How To Decrease Shame After A Pregnancy Loss

What's your experience like, is it hard to find community? It takes courage and vulnerability to foster connections that support our growth and healing, especially when we're struggling.

As we welcome November, I'm reflecting on October and the advocacy and awareness highlighted through the Pregnancy and Infant Loss Awareness month campaigns on social media. I was reminded by Sara*, a member of my infertility group, how much work there still is to do. Sara's experienced multiple pregnancy losses over recent years and yet never heard of this awareness campaign. How about you?

Sara joined the group feeling emotionally isolated from her large and loving family. As the parent of a toddler, there were a lot of questions about baby number 2’s arrival. She shared little with family about her recurrent miscarriages and secondary infertility and came to loathe family events. The barrage of questions that would inevitably come, and the feelings of shame were too much. Isolation was easier.  
 
Thankfully, someone pointed Sara to my group. She loved hearing from other group members who faced similar dilemmas, and similar grief. She perked up when I shared about the Pregnancy and Infant Loss Awareness campaign early in the month. We discussed the different hashtags to explore, and the Wave of Light ceremony on October 15th, where people light candles in honor of their babies who have died.

Earlier this week we met for our final group session. Sara beamed as she shared about her disclosure on social media. Inspired by the online community around #pregnancyandinfantlossawarenessmonth and the connections she made in group, Sara shared publicly for the first time about her journey.  

She was blown away by the thoughtful comments, love, and compassion she received from her community. When she attended a family event over the weekend, no one asked her about baby number 2. Was it a coincidence? She wasn’t sure, but she felt inspired by the response to her vulnerability and encouraged to keep talking with those she loved. 

I share Sara’s experience for a few reasons. To highlight:

1- Campaigns like Pregnancy and Infant Loss Awareness Month are so important!

They help create community for people who are feeling isolated. They decrease shame and inspire people, like Sara, to break their silence and gain needed support to weather difficult times. Campaigns like this also help to educate our community so we can be more empathetic towards one another.

2- Your voice matters.

Letting people in takes courage and vulnerability.  Letting people know your pain means they can offer you support. Does sharing on social media feel like too much? Consider what it would be like to open up to someone you trust. What might you gain in return?

3- Therapy groups are healing.

Not only do groups decrease isolation, but connecting with others experiencing similar struggles has the power to reduce shame. After all, empathy is the antidote to shame. 

I know it can feel scary to step out of your comfort zone. While social media can be a tough place, when you look in the right places there are many supportive communities waiting. To join a group, to speak up, to ask for help— it takes courage. And yet, taking risks, like Sara, is what brings us out of isolation and closer to one another. 

If you're interested in joining a group here in San Diego, or virtually throughout California, or would like to explore individual support along your reproductive journey, don’t hesitate to reach out.

Why I took a risk and joined a therapy group

In May of this year, I published this in my newsletter. I want it to live on for others to read and learn more about group therapy so I’m sharing it here. (If you’d like to join my mailing list to receive future newsletters, please sign up here).

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Last October I enrolled in a group therapy training program. If you’ve been following along for any length of time you know I’m passionate about running groups. If you're new here— welcome!

Enrolling in this program seemed like a natural step to deepen my work. What I didn’t realize was just how much I would learn about myself. In addition to the monthly Saturday classes, students are required to participate in a weekly interpersonal process group. I was aware that one's role in the group often mimics interactions in the outside world. But I had no idea how that would FEEL.

To see myself more clearly has been liberating. From my interactions with colleagues, to the group of parents I’ve met through my child’s softball team, to my family of origin— I'm the same person, doing the things I do that keep me feeling safe and that simultaneously hold me back from being the person I'd like to be. 

The group provides an experimental place to try out new things and take risks in being the person I'd like to be in the outside world. With practice, the hope is that I will start making changes in all my real-world groups.

Participating in a group is a risk. We don't know how we will change, and if the group will deliver what we are seeking. It takes vulnerability and courage to show up, commit, and make changes where old patterns are no longer serving us. By the end of the group, most people feel more comfortable in their own skin.

I don't usually disclose so much about myself, but I’m sharing my experience because soon I will be offering process groups in my practice to provide a similar opportunity for others. Message me here with any questions you have about process groups. What would it be like to lean into being a better version of yourself? 

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As of August 2024, I’m opening enrollment for a women’s group I’m starting this fall. This group is open to everyone and anyone who identifies as a woman. Would you like to learn more about yourself, challenge old patterns, improve relationships at work, home, with peers? This group is for people who are interested in learning about their own reactions and interpersonal interactions. The focus is on what comes up within and between the members in the room. You can learn more about the group here.

