“Supporting Women With Pregnancy Loss” – with Shira Billet

Dr. Fox: Welcome to High Risk Birth Stories, brought to you by the creators of the Healthful Woman podcast. I’m your host, Dr. Nathan Fox. High Risk Birth Stories is a podcast designed to give you, the listener, a window into life changing experiences of pregnancy, fertility, and childbirth. So, Shira Billet, who is a doctor, you’re a PhD in the philosophy of religion, correct?
Shira: Something like that. Yeah.
Dr. Fox: Shira experienced a loss of pregnancy in 2014, so, almost six years ago. And over the past five to six years, Shira and her husband, Rabbi Steven Exler, have become a resource for women and for families working through pregnancy loss. And you’re an advocate, you’re a counselor, you’re someone who listens, you’ve been open, you speak publicly about it, which is really special, because many people are just unable to do that. And I’m so happy that you agreed to come on our podcast today to talk about it, to talk about pregnancy loss.
Shira: I think it’s such an important topic. Thanks for giving me an opportunity.
Dr. Fox: We spent a lot of time together over the years and we speak a lot. And I’ve always found that your perspective, both for yourself and for others is so thoughtful and so important. And there are so many people who are either themselves going through a pregnancy loss, or have recently been through a pregnancy loss, or it’s something that happened a long time ago, but still hurts them very much obviously, or for people who have not gone through that, they have a friend or a family member who went through that, and don’t really know how to interact with them, and how to help them, and how to comfort them. And I think that your experience and your perspective on this, is really helpful for all of those families. And it’s really important that you’re doing what you’re doing.
Shira: Every time I’ve spoken about this publicly, I always try to say to the audience that I think a lot of people in the room, especially people who are finished having kids and haven’t experienced a loss in a pregnancy might feel like this topic is irrelevant to them. This might sound morbid, but I just think it’s realistic that this stuff is never going to stop happening in the world. And so even if it hasn’t happened to us, it will inevitably happen to someone we love at some point in our lives. And so I really do think it’s important for everyone to educate themselves about this, learn about this because even if, thank God, it doesn’t feel relevant to you, it’s something that will be useful in the future to know something about.
Dr. Fox: Right. And in terms of how common it is, I mean, early pregnancy losses, what we, you know, colloquially call miscarriages are very, very common and most, you know, women who have tried to have families and have gone through a pregnancy loss, an early one, you know, there are those who are very blessed who haven’t been but it is very common. But as you get later in pregnancy and more advanced in pregnancy, those become less common, but they’re not so uncommon. As you said, everyone either knows someone who’s gone through this or knows someone who knows someone who’s gone through this. It’s not as far away as you might think. And a lot of people don’t talk about it, either their own experiences or others, have you found that other women are willing to discuss it with others or publicly as you are?
Shira: One of the things that I’ve learned in both from my own story, which I think we will talk about a little bit later, and from speaking now to so many women and couples who’ve had pregnancy losses, and particularly at later stages, is often when they find me, is that every story is so different, and every person is so different, and every person’s reaction is so different. There are also some really, I think, common universal themes that I’ll touch on, like at some point in our conversation as well. And because of that, I would say that there are some people who are comfortable being open and more public, and I think there are other people who aren’t. But I think that one thing that helps is when we de-stigmatize the topic by talking about it.
I’ll just mention briefly that someone in my life who had an early miscarriage a few years ago, thought that she didn’t know anyone who had an early miscarriage. And then she like kind of bravely told maybe three of her close friends, and it turned out that all of them had had one and they just had never told her. And she felt so comforted knowing that other people had gone through this and it wasn’t just her. And I think one of the things that really helps is when we do talk about it, all those people will come out of the woodwork.
And I think especially one thing I found when I’ve spoken publicly is that older women who had losses at a time when this really wasn’t talked about and when people were really just told to kind of move on and forget, they’ll sometimes still come still processing their traumas from some many years ago, 30, 40, 50, 60 years ago, and just say like, “Thank you for talking about this because I’m still kind of dealing with what I went through.” And a lot of why I think it’s unprocessed sometimes for older women is because even less than today, this was really a silenced topic. So it’s so important to be open and to talk about it.
Dr. Fox: Absolutely. And there’s, you know, so many important things you just said there. And just to highlight a couple of them, when you’re talking about early miscarriages, it’s an interesting phenomenon that most people don’t tell anyone they’re pregnant until they get past a certain point. And whatever that point is, is different, you know, for a lot of people, after the first trimester, after 10 weeks, after normal ultrasound, whatever it is. And I think the reason is, because if there’s, you know, there may be a miscarriage, and they don’t want to have to tell people that they were pregnant, and then tell people they’re no longer pregnant. And that goes back a long time.
And it’s part of the reason why, as you said, so many women, so many families, they don’t realize how common it is, because everyone keeps it a secret, the early pregnancy losses, but it is very common. And the other thing is your mentioning how it is a real trauma to have a pregnancy loss, particularly when they’re later in pregnancy, obviously, very traumatic early in pregnancy, too. And it’s not something that you just forget or get over. It doesn’t work like that. I mean, trauma, as you said, is going to stick around for 30, 40, the rest of your life, maybe whether you talk about it or don’t talk about it, but it’s it seems to be made, you know, easier, if you are talking about it.
Shira: Yeah, absolutely. I do think that trauma is a key piece of this. You know, I think, obviously, depending on the person, it can be traumatic at any stage. But I certainly think that at the later stages, it really is. And I think, though, that people who are able to kind of process their trauma in healthy ways will find that even though you never forget, and that’s one of the things I do want to talk about today more is how you really never forget. But I think though that there’s different kind of internal memory. I think there are kinds that are continually re-traumatizing us or unprocessed pain.
