But grief can exist alongside depression, anxiety, PTSD, PMADs, and other mental health concerns, and sometimes the hardest part for a perinatal professional is knowing when someone needs more.

In this episode, Vallen breaks down five experiences that can occur after pregnancy or infant loss:

• Normal acute grief
• Traumatic grief
• Perinatal mood and anxiety disorders
• PTSD
• Prolonged grief disorder

We also talk about what doulas, nurses, midwives, postpartum professionals, and other non-diagnosing providers should actually watch for, including function, safety, escalation, isolation, duration, and substance use.

And most importantly: how do you refer someone for mental health support without making the referral feel like abandonment?

You'll leave this episode with practical language you can use, a clearer understanding of professional scope, and one simple assignment:

Build your referral list before you need it.

Support Resources

988 Suicide & Crisis Lifeline: Call or text 988.

Postpartum Support International HelpLine: 1-800-944-4773.

The PSI HelpLine provides support and connection to perinatal mental health resources but is not a crisis line.

Links + Resources:

• 💌 Visit the Evelyn James Shop on Etsy!
• 🧡 Follow us on TikTok!! @pregnancyloss.motherhood

Welcome back to the Grief Informed Paranatal Care Podcast. We are so glad you're here to today. A quick note before we begin, today we're talking about suicide, maternal mortality, and mental health after pregnancy and infant loss. I want you to know that before we get into the conversation, and if you or someone you love needs immediate support, you can call or text 988 at any time. Okay. Let's talk about this.

Not every grieving parent needs therapy. Every grieving parent deserves support. And confusing those two sentences is how we feel people in both directions. We pathologize the ones who are grieving normally and we abandon the ones who are drowning. Grief is not a

mental illness.

But here's the distinction, okay? Grief can exist beside one. Grief can help uncover one. Grief can complicate one. And sometimes grief needs more support than you, I, or any professional can provide alone. So the question isn't whether we can diagnose it. The question is, can we notice? Okay, just notice when someone needs more.

Welcome back to the Grief Informed Perinatal Care Podcast. I'm Valin Webb, founder of Evelyn James and Company, educator, Brievement, and Postpartum Doula, counseling graduate student, and Evelyn's mom. And around here we're having the conversations I think perinatal professionals should have been having a long fucking time ago about grief, loss, postpartum, the family system, what happens after discharge, and about us professionals.

And about how we create continuity of care from hospital to home, instead of giving families one beautiful or sometimes not so beautiful hospital experience and then expecting them to somehow figure out the rest by themselves. If you're a doula, nurse, midwife, therapist, newborn care specialist, chaplain, hospital professional, birth worker, or you work anywhere around pregnancy, birth, postpartum, or loss, you are in the right place.

This week is National Suicide Prevention Week and today, Thursday, September tenth, is World Suicide Prevention Day. I'm doing this episode because this is one of the most common places I watch really good professionals freeze. They know how to sit beside somebody who's crying, they know how to bring water and nutritious foods, they know how to listen.

They know how to talk about the baby and use their name and use the parents' language. They know how to hold space. And then something changes. Maybe the parent says something that scares them. you know, maybe weeks have passed and things don't seem to be improving. The anxiety for that family could be consuming everything. Maybe the parents not sleeping and they're isolating themselves. You know, maybe something about the grief of the family feels bigger than what that professional feels equipped to hold.

Then starts the internal panic, okay? Is this normal grief? Is this depression? Is this trauma? Am I supposed to do something? What if I overreact? What if I underreact? What if I say the wrong thing? And before we go on, I just want to make something really clear. Your job is not to become perfect at this, you know? Your job isn't to diagnose. For many of us, diagnosis isn't within our scopes at all. our job is to notice. Our job is to

Is

to know our lane and our job is to know when somebody else needs to enter the care team. We need to bring somebody else on who knows what to do for this thing. And our job is to make the handoff without making the family feel like you just drop them. You know, because their grief got too uncomfortable, it got too big for you. the handoff does matter, and so that's what we are talking about today. So let's talk about why this matters. I'm gonna talk about four numbers today, okay?