Becoming More Mindful: Where to Start?

Photo by Tanushree Khanna on Unsplash

We live in a fast-paced society where it feels like there's rarely (dare I say never) enough time. I know I'm not alone in this feeling; I hear about it daily from friends and family, and of course the clients I counsel in my practice. The overwhelm is folded into the lives of my clients who are struggling to conceive, those grieving, the women who are adjusting to the reality of motherhood, the men who feel a ridiculous amount of pressure to provide and succeed financially. Sometimes the greatest stressors come from within, our attempts to be the best partner/parent/daughter/brother/insert role.

Mindfulness has been a buzz word for the past decade or so and shows no sign of leaving center stage of the $3.7 trillion global wellness market (Reference). And there's good reason-- midnfulness is touted as the antidote for aging, perfectionism, anxiety, depression. The list goes on. But for those unfamiliar with mindfulness, learning what it is and what it isn't, and figuring out how to bring it into your life can cause more of those feelings of overwhelm we're trying to conquer. After all, won't adding something else to your to do list make you even busier?

That feeling of being busy and rushing all the time, there's a choice in that. At least that's what the gurus of mindfulness tell us. With a mindful approach, we get to decide how we interact with the world around us. Mindfulness helps us to slow down and  to pay attention to our thoughts, behaviors and reactions. Mindfulness allows us to respond rather than react.

How to Be More Mindful

So how do we bring mindfulness into our daily lives? Like all things we strive towards, we must develop a mindfulness practice to reap the rewards. We must schedule a time, then stop what we're doing, and sit. Starting with a guided meditation can often be a helpful place to begin for those who have no prior experience with mindfulness. Below is a short 5-minute guided mindfulness exercise. It's one that I introduce to clients in my practice and in my infertility support groups: 5 Senses Mindfulness Exercise. I didn't write it myself, but it's my recording.

I like this exercise because it allows us to recognize the many ways we can be mindful in our own bodies each and every day. By attuning to the senses we can invite ourselves to stay in the present moment when we're eating, resting, gazing, walking, listening-- grounding ourselves wherever we may be, whenever we need it. 
 

The Wandering Mind

Photo by ANDRIK ↟ LANGFIELD ↟ PETRIDES on Unsplash

I like to remind my clients that there's no right and wrong with mindfulness; it's simply about cultivating awareness. Many people incorrectly believe they're "doing it wrong" because their mind wanders. This is normal as our minds are made to think. The practice of mindfulness is to simply guide your attention back to whatever it is you are doing-- breathing, pushing a grocery cart, taking a shower. Yes, each of these activities can be done mindfully. But let's start with sitting.

So find yourself a quiet place to begin. Push the button below when you're ready. You will need to download the link in order to play it on iTunes. I hope this experience allows you to slow down, if even for just 5 minutes

Whether you're a busy parent or longing to be one, mindfulness is an invaluable tool to help cope with the stressors of daily living. If you’re looking for a therapist in the San Diego area, I’m happy to help. Feel free to reach out by phone or email and we can talk about ways you might benefit from counseling. 

Birth Trauma: Strategies for Healing and Prevention

This is the second part of a two part series on Birth Trauma. In Part 1, which you can read here, you met Sara who was fearful of becoming pregnant with a second child. Although she was riddled with anxiety, she was unaware she had a real problem: because she’d experienced trauma after the birth of her first child she feared getting pregnant. Although birth trauma is a real psychological condition, with concrete symptoms and a diagnostic criteria, many people internalize their experience, feeling shameful instead of seeking support.

My chance encounter with Sara was pivotal. A few weeks later she reached out asking for a referral to a local therapist. Through our informal talks I was able to help Sara understand how her unique experience left her vulnerable to experiencing a traumatic birth (also called postpartum PTSD), and that it was not only extremely common but treatable.

Sara, like many women I see in my practice, was unaware that her symptoms were worth paying attention to. The most common coping strategy I hear about is the attempt to ignore symptoms- to sweep them under the rug so to speak. But this approach is rarely successful for very long.

Women who eventually enter my office for therapy are typically struggling with one or more of the symptoms addressed in Part 1 of this series- symptoms that interfere with their ability to function at home or at work.  In this article I’d like to offer some recommendations for healing from traumatic birth and/or preventing a subsequent similar experience. 
 

