Miscarriage, the loss of a child before 20 weeks gestation, is so very common. Since 1 in 4 pregnancies end in miscarriage, it’s highly likely that every natural family planning (NFP) or fertility awareness method (FAM) instructor will find herself accompanying clients through pregnancy loss at some point [1]. Whether a client is just learning to chart and has a history of miscarriage, or experiences a miscarriage while actively working with an instructor, it is essential that NFP/FAM instructors think through how they will support these clients. Together, we can begin to better support parents who have lost a child to miscarriage, stillbirth, or infant loss by becoming more grief-informed.
As a Creighton Method instructor, bereavement doula, and loss mom myself, I’m sharing 4 ways you can walk with clients in a grief-informed way. I invite you to consider incorporating these into your practice as a NFP/FAM instructor. (And if you are a medical care provider but not an instructor, here are some ways you can become more grief-informed when it comes to pregnancy loss.)
What does it mean to be grief-informed?
According to Saint Louis University professor of sociology and health care ethics (and bereavement doula), Dr. Abby Jorgensen, grief-informed care includes “two key elements:” First, a grief-informed NFP/FAM instructor “anticipates that every person in her or his care may have a history of grief and loss;” secondly, a grief-informed FAM instructor “chooses to speak and act in a way that reflects that possibility of grief and loss.”
Jorgensen notes that adopting a grief-informed approach “may require a dramatic overhaul for many of us, as society has taught us to ignore, hide, or shy away from conversations about death (especially the death of a child and prenatal death).”
Four ways you can be a grief-informed NFP instructor
#1: Have a list of resources ready to go at all times
First, I encourage you to create a list of resources for loss parents to have on hand. There are many types of national and local resources you can consider adding to your list. Clients with a past loss (even if it was years ago) as well as clients who have experienced a more recent loss may benefit from a support group. Some virtual examples include Bereaved Parents Community Group or Star Legacy Foundation support groups. The Star Legacy Foundation also offers a peer companions program.
Additionally, check with your local hospital to see if they offer perinatal loss groups. You could also include on your list a “warm line” (a phone line not intended for emergency or crisis situations, but for advice-giving and active listening) such as the Postpartum Support International HelpLine, as well as a 24/7 hotline such as SAMHSA’s Helpline, which connects clients with mental health resources. In addition, you can seek out local resources such as a funeral home, a therapist experienced in working with grief, local clergy, and bereavement doulas. You can find other ideas for grief-informed resources here.
#2: Don’t shy away from bringing up your client’s loss
Secondly, acknowledge your NFP/FAM client’s loss. Avoiding the topic does not lessen grieving parents’ pain. Let me reiterate: avoiding the topic does not lessen grieving parents’ pain. They will remember their lost baby regardless of whether you mention it. For clients with a history of loss, you can acknowledge their loss by simply saying “I’m sorry for your loss.” If you are recording the number and/or names of their children during the intake process, you can ask your client how they would like you to record the number of their children. You can also ask for the names of any lost little ones. Know, too, that not every family chooses to name babies who died before birth.
If you see a potential loss on a fertility chart or a client tells you about a positive pregnancy test that was followed by bleeding, I believe that it is important to discuss the possibility that this was an early loss, sometimes called a “chemical pregnancy.” Part of our role as NFP/FAM instructors is to help our clients to gain a greater understanding of their fertility. Having a gentle and sensitive discussion about the possibility of an early loss can be part of that.
#3: Incorporate grief-informed language in your client conversations
Additionally, consider choosing grief-informed language when talking with your clients. For example, I would advise avoiding the term “spontaneous abortion.” While this is the medical term for a miscarriage, it can sound shocking and even accusatory to a woman who has experienced a miscarriage. Simply using the term miscarriage on any forms that you use for teaching and in discussion with your clients can make a big difference. If a client comes across the term “spontaneous abortion,” you can explain to them what it means and how it is very different from an induced abortion.
When discussing a loss, you can use the noun form, “miscarriage,” rather than the verb form “miscarry.” While this may seem like an insignificant difference, it can avoid placing blame on the mother and her body for the loss. Similarly, using the phrase “experienced a loss” is more grief-informed than “lost the baby.” Again, this avoids language that may sound as if it’s placing blame on the client and her body.
#4: Offer guidance on fertility charting after a miscarriage
Finally, it is important to prepare clients for charting after a miscarriage or other pregnancy loss. This article is a great guide to charting using an NFP/FAM method after a miscarriage. It is important that women know that they can ovulate soon after a miscarriage, although some women’s bodies will take longer to resume ovulating. Most importantly, don’t assume that clients will want to try to conceive right away or anytime soon after a loss. Some couples may want to conceive again right away, and some will need more time to recover physically and emotionally before starting to try again. Some may never want to conceive again. In all cases, check in with your client to see what their intention is in charting, so you can best support them.
The bottom line on becoming a grief-informed NFP instructor
Whether you are a new or seasoned NFP/FAM instructor, it’s worth taking the time to consider how you can support clients who have experienced (or will experience) a miscarriage or other pregnancy or infant loss. You care so much about your clients, and becoming grief-informed is just one more way you walk with them along their fertility journey.
Know, too, that being grief-informed doesn’t just benefit women and couples who’ve suffered child loss, because everyone has experienced loss in some way. Grief can arise when there is a health challenge such as PCOS (Polycystic Ovarian Syndrome) or endometriosis, while infertility brings its own grief. Whether it’s providing resources to a client who has just lost a baby or one who is navigating a cycle affected by the stress of losing a parent, developing the skills of listening with sensitivity and care will benefit each person you work with as a FAM/NFP instructor. Thank you for the important work you do to help women and couples become more knowledgeable about their fertility and health.
References:
[1]Dugas C, Slane VH. Miscarriage. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532992/Additional Reading:
Four things everyone needs to know about miscarriage
Resources for emotional healing after miscarriage and other forms of child loss
5 ways the medical community can support those who experience miscarriage
Fertility awareness and early pregnancy loss
How to chart your cycle and figure out when you will ovulate after a miscarriage
