Characteristics and Stages of Grief

Grief can be divided into four stages: shock and numbness, search and yearning, disorganization/ disorientation, and reorganization/resolution. Sometimes these stages overlap and you may move back and forth between them or you may not experience some of the stages.

Miscarriage About one in three pregnancies end in miscarriage. Most occur within the first 12 weeks. This loss may not receive much sympathy from others because there is usually no baby to see. Others may dismiss the loss of your baby, saying things like, "You can have another baby." But miscarriage may bring deep disappointment and a sense of failure. "Everyone has babies, why can't I?" The mother's depth of emotion may not be shared by her partner. He may seem more concerned about the mother's physical well-being.

Ectopic Pregnancy Ectopic means 'in the wrong place.' Occasionally a fertilized egg does not implant correctly in the uterus and begins to develop elsewhere, typically in one of the fallopian tubes. This causes pain and pressure, requiring surgery and the loss of your pregnancy. Because this happens so early in the pregnancy and may be a medical emergency, little mention is made of the developing baby. But the loss of your baby is still very real and may be felt deeply.

Stillbirth A baby is stillborn when born after 20 weeks gestation without a heartbeat and with no possibility of resuscitation. Sometimes an exam during pregnancy reveals that the baby has died. Other times the baby dies in labor. Either way, delivering a baby that is not alive is a tremendous shock. The emotional pain may seem much greater than the physical pain. It is often desirable for parents to see and hold the baby and take pictures.

Infant Death There are many causes of infant death. The nightmare may begin with a premature birth and an uncertain outlook. Or there may be a birth defect, unexpected illness or other complications. If your baby had obvious health problems, friends and family may focus on the 'blessing' of death that kept your child from a life of suffering. That may not comfort you right now. Sometimes death comes like a thief in the night - as with SIDS (Sudden Infant Death Syndrome). The shock from a seemingly healthy baby dying suddenly may be long lasting.

Shock is a normal response to overwhelming sorrow. Sometimes it lasts only a few minutes, but often it goes on for hours and even days. It brings a feeling of numbness, of being stunned, a shutting-down of usual feeling and thinking. This numbness is protective, a 'blessed anesthesia', that allows time to accept painful reality. Shock keeps you numb until you are ready to move on. Shock and numbness are your introduction to grief.

Characteristics of shock and numbness are most intense the first two weeks after the loss of your baby.

Characteristics of Shock and Numbness

Short attention span Concentration is difficult Decision-making is impaired Stunned, disbelief Resistant to stimuli Functioning impeded Denial (This isnÕt really happening) Confusion or loss of memory Failure to accept reality Fear, panic, feeling out of control

Outbursts of anger, hostility Powerlessness Restlessness Exhaustion Heaviness in the chest Lump in the throat Wringing hands, crying, sighing Feeling cold Lethargy

Shock and numbness begin to wear off. The pain becomes more severe and reality hammers you. You cannot believe this has really happened. These are the signs of beginning the searching and yearning phase of grief. You search for answers and yearn to experience what could have been. You may feel empty.

Thoughts of 'what if', 'if only' and 'I should have' are typical. These thoughts can become obsessive and you may think about them constantly. You wish you could change what happened. You may feel restless, impatient and nervous. You may think you are going crazy and are afraid to tell others how you are feeling. Take comfort - these feelings are only a temporary part of grief.

Characteristics of Searching and Yearning

Searching mentally for your child Searching for answers, the cause of death Looking for someone to blame Having bizarre thoughts and feelings Feeling jealous toward other parents Feeling anger toward your doctor or partner Questioning why and other spiritual questions Being preoccupied with your baby Dreaming about your child Continuing to feel pregnant or obsession to get pregnant again Having anxiety attacks Having arms that ache to hold your child

Experiencing pains, loss of appetite, headaches, insomnia, heart palpitations Sensitive to stimuli Anger and guilt Restless and impatient Irritability Resentment Bitterness Weight gain or loss Sighing Lack of strength Time confusion

After the loss of a baby you may search for answers or ask what went wrong. You might not find satisfying answers. There may have been genetic, fetal or external factors beyond anyone's control - yours or your doctor's. Most women can think of things they wish they had or had not done, but rarely is the death anyone's fault. It is best not to place blame. Even an autopsy may offer no real answers. Just ask your doctor to explain as thoroughly as possible what happened and why. If the problem was genetic, seek genetic counseling before considering another pregnancy.

