Caring for Yourself After Your Early Loss

CEAC 1314 February 2020 Regina Area

Table of Contents

Caring For Yourself After Your Early Loss ...... 3

Early Pregnancy Loss...... 3

Information to Help You Cope ...... 3

Feelings About Pregnancy and Loss ...... 3

Diagnosing a Loss ...... 3

After Your Loss ...... 4

Emotions and Grieving ...... 4

Stages of Grief ...... 4

Shock...... 5

Denial ...... 5

Anger ...... 5

Guilt and Bargaining ...... 5

Depression ...... 5

Acceptance ...... 5

Maternal Mental Health ...... 6

The ‘Blues’ ...... 6

Depression ...... 7

Anxiety ...... 7

Reaction of Friends and Family...... 8

Another Pregnancy ...... 8

Health Care Follow Up ...... 9

Maternity Visiting Program (MVP) (306) 766-3700 and Primary Health Care Networks (306) 766-7500 ------9

Warning Signs ...... 10

After Care and Healing ...... 10 CEAC 1314 February 2020 Page 1 of 17 Regina Area

Health and Wellness ...... 12

Where to Find Help...... 13

Bereavement / Loss Supports ...... 13

Community Resources and Websites ...... 14

Crisis Services/ Emergency Numbers ...... 15

Mental Health Services/ Postpartum ...... 16

Other Resources ...... 17

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Caring For Yourself After Your Early Loss

Early Pregnancy Loss Information to Help You Cope

Please read this information when you feel ready. We hope that it will help you. No one can predict how you will feel after a pregnancy loss.

Feelings About Pregnancy and Loss

When a person finds out they is pregnant, the emotional response can be very different from each individual. Sometimes pregnancies are highly desired and have taken a long time to achieve and sometimes they are unexpected. Sometimes there is a partner involved and sometimes there is not. Your partner’s response, as with a loss, may be the same as yours, or it may be very different. Pregnancy loss (miscarriage and ectopic pregnancy) is most common in the first three months of pregnancy. Some people and families have chosen not to tell friends and family, while others have told many. Some, but not all, feel a sense of isolation and grief following a pregnancy loss. This is a time to heal physically while acknowledging the emotional impact on a person and their relationships. For some people and families, pregnancy loss is not difficult to recover from emotionally. A person may respond to an early pregnancy loss the same way as another short-term life event that affects health, such as a surgery. Some individuals will feel relief after an early loss if a pregnancy is unplanned, sometimes causing feelings of guilt. There is no right or wrong response after a pregnancy loss. Your response is not necessarily within your control and may be different from those around you.

Diagnosing a Loss

When the health of the pregnancy is brought into question it can be frustrating waiting for a complete diagnosis. Often times it can be unclear if the pregnancy is growing normally between the time of having a positive pregnancy test and when the pregnancy can be seen on ultrasound. It is important for health care providers to be clear in the diagnosis, so that the best plan of care can be made. Ask your health care provider whenever any information you have received is unclear.

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After Your Loss

After a pregnancy loss you need to recover physically and emotionally. The physical recovery may be faster than the emotional recovery. Sometimes there are feelings of emptiness after the miscarriage, even if the pregnancy was not expected, and you may wish to get pregnant again, as soon as possible. The physical ability to get pregnant again can return within a few weeks, however most healthcare providers suggest waiting to try for pregnancy again until after your next period. If you are not choosing to get pregnant again, birth control plans should be made. Choose the right time for you to try to get pregnant again. Many people may feel some anxiety about future pregnancies and potential losses. If anxiety interferes with your daily functioning and sleep, then you may wish to consider seeing a counsellor or using other techniques to reduce anxiety such as exercise, relaxation, and meditation. This is a time for you to take care of yourself. Most of the time there is no reason for the pregnancy loss and we encourage you to let go of guilt and blame. Let others know what you need or do not need to best help you through this time. It is ok to avoid events that trigger strong emotions such as family gatherings or baby showers while you are healing emotionally. Most people who are grieving will go through distinct stages of grief at some point such as bargaining, self-blame, sadness, and anger. Be compassionate towards yourself, your partner and others. Connecting with support people in your life, whether those are friends, family, or caring professionals can be very helpful. We hope that having some information about this common life event helps you cope with the loss of your pregnancy. Please ask your health care provider if you would like more information, more resources or to speak to a medical social worker. Emotions and Grieving As a person who is experiencing a loss, you have hormonal changes and strong emotional feelings. You may find yourself experiencing anger, sadness, guilt, concern, anxiety, loneliness, disbelief, loss, and numbness. These feelings are normal. They are part of the grieving process. The time following your pregnancy loss can be one of ups and downs. Feelings can remain strong for several months or longer. If you feel like crying, do not hold back, it may help you. There are 6 stages of grieving. Not everyone experiences them in this order or goes through all 6 stages.

