ACT, Grief and Pregnancy Loss

Often when we think of grief, we think of the loss of a loved one, a friend or family member. Those of us unlucky enough to experience miscarriage also experience the loss of a loved one we never got to meet. Those of us who experience stillbirth experience the loss of a baby that never got the chance to grow up. This week the local media covered a horrific tragic accident where a 91-year-old lady drove her car onto the pavement, killing a 3-year-old child and injuring a mother. I can’t imagine the pain of losing a child in that way, my mind blocks it to protect me when I think about it. I was on the exact spot the accident happened with my own child a few days before the accident – there but for the grace of god go I. I have felt as though a cloud has been hovering over me since hearing the news and noticed worry that I may know the child since they were the same age as my daughter. My thoughts then moved on to acknowledging that whether I personally know the child is irrelevant – a mother is still without her child tonight. My experience with grieving is that the pain of loss is there to show us what we value. I have been feeling vicariously sad this week because of my love for my own children. Rather than wallow in grief, I have also learned that my sad and angry feelings can become a springboard for acting on my values, which was the sentiment behind writing this blog. I will be forever in Steven Hayes’ debt for writing “Get out of your mind and into your life”. I read the book when I was grieving the loss of my dad which happened during my clinical training, and if I hadn’t I’m not sure I would have found a way to both move forward with the grief and complete my training while doing so. My husband celebrates his 40th birthday this month and that day will also be the 11th anniversary of my dad’s death. Later in the year, the anniversary of when I first met my husband also marks the anniversary of my first miscarriage. Love and loss go hand in hand.

During Covid-19, we have been unable to attend a family funeral due to restrictions in place and I know lots of other families will have been in the same position. Funerals offer a ritual to mark the loss even for those of us who are not religious or seeking comfort from religion, and I feel for those who will have been denied that opportunity. Funerals are also an opportunity to support loved ones and connect which is key to actively coping with grief. There have also been many more people experiencing other kinds of losses during Covid-19 – the loss of the chance to experience an ending of primary school, the loss of the chance to finish high school, the loss of the chance to sit final exams in an exam hall at Uni, the loss of a long planned for wedding day, miscarriage or baby loss in isolation too. There are also other times in our lives we might experience a grief reaction, for example when told we have a chronic condition like dementia, or that our loved one does, or as a parent when we learn that our child will develop with a difference, like autism or a learning difficulty. Having set the scene, I thought I should move on to some ideas about how we can cope with grief and loss.        

Elizabeth Kubler Ross five stage model

  • Denial (avoidance, confusion, shock, fear)
  • Anger (frustration, irritation, anxiety)
  • Bargaining (searching for meaning, seeking connection, drive to share experience)
  • Depression (overwhelmed, helpless)
  • Acceptance (exploring options, planning for the future, moving on)

It is helpful to note these are not stages you go through in order, and it is common to go back and forth and cycle through them. It is also helpful to know it can take ten years to reach Acceptance – and that’s within the normal range, not a sign there’s anything the matter. If you’re currently in denial about a loss you’re probably not reading this now. If you’re currently working through anger, you might have noticed some typos in my work and be finding them annoying – if so, please do tell me as I also hate typos but because I’m permanently sleep deprived I’m less good at detecting them just now. If you’re bargaining, you might be reading this in an effort to make sense of your loss like I was when I first learned about ACT. If you’re looking for meaning, the diagram at the top of the page – the pregnancy loss Grieftrix – might be particularly helpful (see below for more on that). If you’re working through depression, you may find there are too many words on the page for you to process now – it’s OK to take your time. If you’re at Acceptance you may be like me in that you’ve spent a lot of time in the other stages before getting to this one, and you may have had to work through some very dark days. Wherever you are in your head, I hope you can allow yourself to just be where you’re at for a moment – however you are feeling is OK if you are grieving.     

Factors that link to complex grief reactions

  • Being female
  • Being older
  • An unexpected or violent death
  • Death of a child

It is interesting to note that if you have experienced a miscarriage or a still birth, your experience likely covers 2-3 of these common risk factors, yet the NHS doesn’t currently offer specialist services for women who experience traumatic grief reactions after miscarriage other than going through Adult Mental Health Services where research indicates that women report the practitioners there don’t always have specialist understanding relevant to baby loss (see Miscarriage page for more on that).

The Pregnancy Loss Grieftrix

Sorry if you’re at the anger stage and finding repetition of content annoying, but I had the thought that it might also be annoying to have to refer back to the top and went with the lesser of the evils. I wanted to explain more about how to use this image to make sense of your own pregnancy loss, if that’s something you need to do.

First, look at the lower right quadrant. If you’ve lost a baby, what name did you give? I know during pregnancy all mine have had nicknames. The lost ones over the rainbow are baby Kauai, baby Rainbow and baby Serendipity. What were your pregnancy hopes and dreams?

Next, look at the lower left quadrant In your grief, what thoughts and feelings come up for you when you think about your lost pregnancy? Some of mine were regret, fear, guilt and anger. I also remember struggling with birth announcements and the need to maintain a coping front.

Then, look at the top left quadrant. What do you tend to do whenever the difficult thoughts and feelings come up – avoid talking about pregnancy, babies and/or miscarriage? avoid people who might bring these topics up? avoid trying to get pregnant again? distract yourself? throw yourself into work or exercise? comfort eat? seek solace in wine? All normal, all with long term costs if you keep them going though. What are the benefits vs costs to you of continuing to avoid your feelings and thoughts?