I want you to hear what these numbers are actually telling us about our system that we live in. Okay. Number one. in a CDC Maternal Mortality Review Committee data from 36 states, it covered 2017 through 2019. Mental health conditions were the leading underlying cause of pregnancy-related death.

They accounted for about 22.7% of pregnancy-related deaths in that data set specifically. And so when the CDC says mental health conditions in these maternal mortality data, we're talking about deaths associated with conditions that include suicide, overdose, or poisoning related to substance use disorder, and other deaths determined by the review committees to be related to a mental health condition.

And that's almost one in four. And I need you to sit with that. Because when we talk about maternal mortality, what do most people picture? We think hemorrhage, blood pressure, cardiac complications, embolisms, maybe medical emergencies, and those things of course absolutely fucking matter. But mental health belongs in that conversation too. It's not something happening over in some separate little category over here. It's maternal health, full stop.

In more recent maternal mortality review committee data from 2021, found that approximately 87% of pregnancy-related deaths reviewed were considered preventable. And so the CDC currently describes the broader picture as more than 80% of these pregnancy-related deaths being preventable. More than 80%. Think about what that the word preventable means, okay?

It doesn't mean every death could have been prevented by one nurse asking one question. It doesn't mean every family had one misappointment and that's why something happened. Maternal mortality is complicated. There's systemic failures.

underlying everything else. Access failures, right racial inequities, provider shortages, insurance issues, transportation problems, stigma surrounding it, continuity problems, right? That handoff.

Making sure that they are supported once they get home. Clinical problems, community problems, there's so many things that can intersect within the lives in their lives. But preventable means somewhere along the line, there were opportunities, different paths to do something different. And that's what is important. Because that means this helplessness that we see, that we are told to see, is not the whole story. Okay.

The second number we're gonna talk about. A 2025 commentary in the Journal of Midwifery and Women's Health reviewed the issue of perinatal suicide and cited research estimating that the suicide accounts for approximately 7% of deaths occurring pregnancy and 20% of postpartum deaths. So 20%. And the author points out that this exceeds deaths from postpartum hemorrhage and hypertensive disorders. Exceeds those.

that should really get our attention because we have emergency cod protocols, right, for the bleeding, the hypertension, we monitor blood pressure, we educate professionals about warning signs, what to notice, which we should, okay. But what I'm saying to ask is where is that same seriousness around mental health? Where is the same understanding that this is part of postpartum care? Because mental health cannot be the thing we address only after somebody is visibly falling apart.

And especially after pregnancy loss, we cannot look at every mental health symptom and say, Well, of course she's sad. Her baby died. That's where we start missing stuff. Yes, of course she's grieving. But grief does not make someone immune to depression, anxiety, OCD, PTSD. And it does not make someone immune to a mental health crisis. And grief, honestly, can sometimes become a camouflage. It kind of just everything else

Is behind it and it kind of blocks off any other issues that may be underlying. And everything gets attributed to the loss. Because the loss explains so much, we stop asking the questions. Okay. Number three, let's look specifically at Stillbirth. 2021 systemic review published in BMC Pregnancy and Child Birth looked at depression, anxiety, PTSD, and OCD following stillbirth.

One of the studies included in the review found that mothers who had experienced stillbirth had more than four times the risk of receiving a PTSD diagnosis compared with mothers who had live births. The relative risk was 4.36. And that remained elevated after adjusting for things like socioeconomic status, mode of birth, maternal complications during labor, and other medical conditions, four times.

And I don't want you looking at the number, you know, I don't want you to start mentally diagnosing grieving moms with PTSD, but and please don't do that. especially if that's not your scope. I'm just giving you that number because it tells us something really important that loss and trauma can coexist. They often do. Birth can be incredibly traumatic, even with a good outcome. The circumstances surrounding a baby's death can be traumatic.

The moment somebody finds out their baby has died can be traumatic. The moment their milk comes in, that can be traumatic. The medical response can be traumatic. The way a provider speaks to a family can be part of the trauma. The silence that the family's experience, the isolation can become part of that trauma. The birth itself can become part of the trauma. And then the person is also grieving their baby.

