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Miscarriage and Pregnancy After Loss with Grace Miano

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Miscarriage and Pregnancy After Loss with Grace Miano

Approximately one in five women will experience a miscarriage in their lives, but it’s a topic that is rarely openly discussed.

Today we are joined by nutritionist and fertility specialist Grace Miano to dive into this tender subject, as she shares how her personal journey with fertility opened her eyes to the need for supportive resources to help women and families through their loss following miscarriage. Grace shares some deep insights that she has learned both from her personal and clinical experience when it comes to navigating the muddy waters of pregnancy loss and the anxiety women can carry with them in future pregnancies. In addition, Grace's advice can help practitioners take a step back and think about how to best approach, communicate and move forward with these patients in a caring and considered manner. Covered in this episode

[00:51] Welcoming Grace Miano
[02:02] Grace shares her story
[13:15] Discussing D&C’s after miscarriage
[17:03] Grace’s third miscarriage
[19:16] Supporting the emotional aspects of miscarriage
[26:45] Supporting clients clinically
[34:40] Broaching the subject of grief
[39:10] Supporting through trying to conceive again
[47:23] Grace’s course: Pregnancy After Loss
[52:45] Additional resources

   


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Grace Miano. She's a nutritionist, womb and fertility massage therapist, certified infant massage instructor and trained doula. Having experienced fertility issues and three miscarriages herself, she now works with women who wish to heal after miscarriage to become and stay pregnant, and prepare for birth and new mother and babyhood.

When she couldn't find it for herself, and going through her own miscarriage and pregnancy journey, Grace created a professional album of guided meditations for miscarriage, trying to conceive and pregnancy after loss, which has provided support to women around the world. Grace has developed an online support program, Healing with Grace, Pregnancy after Loss, and through her speaking engagements speaks openly in an effort to smash the taboo and isolation of pregnancy and baby loss. You can find out more about Grace at goodnessgracioushealth.com. Welcome to FX Medicine, Grace. How are you going?

Grace: Hi, Andrew. Thank you. I'm good. Thanks.

Andrew: Now, Grace, I read out a little bit about your story, but can you take us through a little bit more about your story and how you got into this work?

Grace: Yeah, sure. It was never my intention, I think, as I've discussed with you back at NatEx. When I graduated as a nutritionist, I had an interest in pregnancy and fertility, a little bit. Because around that time my partner and I were thinking of starting our own family. But it wasn't until we started to really experience our own difficulties through that journey that I found where I really needed to hone in on. And the reason for that was because, one, we hit a few stumbling blocks being easily pregnant. And then secondly, when we did achieve pregnancy, several times, we miscarried. So that opened up a little bit of a world for me that I hadn't anticipated. And obviously, when you have your own personal experiences, you become interested in those and being a practitioner myself. You know, researching, you know, what would be appropriate for me to do around all of that, where to seek support…


READ ARTICLE - Autoimmunity can underlie recurrent miscarriage by Stacey Roberts


So there were a few things. One, we hit on the fertility issue around not achieving pregnancy as quickly as some other people appeared to. You know those stories you hear about, "Oh, well, we thought it would take a year or two. And then on the first try." So that wasn't us. After about 12 months of trying to achieve a pregnancy, I went and had some surgery, I had a laparoscopy. And we found out our first piece of information that I had endometriosis. So that's another little factor in all of this as well. And so, once we had that laparoscopic surgery and you know, that clears out a bit of inflammation and clears tubes out and things like that. Nothing else was an issue. We achieved a pregnancy immediately, which we thought might be the case. And so of course, that's really exciting. And about eight weeks into that is when, unfortunately, we lost that pregnancy. And I hadn't had any scares or anything yet, up until that point we were just sort of coasting along. So we don't know actually, what the issue was or what went wrong at that point. And that, I see it as a fortunate thing that, you know, luckily, I was able to miscarry that one, naturally at home without any intervention.

I didn't require a D&C at that time. I didn't require medications or other monitoring. Everything was fine. I had a bit of a interesting experience dealing with the medical system with that one because I didn't know any better and I hadn't experienced anything like this before. When I…my first clue that something might be going wrong was a bit of bleeding. So I went to a GP and he sent me to the emergency department of the hospital. And there I encountered some interesting reactions from medical staff and from, you know, nurses checking me and that sort of thing. And that was my first experience of how uncomfortable people can be even those in the medical system with the idea of baby loss. Yeah, I encountered a bit of not so compassionate response from some. And I kind of think that was because at that time because I didn't know exactly yet that this was a miscarriage. We were just sort of checking things out. I wasn't visibly, hugely emotional. So perhaps they thought I was fine. I wonder, I often wonder if I was in tears or visibly extremely upset at that moment if they would have been a bit more compassionate.

