Losing a Baby to Miscarriage or Stillbirth

Both miscarriage and stillbirth refer to the loss of a baby during pregnancy. Whereas miscarriage occurs before 20-24 weeks of gestation, stillbirth is when a baby is born dead after 20-24 weeks of pregnancy.  

Statistics in Singapore

In Singapore, about 20% of pregnancies end up in a miscarriage while stillbirth happens in 0.5%-1% of pregnancies. In most cases, the cause cannot be established. Some known causes include infection, umbilical cord accidents, and placental complications.

A word from our clinical psychologist:

Perinatal loss is a term broadly used to describe losses before, during and after pregnancy. There are different types of losses during pregnancy, including miscarriage, stillbirth, ectopic pregnancies and medical termination for various reasons. No matter when or how the pregnancy loss happened, losing a baby has been described by some of the clients I have worked with, to be the worst kind of pain. Their loss experience defied their assumptions and expectations of a "normal" course of pregnancy through the trimesters until the smooth delivery of their healthy baby, just like everyone else! A "typical" path towards parenthood, towards forming a family (with children) is all that they had hoped for. Given this, a range of emotions - anger, sadness, grief, shock, guilt amongst others may result, as a part of the grieving parents' mourning process. 

For there is so much to mourn - the loss of their "healthy" baby, the loss of sense of "normalcy" in their lives, the loss of that anticipated future with baby as a part of the new family, and the loss of the new identity, hopes, dreams as soon-to-be parents. Instead of celebration of their baby's arrival, some grieving parents may find themselves confronted with the starkest reminder of their loss, in the form of a symbolic farewell ritual, or funeral ceremony and burial event for their baby. For some families who choose these practices, they shared that it can be very helpful for their grieving process and closure. But, there is no one way to grieve, so honour your own needs, beliefs, emotional and physical capacity to decide what is best for your unique situation. 

What can complicate perinatal grief is also in part due to the "invisible" nature of pregnancy loss, especially in the early stages. This can make it very hard to talk about it with others and for loved ones to fully acknowledge the deep, emotional and psychological impact of such losses. Hence, it is necessary to remind all that perinatal losses are as worthy of care and compassion as other types of relationship losses. This is because attachment relationship bonds has already formed between conceiving parents and baby, as soon as they learn about being pregnant. 

Given the tough, unbearable pain of perinatal losses, much compassion is needed all around. Grieving mothers/fathers need to learn to be more self-compassionate and manage their own harsh self-talk, especially those about failure and being unworthy as parents. Given that the nature of perinatal losses are often unexpected, resulting in a big sense of loss of control, it can be beneficial to find little ways of taking charge, for instance, of daily routines, or setting of boundaries about what you are comfortable discussing. This can assist with restoring some sense of normalcy and control as you navigate grief. 

A journey shrouded by shame and silence

Given that pregnancy losses are common, some women may feel that they do not deserve to grieve. On the other hand, despite the substantial occurrence rate, resources to support these women are scarce.

There has also been stigma and blame attached to pregnancy loss, where mothers are implied to have failed to take good care of their babies. Even well-intentioned advice could come across as insensitive and dismissive. This unspoken roller-coaster journey can feel unforeseeably lonely and difficult. 

An unimaginable pain

The loss of a child, no matter how brief they have been in your life, is profound. It goes against the natural order of life and no parent can ever be prepared for it. The loss of a child is also the loss of an imagined future with them – the hopes and dreams that cannot be fulfilled.

With the devastation, there may also be guilt that you could have been more attentive to your diet and body, and anger that it had to happen to you. Mothers may also feel alone thinking that their partner does not understand their pain since their partners are not the one who carried the child.

How can I cope with a miscarriage or stillbirth?

Everyone grieves differently – in different ways and on different timelines.

Here are some ways we hope can help with your grief.

Ψ Make room for your feelings

Allow yourself to feel all that you feel – guilt, anger, confusion, panic. Observe where you are feeling these emotions in your body – aches in the stomach, tightness in chest? Let yourself be where you are at the moment. There is no prescribed timeline which states the stage of grief you should be at at any point of time.

Ψ Be compassionate to yourself

Understand that it is not your fault nor a personal failure.

As mentioned earlier, there is no timeline for grief; you will move along with your grief rather than moving on from it. Do not expect yourself to forget. Instead, expect yourself to feel triggered on the anniversaries or when you see other families with children. When that happens, allow yourself to take short breaks to grieve – it can be in a toilet cubicle or in a corner of a park. This place should be somewhere you feel safe and comfortable to express your emotions. 

Ψ Pay attention to unhelpful thoughts

Certain narratives may start playing in your head: “My life is worth nothing if I do not have children”, “I am not complete without children”, “It is all my fault”, “I’m a useless mother”. When played enough times in your mind, these thoughts may seem convincing. But they are not true.  

You could challenge these thoughts by asking these questions.

• What's the evidence for and against these thoughts?

