In the moments leading up to and following late-term pregnancy loss, you may find yourself experiencing emotions and having to make decisions you never imagined. In such an incredibly difficult and unfair time, it’s important to have people to advocate on your behalf and help you understand all of your options. Depending on your situation, you may be able to lean on your medical providers to guide you through some of these decisions, but it helps to understand exactly what you may be faced with and to surround yourself with extra support at a time when it may feel incredibly difficult to make these decisions alone.
With advice and guidance from bereavement doula Erica McAfee, who has personally experienced loss in the second and third trimester, this article helps you navigate the challenging situations after pregnancy loss and make decisions that feel right for you and your family. Nothing about this experience is fair or easy, but we want you to know that you don’t have to do this alone — the help you need is out there.
Seeking the help of a bereavement doula
Pregnancy loss is a challenging experience no matter how long you carried your baby, and it’s often difficult to know what to do or how to cope. Bereavement doulas are trained to help you navigate these times and provide invaluable, personalized support. As an option, most bereavement doulas offer pro bono work with minimal to no fees, so even if money is tight, don’t hesitate to reach out to a doula in your area.
What is a bereavement doula?
A bereavement doula is a non-clinically trained emotional, mental, and physical support person to people who have experienced miscarriage, abortion, stillbirth, or infant loss. They support your grieving; help you make logistical decisions regarding testing, burial, and memorializing your baby; ease any fears and anxieties; and assist you in the healing process. Bereavement doulas know what situations and decisions you may be faced with after pregnancy loss — and all the options you have to address them. They’re an invaluable resource along all parts of the pregnancy loss journey.
When do I need one?
Anyone who has experienced loss can seek the support of a doula. Doulas are especially helpful in supporting someone through loss in the second or third trimester since there are difficult emotional and logistical decisions to make—such as what to do with your baby’s remains—that can be greatly supported with their guidance. Bereavement doulas support people anytime during the first full year after pregnancy loss, so you can still seek their help even if it’s been several weeks or months since your loss. You may want to consider a bereavement doula if:
Where can I find one?
There are several resources to find a doula in your area or to connect with one virtually.
What will they help me with?
Bereavement doulas provide individualized support specific to your needs. Doulas will work with you to understand what you need and how they can best offer support. The help they provide will vary case by case, but doulas can help with:
Advocating for empathetic care
When navigating pregnancy loss, you may find that you need to advocate for yourself, since, unfortunately, there is no standard protocol for the care provided to someone after a stillbirth. With the help of those supporting you, ensure you have the space to heal and grieve in the hospital (or wherever you delivered) in ways that are safe for you.
If you delivered in a hospital setting, you may want to ask your healthcare providers to:
Making arrangements for your baby
For losses after 20 weeks, you will likely have several options for burial, cremation, or other arrangements, as well as for the types of medical tests (if any) you’d like performed. Options for burial arrangements are dependent on what state you’re in and the gestational age at the time of loss. This article offers general guidance based on common policies across states, but we recommend consulting your hospital or a funeral home to understand any restrictions.
After a stillbirth delivery, you typically only have 2-3 days to make these decisions. Making arrangements for your baby’s remains may be overwhelming, especially since you are still physically recovering from delivery. A bereavement doula will help you to understand your options and alleviate some of the burden of navigating these painful decisions. If a doula is not available, you can ask loved ones around you to help identify your options for arrangements.
Arrangements at the hospital
If you choose to have the hospital make arrangements for your baby, these services are often free or carry very minimal costs. Often, you have the option to:
Arrangements outside of the hospital
If you choose to make your own arrangements for your baby outside of the hospital, keep in mind that costs will often be higher, but you will have more control over logistics. You have the options to:
For losses before 20 weeks
With miscarriages in the first or early second trimester, you typically cannot make arrangements for your baby’s remains. If there is a final ultrasound before a D&C or D&E procedure, you can keep that picture as a memory of the baby or you can record the heartbeat (if one is present) before going through with a medical procedure. Explore our pregnancy loss hub here to learn more about coping with miscarriage.
