Pregnancy loss during the COVID-19 pandemic

“Do you know what I miss, if I’m being honest?” reflects Anna Maria Verling.

“I miss not being able to give somebody a hug. I miss not being able to hold a hand in the same way. I hate talking behind a mask […] it’s not natural for me.”

Anna Maria is a clinical bereavement midwife specialist at Cork University Maternity Hospital (CUMH), and a key support to couples who have experienced the loss of a baby. In Ireland, loss in the form of early and late miscarriage, stillbirth, neonatal or infant death, occurs in 20-25% of pregnancies, according to INFANT Centre. What can be a lonely experience in normal times has only intensified with restrictions around COVID-19.

“The typical resources of family – the cups of tea, the chats, the hugs, the contact – COVID-19 has certainly impacted on all those things,” says Anna Maria. “So what had always been an isolating time is doubly isolating in that regard.”

At CUMH, the pregnancy loss team have been working hard to maintain their standards of care. While in general maternity services, partners are currently only being allowed in for the later stages of labour and delivery, in the case of pregnancy loss, the updated clinical guidelines on COVID-19 and maternity practice acknowledge that “the importance of the presence of a partner/support person during what is finite time should be protected (unless a partner is confirmed/suspected COVID-19 positive)”.

The guidelines also stress the importance of supporting parents to make memories with their babies in hospital – for example, taking photographs and hand and foot prints.

“We want our mothers to know we’re going to care for them as best we can, within some of the limitations that we have. But we want them to know they won’t be on their own,” says Anna Maria.

Where possible within guidelines, Anna Maria and her colleagues are still meeting people in hospital, though they are also running more clinics over the phone, as well as directing to resources such as www.corkmiscarriage.com and www.pregnancyandinfantloss.ie. One of the key challenges is that family and friends are unable to visit, while other support services, such as voluntary professional photographers, who are usually on call to come to the hospital, are on pause.

“The memories that people are making, often they’re making on their own now or with a partner,” acknowledges Anna Maria, who advises people to take “as many photos and recordings” as they can of their baby, in order to be able to share these precious memories in the future. Her most important message however, is that while COVID-19 has not put a stop to pregnancy loss, it has not changed “the care that we want to give”.

“I know how we look is may be a little bit different,” says Anna Maria, “but our hearts are still in this.”

Irish charities are also playing a huge role in supporting bereaved families in these challenging times. Féileacáin (stillbirth and neonatal association of Ireland) was established by a group of bereaved parents in 2009, and registered as a charity in 2010.

Services include the provision of “memory boxes”, which contain items such as a hand-knitted blanket, teddy bears and remembrance candles, as well as important information to help parents make precious memories in the limited time that they have with their babies. About 800 of these boxes are given out in Irish hospitals each year, along with others tailored towards second trimester and “long ago” losses (for those who lost babies many years ago, but never had the opportunity to have them acknowledged.)

The charity also provides over 100 “cuddle cots” with cooling mats nationwide, which allow parents to keep their babies with them for as long as possible, and until COVID, had volunteers going in to hospital to take precious hand and foot prints, which are then beautifully framed and gifted to parents.

Restrictions have meant that the charity has had to train midwives/hospital staff to take these prints, and disruption to supply chains means that framing is taking longer. Other face-to-face supports like group meetings and remembrance services are also on hold, but chairperson Mairie Cregan explains that their trained volunteers are busier than ever, providing support on the phone and online.

“These are extra special people, these are extra special circumstances. It’s not going home from hospital to recuperate – you’re going home with your infant who has died,” says Mairie, who adds that in exceptional circumstances, trained volunteers have been able to make house calls by wearing PPE and practising careful social distancing, if parents did not get the opportunity to get prints done in hospital.

“For people who are burying loved ones that they have memories for, it’s horrific at the moment – but can you imagine what it’s like to bury your little baby that you didn’t expect to have any issues or even if you did, to have to do this on your own? At least Féileacáin can help you to make whatever memories you can, the most you can.”

COVID-19 has also impacted on fundraising events, but Mairie says that people are generous, for example, sponsoring a Féileacáin memory box in their baby’s name.

For those who wish to provide support to a friend or a family member who is going through a loss, Mairie says the most important thing is to show them that their child is not forgotten, even if it’s just by making a phone call or sending a message or a gift because you can’t physically be there for them due to social distancing.

“When you talk to somebody about their baby, you’re afraid that you’re going to make them cry. And you might, because it’s just so close to the surface for the first couple of years. But the hardest thing for any parent is that you don’t mention them,” says Mairie.

“And that’s what we fear a lot more, thinking that you’ve been forgotten.”

For further information or to donate, visit www.feileacain.ie

Another charity that continues to provide support is FirstLight, which was originally established in 1977 as the Irish Sudden Infant Death Association. In 2012, it expanded its remit to provide support to parents suddenly bereaved of a child up to 18 years of age.

Clinical services director Georgia Howard explains that the charity supports on average 125 families every year. Pre-COVID-19, the first point of contact after referral would be a phone call, followed by a home visit from Georgia herself, with a range of free, follow-on services available nationwide if required, including up to eight counselling sessions for each adult in the family, and six play therapy sessions for children.

FirstLight also offers a 24/7 emergency helpline, and runs private “mammy”, “daddy” and “parents” Facebook groups for peer support. While these phone and virtual supports have continued throughout the crisis, Georgia explains that home visits have been temporarily replaced by “a lengthy phone call”, while counselling sessions had to move to platforms like Zoom; though as restrictions start to lift, face-to-face sessions are becoming possible once social distance can be maintained.

Maintaining these links is vital, says Georgia, especially as families find themselves isolated from their usual supports.

“No matter what else is going on in the world, you have to carry this and you have to process it, you have to go through it and it’s so painful and heavy and difficult to carry with you,” she says. “There’s no pain like the loss of a child.”

Major fundraising events like the Women’s Mini Marathon have also been affected, though Georgia says that people have been “very kind” and continue to hold individual events. For further information or to donate, visit www.firstlight.ie. Other Irish organisations providing support at this time include the Irish Miscarriage Association (www.miscarriage.ie), A Little Lifetime Foundation (www.alittlelifetime.ie) and Nurture (www.nurturehealth.ie).

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