Before we start trying to conceive we assume having a baby will be easy. We spend years contracepting and worrying about getting pregnant when we’re not ready, because this is what we were taught in health class and this is what we see in movies. We spend our whole lives not trying to conceive, and then, when we are ready, it may take longer than we expect. Then, when we finally see those two lines on the pregnancy test, we’re elated and start imagining the family we’ve been dreaming off. Will it be a boy? A girl? When is the due date? Maybe we tell people…maybe we post to social media. The expectation is perfection: belly bump, baby showers, and gender reveal parties. But then, it can all come crashing down. Bleeding, cramping, an ultrasound with no heartbeat… One in four pregnancies end in miscarriage. What went wrong?
You can be reassured by medical providers and your family and friends that this happens, it’s common, you did nothing wrong. You pick up the pieces, and you keep going – focused on the goal: a baby. But what if it happens again and again? Missing a period and a positive pregnancy test no longer bring elation – they bring dread, anxiety. You may stop telling people, you may withdraw from friends with babies, you may lose hope. You may doubt yourself or even feel shame, guilt. To top it off, you may feel broken.
You are not alone.
As a recurrent miscarriage specialist, I’ve cared for hundreds of couples with different diagnoses, stories, and paths to my clinic, but they all share one need: emotional healing after miscarriage. Medical training taught me the evaluation and treatment for patients with recurrent miscarriage. But I’ve come to understand through the years that the emotional impact of miscarriage is just as important as the tests and treatments. Women come to us feeling broken, betrayed by their bodies. They want answers, and they want their family. An incredibly crucial part of care for patients is rebuilding hope and encouraging emotional healing, regardless of medical diagnosis and treatment options.
What I see in my practice has been studied and validated in the medical literature. Symptoms of depression and anxiety and signs of post-traumatic stress disorder develop or become worse with miscarriage and recurrent pregnancy loss (1). Patients live through a grieving process, and without support and understanding of the common causes of miscarriage, women especially begin to blame themselves for miscarriages. They blame their bodies, their stress, their diets, and their decisions to wait to have a family. Without support and help, this can turn into crushing guilt, isolation, and doubts of self-worth. Men struggle with the psychological impact of miscarriage as well. They can feel angry, depressed, and helpless watching their partner go through miscarriage after miscarriage without knowing how to help or what to do (2).
Support For Pregnancy Loss
Supportive care for patients with miscarriage is essential. Studies have shown decreased miscarriage rates for women who receive supportive care in the first trimester (3). The authors of the studies cannot explain exactly why they see these results but argue that more contact with medical providers and emotional support and well-being counseling should be a part of medical care for couples with miscarriage and recurrent pregnancy loss. There is no universal definition of supportive care for miscarriage (4); some describe it as counseling, close monitoring in the first trimester with serial pregnancy hormone blood tests and ultrasounds, or both. Regardless of how one defines supportive care, all patients with multiple miscarriage and pregnancy loss are more likely to have signs and symptoms of depression and anxiety and should be offered support and wellness resources.
Support and Wellness Resources for Miscarriage
Emotional health is as important as physical health, and every person is unique with different needs. Here is a list of some support and wellness resources that I have found helpful with my patients.
Individual and couples counseling can be a wonderful resource for anyone dealing with the emotional struggles and grief surrounding miscarriage. The benefits of a counselor include privacy, individualized care, and an ongoing relationship with someone who can be supportive through future triggers and emotional ups and downs. Patients often decline counseling at first. They are worried about cost, finding the time for appointments, and other concerns. But those who come back after connecting with the right counselor report feeling a sense of relief and security.
How to Find a Counselor
If you have insurance coverage for counseling start with your insurer’s list to limit the financial burden of care. Ask for references from your health providers, friends, and online. When you call to make an appointment, ask if the counselor has experience with caring for people with infertility, miscarriage, and grief. If you do not feel a good connection with one counselor, don’t waste your time and money – try someone new.
Some people enjoy the camaraderie they find when sharing their own experiences and listening to others share their personal struggles in a support group. Support groups specifically for recurrent pregnancy loss are less common, but support groups for infertility, pregnancy loss or infant and child loss support groups often welcome patients with miscarriage.
Finding a Support Group
Look online, ask your medical provider and friends, or call local churches and hospitals. Churches often have support groups that do not require that you be a member of the church and are not always faith-based. If you do not share the same faith as a church with a support group, ask about joining – do not assume you can’t. Hospitals, especially women and children’s hospitals, often have support groups available for miscarriage, still birth, and infant loss. One very helpful national online resource for finding support is the National Infertility Association’s website Resolve.org, which has a list of support groups across the United States. Resolve began in the 1970s and has become an excellent resource and advocacy group for infertility and miscarriage.
Dealing with miscarriage and recurrent pregnancy loss has been compared to dealing with chronic disease and even cancer.
Mind Body Program
This is a program designed around the mind/body connection. Its foundation stems from observing biological responses (slowing heart rate, decreased blood pressure) with deep breathing and relaxation techniques at Harvard University in Boston in the early 1980s. Dr. Alice Domar is the pioneer for studying and applying stress reduction techniques to help women with infertility. She runs programs through her Mind/Body Center in Boston, but other therapists and counselors run programs throughout the United States based on her model. The programs usually involve 8-10 week sessions of weekly meetings in which people learn stress reduction techniques and often share their experiences with others.