Ultimately, it’s important to understand that there are several factors that will determine arrangements you can make, including the state you are in, gestational age at time of loss, and the hospital where you deliver (if you are at a hospital). Every state has different rules and language around this, but your doula or medical providers can help you understand your rights and what options are available for you and your baby.
Identifying your testing options
Deciding on testing is a personal choice that you will have to discuss with your medical provider. As standard protocol, most medical providers won’t offer additional options for autopsy or testing to determine how or why the baby died — it’s possible you’ll have to explicitly ask for this, and it can help to be prepared with the support of your partner or a bereavement doula. You may also want to check with your insurance provider to confirm what testing options are covered. It’s important to know that testing isn't always conclusive and you may not get the answers you’re looking for — but for some people, testing is an important part of the healing process.
Options for testing include:
Medical providers will take a blood sample from you to determine if there are any existing conditions that may have affected the baby.
Medical providers will evaluate the placenta to identify any potential abnormalities or infections.
A pathologist will examine the baby’s body (body parts, tissues, and organs) to help determine what may have been the cause of death.
Certificates are a way to document your loss and memorialize your baby. Regulations around certificates vary state by state, so talk with your doula or healthcare providers to help you determine how to obtain one.
This is an official documentation to record details of the loss (i.e., name of the baby, delivery date, time and location, and parents’ names). Depending on the state, death certificates may have to be requested via online or mail-in forms.
This is a commemorative certificate to document the loss of your baby. In the last 5-6 years, many states have started to adopt the use of stillbirth certificates for loss after 20 weeks. As these certificates become more common, it’s possible you can still receive a stillbirth certificate years after experiencing loss.
Spending time with your baby
You can decide to spend time with your baby alone or with others (a doula may be helpful in arranging this). This can be a beneficial step in the healing process and allow you to make memories with your baby.
Photos of your baby
You may decide to take photos with the baby before taking care of the baby’s remains. There are organizations, such as Now I Lay Me Down to Sleep, that offer photo sessions free of charge. They can come to the hospital within 24-48 hours to take pictures of the baby. Some organizations will also donate clothes for smaller babies for these photoshoots and send them to the family afterward as a memorial.
Cuddle cots, or carrying cradles, allow you to spend time with the baby. Found in some hospitals, these bassinet-like cooling devices help preserve the body so you have additional time with the baby. Some hospitals may not have these cuddle cots, so check with your hospital to see if this is an option for you.
Bringing baby home to meet family and friends
In some cases, you can bring the baby home so friends and family can meet them before any funeral arrangements. This can be a way to include others in your healing process. You will have to work with a funeral home to make these arrangements. This can include signing off the baby to the funeral home and ensuring they can provide proper care to embalm and transport the baby to and from the funeral home.
Honoring and memorializing your baby
Finding ways to remember your baby with a memorial or commemoration can be an important part of the healing journey. Some people choose to memorialize the loss soon after it occurs, while others may wait until the one-year anniversary to do something. There’s no one way to honor your baby. You can decide if you’d prefer to commemorate the loss by yourself, with a small gathering, or with extended family and friends. What you choose to do will depend on what feels right for you and your family.
Ways to memorialize your baby
A memorial can serve as a token of remembrance of the loss. Below are some of the ways members of the Bodily community have memorialized their pregnancy losses, which you can consider in addition to (or instead of) a formal memorial:
Sharing the news
How you share with others is personal and completely up to you. If you prefer, let another person in the family share the news with others. This way you don’t have to directly share information or answer calls or texts while you are experiencing the raw emotions of your loss. A doula can help you navigate communicating with loved ones when you are ready. You can also see our article How to Talk About Your Pregnancy Loss for specific examples on what to say during this difficult time.
The emotional and physical healing journey after pregnancy loss requires meaningful support and resources. In addition to this article, you can take a look at some of our other resources on pregnancy loss to help you navigate this time.