Shattering the Silence: Why Doula Support Matters in Loss

By Anita Goggin

I recently had a missed miscarriage and a traumatic early birth. I couldn’t find a doula with experience in loss within my area to support me. Why do we place such reverence in birth only when a baby is expected to be born live and full term? What about the women and their babies who do not fall into this box? Do we matter less?

Here I sit in deep contemplation, still bleeding, freshly swirling in all that comes up with experiencing a pregnancy loss. The myriad of physical, emotional, and spiritual realms, blurring together in something that is so ordinary based on statistics, but yet so extraordinary in the bearing it can have on one’s life. We know 1 in 4 women have miscarried, 44 miscarriages are happening globally every minute. This does not account for unknown early losses and unreported losses. Researchers suggest both miscarriage and stillbirth rates are on the rise. I am sure many of you reading have had a loss, if not, it is likely those close to you have. Loss is happening and it is happening frequently.

Loss can bring up a vast array of emotions all of which are totally valid, whether sadness, anger, disappointment, guilt, or relief. It is important to understand the reaction to offer the appropriate tailored support. Not all losses are mourned, nor do all women feel they need to be within themselves. The differentiators in perception appear to be linked to the individual’s perspective on fetal personhood, the permissiveness around mourning, and the support she is given. Loss affects not only the woman, but has a bearing on her whole family.

For context, this was my fifth early birth, my first in the second trimester. I have three beautiful living young children, all of whom I free-birthed. I love birth. I love celebrating the sacred journeys that we as women are privileged to go on. Beyond my own experiences, I have dedicated a significant amount of my life to learning about and finding ways to be involved with birth, motherhood, and womanhood. My recent early birth has left me shaken, angry, confused, and curious, questioning why as a society we do not give loss the same reverence we give live birth or share our knowledge and experiences with freedom and honesty. It has also left me with a burning desire to attempt to shift this trajectory even if ever so slightly for other women into the future.

Initially, I wanted to share about the lack of empathy, compassion, dignity, and appropriate communication I had experienced during my interactions with the medical system. This was my first time engaging with the medical system during a loss, disappointingly it was a similar scenario throughout the entirety. I had first attended emergency to discover I’d had a missed miscarriage, then subsequently later that week when I haemorrhaged two days after my early birth, returning to hospital via ambulance. Both interactions were painfully traumatising and unsupportive. While I appreciate that the system and care providers are stretched, that doesn’t excuse the lack of care factor during a loss. Kindness and empathy cost nothing, they are basic underpinnings of humanity. Reflecting back on this, reading and hearing about the multitude of women’s experiences of dealing with the loss of their babies upon attending hospitals and many medical providers, I almost feel lucky. The cataclysmic shit show I experienced seems minimal compared to so many women’s horrific experiences. That gave rise to my next emotion, one that is currently bubbling up more prominently, rage. I am beyond outraged that so many women are unsupported, ridiculed, ignored and downplayed in their experience of loss by many health providers in their darkest hours. Perhaps I shouldn’t be surprised, given the way women are often treated when birthing live babies in what should be amongst the happiest days of their lives.

What else has stood out during my losses was the lack of understanding, awkwardness and avoidance in my dealings with most of those around. Conversely how grateful I was in the moments when someone truly leaned in to hold me, especially when I couldn’t quite articulate what I needed. We seem to have a series of societal conditioning problems currently present in the way we support women during loss. Heck! The way we support each other regardless of gender during times of grief in general and in the way we as individuals ourselves, often fail to process our grief and trauma. Even more concerning to me has been the lack of understanding from some women whose work and supposed life calling is supporting in the space of perinatal, birth and postpartum care. Maybe I was unlucky in my searches for help, maybe I didn’t try hard enough to follow up once initial arrangements were made but what I can say is in my vulnerable state I gave all I could to seek help, yet time and time again I was unable to get the follow through. Is there a gaping hole in this space or this is just reflective of the general societal discomfort around loss?

During my most recent loss, I reached out to try and find a doula to join our family as I birthed our baby who we knew would never take a breath. I could not find anyone near me who had experience in supporting early birth, let alone in the form of free loss. Having previously utilised doulas in two out of three of my free births, I would have loved a compassionate and experienced woman to help bring more reverence, beauty and comfort to my early birth. Instead like many women, I found myself overwhelmed, stuck on a cold bathroom floor, wedged between the shower and toilet labouring. My husband looking on, not really knowing how to support me. The hospital had refused to show me the ultrasound when they told me my pregnancy was not viable two days prior. I was desperate, I needed a tangible source of connection to my baby that had died and with it all my dreams around how he or she would have fit into our family. In a frenzied state, I alternated between emptying my bowels onto paper towels and sifting through clots on the floor, searching, trying to find any evidence of the life that had once existed inside of me. My husband watched on, perplexed as to why I was “acting like a mad scientist.”