And then I think there are memories that we can really live with, in healthy ways. And I think the goal really would be that, given that it’s impossible to forget the experience and the baby or babies that have been lost, I think the goal would be to find healthy ways to live with those memories. And I think when it’s not processed in healthy ways, then it becomes those kind of painful, continually re-traumatizing memories. And when it is processed in healthy ways, I think we find ways to incorporate these babies that have died into our life story, but not necessarily in ways that hurt, you know, with the passage of time, once we’ve kind of healed from the initial phases of intense grief and pain.
Dr. Fox: Right. And it’s, I mean, no different from any other loss or a death. I mean, this is true for people whose unfortunately, they lose children or they lose family members who are young or, you know, friends who are young, and sort of something more “unexpected.” You know, when you lose someone, it’s always painful, obviously, but the more sort of different it is from what they expected, it’s sometimes more traumatic. And, you know, when people lose, you know, babies before they’re born, it has the same effect on them, and all the things that you would sort of expect for someone who has a loss of, you know, of a child who is born, parents go through the same process and the same grief.
Shira: Yeah, I think it’s really true. And it’s one of the things that I’ve really come to understand, I think, about grief is that there’s something quite universal about grief and especially like what you’re saying about grief after traumatic losses now, because I think people who haven’t experienced a pregnancy loss, a late pregnancy loss, really don’t understand that.
I personally don’t…you know, if I’m talking to someone who’s lost a born person, whether it’s a child who has been born or a sibling, or any of the other examples that you gave, you know, I won’t say to them, “I understand a little bit about what you’re going through because of this thing that I went through when I lost twins at 23 weeks of pregnancy,” because I do think that can be really jarring for someone and even offensive, the suggestion that there’s some equivalency between these losses.
And I don’t think there is an equivalency but what I have come to believe is really true, is that there’s something universal about grief that I do think cross over in a bunch of different kinds of losses. And there’s a lot of similarity to the experience even though I think intuitively, we wouldn’t expect that on some kind of scale of how real we think people are. And I think it’s pretty common in our society to think that unborn babies are less real in some way than other sorts of humans.
And so again, it’s not something that I would say to someone who had a different kind of loss, but it is something that I actually think is true, that there’s a really strong shared element to the grief that’s just worth people going through the loss knowing because they might think, “Why am I grieving so much, this wasn’t a fully real person, or this wasn’t a child that I actually knew?” And so they might even think that there’s something wrong with them for how much pain they feel. And I think it’s actually important to realize, like what you said, that it’s a really shockingly intense pain that feels like you lost a child, even if you also think it’s different from losing a child.
Dr. Fox: Right. And, you know, my perspective is not as someone who had that kind of loss, and so I can’t understand it from the same perspective you would or someone else would, who has undergone a loss. My perspective is just as the physician and maternal fetal medicine specialist, so people come to me after losses for their subsequent pregnancy.
So I spend a lot of time talking, you know, to women and to couples, and to families about loss and about what sort of to expect and what we’re going to do and sort of what…and that’s really just my experience in, you know, meeting with and knowing and talking to a lot of families who undergo this. Obviously, it’s not the same for me, but, you know, why don’t you tell us your story? Tell us what happened to you and to Steven, and what was your experience of the loss, and how it affected you at the time, and then obviously, to this day?
Shira: So, you know, one thing I’ve been thinking about, in anticipating this conversation is, is actually how little I tell my story, even though I talk to people rather often, you know, sadly, often. And so I kind of want to caveat this by saying that I already mentioned earlier that every story is so different, and every person is so different. And I think a real reason why I almost never talk about the details of my story is because when I talk to people, I don’t want to impose my experience on them. My story is what happened to me. And the ways in which I reacted are the things that are what were right for me. And I would never want anyone to view this as normative or universal.
And so often, I listen rather than tell, because I think it’s much more helpful to meet people where they’re at. But because right now, it’s just you and me talking, and although you know, folks who are going to be listening to this will have their own story, some of them, I feel more comfortable saying my story, but I want to preface it by just saying that this is just my story and, you know, nothing that I did should be viewed as what everyone ought to do, and at the same time, maybe it’s helpful to hear it nonetheless. I guess with that preface, I’ll just say that, five years ago, literally this week, I had a positive pregnancy test for my second pregnancy. And one thing I’ll say is that I have three children who are alive and in my home that I’m raising, and I have no clue when I had a positive pregnancy test with any of them. I only remember the date of the pregnancy test from this pregnancy that I lost.
And I think it’s because with trauma, and the subsequent trauma that wound up happening in that pregnancy, it kind of froze those memories and the vividness of the time, such that the kind of five and a half months of that pregnancy, I actually remember in greater and more vivid details than some things I did like last week. But it does still feel kind of significant for me to be having this conversation exactly around the time when I first found out about that pregnancy five years ago, in May 2015. It was my second pregnancy and my oldest was about 18 months old. And my first child was 18 months old. And I was both excited, but also scared about having another child. Life was busy, life was full.
And then the really shocking thing was, at about seven weeks pregnant, I found out unexpectedly that I was expecting twins. This is what actually ultimately led me to your practice. I was seeing a midwife at the time. And then I kind of realized that that practice was pretty much in over their heads, once we realized that the twins were identical and shared a placenta. And so someone had recommended your name actually, and I switched over to your practice. It was a really happy time in my life, I guess I would say, from the initial intense fear of being pregnant with twins when I was nervous about even having one more child at the time, came this excitement and the feeling of being really lucky. They were identical twin girls and there was this feeling of just how special that was.
And my husband and I felt very blessed and I remember that summer we had a farm share and we used to get eggs and for whatever reason just that summer, the eggs always had two yolks in them. And it felt like a sign that like twins, this was meant to be. It was all this kind of crazy stuff coming together. And it’s really funny because I still get that farm share and I’ve never had twin eggs since that summer. And in any case, it was a happy time. And other happy things happened that summer. My younger sister got married and my parents married off all of their children and I was 18 weeks pregnant with my baby girls, and my sister was getting married, and it was sisters and all these things kind of felt like they were coming together and life felt really good.
