WHEN A NEW MOTHER’S JOY IS ENTWINED WITH GRIEF
Every Mother’s Day, Maggie Nelson, her husband Mike, and their three young children head to the cemetery to take a family photo at the grave of their daughter, Emily. She was stillborn in 2010, but her twin, Mikey, now 7, survived.
“People say, ‘That’s kind of sad,’ but I can say, ‘I’m a proud mom of four. Here I am with all of them,’” Ms. Nelson, 39, said of the photos of her and the kids gathered on the grass by Emily’s stone plaque. A Bloomington, Ill., kindergarten teacher, she is a member of an unofficial sorority of women who experienced acute grief while postpartum.
The grief of fathers, adoptive mothers and other relatives after a family death is no less real, but postpartum women in mourning endure a particularly complicated blend of physical and emotional duress.
First, there are factors that can affect any new mother: the physical discomfort of childbirth, the lack of sleep and anxiety about the baby.
After giving birth, a new mother experiences rapid drops in levels of estrogen and progesterone and steep increases in prolactin. This can result in strong feelings of fatigue, irritability, insomnia and sadness known as the baby blues, which the National Institute of Mental Health says affects up to 80 percent of women.
This is not the same as the more intense, ongoing postpartum depression, which doesn’t reveal itself immediately, says Christiane Manzella, a senior psychologist who specializes in bereavement at the Seleni Institute, a women’s counseling center in New York.
Grief disrupts the body in different ways, with effects that can include a weakened immune system, a perilous situation for a new mother.
“I was a mess, to put it in a nutshell,” said Gayle Brandeis, 50, a Nevada writer whose mother committed suicide in 2009, days after Ms. Brandeis gave birth to a son. She experienced bouts of dizziness and had difficulty catching her breath. “I was really worried that my milk would dry out. I had a lot of stitches and walking was very painful,” she said. “I felt so disoriented in my body.”
Bereaved new mothers need people to remind them that there are no wrong feelings.
“It feels incredibly isolating because you’re supposed to be happy,” said a Boston-area 47-year-old mother of two who works in marketing and asked to be identified only by her first name, Susan. In 2012, when Susan was on bed rest with a high-risk pregnancy while living overseas, her mother died unexpectedly. She could not travel for the funeral and was able to attend only via Skype. When Susan eventually gave birth to a daughter, her relationship to her baby was not what she expected. Her daughter had acid reflux, screamed a lot and slept little.
“I thought there would be this bond that I wouldn’t want to break because she was somehow my mom incarnate. It wasn’t that at all.” Throughout this experience, Susan, like most grieving new mothers, wondered, “Is this normal?”
Pediatricians are on the front lines of spotting signs of postpartum depression in new mothers, since they see babies and mothers sooner and more frequently than obstetricians. Dr. Dafna Ahdoot, a Los Angeles pediatrician, has helped grieving new mothers who were anxious about their surviving baby’s health, concerned over whether they could take their newborn to an out-of-town funeral, or worried that their grief would negatively affect the baby. She advises grieving new mothers to prioritize their own eating and sleeping by securing help with night feedings and switching to formula feeding as needed if breast-feeding is too difficult.
Many therapists specialize in postpartum depression or grief and can address both. “It’s so hard to tease those symptoms apart,” says Juli Fraga, a San Francisco psychologist who specializes in postpartum depression.
A woman may think: “‘Why wouldn’t I be crying? I’m not sleeping.’” She helps her patients try meditation or breathing exercises to reduce levels of cortisol, the stress hormone, and then discuss, as needed, next steps like seeing a psychiatrist or integrative medical options.
Not all women have access to or even desire professional support. With initiatives like Therapy for Black Girls, the mental health community is working to build a bridge to African-American women who may mistrust medical institutions.
“African-American women are at higher risk for premature birth, and so we are losing our babies,” says Keisha Wells, a counselor in Columbus, Ga. “If you’re dealing with that and you don’t have anybody to talk to and you’re a person of color, that’s added sorrow.” Ms. Wells did not have access to this type of mental health care 11 years ago when her twin sons, born prematurely, both died. But she said she found comfort in faith-based support.
In the first weeks after a birth paired with a death, close loved ones can lighten a new mother’s load by making thoughtful executive decisions. Ms. Nelson’s twins’ room was painted half pink and half blue, and set up with two cribs. Friends repainted it and removed Emily’s crib. “Nobody asked,” Ms. Nelson said. “I didn’t know if I wanted to be asked. It had to happen, and friends and family had to take care of it.”
More than anything, most grieving new mothers need to express their grief. After Ms. Nelson took Mikey home, a friend brought over a picnic dinner.
“She put the basket on the counter, took both my hands in her hands and said ‘Tell me about Emily,’” Ms. Nelson recalled. She said she appreciated that opportunity. Other well-intentioned people misunderstood and said, “I didn’t mean to make you sad,” when she’d start to cry. She said she wanted to tell them: “Emily’s death makes me sad. You talking about her makes me hope-filled, it makes me proud. The tears are going to come, but let me do that.”
Many grieving mothers find solace in the stories of others, be they in books, online or in groups.
Ms. Nelson was intrigued by the show “This Is Us,” in which the main characters lose one of their triplets at birth and impulsively decide to adopt an abandoned baby. “The first episode made me angry that they were like, ‘We’ll just take this baby home instead,’ but when they later showed the raw emotions that she had, I was a little more on board,” Ms. Nelson said.
Mourning new mothers eventually find a way to honor both their lost loved one and their child using what is known as a continuing bond grief paradigm. Dr. Manzella said that it can be compatible with the ongoing waves of grief many mothers who have gone through loss experience, and that the thinking about grief has evolved from the “accept and let go” ideas in the classic “five stages of grief” model of the Swiss psychiatrist Elisabeth Kübler-Ross. “Why not continue loving in absence and getting solace from the sense of love?” she said.
Sometimes, finding a way to mark the loss can help.
Each year, Ms. Nelson and her family honor Emily’s birthday a day before Mikey’s, since her heart stopped beating the day before he was born.
“I have my day to be sad,” Ms. Nelson says. “We go to the cemetery with balloons. The kids are fully involved. Then the next day is all about Mikey.”