Expert's Perspective

How to Survive the Emotional Toll of Miscarriage

On a sadly regular basis, I see women, and frequently their partners, who have just been told that they are either going to have a miscarriage or have already had one. And I tell them the same thing: Miscarriage, especially after infertility treatment, feels grossly unfair, tragic, and unbearably disappointing. It can come as a complete shock or there may have been warnings, such as bleeding. But in either case, it is a huge loss.

I also tell them that they need to prepare themselves for another shock: the reactions of friends and family members. Some of whom will in fact be warm and loving and supportive. But others may not be. For whatever reason, our society does not seem to embrace miscarriage as the tragedy that it is. People may say stupid or hurtful things, such as that it was meant to be, or that you can simply try again, or that it happens to everyone. But it doesn’t happen to everyone, and especially for those who experienced infertility, miscarriage can feel like a cruel joke. That carrot was dangling right in front of you, and was then snatched away.

Research supports the notion that miscarriage can lead to significant distress. In one study, a month after a pregnancy loss, 25% of women reported symptoms of PTSD and 34% reported symptoms of depression. After a loss, women and men experience real grief. But unlike the grieving after the death of a family member, there are no memories to cherish, there are no established “miscarriage rituals”, and often minimal support because miscarriage is considered by many to be a shameful secret. Just think of the language we use: she “lost” the baby. Which makes it sound like her fault, when in fact miscarriage has medical causes. It is no one’s fault, least of all the woman who wanted that baby more than anything.

Time is the best healer, and in fact, most people who have experienced a pregnancy loss grieve and then slowly recover. The time you need to grieve is unique to you. Some individuals feel intense distress for weeks or months, and then begin to feel like themselves again, while others can experience pain for years. Women who have a more difficult time emotionally recovering from a miscarriage tend to have a history of anxiety or depression, do not have other children, have poor social support, and/or have marital issues.

A pregnancy loss can be challenging for the couple. Your partner probably is not reacting exactly the same way you are. Remember that the way you are reacting to the loss is the right way for you, and the way your partner is reacting may well be the right way for him/her. The pregnancy was very real to you — your body probably felt different, you may well have experienced pain and bleeding along with the loss — but you have to remember that this was an entirely abstract concept for your partner. It is harder in some ways to grieve a loss which may not have felt real yet.

The question of when to try again is both medical and psychological. Speak with your doctor about when it is medically ok for you to try, but also trust your gut feeling as to whether or not you feel ready. Getting pregnant again quickly might feel like a good way to end the pain of the loss, but that is not always the right decision. Some women ask if they could take medication to treat their depression and anxiety. This is a discussion you need to have with a mental health professional, but in my experience, one has to grieve at some point. However, if your quality of life is impacted by your symptoms, do have that conversation to discuss the pros and cons.

Make sure to allow yourself the time YOU need to grieve. Don’t listen to others in terms of how you “should” be feeling. If you are so inclined, do something in memory of that soul. Have a ceremony, plant a bush or tree, get a piece of jewelry, or write a letter to say goodbye. Be prepared for the comments of others and if you can identify the comments which really get to you, memorize some snappy comeback lines. They can be polite, educational, or zing right back. Your choice. But most of all, care for yourself. This is hard. It gets easier, but in the meantime, allow yourself the time, the space and the compassion to grieve as you need to.

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