Those are related experiences, but they're not the exact same experience. So we're gonna talk more about that distinction in a minute. Let's go over the last number, number four, and perhaps one of the most important things for us to understand. there isn't there isn't a stop date, right, on grief. There's not a expiration date on the psychological impact of stillbirth.

A retrospective study by Gravenstein and colleagues followed women five to eighteen years after stillbirth. Five to eighteen years. And about one-third of the women in that study still had clinically significant levels of post-traumatic stress symptoms. One third years later, anywhere between five and eighteen years later. So let's be careful with that because I don't want, you know, grieving parents to hear the statistic and think, my god, this is gonna be forever. That's not what I'm saying. People change, people integrate grief differently, people heal from their

trauma people build beautiful lives and find purpose symptoms can decrease decrease symptoms can decrease okay support matters treatment helps community matters and grief itself changes over time

What the research is telling professionals is that we cannot assume time is equal to the resolution or time equals fixed or healed. Okay? Six weeks isn't resolution, especially after you give birth, regardless of the outcome. A year isn't resolution. The next pregnancy is not a resolution. Another living baby isn't resolution. And five years doesn't necessarily mean someone should be over it. So that brings us back to the number I asked you to remember. More than eighty percent preventable.

With the twenty twenty one review data putting it around eighty seven percent, even higher.

And the gap is not just whether medicine exists to fix it. oftentimes the gap can be access. It can be c the continuity of care that we're missing. Sometimes it's whether someone asked a a question, you know, getting curious. Sometimes it's whether the person was believed.

Sometimes it's whether the referral was actually usable and their insurance took, you know, takes the referral or takes their insurance. Sometimes it's just whether somebody notices what is going on. And that is what really brings us to the part I want us to understand is when someone is grieving after pregnancy or infant loss, what exactly are we looking for?

Okay, because not all the stress is the same and we all have different job descriptions, different scopes, so what we want to notice are different. But five things it could be, okay? And it's not, you know, diagnosis, this is not a grief bingo. But this is more of a framework to just help you understand why noticing and referring matters.

So number one, normal acute grief. So as a culture, we've done something like totally bizarre with grief. On one hand, we pathologize it, okay? Someone is crying constantly three weeks after their baby dies. People start saying things like, Do you think she's depressed? No, I just think that she her baby died and she's sad. And and then on the other hand, we minimize grief so aggressively that when somebody actually does need additional support, we say that's normal, she's grieving.

Or tell them, No, that's normal, you're just grieving.

So, do we see that problem? We're fucking it up in both directions. Normal acute grief can be enormous. And I will say the acute grief after your baby dies is fucking visceral. It's physical. We can feel feel the aching in our bones, in our organs. We can feel the pressure building in our chest and our heart. Things actually hurt that you.

didn't know can hurt. They may not have any appetite, or they may be constantly eating because food is one of the the things that, you know, temporarily settles our nervous system in terms of dopamine. Sleep can be completely disrupted. Disbelief, there may be lots of disbelief. Searching.

Searching for why this happened, searching for how it happened, searching for why nobody told me, you know, reaching for the baby mentally, thinking that you heard a cry, you know, phantom phantom sounds still happen even after your baby dies. You know, looking towards the backseat or checking the the back door of the car when you're getting out, because you forget. Waking up and having the half second where we haven't remembered yet that the baby's gone.

and then remembering again. It is like the grief and the trauma hitting us again. There can be anger, so much anger. There can be relief. Then there can be guilt. Numbness. Devation. And then laughter. And then guilt because we're laughing, you know?

We may want to talk about the baby, our baby, for three straight hours. The next day, we may not want to say talk about the baby at all. We may not want to anybody to talk about the baby. Grief comes in waves. We know this. We know that it's not linear timeline. And one difficult symptom by itself doesn't equal a disorder necessarily. Yes, I know there's nuance, okay?