Stages of Grief

There are 6 stages of grieving. Not everyone experiences them in this order or goes through all CEAC 1314 February 2020 Page 4 of 17 Regina Area the stages. There is no set pattern for everyone; not even within each person. Each grief is unique, as each loss is unique. These stages are meant to help normalize and validate what you might experience or feel during this time of loss and grief.

Shock

At this point, the loss has not “sunk in”. Things feel unreal, almost like you are watching a movie or an event in someone else’s life. You may feel numb, tired, or tearful. Denial

Denial is when you know something has happened but you do not want to believe it. It is hard to go from being pregnant and expecting a baby to having a pregnancy loss. Sometimes when people are in denial they push away everything connected with their loss or begin to have obsessive daydreaming. To keep uncomfortable feelings away, some turn to drugs, alcohol, or plan a non-stop social schedule. All of these things cover up the pain for a while but they do not get rid of the pain. Anger

You may feel angry at yourself or your family, or experience spiritual crisis. You may feel short tempered or feel that little things set you off. Try to express your anger in healthy ways such as talking, exercising, punching pillows, or writing out your angry feelings. It is important to let your anger out in a healthy way. Bottled up anger and frustration hurts your body, spirit, and mind.

Guilt and Bargaining

Whenever a major life event occurs we usually wonder “what if”. You may find yourself questioning your decisions or feeling guilty for the choices you have made. When people feel guilt, they sometimes try to resolve the situation by bargaining with a higher power.

Depression

When you realize that your efforts of avoidance and bargaining are futile, a period of depression generally sets in. You finally realize that you had no control in preventing the loss. You may turn away from loved ones, believing that there is no one who can understand what you are going through, or no one who can help you feel better. You may cry frequently, feeling despair, sadness, and exhaustion. Acceptance

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When you reach acceptance, you regain your normal energy level. You feel interested in life again. When you think about your loss it is less painful. Your family or partner may be grieving but may try to stay strong to support you. They may show their grief at a different time than you and in a different way than you. There are many ways to deal with grief. Here are some suggestions:  Take time for your partner and family.  Talk to others. Let your friends know how you feel. Tell them what you need.  Seek out others who have had an experience similar to your own.  Talk with a counsellor, social worker, or support group. See the Community Resources and Websites at the back of this booklet.  Take time to grieve. Do not avoid thinking about your loss. Spend some time working through your feelings.  Put off major decisions for at least a year. Delay changing jobs or moving to another town until you feel certain that you have really come to terms with your grief.  Keep a journal.  Write down your thoughts and feelings in a story or poem.  Eat a balanced diet, get enough sleep, and exercise.  Avoid drugs and alcohol; trying to numb emotional pain with drugs and alcohol only worsens the pain and may lead to further problems.  Do not expect yourself to “just get over it”. Give yourself time and space to grieve.  Spend time with friends and family members who support you.  Hold a private ceremony or have a personal ritual each year on the anniversary of your loss.  You may want to look at the momentos if you have them: pictures, hand/foot prints, blankets, and keepsakes.  Set realistic goals for yourself, some that are easily within reach and some that will be more challenging. Working towards your goals helps you to move ahead.  As you heal, share your experiences. You can help others.

Maternal Mental Health Being aware of your mental health following your pregnancy loss is important. According to the MotherFirst (2010) Saskatchewan’s Maternal Mental Health strategy, 20% of mothers may experience severe depression or anxiety with pregnancy or childbirth.

The ‘Blues’

After giving birth, there is a change in the hormones from your pregnancy. This can cause feelings of sadness, crying or mood swings, and anxiety. Although, you may be sad with grief of your loss some of the changes can be part of the body’s change in hormones. You may feel tired and unable to think clearly. Your feelings of grief and sadness caused by the loss of your baby cannot be diminished or expected to pass however, even as your hormones normalize.

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Depression

Although depression is an expected part of the grieving process, it is important to recognize that people who experience a pregnancy loss are also at risk for postpartum depression. Postpartum depression is more serious than the “blues” or the depression you may feel as you grieve. It is considered an emotional illness. Postpartum depression after the loss of a baby is more complicated by the fact that, in addition to the normal postpartum changes, you are faced with a devastating loss.

