Sometimes, getting pregnant again after babyloss is just the tip of the iceberg, and instead of feeling relief after seeing a positive test result, many loss parents feel dread. Though they wanted and hoped for another baby, now the reality has set in: they must go through pregnancy once more, and this time, hopefully, bring home a healthy baby. The steps to get to this place of safety can seem insurmountable. Furthermore, when a loss parent is expecting again, often family and friends tend to think that the original grief has been “resolved”, and expect that pregnant people should just “be happy” to be having another baby. Anybody who has experienced babyloss knows that the sadness, grief, and anxiety doesn’t magically disappear after a certain amount of time, or with a new pregnancy. Even parents who have been in therapy struggle when they become subsequently pregnant. It is helpful to continue therapy, or return if you’ve had a break, if you find yourself pregnant again. Even uneventful pregnancies can feel full of nerve-wracking milestones, and a therapist can truly help you along this path. One useful model that can be applied in therapy is called RAINBO, and it is developed by this writer. RAINBO stands for Rehearse, Anticipate, Internalize, Neutralize, Breathe, and Observe. Below is an outline of what each of these steps consist of and how they can help you when applied in the safe environment of therapy.

Rehearse and Anticipate. Many loss parents experience intrusive memories and painful thoughts about specific aspects of their loss pregnancy, especially when it comes to prenatal testing. If you received bad news at an ultrasound, especially, you may truly feel some dread during diagnostic scans. Therefore, it can be helpful to practice, or rehearse, these moments with your therapist. You can begin to imagine walking into the ultrasound suite or even the waiting room of the doctor’s office, and anticipate some of the thoughts and feelings that might arise. By practicing and preparing, you can address anxious thoughts and feelings at the outset, instead of experiencing them unexpectedly during your scans and appointments. Even the idea of imagining yourself at a scan can cause you to feel nauseous and uncomfortable, which is why it is so valuable to do it: to get used to the feeling of discomfort instead of pushing it away. This is also a time where you can brainstorm about tools to use to cope: bringing headphones or work distractions? Asking for the tech to turn off the screen so that you don’t have to watch the ultrasound as it happens? You have more choice than you might expect when it comes to taking control of the ultrasound space and other triggering testing environments.

Internalize. This may feel like one of the most challenging goals of therapy during a rainbow pregnancy, but internalize refers to attachment, or making an emotional connection with your baby. The tip on emotional cushioning covers this in more depth, but many parents feel unsafe getting their hopes up that a pregnancy will be successful, and they are afraid to attach to their fetuses because of this. It’s possible that you think avoiding attachment will cause a loss to hurt less, but unfortunately, there is no way to prepare for the grief that comes with loss. By nature of being pregnant again, you are already attached: you had hopes and dreams for a successful pregnancy, even if it terrifies you. Denying your feelings will not protect you, but it may cause you more psychological anguish, especially if this pregnancy is healthy. Your therapist can help you gradually start to let down your guard and internalize your connection to your future child.

Neutralize. As discussed in the Babyloss and Therapy tip, sometimes a person’s thoughts and feelings change after losing a pregnancy. Often, beliefs about oneself and the world are altered in unhelpful ways, and these new cognitions create more psychological stress. During a subsequent pregnancy, these new uncomfortable, unhelpful responses can feel overwhelming, and they need some unpacking. For example, you may begin to think, “This pregnancy is doomed like the last one”. It is understandable that after a loss you might both fear losing another pregnancy as well as emotionally cushion by thinking of worst-case scenarios to keep your heart safe from loss, but these will only cause you more stress. Therefore, neutralizing refers to identifying, challenging, and replacing unhealthy thought patterns with new ones. Using tools from cognitive behavioral therapy to chart the connection between your thoughts, feelings, and actions, is a great place to start, and your therapist will provide you with tips and tools for how to neutralize thoughts that feel dangerous and toxic.

Breathe and Observe. Mindfulness refers to the process of simply observing your thoughts without attachment or judgment, and usually this involves paying attention to how you breathe, replacing anxious, fast, shallow breaths for smoother, deeper, lung-filling ones. During a rainbow pregnancy, it is helpful to remind yourself, “Don’t believe everything you think!”, because frightening and distorted thoughts can seem very persuasive. One way to remove attachment from anxiety and negativity is to take a posture of curiosity toward your thoughts, observing them without engaging with them. What is the difference between engaging and disengagement? Consider the following example.

Engagement

Tricky Thought: My pregnancy is doomed!

Unhelpful (but common) Response: Oh my God, if I’m thinking my pregnancy is doomed, it must be because my body somehow knows it’s already doomed. I need to check for bleeding every time I go to the bathroom and prepare myself for a loss.

Disengagement

Tricky Thought: My pregnancy is doomed!

Helpful Response: I’m noticing that I’m having a thought about my pregnancy being doomed. I need to take a deep breath (breathe in, slowly through the nose, for 4, out, slower, through the mouth, for 5). It is interesting that I’m having this thought. It is making me feel unsafe and anxious. I am going to take another deep breath. (Repeat breathing exercise). I am choosing not to talk to this thought. I do not have to engage with it. I am going to…a) distract myself; b) write about the thought to move it out of my head, c) engage in vigorous exercise; d) call my therapist…

It can feel like observing and not interacting with your thoughts is impossible, but that is the point of practicing with your therapist. Practicing neutralizing exercises where you identify your distortions can also help you be more critical and less interactive with thoughts that feel dangerous.

Note that the RAINBO model is really best administered by a therapist experienced in working with babyloss and the multiple therapeutic orientations like Exposure and CBT that form the basis of this treatment. Most of us are unable to help ourselves—even therapists need therapists!—so it really is worthwhile to seek out somebody who is knowledgeable and skillful at working with loss parents, especially during subsequent pregnancies. With the right help, you can actually start to enjoy your rainbow pregnancy experience, instead of dreading it.