The practice of meditation has become increasingly popular. Definitions differ, but in general, meditation is the practice of quieting the mind, relaxing, and bringing into focus a goal, a mantra, or a state of being calm. There are many resources for learning how to meditate, including books, online resources, and even apps for your smartphone that walk you through the process. Meditation can be intimidating, but give it a try. Be kind to yourself, and try a little each day – it takes practice.
Mindfulness is a practice of self-awareness and striving to be present in the moment. It is grounded in Buddhist meditation, but it is not strictly meditation. Mindfulness is being present, being aware of your body, your thoughts, your life in a single moment. It is taking time each day to stop, breathe, and be aware of sounds, feelings, and thoughts. It’s a way to quiet the mind and reset, and it can be a useful stress reliever. Mindfulness can be less intimidating than meditation for beginners. There are simple exercises that you can do quickly on your own to try it out. Look for resources online and several books written by Dr. Ellen Langer, social psychologist at Harvard University and ‘mother of mindfulness.’
Yoga is a group of physical, mental, and spiritual practices that originated in ancient India. Today, yoga is incredibly popular, and there are many different types of yoga practice, from slow, stretching, meditative yoga to hot, intense, club-music pumping yoga. Yoga for fertility has become popular, and many of my patients find yoga improves their physical mobility and decreases their stress. If you have never tried yoga, it can be intimidating at first when the instructor calls out moves and positions you are not familiar with or you are stretching next to someone who can wrap their leg around their head twice. Watch a beginner’s video online before your first class, find a studio with beginner’s yoga, and forget the other people in the class – we all start somewhere! Don’t use the excuse “I can’t do yoga because I’m not flexible” because people do yoga to increase flexibility. Try it!
Self-care is taking good care of yourself, and it is an essential part of your overall wellness. In the everyday hustle of family, work, friend, and community commitments, it’s easy to put your own needs last. Self-care means putting yourself and your needs first. Consider these tips:
- Be kind to yourself.
- Make sleep a priority.
- Exercise, but give yourself a break from it when you need to. Find restorative exercise like pilates, yoga, walking, jogging, and weights, and avoid heavy training, intense exercises, and competitive classes.
- Eat well – plan ahead and make healthy, well-balanced dietary choices.
- Say ‘No’ to social engagements and extras at work if possible when you need a break.
- Surround yourself with people who lift you up. Choose positive, supportive people.
- Nurture your partnership – infertility and miscarriages are extremely difficult on couples. You are in this together – be kind and supportive to each other.
- Ask yourself, ‘What am I going to do for myself today or this week?’
How to Cope with Miscarriage
To summarize, dealing with miscarriage and recurrent pregnancy loss has been compared to dealing with chronic disease and even cancer. With both scenarios, similar feelings of frustration, isolation, and questions like ‘Why me?’ surround these journeys. But, the reactions from friends and the support provided can be different. As a society, we know what to do when someone gets cancer – we have meals to organize and flowers to send. For people suffering with recurrent pregnancy loss, the standards are not as established and couples often suffer in silence.
Most miscarriages are in the first trimester, before people are physically showing pregnancy and before they announce it publicly. When miscarriages do occur, women so often feel guilty in some way that they don’t want to share with friends and family. Even worse, when people have the courage to share, they can get awkward and sometimes painful responses from family and friends. Hearing advice or other people’s stories can add to the guilt and shame, even when it is intended to help.
Find the support you need and take care of yourself through this journey!
- Farren J, Jalmbrant M, Ameye L, Joash K, Mitchell-Jones N, Tapp S, Timmerman D, Bourne T. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study.BMJ Open 2016;6:e011864.
- Kong GW, Chung TK, Lai BP, Lok IH. Gender comparison of psychological reaction after miscarriage-a 1-year longitudinal study.BJOG 2010;117:1211-9.
- Liddell HS, Pattison NS, Zanderigo A. Recurrent miscarriage–outcome after supportive care in early pregnancy.Aust N Z J Obstet Gynaecol 1991;31:320-2.
- Musters AM, Taminiau-Bloem EF, van den Boogaard E, van der Veen F, Goddijn M. Supportive care for women with unexplained recurrent miscarriage: patients’ perspectives.Hum Reprod 2011;26:873-7.
- Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Lossby Dr. Lora Shahine. An evidence-based but easy to read guide to testing, treatment, and emotional healing for recurrent first trimester miscarriages.
- Not Broken Illustrated: A Gift for Those Who Have Suffered Pregnancy Lossby Dr. Lora Shahine. A gift of beautiful illustrations and supportive words to give some you know who has had a miscarriage or still birth including a list of resources for emotional support in healing.
- Finding the Rainbowand other books by Rachel McGrath. Memoirs and one woman’s journey towards her rainbow baby.
- https://resolve.orgPatient centered support website with information and links to support groups throughout the United States
- http://rtzhope.orgWebsite with support information for grief surrounding miscarriage.