Next, reflect some more about your pregnancy hopes and dreams, perhaps also the qualities you had hoped to develop as a mum and the love you have to offer a child. Then, look at the top right quadrant. If you’re ready to consider an alternative to avoiding painful feelings and thoughts, how can you connect your pregnancy hopes, dreams, the qualities you hoped to develop as a mum and the love you have to give with living a life you value? Who could you connect with today to share this with – who else do you know who has experienced miscarriage or stillbirth? Would connecting with a counsellor be helpful, either through a charity like SANDS or through a referral from your GP to Adult Mental Health Services? Are you someone who wants to get involved in baby loss awareness campaigning on social media? Who do you already have in your life now you can share your capacity for love with – your partner, your friends, your family, other children?

Lastly, look at the heart in the middle – that’s you – you’re big enough to contain all your thoughts and feelings, and complicated enough to need a range of coping strategies at different points in time as you work through this. You’re also worthy enough of compassion and care, not least from yourself. It’s OK if right now you need to just be where you are – just know that there may be a chink of hope ready to filter through the cracks when you’re ready.

Ten Tips on Surviving Grief

If you are still reading this far, you might be particularly interested in how ACT might apply in coping with grief, so here are some introductory thoughts inspired by Russ Harris’s writing –

  1. Allow your feelings and thoughts to be there. This might include being open to shock, anger, despair, hopelessness, emptiness or loneliness. Whatever you feel, make some room in your life to let yourself have it. While you do that, make time to rest and cut back on demands on you if you can.

2. Accept that there will be times of feeling overwhelmed, especially in the early days. It might help to think of this as standing in giant tidal waves which might knock you over, but you will still be there when the wave passes. You may want to remind yourself of the saying “This too shall pass”.

3. Learn some mindful noticing skills to anchor you when the waves hit – for example, practice noticing what you can see, hear, feel, taste and touch when you are calm – when you are overwhelmed, it becomes easier to call the noticing skills to mind with practice.

4. Values – What really matters to you and how can you get more of that into your life? What small step could you take towards that starting today?

5. A powerful question to ponder – Suppose you could choose – 1. You never have to have these painful feelings ever again – but it means you never get to love or care about anyone or anything again either. 2. You get to love and care about all sorts of people and things – but when you lose what you care about, you will feel intense pain. Which option would you choose? While acknowledging your loss and allowing your feelings about it, keep an awareness of what you still have in your life that you value, particularly considering relationships.

6. Develop self-compassion – this takes real courage to allow ourselves to be vulnerable but is such a powerful tool when we’re grieving. If you find it tricky to do this, that’s normal – but what would you say to a friend going through what you are?

7. Watch out for unhelpful stories or life rules you’ve told yourself for a long time or society may even have told you which are now unhelpful. For example, “My life is worth nothing if I can’t have children” or “I’ll never heal from this” or “it’s all my fault”.

8. Find meaning and positive energy to move forward from within your pain. Your grief – perhaps about your miscarriage – tells you two very important things: a) you’re living, and b) you have a lot of love to give. Tune into that and connect with your values to keep going with life, doing the things that matter to you. And take your feelings of loss and memories of your pregnancy with you, carrying them as gently and carefully as if they were a kitten in your arms.

9. Consider how you can grow as a person from this experience. What is there to learn about forgiveness, compassion, letting go, acceptance? How might your own experience benefit others that you care about? It’s amazing how many more women have miscarriages than there are women who openly discuss their experiences. There are great opportunities to support and empower one another here.

10. Consider a grief ritual to mark the loss of a pregnancy, regardless of how soon it ended. You are marking the loss of hopes and dreams, even if it ended early. For example, light candles, write a poem or journal, bake a cake, make a memory box or scrapbook.

ACT and grief resources

The link below takes you to a powerful blog post written by Russ Harris after his son was diagnosed with autism on the grief reaction he experienced and how ACT helped him cope

The link below takes you to a YouTube clip illustrating the “Grieftrix” which is an ACT way of understanding grief. It’s fairly straightforward and accessible if you’re reading this as someone keen to make meaning from their experience, although the clip is aimed at ACT therapists.

The link below takes you to a video on YouTube from a series of videos by Tom Lavin on using ACT to deal with a range of difficulties – this one is on the topic of grief. He talks about how grief is often underneath mental health difficulties, and that to deal with the mental health difficulty we need to feel what we don’t want to in order to feel the grief. He also talks about how love is key to the meaning in life, and that people we love die – so since love and loss are inextricable, we can either have both or neither. He talks about how saying “yes” to living a meaningful life, we also need to say “yes” to being willing to experience the pain of loss.      

Last but not least, if you are grieving it may be of value to seek therapy at this time in your life. If that’s where you’re at, your GP can refer you to a mental health service if that is appropriate. If you’ve experienced baby loss, SANDS offer specialist counselling. Alternatively you might want to try the BABCP or the Association of Contextual Behavioural Science website to search for a therapist trained in either CBT or ACT.  Do also feel free to take a look at the Further Help page if you need more resources.  

Published by Mummy ACT

Qualified Clinical Psychologist blogging about pregnancy, miscarriage and parenting in the early years using tools from Acceptance and Commitment Therapy and Compassion Focussed Therapy during a pandemic

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