Being With Loss and Uncertainty

A companion piece to our upcoming webinar on perinatal grief, led with Jen Moffitt, RN, CNM.

"This is the happiest story in the world with the saddest ending."

The writer Elizabeth McCracken said that about her own loss, and it names something some of us struggle to say plainly. A pregnancy is a story that begins in hope. When it ends in absence, the hope does not simply disappear. It has nowhere to go.

There is a way to think about this that we return to again and again. Grief, as Dr. Alan Wolfelt writes, is not an illness. It is the natural and necessary sequel to love. That single reframe sits at the center of how we hold loss in Mindful Birthing. We are not here to treat grief, fix it, or move anyone through it on a timeline. We are here to learn how to be with it, and to help others do the same.

A loss that is common, and often unseen

Perinatal loss is far more common than most people realize. Roughly 10 to 20 percent of known pregnancies end in miscarriage. About 1 in 160 end in stillbirth. Neonatal death affects around 4 of every 1,000 live births. Ectopic pregnancy accounts for 1 to 2 percent of pregnancies and can be dangerous.

The numbers are large, and yet so much of this grief happens out of sight. Early losses often occur before a pregnancy is ever shared. Even when people know, they rarely grasp how far the imagination had already traveled into the future. Parents are not only grieving a medical event. They are grieving a baby, a story, and a whole life that had already begun to unfold in their minds and hearts.

Why this grief is different

Perinatal loss is not only the loss of someone. It is the loss of a future.

Ask families what they are grieving, and the answer is rarely one thing. The baby they planned for. The change in the shape of the family. The chance to step into parenthood. A sense of who they thought they were. Their place among friends who have children. Their footing, their plans, their trust that life is something you can steer.

There is often shame woven through it, too, in a way that other kinds of grief do not always carry. Was it a "real" pregnancy? Did I do something wrong? Why couldn't my body protect my baby? And because the world so often fails to recognize the depth of the loss, this grief can become disenfranchised, meaning it is not fully seen or validated by the people around it. That makes it harder to ask for help, and harder to feel entitled to compassion at all.

The people who companion loss grieve too

If you are a birthworker, a midwife, a nurse, a doula, a chaplain, or a therapist, you already know that this grief does not stay on one side of the room. Clinicians grieve when a baby dies. The weight is real enough that as many as 1 in 10 obstetricians have considered leaving the field because of the emotional toll of caring for families through stillbirth.

This is part of why we teach what we teach. Holding space for someone else's loss while quietly carrying your own is not sustainable without practice. Compassion fatigue is not a character flaw. It is what happens when we are asked to be present to pain without any way of being present to ourselves.

What "being with" actually means

Here is the countercultural part, and the part we care about most. Mindfulness does not offer to take the grief away. It offers a different relationship to it.

Wolfelt describes companioning the bereaved as being present to another person's pain rather than trying to take the pain away. Bearing witness rather than judging. Walking alongside rather than leading. Honoring stillness rather than rushing toward forward motion. This is not a soft version of care. It is a demanding one, and it maps almost exactly onto what mindfulness asks of us.

One image from the tradition helps make this concrete: the two arrows. The first arrow is the raw pain itself, the wave of sadness, the ache in the chest, the longing. That arrow is not the problem. That arrow is love. The second arrow is everything we pile on top of it: this is unbearable, it will never end, this proves something is wrong with me. Mindfulness does not pull out the first arrow. It gently loosens the grip of the second.

We do not promise a healthy pregnancy, and we do not promise that grief will resolve on schedule. What the practice offers instead is the capacity to be present with whatever is actually here, whether that is fear, numbness, joy, or sorrow, and often several of them at once. As one of our graduates put it, the practice "expanded my capacity to be with what is."

The research is beginning to catch up to what practitioners have long observed. A recent review of seventeen studies found that mindfulness-based approaches, including the MBSR lineage our program grew from, are associated with reduced grief-related distress and rumination, less experiential avoidance, and more self-compassion. Self-compassion matters here in particular, because guilt and shame do so much of the damage in perinatal grief. When a grieving parent can move from I must be crazy to hurt this much to I hurt because I loved, the pain does not vanish, but it stops being evidence of something broken. It becomes what it always was: testimony to a bond.

Practices to carry

None of this erases grief. But small practices can become something to hold onto when the ground gives way. A few we teach and return to:

• The Three-Step Breathing Space, a brief pause to notice what is here, to gather attention on the breath, and to widen back out to the whole body. It takes a minute and can be done anywhere.

• AVP, a simple sequence popularized by Dr. Becky Kennedy: Acknowledge the feeling, Validate that it makes sense, and Permit yourself to feel it. Say hi to it. Let it be allowed.

• RAIN: Recognize what is arising, Allow it to be there, Investigate it with some gentleness, and Nurture yourself with compassion.

And one that is less a technique than an act of love: speak the baby's name. Make room for the anniversaries, the due dates, the small rituals. A later healthy pregnancy does not undo an earlier loss, and a person can carry joy and grief in the same body at the same time. Honoring that is not dwelling. It is telling the truth.

An invitation

If any of this resonates, whether you have lived it or you sit with families who have, we would love for you to join us.

Jen Moffitt, RN, CNM, will be leading a webinar on being with loss and uncertainty at 7 pm EST on Tuesday, July 28. We will explore how mindfulness prepares us to companion grief without fixing it, and share practices you can bring into your own life and your work. It is a space to learn, and also a space to be human together.

Register here: https://programs.mindfulbirthing.org/courses/mindful-birthing-s-webinar-series-2026--3950df2d-a4d5-40ba-82fa-632c84e340a0/salespage 

Grief is not an illness. It is love, still looking for somewhere to go. You do not have to be with it alone.

References and sources

• Elizabeth McCracken, An Exact Replica of a Figment of My Imagination (Little, Brown, 2008). Source of the opening line. (Marrelle, worth a quick confirm on your end since your notes just had "McCracken.")

• Alan D. Wolfelt, "Tenets of Companioning the Bereaved," Center for Loss & Life Transition. centerforloss.com

• D'Antoni, F., Mattiussi, F., & Crescentini, C. (2026). Mindfulness-Based Interventions for Bereavement: A Systematized Narrative Review. Healthcare, 14(5), 673. https://doi.org/10.3390/healthcare14050673

• Weir, K. (2018, May 1). Healing the wounds of pregnancy loss. Monitor on Psychology, 49(5). American Psychological Association. https://www.apa.org/monitor/2018/05/pregnancy-loss

• Heustis, J., & Jenkins, M. M. (2004). Companioning at a Time of Perinatal Loss: A Guide for Nurses, Physicians, Social Workers, Chaplains and Other Bedside Caregivers. Companion Press.

• Wildflower LLC. Honoring the Complexities of Perinatal Loss: A Guide for Clinicians. https://www.wildflowerllc.com/honoring-the-complexities-of-perinatal-loss-a-guide-for-clinicians/

• Glow in the Woods, a site and reading list for bereaved parents. https://www.glowinthewoods.com

• The AVP framework (Acknowledge, Validate, Permit) is associated with Dr. Becky Kennedy (Good Inside).

• RAIN is attributed to meditation teacher Michele McDonald and has been widely taught by Tara Brach.

• The two-arrows teaching and the Five Remembrances are drawn from classical mindfulness and Buddhist tradition, the same lineage our program traces through Mindfulness-Based Stress Reduction.