Baby Loss Awareness Week: How doulas can support families through pregnancy and baby loss

Content note: This article discusses miscarriage, pregnancy loss, stillbirth and the death of a baby. Please take care of yourself when deciding whether to read on.

Every year, from 9 to 15 October, Baby Loss Awareness Week brings people together to remember babies who have died and to acknowledge the families whose lives have been touched by pregnancy and baby loss. The week ends with the Wave of Light on 15 October, when people around the world are invited to light a candle at 7pm local time in remembrance. For some families, it is an opportunity to speak openly about a baby they love and miss. For others, it may be a quieter moment of reflection, perhaps remembering a pregnancy that ended before anyone else even knew it had begun.

Pregnancy and baby loss can be difficult to talk about, particularly when we are unsure how to respond to someone who is grieving. We may worry about saying the wrong thing or bringing up painful memories and sometimes that uncertainty leads us to say very little or avoid the subject altogether. Yet for some bereaved parents, the silence surrounding their experience can add to their sense of isolation, particularly when they feel that the people around them have stopped acknowledging what happened.

As doulas, much of our work involves supporting women and families as they prepare for birth and the arrival of a baby. We spend time exploring their choices, listening to their hopes and concerns and helping them feel informed and supported. Sometimes, however, a pregnancy or birth takes a very different direction and we may find ourselves alongside a family experiencing the death of their baby.

At The BirthBliss Doula Academy, we don't train doulas to become specialist bereavement doulas, although pregnancy and baby loss are subjects we include in our doula education. I believe every doula needs some understanding of how to respond when a family experiences loss, because none of us can know whether this will happen to someone we support. It might be an early miscarriage, an ectopic or molar pregnancy, a pregnancy that ends following a difficult antenatal diagnosis, a stillbirth or the death of a baby during the neonatal period or later in infancy. Each situation is different and so is the way parents experience it.

Over the years, I've spoken to doulas who have found themselves lost for words when a client has experienced a loss. They wanted to help but were worried about saying something inappropriate or making an already painful situation more difficult. I think this is something worth talking about because although we cannot prepare ourselves for every situation, we can develop a greater understanding of what compassionate support might look like before we find ourselves needing to offer it.

Understanding that grief is different for everyone

One of the most important things we need to understand is that grief doesn't follow a predictable pattern. We sometimes make assumptions about how deeply someone will be affected based on how far along they were in pregnancy, but the length of a pregnancy tells us very little about what that pregnancy meant to the person experiencing it. Someone who miscarries at seven weeks may already have imagined a future with their baby, thought about names and pictured the life they hoped to share. Another person may experience an early miscarriage differently and neither response is more appropriate than the other.

The same applies to stillbirth and neonatal death. Some parents want to talk about their baby from the beginning, while others find it difficult to speak about what has happened. Some want to be surrounded by people and others need privacy and time alone. Grief may involve sadness, anger, disbelief, numbness or a mixture of emotions that change over time. There may also be moments when someone laughs, enjoys something or feels temporarily distracted from their grief. None of these responses tells us how much a baby was loved or how deeply their death has affected the family.

We should also remember that not everyone experiences pregnancy loss in the same way or uses the same language to describe it. Some people will have named their baby and may appreciate hearing that name spoken. Others may refer to their pregnancy rather than their baby, while some may prefer not to talk about what happened at all. Following the language parents use, rather than introducing our own, can help them feel respected without having to explain or defend their feelings.

Sometimes parents may question whether something they did contributed to their loss. They may go over events repeatedly, wondering whether they missed a sign or whether something could have been different. As doulas, we need to listen without reinforcing those fears or offering explanations about what caused the loss. If parents have questions about what happened medically, we can encourage them to discuss these with their healthcare team and support them in seeking the information they need.

Our role isn't to decide how someone ought to feel or encourage them towards a particular emotional response. We can listen, acknowledge their experience and allow them to tell us what they need, without expecting their grief to follow a particular path.