And then at about 22 or 21 weeks, that all changed when we found out pretty unexpectedly that the twins had gone through the most common complication of identical twin pregnancies, called Twin-to-Twin Transfusion Syndrome. And we found out that one of the twins had died in utero. And this was a really intense shock, and it was really painful. One of the twins was still alive at the time. And it was kind of this feeling of like the twins were gone. There was a baby now. And in fact, even in medical terms, I remember sitting in the office of your practice and watching them go through all of the appointments that I had scheduled and switching them from twin appointments to singleton appointments, which was like so shockingly painful, because suddenly I was pregnant with a singleton, even though I had two babies inside of me, it’s just that one of them was dead.
And there were so many feelings, and I can’t even get through all of them. But one of the things that I felt was both incredibly grateful that I still had one baby, and then also not quite knowing how to deal with this shift with the fact that there were supposed to be two and now there was only one. But then of course, even that one was taken from us when about a week later, I went into pre-term labor that was unstoppable. And I gave birth to both babies and the one that had been alive, died at birth, because it was too early to be born and to live.
And I also gave birth to the one that had died in utero. And this began this, a really intense journey of grieving, which is what led me to the work that you described that I do on the side. It’s not my professional work. It’s all just kind of word of mouth, and whoever wants to talk to me and whoever sends their friends to me of supporting others through these things so that they can have more support and feel more understood when they go through what I went through.
Dr. Fox: Was that something that you did intentionally or did it just sort of happen that people started calling you, and, you know, “Hey, I have a friend,” and they say, “Would you be willing to talk to her or talk to them?” Or did you sort of seek out those opportunities?
Shira: So I think it was a combination of both. Only just about three months after our twins died, a couple that my husband knew, that my husband had gone to school with the husband and the couple, they reached out to my husband saying that they were expecting identical twin boys who shared a placenta that had just been diagnosed with Twin-to-twin Transfusion Syndrome. And they were scared and they didn’t know who to turn to. And because they had heard through the grapevine about our story, they called us and we supported them.
And I’ll confess it was extremely painful, actually, at the time, because their babies were still alive. And it was kind of like helping someone else have their babies live when my babies had been taken from me. And it was sharing all the knowledge that I had gained, that I wished I had known at the time before a loss. And at the same time, it felt like absolutely the right thing to do and it felt like something I was doing for my babies. And so what I’ll say is, the way that it began, in my mind, the way that I thought about doing this work was because one of the things that I felt had been taken from me was the opportunity to be a mother to these babies, because they were dead. And yet I had already dreamed about them and kind of planned to be their mother from before.
And so the way it kind of worked in my mind was that, if I could do something that would make the world better, or help other people, and it was something that I wouldn’t have done or couldn’t have done if not for the fact that those babies had once lived inside of me and now died, then that felt like some kind of alternative version of being a mother not like, you know, changing diapers or feeding or, you know, whatever mothers do for babies that live but it felt like something like mothering. And with that framing, it really felt very meaningful to me to support others and those people…by the way, I’ll just mention that those people, it wound up being that their babies also died. So it shifted from helping them get the right medical care to supporting them through loss.
And they, by the way, got the best medical care possible, and still their babies died, which was also an important lesson for me because we had kind of missed the opportunity to know what was happening to our babies before it was too late, and they didn’t. And it showed me an example of just how precarious these things can be, even when you do have the best knowledge and treatment. But that’s a different story for another time. And so, yeah, once I kind of framed it for myself as a kind of motherhood, it really felt like a calling, and then different sorts of opportunities arose in different kinds of ways. And as much as I helped others, it helped me heal to do that work also.
Dr. Fox: Right. So it was somewhat, you know, partially therapeutic in the same time that you’re helping others, it’s helping yourself go through loss.
Shira: Oh, it was absolutely therapeutic. And people would always thank me for the time and for, you know, the effort. And I was always honest with them, that it also helped me. So, you know, it was very mutual.
Dr. Fox: Right. And also, at the same time you develop, I’m sure, very strong bonds between people, because, I mean, this type of shared experience, even though as you said, each story is unique and different, but this concept of this, you know, intense grief around pregnancy is. And to have that and to share that with another, you know, person or another couple is probably something that they’ll never forget. And you probably…I imagine you’re in touch with a lot of these people well beyond the initial loss.
Shira: Yes, absolutely. I mean, I have times of year that I try to go through my proverbial Rolodex of people that over the years I’ve spoken to. And Mother’s Day, which just passed this year is one example of a time when I tried to reach out to as many people as I can remember that I’ve connected to, to just tell them that I’m, you know, remembering their baby that died on Mother’s Day. And for different people, there are other times of the year that I know are connected for them, whether it’s the season of when the loss happened, or holidays, or other sorts of moments of the year.
So, absolutely, I try my best to remember and reach out and it is a bond and a connection that doesn’t go away. And even though many of those people I’m no longer in active touch with, often in the beginning, you know, I’m regularly in touch with them, and they’re regularly in touch with me. And as lives move on, we’re not in active touch, but it’s always special to reconnect at those moments, and for them to feel like their baby is remembered and for me in turn to know that they remember my babies absolutely.
Dr. Fox: And do you think that…you know, you’re sort of part of you being drawn to this, do you think your experiences growing up in the house, you know, of a pretty prominent pastor, you know, your father is a pulpit rabbi, and you’re married to the rabbi of a congregation. And so you’ve always been in this sort of communal, pastoral household, do you think that has anything to do with it or is it just somewhat coincidental?
