This post was originally published in October, 2014.

October is Pregnancy and Infant Loss Awareness Month, and this is a topic that hits close to home for me personally. In 2012, just after my husband and I decided to start trying for our first baby, I lost three pregnancies in eight months. This month, the first baby – Ziggy, to us – would have turned two years old.

Pregnancy loss is a particularly tough grief to carry, because it’s sort of invisible. For me, like many women, miscarriage happened before I’d reached the point in my pregnancy where I’d started to share the news with others. So when the pregnancy ended, it was difficult to talk about or ask for support. Doing so can be very awkward: “I was pregnant, but now I’m not.” Miscarriage is grief for a person we’ve never met, never saw, never touched – but to whom a lifetime of dreams are attached. It’s grief magnified by self-doubt; by persistent wondering if we’ve done something or not done something to cause this, if our bodies will be able to do it right next time, if there’s something “wrong” with us that might not be fixable. It’s grief accompanied by guilt, for having let down our partners and even more so, for somehow having failed our babies. It’s grief for one’s hopes of becoming a parent, or becoming a parent again, or giving one’s child a friend for life in the form of a sibling. And all these many layers of grief come on top of the intense physical challenges that a pregnancy loss brings – pain, fatigue, readjusting hormones, and sometimes frequent and invasive trips to the doctor.

Let me also be very clear that miscarriage is only one kind of pregnancy loss. Many also struggle to cope with pregnancy losses due to stillbirth (defined as the spontaneous loss of a pregnancy at 20+ weeks of gestation) or termination of a desired pregnancy for medical reasons. The emotional ramifications of these events can be complicated, especially when they include difficult feelings such as shame and guilt.

Here are a few things you can do to provide effective support to a friend or loved one during the experience of pregnancy loss:

• Encourage her to take some time for herself. Pregnancy loss can be traumatic, and if possible, it’s best to let the experience be private. Encourage her to take a couple days off work, rent some good movies or grab a great book, and just relax and heal.
• Be open, but not pushy. Some moms will want to talk about their experience, and some will not. The best thing you can do is to make yourself available to listen, but leave the decision up to her. Say something like, “I’m here for you if you want to talk about it, but please don’t feel like you have to.” Make this offer a few times, reminding her that the door is open.
• Use your knowledge of her. One of the nicest things that anyone did for me when I miscarried the first time was to send me a beautiful, thoughtful care package. It contained a heartfelt card, a CD with a song she knew I’d like, a soft blanket in my favorite color, and a tube of my favorite lip gloss. It was simple, beautiful, personal, and made me feel so loved. Today, when I hear that song or use that blanket, I think of that friend and I think of Ziggy – but the feelings that wash over me are warm and safe.
• Use HER language. Some of the language that surrounds pregnancy loss is tough to hear – the medical term “spontaneous abortion” is particularly difficult. When supporting a grieving mom, listen carefully to the words she chooses and then use them yourself. My husband and I talked about Ziggy, and called our baby by that name all the time (we still refer to him by that name) – it really meant a lot to me when friends called him Ziggy, too. It made him feel more real, even after he was gone.
• Give her permission to grieve. It can be very helpful to just have someone acknowledge that a loss has taken place, and that grief is an appropriate response. Let her know that it’s okay to be sad, angry, confused, etc.
• Don’t forget about the due date. Miscarriage grief often happens in two phases: when the loss actually occurs, and then when the due date approaches. But by the time the due date rolls around, the world has moved on and the sadness that re-emerges can be particularly tough to handle. It will mean a lot to a grieving mom if you remember the approximate due date and check in with her around that time, offering your gentle support and understanding.
• Remember the other parent. It’s easy for the other (often male) partner/parent to be overlooked in the pregnancy loss grief process, and these partners are often carrying the bulk of responsibility for supporting mom. It will mean a lot if you reach out, offer support, and acknowledge the other partner’s experience, too.

There are also a few things to steer clear of when supporting someone grieving the loss of a pregnancy. Here are a few phrases to avoid:

• Everything happens for a reason. This one stings, because although sometimes miscarriage does happen for a reason, it’s not often a reason a grieving mom is ready to think about. For me, the reason I kept having miscarriages was because my body was malfunctioning and terminating instead of nurturing my pregnancies. So when people told me it happened for a reason, a voice in my head said, “yep, and that reason is me.”
• At least you know you can get pregnant, you can try again soon.  I understand the spirit behind this one, but honestly, it’s small consolation when in the throes of grief and loss. The prospect of trying to get pregnant again feels daunting and far away, and thinking about another baby feels like a betrayal of the one just lost.
• At least you weren’t that far along. This statement implies that there is some sort of timeline for grief. If I miscarried at 24 weeks, am I allowed to grieve longer and more deeply than if I miscarried at 8 weeks? Just like you can’t be a little pregnant, you can’t have a little miscarriage. It’s a loss, no matter when it happens, and each mother should be allowed to grieve in her own way and on her own timeline, without others making assumptions about how much grief is appropriate.

Early on in my experience with pregnancy loss, I made a conscious decision to be open about it, and I try to continue to do so. It bothers me that pregnancy loss is such a taboo topic – that we don’t talk about it or provide the support that’s needed because it’s uncomfortable to talk about or we’re embarrassed to admit that we’ve lost a baby. It might surprise you to learn that pregnancy loss occurs in approximately 1 in 4 recognized pregnancies — many of us just think the number is lower because it’s not talked about with anywhere near that frequency. I hope that as more people talk about it, the conversations will become easier and the taboo nature of the topic will fade away.

Lindsey Hoskins & Associates provides couples, family, and individual therapy in downtown Bethesda, MD. We are available to provide support to women and couples experiencing pregnancy loss or fertility challenges. Call us at (240) 752-7650 to schedule an appointment.