Being present when there are no easy words

When someone is grieving, we often wish we could ease some of their pain. We look for something reassuring to say, perhaps hoping that a few carefully chosen words might bring some comfort. Unfortunately, this is often where well-intentioned comments can leave parents feeling misunderstood.

Comments such as at least you know you can get pregnant, you can always try again or everything happens for a reason may be intended to offer hope, but they can also suggest that the loss should somehow feel less significant. Even encouraging someone to be strong may create an expectation that they should manage their grief in a way that makes other people more comfortable.

There may be very little we can say that changes how someone feels in that moment and accepting this can help us become more comfortable with simply being present. We can acknowledge what has happened, express our sympathy and ask whether the person would like us to stay. Sometimes sitting quietly beside someone, offering a cup of tea or listening without interrupting may be more helpful than trying to find something reassuring to say.

Of course, being alongside someone who is grieving can affect us too. We may feel helpless, frightened or deeply upset, particularly if the experience brings back memories of our own losses. These feelings are understandable, but we need to remember that the parents shouldn't have to manage our emotions alongside their own. There will be time afterwards to reflect on how the experience affected us and seek appropriate support if we need it.

Offering practical support without making assumptions

When someone experiences a loss, ordinary everyday tasks can suddenly feel overwhelming. There may be appointments to rearrange, people to inform, shopping to do and meals to prepare, all while the parents are trying to understand what has happened. This is an area where doulas can offer something genuinely useful, particularly because practical support is already such an important part of our work.

Rather than offering the familiar let me know if you need anything, which places the responsibility on the grieving person to think of something and ask for it, we can make specific suggestions. Perhaps we could prepare a meal, collect shopping, walk the dog or help with household chores. We might ask whether there is anyone the parents would like us to contact on their behalf so they don't have to keep explaining what has happened. Even helping someone write a short message to friends or family can take away a task that feels difficult at the time.

There may also be a nursery at home, baby clothes waiting to be washed or a pram sitting in the hallway. It's important not to assume that these things should be put away before the parents return home. Some may want everything left exactly as it is because those belongings represent their baby and the future they had imagined. Others may find it too painful to see them. The only way to know is to ask and whatever they decide should be respected. Nothing should be removed or rearranged without their clear agreement.

What matters is that we're responding to what the family actually needs rather than what we imagine we would want in the same situation. Sometimes the most valuable thing we can offer is ordinary practical support that gives parents a little breathing space at a time when everyday life may feel overwhelming.

Supporting parents when a baby dies before or during birth

For doulas who provide birth support, there is also the possibility that a baby may die during pregnancy or labour. This can be an especially difficult situation because the woman may still need to labour and give birth while coming to terms with the news that her baby has died.

There may be a great deal of information to take in and decisions to consider at a time when parents are struggling to understand what has happened. Depending on the circumstances, the maternity team may discuss options around the timing and method of birth, pain relief and what will happen afterwards. Our role isn't to provide medical advice or influence those decisions, but we can help parents find the space to ask questions and understand the information they're being given.

Many of the things we ordinarily offer during labour may still be helpful. A calm presence, reassurance, physical comfort or simply being someone familiar in the room can make a difference. At the same time, we need to recognise that what the woman wants from us may have changed completely. She may no longer want the techniques or support she had previously planned and that's something we need to accept and respect.

We should also remember the partner or other birth companion, who may be grieving while trying to support the woman giving birth. Partners can sometimes feel that they need to hold everything together, particularly when there are practical arrangements to manage and difficult decisions to make. Acknowledging their experience and asking how they're coping can create space for feelings that might otherwise go unnoticed.

Following the birth, parents may be offered opportunities to spend time with their baby, hold them, take photographs or create memories through handprints, footprints or keepsakes. Some hospitals have specialist bereavement facilities and cooling cots that allow families more time together. These opportunities can become incredibly important to some parents, while others may not feel ready or may choose not to take part.

