Psychosocial Care

Pregnancy after loss is frequently described by families as a rollercoaster of emotions with extreme anxiety. Even the decision to pursue another pregnancy can be stressful. The variety of challenges have been described as developmental phases. It is essential for families to have health professionals who understand the complexity of these thoughts and emotions.

Common concerns of families include worry about replacing the baby who died, avoiding attachment to this baby, feeling paranoid about symptoms, and increased grief intensity. Many families have reported that they worked with health professionals who made insensitive comments, lacked empathy for their anxiety, were unaware of their history, and did not provide important information. They will also receive insensitive comments and questions from family and friends and often need support to cope with the emotions that arise.

Trauma-informed care is an important component of the protocol for these pregnancies. Health professionals should be willing to listen without judgment, establish trusting relationships, be mindful of triggers, and include the family in all decisions. Families also appreciate when their concerns are taken seriously, including offers for additional clinical care as needed for reassurance. Referral to specialists and mental health therapists may also be helpful.

Recommendations

• Acknowledge the previous baby(ies)
• Ask if the baby(ies) were named and how the family would like health professionals to refer to those babies during this pregnancy
• Provide multiple support options with contact information
• Discuss plans for antenatal care, labor/delivery, and postpartum care to identify, avoid, and manage potential triggers
• Minimize interaction with other pregnant women if desired by the family. Examples include a private entrance/exit or a separate waiting room.
• Acknowledge the anxiety and mixed emotions and offer options for coping with them
• Support flexible and/or additional care as needed for reassurance