Searching and yearning give way to reality. You are confronted with the fact that life will never be the same. You have a new sense that life is unfair. Some parents talk of losing their innocence about life and feeling vulnerable in the world.

Disorganization and disorientation are words used to describe the upheaval of normal thoughts and daily living patterns that occur at this stage. It is a time of ups and downs. Sometimes you feel you have hit rock bottom and you wonder if you will ever come up for air. You might feel deadlocked and without much hope that life will ever be good again. Everyday things are difficult to do. You may go back to work, but you can't keep your mind off your grief.

Some of the experiences and emotions of this period are common to most grieving parents - difficult relationships, guilt, anger, and depression.

Difficult Relationships

Grief tends to make each parent self-centered. At this time, when they need to support each other, they are least able to do so. Partners may become very unhappy with each other. Relationships with friends and family members also suffer because they do not seem to understand the depth of the parent's loss.

Guilt

Parents feel responsibility for the health and well-being of their child. When their child dies, they are overcome with a sense of powerlessness. They feel they should have been able to do something. A feeling of guilt is a natural by-product of losing a baby.

Often parents re-examine every detail of what happened and wonder if it was their fault. The most important thing to remember is - the past cannot be changed. You cannot change what happened, all you can do is work through how you feel. Beating yourself up again and again is self-destructive. Identify and clarify guilt and then put it to rest.

Anger

Some parents stay in the disorganization phase of grief because of unresolved anger. Anger cannot be resolved unless it is expressed. You must be honest about it, trace it back, talk it out and do something about it. Denying deep feelings of anger gives a foothold to resentment and bitterness that can destroy your health, relationships, and joy.

You may be angry at God, medical personnel, your partner or your family. If so, talk it through with someone who is understanding, who will listen without judging. Do your best to forgive those who have hurt you. Let go of your anger in your own time.

Depression

For many, depression is the longest, most tedious part of grieving. Life seems like it will never be good again or even get better. Everything is gray and cloudy. Parents feel locked in their thoughts. They have lost their spark for living and are wrapped up in the past. They feel alone and isolated.

Holding on to guilt and anger may make depression worse and especially difficult to shake. Although depression is common in grief, it should not be accepted for very long. Do not get stuck in depression. Help is available and admitting you need it is the first step to feeling better. Talk to your doctor, grief counselor, family counselor, spiritual leader or therapist. Get the help you need to work through your thoughts and feelings.

Characteristics of Disorganization/Disorientation

Thinking "I'm going crazy" Social withdrawal Depression Guilt Anger Fear Insomnia Anorexia Weight gain/loss Sense of failure Sadness Exhaustion Difficulty concentrating

Disorganized Forgetfulness Feeling ill Lack of energy Feeling empty, lifeless, hopeless No interest in things previously enjoyed Neglect of personal appearance and daily tasks Feeling trapped in mourning Preoccupation with the loss Dry mouth Nervousness Listlessness

Grief is something that happens to you without choice. It is mostly beyond your control. But recovery from grief does involve choice. There comes a time when you need to consciously let go of the pain. You choose to reorganize, regroup, and get back into life. You accept the loss of your baby. You come to terms with what happened and choose to go on.

This does not happen all at once. There will be detours, good days, and not-so-good days, but soon more good days than bad. A bittersweet grief occurs when sadness mixes with happy feelings of renewed life. You think, "Maybe I am getting better." You laugh for the first time and find yourself less consumed with the loss of your baby. You realize you are going to make it.

Everyone is changed by personal crisis. Most people survive it. Some suffer for the rest of their lives, but they do survive. Some come away with a new purpose and direction. For many who suffer the loss of a child, life takes on new meaning, values change and relationships become more important.

To begin to reorganize you must fully express your emotions and feelings as you grieve. You must say good-bye and let go of the emotional attachment. This is especially hard for the mother. She might feel if she lets go, no one will remember her child. Take hold of the memories even as you let go of your child.

The key to reorganization is acceptance. You can choose to accept what you do not understand and do not want to accept. Do this and you will have renewed energy, a sense of release, and new stability.

Characteristics of Reorganization/Resolution

Sense of relief Renewed energy Able to make decisions easier Eating and sleeping habits re-established

Able to laugh and smile again Improved self-esteem (appearance, diet, rest, exercise) Begin planning for the future