Intrusive thoughts or images can occur when you're grieving. I had that a lot. I started getting intrusive thoughts about my other children dying. Sleep disruption can occur when we're grieving. Difficulty concentrating can occur when we're grieving. Social withdrawal and isolation occurs when we're grieving. Crying, not crying.

That all occurs when we're grieving, and none of that by itself is pathology. That's a person whose baby died. And our discomfort with the intensity of grief does not make the grief abnormal, okay? Sometimes what a grieving person needs isn't therapy, always, although I highly recommend it.

Somebody sometimes they just need somebody who can just tolerate their grief. Who can just sit there with them. Somebody who doesn't try to reframe it or tell them everything happens for a reason or help them find meaning before they're ready. Sometimes we need somebody to just fucking sit with us and in bed rot or couch rot, watch funny movies and just laugh just because it makes us feel better.

you know, or eat a whole whole pie or cake with us and just cry or sob, you know, somebody who can talk about the baby without being weird and can just sit there and listen and and treat them like a parent who's talking about their baby. Okay, number two, traumatic grief. We then have grief that becomes tangled with the circumstances of what happened.

And this is where I want you to start separating d the two questions of okay, who is missing and what happened. Because grief is often about the relationship or whatever, like whatever was lost and that absence of that relationship or thing that was lost. Trauma is often about the event and what the nervous system experienced. And these things

absolutely can exist at the same time. A parent may miss their baby desperately and also have intrusive memories of the hospital room. They may, you know, really long and want to talk about their child, but also may avoid driving past the hospital where they died. They may want another pregnancy, but then experience overwhelming fear in medical settings.

There may they may be grieving their baby, and also grieving the way that they were treated. There were, you know, loss of control, procedures they didn't understand or didn't want. Language that providers used. You know, the moment the ultrasound room got quiet or when they shuffled in, you know, multiple, multiple people to keep trying to use the ultrasound and keep coming up with nothing. The moment somebody stopped making eye contact with you, you know, the way

they were told that their baby was died, the way that the birth happened, the way that the goodbye happened, there's two things that happened. Their baby died and something happened to them. This is when we're talking about traumatic grief. Their baby died and something happened to them.

Sometimes many thing many things happened to them and that matters. Grief is about who's missing, trauma is about what happened. And in two weeks, we're gonna dive deeper into this because traumatic grief definitely needs its an its its own episode. number three, perinatal mood and anxiety disorders. So let's talk about it. and I know there's a lot of I think being renamed, but

Perinatal mood and anxiety disorders don't just walk away or just go away or don't show up because the baby died. It can happen at the same time. You can still get perinatal mood and anxiety disorders without having the baby. Depression, anxiety, panic, OCD symptoms, and other perinatal mental health conditions.

It's like thinking our body is not going to go through, you know, postpartum because the baby died. Grief doesn't protect somebody from these mental health conditions that could happen.

Grief is an excellent place for peanuts to hide because everyone expects the person to be d distressed, okay? And this is where we have to get comfortable with curiosity. We have to ask questions. instead of thinking, yes, she's grieving, obviously, you know, she's not sleeping, she's not eating well, we want to ask, okay, what has sleep looked like?

Instead of assuming, yeah, of course she's anxious, look at what she's going through, you know, tell me what that anxiety feels like. Where are you feeling it in your body? When does this anxiety show up? Instead of maybe saying she's not responding because she's sad and depressed. Like, are you able to get through the basic things you need to do during the day? Are you able to brush your teeth and get out of bed? Are you able to take a shower? You know, bare minimum hygiene for one.

We're looking and watching for patterns. We're watching for function and intensity. We're looking and watching for any escalation. We are looking and watching for any safety warnings. We're not looking, you know, for that that moment.

where the person looks just sick and finally they do need help. Like we think they deserve the help because they look so terrible. We wanna connect with these people and get them support before they reach the point of no return. And this is so important, okay, because ACOG's current perineatal mental health guidance

Recognizes depression, anxiety, and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis as part of mental health screening and diagnosis during pregnancy and postpartum. So this is part of obstetric care. It belongs here. It's now part of the guidelines. It doesn't stop belonging just because the baby died.