As the process continued, I breathed my way through the fast and furious labour. My husband offered to light some candles as I moaned about why we hadn’t thought of making this birth more reverent and celebratory of the soul who had chosen now was not the time to join our family earth-side. I thought about all the beautiful birth spaces I had birthed in before and wondered why it wasn’t the norm to create a nest in the event of miscarriage. I thought about the countless amounts of women who had birthed and were birthing babies with me right now, the babies who would not take their first birth. Despite having items from my last birth altar that drew upon this connection, I felt petty and avoided asking my husband to bring them into my line of sight, even though deep down it is what I desired. When he asked if I wanted to listen to any music I thought wow, I have had birth affirmations, hypnobirth tracks and birth playlists in the past available had I felt the yearning. Gosh, I’d even asked my doula to play singing bowls as I transitioned in my last birth to help me connect to my breath and welcome my baby but this time nothing. The thought hadn’t crossed my mind, I had been caught up in my anguish, wondering when I would start labour and in a state of disbelief. Simultaneously I had also been praying for miracle, hoping they were wrong. As things progressed, I realised how uncomfortable I was and how none of this was allowing me to connect inwards. I asked him to pass me my velour splash blanket I had used in other births, so that I could at least lean on something soft, pop some clary sage in the diffuser, set up a mattress on the floor for once I needed rest and dim the rest of the lights in the house.

Once the bleeding subsided for the interim, I flopped onto the mattress and my mind began spiralling out of control. Why didn’t I know if active birth positions are just as beneficial during an early birth? What comes next? Is this just an intermission? Did that first giant clot I accidentally released down the toilet contain my baby? Berating myself for that one clot getting away. How do I know if I have passed everything? Why couldn’t the early pregnancy clinic answer all my questions? Why couldn’t emergency answer ANY of of questions? Why don’t women hire doulas as soon as they are pregnant in the event a loss occurs and they choose to be supported during process? Why aren’t we teaching women about things like specific tinctures or acupressure points that can help in the event of a loss? Why aren’t we detailing what it may look like if it were to occur in different scenarios? Why do we omit the graphic details, why do we keep so much of this in the shadows? So many thoughts sprung to mind.

These questions continued with me as I searched for a doula to support in the postpartum so I could rest and have some extra emotional support. Why was this not something that was being routinely discussed and offered as an option to women? Being in a postpartum phase with all the hormonal fluctuations occurring, a body that is coming back to its non-pregnant state, exhausted and weak after haemorrhaging, still bleeding heavily, trying to wade through the grief with no delicious little baby to snuggle weighs heavily. The taboo nature of the experience means many fail to understand the gravity of what happened. Instead responses consist of parading a mix of societal awkwardness or silence or hallmark comments at best, all of which are both heart breaking and isolating for the women, very few know how to respond.

Women deserve better during this time. Why is there no space in our society where we wrap women in love and encircle her as sisters in reverent ceremony after a loss if she would like this? Wouldn’t it be so beautiful to honour her, the journey and the tiny being who was too delicate to continue on earth-side and come together as a village? By doing so she would be witnessed and validated in her experience. Consequently causing ripples for generations of women, allowing words and actions to also heal the hearts of women who have come before her.

Words matter, the language around early pregnancy loss needs a revamp. A woman may suffer a loss but saying she has lost a baby implies negligence on her part. Even the word miscarriage suggests a failure in her body’s abilities. Medically speaking the terms “passing the products of conception” and “spontaneous abortion” are still being used. So often very little is said to women by those around them beyond “I’m sorry for your loss” or “I have no words” or catch phrases of “you can try again” “at least you know you can get pregnant” “you should be grateful for your other children” “it is so common” “it likely means something was wrong with the baby.” Isn’t it time we did better, we started listening, validating women’s experience of loss more, sharing the stories and truly holding women?

Don’t we owe it to the women in our communities to find ways to support them through loss? To change the language, have the hard conversations? Allow for ritual, ceremony and ways to find beauty and comfort in those dark moments? Ways to wrap women in love and understanding, allowing them to process, grieve in whatever way that they need? Isn’t it time yet to lift the veil on a topic that is still somehow taboo and uncomfortable for so many? Personally I think it is time.