After the loss of a baby, either due to miscarriage or stillbirth, what exactly is it that a mother goes through as she grapples with this devastating experience? Is it grief or is it postpartum depression? Could it be both?

This is an excellent question, and I wanted to follow up on my post this week about postpartum depression and miscarriages and stillbirths to discuss this further. Sarah Pollard responded to the post with a comment I wanted to highlight:

It can be confusing to sort out grief vs. depression as there are many commonalities. We must remember that grief is a very normal reaction to a very abnormal event (losing a baby) whereas depression/anxiety are disease states that need treatment. Grief in and of itself does not require treatment but instead support, education and understanding from appropriate parties.

Grief can get complicated (depression/anxiety can occur) and it can certainly excacerbate a pre-existing condition like depression, anxiety, Bipolar etc. Women who experience perinatal loss and have a history of any mental health issue should make sure their provider is aware of this history. Women should also be taught how to differentiate between grief and depression and when to seek help.

The typical PPD support group, which usually contains at least a mom ortwo who is experiencing regret/ambivalence about motherhood, is not the optimal place for bereaved moms to find support. We know these feelings are normal with PPD but imagine the impact of such words on a grieving mother.

Mark, the husband of Paula (whose story was referenced in my last post), echoed these sentiments with he and his wife's personal experience with depression after a miscarriage:

"One of the toughest parts of dealing with the PPD after miscarriage was that there are some people who deal with and understand PPD and there are people who deal with and understand miscarriage, but there seem to be few people or resources to deal with the horrible combination of depression and grief that can come when you have both. To make it worse, some of the things that therapists worry about and try to stop in depression patients (like too much sleep) are normal ways of handling grief. There are a number of behaviors that have conflicting meanings or importance depending on if you view it as PPD, grief, or a combination of the two. It takes some real attention to treat them both."

In her book A Deeper Shade of Blue, Dr. Ruta Nonacs discusses grief and depression after perinatal loss and the differences between them.

"Grief is not just feeling sad. It is a complicated, sometimes prolonged process by which you learn to cope with a loss and ultimately to move beyond it … The process of grieving requires time, patience and the support of others."

She describes several stages of grief. Feeling numb at first, in total shock.Sadness. Then a time where you may be preoccupied with your loss, questioning why, having difficulty focusing on anything else, along with possible changes in sleeping and eating patterns.Experiencing anger and emptiness.

"With time, you will move toward acceptance of the loss and will be able to settle back into your life. It is unlikely that you will completely obliterate these painful feelings, but you will eventually be able to give them their allotted space in your emotional life … The symptoms of grief after a miscarriage typically last about six months to a year and do not usually affect your ability to function for a prolonged period of time; however, some women may have a grief reaction that is more intense or more prolonged. When the grieving process seems unbearably intense or seems to persist for a longer period of time, this may be a sign of what is called 'pathological' or unresolved grief, or this may be an indication that depression has complicated the picture."

Nonacs states that depression is never normal, even for those who've had a loss, and it can impede recovery if not treated. I imagine it would be very important in this situation to keep in close contact with someone who can help monitor one's grief and watch out for signs of depression.

In the meantime, I wanted to offer a few websites of organizations that support grieving mothers and families, and would have more experience in understanding what these families go through:

Share Pregnancy & Infant Loss Support

Missing Grace

Hygeia Foundation for Perinatal Loss

Silent Grief

If you are interested in more stories from Postpartum Progress on grief and depression after miscarriage or stillbirth, click the links.