And before we get into PTSD and prolonged grief, I just want to take a few minutes to talk about exactly why my company exists. If you're new here, my daughter Evelyn died. She was stillborn at 40 days and five weeks. 40 weeks and five days. Wow. perfect pregnancy. Nothing was wrong. And she died anyways, the day before I had gave birth to her. Right before I went to labor. Things started

movement felt different, okay. My husband was on a seven month deployment. I had my doula with me and I experienced some of the worst care and then some of the best care, thankfully. the hardest point of that

was literally separating from Evelyn at the hospital, having to leave her, not being able to change my mind, them not letting me come back to hold her, 'cause I did try. they kind of pushed me out the door.

And then going

Not even getting to go home, okay? I had to go to I had to go, was it Ride Aid or CVS? I had to go into the fucking pharmacy to get a prescription of sleeping pills that they could have given me at the hospital. They could have just fucking given me one for the night. Like they could have done me that honor of not making me go into a place of business standing in line with all these people while I'm

Clearly distraught. I just had a baby less than eight hours ago. I'm bleeding, I'm grieving, I'm all of these things. And then I go home. And my friend Beth was there and she was cleaning up and getting things done. My friends were with you know with my other friend, Jenna, the incredible human who was with me at the hospital alongside my doula, who took care of me.

brought me home. But then I was alone.

And I wanted to be alone because I had no idea what to do. And

I had a meal train, I had these wonderful humans and women milit my military community rallying together, bringing me dinner, tr helping with my girls and my kids, you know, bringing me coffees every day on my porch, just dropping it off so that I could function. And

But then there's nothing. I had to beg my midwife to give me Zoloft.

There's a lot of problems here. And the reason why Evelyn James and Company exists, it is so that families are not left alone once they leave the hospital. It is to build out the continuity of care by training doula's, by training other perinatal professionals, nurses, you know, lactation consultants, volunteers, anybody who wants to be a bereavement doula.

Training them so that bereavement doulas can be the gap. They c they can fill that gap. They can be that bridge from hospital to home. They can be the ones with the check-in framework, the text seek framework, the knowing when to reach out, knowing when to check in. We have to have that continuity of care, especially if we want our maternal mental health crisis to improve.

And I will go even further saying every postpartum family needs support, continuity of support through that first year. At least, at the very least, they deserve that. That is why my company exists. We train perinatal professionals to be bereavement professionals, to be the people in the rooms in the most uncomfortable situations who know what to do and can carry that. That is why my company exists.

So you've ever walked into a room with a grieving family and thought, I really care about these people, but I really don't know what to say, check out our self-paced course, our pregnancy loss education course. We are having a live training in November in Chicago, in the Chicago area. Join us if you want. Everything is on the website to sign up. Okay, back to the five things. Number four, PTSD.

PTSD isn't just really bad grief. And grief is not PTSD. But they do overlap. I think about Venn diagrams a lot when it comes to grief, trauma, PTSD, depression. They can all coexist in the same, you know, area. But there is distinction and nuance. There are differences.

And we have to notice those. So with PDSD, we're thinking about symptoms connected to the traumatic event, okay? Intrusion, avoidance, changes in arousal and reactivity, changes in mood and thinking associated with what happened. someone might have nightmares, they may avoid medical environments, they may become really intensely triggered or activated by the sound of monitors.

Ultrasound machines, smells, language, dates, bodily sensations. They may experience hypervigilance. Their nervous system can react as though the threat is happening again, even though cognitively they know they're not back in that room. So grief is about who's missing, what is missing, trauma is about what happened.

And you don't have to determine which diagnostic box somebody belongs in before you decide they deserve support. And that's the thing I that's the part I think sometimes gets lost. We think I'm not qualified to diagnose this, you know. Okay, correct. And you don't need to. You can say something like, I've noticed how intensely your body seems to react when we talk about the hospital. I wonder if having someone who really understands trauma after birth and loss might give you another layer of support. What do you think?

