As a health and exercise professional, it’s important to remember that you work with people who have real lives outside of your sessions together. The ACE Integrated Fitness Training® (ACE IFT®) Model emphasizes the importance of rapport building because we know that understanding the psychological and emotional needs and characteristics of your clients is the key to building this relationship… especially when they’re going through extreme hardship.
Pregnancy loss is the loss of a fetus at any time during the pregnancy. Typically, medical professionals consider it a miscarriage if it’s prior to 20 weeks gestation and stillbirth after 20 weeks. In our Western culture, pregnancy loss is often not viewed as a legitimate reason to grieve, according to 2017 research in APA PsychNet. This concept—of [DG1] delegitimizing a person’s grief—has been referred to as “disenfranchised grief.”
It’s time to change that.
Acknowledging Their Pain
As someone who has experienced two miscarriages, I found it particularly hard when people didn’t even know I had been pregnant, let alone had just lost the child I had hoped and dreamed for. If you haven’t personally experienced a loss of this type, your initial reaction might be to say something that is dismissive—even if that’s not your intention—especially if the loss was early on in the pregnancy.
James Miller, MD, an OB/GYN in Wooster, Ohio, warns against this. “Treat all pregnancy loss equally, regardless of trimester or pregnancy history,” says Miller. “This ensures that [clients] feel comfortable to grieve and all losses are recognized appropriately. [Clients] that have had other live births still have a loss and still have grief. Be sensitive to these situations.”
And avoid any unsolicited advice or “I told you so’s.” Pointing out, even subtly, that you told your client to eat better or that she needed to better manage her stress, does nothing to help her healing journey, and instead highlights the shame she might already be feeling.
The March of Dimes Recommends:
Being honest: If you can’t find the right words, simply say that. “I can’t imagine what you’re going through right now and I’m not sure what to say.”
Keeping it simple: “I am so sorry for your loss.”
Being compassionate and comforting: “I really care about you and am concerned for your well-being. What can I do to help?”
What Not to Say:
It’ll get better over time.
At least you already have a child/children.
It’s for the best.
Everything happens for a reason.
You can always try again.
Maybe you should have tried _____.
How Can You Help?
“Helping the [client] with grieving resources, such as grieving/trauma books on pregnancy loss is so helpful,” says Miller. Miller also suggests recommending walks/5Ks and support groups that offer a community and safe space to talk about pregnancy loss. His practice uses Forget Me Not Baskets, which provide products specifically for those dealing with pregnancy and infant loss.
The March of Dimes also encourages patience, as there is no one way or “right” way to grieve. Depending on the age of the child lost, there might be a memorial service. Attending it, or at least acknowledging it, will show that you are being supportive of your client and their family.
What About the Other Parent?
“The father seems to get lost in all of this because the mother goes to their OB/GYN but the father has no follow-up,” says Miller. “Dads grieve and are a big part of the mother’s recovery process.”
If your client is the one who carried the child, Miller recommends asking about how the father is coping. “This can spark conversations about how a recovering mother’s home life is,” explains Miller. “On the other hand, fathers may not be supportive of the mother’s grieving, and these are all important topics to [consider].”
Our society often tries to coach men into feeling like they don’t have a right to grieve a pregnancy loss because they weren’t the ones housing the baby. But research, such as a 2020 review in Qualitative Health Research, reveals that many men “recounted feelings, uncertainties, and desire for support beyond anything they would have anticipated. Many suggested that social expectations and relationships with others including health care practitioners obstructed them from articulating and addressing unfamiliar emotions, uncertainties, and any support requirements.”
Getting Back to Movement
It’s vital that you’re patient with your clients following pregnancy or infant loss. While you may want to educate them on the benefits of exercise during pregnancy and explain how getting healthier can provide more insurance for a healthy pregnancy, they may not be ready to hear this. Allow them the space to decide, with their care team, when they’re ready to come back and at what capacity. Consider that they’re healing both emotionally and physically and they may want and need to start off with different types of workouts.
A 2021 study published in Reproductive BioMedicine Online suggests that meditation and mindfulness can reduce stress and depression in women experiencing recurrent pregnancy loss. Is there a way you could incorporate meditation and mindfulness into your sessions? If you’re not trained to lead meditation, there are plenty of online resources and apps that offer guided meditations, some specifically for pregnancy loss, like the Miscarriage Warrior app.
Whether you have personal experience with pregnancy loss or not, it’s important that you show compassion and empathy for your clients going through these types of experiences. Allow them to talk about it if they want to and let them be the guide of that conversation, telling you what they need. Ask them what they really need in this moment. They may need permission from you to know that it’s okay to slow down their workouts and sit with their feelings.