Shira: It’s hard to know. One thing I know from growing up in my parent’s household is how much of an emphasis they gave, especially my mother, on being able to speak publicly. For me and my siblings, from time to time in our lives, there were moments when we were called on to speak publicly and my mother practiced with us and made sure that we looked up from the page and spoke with enunciation and things like that. And so I certainly attribute my ability to speak publicly about things even when it feels hard, which is part of what this has been for me to growing up in my household.
And certainly, I think that in my role now and in my parent’s role, when I was growing up, supporting people through pain is a big part of it. I can’t say that it’s only because of that, meaning there are certainly other people who do this who weren’t raised in the households of pastors or rabbis, etc. And so I’m sure it’s a piece of it, and also a calling in its own right that different people find. Now I also know other people who’ve done other sorts of things to use that expression of mothering for the babies that aren’t alive, have done other sorts of work that isn’t necessarily direct pastoral care for people going through losses but other kinds of creative responses. I know someone who created a kind of happiness program that wound up being like quite popular and successful that people dealing with all sorts of grief or disappointment or other things, you know, it wasn’t just about losing babies, even though that was the impetus for creating the program for this woman. So, yeah, I’m sure it’s a part of it and also, it’s something that people can do, even if they haven’t been raised in that sort of household.
Dr. Fox: Right. Now, obviously, I think that anyone can go and decide that they’re going to help others and decide that they’re going to talk about it either publicly or just individually. But I do imagine that there’s some just…it’s sort of like an expectation. You know, you’ve always been around your whole family, you know, when you’re growing up, and now we’re just people who help others in many different ways. And I think it’s just sort of your own personal values and culture. And it’s, you know, one of the reasons I’m sure, also people are drawn to you, in addition to just, you know, being someone who’s easy to talk to, and, you know, very caring, I think it probably does have a…maybe even it makes the people who come to you more open about it themselves, I don’t know. It’s hard to know with these things.
Shira: Well, I certainly think that that’s true. I do think that some people who might be hesitant to talk to someone are more open to talking to me because they see me as a rabbi’s wife, and as someone who…I don’t know, is in a more official role, or just someone who it feels more comfortable to talk to. So I certainly think that that has helped people feel open. One thing I found is that a lot of people who especially are in the early stages of this kind of traumatic loss and grief are so just lost in the world and overwhelmed by what they’ve gone through that they find it really hard to talk to anybody.
And I actually remember feeling this way very much. I really couldn’t talk to anybody. And yet, if someone suggests that they talk to me, and they will, maybe because of the role in the same way that people might talk to their pastor and not to anybody else, during certain challenging moments. I do think the role does help open people up. And I’m glad for that, because I do find that it’s often a relief for them to talk to someone but they wouldn’t necessarily have kind of found the energy to do it in all contexts.

Dr. Fox: Welcome to “High-Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High-Risk Birth Stories” is a podcast designed to give you, the listener, a window into the life-changing experiences of pregnancy, fertility, and childbirth.
Shira: One of the key themes that I always say every time I talk to someone is, number one, it will get better, but it will take a long time. It will take longer than you think. And that it can’t get better without experiencing a tremendous amount of pain. And it’s a pain that nobody can really take away from us. It’s something that we have to live through. What friends and family can do, and I’ll talk more about that in a bit, is to be there, and to support, and to help kind of cushion the blow, and to help us feel less alone on this journey. But grief is a journey of pain that has to be lived through. It cannot be taken away or kind of shouldered by someone else. It’s just not how it works.
So that’s number one, but you will go through a lot of pain and you will also be better one day. It won’t always feel like this. That’s something that I tell people. I’ve really come to believe that that grief is a kind of natural process that has both physical and emotional elements to it. And as a physical process, I think it’s important to…like any other physical process that our body needs to go through, I think it’s really important to kind of lean into the grief and to almost, like, trust our bodies, that they know what they need to do to get through this.
I think a lot of people and especially, I think, family members have a sense of the kind of how long, like maybe a week, two, maybe a month, is, like, a time to be really sad. But then after X amount of time, like, it becomes thought to be unhealthy that someone is still grieving. That’s something that I really want to kind of emphatically disagree with. Meaning, I do think there’s a time when…I should just say, I think there’s a time when it can feel unhealthy, but I think that time is much longer than people often think. I think that I always tell people, like, give yourself a year before you start to really feel like maybe something needs to really, really change here. Or trust yourself. If you feel like it’s unhealthy, it’s gotten to a point of being unhealthy, then do something about it, seek professional help. But I think that there’s a kind of common thought that if someone is still feeling so sad after two weeks or a month, something must be wrong. And I think that’s really not true. This is a natural process that can’t be hastened.
And I think that one of the things that I’ve come to learn is that we actually have a lot of intuitions that we ought to listen to in this. Like, we should trust our hearts and our bodies that they actually know what they need to do to get through. And basically everyone I’ve spoken to has gone through…you know, has gone through a journey of tremendous pain, and everyone gets better. Everyone doesn’t remain forever stuck in that time. But I think that we need to let ourselves go through the process. And I think I’ll just say personally for myself, there was a time when I sought out therapy for PTSD. And that was a moment when I felt like this was no longer just the natural grieving process, but I felt like I had gotten stuck and that I needed an outsider to come and help me get to a place because I felt that it got to a point where I didn’t feel like I was where I was supposed to be in my life, that I was still in too much pain and I needed to kinda be present fully for my children.
And that was something that I did, but that was after, I would say, about a year and a half after losing my twins. And up until that point, I actually felt that the pain I was experiencing, it felt like the right thing. And then it got to a point where it didn’t feel like the right thing. And then the therapy that I did really helped me. And so I would say, for each person, don’t let other people tell you when it’s unhealthy. Wait till you agree. Wait till you feel that. Because I think one of the very common things that I see with people is that their loved ones are trying to hasten the process. Their loved ones don’t want to see them so sad and so they push, you know, to heal quicker. And I just think it doesn’t work that way.