Treatment of Traumatic Birth, or Postpartum PTSD

While many women who experience some symptoms of Postpartum PTSD will resolve their emotional stress with positive support from friends or family members, others will continue to struggle and will benefit from professional help. Recommended treatment for Postpartum PTSD starts with a thorough assessment by a trained mental health provider.

1. It’s critical to be assessed by someone who specializes in maternal mental health for a correct diagnosis to be made.  Therapists unfamiliar with postpartum PTSD might inadvertently recognize the symptoms as postpartum depression or anxiety. Although some of the symptoms are similar, the underlying experience of a birth trauma calls for a different treatment approach.

2. Both medication and therapy are evidence-based recommendations for treating birth trauma. Many therapies work quickly and effectively with postpartum PTSD, such as EMDR, which I offer in my practice. Narrative, group, and body-based therapy can be helpful treatment modalities.

Avoiding a Subsequent Traumatic Birth 

Whether you're anticipating a future pregnancy or currently pregnant, there are many things you can do to reduce the likelihood of experiencing a subsequent birth trauma.

1. Include your partner in this process. While it might seem obvious to some, others may feel isolated by their initial trauma and not realize the important role a partner can play in providing support and mitigating a subsequent traumatic experience.

2. Hire a doula. Simply put, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. If for some reason the birth is not going according to your ideal plan, a doula will intervene during labor with the intention of alleviating the trauma to reduce a woman’s chances of developing PTSD.

3. Take a childbirth education class. It’s important for women (and their partners) to be educated about what is supposed to happen during childbirth and what happens in the body during the birthing process. Childbirth classes also help to inform expecting parents about options during birth including: pain management, birthing positions, and how to cope with complications during birth.

4. Develop a written birth plan with your birth team. Discuss and include the interventions you are open to, those you want to avoid. Explore your back up plan. Remember to plan for the postpartum period and to consider the support that will help ease your adjustment to motherhood, or to mothering an additional child.

5. Talk to someone you trust. Work through any past traumas with a therapist, or at the very least discuss your history with your care providers to best prepare for the experience of labor and birth.  Meeting with a psychotherapist or body worker specializing in perinatal mental health allows you to focus on beliefs, emotions, sensations and andy past experiences that may influence your upcoming birth.
    

Help Is Available

Birth trauma is highly treatable; the first step of course is to recognize there's a problem.  With help you can avoid additional suffering and complications for both mom and baby. In San Diego, Postpartum Health Alliance offers a warmline with trained volunteers as well as a provider directory to locate trained therapists and other birth professionals. Outside of San Diego, Postpartum Support International can connect you with therapists worldwide who specialize in maternal mental health disorders.

Infertility Support Group

The journey through infertility can be lonely and isolating. Maybe you've lost touch with some of your friends or they just don't understand what you're going through. Even family, while well-meaning, often don't get it. 

The anxiety and stress can feel overwhelming. You're not sure what your next step is and how to navigate this stage of your life- this stage you never imagined having to go through in the first place. Maybe you worry you're too depressed to be around a group of other women. But remember- these women GET it! 

Join me, Rachel Rabinor, Licensed Clinical Social Worker and Dr. Elizabeth Winter, Licensed Naturopathic Doctor and Midwife for this 6-Week Mind/Body Infertility Support Group. 

Share as much or as little as you like. Listen to others. Feel the power of community. Reach out for support during this challenging time in your life and know you are not alone.

Dates: 
February 21 + 28
March 7, 14, 21 + 28

Cost: 
$275 ($225 before February 1, 2017)

Throughout the six weeks we'll explore issues related to fertility, including the impact on identity, self-esteem, sexuality and relationships. You'll have the opportunity to learn and practice relaxation and other mind/body coping skills each week. While we can't change the stressors you experience each day, we can help you learn to manage your response to allow you to live more comfortably and engage with life more fully. 

Women experiencing both primary and secondary infertility are welcome.

Registration required. 
 

Birth Trauma: Is THAT What I've Been Experiencing?

I met Sara and her 4-year-old daughter, Claire, at our local playground earlier this week. Claire instantly gravitated to my 5-year-old son and within moments they were chasing balls together, holding hands and laughing. Having just moved to San Diego from Boston, she was excited to meet us.

Like many mom-conversations go, Sara asked about the age difference between my two kids and how I felt about it. She told me that although her daughter was begging for a sibling and her husband was also ready, she wasn’t prepared to get pregnant again just yet. She was conflicted about her timing tho, noting her age and the pressure she was feeling to have another baby.