Andrew: Yeah.

Grace: But who's to know? 

Andrew: Yeah.

Grace: So you know, and plus I've heard many, many other people's stories where they don't get that compassion. But having said that conversely there are people out there who are, you know, understanding and compassionate and I have had other experiences since with with medical doctors and others who were wonderful.

Andrew: Yeah.

Grace: But yeah, so that was that one. And then lo and behold, we got pregnant again quite quickly, probably the next month or two. And at eight weeks again, we lost that one as well. And I just I couldn't believe it. I ,you know, I just thought, "No way, not again," and at the exact same moment.

Andrew: Right.

Grace: At the same stage. And that one was a bit of a blur I because it happened so quickly after the first one. And I hadn't actually written about it. I wrote, for my own people, I wrote a blog post about the first one so that sort of was in my mind a bit more. The second one coming so soon and being, yeah, a bit of a blur there. But again, you know, we had a natural and complete miscarriage at home. Again, it was just... You know, when you have a miscarriage around that eight weeks mark, and not knowing when the baby passed, it may have been weeks earlier, don't know. Miscarriage at that time can be similar to just a very heavy bleed. It's not... I'll tell you a little bit more about my third miscarriage, that was it. But you know, at that stage just for people's information, it can feel just like a heavy period, basically. So, with that one, I didn't bother going to the doctor or the hospital. I thought unless something goes wrong or I feel unwell, I think I can take care of this myself and just let the process happen naturally. 

I did seek my Chinese medicine practitioner that I was seeing for a bit of acupuncture support for bleeding, but other than that, everything sort of just progressed naturally. And, you know, I see that as a good thing. You know, one of the things that women say to me when they're, you know, having miscarriages and losses like this, is that they feel that their body failed them or that they're broken. And my view is that if you are miscarrying there's a reason for it. And your body is intelligent, and it's doing what it needs to do. And then if you're in the fortunate situation where your body can then cause the whole process to happen without intervention, then that's another fortunate thing. And your body's doing what it needs to do. And that's the body being effective. I really see it that way.

So I was, I mean, I wasn't happy. But I was glad at the time that those things could happen for me. So that was two in a row, quite early miscarriages at eight weeks. A bit discouraging. And the thing is that once you become pregnant again after a loss, as I often mentioned, is that there's that extra level of concern now because you know what can happen and that's it's happened to you already.

Andrew: Yeah. So you've already got that underlying anxiety.

Grace: Yeah. And you start to... And especially when it happens more than once. You start to think, "Well, is this just always going to be the case for us?"

Andrew: Right, yeah.

Grace: You know, and I have met women who have had many, many, many miscarriages. So you can just imagine after three, five 10, 20 plus what kind of courage you have to have and belief to keep trying and hope that that's going to happen for you, that next time this will be it. Yes, just got to be persistent.

Andrew: Yeah, you know, one thing that really, I admire about you is that all through this you're using we, we and us, not I or me. 

Grace: Oh.

 

 

Andrew: So there's this, too often women blame themselves for what's happening, rather than I it just being a process indeed, sometimes it can actually be a much needed process for a foetus that's gone wrong. A genome that's gone wrong, if you like, kalter anesthesia, and sometimes it can be an issue with the sperm. 

Grace: Yep.

Andrew: So we have this assumption that because it's happening in the woman's body, that it is only due to the woman. It's not. And women need to stop blaming themselves when it's a process. And I'm so glad that you take that stance. So did you always have that stance or did you change your vernacular once you basically recovered?

Grace: That's an interesting question. I wonder where, I'm not sure where along the line I started saying we or if I was a “we” person right from the beginning. I think maybe, I think I always had that view. And perhaps that's because back in the, you know, trying to conceive getting support with fertility stage, I was seeking support from other practitioners. 

Andrew: Right.

Grace: And so I had advanced my knowledge to a point where I understood that it's not just the woman.

Andrew: Yeah.

Grace: You know, and the male if it's a male partner that you're with, that you're doing this with, contributes 50% of the DNA. So miscarriage, you know, half the time can be the reason... that's the reason for it, is through the sperm.

Andrew: Yes, that's right.

Grace: Yeah. So yes, and I really do try and push that with other people because women do blame themselves so terribly. And it's not all just about the woman.

Andrew: Let's talk a little bit about the D&C, like dilatation and curettage. So normally, it's like I... Forgive me. I don't know if it is standard for every miscarriage or if it's only standard after a certain time of carriage.

Grace: My experience is... Well I haven't had one. But my experience of many others is that it's usually done and if it's what they call a missed miscarriage, which I really don't like this term, but if they find that they've had perhaps an ultrasound and they find that the baby is measuring much smaller than whatever weeks gestation they're meant to be up to, that it's been "missed." And so that they've got this, you know, dead foetus inside of them for how many weeks…

Andrew: Oh.