Let me just emphasize further. I’m not giving medical advice, meaning I think it’s great. Some people already have a therapist that they’ve already been seeing in their lives and then they continue with therapy to work through the loss. Other people start seeing a therapist immediately. And that’s great. And it’s not…what I’m saying is not really about the timing of when you might seek outside help. It’s more about how we judge the grieving process and whether it’s gotten to a point of healthy and unhealthy. I think that people should process this with whoever helps them from the beginning or at a later time, but trust yourself that you know what you need.
Dr. Fox: Right. And I think that it’s so important when you’re talking about that. It’s not really another’s decision about when it’s too long or when it’s sort of answer this, why are you still grieving? It’s really not. It’s internal. And, you know, I see women in the subsequent pregnancy, this could be years later, and, you know, they’re still grieving. And as you said, they’re better because it’s been time. They’re not…you know, they’re still obviously in a lot of grief. And then when the next pregnancy happens, all that comes back because there’s tremendous anxiety, you know, there’s aspects, like you said, PTSD because the next pregnancy is so hard on them. And when we talk about that, I tell them, I say like, “It’s okay to feel these things. Like you’re supposed to feel these things. You know, this is normal.”
And I say, you know, “If something…” you know, “If someone were walking through Central Park at night and they got attacked, and then, you know, as a horrible thing, they’re in the hospital and it’s awful. A month later, if they’re walking through Central Park at night and it’s dark, they’re gonna be physically ill. Their heart’s gonna be racing. They’re gonna throw up. They’re gonna feel awful.” And I say, “That’s what’s happening with your next pregnancy.” So you don’t have to, a, feel bad that you feel so anxious and worried, and you certainly don’t have to explain yourself or justify to others. I say, “This is what you’re supposed to be feeling, will help you get through it. But don’t feel like there’s something wrong with you cause you’re having that. This is something right with you. This is the normal human response to a trauma. And you should be feeling this as you go through the next pregnancy.” And I think when we stop…we as, you know, doctors or family members, whoever, stop trying to tell people, “It’ll be okay, it’ll be okay. Feel well, feel well,” like, yeah, we should reassure, but, you know, at the same time, you have to validate that what they’re feeling is real and is supposed to be there.
Shira: Exactly. I think that’s exactly the point, is that it’s supposed to be. You know, I sometimes say to people, “Given this abnormal…given this situation that isn’t supposed to have happened, the way you’re feeling now is exactly what you’re supposed to be feeling.” And so it feels like it’s not a normal situation, but given that, this is exactly the normal thing. And I do think that’s so important. And, you know, I remember reading a piece kind of early on where the theme of the piece was the only way out is through. And it’s just really true. If we allow ourselves to go through that process and to feel permission to feel the feelings that we feel, those feelings won’t haunt us anymore. They will actually go away.
Whereas the women who I meet who lost a baby 50 years ago and the baby was kind of whisked away, and no one ever spoke of it again, and it was all in hush terms behind closed doors and then it was silenced forever, those are the women who were never allowed to feel their pain, to really feel it, because there was no social permission and then they still are stuck in it now. Whereas I think the people who go through this intense process of really leaning into the grief in the first year or however longer, shorter, it’s different for each person, then those people actually get healthy afterwards. And that’s kinda the amazing part of it, is that if we allow it to happen in the way that it should, it actually doesn’t haunt us forever.
Dr. Fox: Yeah. I mean, it’s…you know, two things you said which, you know, struck me is, the first is about that sort of that line between when the grief is sort of normal to when you feel that this is something that’s not right and maybe you should seek help. You know, I’m not a mental health professional. Like, I’m not a psychologist, psychiatrist, whoever. I obviously see a lot of people with, you know, mental health diagnoses or concerns. There are lines that people pass in their grief where it becomes unhealthy for them. You know, things like they can’t eat anymore. They can’t sleep anymore. They can’t function, you know, and they’re really, you know, suffering physically. And, you know, okay, in those points it’s probably wise to make sure that there’s nothing really unhealthy going on, but that’s…you know, for most people it’s not clinical depression, it’s grief. You know, people who…
Shira: Exactly.
Dr. Fox: …are sad, right? If you’re sad over a loss, you maybe have the symptom of depression or you may feel depression, but you don’t have the diagnosis of depression, right? It’s a different situation. And the same is true, like, anxiety. You can be anxious over something and not have an anxiety disorder, you’re anxious, like, over something that’s real. And so it’s not always…you know, it’s not really necessarily the symptoms, it’s sort of how the other functions are going.
And, you know, in terms of the grief, you know, unfortunately, as you know, I’ve had to deliver babies that we knew before, you know, had passed. And that whole experience is horrible, obviously. And after the baby is born, the mother has a choice of whether she would like to, you know, see the baby, hold the baby, spend time with the baby. And I would say most women do. And we typically encourage them to, for the reasons you said, that it does give women some…it helps them through the grieving process potentially. And a lot of people who don’t, you know, see the baby or hold the baby, come to regret it later.
And, you know, in those circumstances, we, too, take photos, and there’s, you know, a keepsake that the hospital just keeps, you know, pretty much indefinitely in case someone comes back and asks. But for women who say they don’t, they’re not ready or they’re just not there to do that, it’s hard. I mean, certainly, we wouldn’t push them to do it, you know, to spend time with the baby, but it’s hard to know if they are gonna later regret that for sort of the reasons you said. It’s a difficult situation, obviously, to make those decisions is hard at the time.
