots of other doctors and other experts on our podcast, I just need to remind you that this podcast is for informational purposes only.

1:00:25 We share lots of medical insights and experience, but everything we talk about is general in nature and may not apply to your specific situation. Please always consult with your own healthcare provider for your individual medical advice when you grow your baby.