1. Lisa Zucker, MSW, LCSW Certified Thanatologist
Pregnancy After Loss
Lisa Zucker, MSW, LCSW
Certified Thanatologist

2. Learning Objectives
Things to know: the language of loss and models of understanding and intervening
A walk in their shoes: Understanding the experience of parents who are pregnant after a loss – their concerns, how they survive, and things to look for
How can I help? Ways that professionals can support, guide, and assist parents experiencing pregnancy after a loss

3. Things to Know

4. The Language of Loss Definitions
Anticipatory Grief
Bereavement
“Complicated Grief”
Disenfranchised Grief
Grief
Mourning
Unresolved Grief

5. History Freud Kübler-Ross Bowlby Mourning and Melancholia (1917)
On Death and Dying (1969)
Five Stages (DABDA)
Bowlby
Attachment Theory

6. Modern Models Bowlby & Parkes (four Phases) Sanders (five Phases)
Lindemann (anticipatory)
Rando (6 R’s)
Worden (4 Tasks)
Wolfelt (dosing and “companioning”)

7. How is Grief Experienced
In the Body
Aches and pains
Soreness
Sleep changes
Eating Changes
In the Mind
Concentration
Forgetfulness
Agitation
Fear
Anxiety
Blaming

8. How is Grief Experienced Continued
In the Heart
Loneliness
Anger
Despair
Seeking / Searching
Withdrawal
In our Relationships
Gender difference in grief
The mother vs. the father/partner
The father/partner vs. the mother
Changes in social activities

9. Dual Process Model of Bereavement
Margaret Stroebe and Henk Schut (1999)
Loss-oriented
Restoration-oriented

10. Narrative Approaches
Meaning Reconstruction: Thomas Attig, Robert Neimeyer, Janice Nadeau
Contiuning Bonds: Klass, Silverman, and Nickman

11. A Walk in Their Shoes

12. Who are “they”?
Parents
Parents who have experienced the loss of a child
“Age” of the child who passed (perinatal or child loss)
Previous loss history
“Rainbow Babies”

13. Bittersweet Dual Process Model Fear, anxiety, sadness, anger
coexist with
Joy, expectations, love, excitement
Appendix 1 – CNN article

14. The “Should”s Grief is unique, personal, individual
Everyone’s got an opinion
Most “should”s come from reflection of the “should”ers own experiences or fears, an attempt to comfort, or the “should”ers discomfort with seeing pain and sadness
What can a parent do?
Appendix 2
Appendix 3

15. Our World of Social Media
Birth announcements
Pics of the kids
Pressure on the parent
Reminders everywhere, all the time
Intolerance to ongoing grief of perinatal or infant loss
The Holidays, Birthdays, Mother’s Day, Father’s Day, “Year in Review” or most shared status

16. How Can I Help?

17. Meet them where they’re at
Acknowledge the loss
Model language from parent’s language
Be patient, kind, understanding, and reassuring

18. Social Reconstruction
Be concrete and direct
Understand how a mother’s trust in her body has been changed – fears, anxieties, and worries that may seem trivial are not to her
Social Reconstruction
Each person’s experience of reality is informed by their personality, prior experiences, and expectations / motivations

19. Mindfulness – for the professional
Mindfulness as a tool to teach
Never be afraid to engage in appropriate, honest inquiry in the form of, “I don’t know how best to support you or what I can say that would be helpful. Please share with me how I can assist”
Higher risk for perinatal or postnatal mood or anxiety disorders – know when to refer and to whom
Dads / partners are at risk too – disenfranchised grief, caregiver’s guilt, and own fears
Appendix 4

20. Resources
Pregnancy After Loss Support (
Baby and Bump has a Pregnancy after Loss specific forum (babyandbump.momtastic.com/pregnancy-after-loss/)
Still Standing Magazine (stillstandingmag.com/)
Subsequent Pregnancy After a Loss Support (
Reconceiving Loss (reconceivingloss.com/magazine/)
Compassionate Friends: organization for bereaved parents; not pregnancy after loss specific (

21. References and Further Reading Suggestions
Attig, T. (1996). How we grieve: Relearning the world. New York: Oxford University Press.
Bonanno, G. (2009). The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss. New York: Basic Books.
Bowlby, J. (1980). Loss: Sadness and depression. (Attachment and loss, Vol. 3). New York: Basic Books.
Doka, K. (2002). Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. CA: Research PRPub.
Freud, S. (1917/1957). Mourning and melancholia. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud (Vol. 14, pp. 152–170). London: Hogarth Press.

22. Jordan, J. R. & Neimeyer, R. A. (2003). Does grief counseling work
Jordan, J. R. & Neimeyer, R. A. (2003). Does grief counseling work? Death Studies, 27,   
Klass, D., Silverman, P. R., & Nickman, S. L. (1996). Continuing bonds: New understandings of grief. Philadelphia: Taylor and Francis.
Kübler-Ross, E. (1969). On death and dying. New York: Springer.
Lindemann, Eric. "Symptomatology and Management of Acute Grief." American Journal of Psychiatry 101 (1944):141–148.
Neimeyer, R. A. (1998). Lessons of loss: A guide to coping. Boston: McGraw-Hill.

23. Neimeyer, R. A. (2001). Meaning, reconstruction and the experience of loss. Washington, DC: American Psychological Association.
Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books
Rando, T. A. (1984). Grief, dying, and death. Champaign, IL: Research Press.
Rando, T. A. (1993). Treatment of complicated mourning. Champaign, IL: Research Press
Sanders CM (1989) Grief: the Mourning After, Wiley Series
Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197–224.

24. Walter, T. (1996). A New Model of Grief: Bereavement and Biography
Walter, T. (1996). A New Model of Grief: Bereavement and Biography. Mortality, 1, 7-25.
Wolfelt, A. (2005). Companioning the Bereaved: A Soulful Guide for Counselors and Caregivers. Fort Collins, CO: Companion Press
Worden, J. W. (2002). Grief counseling and grief therapy: A handbook for the mental health practitioner (3rd ed.). New York: Springer.