I empathized with her situation and shared some of my own personal experience, as well as my professional experience as a psychotherapist supporting women on their journey through motherhood. I offered myself as a local resource given my knowledge of San Diego’s network of reproductive health providers.  

A few days later we met again by the swings. Sara jumped right into the conversation, saying, "you know, I think I could probably use some help from someone like you. I'm pretty sure I suffered from some postpartum stuff and that's what's holding me back from having another baby." She went on to tell me about her difficult pregnancy, challenging labor and unplanned cesarean birth that left both her and Claire in the hospital for several days. The experience was distressing and she was anxious about becoming pregnant again. She had wanted an unmedicated, natural birth and was understandably afraid of having a repeat similar experience with her next child.

I spent some time talking with Sara about how her traumatic birth might be impacting her. As I spoke her face softened and her head nodded. She appeared to feel validated by my explanation: that trauma after birth is REAL.

While many around her would like Sara to move on and be grateful for a happy and healthy child, Sara is still reacting to her birth experience with Claire. Although Claire had suffered no long-term effects, Sara did. And her daughter’s health does not negate Sara’s experience and the anxiety and fear left in the wake of her birth experience. As we talked more, I stressed that it’s not the specifics of the birth that is traumatic, but one’s perception of these events. This is such a key aspect of trauma.
 

What Are The Symptoms of Birth Trauma?

Post traumatic stress disorder (PTSD) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a car accident, a natural disaster, or sexual assault. However, a traumatic experience can be any experience that involves the threat of death or serious injury to you or someone close to you, like your baby (birth trauma or postpartum PTSD). Again, it's your perception of your childbirth that matters most.  It is less important whether the hospital staff were in communication about recommended procedures than your interpretation of what happened.

Common symptoms of women who’ve experienced birth trauma may include:

• Feeling socially isolated
• Difficulty bonding with their baby
• Lonely
• Angry
• Depressed
• Irritable
• Difficulty sleeping
• Anxiety or panic attacks
• Worry excessively about the health of their babies
• Worry that their child might die
• Flashbacks or memories that repeat over and over about medical procedures or the behavior of medical staff.
• Nightmares

Why Some People Experience PTSD Postpartum

It’s not always the dramatic events that trigger childbirth trauma but other factors such as a loss of control, the intimidating, aggressive or difficult attitudes of people around you, not feeling heard, or a lack of informed consent to medical procedures.

Risk factors for Postpartum PTSD include a complex mix of objective factors, such as the type of delivery, ability to feed as planned, etc, and subjective factors like those mentioned above. Additional risk factors include:

• Induction
• Length of labor
• Feelings of loss of control
• Unwanted medical intervention
• Traumatic or emergency deliveries/cesarean
• Lack of support from partner or medical staff
• Impersonal treatment
• Not feeling listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth or loss soon after birth
• Birth of a disabled baby
• Baby’s stay in NICU
• Poor postnatal care
• Previous trauma (childhood, with a previous birth, domestic violence)
• History of anxiety or extreme fear of childbirth
• History of abortion or infertility
   

How common is Birth Trauma?

It’s estimated that approximately 9% of new mothers in Western societies experience full blown post traumatic stress disorder. However, research shows that 25-34% experience subsyndromal symptoms (symptoms that don't meet the diagnostic criteria for PTSD)! So while not meeting diagnostic criteria for PTSD, up to a third of mothers experience symptoms like intrusive thoughts and memories that may stimulate feelings of fear, anxiety or helplessness that interfere with daily life. That's a huge number! 

It's important to remember that while mothers most commonly receive treatment for postpartum post traumatic stress, their partners and even their medical providers may also suffer. 
 

Why You Should Seek Help

There are numerous potential consequences for women who experience a traumatic birth. They may avoid routine follow-up medical care because it reminds them of their childbirth experience. Like Sara, they may fear subsequent pregnancies and are statistically shown to be less likely to have subsequent births.

Those who do have another child are more likely to have an epidural or a scheduled cesarean; they are less likely to breastfeed and more likely to experience challenges bonding and attaching with their newborns. They’re also more likely to experience difficulties in their relationships and sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to suffer from depression, which also impacts bonding and attachment with their baby.

In part 2, we’ll look at ways to avoid the effects of birth trauma and ways to support healing. If you’re not sure you can wait to read part 2, please don’t hesitate to give me a call. I’m a licensed clinical social worker in the Banker’s Hill neighborhood of San Diego, California. I’m passionate about helping families cope with trauma and other challenges after bringing home their baby. You can reach me at 619.780.3277 for your free in-person 30 minute consultation.