October 15th is a Pregnancy and Infant Loss Awareness Day. One in five pregnancies end in miscarriage, and six infants in 1000 is stillborn. I wanted to write for those who have experienced a perinatal loss or know someone who has. Whether this woman has other children or had a subsequent successful pregnancy, the sense of loss does not go away – she cannot get past it, only through it. Unfortunately, this experience of loss tends to be medicalized in our society often disregarding emotional toll it has on a mom and her family. Doctors often try to normalize the loss as part of a normal process of trying to have a baby; while it can be true, it is no less difficult and, if not addressed and acknowledged properly and appropriate to individual experience, this loss may become even more devastating and suffering more prolonged. Here are some things to keep in mind if you are a family member or a friend of someone who had experienced a perinatal loss: Sometimes, even partners and close family members express frustration and irritation when the mom “keeps bringing up” the loss because “why can’t we just try to put this behind us?” The mom often blames herself for “failing” and keeps replaying in her mind what she could have done differently to ensure a healthy pregnancy: diet, exercise or no exercise, stress, different supplements, more OB visits, etc. We often don’t know if this was a late pregnancy loss, planned pregnancy, recurrent miscarriage, stillbirth, or failed IVF – even when it is a close friend or a family member. It is very important to not assume anything and just offer support. Let the mom tell you what she needs. Acknowledge the loss and allow a grieving process to run its course; there is no timeline – everyone grieves differently. Just listen – you are not expected to say anything or offer an explanation; “I don’t know what to say,” “it’s ok to cry” and “it is not your fault” are always appreciated. Do not dismiss or minimize the loss in an effort to make the mom feel better – normalize the grief and not the loss. Do not change the subject when the mom starts to talk about her experience; do not avoid the family; and do not say “it was for the best”, “it was nature’s way of ending an unhealthy pregnancy” or “at least you didn’t know him or her.” If the woman is pregnant after the loss, she cannot help but think about the loss while pregnant no matter how long ago it was. She may experience anxiety and/or depression, be unable to enjoy or look forward to birth for the fear of “jinxing” the pregnancy. She may refuse to have a baby shower, bond with the baby, or buy anything for the baby until the very last moment. She is afraid to hope. Do not push her to do anything she doesn’t want to do because this often implies judgment or criticism of not being able to let go and move on. Once the baby is born, the mom may feel sad because she imagines what the other child would have been like had he or she made it. It is important to acknowledge that this happens and not make the mom feel guilty for not being grateful for the baby she has now. The two are not mutually exclusive – of course, the mom is grateful but the loss is not forgotten. Often, ritualizing the loss is helpful. Writing a letter to the baby and reading it out loud, releasing balloons, or planting a tree can bring some piece of mind that the loss will not be forgotten.