We're not diagnosing, we're noticing. That is the care that we need. It is not wrong to say that, that we notice that this is happening when we have this conversation. It's happened the last five times. I think, you know, it would be a really great idea for you to get

some some talk therapy, somebody who really knows PTSD after birth. Like what are your thoughts on that? Does that sound like a plan? Do you want me to help you find somebody who takes your insurance? That is care. Five, prolonged grief disorder. Okay, this one is in the DSM. So let's talk about this one. This kind of makes people nervous.

This diagnosis was formally added to the DSM 5TR when it was published in 2022. And for adults, the DSM 5TR includes a time threshold of at least 12 months after the death before this diagnosis can be made. So we need them to be grieving for at least a year before we can diagnose them. For children and adolescents, it's six months.

the ICD-11 uses a different framework and includes a duration threshold of at least six months, while also emphasizing that the grief response must persist for an abnormally long period and exceed expected social, cultural, or religious norms. And the cultural piece really matters a lot because there's no universal way to grieve.

Culture matters, religion matters, family structure matters, community matters. The relationship with the person who died matters. The nature of the death matters. And a diagnostic manual definitely doesn't get to erase the cultural meaning of mourning. So prolonged grief disorder is in I you still miss your baby. Of course you fucking miss your baby after a year.

Parents don't move on from their children. We learn how to continue carrying a relationship that changed shape. So prolonged grief disorder involves persistent, intense grief system symptoms that are associated with significant impairment and extend beyond that which would be expected within the person's cultural and social context. So for instance

In the acute grief stage, it is severely intense. Some people can barely function, get out of bed, take care of other children, go about their day, take care of themselves. If that's still happening you like twelve months later, then obviously that is beyond what would be expected, at least in my culture and the societal context in which I live.

And I want everyone who's not a diagnosing clinician to hear this really clear. We obviously as doulas do not diagnosis. Okay? A nurse doesn't diagnose, but knowing that it exists, that prolonged grief disorder exists, changes how you refer, right? It it does not change what you say to the grieving parent, right? You say things I've noticed, things that have felt increasingly hard.

And I want to make sure you have enough support. Same, you know, compassionate care. Scope. What do I actually watch for? Okay, so as non-diagnosing people, what are we actually watching for? I think about five things: function, safety, duration, escalation, isolation. And I would probably add substance use.

Because we do need to be aware of that if that is, you know, intensifying symptoms. So function. Can this person do the basic things necessary to move through their day? and I don't want, you know, like actual grieving people to misunderstand this. Like being productive is not a measurement, okay? whether their laundry is folded, that type of thing. I'm talking about basic functioning.

Eating, hydration, sleep, personal care, attending unnecessary appointments, caring for living children if they're responsible for being able to make decisions, being able to access support, and just taking note over time to see if anything's changing. Safety. If somebody tells you something that raises concern for their immediate safety, this is no longer the moment where you worry about being awkward. You ask directly.

And for clinicians, follow your organization's risk protocol. ACOG specifically recommends immediate assessment of the likelihood, acuity, and severity of suicide risk when a patient answers a suicide or self-harm item affirmatively, followed by risk-tailored management.

for non-clinical professionals, we need to know our scope, know our have or know an emergency process, know your local resources, which is why I harp on having a your own local resource guide to have these emergency local resources. Knowing 988, we cannot attempt to be someone's entire crisis plan, okay? We cannot. duration.

Duration by itself doesn't really tell you whether grief is healthy or unhealthy. but you know, there are parents who will cry about their babies 50 years later. If you've listened to my podcast, you know the first support group I ever went to, the lovely lady who was leading it, she was about 30, 40 years out from her loss and still upset about it. Still crying. That's not what duration like that, that's not what we're talking about. and it's not pathology, that's grief.

We're looking at duration together with function and intensity, culture and the broader picture, okay? Escalation is something becoming substantially worse? Is their exan anxiety expanding into more areas of their life? You know, are they just not able to drive now? Are they not able to go in public? Is this person becoming increasingly unable to function? are they using substances? Is are the substances increasing? Is fear becoming more consuming? You know, fear of everyday life.