Shira: One of the really hard things that I’ve felt is that oftentimes when these sorts of late-pregnancy losses happen, and then there’s a birth of a baby that has either died in utero or, you know, in my case, it was kind of a combination of a baby that died in utero and a preterm labor of a baby that couldn’t survive past birth. And in either of those cases, you’re sudden…oftentimes you didn’t know that far in advance that this was gonna happen. Oftentimes it’s like just found out on an ultrasound that the baby died and then suddenly you’re either getting induced to give birth or, you know, if you’ve gone into kinda a sudden unexpected preterm labor and things like that, and all sorts of decisions have to be made that are permanent decisions, but you don’t have time to do the research or to really know what to do. And it’s also a time of being so emotionally overwhelmed. And sometimes I really regret that by the time someone talks to me, it’s after all those decisions have been made. And I wish I could have been there before because I think it helps to be able to talk to someone first to have a little bit of a sense of what to expect and what decisions to make.
And I will say that for me and my husband, one of the things that we were, like, kind of tragically lucky about was that a really close friend of ours had had a pregnancy loss at a very similar stage of pregnancy, only seven months earlier than us. And we had supported them through the loss without knowing what it was because at that time we had never gone through anything like that. And then suddenly, it was kind of a role reversal where I called them the day that I was going to give birth when I was in labor. And I said to them, like, you know, “Give us advice, what should we do?” And they kind of tragically shared with us that they didn’t have any…they had, like, one weird picture of the baby that the hospital took, but they didn’t have any pictures of themselves holding the baby because at the time they didn’t want it, but now they, like, deeply regret that they didn’t have it. And so they just said, like, you know, “Hold the babies and make sure to take a lot of pictures of yourselves holding the babies.” I don’t know what we would’ve done if we didn’t have these friends to kind of guide us in that.
And I think far too many people obviously don’t have someone there to guide them who’s been there. And so all sorts of decisions are made in the moment based on whatever advice you get or what you intuitively feel. And I would always encourage people to hold the baby only if for no other reason than that you might regret it later. But I also think that if someone feels so confident that they don’t wanna hold the baby, I would never push them not to, because I do strongly believe in kind of trusting ourselves in this process. And so even though for me, I would never do it any differently, you know, and we did hold the babies and we have lots of pictures, rarely look at the pictures now, but I really deeply value having them and knowing exactly where they are.
And it was extremely painful at the time. And I think that holding them kind of magnified how real they were, at the same time as I think it helped me in the ways that you and I have been talking about, of really, like, leaning into the pain and the reality of how deep this loss was, that sent me on a journey that helped me ultimately get to a place of where I am today, where I feel like, you know, a really healthy person and I don’t feel like this loss…as much as it’s a huge part of me and it has certainly changed me, I don’t feel like it is something that is a source of tremendous kind of pain in my life.
It’s more something that I can think of with sadness that we never got to raise those babies, or have those babies, or know what our family would’ve been like with those babies, but also a kind of acceptance of this is my life story. And it has given me an opportunity to help so many other people. My living children know about these babies. And I know that they will be more compassionate towards others in their lives when they’re adults because this is part of our family story. And so, you know, while I certainly don’t wish it had happened and I, in fact, you know, wish it had never happened that we lost them, I also see how it has made me the person I am today and I’m able to kind of think about that with a healthy perspective. And I really do attribute that to just going through the grief process and getting there. And it just takes a lot of time and pain.
Dr. Fox: And I think that you know, one of the things that, you know, you touched upon before, and I think it’s the big difference between what you’re describing, which is coming to that place where…you know, that this is your, you know, reality, and this is your family, and this is your experience. And the difference between that and the term, like, closure. Like, closure implies, like, this is, you know, “Close the book. It’s behind me, I’m gonna move on,” but that’s not what you’re describing at all. You’re describing, you know, the idea that these babies, you know, are a part of your family and your family story, and it’s not something that’s sort of behind you to never be thought about again.
This is obviously a very tragic experience, but this is the experience your family and you…you know, your daughters, you know, they have names, right? I mean their names, you know, they Yakira, they’re Tamima, you know, they’re babies who are named, and they’re part of your family, and they’re part of your story. And I think that’s such an important thing. And I know that, you know, you’ve shared with me a lot of the things that you’ve, you know, said to others and spoken publicly. And that’s one of the themes that you talk about, is recognizing that these babies are a part of the family, and that’s not just for the people who are grieving, but also for the rest of us who are trying to either help the people who are grieving or just know the people who are grieving. And this, you know, shift from maybe how it was that these babies are forgotten and not spoken about, and sort of, you know, that they’re in the past, and actually thinking about them as babies, like you said, and, you know, thinking about people on Mother’s Day, or what the baby’s, you know, birthday was, or what the due date would’ve been, or whatever that date might be, as opposed to thinking about something that’s gone and in the past.
Shira: Yeah. I think that 100% true that closure isn’t the right word because babies that people have lost are always part of them. I think the right thing is to realize that and to acknowledge that and to help people find what I’ve kind of described as a healthy way to live with this as part of your story, not something that brings you down or makes you sad forever, but something that is just a part of your life, like so many things are part of our lives. And so I do think that acknowledging that you remember the baby or the babies to people from time to time over the years, whether it’s Mother’s Day, or I think of other milestone moments, like when another baby is born, you know, if that’s part of people’s stories, that they have another child after a loss, that doesn’t always happen, or when people buy a new house, or any kind of milestone moment when you’re kind reflecting on your life and your family as it is, I think those are the moments to say to people that you remember the baby.
And I think some people are worried about bringing it up because they think that they’ll kind of bring someone down at a happy time, but I think it’s just the opposite. I think the working assumption should be that if you’re thinking about the baby, they are, too. And in fact, if you’re not thinking about the baby, they are, too. And I think people really appreciate knowing that this little existence hasn’t been forgotten. I think one of the things that is painful for people is kind of not knowing what to do with this baby who feels real to them but it feels like was never part of the world. And so I think that when other people remember in some way, it does feel like, in some way, the existence lives on of this baby that never got to live. And I think it is really meaningful to them.