Postpartum depression can start right after the birth and up to one year following. It can affect you in many different ways. Feeling tired and listless, having sleeping problems, always eating or not eating at all, losing interest in the things you used to enjoy, and feeling sad and hopeless are all parts of depression. Experiencing anxiety can also be a symptom of depression.

Individuals with postpartum depression feel lost and anxious - like they cannot cope. They have trouble sleeping and eating. They feel overwhelmed with guilt, shame, isolation, fatigue, and a sense of loss. They may have very scary thoughts.

If you think you have postpartum depression, you are not alone and you can get better. Postpartum depression can have negative effects on you and your family. Talk to your partner and your friends about how you are feeling. Remember – postpartum depression is common and can be treated, you may need medical treatment. There are various, helpful ways to treat postpartum depression.

If you feel you are not coping well and/or thinking of hurting yourself, or others call your health care provider. There are various, helpful ways to treat postpartum depression. The most important thing is to seek help.

Anxiety

Anxiety can occur during the pregnancy or following the loss. People experience feelings of worry, irritability, or restlessness. The symptoms may also be physical with feeling tired, having a headache, or muscle tension.

To get some relief:  Talk about your feelings with your partner or a trusted friend.  Stay away from stressful situations, if possible.  Get lots of rest and do only what needs to be done.  Take breaks and accept help from others.  Cry when you need to - it is healing.

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 Do something nice for yourself every day.

It is important to surround yourself with support. If you feel you are not coping well and/or thinking of hurting yourself or others, call your health care provider. It is important to seek help. Postpartum depression can be treated.

For more information on postpartum support call:

Post-Partum Support YMCA 2400 - 13th Avenue, Regina (306) 757-9622

Reaction of Friends and Family

Your friends and relatives have emotions surrounding the loss of your pregnancy. If the important people in your life are supportive, spend time with them. Being with people who care about you can be very helpful at this time. They want to extend their sympathy and comfort you. Do not be surprised to find a wide variety of reactions from friends and loved ones. Even though others mean well, they may not know how to express their concern and care. Some of your close friends may avoid you, or if they do see you, they may never mention your loss. Sometimes their own discomfort causes people to make insensitive remarks. They are trying to help, but may not know what to say. If this happens it may be helpful to share your feelings about these remarks with someone who cares about you and who you trust. As time goes by, you may find that your grief is forgotten by others. Friends and loved ones become involved in their own lives, and often do not realize your continued need for support. Do not be afraid to ask others for help. Your friends and loved ones cannot read your mind. Tell others what you need so that they can help and support you. Another Pregnancy In the future, when you start to consider getting pregnant again, you may receive advice from friends, family, or health care providers. Only you can make the decision and know when the time is right. Below are some general guidelines that may be helpful in your decision making process:

There are 4 main areas to consider: 1. Take time to recover from your recent pregnancy. Let your body return to its non- pregnant state. Taking care of your physical well-being will support your recovery. 2. Take time for emotional healing and grieve your loss. The information in this booklet can help you understand your feelings about your loss and help you to understand that CEAC 1314 February 2020 Page 8 of 17 Regina Area

being pregnant and grieving at the same time would be very stressful. 3. Take time to seek medical advice. Having additional information can help ease worries you may have about your next pregnancy. Do not be afraid to ask your health care provider questions. 4. Put off making major decisions. You will be more satisfied with your decisions if you wait until you feel that your thoughts and emotions have begun to stabilize.

Health Care Follow Up

All families in the Regina and surrounding areas are offered follow-up with a Public Health Registered Nurse after going home from the hospital. Your care providers in hospital send a referral to the Maternity Visiting Program or a Primary Health Care Network Office for a nurse to support you and your family at home. At the home visit, the nurse will complete an assessment, provide care during the grieving, provide health information, answer questions, and give you and your family support.

Maternity Visiting Program (MVP) (306) 766-3700 and Primary Health Care Networks (306) 766-7500

If you live in and around Regina, a nurse from Maternity Visiting Program (MVP) contacts you 24- 48 hours after leaving the hospital and will arrange a time to visit you in your home. MVP nurses will continue to provide support until 14 days after infant loss. After this time, a Public Health Nurse from your Primary Health Care Network will continue to provide support through telephone contact or home visit as needed.