Bad things happening. Now I won't let my kids go to school. Are they becoming less able to s access support rather than more? Those changes matter. And again, these are noticing. Isolation. This isn't about introversion, intro being introverted. I really mean like disconnection. When somebody has no safe person.

Who knows what is happening. Social support is truly protective. Community support is protective. And grief has this really horrible way of revealing exactly which relationships can hold difficult things and which ones can't. We often see people disappear. or people stop checking in, or they try to change the subject. They don't want to talk about the baby, those types of things. But we're talking about social withdrawal, so you know.

We're us thinking as grievers, nobody can tolerate my grief. maybe substance use, we're not moralizing, we're not shaming, we're noticing coping, okay? If somebody increasingly needs a substance to sleep, to get through the day, to stop feeling or to function, that's a lot of information for us that can help. and may indicate another professional needs to become involved. So we're noticing, we're not diagnosing, we're connecting.

So there's two things that should increase our awareness and that's previous mental health history and previous trauma or previous pregnancy or infant loss, okay?

Risk and protective factors.

So some things we should know. Previous mental health history, previous trauma, previous pregnancy or infant loss, traumatic circumstances surrounding the birth or death, limited social support, difficult relationships, financial strain, discrimination, barriers to accessing health care, and none of these mean that somebody is directly gonna have a mental health disorder. These rick risk factors are not predictions.

But protective factors matter. Okay? So protective matters protective factors

mean being believed, being listened to, having consistent care, knowing who they can contact and knowing that there's somebody on their side. Access to competent mental health support. Having a community that doesn't rush the grief, like you like a church group or a a mom group, something like that. A provider who remembers what you went through. Somebody who uses the baby's name. Somebody who follows up when they said they would. Someone who doesn't disappear.

Those protective factors matter the most and that is where we see continuity of care, okay? Continuity of care is a huge protective factor. And sometimes one of the most protective experiences a brief parent can have is simply discovering that somebody meant what they said. I'll call you Thursday. Thursday comes and they get the fucking phone call and they can breathe.

So I wanna give you something that I might that I think is probably one of the most useful parts of today's episodes. How do you actually refer somebody without making them feel abandoned? Okay. Referrals can often feel

Awful. Okay. It can we can feel really we can feel guilt for referring somebody. So imagine you've trusted this doula or this nurse or this postpartum professional. I go through this all the time as a postpartum doula and it's like time to go. they know it's time to go, but we're one of their protective factors. So it it's very hard for us to leave and prepare to leave.

But pretend you have this professional, you've told them things you haven't told anybody else. They're one of the only people who can say your baby's name without getting weird. You know, they're probably the safest person you've had in your entire life. And then you finally tell them how difficult things really are. And they respond with, You should probably see a therapist. Think about that for a minute. How do you hear how that can land?

They don't hear the I want more care for you. I I I'm worried about you. They th they hear that this is too much. That they are too much for you. And so there are definite moments where boundaries have to be clear. there are moments when somebody needs a level of care outside your scope. You're not supposed to become their therapist. You're not supposed to be available twenty four hours a day, you're not supposed to rescue them. but

A referral doesn't have to feel or sound like an exit plan, okay? So practice the sentence. I'm going to keep supporting you, and I also want you to have someone whose whole job is this. Can I give you a name for a local therapist who does this specifically? Again, I'm gonna keep supporting you. And I also want you to have someone whose whole job is this. Can I give you a name?

I have a great local therapist who deals with this grief. I can't diagnose you. I can't give you some of the things that it seems that you may need. So I'll still be here with you. I'll still be by your side. But I would love to give you this information, this contact information. So there's three things happening in the sentence. I'm gonna keep supporting you. Okay, keep supporting you. You're not leaving. the relationship isn't disappearing just because they need more help.

Now you only say that within the reality of your scope and your relationship, okay? If your professional relationship is ending, don't promise ongoing care that you can't provide, so you could modify it. I'm still here through the mi remainder of our postpartum work, or I'm gonna help you make this connection. or we're gonna figure out who belongs on your care team next, since our time is coming to an end. the point is not to make the referral feel like a j rejection, okay?

