What can cushion the grief after miscarriage and other kinds of pregnancy loss

The experience of being pregnant can be transformative for your body, mind, and spirit. Physically, you might feel different as you deal with morning sickness, tender breasts, and fatigue. Emotionally, you may start to see your surroundings through the eyes of your future child. Your relationship with your partner might change in anticipation of bringing new life into the world. Your identity may begin to shift as you feel the great responsibility of being a parent.

But then something happens to your baby. You start bleeding and suffering abdominal cramps. Or your first ultrasound shows that your pregnancy isn’t viable. After the loss, your whole existence seems to change on a cellular level. All those new, hopeful, transformative emotions are now ungrounded, tethered only to a devastating emptiness. And you succumb to grief.

This is not a guide for recovery from miscarriage, because even though a woman’s body usually heals completely four to six weeks after pregnancy loss, painful thoughts of what could have been may linger for years, or a lifetime. But it’s important to know that you’re not alone, and that you can set up emotional safeguards to keep your grief from compounding. 

Risk Factors for Complicated Perinatal Grief and PTSD

Though the traumatic experience of losing a baby is universal and as old as humanity itself, every parent reacts differently to a perinatal death. The clinical term for the grief one feels after a loss such as miscarriage, stillbirth, ectopic pregnancy, or neonatal death is perinatal grief. 

Miscarriage < 20 weeks

Stillbirth ≥ 20 weeks gestation

Neonatal death = newborn to 28 days old

This form of grief can sometimes feel like a disenfranchised emotion because the person suffering might not receive widespread social support and validation. For example, a woman who miscarried very early in her pregnancy may not have shared the news with close friends and family yet. Or other people may not recognize the significance of her loss. This can contribute to feelings of isolation in grief. Or maybe a woman had to make the difficult decision to have an abortion, and she finds it hard to express her ambivalent emotions to loved ones. 

Studies show that many women experience the symptoms of post-traumatic stress disorder (PTSD) after pregnancy loss. And intense grief is not unusual, especially in the first six months. But sometimes grief can become pervasive and cause long-term impairment in functioning and mental health. The following risk factors can contribute to what’s called complicated grief, or prolonged grief disorder, after a perinatal death:

• Guilt. Parents who blame themselves for a perinatal loss may have more trouble managing their grief. And in a tragic situation where there’s often no clear explanation for the loss of a pregnancy, many parents decide that they must have done something wrong. This kind of guilt is associated with complicated grief reactions.  
• Repeated miscarriages. If someone has experienced recurrent pregnancy loss, they may develop negative emotions about their bodies, feeling that they’ve somehow failed in their perceived biological roles. 
• Ongoing miscarriage symptoms. A miscarriage can be an extended process, which means that parents may not get closure overnight. It’s hard to start healing emotionally when your hormones are still raging. For example, a woman might begin bleeding, but still have enough HCG hormone levels to produce a positive pregnancy test. She may cling to hope because she still has all the symptoms of pregnancy even as she’s losing her child. Or a woman may have an incomplete miscarriage and require a medical procedure like dilation and curettage (D&C). And so it may take weeks for the body to adjust to reality, which can feel both confusing and heartrending day in and day out. 
• History of depression. People with a history of psychiatric issues like depression or anxiety are more vulnerable to complicated grief. People with neurotic personality traits are also at-risk.
• Family composition. People who have lost a pregnancy tend to experience more prolonged, disruptive grief if they don’t have existing children. 
• Gestational age. One might assume that the longer you’ve carried a child, the more you will suffer from the baby’s loss, but research shows that there’s little association between level of distress/depression and how far along you are in your pregnancy.
• Lack of social support. People who don’t have friends, family members, or a supportive community to lean on in their bereavement tend to take much longer to heal.
• Pre-existing relationship difficulties. A pregnancy loss can aggravate existing relationship issues with your partner, turning what should be a source of support into a source of stress and conflict. 

The enormity of one’s loss doesn’t just manifest as sadness and grief; it can also show up as anxiety. Because 50-85% of women who have miscarried get pregnant again, they may feel increased anxiety, fear, or hyperarousal (a symptom of PTSD) during their subsequent healthy pregnancies, especially when their new child reaches the same gestational age of their previous loss. These women may seek out frequent medical reassurance, or schedule additional prenatal visits for their “rainbow baby.” Being pregnant again does not automatically remove their previous grief and can in fact serve as a constant reminder of their past loss. These women are also more prone to postpartum depression. 

Other normal symptoms of perinatal grief may include intrusive thoughts, feelings of numbness, loss of identity, awkwardness and/or jealousy around other peoples’ children, anger, avoidance, yearning, and disbelief. Partners of the pregnant woman may experience feelings of loneliness or helplessness. It’s also okay to adjust quickly and easily, without emotional turmoil. There’s no wrong way to grieve these kinds of losses. 

Strategies for Physical and Emotional Healing after Miscarriage

As with any type of grief, the goal is not to fix it, but to find ways to go forward even when you desperately want time to stop or reverse. You can’t bring back your child and all the hopes and dreams that you’d harbored. But you can show compassion to yourself and your healing process through the following approaches:

• Self-care. After a miscarriage or another kind of perinatal loss, the grieving process must take place alongside the physical recovery process. You may have gone from taking excellent care of your body, knowing that you were carrying a child, to being angry at your body for not sustaining the pregnancy (even though it’s not your fault). But at this point you have to remind yourself that you deserve care as well. Continue to eat well, take your prenatal vitamins, sleep, and exercise. Get the health care you need. Use your PTO. Schedule a massage. Let your mind and body work together to find resolution.
• Couples therapy/marriage counseling. Research shows that women tend to become attached to their babies very early in their pregnancies, while their partners may not start to bond until about 20 weeks gestational age. This means that a miscarriage might elicit completely different emotional reactions from co-parents. Talking through these feelings and identifying them as normal and not pathological can help intimate partners reconnect and support each other. 
• Learning the facts. Though miscarriage can be traumatic, it’s incredibly common, and most likely out of your control.
• Telling or writing your baby’s story. You don’t have to give up the bonds you had with your baby. You can make personal meaning from your devastation. Even if you were never able to share memories with your child, you still experienced sharing a heartbeat, and there’s incredible beauty in that. 
• Memorializing your loss. Humans have rituals for a reason. Perinatal death is often sudden, leaving you no time to prepare. But you can find a way to say goodbye. You may find meaning in planting a tree or holding a private ceremony. You could buy yourself a small piece of art that speaks to your loss, and hang it where you’ll see it everyday. You could wear a piece of jewelry that reminds you of your baby, something you can touch when you’re in distress.
• Therapy/counseling. Professional therapists can help you truly feel your emotions, manage your anxiety, and modify any negative thinking patterns you might have regarding your loss. It’s especially important to talk to a licensed mental health provider if you have a history of depression.
• Human connection. Try not to self-isolate. Yes, the people in your life are inevitably going to say the wrong thing. No one has been through exactly what you’ve been through, so that’s to be expected. But it’s far more difficult to recover alone. If you’re struggling to communicate your needs and wishes, enlist a close friend or family member as a spokesperson who can help you maintain your boundaries.