The Primary Health Care Networks can also offer support to individuals and families such as referral to the Maternal Wellness Health Line 811, individual counselling and support group information, such as the Bearing Loss Support Group. For more information, please go to http://www.rqhealth.ca/departments/public-health-nursing

You should arrange to see your health care provider six to eight weeks after leaving the hospital. Write down any questions you have before the visit. It will help you remember what you want discuss. There are four reasons to see your health care provider after your discharge from the hospital:

Your health care provider:  checks that your physical healing has been normal  may go over the details of your pregnancy. Reports may be available for review and to give you more information.  can help you select the most suitable method of birth control  would like to know that you have started the normal grief process. If the process has been delayed, your health care provider can assist you. CEAC 1314 February 2020 Page 9 of 17 Regina Area

Warning Signs

If you get 1 or more of these symptoms after you are discharged from hospital, call your health care provider right away or go to the Emergency Department.  Fever over 38.5° Celsius or 101.3° Fahrenheit  Sudden, very heavy bleeding or discharge: soaking more than 1 pad in an hour, clots bigger than a toonie, or bleeding that drips into the toilet.  You cannot catch your breath for any clear reason  Fainting or dizziness  Painful, reddened breasts and flu-like aches, fever, and chills  Vaginal discharge that smells bad  Burning, stinging, or difficulties when you pee  Flow that lasts longer than 6 weeks  Red, uncomfortable, or swollen legs  Headaches  Problems seeing, such as blurring or spots in front of your eyes  Increase in pain around your vagina, perineum, or lower stomach  Bad cramps or a sore abdomen that never goes away  Not coping well and thinking of hurting yourself or others

After Care and Healing

Vaginal Bleeding Afterwards, bleeding and discharge from the vagina is normal. It is usually small to moderate in amount and can last for 2 to 6 weeks. Do not use tampons during this time. Change your pad frequently. In the first 3 days your bleeding is bright to dark red. You may notice that your flow increases when you stand up. You may pass small loonie sized blood clots during this time. As your uterus heals, the colour of your flow changes to pink or brown tinged and becomes lighter.

Perineal Discomfort and Care The perineum is the part of your body between your vagina and your bum. Your perineum may be sore, bruised, and swollen. CEAC 1314 February 2020 Page 10 of 17 Regina Area

For Perineal Pain or Discomfort:  Cool the area with crushed ice. This helps to reduce swelling and gives you some short term relief. Never put ice directly against the skin. Place ice in a towel then place the towel against the skin.  Soak in a warm tub daily.  Use pain relievers as needed.  Sit on a soft cushion.

Perineal Care means rinsing your perineum with clean, warm water every time you pee, have a bowel movement (poop), or change your pad. Continue this routine until your bleeding stops. To clean the area, use the plastic squirt bottle you got in the hospital, or take a bath in a clean tub.

After-Pains

After-pains are cramp-like pains felt in the abdomen. These cramps are the result of the uterus returning to its normal size. They are more common and often more painful for people who have had more than 1 child. After-pains should go away in 4 to 7 days. Talk to your health care provider if you need some medication to help with the pain.

Return of Your Period

It is hard to predict exactly when you will get your period back. Your first period may be heavier and last longer than normal, and there may be some clots. Periods may be irregular for a few months as your body gets back to normal. It is possible for you to get pregnant as soon as you start having sex, even if your period hasn’t returned.

Sex and Birth Control

You can have sex again when you are physically healed and emotionally ready. Grieving your loss can affect your readiness for sex. It is important that you talk about birth control with your partner and your health care provider if you have questions.

Please refer to CEAC 1198 Contraception Methods for more information on birth control.

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Health and Wellness

Nutrition It is important to eat well. The right food choices give you energy, prevent constipation, and help you maintain good health.  Follow Eating Well With Canada’s Food Guide  Drink 6 to 8 glasses (250 mL or 8 oz) of fluid every day.

Rest and Sleep Rest is important for a person’s physical health and emotional wellbeing. Your body needs rest and proper care to restore strength and energy.  Rest as much as possible.  Accept help from others and ask for help when you need it.  Let unimportant household tasks wait.  Try not to take on extra tasks.  Stay away from heavy exercise for 6 weeks.

Pelvic Floor Exercises

Get comfortable Pelvic floor strengthening can be performed in any position. You can start by lying down in a comfortable position.

Focus on ‘what you feel… and where’ To contract the pelvic floor muscles, imagine that you are stopping the flow of urine or holding back gas. If you feel comfortable, you can observe using a mirror and touch the muscles as they contract. Place your finger into your vagina to check if the muscles are working and to check your progress. If you are activating these muscles, you will feel a contraction around your finger. Focus your contraction on the pelvic floor muscles and not using the muscles of your abdomen, thigh, and buttocks.

