Ms. Joey Miller, MSW, LCSW is a licensed clinical social worker with 20 years of experience in reproductive health, loss and trauma, and women’s mental health. She received her training and degrees from Northwestern University and Loyola University. She began her career working in the areas of adult trauma and emergency medicine before gaining unparalleled experience in the areas of pregnancy and infant loss while serving as the Perinatal Loss Program Coordinator at Northwestern Memorial Hospital in Chicago – the largest birthing hospital in the state of Illinois. Her work in this area is now a primary focus of her clinical practice at Wellsprings Health Associates where she sees patients for urgent consultation, and ongoing individual and couples therapy. She has also served as a faculty member at Northwestern Feinberg School of Medicine, and remains affiliated with Chicago Medical School as she continues education and support of medical students and residents, and volunteer work in community-based clinics.

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John: Welcome to another edition of the Impact Podcast. I am John Shegerian. I am so honored to have with us today, Joey Miller. She is a psychotherapist. She has written this great book called “Rebirth.” I welcome you today, Joey, to the Impact Podcast.

Joey Miller: Thank you so much, John. It is great to be your guest.

John: It is wonderful to have you and this is a very important topic, one that is not covered a lot in the mainstream media. Before we get talking about this, I would love you just to share your background and history leading up to becoming a psychotherapist and how you even got here.

Joey: Thank you so much. I am currently based in Chicago. I am practicing at Wellsprings Health Associates, which is a multidisciplinary psychiatric practice, and while I do practice across the board seeing individuals and couples, my main focus tends to be reproductive psychology. I also focus on loss and trauma and women’s mental health.

John: Wow. How many years have you been practicing and doing this great and important work?

Joey: Just a little over 2 decades.

John: You do not look old enough to be doing this [inaudible].

Joey: [laughs] You are very kind, thank you.

John: That is a good thing, but I totally believe you. We were chatting a little bit before we tape this podcast, and I was sharing with you my own personal story. Before my wife and I had our two beautiful children, in between our daughter and our son, we lost two children along the way. It still stays with us to this day, so when I was asked to host you on the podcast, it really resonated with me. I really want you to know that this is such an important topic not only personally, but, when I got to read your book and start studying this more, I was absolutely shocked by the numbers. Could you share with our audience in order of magnitude the sheer numbers of how much of a problem this really is and a crisis?

Joey: Absolutely, in the United States alone, there are an estimated 2.2 million pregnancies that end annually in loss. When we look at that and we break that down a bit, there are an estimated 10 to 20% of pregnancies that we believe end in miscarriage which is defined as a loss prior to 20 weeks gestation, and approximately 1 in 100 pregnancies end in stillbirth or loss greater than 20 weeks gestation. Worldwide, those numbers only explode when we look at them globally that the World Health Organization estimates annually there are 6.3 million pregnancies that are lost every year worldwide and an additional 4.1 million infant deaths which is defined as the death of a baby or a child under one year of life. These numbers are pervasive, and this is a very real issue. Even though we do not talk about it as much as we should, this does affect a significant population every year.

John: Joey, when did you take your classic training and education and shift into this critical problem? When was that? When did you have that all aha moment that this should be your focus because the magnitude of the problem really warranted your attention?

Joey: I began my career working in adult trauma and emergency medicine and had a lot of exposure and experience working with crisis intervention, sudden injury, death, or life-changing events. I did that work in Chicago and then was eventually recruited by the largest birthing hospital in the state of Illinois, Northwestern Memorial Hospital, to focus on the other end of the life cycle, working with women and with partners and families who experience the death of a baby or the loss of a child either during pregnancy, during delivery, or afterwards. That was a little over 20 years ago, and I worked to build a program. Now, more and more hospitals do have what we call a perinatal loss program, but at that time it was really novel because, again, it was not something that was discussed.

Joey: Even as early as the 1970s that when a woman experienced a stillbirth, it was very common for hospitals to take the baby away and not even allow the parents to see the baby, thinking that somehow their grief would be exacerbated if there was an opportunity to see and hold and touch. Over the years we found that these attachments are very real, and some parents do choose to spend some time with a deceased baby. Over the course of my professional career, I have seen attitudes shift. I have seen practices shift and it was wonderful to be on the ground and working actively to create and then grow a program to provide support. I started approximately 20 years ago and then continued work to flush out services, resources, raise awareness and deepen education.

John: It is still so fascinating that until I read your book… Again, your new book is “Rebirth,” and I really suggest to our audience, if this is a problem that you have been faced with or have a family member or a friend that has been faced with this, this book is really worthwhile. I got a lot out of it, but it was actually very emotional for myself to read it. Our losses were 27 and 25 years ago, and those losses have never gone away. It is something that I have just chosen to push aside or ignore or just push down in one way shape or another, but this book really covered the topic in such an elegant and informative and beautiful way and also offered a lot of hope. What made you write this book? Obviously, your practice is very busy. What was your aha moment to write this book “Rebirth”?

