Maggie McKay (Host): When you're pregnant and lose your baby, it is devastating, and one of the most painful things a parent can go through. Today, Dr. Sara Carlini, a Board Certified Psychiatrist at Maimonides Medical Center, is here to tell us how to deal with pregnancy loss. Welcome to Maimo Med Talk, a podcast from Maimonides Health.

I'm Maggie MacKay. Welcome, Dr. Carlini. Thank you so much for joining us.

Sara Carlini, MD: Thank you very much for having me.

Host: I cannot even imagine the range of emotions from sadness to anger to numbness and shock and everything in between in finding out you've lost your baby in pregnancy. What do you tell women going through this hard time?

Sara Carlini, MD: I think one of the most important things to discuss is that there really is no right or wrong way to feel in a situation like this. People grieve differently, and some people may find themselves not grieving at all, and that can actually be right for them. That can be okay. You know, I think a lot of suffering can actually arise from us being judgmental of our feelings instead of just observing them and really sitting with them.

And grief, it's part of the human experience. The last thing we want to do is pathologize that. But for some folks, grief can become complicated by a major depressive episode where their symptoms are so intense that they interfere significantly in their lives and relationships. Some people might even start to have thoughts that life isn't worth living. They may even actively want and plan to kill themselves. Those symptoms are beyond what's normative for grief and they do require medical attention.

Host: Do you counsel women differently depending on the circumstance of their loss? For instance, a stillborn baby versus a miscarriage.

Sara Carlini, MD: I think it, you know, it actually goes back to the answer to the previous question that although these are all different circumstances, there really are no right or wrong ways to feel in these individual situations. One person may feel intense pain and grief after the loss of a pregnancy at 10 weeks, and another person may not.

The focus again is, not on the right way to feel, but on how you feel. And for those that are grieving, I think one misconception that can arise about seeking help with grief is that you're going to be told how to feel, you're going to be told you have to move on or that you have to forget your lost loved one.

And that is definitely not the goal of therapy and treatment for complicated grief. The goal is really to establish a new relationship with your lost loved one that exists in the new reality, in the context of separation. Just because someone's gone, it doesn't mean our relationship with them is over.

Host: What about the physical side effects of losing a baby in pregnancy?

Sara Carlini, MD: So I can speak to some of the psychological dimensions of those physical side effects. You know, for some, a pregnancy loss is physically very painful with cramping and bleeding. It can occur in an inconvenient time or place when you're alone and you don't have your usual support system. The process can be lengthy. It could take several weeks. Some women even require procedures to remove the remains of the pregnancy. And some women may have to labor and birth their stillborn baby. Some women even begin to lactate after a pregnancy loss, which is a uniquely difficult thing to go through to have your body undergoing this process associated with nourishing a baby in the context of losing one.

So, yeah, for all of these intensely physical experiences, there's a psychological dimension too.

Host: Dr. Carlini, why do some hospitals insist that the parents, especially the mother, hold and name their baby even though the baby's already passed?

Sara Carlini, MD: So, what I would say is that the process of grieving, I think, is about personal choice. It's kind of maybe I'm harping on it a little, but it's unique to each individual and it's really important that we don't impose any idea of what grief should look like.

So, certainly parents and families should be empowered to make those decisions about what's right for them and they shouldn't be pushed to hold or name their baby if they do not feel that that's going to be helpful for them. But it is the case that some folks do find seeing their baby, naming their baby, having photographs taken of their baby, or taking home mementos such as handprints, that those things can really allow them to feel a connection to their baby that helps them feel more at peace.

Host: How do you advise parents not to be afraid to try again in the future to get pregnant?

Sara Carlini, MD: And more on my theme of the day, I've kind of let folks tell you what they want. And, I think it's important to help folks clarify what their feelings are about wanting to try again in the future. For some people, they may conclude that it isn't right for them. And, again, that may be the right choice for them. For others, they may dearly want to become pregnant again, and they may be very hindered by fear or even guilt. Part of the process is working together to understand those feelings as they occur, and also trying to get at what some of the inner beliefs about yourself and the world are that are giving rise to those complicated feelings.

Host: What about when the mom feels guilty, like it's her fault, like she did something wrong? How do you help her get through it? What tools?

Sara Carlini, MD: I alluded to guilt before. You know, guilt can be a major issue. It is so heartbreakingly common for folks to blame themselves after a pregnancy loss. And unfortunately, in some ways, there's a larger societal context that can sometimes almost seem like it's encouraging people to blame themselves for the outcome of their pregnancies.

There's quite a tendency to scrutinize pregnant bodies and to ask questions like, well, what were you eating or what were you drinking? Were you exercising too much? Were you not exercising enough? Were you too stressed out? And the truth is most pregnancy loss just has to do with the fact that the pregnancy is not developing normally and it's beyond control. It's also important to remember that excessive or unreasonable guilt can be a symptom of a major depressive episode.

Host: Do you prefer group therapy as a useful tool or one on one after an experience like this?

Sara Carlini, MD: When it comes to different types of treatment, and really the spectrum of treatment; medications, individual psychotherapy, group psychotherapy, there are some folks who respond well to some things and not to others. I mean, group therapy is wonderful. It can be a really useful and important treatment modality.

And in addition to it's many benefits; one of its kind of unique benefits, just by virtue of the group setting, is it can help folks feel like they're not the only ones going through this experience. And pain and loss and grief can be very isolating. People can feel very isolated in these moments. So that is something that group therapy is kind of uniquely suited to, to assist with.

Host: So it really just depends on the person.

Sara Carlini, MD: Yeah, depends on the person.

Host: What about the partners of the mother who's lost the baby, for instance, a husband? Men react so differently. How do you suggest opening up a dialogue, so that they can be treated as well, their feelings?

Sara Carlini, MD: Absolutely. It's so important to engage the partner of the birthing parent and an event like this can be so staggeringly significant to a relationship. Sometimes the relationship itself may struggle or even fracture. For the partner engaging in therapy or other supportive interventions together, with the birthing parent or the other partner can be helpful.

But also partners should consider that they may benefit from their own treatment that is individual and tailored to them. These are two important things to consider. Therapy together and therapy separately.

Host: Is there anything in closing that you'd like people to know that maybe we didn't cover?

Sara Carlini, MD: So I would like to kind of point folks towards Postpartum Support International. It's a wonderful resource. Their website is www.postpartum.net. It's a wonderful source of information. They have free virtual support groups available, which is something I definitely like for folks to know, including a bereavement support group. It's an excellent resource to keep in mind.

Host: Thank you so much again for sharing your expertise on this incredibly sensitive topic.

Sara Carlini, MD: Thank you again. Thank you very much for having me.

Host: That's Dr. Sara Carlini, and to schedule an appointment at the Brooklyn Center for Perinatal Psychiatry at Maimonides Health, visit maimo.org for more information. Call 718-283-7800 to make an appointment. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Maggie McKay. This is Maimo MedTalk from Maimonides Health. Thanks for listening.