Grace: …that they then tend to say, "Well you know, it's been however long we need to remove this now."

Andrew: Right.

Grace: But yeah, so my experience is that's that's often when they suggest it more consistently. And it seems to be actually most people, most women I know of has a D&C for this.

Andrew: Yeah.

Grace: And again, it's better choice as well. I mean, some women or some couples, I should say, are given choices where they can have the D&C, they can take medication or they can go home and see if things progress naturally. And for some people, they choose to have the D&C so they feel that they want to move this process along, so that they can start to move forward. It's an emotional, you know, it's emotionally what they want to do. So there's different reasons for it, but I do find that it seems to happen rather often.

Andrew: Yeah, rather often. My wife when she went through our miscarriages... I'm going to change that vernacular from now on, thank you.

Grace: So good.

Andrew: She was never offered an option of not having a D&C dilatation and curettage. So admittedly, our pregnancies were further along, you know, between the eight and 12 weeks. It's really interesting one though, I was reading some stuff from the Royal Women's Hospital in Melbourne, and there, they offer the option of naturally passing the pregnancy tissue. And if signs arise maybe of infection, then they'll go in for a D&C. But it's an interesting thing that this is a natural process that happens very, very, very commonly. And yet, it's very medicalised, i.e. not offered an option. I think that's an interesting thing.

Grace: Yeah, I agree with you. Well...

Andrew: And forgive me, sorry. And even the process of having a D&C for the woman is traumatic in itself.

Grace: Oh, definitely. You're going in for this medical surgery, you're put under, and often the outcome of that is that you don't see the foetus.

Andrew: Yeah.

Grace: And so there's also that, you know... And sometimes it's totally necessary, like what you were mentioning is there starts to become signs of infection and it needs to be removed. But not laying eyes on that little foetus can be another component that adds a little bit of trauma or grief to the whole situation.

Andrew: Without closure.

Grace: Yes, yeah.

Andrew: How interesting. I've never thought about that before.

Grace: Mm-hmm.

Andrew: Wow.

Grace: Yeah, well, I had a third miscarriage that was further along. And about a year after those first two, and I could have again, for a third time gone and chosen to do a D&C but having experienced two naturally occurring miscarriages myself, I decided that we would see how we went with that. And I…this is really interesting as you know, that may be something that people may not have ever thought of. And so we were 12 weeks. But I did go in for an ultrasound to check things out because there was a bit of bleeding and we found out that the baby had passed at around nine-ish weeks.

Andrew: Right.

Grace: But at that time, it was still far enough along to the point where I experienced what I call a little mini-labour and birth.

Andrew: Ah, okay.

Grace: Even at that stage.

Andrew: Right.

Grace: Yeah, yes. So...

Andrew: Because I know you can have cramping and things like that…

Grace: Yeah.

Andrew: …but you're talking about a labour rather than just an expulsion.

Grace: Well, I call it that because yes, it was cramping. But it didn't occur to me... Like, I was having these sort of regular cramps. And then I realised, "These are contractions." Now, obviously, not to the scale that it would be required for a full-term baby.

Andrew: No, no.

Grace: Because this was just a little fetus, but...

Andrew: But they were rhythmical. They were you know, ascending and descending sort of thing.

Grace: Yes.

Andrew: Rather than just like a cramp.

Grace: Yes, I think it was a little more than that.

Andrew: Right.

Grace: A little bit more than just like a little bit of period pain. And you know I even went, without going into the whole story, but we even had a breaking of the waters that happens spontaneously, a pop and a gush of water.

Andrew: Yeah.

Grace: Like, these are just things you wouldn't think of, at that early stage. And then, you know, a little baby and placenta at home.

Andrew: Yeah.

Grace: You know, as a practitioner, the practitioner side of my brain found this absolutely fascinating. And although, you know, the person side of me was going through a grief process. But that is something to bear in mind also, that even at an early stage like that, and I don't know, you know, it'll be different for everyone, and especially if you have to go in and have a procedure in the hospital, you know, the D&C and that sort of thing. It'll be different. But that occurred for us. And that was just a little bit further along. 

Andrew: Yeah.

Grace: So really, really interesting. And at that time, we were able to lay eyes on... And I don't know if this is too much information Andrew, but I don't think so.

Andrew: Well, I will…we experienced the same thing, Grace.

Grace: Yes?

Andrew: Yeah, we experienced the... Lee passed the whole foetus early that it was. So and I've got to say like I had a different feeling from Lee. I actually thought. "Phew, Lee's body has passed something that just wasn't right. It wasn't ready, it wasn't complete, something was wrong." And indeed it was tested and something was wrong. 

