A link between stillbirth and maternal depression is now established.

A study undertaken by the NIH’s Eunice Kennedy Shriver National Institute of Child Healthand Human Development has shown a link between stillbirth and heightened risk for protracted maternal depression. http://www.nih.gov/news/health/feb2015/nichd-18.htm(link is external)

This is significant because it identifies an important reality that is often overlooked in the medical field, and also because it yields some actionable information that could be used to improve the mental health of mothers and their families.  It is useful information for woman with a personal history of depression, and also for those without this history.

Says study author Marian Willinger, Ph.D., “This study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth… These findings suggest that women who have had a stillbirth may require longer-term monitoring for depressive illness and referral for treatment when they need it.”

As a baby loss mom, I am gratified to see this important finding come to light. Maternal depression following stillbirth is both typical and understandable. Its nuances, however, may be somewhat obscured by life events that often take place following a stillbirth. For example, many families who face stillbirth will attempt another pregnancy within 12 to 18 months, and the complex emotions that surround this are little acknowledged by society at large.

Pregnancies that follow loss may often be fraught with a myriad of emotions that can range from fear and guilt to joy and relief. In addition, should a woman find herself pregnant again, those who surround her may dwell heavily on the positive—it is humannature to reach for the happy ending—inadvertently negating the fear, guilt and anxietythat can accompany a post-loss pregnancy.  This may impel a woman still mourning baby loss to guard her own grief zealously.  She stores up residual sadness, not talking about it and withdraws.  The effect of this is the isolation that may lead to the emergence of depressive symptoms.

These symptoms may last for several years, extending well after the birth of another healthy child. According to study author Carol Hogue, Ph.D., “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child … Symptoms of depression are a normal part of grieving after a stillbirth but depressive symptoms that don’t resolve within six months of the loss can become debilitating.”

In the months that precede another pregnancy, many women find themselves isolated within their peer groups. For women who have not yet become pregnant again, the weeks and months that follow stillbirth can be traumatically isolating and lonely.  Her peer group may have babies and small children.  Dialogue surrounding loss may feel difficult and strained.

People in the medical field (obstetricians, midwives, primary care physicians, pediatricians, doulas) can use this information to help post-partum women in various ways. Understanding that society at large does not address baby loss effectively, these health care professionals can take the time to ask about the mother’s emotional health. These questions can and should continue for months after the loss. They should continue in the event that another pregnancy is successful. This can and should extend beyond the birth of a healthy baby.

Ask any baby loss parent about anxiety and they will tell you about the number of times they check to make sure a baby is breathing, how they can spin quickly into catastrophic thinking, and how this sometimes makes them feel unhinged. Effective referrals to mental health experts can have lasting benefit to women who are having a normal psychological response to an atypical, devastating outcome.

For those coping with loss, help is available. Writes Dr. Julie Bindeman, “Most people wait to see a professional when they feel like their emotions are getting out of hand—whether it is for grief or any other mental health concern.  One can argue that seeking out treatment early on might be more beneficial, as it will provide you with an outlet and coping tools from the beginning. Don’t settle for any clinician. Finding one that is trained in perinatal loss is essential. Often times, if there is no one available in-network with this specialty, an insurance provider might be able to provider a “single case agreement” with an out-of-network provider, thus you would only pay the in-network rate and insurance would cover the rest (check with your state to see what insurance laws are, as they vary).  Often times, out-of-network providers will slide their scale and they will help you to get whatever reimbursement might be due to you for services.” http://reconceivingloss.com/calling-in-the-experts/(link is external)

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This article originally appeared on Psychology Today.

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