Joey: I loved my work working with trauma patients and an emergency medicine. When I started working on the other end of the life cycle, my patients captured my attention, and then they captured my heart. Again, there was not a lot of conversation if any about pregnancy and infant loss, and I really felt that the story needed to be told. So, in the book, I have included 25 excerpts of my patients’ stories that really underscore the individual nature of trauma, of tragedy, of depression, anxiety, and the pathways that many of my patients took to finally becoming parents. I just felt it was so important to shed more light on this issue and in so doing open the door for supports for families who oftentimes, again, received very little if anything from society. I have always shared with my patients, I do not think the goal is to get over losing a baby. I think the challenge is to learn to live with the loss. Unfortunately, society continues to this day to sometimes minimize or misunderstand these types of losses, thinking “This was early. This happened before you really got to know the baby. You will get over this. Go on and have another child.”

Joey: Well, many of my families can and do go on to have another baby, but another baby never replaces the deceased baby. Also, for many women, there is an attachment from the moment of conception that the grief is a reflection of that. It is not necessarily based on the length of gestation. It is more based on the depth of the attachment, especially for couples who go through fertility treatments, who are intending to conceive and sometimes spend months and years that they are attached the moment they have a positive pregnancy test. When that pregnancy ends prematurely, it is not just the physical loss of that baby, but it is the loss of many of those hopes and dreams. In order to grieve and then to begin to take some of the steps forward, it is important to first recognize and then validate that loss is real.

John: For those who just joined us, we have got Joey Miller with us. She is a psychotherapist. She has written this book called “Rebirth” and you can find Joey in her practice, if you have this issue or a friend or a relative has this issue, at www.joeymillermsw.com. What are some of the greatest challenges that a couple face when this tragedy happens?

Joey: I think it is really to be seen and to be heard that, again, these losses are very real, but they are so individual that I can have 2 patients who experienced a miscarriage or stillbirth and the meaning that is attached to that loss looks very different. As a society, it is not necessarily encouraging people to sidestep their grief. It is listening. It is providing support. It is acknowledging. It is validating. While the grief can feel overwhelming at times that many of these couples know they want children, they want a family, and so it is a very steep challenge to have acute grief against the closing window of reproductive opportunity, that if couples waited until they felt 100% better, they would wait the rest of their lives to try again to conceive. So, many couples are faced with grief and loss but also extraordinary pressure that if they are going to think about trying again, they have a very limited window in which to do so.

John: Joey, in order of magnitude, the problem is massive, and before you wrote this book and I had the chance to read it, I never realized that your kind of practice even existed. Given someone like me who believes that seeking help and having a coach in life, a psychotherapist or psychologist, is a form of strength and not of weakness, are there people who refuse to or do not even know where to find hope like you and help like you and are suffering in silence, and part of the underpinnings of you writing the book is trying to reach them as well?

Joey: Yes, historically, there have been a lot of barriers to people seeking mental health supports whether there was stigma, embarrassment, shame, financial barriers, geographic challenges. I practice in Chicago. It is a metropolitan hub and not everybody has access to specialty providers. This may be one of the very few positives as a result of COVID, that my practice has converted to all virtual or telehealth appointments. That has really opened the door for many people who might not have access to someone locally, a specialty provider, that it is becoming much more common for people to seek out supports, and there are many more avenues in which to do so. The stigma has also started melting away. As a nation, we are dealing with more depression and more anxiety across the board, and more and more people are seeking mental health treatment, which is, again, helping erode some of the stigmas. I am seeing that, even just in the last year, that has shifted in a very positive way that there are many more opportunities than ever for people to seek individual or couples counseling, join us support group, and they can do so from their own home now.

John: Because of the pandemic, one of the blessings of this tragic period is that your practice has opened up, and people could literally be seeking your help from Los Angeles or London or wherever they need it because you can now see people over Zoom.

Joey: There is much more opportunity and networking and collaboration within the professional community which I see as a great positive. Well, that does not take the place of in-person appointments.

John: Right.

Joey: It certainly is a bridge until we are able to resume in-person office appointments.

John: Is your area of expertise of growing area, and since you broke through in 20 somewhat years ago and decided to take on this issue, have you seen it grow widely comparatively speaking to 20 years ago?

Joey: Absolutely. I am cautious about my response that even though I have seen growth, there is absolutely more work to be done here. I am grateful for different public figures who have come forward and expressed or disclosed that they have experienced a loss. That also helps further remove the stigma and opens the door for women and their partners to seek help.

John: What is the largest cause of death if there is such a thing on the infant category, the one year or under? When my children were infants, there was a lot of media back then around sudden infant death syndrome. Is that still a big deal or are there other causes of death that are potentially preventable?

Joey: Absolutely. The March of Dimes has really focused on their Back to Sleep campaign or placing infants on their back when they go to sleep in an effort to reduce the risk of SIDS. SIDS or sudden infant death syndrome remains an issue. It remains one of the leading causes of death, prematurity. With more and more medical and obstetric and neonatal technology, we are able to better support preterm and premature deliveries. 20 years ago or 40 years ago, if a baby was born around the point of viability, there was no expectation that that baby would be able to survive. Now, with all of the technology and the neonatal intensive care units, we are able to support earlier and earlier deliveries, but, again, there is still more work that needs to be done here. The messaging here is I try not to focus on the leading causes of death, for example prematurity or SIDS, because there can be either… There are so many.