How often? Make pelvic floor strengthening part of your daily routine, 4-6 times per day. It is recommended to tighten the muscles of the pelvic floor and hold for up to 10 seconds. Fully release the contraction. Repeat as many times as you can (up to 8-12 times). As you get stronger, increase the number of repetitions and length of hold.

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Remember to breathe! Breathe freely during your exercises. Counting out loud can help ensure that you do not hold your breath.

Where to Find Help

Getting your life back in order after your loss is not easy. You may be overwhelmed with the physical and emotional reactions you have experienced. You may lack the motivation it takes to work through your grief or you might just not know where to start. You are not alone. There are professional people available to help you sort out your feelings. See below for a list of community resources and websites.

Bereavement / Loss Supports

HealthLine 8-1-1 24 hour professional health advice and information line

Primary Health Care Networks

Phone: 306-766-7500

The primary care networks can offer support to individuals and families such as referral to the Maternal Wellness Health Line 811, individual counselling and support group information, such as the Bearing Loss Support Group. For more information and public health office numbers throughout the province please go to https://www.saskatchewan.ca/residents/health/public-health/public- health-offices

Bearing Loss Support Group Bearing Loss is a support group for families grieving perinatal loss. This group is for families who have experienced pregnancy loss through miscarriage, ectopic pregnancy, interruption, stillbirth, newborn, or neonatal death. Bearing Loss group support is available on the first Tuesday of every month from

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7:00 p.m. to 9:00 p.m. at 3510 Queen Street (St. Mark’s Lutheran Church). Parking is available.

Please contact Bearing Loss Support Group facilitators with the Saskatchewan Health Authority, Regina and area to register and for more information. Phone: 306-766-7200 Email: [email protected]

Community Resources and Websites

The Compassionate Friends Phone: 306-761-0974 A non-profit, non-denominational, self-help organization, offering friendship, understanding, grief education and HOPE for the future to all families who have experienced the death of a child at any age, from any cause. www.tcfcanada.net/chapters/saskatchewan

Caring Hearts Provides grief and bereavement services in a safe environment for people to share in the experience of journeying through their grief. http://www.caringheartssk.ca/palliative-care/group-counselling

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Crisis Services/ Emergency Numbers

Family Services Regina Phone: 306-757-6675 Working with individuals, families and communities in all their forms, who are currently in distress or at risk. http://familyserviceregina.com/

Mobile Crisis Service Phone: 306-757-0127 Offers 24 hour assistance. www.mobilecrisis.ca

Regina Crisis Line Phone: 306-525-5333 Offers 24 hour assistance.

Family Planning Planned Parenthood Phone: 306-522-0902 1431 Victoria Ave, Regina For birth control and family planning information www.plannedparenthoodregina.com Sexuality and U (The Society of Obstetricians and Gynecologists of Canada website) Information about birth control, sexually transmitted diseases, and sexual health www.sexualityandu.ca

Health Services Health Canada Food and Nutrition Eating Well With Canada’s Food Guide http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/myguide-monguide/index- eng.php

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Mental Health Services/ Postpartum

The Caring Place (Regina) Phone: 306-347-2273 Offers counseling for parenting, marriage, addictions, depression, low self esteem, stress, and abuse. www.thecaringplace.ca

Employee Family Assistance Programs (EFAP) Offers counseling services through your employer; inquire through your workplace.

RQHR Mental Health Clinic Phone: 306-766-7800 Counseling for adults who are experiencing distress.

Women of the Dawn Counseling Centre Phone: 306-522-6040 Offers postpartum counseling for people who identify as Indigenous www.reginacity.com/fnac/contact.htm

Al Ritchie Health Action Centre Phone: 306-766-7660 www.rqhealth.ca/facilities/al-ritchie-health-action-centre

Catholic Family Services Regina Phone: 306-525-0521 Offers counseling services and parenting classes. www.cfsregina.ca

Four Directions Community Health Centre Phone: 306-766-0200

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Other Resources

Health Care Providers If you require health care services or are feeling depressed, talk to your doctor, nurse, social worker, or midwife.

Medical Social Worker Social worker, psychologist, and/or family counsellor may be helpful if you feel the need for additional counseling. The medical social worker can refer you to one of these professionals in the community and provide information about groups that can help you. The social worker is available to at 306-766-4210.

Spiritual Care Whether or not you have been affiliated with an organized religious group in the past, you may find yourself now searching for some answers to many of life’s puzzles. Seek help through your clergy or ask hospital staff for spiritual care contact numbers.

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CEAC 1314 February 2020 Regina Area