Grace: Yeah.

Andrew: So, for me, I had an acceptance that nature did its job successfully. Lee obviously carrying that baby, carrying that foetus, obviously had a much closer relationship with it. And so Lee obviously, went through the grieving process. Lee was devastated. So for me, it was very interesting this...it wasn't a dichotomy, it was so close and together about it, but just the difference in feelings.

Grace: Yes. And I think that's an interesting point of view and a good one to have if you can get there. And the other thing is to perhaps, I don't know, did Lee come to that conclusion herself at some point later on? It's the different stages that the two, the two in the couple, go through at different times that don't often match up.

Andrew: What I'd like to know, though is, what can we do? What do you teach people about how to support a client going through this experience? How do you get on their level when, for the most part, the practitioner is not going to be pregnant? And certainly there are going to be those males out there that are dealing with a female client. How do we be compassionate and empathetic and really get on their level about what's going on with them?

Grace: Well, I feel like I say this a lot all the time, but it's important to continue to say, and I think it's actually really simple. You know, we encounter people who have experienced a loss like this or other kinds of losses. And it can create a bit of discomfort in us, especially if we haven't had that experience ourselves. 

Andrew: Yeah.

Grace: And so we you know, it's our human nature to try and help and fix and cheer up. And the one thing that I, you know, I just always advise is to keep it really simple and you don't need to do those things. And in fact, by doing those things you are dismissing their pain.

Andrew: Yeah.

Grace: So what can you do? Tell them your story, just allow them to talk about it. Just hold space for them and be in their presence. If you have a client sitting there crying in the chair opposite you, let them. You know, my term that I use is don't try to silver lining it for them. And this is all very well intentions, but I could tell you, Andrew, some of the comments that were sent to me, of beautiful friends and people who had, as I said, good intentions, but things like, "Well, at least you know, you can get pregnant. You can try again." You know those sorts of things or for other people they've been told, "Well, you already have a beautiful daughter, so don't worry." And...

Andrew: So don't worry. I love that.

Grace: I know, or you know or...

Andrew: Or the cracker, "I know how you're feeling."

Grace: Yeah. I've even heard of people comparing it to, you know, "Well, my pet died. So I understand how you feel."

Andrew: Yeah.

Grace: And it's just everywhere. It's just us, you know, being humans trying to relate. And I understand that, but if you once you know, the more you know, the better you know, the less you can, you know, do those sorts of things and say those sorts of things that just are not helpful. So not trying to silver lining it or give them solutions or "Next time do this," is a good place to start."And just holding in that space and if they want to talk, let them talk. And but it's really just about listening and allowing them.

You know, I had a nice experience where I went into an acupuncture session, and, you know, she just let me be and then just allowed, you know, tears or whatever needed to happen and she didn't really say much of anything. And that's a good...that's a positive experience. Obviously I remember that as a positive experience for me with I then can compare that to perhaps dealing with someone else who just tried to, you know, cheer me up with a comment that they thought might be helpful, which was not helpful. Because the one that is often said is, "At least you know, you can get pregnant." My brain immediately goes to... and I know this is the same for other people as well, is "Yeah, I can get pregnant, but can I stay pregnant?"

Andrew: Yeah.

Grace: So real helpful.

Andrew: No, that's right. I think it also has a lot to do with how comfortable we each are with death, whether it be our own mortality, which eventually we're going to be faced with, or indeed the process and the experience and the exposure that we might have had to the death of others, of significant others. I really think we need to check ourselves as part of this, to be able to help others.

Grace: Yeah, I agree with you.

Andrew: You know, I think it's really interesting what other cultures do and how they accept death as part of, you know, the process of life at the end of process of life. And, you know, what we don't do. We like to get a, you know, take it away. Whereas other cultures really quite embrace that. Indeed, some look after their, you know, ancestors and they sort of tend them, if you like.

Grace: Yes. And yes, our experience and knowledge and feeling towards death is one of great discomfort, isn't it?

Andrew: Yeah.

Grace: And especially if you apply that to baby death, however far along the pregnancy that is, that's another level.

Andrew: That's another level. Yeah. So okay, so jumping from the emotional to the clinical. What sort of clinical advice for healing after pregnancy loss can you give us?

Grace: Well, I think the main thing is to treat it, like the way I treat it, and I think my advice to others would be is going through the loss of the baby is…at whatever stage of the pregnancy that occurred, you have somehow in some cases literally birthed a baby or in others had that removed or pass through you somehow. And so this period immediately afterwards, my suggestion is to treat that like postpartum, like you would with a new postpartum mother. Now, obviously this mother does not have their baby with them anymore. But their body has still been through something.

