Addressing the not-so-tiny loss
Bereavement counselling is still not such a known concept in India. But doctors believe it is very crucial for women who undergo miscarriages or still births, and rather for their partners too
Bereavement Counselling — doesn’t it sound like a rather alien concept? It is, in a country with the world’s second highest population. We do not give enough significance to an unborn child and more so, the loss of it. “In the West, every pregnancy is much desired, and people start identifying with their baby the moment it is conceived, making plans and even deciding the name, since they know the gender,” says Dr Nina Mansukhani, obstetrician and gynecologist at Jehangir Hospital.
But here in India, pregnancy is not so well planned, she says. “There are small nuances of the phase. Every time a mother feels the kick of the baby, she builds a relation with it. These tiny things must be understood by her family and loved ones. But that doesn’t happen often here,” she adds.
With the kind of roles a majority of women in India play, we often forget to tend to her needs. When caring for her during pregnancy itself is limited to a section of society, her facing a miscarriage or a still birth is hardly acknowledged beyond basic condolences. The need is for the family, friends and colleagues to be much more than that. This is where bereavement counselling comes into picture. “It is a one-on-one interaction between the counsellor and the bereaved mother or couple. It can also take the form of a support group, as is often seen in the West. It involves empathetic listening to the outpouring of grief. Sometimes the grief is bottled up and with gentle and sensitive probing, the counsellor can help bereaved parents let it out and deal with it, so that they can slowly but surely move on from their grief-ridden state,” explains Dr Niloufer Ebrahim, psychologist, perinatal educator and baby whisperer.
“We don’t give such mothers any time at all to grieve. We just immediately speak of planning another pregnancy instead,” adds Dr Mansukhani. In such cases, what exactly is the gynaecologist’s role? At the primary level, “I personally do empathise with my patients. Sometimes, I even let them hold the foetus for a while and leave the couple alone in the room for a few minutes with it,” she answers.
Dr Ebrahim goes on to say that the loss and its impact may vary from mother to mother, depending on her ability to handle it. There are those who go to pieces, and there are others who deal with it more practically, accepting that the foetus may have had some developmental issues and that nature chooses to discard what is not perfect. “Family members in India often try to brush a miscarriage under the proverbial carpet, telling the mother that she will have another. Some make the mother feel guilty for her loss, blaming her work life, exercise routine etc for it. Mothers who suffer repeated miscarriages suffer both physically and emotionally a great deal. The trauma takes a toll. As for still birth, that is a lot worse because the mother has carried the baby for seven to nine months, she has built her dreams, she has loved her unborn child. The pain and shock are unbearable. Mothers need a lot of support at times like this,” she elaborates.
However, in cases where the lady does go for the next pregnancy after a miscarriage, that one is very crucial. “It’s a called a rainbow pregnancy. In such cases, you need to be all the more supportive. These women tend to get paranoid with small things. Their paranoia needs to be addressed in the right manner,” Dr Mansukhani says.
All this counselling, however, comes at a cost, if it’s happening in a professional manner. “At the end of the day, such kind of counselling is an art and only experts can do it right. So charging for it is inevitable. If you involve counselling as part of the package at hospitals, people don’t go for it in India,” she adds.
In case of miscarriages, gentle and supportive family members, sensitised behaviour, support in handling the post-loss hormonal changes, clean eating, maybe a holiday to relax, and counselling to help the mother talk out her grief and discuss her fears of future pregnancies are all hugely helpful, Dr Ebrahim suggests. “In the case of still births, healing may take months or even years. It is a very intense period. Both parents are at a loss. The mother may withdraw into a shell, feel as if her body has let her baby down. Each grieving parent heals differently. Sometimes grief draws couples closer, in other cases it drives them apart. Dad needs healing too, most of us forget that. Grieving parents need support to heal, there is no magic formula,” she stresses.
However, we must get our basics right too. Once you get the heartbeat, there are only three per cent chances of miscarriage. “Generally too, in healthy couples, hardly 10-15 per cent miscarry. So there’s no harm in announcing it, making it easier for the woman to access support in case things go wrong,” Dr Mansukhani suggests.
With nearly 30 years of working in Canada and India, Dr Ebrahim shares an incident from her experiences. “Having experienced stillbirth myself, I know how heartbreaking and traumatic it can be. One swings between tears and numbness, bafflement and a sense of defeat. I’ve seen mothers feel a lot of anger after the shock, and their coping skills are sorely tested. Some want to rush into the next pregnancy as if to prove to themselves and others that they can “get it right” the next time. Some turn to prayer, some turn away from it. I’ve had to deal with superstitions of all kinds among my clients. In my case, I decided to help mothers bring babies safely into the world. I became a prenatal and childbirth educator and ran some very successful prenatal programmes. One can convert loss into something very positive too!” she exclaims.
Dr Mansukhani, on the other hand, tells us about one of her patients who had gotten very attached to her baby. “She had been in severe pain 10-12 weeks into the pregnancy and we knew it had to be miscarriage. But she didn’t allow me to actively do anything to the baby. She bore the pain till it became an inevitable miscarriage. She had identified so much with the baby,” she explains.
People therefore need to become more sensitive, says Dr Ebrahim. “Just because we are a nation over populated with babies does not mean any baby is less precious. We need more counsellors to handle grief and loss. Post-traumatic stress disorder and post natal depression can be prevented or overcome,” she concludes.