It's important that we don't allow our own feelings about what we would want to influence how we support parents. The midwives and bereavement team should explain the available options and any time-sensitive considerations, while we can help parents ask questions and feel supported in making their own choices. If they decline something, that decision needs to be respected. If they later change their minds, they should feel able to ask again where the option remains available.

We should also remember that not every family will have had the opportunity to see or hold their baby or create physical memories. Some parents may have very few tangible reminders of their pregnancy and this can bring its own sadness. We need to be careful not to suggest that there is a particular experience parents ought to have had or that the memories they do have are somehow less meaningful.

When parents face difficult decisions during pregnancy

Not every pregnancy loss happens unexpectedly. Sometimes parents discover during pregnancy that their baby has a serious medical condition and they may be faced with decisions they never imagined having to make. Others may need to consider ending a wanted pregnancy because continuing it presents serious risks to the pregnant woman's health.

These situations can involve enormous emotional complexity and parents may experience grief, uncertainty, guilt or fear of being judged. Unfortunately, they may also encounter people who make assumptions about their decisions without understanding the circumstances.

As doulas, this is an area where we need to be especially aware of our own beliefs and opinions. We are not there to tell parents what we think they should do or to guide them towards a particular decision. We can listen, help them formulate questions for their healthcare professionals and support them in accessing reliable information.

Organisations such as Antenatal Results and Choices, known as ARC, provide specialist support for parents facing difficult decisions following antenatal screening or diagnosis.

Whatever decisions parents make, they deserve to be treated with compassion and respect. We don't need to understand every aspect of their experience to support their right to make informed choices about their own pregnancy.

Remembering the whole family

When a baby dies, attention often centres on the woman who was pregnant, which is understandable given the physical and emotional experience they may be going through. However, partners, grandparents and other family members may also be grieving and their experiences can sometimes be overlooked.

If there are older children in the family, parents may be worried about how to explain what has happened. Children understand death differently depending on their age and development, and they may ask questions that adults find difficult to answer. Generally, clear and age-appropriate explanations are more helpful than expressions such as the baby has gone to sleep, which can be confusing or frightening for young children.

A doula can offer practical support by helping with childcare, preparing meals or maintaining familiar routines while parents have time together. We can also direct families towards organisations such as Child Bereavement UK and Winston's Wish, which provide specialist guidance on supporting children through grief.

We should also remember families who experience the death of one baby in a multiple pregnancy. They may be grieving while continuing to prepare for the birth of another baby or caring for a surviving sibling. Their feelings may be complicated and they deserve space to acknowledge the baby who died without being expected to focus entirely on the baby who survived.

Families may also have cultural, religious or personal beliefs that influence how they respond to death, how they remember their baby and what arrangements they wish to make. We should never assume that our own understanding of these things is shared by the people we're supporting.

The weeks and months afterwards

One of the things bereaved parents sometimes describe is how much support they receive immediately after their loss and how quickly it can disappear. In the beginning, there may be flowers, cards, meals and messages from people who want to help. As everyday routines gradually resume around them, parents may find that their own experience of grief remains very present.

This is where remembering someone can matter enormously. A message a few weeks later, asking how they're doing or letting them know you've been thinking about them, may be deeply appreciated. Some parents find comfort in hearing their baby's name and knowing that other people haven't forgotten. Important dates, such as the baby's birthday, the anniversary of their death or the date they were expected to be born, may also bring difficult feelings.

Of course, we shouldn't assume that everyone wants to be contacted in the same way. Some parents welcome regular messages while others prefer more privacy. Asking what they would find helpful allows us to respect their wishes rather than creating another expectation for them to manage.

It's also important to recognise that grief doesn't have an expiry date. A parent may still feel deeply sad months or years after their baby died and that doesn't mean they're grieving incorrectly or that something is wrong. There may be times when additional professional support would be helpful, particularly if someone is experiencing severe anxiety, traumatic memories or difficulties managing everyday life, but sadness itself isn't something that needs to be fixed.

As doulas, we can continue to offer compassionate support within the boundaries of our professional relationship while recognising when someone might benefit from speaking with their GP, midwife or a specialist bereavement service.