Andrew: Yeah.

Grace: It's been through pregnancy, whether it was just for, you know, a couple of months or a lot longer. Their body needs to heal and recover, not to mention equally, if not more so, the emotional-mental side of things. And so thinking about it, like a postpartum period, I think helps a lot of people to sort of look at it from a different point of view. So what would you do for a client who is newly postpartum if you happen to see one that came in quite soon after birth? You would be providing them with nourishing, warming, easily digestible meal suggestions. And, you know, offering whatever lifestyle suggestions that would be supportive for them. I think at this stage, if they are able to, I mean, everyone's different, but if they are able to put into place, things that are going to be supportive at this time that remove stress and burden from them. So things like meal delivery, if they're fortunate enough to have friends who will drop off, you know, meals to them, come by and maybe do a little bit of help in the house, those practical things.

Andrew: Yeah.

Grace: Those will be really helpful because they are healing in so many different ways. And...

Andrew: In so many different ways.

Grace: ...at the same time now... In so many different ways, you know that physically, emotionally, mentally, spiritually...

Andrew: And connection with friends, you know, true connection when they help…

Grace: Oh, yes.

Andrew: …the act of physically helping you to do a chore. You know, while you're resting that sort of thing, it's actually you know, love. It's great.

Grace: Yeah, it's amazing. I mean, I remember a friend of mine who happens to also be a practitioner just sent me a message and offered to bring me a smoothie. Like those are...and obviously, that's stuck in my mind, because that is,  those are the things that are really helpful at this time. And the other thing too, is to suggest to your client, that if people want to help you, let them. I can't tell you how many times I've heard people say, "Oh, you know, this person, this friend offered to come and do a load of laundry or this person offered to come and unpack my dishwasher and I said, no, it's okay. Don't bother." And...

Andrew: You've just refused them. Yeah.

Grace: ...say yes, because well, that comes back to also our feeling of we don't want to bother other people…

Andrew: Yeah.

Grace: …or inconvenience people. But if people want to help, and they're offering this to you then say yes.

Andrew: They're offering their connection to you. Maybe also the strength of the person offering their help has something to do with it as well. You know, if they know what you're going through, know that you're feeling less of less worth, because you might be grieving at that point. And just to push the point to say, "No, no, I'm coming over." That sort of, "Look, I'm coming over. If you really don't want me there, say so. But other than that, I'm coming over. Now.” There's a fine line as well.

Grace: Yeah, because you might not want....

Andrew: To tangled web we...

Grace: ...see people. Yes, you know, and there will be times of course, where you're just not in a state where you want to have people coming over. 

Andrew: Yeah.

Grace: But in general, learning to say yes to offers of support, and then conversely learning to say no. You know, some people don't give themselves any grieving time and or, you know, or time off or... You know, I've had people say to me, "Oh, well, I just need to keep my mind occupied. I don't want to think about it." But my view on that is I mean, of course, you know, we do what we think we need to do to cope. But if you shove down the emotions and the grief that can come up with this, my experience with others is that it's going to come out somehow. And I'll give an example. One of my recent clients who is happily pregnant with twins now, you know, experienced a miscarriage and she just filled up every moment of her time, which you can understand, with work and doing other things. And so she didn't give herself, and that was immediate, she didn't give herself any grieving time or time to feel anything about it. And so what happens when she went to bed at night, her body would wake her up at consistently at 3 am every night, where she would be in an extreme state of anxiety and not able to sleep again.

Andrew: See, I would say that that actually is grieving. It's just stuck in one of them, one of the five processes, the denial.

Grace: Yep. So it's going to come out anyway. So allow yourself, you know... I mean, it's hard. You don't want to you know... It's difficult to deal with pain. So if there are things we think we can do to avoid it, then we might want to do that. You know, I've noticed people who only take a day or two off work, and then get right back into it.

Andrew: Yeah.

Grace: But I…yeah. But it’s going to pop up anyway, just like that example. And so my advice to my clients is let yourself have as much time as you need, cancel everything, take off however much time you need. If it means that you need to lie on the couch and cry for a week, or more, then let it happen. If you need to take a one hour bath every day, then do it. And so learning to say no. That's where I was going with that, the opposite of the yes to support, is learning to say no. You know, if you're being asked to do things that you just don't feel you are able to take on during this grieving time then you say no. I mean women feel like they... This is notorious with women, where women are praised for putting others ahead of themselves…

Andrew: Yeah.

Grace: …and putting themselves last on the list of priority. And so feeling like you need to continue to do everything for everyone else or if you're being asked to take on extra things at work or something like that, say no. I think it's really important.

