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 postpartum depression support group, which usually contains at least a mom or two 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 postpartum depression 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 blogs and organizations that support grieving mothers and families, and would have more experience in understanding what these families go through:

  • Unspoken Grief – A support community for those who’ve been touched directly or indirectly by miscarriage, stillbirth or neonatal loss. At this site, anyone can share their stories and learn from others. In addition to the forum, site creator Devan McGuinness educates readers on everything from the symptoms of grief to the causes and risk factors of miscarriage.
  • Glow In the Woods – A  blog dedicated to providing support to “babylost parents,” this site features beautiful writing by some bloggers you may recognize, including Kate Inglis of Sweet Salty and Bon Stewart, who formerly blogged at Crib Chronicles, as well as a few discussion boards.
  • Silent Grief – Silent Grief offers weekly emails of encouragement to grieving parents, lists of reading materials, and an articles archive to help guide parents through topics like getting through Mother’s Day or answering the question, “How many children do you have?”
  • First Candle – First Candle is dedicated to safe pregnancies and the survival of babies through the first years of life. Their current priority is to eliminate Stillbirth, Sudden Infant Death Syndrome (SIDS) and other Sudden Unexpected Infant Deaths (SUID). They have a specific section on their site for grieving families.
  • Hygeia Foundation – They offer a bereavement resource lending library, funeral assistance to low-income parents, and educational programs to raise awareness among medical and other professionals of the effects of pregnancy and infant loss on families.
  • Share Pregnancy & Infant Loss Support – Share offers a list of support groups around the country, information on parents’ rights when a baby dies, information on legislation related to infant loss and more.
  • Bereaved Parents USA – The organization has chapters around the United States that hold local support group meetings for bereaved parents.