Someone whose whole job is this? The phrase moves the reason from the referral away from you're you're too broken, this is too much for me.

Towards you definitely deserve somebody with a specialized skill set, a specialized capacity. You know, it's it's like thinking, like, if I break my arm and send someone sends me to orthopedics. Wow, apparently I failed at having an arm. No. Specialists exist because something different because different problems require different training. Mental health should not be framed as some moral failure. That means your regular support person couldn't handle you anymore. Can I give you a name? This is consent.

You're asking for consent. Okay? Not here's a twelve page resource list. Good luck. You know, not Google therapists who take your insurance or have you tried psychology today? Giving them a name. A a real human, you know, a next step and if possible, whenever possible, a warm handoff. And what does a warm handoff actually look like?

A warm handoff means I've done some work before giving the resource to the family. I know the provider exists. I know that they're currently practicing and they're open to, you know, new patients. I know the population that they serve and the skill set that they have. I know that they understand pregnancy and infant loss. I know that they take your insurance.

So again, instead of here's a list of twenty therapists, you can say, I know a therapist named Sarah who specializes in perinatal mental health and pregnancy loss. I verify that she's currently taking referrals. Would you like her number? That's a much different, much different experience. And then you follow up.

couple of days later, hey, I was thinking about you. Were you able to connect with Sarah? And if they say no, we don't shame them. You know, executive functioning after trauma and grief is shit. I mean, my my executive functioning seven years after grief is shit. making a phone call can really feel like climbing Mount Everest and that's not that's not being dramatic.

So the next layer of support maybe, hey, maybe if I sat with you, do you want to call them together? Depending on your scope and role. As a do as a postpartum doula, I would totally do this. Yes, I can call a provider with them and make an appointment and that type of thing. Or would it help if I emailed the office and asked them to contact you? That could be a warmer handoff.

So here is your grief informed takeaway this week. Build your refer for a list before you need it. This week, not eventually, not after your next client scares the hell out of you. Open your phone, create a note.

And I want you to put three resources in there, okay? The first one, make it a PMHC therapist or a similar clinician with demonstrated perinatal mental health expertise. PMHC is a perinatal mental health certific certification through PSI. Number two, a therapist or counselor who is genuinely competent in pregnancy and infant loss, okay? Not someone whose website like has those words buried under a million different specialties, but a vetted person, okay?

and then a local crisis pathway plus nine eighty eight, okay, so four. So what's a non-emergent phone number for your county? What is the emergent phone number for your county? where is maybe an inpatient or outpatient mental health facility near you, you know, with an emergent phone number.

We don't want to be r scrambling for referrals.

And honestly Scrambling for referral in the middle of a moment is how families fall through the cracks. And it's not because we didn't mean it's not because we intended to drop them. But I'll find somebody and get back to you.

The shift changes, the kids need dinner, somebody else goes into labor, my inbox, you know, fills up and their email gets thrown all the way to the bottom. Like life happens, so we need to build it when it when before we need it and in our phone, where we can find it. And then every few months, check it. Make sure they're still practicing. Make sure the phone number didn't change. all those types of things. So remember, not every grieving parent needs therapy.

But every grieving parent deserves support. And some grieving parents need more support than we can provide alone.

So recognizing that isn't failing them, referring them isn't abandoning them. Sometimes the most grief-informed thing you can do is look at someone and say, I am staying with you and I want more care around you than I can give by myself. That's community care, that's continuity of care, and that's how people stop falling through the cracks, and that is the work.

Thank you so much for being here. Thank you for be willing to having a conversation that really isn't particularly comfortable. the goal isn't to make us afraid of grief. It's to make us less afraid of noticing when grief and something else may be happening at the same time. if you need help creating a resource list, head to the website under the professionals shop. There is a template.

For I think less than $6. And it'll walk you through the tons of different types of resources that you should have on your referral list and how to search for them in your community. Until then, notice the gap, build the bridge, and make sure to take care of yourself too. I'll see you next week.