Andrew: Yeah. How do you broach the topic of the stages of grieving and as you say, when to say yes, When to say no? For some people that may be stuck, they're in grief, they don't want to be told that there's a silver lining right now. They want to just be, as you say. They just want to just be right now. And yet, there's a thing to say, "Look, this is a normal part of grieving." And a lot of patients won't know that there are stages that we may go through. We don't all go through all of them. But it becomes destructive or disintegrative if somebody gets stuck in a phase. How do you broach that topic?

Grace: I directly do go into that with each client. And I will ask them questions like how much time off work they've had? How are they feeling? How are they managing how they're feeling? And I think the important point to bring with that is that I do assure them that it is, however they are feeling whether it's just numbness, whether it's sadness, whether they're angry, you know, or disappointed or full on grief, whatever they are feeling is right. And there's no wrong way to be or to feel at this time. And then we just go through a bit of conversation around what's happening there. And when I, you know, come across those who say, "Oh, you know, it's fine. I'm just keeping myself busy. I don't want to think about it. I can't think about it." You know, we'll gently discuss how it's important to allow yourself to feel and let those emotions happen and letting others support you, whether that's friends and family, it’s practical things or seeing your practitioners who can take care of you, whatever types of modalities, those are, whether that's coming to see me someone like a nutritionist or having a, you know, a massage …

Andrew: Yeah.

Grace: …or a counsellor, whatever.

Andrew: What about including the significant other, the couple, the male, the female, whatever, you know, the partner?

Grace: Yes, we have a little bit of discussion too around how there can often be that mismatch because this can be a time where one of you is feeling strong when the other is feeling not so strong.

Andrew: Yeah.

Grace: And then vice versa, you'll go through different periods. And understanding that that will happen, I think is a good place to begin just right from the start, because I know that there... You know, I've had people tell me, you know, "I was really upset and my partner didn't seem to care. He seemed fine." When that's not necessarily the case, because they are perhaps being stoic or feeling that they need to be strong for her.

Andrew: Yeah.

Grace: Which is often the case. And, or even me with my personal experiences. There was at one point, I do remember that I was very upset. And my partner appeared to not be upset, and I got really angry with him. We had a little bit of a blow over that. And then I realised when he broke down, that he was just trying to be strong.

Andrew: Right.

Grace: You know? And that's the burden placed on a male as well, isn't it? Where, you know, men don't cry and men have to be strong and "you have to be strong for her." And I know that a lot of the males in these couples even will have comments from friends and family and practitioners where they will say things to them like "Okay, well, you know, take care of her, be strong for her."

Andrew: Yeah.

Grace: And meanwhile he's going through the same thing, Now it might be at different times, and it might be at a different level. But...

Andrew: Males grieve too.

Grace: Exactly, yeah, men grieve too.

Andrew: What about you've been through the grieving process. You've said goodbye to that foetus, that baby, whatever term you attached to that. How then do you bravely approach trying to conceive again and indeed once you are pregnant again, the anxieties of the previous pregnancy or pregnancies rear their head again?

Grace: Yeah. That’s really, that's a big one. And a lot of people go through really horrific anxiety and feelings of, I go so far as to say terror, at the prospect of either becoming pregnant again, or being pregnant again. And, but I do think there's a lot that can be done to help with that. I mean, you won't be able to alleviate that 100% necessarily. But things like implementing anything at all that is going to provide you with some sort of calming to the mind, things like listening to meditations. I mean, we know how effective you know, meditation and mindfulness and those sorts of things can be and, but what with my own clients, and with myself, I recommend meditation highly, or visualisation. 

Visualisation is actually a really great one. It's you know, being able to allow yourself...Because that's the other side of it too. You don't want to think too far ahead, just in case that doesn't happen, you know, or we experienced more let downs. But to allow yourself to relax and visualise, depending on what stage you're at, you know, becoming pregnant again. This baby growing and thriving, you becoming pregnant and larger, you know, all the way through to, you know, the birth and holding this baby in your arms. I personally think that can be really effective. And I have had feedback that those sorts of things have been very helpful for people. And my suggestion is if you have to sit down and stop what you're doing, and listen to a meditation several times in a day, if you're in a position to do that, then... you know, in a place that you can do that, then do it. Because that will interrupt that spiralling thought pattern that you're getting into, and sort of help reset, even if it's only for a few short moments, the thinking.

Andrew: You know, I was thinking just before about, you know, what if that of that subsequent pregnancy fails, and you're back at square one? But now I realise what you're saying is well, you're already there, so you're already suffering anxiety. So even if you took away those stress impulses, those stress hormones flooding your body, even if you reduce those, and it ends up, you know that you have another miscarriage, then big deal, you’ve at least taken the stress hormones away from it for a period of time. So I take that point and even if it is... I guess part of it would be though, do you teach your patients that things can fail again in the future, and that's okay?