Pregnancy after loss

For some families, a pregnancy after loss can bring many different emotions, including hope, fear, uncertainty and grief. They may find it difficult to feel excited or allow themselves to imagine bringing a baby home. Appointments and scans can bring back memories of previous experiences, particularly if that was when they first discovered something was wrong.

Well-meaning comments about how wonderful it must be to be pregnant again can be difficult to hear when parents are still grieving the baby who died. A subsequent pregnancy doesn't replace the previous one and parents may need space to acknowledge both their feelings about this pregnancy and their continuing love for the baby they lost.

If we're supporting someone through pregnancy after loss, we can listen to their concerns, accompany them to appointments where appropriate and help them discuss their wishes with their maternity team. Some parents may want additional reassurance or more detailed conversations about their birth preferences, while others may find preparing for birth particularly difficult. As with every aspect of doula support, the important thing is to respond to the individual rather than assume we know what they need.

Knowing our limits and looking after ourselves

There is a difference between providing compassionate support and taking responsibility for someone's grief. Doulas are not counsellors or mental health professionals unless they hold separate qualifications in those areas and even then it's important to be clear about which professional role we're fulfilling.

Knowing where to direct families for additional support is an important part of working responsibly. Organisations such as Sands, Tommy's, the Miscarriage Association and ARC provide information and specialist support for different experiences of pregnancy and baby loss. Having these resources available before we need them means we can respond more confidently when someone asks for help.

We also need to think about ourselves. Supporting a family through the death of a baby can be emotionally demanding and sometimes the experience stays with us long after our professional involvement has ended. We may find ourselves wondering whether we said the right thing, whether we could have done more or whether something we did might have made the experience harder for the parents.

Having access to confidential debriefing, appropriate supervision or professional support can help us process those feelings without placing that responsibility on the family. We must, of course, protect the privacy and confidentiality of everyone involved. Looking after our own emotional wellbeing is part of being able to continue supporting families with care and compassion.

Why I believe this matters

I've been working as a doula since 2002 and one of the things I've learnt is that being good at this work doesn't mean always knowing what to say or having an answer for everything. Sometimes the most important thing we bring into a room is our willingness to be there, to listen and to allow someone to experience whatever they're experiencing without feeling that they need to make it easier for us.

When a baby dies, we cannot change what has happened. We cannot take away the grief or promise that things will eventually feel better. What we can do is help parents feel that they haven't been forgotten, that their baby matters and that they don't have to explain or defend the way they feel.

I don't believe every doula needs to specialise in bereavement support, but I do believe that every doula should have thought about how they might respond if a family they support experiences loss. Not because we can prepare ourselves for every possibility, but because having some understanding of what might help allows us to be more present when someone needs us.

Sometimes that means sitting quietly beside someone who is crying. Sometimes it means making lunch, collecting a prescription or helping a parent find the words to tell their family what has happened. Sometimes it means remembering a baby's name months later, at a time when fewer people may be acknowledging their loss.

None of these things will take away the pain of losing a baby, but they may help a family feel a little less alone in it.

This Baby Loss Awareness Week, I'll be remembering the babies who died and the families who continue to carry their love for them. On 15 October, I'll be lighting a candle at 7pm as part of the Wave of Light.

If you've experienced pregnancy or baby loss yourself, I hope that the people around you have given you the space to remember and speak about your experience in whatever way feels right for you.

We may not always know what to say, but we can take care with the words we choose and the way we respond.

Support and further information

If you or someone you know has been affected by pregnancy or baby loss, the following UK organisations offer information and support.

• Sands: https://www.sands.org.uk/

• Tommy's: https://www.tommys.org/

• The Miscarriage Association: https://www.miscarriageassociation.org.uk/

• Antenatal Results and Choices: https://www.arc-uk.org/

• Child Bereavement UK: https://www.childbereavementuk.org/

• Winston's Wish: https://winstonswish.org/