• What would I tell a loved one who is going through the same situation? 
  
  

Ψ Grieve with your partner

An event like the loss of a child could bring a couple closer to each other or lead them to drift apart.

You and your partner may respond to the death of the baby differently – one may turn to crying, one may turn to work to avoid thinking about the pain. Some couples may not want to burden their partner with their anguish so they choose to keep their feelings to themselves. When you are unsure of how your partner feels about the loss, there is a chance that you feel that they are less affected by the loss. And this, will lead to emotional distance and tension in the relationship. 

Recognise that this is uncharted territory for both of you. Seek your partner to grieve as a team. Communicate with each other your sorrow, and try to understand how both of you will grieve in different ways, but together. 

Ψ Consider a grief ritual

For some, a grief ritual gives some form of closure to the episode. The symbolic ritual could be in the form of a scrapbook, memory box, journal entry or even a remembrance trip. 

Ψ Look after yourself

The miscarriage or stillbirth takes a toll on your physical body. The grief and emotional pain may take hold of your life, leaving you with no mental capacity to plan for your day. A routine may be helpful to ensure that your physical well-being is taken care of. You need your sleep, food and physical activity.

Ψ Seek support

Reach out to your family and friends. Be with your loved ones even if you do not feel like talking about the loss; their company in itself may be comforting.

To ease your return to work, we encourage you to speak with your bosses to let them know how you want your return to be managed (e.g., shorter hours, work-from-home arrangement, inform your colleagues to not broach the topic).

The pain of grief could be overwhelming. But you are never alone. Consider seeking professional psychological help in the forms of support group and therapy. Some support groups include:

• Child Bereavement Support (Singapore)

• Angel Hearts

• Miscarriage, Stillbirth, & Child Loss Support Group

• Pregnancy and Infant Loss Support Group Singapore

• Pregnancy After Loss Support (PALS)

How family members can support their loved ones

This key idea should underlie all of your efforts to support them: Acknowledge and validate their pain.

Understand that the loss hurts them deeply, and it will take time for the pain to feel more bearable. Some may feel comforted by phrases like “I’m so sorry it happened”, “I cannot imagine your pain but I’m here for you”.

The aim is never to cheer them up – you would be disappointed if you want to do that because you cannot take their pain away; rather, it is to join them in their pain as they struggle with their intense and painful emotions.

On anniversaries or in situations where the parents may be reminded of their loss, you could check in on them gently by asking how they are feeling or if they want to spend time together.

If you notice that their grief has affecting their daily life for a concerning amount of time, let them know why you are concerned (i.e. what did you notice and explain why it is concerning), and encourage them to ask for professional help. You could also go the extra mile and accompany them to visit a psychologist.

Gaslighting: Subtle Psychological Manipulation

There never seems to be a way out that you can find without slamming face first into your own reflection. Some mirrors even make you appear distorted, and you begin to questions which parts of this experience are real. To victims of gaslighting, this is an analogy of what it might feel like to be gaslighted.

What is Gaslighting?

(clue: it is not lighting a fire using gas)

Gaslighting is an insidious form of psychological manipulation that can have a profound effect on the individuals affected by it.

Gaslighting is a term used to describe when someone intentionally, and often successfully, manipulates another person into questioning their own memory, judgement, or reality. It is a form of psychological manipulation that occurs over a gradual period where the perpetrator takes advantage of a target by sowing seeds of doubt within them.

So how does gaslighting look like? 

A gaslighter (aka the abuser) may use tactics such as making false statements (which they will strenuously deny if challenged), disagreement with factual information and downplaying emotions, all in an effort to make the victim doubt their own perceptions.

Over time, victims are not only unsure about their perceptions of reality and even their own thoughts, but come to rely on the abuser to tell them the “truth” about.

The ultimate goal of gaslighting is to de-legitimise a victim’s thoughts and to cause them to question themselves. This can occur via a variety of techniques and behaviours that the gaslighter employs, which may look like: 

• Lying – “That’s not what I said, I said this…” 

• Discrediting – Telling people around you that they are concerned about your recent behaviour and that you might be “crazy”. 

• Distracting/Deflecting – “Why did you bring this up? What about the time you….” 

• Minimizing thoughts and feelings – “Why are you so sensitive?” 

• Shifting blame – “I only behave this way because you did so first. I wouldn’t do it if it weren’t for you.” 

• Denying wrongdoing – “I didn’t do anything wrong”  

• Changing the storyline – Retelling stories by changing it so that the storyline is in their favour.  

While gaslighting often occurs in romantic or familial relationships, it can sometimes occur in the workplace, with friends, or in schools. Several teachers in Singapore even complained about being “gaslighted” by an AI Chatbot designed to provide “AI therapy”!

Why do people gaslight? 

Gaslighting is often employed by narcissistic individuals looking to evade accountability.

