Strategies to cope with the loss of the pregnancy you envisioned when you have a preterm infant.

1. Name and Validate the Grief

Many parents feel guilty grieving when their baby is alive.

• Normalize it and tell yourself it is ok to feel sad about the pregnancy and birth you expected even when loving the baby you have just given birth to.

  • Acknowledge dual emotions: joy + fear + loss can coexist

  • Avoid minimizing language like “at least the baby is here and alive." Don't minimize your emotions, they are valid and deserve to be felt.

2. Explain This as a Form of Loss

Framing helps understand your feelings better.

• Loss of the “expected story”

• Loss of control and predictability

• Loss of early bonding experiences

• Sometimes loss of identity as a “healthy pregnancy parent”

This is often referred to as ambiguous loss—there’s no single event, but a profound shift in expectations.

3. Create Space to Tell Your Story

Narrative processing is powerful.

• Share with those you trust and are able to confide it what you imagined your pregnancy/birth would be like and then what actually happened.

  • If someone is confiding in you, listen without correcting or reframing. Let them tell their story in their own words without judgement.

• Writing, journaling, or voice notes can help process emotions/grief.

4. Build Connection with Your Baby (in a New Way)

Help build connection with your baby by:

• Skin-to-skin (kangaroo care) when possible

• Participating in care (diapering, oral care, feeding, giving a bath)

• Creating rituals (reading, singing, pumping with intention)

• Acknowledge milestones: first time holding, first feed at the breast or by bottle, breathing milestones like when the breathing tube comes out or your baby is breathing without any support, first bath, first day without supplemental heat, etc

5. Address Guilt and Self-Blame Directly

This is extremely common.

• Gently challenge thoughts like:

  • “Did I cause this?”

  • “My body failed”

• Remind yourself that you did not cause this to happen. Ask a medical provider for reasurances if needed.

  
  

6. Micro-Coping Strategies

Big advice can feel overwhelming—keep it small and doable.

• “One day at a time” or even “one hour at a time”

• Grounding techniques during stressful moments

• Identifying one controllable thing each day- pumping schedule, being there during their scheduled care times, journaling at their bedside each day at a specific time, reading a book to them while they are in between their care times, etc.

7. Peer Support

Nothing reduces isolation like talking to someone who gets it.

• Ask if your NICU has a parent support group- if not try to create one!

• If it seems too hard to find other NICU parents to talk to, start by making small talk with other parents in the hallways, you can start small and build big connections this way

• Online communities can be a great option but be careful - there is a lot of misinformation online.

8. Complicated Grief or Trauma

Some parents will need more support.

If you have:

• Persistent guilt or intrusive thoughts

• Avoidance of the NICU

• Symptoms of anxiety, depression, or PTSD

Seek professional support from your health care provider, the NICU social worker, or your baby's medical providers.