Grace: That's a really good point, actually. I guess when we go into it, our current our language is language that doesn't ever guarantee. It's about providing hope. But of course, we can never know what's going to happen. So, from my point of view, the way I work with it, is allow yourself to hope. Allow yourself to feel joy like what you were bringing up there. You know, we hold ourselves back because of just-in-case scenarios. But the thing is, you're going to feel grief or disappointment or sadness anyway, you may as well allow yourself to have some level of joy…

Andrew: Yeah.

Grace: …when it can come in. So, you know, let it happen, don't hold back. So yes, but you know, I don't think the point actually needs to be stressed because these clients already know that they may miscarry again.

Andrew: Right.

Grace: And that's their fear.

Andrew: Yep.

Grace: So I don't specifically go into that with them, saying, "You know, this may happen again." I don't specifically do that. We just focus on what can we do to help this, knowing that sometimes there's nothing we can do. You know, if it's a chromosomal issue, there's absolutely nothing that we can do…

Andrew: Yeah. Change, yeah.

Grace: …to change that. But it's about hope. It's allowing joy. It's while you are in that trying to conceive stage and/or already pregnant, to do whatever you can to, you know, like you said, reduce stress hormones, to provide appropriate nourishment for yourself and the baby or the baby to come. You know, if we get into the clinical side taking supplements that may be helpful, that sort of thing. But yeah, that's the point that I take.

Andrew: Like I guess it also gives you, at the end of this process, it gives you an opportunity to then talk to the couple and prepare for the next pregnancy in a more informed way. So that you can say "Look, you know, there are these sort of issues," you know, you work in a smelter, there may be sort of this sort of opportunity to then do testing on the male, or you know, if the female maybe as a pilot, then you know, there may be risks associated with ultraviolet radiation, which we know, affects females particularly. So, you know, you can then have this informed program moving forward about "Well look, this happened before. This is possibly what added to it. Now, we can intervene in some way at least try and protect you during the next pregnancy." Do you find that is helpful for them?

Grace: Yes. And at this stage, once they've experienced a loss, they want this. They absolutely want this, especially if it's been more than one loss. So, there's a whole load of testing that can be done. And, you know, I may be referring them back to their GP who then refers them to a fertility specialist and go through all the miscarriage screening stuff. You know, we'll be doing our own testing with the male and female, both of them. And they are open to all of this at this time because they've already experienced that loss and they don't want to experience that again. And my experience is that people are so open and wanting and seeking whatever it is that they can do to either test to see what may have gone wrong or what could go wrong. And what is it that I can do now to prevent this happening again? 

Andrew: Yeah.

Grace: And that's all that stuff. It will be, you know, it'll be the diet and the lifestyle and the supplementation and all the emotional stuff. But yes, they're absolutely, absolutely wanting it.

Andrew: Now, tell us a little bit also about the course. What sort of processes does it involve, and is it mainly directed to practitioners, or to the grieving parents?

Grace: My pregnancy after loss?

Andrew: Yeah.

Grace: Online course? That one is for women specifically…

Andrew: Right.

Grace: …women who are pregnant themselves following a loss. So this one's aimed at clients. And we go through a four week process where we look at... We start off with honouring the babies that have been lost, because sometimes they haven't had a chance to do that. You know, as you mentioned back earlier on in our conversation, Andrew, especially if you've had, you know, a medical procedure where the foetus was removed, and you didn't see it. And that loss of perhaps, you know, if you like to call it closure or connection, or whatever you would like to call it. So being able to honour and remember your baby or babies, if there were more than one. And we do that through discussing, you know, "Was there a ceremony that you did?" I mean, some people have funerals if it's been much further along. 

Andrew: Right.

Grace: Others, you know, may perhaps have a little burial or others might just have a symbol that they keep in their home. You know, for me, I had a few little symbols, objects and trinkets and things that were my connection to my three babies that are not with me. And that can allow... Not only do I find that important to honour those babies, but also it allows these women to then…it frees them up to feel like they can connect with their current pregnancy.

Andrew: Yeah.

Grace: Which can be very, very difficult. You know, I know of people who are nearly to the end of their pregnancy and they're still not happy about it because they are thinking about the baby that's gone.

Andrew: Yeah.

Grace: And it's just too sad for them. And they're still worried. 

Andrew: Oh, for sure.

Grace: And that's normal.

Andrew: Yeah, for sure.