Dr. Fox: Right. And I mean, one other horrible part of losses is not just…you know, there’s the loss of what was, but there’s also the loss of, you know, moving forward, that that’s not gonna happen. And people grieve over both, they grieve over their…you know, the loss, and then they grieve over the fact that things aren’t going to occur that would’ve occurred. And the thought, the idea that someone is remembering, you know, “I don’t forget, I’m not forgetting,” and, you know, “Your baby is not forgotten,” like you said, I think, is very meaningful to people more so than painful and would, as you said, be very much appreciated.
Are there other pieces of advice you could give to those, not who are going to through the loss, but who are…you know, who knows someone who’s going through a loss, whether it’s a family member or friend, how they can be supportive and helpful in addition to just things like you mentioned of not forgetting the baby and of recognizing and mentioning and talking about the baby at various events? Are there other things that you’ve seen that…you know, sort of common either mistakes that people make frequently or good things that people do frequently that you wanna highlight?
Shira: I guess, just going back to the theme of grief I think that one of the most important things is to really understand it. If you do, you can be the most helpful and avoid some of the things that hurt. And so I wanna kinda reiterate what I said before about grief being a natural process, to say that it’s real, and in some ways, it’s something that we can’t control in the ways that we would want, certainly in the early phases of the kind of initial moments of loss. And I think that the instinct of friends and relatives is to take away the pain. And I think it’s really important to understand that that’s something we can’t do.
And the other thing is that we want the person to get better quickly, to be happy again, because we love them. And we want them to be happy because I think often something we think about people we love is that we want them to be happy, right? That’s natural. And the issue is that we actually can’t force that. We have to let people go through this, but I think that we have to also really be there with them in going through it.
And that’s really hard because what that entails is that you have to be able to really kind of bear witness to someone’s raw, and devastating, and ongoing pain and not try to fix it and just to kinda be there with them and to continue to show our love and care and to continue to show up, even though it actually, A, hurts us to see them in so much pain and, B, is a real downer. Like, if we’re not going through that, we don’t wanna constantly be brought back into something so horrible. And so I think there’s both of those elements are part of what motivates us to kind of not want the person to be in pain anymore. And I think a key thing is to realize that we can’t stop that and that we actually have to stay with them, even though we don’t want to in a lot of ways.
And, you know, one of the things that I think about when I think back to myself in that time is that it was probably the most selfish time of my life in those early months of intense grief. Normally, the kind of person that I am is I’m always, like, doing things for others, giving, trying to take care of people, trying to help people, trying to, you know, solve peoples’ problems and whatever. And in the early stages of grief, I was literally, like, in pure survival mode, I was in so much pain that I felt almost like I could die. I mean, not literally, but it felt, like, so painful that I could…I felt like I could barely manage to live with this much pain.
And what I really couldn’t do when I was just trying to survive was, like, somehow make what I was going through better for other people. I couldn’t make them feel better when they were suffering by seeing me in so much pain. And I think that that was something that was really hard, was, I think, other people wanted me to kind of tell them that I was okay or I was gonna be okay, and I just couldn’t take care of them because I just could barely take care of myself. And, you know, I remember, like, just thinking back to it that I was, like, just so fragile and so easily crushed and I felt like the whole world was, like, just full of landmines. Like, any second, someone could say something that could just kind of throw me back into, you know, whatever.
And so I think that that’s a time of recognizing that people who are in really deep grief, I think they’re self-absorbed, but I think it’s because they have to be, they’re in pure survival mode. And one of the things that I learned later from a friend of mine was that apparently in one of those early days, like, she dropped everything in her very stressful life to, you know, do a favor for me and my husband. And years later, she told me that it was, like, so hard for her to drop everything and do this for us. And that she said that I barely looked at her and I never thanked her for doing it.
And I mentioned earlier that I have, like, hyper-vivid memories from this time in my life, like, better than things I did last week. I remember the whole pregnancy and the aftermath. And, you know, I racked my brain when she told me about this and I could not, for the life of me…I had no memory of what she was describing. Like, it literally didn’t penetrate into my consciousness at the time. And what it made me realize is, I think, that a friend who’s grieving really demands a lot of care, not like they’re actively demanding it, but they need, and that’s really hard and it kinda sucks.
And we’re used to friendships being mutual and, like, we give, and our friends give, and it’s two-way. And I think in the moment that a friend is grieving, a friendship really becomes one way. And they might not even, like, notice when you do something nice for them or thank you. And it’s not because they’re, like, mean or they don’t like you or something, it might literally be that they’re just, like, so trying to stay afloat and trying to survive. And so my advice for friends is to realize that this might be a phase of friendship that is really one way, it’s just pure love and pure giving. And that can be really, really hard. And if you need to take a break, you know, take a break. But also be really compassionate and know that your friend will come back, but it takes time.
And I guess the other thing I would say is that we never know when we’re gonna be the ones going through something. And I think that every friendship has a time when one person is giving and one person is taking. It happens for the different members of the friendship at different moments. And we will all have a time when we need to receive and we can’t give. And so I think if friends can recognize that and be forgiving, it will help the friendship get through this hard time. So that’s just another thing, I think, that friends can do. And it’s hard. It’s really, really, really hard, I would say, to support a friend who’s intensely grieving.
Dr. Fox: Right. And as you said, sometimes it means literally just sitting there, just being there, just showing up, you know, sitting, holding someone’s hand, or just sitting next to them and just saying, you know, “I’m so sorry, I’m here for you.” And…
Shira: Right. And also continuing to show up even if they don’t respond to your texts or your calls and not getting hurt or offended, but rather just knowing, like, they can’t right now, but I still love them and so I will continue to show up. You know, it’s like…this is a ridiculous analogy, but, you know, with like feeding children, introduce new foods, like, all the books say the child can refuse a food, like, 10 times, but the 11th time they might take it. And so don’t give up after five times of refusal. And I would say that in some ridiculous analogy to that, don’t give up on supporting and reaching out to your friend, even if it seems like they don’t want it or they’re not responding, just continue showing up with love. They will appreciate it. They will thank you later for kind of sticking it out with them.