By redirecting attention onto the supposed flaws or shortcomings of others, it reduces the likelihood of their own flaws being discovered. They might also believe that they are never at fault, naturally it would be easier to put the blame on others when things don’t go their way. As long as the victim believes they are flawed and need help, the gaslighter would never have to take responsibility for their actions and can continue behaving in the way they do.   

What are the effects of gaslighting 

Ψ Isolation  

Being gaslighted can make you feel extremely alone and dependent on the abuser. It may feel as if everyone around you thinks you have issues or even to the extent of feeling crazy, just as the abuser would describe. As you begin feeling more isolated, the behaviour of the abuser becomes more normal since there is nothing else to compare it to.  

Ψ Emotional Trauma 

Gaslighting has significant negative effects and can cause emotional trauma to the victim. Children exposed to traumatic events and abuse in childhood can become hypersensitive to such threats, and reduce their resistance to stressful events in future. Trauma can also lead to difficulties in emotional regulation in adulthood, alongside other physical issues such as somatic symptoms or heart disease. 

 Ψ Reduced self-esteem 

Prolonged emotional abuse can also lead to a loss in self-esteem, as you constantly feel that you’re never enough. You might begin wondering if you can believe in yourself to do anything correctly, or if you’re to blame for everything that has gone wrong. You might feel incapable of judging the situation realistically, and if you can accurately remember the details of situations. You might feel obliged to continue to stay in the abusive situation because it might feel like no one would believe you or want you anyway.  

Ψ Psychological issues

You might even feel nervous or afraid to say things, lest the abuser retaliates or no one believes you. Gaslighting can lead to psychological disorders such as anxiety, depression or even psychosis.  

Signs that you are being gaslighted

Unfortunately, gaslighting can be incredibly hard to detect without an outside perspective which could make it incredibly difficult for victims to identify what’s happening and take action before it’s too late. On the surface, what might seem as an innocuous quarrel between a couple or might in reality be more complex than a mere argument between two individuals.

It can be difficult to spot gaslighting within a relationship as the signs can appear “normalised” to you after some time. Recurring manipulation and abuse, coupled with the feelings of isolation and reduced self-esteem, causes the individual to constantly doubt themselves and the reality that surrounds them.

If you identify with some of these emotions and suspect that you are being gaslighted, the following are several signs that can indicate gaslighting behaviour. 

Ψ Repeated patterns of manipulation  

“Nope, that didn’t happen” 

“Your memory is getting so bad!” 

“You’re being so sensitive”  

These statements are often used by gaslighters to manipulate you.

While they might be common statements used in many arguments, it is important to note that these statements are often used throughout by the gaslighter in the relationship. This happens often enough such that it forms a consistent pattern in a relationship.  

Ψ Being invalidated constantly

When expressing your needs or concerns, the gaslighter often invalidates you by calling you oversensitive, convincing you that you’re unstable, and how everyone around you thinks you’re crazy.   

Ψ Deflection

When it comes to finger pointing, no one can beat a gaslighter. As soon as you bring up a topic that is concerning to you, they either change the topic or manage to turn it around to pin the blame on you for something completely irrelevant.   

Ψ Losing a sense of self 

When you begin second guessing your own judgment and perceptions of events that happened, it almost feels as if you lost your identity and status as an individual. Perhaps you begin wondering if everything the gaslighter is saying is true, that you’re weak and not enough, that you’re too sensitive, and you cannot stand up for yourself. You start to wonder if you’ve been like this all this while. Perhaps it’s true and you begin to accept it.  

Ψ Walking on eggshells

What happens when you start convincing yourself that it is not as bad as it seems? You just have to be careful every time you interact with them and ensure not to say the wrong thing, right? You become afraid to voice your opinions for fear of getting shot down or because you’ve learnt that your opinions don’t matter anymore. You live as though you’re always on the edge of your seat and get spooked by every little thing.  

What can you do if you are being gaslighted?  

Here are a few steps you can take to protect yourself from being gaslighted.  

Ψ End the conversation  

When you find yourself being gaslighted, understand that the abuser might be overwhelmed and unable to control the words that they use. That does not mean that it is okay, hence you should try to end the conversation as soon as possible. Set appropriate boundaries and let them know that you do not wish to continue the conversation if they are only going to continue to berate you.  

Ψ Save evidence for yourself  

Recording conversations and saving receipts of text messages can help you remember that your reality is not based off of what one person says. It helps you recall that you’re not the one that remembered things wrongly or did something that you didn’t. Do be careful when confronting an abuser with evidence, for it might result in an even more explosive outburst.   

Ψ Getting an outsider’s perspective  

When you’ve lived in the world of the abuser for too long, it can be difficult to identify what’s real and what’s not. A trusted individual outside of the relationship (perhaps an old friend of yours) can help to give a different perspective from yours, helping you untangle the web of distortion.  

Being a victim of gaslighting can feel invalidating, dismissive, and most of all, lonely. Keep in mind the abuser wants to make you forget about who you once were, before the relationship. This process can be gruelling especially if you’ve been a victim for a long time. Do not hesitate to reach out to us for help!