Grace: So, yes, we do that. And so we're connecting to previous babies, connecting to the current baby. So there's a lot of that sort of emotional stuff that has nothing to do with nutrition or anything to start off with. And, you know, and I'm no psychologist or anything like that. But it's just through my own research and experience that I can bring this to other women who can find this helpful as well. You know, I created guided meditations because we needed something that was specific to the stages of loss that we were going through. And we use those as well, to sort of interrupt those spiralling thought patterns of anxiety. 

So, yes, we do that and then we go through, of course, all of the nutritional and supplement suggestions and, you know what's important to do there and what they might choose to do, or not do. All the lifestyle stuff. We go through what to do around moments of anxiety, you know, food for anxiety. You know, just everything around that. As part of this, I actually commissioned Amy at Naturopathic Yoga to create a specific pregnancy after loss of yoga series for us. So that's part of my program as well.

Andrew: Right.

Grace: And yes, which is fantastic. There's nothing like that around. So this is for us. It's not just prenatal yoga, but it's it's a yoga for women who have experienced loss. 

Andrew: Yeah.

Grace: So there's another element to it. So that's part of the program as well. And then we go through preparing as you head towards the end of the pregnancy, preparing for labour and birth, however that looks like for you. Because that can be another time of extreme anxiety as you think ahead to what might go wrong, especially if your experience of loss was around this time. You know, with stillbirth or, or neonatal loss soon after birth. And so we go through all of that, how to create a supportive team around you and all that. 

Andrew: Yeah.

Grace: So it's the whole gamut from beginning to end of how to feel safer and more confident in this pregnancy. And basically, well, mainly reducing stress and anxiety around it.

Andrew: Yeah.

Grace: Which could really escalate and get really extreme if you don't do something about it.

Andrew: That's right. So, there's Goodness Gracious Health. There's Amy, Megan at Naturopathic Yoga. What other resources can you give our listeners?

Grace: There is a great book out there by an American doctor named Laura Shahine. And it's called "Not Broken." And that one, it's a good read because it is... It's got all the clinical stuff in there with studies and things like that, but it's not a difficult read. So I think it's a good resource for practitioners and clients who are interested alike. And you know, she's on social media and all that sort of thing, so Dr Laura Shahine, her book, "Not Broken."

I'd like to say that my guided meditations would be a really appropriate resource. So these were created for... and it's broken right down into several tracks from finding out that your baby is gone through to going through the actual miscarriage, through to trying to conceive again, being pregnant again. I've got a track on there on if you're having a moment of extreme anxiety. And I felt that was important to do because, well, personally, I felt I needed something that would give me... that I could listen to that had the right words to help me through this moment, this horrible moment and was calming and relaxing, but specific. And I remember I was going through YouTube and everywhere that you can find meditations, I couldn't find anything. And so this was created. I do have one of them, the track on "Going through miscarriage," up on Insight timer. And so that's freely accessible to everyone.

Andrew: Insight timer.

Grace: Yes, Insight timer. That's the free meditation app. It's very popular worldwide. And I've got a track up there called "Saying goodbye. Going through miscarriage." And the responses I've received to that have been pretty unbelievable.

Andrew: I would assume that they'd be very powerful. You know what, like, I'm so glad that you have offered something for especially women going through moments of anxiety. Because we all talk about prevention. We all talk about long term treatment. But we don't talk about moments. And this is the thing. 

Grace: Yeah.

Andrew: It’s like how do you help somebody now? And this offers some succour to those people going through an extreme moment of anxiety and grief and hopefully give them some hope to carry on and move forward to experiencing a successful pregnancy in the future. I gotta thank you so much. I just want to ask you though, Insight timer?

Grace: Yeah.

Andrew: How do they then access your thing? Do they look you up in Insight timer in the app?

Grace: Yeah, they can look me up by my name or they can search by the name of the meditation, which is "Saying goodbye. Going through miscarriage." I think, the overall name of the whole thing is "Healing with Grace." 

Andrew: Gotcha.

Grace: That’s my overall tagline or whatever you want to call it. Yeah.

Andrew: Grace I can't thank you enough for taking us through this. This is really important stuff and you know, I've got to say from your pain and your grief, you've come out to be so much more powerful and giving and sharing for, you know, so many other people, so many other not just women, but couples, and I really thank you. You know, I really hope that others get on board and look you up on Goodness Gracious Health, and indeed in that app to you know, get some help in the moment, but also give them joy and hope to move on in future pregnancies.

Thanks so much for joining us on FX Medicine today.

Grace: Thank you, Andrew. It's been my pleasure.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.



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Grace Miano

Grace Miano, of www.goodnessgracioushealth.com is a Nutritionist, Womb & Fertility Massage Therapist, Certified Infant Massage Instructor and trained doula. Having experienced fertility issues and three miscarriages herself, she now works with women who wish to heal after miscarriage, become and stay pregnant, and prepare for birth and new mother- and babyhood.