Dr. Fox: Right. I mean, the wisest person in my life, my wife, you know, always talks about this idea that don’t send someone a text saying, “What can I do for you?” Or, “If you need something, I’m here.” She said, just do it. Just show up. You know, show up, drop something off that you don’t know if they need, they don’t need, bring over food, offer to take their kids somewhere, you know, just do something. And if they don’t want it, they’ll say no, but putting the responsibility on the person who’s grieving to think of how can someone help me? All right, if they happen to have something, fine. But most of the time, like you said, you’re not even, like…you’re barely taking care of yourself, and to think, “Oh, you know, you can go buy milk for me,” like, you’re not even thinking about that. And so just do it.
And this idea, like you said, of not…you know, so many times when I’m speaking to people, they’ll tell me of all the things that people said to them that were so hurtful, and obviously, the people who said them were not trying to be hurtful. They were trying to be helpful. They care about them. They love them. They just didn’t know what to say. And so people say things like, “Oh, you know, you’ll be better when,” you know, whatever it is. You’ll be better in a month. You’ll be better when you have your next baby or something of that sort. Or they try to minimize the pain. Again, it’s done out of love and mostly, you know, sort of ignorance about what to say, but those things aren’t necessary. You know, someone’s grieving just, you know, just be there for them and just let them know you’re there and you love them and do things for them, like you said. And it’s not about trying to, you know, remove their pain as much as just be there with them as they go through it. Like you said, it’s a journey that’s required to get to the other end.
Shira: Absolutely.
Dr. Fox: Shira, I’m so thankful that you agreed to come on to talk about this. I know that this is something that you’re very passionate about and something that, as you said, you know, you do on a regular basis for, you know, individuals who are going through this. It just so important and so critical for people who are going through such loss to have, you know, someone who’s been through some form of loss, you know, like you said, maybe not the exact same, but something, you know, very traumatic, and you have insight, and you’re caring, and you’re helpful.
But also in this form where you’re talking to people who you don’t know, you have no idea who’s listening and whether it’s someone who themselves is going through a loss or went through a loss and maybe they’re rethinking about it and their own grieving process, or all the people are fortunate enough to not have gone through a loss but, you know, we all learn from your insights and your, you know, openness about how to help others who might be going through this. And it’s so important because, as you said, this is not so rare. So many people have to go through this. And the more that all of us can understand that and recognize that and talk about it, hopefully, we will continue to move in the right direction and be available to support, you know, women and families who are going through such, you know, tragedies,
Shira: Thank you for inviting me. And it has been my pleasure to have this conversation with you. And just before we end, I wanted to kind of publicly say something about what you’ve done for me, which I think is a broader lesson about what a doctor can do and the role that a doctor can play in this journey. And I think it’s a big role actually. And so I just wanted to say that, you know, when I think back to that time, first of all, just in the most horrible week of my life between when the first baby died and the preterm labor, you were literally there for me 24/7. You didn’t make me feel like a burden at all. I think once I called you in the middle of the night and you answered my call, and you were compassionate, you listened to me, and you were honest with me.
And one of the things I appreciated is that you kind of balanced between not promising me anything you couldn’t deliver. Like, you couldn’t promise me that this was gonna be okay or that the second baby was gonna live, but you also allowed me to hope in ways that were reasonable, even if they weren’t certain. And I really needed that, that balance between realism and hope. And I still remember that the morning after our babies were born, which they were born at midnight, you must have been on call the next morning, and you came in at 7 a.m. and you brought me and my husband coffee, which was such a nice gesture. And you called us a few days later just to check in.
And then you spoke to me at my postpartum appointment and help me kind of rehash and process everything. And then a few months later, I reached out to you because I still needed to rehash and process everything and you gave me so much time. And over the years, I’ve sent you things that I’ve written on this topic, and you always read them, you write back, commenting with compassion and with interest. And you were my doctor in my two subsequent uncomplicated pregnancies.
And as you described, you really understood my trauma and the ways in which being pregnant again was so terrifying for me, and the only way I was able to survive those pregnancies emotionally was because of your compassion. And I would say that as much as I really do wish I had never gone through this experience, one of the gifts that my husband and I always feel came out of it was our friendship with you. So we’re extremely grateful to you for all you’ve done for us. And we know that you’ve done that for infinitely many other people, and we just are always in awe of the work you do.
Dr. Fox: I appreciate that very much. Thank you. And yes, you know, this is not about me, obviously, but it’s…you know, when we have people who, you know, are patients of ours, or friends of ours, or both, and they go through these losses, it’s very difficult on the doctors as well to varying degrees, obviously based on the exact circumstances of who the person is, what the story is, but it’s hard. I mean, these are things we take home with us and we think about, and, you know, there’s so much, that’s…you know, it’s a whole other topic about, you know, the grieving doctor, which is clearly not what we’re talking about today, but it is a very difficult thing. But, you know, as you said, one of the things that happens to these, you know, experiences that are so traumatic, obviously for you and for Steven and, you know, to a much lesser degree to the doctor, is it really does bring people together who may not have done that otherwise.
And in the same way, you know, the reason I read the things you send me, it’s not because I’m kind, it’s because they’re great. And it’s, you know, what you write about this and the thoughts you have about this, and, you know, as I’ve always told you, your problem is you’re too smart, your IQ is too high. So, you know, the way you process this and, you know, sort of the insights that you bring, I really value and it helps me when I’m working with people who are going through this, whether professionally or personally, and that’s why it’s so important the work you’re doing to help everyone sort of do this a little bit better for others who are going through this. So thank you so much.
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