John: Right.

Joey: There can be issues of infection or injury, complications surrounding the placenta or membranes or cord. There are so many reasons why and how these losses can occur that I am cautious of focusing on one because I think they all need more attention.

John: Right. For people who are seeking you out, is it mostly couples or is it the mom herself? How does that break down in terms of your practice? I am fascinated because, originally, when I started reading over your practice materials in your book, I thought it was more female basement[?]. I got a lot out of it myself as being a male who went through this. What does your practice look like in terms of breakdown?

Joey: I have a nice mix of both that I see individuals both women and men, that sometimes it is the father who presents, who comes to me and says, “I am hurting, and I am feeling really helpless. I cannot do anything to help my wife feel better. I cannot change the circumstances. I am needing some help to talk about that.” I oftentimes have grandparents who contact me saying, “I [inaudible] double loss. It is the loss of this greatly anticipated and desired baby, but I am also seeing my own adult child hurting.” Sometimes I do work with families, but I think one of the important messages here is it is not just the woman who is the patient, that both parents are impacted even though in very different ways.

Joey: I love the name of your book “Rebirth” and when I think of you and I have read your website… Again, for our listeners and viewers, to find Joey, go to www.joeymillermsw.com. There is a ton of information on it. I have it up in front of me now, but I have gone over it. I really feel that although this is such a difficult topic, you represent hope. Can you explain? Getting people to the other side and part of why this is so important, that this is truly a book of hope and your practice is one of hope and help.

Joey: Thank you. I believe that is my strongest and most important message here, that for the unfortunate parents who experienced the loss of a pregnancy or death of a baby, they have learned all too well that pregnancy is not a promise. Even the words that we use when we are pregnant, “I am expecting. Yes, I am expecting that in 9 months, there will be a happily ever after.” That is is not the case for the majority of people I work with, but one other statistic that I want to share is that the overwhelming majority of parents who lose a baby, approximately 80% will go on to conceive again and have a healthy full-term pregnancy and baby.

Joey: That is not to suggest that another baby makes up for, takes place of the deceased baby, but there can be life beyond loss. It is helping parents and families grieve the loss of a desired baby and an intended baby work through layers of depression and grief and anxiety as they dare to think about trying again and then help them manage through another pregnancy and through a subsequent delivery. So, I think even though we sometimes get stuck in the numbers of loss, which are very important to talk about, I also want to showcase that 80% saying there is that possibility. There is that chance, and even though that road might feel very difficult… Even in your family history that you share…

John: Right.

Joey: …proving that it is not impossible.

John: Well, it is not only impossible. If there is anything that I was embarking on, Joey, and I had an 80% chance of success, that is a lot of hope right there itself, right there, the sheer numbers. I forgot to ask you earlier, and I meant to ask you, given that a family is its own ecosystem and you bring up the topic of not only husbands and wives and grandparents, which is fascinating to me, are sometimes predecessor children also included in your counseling? I am sure the impact is also felt to them. There is much confusion with them, and they were expecting a little brother or sister. Are they also included sometimes in your practicing and your counseling as well?

Joey: Absolutely. I do a lot of work with parents who have siblings to a deceased baby working with age-appropriate recommendations in terms of how to counsel a 6-year-old that he or she is not going to have a little brother or a little sister coming home. It is especially challenging when parents have lost their confidence and huge pieces of their identity after a loss for them to be able to go on and parent a sibling when they are grieving themselves and maybe not feeling that they are operating at capacity. There are a lot of different recommendations that I can give to families beyond just the 2 parents, the mother and the father, or a same-sex couple, especially if there are other children at home as well because, again, when there is a tragedy, when there is a loss, in my experience, it impacts the whole family.

John: It does[?]. I also want to give out as a public service to anybody who is suffering and feels at the end of their rope, please call either 1-800-Suicide, and that number is 1-800-784-2433; that is a National Suicide Prevention lifeline. We want everyone who is suffering who has not sought help like from a great Joey Miller or read her book yet, please reach out. That number is 724, and it is a lifeline. For those who want to find Joey, again, please go to www.joeymillermsw.com. Read her book. I have read it, it is a great book. There is a lot of hope in here. As Joey said, 80% of people who have suffered tragic losses, including our family as well, are going to find hope on the other side that there is going to be another baby.

John: Joey, we call this the Impact Podcast because we want to always have great people like you who are making an impact, who are making the world a better place for doing great things, and you are included in that. Even though this is a very difficult and tough topic, it really warrants covering, and we are so grateful for the important work that you do, and there is a great book that you have written. Thank you for being a guest today. God bless you and your practice. Thank you for being a guest today on the Impact Podcast.

Joey: Thank you, John. It has been my honor, and I am so grateful to you for raising the awareness. Thank you.

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