Miscarriage (or spontaneous abortion) is common, affecting an estimated 10-25% of pregnancies. And its emotional impact is often underestimated and hidden. Historically, there has been a cultural stigma around the topic of pregnancy loss, leaving many to suffer in silence. People may feel isolated, ashamed and experience self-doubt, wondering if their distress is an overreaction.
In fact, many experience a range of painful emotions after miscarriage, including grief, sorrow, loss, anger, loneliness, and inadequacy. It is common to feel guilt (up to half of people) and shame (28% in one study). It is therefore important to understand that these feelings are natural and are normal reactions to a significant loss.
After a miscarriage, it is common to want to know why, what exactly went wrong. (Usually there is no clear explanation, but the desire for one reflects our human discomfort with uncertainty and lack of control over future events). However, this often leads to a process of reviewing past actions to find something you did “wrong” that might have caused it. Or wondering if the pregnancy loss is a punishment for a “bad” thought or past behavior. Or even as basic as blaming yourself for a “defective” or imperfect body.
People may wonder “what is wrong with me?” and “What did I do to deserve this?” They may be ashamed of their anger or of feeling envious and resentful of others who seem to have children easily.
Our culture of secrecy around miscarriage (almost a taboo topic) can breed shame. Traditionally, the advice has been to wait to tell people until the end of the first trimester. However, most miscarriages occur before then, leaving couples to experience the loss alone. In reality, many have been through the experience and are often eager to talk about it; sharing these stories with others can be mutually comforting and reassuring.
The grief of a lost pregnancy is a unique type: an invisible loss, the loss of a baby-to-be, of the dream of parenthood, of an envisioned future. It is felt by the couple as the loss of a child, but often not acknowledged as such. There are no established rituals or ceremonies to mark the loss. People often feel internal or external pressure to get past it, to jump back into their lives, their pain minimized. Conversation about the topic can be awkward; people don’t know what to say.
The grief of miscarriage is also often complicated by anxiety, uncertainty, and fear. There is fear of never being able to carry a baby to term; that your body is inadequate (especially for women who do not yet have children). There is uncertainty about one’s reproductive capabilities and worries about the risk of future miscarriages, questions that may not have clear answers. People often then experience intense anxiety and conflicting emotions in future pregnancies.
Distress usually improves gradually over the first 6 weeks to several months after miscarriage. However, approximately 25% of people may experience ongoing adjustment issues after miscarriage. Some develop clinical levels of depression, anxiety, or even PTSD symptoms. Risk factors for higher levels of distress include: a history of infertility; longer periods of time trying to get pregnant; not already having children; prior miscarriages; a planned pregnancy; and sudden unexpected loss (no prior signs of problems).
It is also important to recognize that partners also experience loss and grief, but may feel even less comfortable revealing it. Partners may feel they have to be the “strong” one, providing comfort instead of receiving it. And relationships may be strained by the loss.
It can be very helpful to talk to someone, to share painful feelings; in addition to providing comfort and support, this can combat the sense of isolation and shame. If distressful emotions remain intense after talking with family member and close friends, consider seeking out an individual or couple’s therapist. And if you know of someone who has experienced pregnancy loss, don’t avoid talking with them. A good approach is to ask how they are doing and listen in a way that opens up space for them to share their feelings if they choose to.
Fortunately, people are beginning to talk more openly about pregnancy loss. It helps when celebrities reveal their own experiences.
In 2018, Michelle Obama discussed her miscarriage experience on Good Morning America, saying, “I felt lost and alone, and I felt like I failed. Because I didn’t know how common miscarriages are. Because we don’t talk about it. We sit in our own pain, thinking that somehow we’re broken.” And “That’s one of the reasons I feel like it’s important to talk to young mothers about the fact that miscarriages happen.”
Beyonce has also opened up about her miscarriage: “…, I was pregnant for the first time. And I heard the heartbeat, which was the most beautiful music I ever heard in my life.” But at a subsequent appointment, the heartbeat was no longer present. “I went into the studio and wrote the saddest song I’ve ever written in my life. … And it was the best form of therapy for me, because it was the saddest thing I’ve ever been through.”
