A Doula’s Guide to Infant Loss

by Anna Balagtas

Content Warning: This post contains discussions of stillbirth and infant loss. Due to its heavy content, we suggest you take breaks when necessary, and check in with yourself. We also encourage you to have a support person accessible to you — whether learning alongside you, in the next room, or a phone call away. The story below depicts the birth of a stillborn baby. This story is shared with consent. If you would like to move ahead to the guide portion of this blog, please keep scrolling below.

Early in my doula career, I supported a family through an unexpected stillbirth. At the time, since I was so new in practice, I felt completely lost with how best I could support this family now moving through grief. It was a stark reminder that no one can ever truly prepare for what grief and loss feels and looks like.

My clients hired me as a birth doula in the first trimester of their pregnancy. Our time together was loving, full of laughter, and constant planning. We moved through our prenatal meetings practicing birth positions, writing birth preferences, and chatting about what color they should paint the baby’s room. There was no way of telling that just a week after our last prenatal visit, they would call me sobbing saying that during their 38 week ultrasound, the doctors could no longer find the baby’s heartbeat.

As soon as I heard the news, I rushed to their house and comforted them through meals, hugs, and endless discussion. We, including myself, were trying to reason with the grief we were now feeling. We didn’t understand how we ended up here. My ego came up and I questioned whether I was a “bad doula” for not noticing the signs. Meanwhile, my clients questioned whether they were “bad parents” for losing their child. In reality, no one was at fault and no one was bad. I accompanied them through every appointment leading to the birth of their baby and in every conversation with the doctor it was always the same – “we don’t know why the baby died.” To this day, we still don’t have answers.

A week after we found out the baby no longer had a heartbeat, my client was induced for labor. The ceremony was heartbreaking, beautiful, loving, and full of grief. After laboring for nearly 12 hours, they gave birth to their stillborn baby. We took pictures, said our I love you’s, gave our kisses, and I left my clients alone with their baby for a few hours to have some family time.

During the whole grief process with my clients, I felt completely unprepared. I judged myself for becoming too personally involved in their grief (though this is nothing to judge – careworker grief is real and valid), I felt I didn’t have the proper tools to support my clients through loss, and worst of all, I had no idea what to say to comfort them.

As I reflect on this story after a few years, I’ve come to acknowledge that my support and my love for my clients was enough. In fact, it was plenty. The times I had judged myself for not finding the right words to say as they cried was actually me giving them space to grieve. There is no easy way to comfort folks moving through loss. All we can offer is our open hearts and open ears.

In creating this small guide for doulas navigating infant loss support, I bring together my knowledge and experience as a grief and loss doula today in hopes that folks who aspire to be infant loss doulas in the future have these tools to lean on as you move through supporting your clients during the grief period.

First, let’s begin by naming the different types of infant loss. (Meg Pirie, 2022) 

It’s important to note that this list is non-extensive and for the purpose of this post I’ll be narrowing down our guide to reflect how to support clients going through losses mentioned in this list.

What are signs of loss? (Meg Pirie, 2022)
Intuition

Trust the pregnant person’s gut feelings. If the birthing person mentions that something feels off, odd, or weird at any point during the pregnancy, listen to them. Take these as valid and valuable reasons to suggest seeking the opinion of a healthcare provider. The birthing person is the only one who knows their body best and it’s our responsibility to listen to their concerns no matter how small.

Lab work, lab results

Any indications in the lab work and lab results (urine samples, blood tests, etc.) that there are abnormalities in the fetus or pregnant person that could result in infant loss.

Ultrasounds

Ultrasounds can detect movements, size, and heart tones of the fetus. Should there be discrepancies with the gestational age of the baby and the ultrasound results, there might need to be a discussion about the health of the fetus and/or pregnant person.

Cramping, bleeding

Unexpected bleeding, sometimes called a “bloody show”, when there is no bleeding to be expected. Loss might also look like excessive cramping or contractions before 36 weeks that may be indicating early labor and premature birth.

Loss of fetal movement

Loss of movement is usually first detected by the pregnant person if they feel like the fetus has not moved in a certain amount of time. In the three trimesters of pregnancy, movements can feel different. If there’s suspicion that there has been a decrease of movement within the last couple of days, call a provider immediately.

Lack of heart tones

Often detected during ultrasounds, the lack of heart tones indicates that the baby may be passing/has passed in the womb.

What are the stages of loss? (Molly Dutton-Kenny, 2021)
Understanding

Coming to terms that loss has happened or will soon be progressing.

Reckoning

Calculating, going over past symptoms, trying to find the logical pathways with how this loss came to be.

Planning

Looking into ways to move forward from the loss or to find ways to carry on following the loss. In the case of my past clients, planning for us meant booking the induction date of the stillborn birth, planning photography sessions, and ceremony.

Release

The process of the embryo detaching.

Expulsion

The process of the embryo being released out of the body. They will be experiencing the peak symptoms of physical loss in the body. There may be intense pain if unmedicated or unexpected.

Resolution

Resolution looks differently for everyone. I would argue that resolutions may be hard to come by after an infant loss. However, what this could look like for folks is seeking grief support, having a grief ceremony, joining loss support groups, finding ways to care for themselves, mourning, etc.

It should be noted that though the process of the “stages of loss” has been listed linearly, that grief is non-linear. Grief is on its own timeline and there is no way of knowing when grief shows up in our body or in our lives. Arguably, I believe grief never leaves the body or our life. Instead, we make room for our grief as it finds its home within ourselves.

How can a doula support in loss?
  • Physically, being there during the loss, cooking, caring for older children  
  • Emotionally, holding a container for their feelings and debriefing
  • Resourcefully, finding them information should they request to learn more about the loss they are experiencing
 Reminders for doulas supporting in loss:
  • You don’t need to save people from their grief, you just need to be a container for them
  • Mirror the language the person is using for their loss ie; they refer to their loss as baby, fetus, cells, etc.
  • Refrain from saying “at least” or looking at the positive side of things. Sit in the grief.
  • Grief is not linear. It will take more than a week for people to heal. Grief will keep coming up for folks even in their happiest of moments – hold space for these moments.
  • Grief can show up during birth, be prepared for this.
  • Infant loss is a part of the postpartum stage spectrum of experiences. Regardless if there is a live baby or not, your clients are still entering postpartum even if they are experiencing loss.

I’d like to end this with what I think is the most important piece of advice of all: take care of yourself. Have a care plan in place for yourself, the careworker.

Similar to the support you offer your clients, make sure you are cared for:
  • Physically: perhaps in having a friend over to help you clean the house or care for you by bringing you meals.
  • Emotionally: debriefing your experiences and feelings with a friend, therapist, accountability doula, or family member and ensuring you are feeling loved and held.
  • Resourcefully: look into other loss kits and guides or find books and podcasts that affirm your experiences as a doula navigating infant loss support.

As you help your clients navigate through their loss, know that you are navigating feelings of grief too. Loss affects everyone and you deserve to be cared for just as lovingly as you have cared for your clients.

Written By Anna Balagtas

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