Thank you.
Good morning, and thank you for inviting me to speak here with you today. I'm honoured to be able to advocate for and represent the women and families that Motion 110 is exploring how to better support.
I'm a registered clinical counsellor at the Fraser Health reproductive mental health program at Royal Columbian Hospital. I sit on the Fraser reproductive mental health operations committee and I'm the co-founder of the Fraser Health reproductive community of practice.
As a clinician at the Fraser Health reproductive mental health program, I have the privilege of working with women who are struggling with new or pre-existing mental health concerns exacerbated due to struggles with fertility, premenstrual dysphoric disorder, pregnancy and the postpartum period, as well as pregnancy interruption, miscarriage, stillbirth and infant death.
Our program provides psychiatric consultation as well as individual and group therapy. For those we support following the death of a child, we listen to their experiences of trauma, loss, grief, social isolation, interpersonal relationship struggles and financial hardship.
Working with the bereaved mother, I provide grief therapy in two phases.
In phase one, the mother tells me, and we work to process, the story of her conception, pregnancy and loss. I teach her about the five stages of grief and normalize the grieving process. We work to continue the bond between between the mother and the deceased baby. The goal is not to push the tragedy aside and move on, but to integrate the death into her life. We discuss rituals and ceremonies that the family has done or is planning to do to say goodbye to the baby, and we work on creating memories and meaning. I educate the mother about trauma, and we identify triggers that are impacting her and ways to manage and cope with them. We devise a communication plan and create and rehearse a script she can utilize for when she's asked where her baby is. We process emotions. We identify and validate the anger, guilt, blame and shame. We utilize mindfulness and increase her self-compassion.
In phase two we work on reintegration. We work on strategies for the mother to start to face the previously identified triggers. We work on behaviour activation for depression, and we work on identifying new and appropriate supports. We cultivate ways for the mother to carry her baby forward with her and to learn how to parent the baby that has passed away, which is often through advocacy and supporting other grieving families.
It is not sufficient nor realistic to believe a woman or her family can heal and move forward from the tragedy and trauma of their baby's dying in a few short weeks and a few short therapy sessions. I often hear from patients when they first arrive at our program that they had no idea our subspecialty existed until they were referred for our services. Patients are referred to the program by their family doctors, nurse practitioners, obstetricians and midwives, or following a visit to the hospital emergency room. If there are concerns regarding the mother's safety, the psychiatric urgent response clinic will bridge for us until we're able to see the patient, and we are grateful for their clinical support.
Our wait-list can be long, and we are constantly problem-solving and developing programming options to try to alleviate the wait. Unfortunately, there is a shortage of appropriate, publicly funded, trauma-informed grief therapy for bereaved parents of miscarriage, stillbirth or infant death, and this is a problem. We have been working to mediate this concern and have created and host the Fraser reproductive mental health community of practice to provide support and education for community mental health clinicians.
I would like to stress today that even after going through the most heart-wrenching experience of losing their baby, every single patient I have ever treated for a miscarriage, stillbirth or infant death has made the decision to try to conceive again. Approximately 85% of women who have suffered a loss will be pregnant again within 18 months. In my experience, most families continue trying to conceive again in approximately three to four months or as soon as they are medically cleared to do so.
A concern is that after a loss, women who become pregnant again are often not able to complete the 600-hour minimum EI contribution in the 52 weeks prior to delivery.
This is frequently due to psychological struggles or physical concerns, and they are advised not to work for the safety of the pregnancy. These are women who have contributed to EI their entire adult lives and are now not able to utilize the maternity or parental benefit because their beautiful baby died.
I advocate today for the creation of a compassionate and educational government website dedicated to supporting bereaved families and parents, as well as community supports and clinicians. It would include a national directory of supports and resources available by province or territory; educational and supportive literature and PDF handouts that could be printed and utilized by the bereaved family, community supports and health care providers; access through a dedicated Service Canada team phone number to a team that would be trained with accurate information and that would learn to deliver it in a caring and empathetic manner; a link to the Service Canada website, which would have a section dedicated to providing bereaved parents with the information and services available to them; and possibly even a secure area for parents to report the loss online, request the stop of parental benefits, start a bereavement benefit or check and manage the status of their report from home.
I advocate for a flexible bereavement benefit for both parents that could be accessed throughout the year following the loss. I recommend a total of 15 to 20 weeks for each parent, at a minimum. With regard to returning to work, a flexible or gradual entry schedule would be helpful.
At the time of the loss, it is important to provide immediate supportive and clinical resources in a timely manner for both parents. The care provider who is attending to the family, be it the doctor, midwife, nurse or social worker, could utilize and share the government bereavement website to gain information and resources to better serve the family. They could also begin the process of an automatic enrolment for a bereavement benefit with the parents' consent at that time.
Sustainable long-term supports also need to be addressed. Each bereavement is unique, and many families experience recurrent loss. Grieving parents and families benefit greatly from peer support, bereavement groups and clinical counselling. Through peer support and educating families, our local NGOs are doing such important and invaluable work in the effort to reduce isolation and stigma. They need predictable financial support to be able to maintain the quality of the work they are currently doing.
Finally, I advocate for families who have gone on to conceive again to be able to access a maternity and parental benefit for pregnancy after a loss, based on their history of contributing to employment insurance, rather than on the 52 weeks before delivery.
Thank you.