According to the Centers for Disease Control and Prevention (CDC), a miscarriage refers to a loss before the 20th week of pregnancy, while a stillbirth happens at 20 weeks of pregnancy and later. The CDC estimates that approximately 24,000 babies are stillborn in the US annually. And while information about pregnancy tends to be directed at women, it is worth noting that this can be experienced by anyone with a uterus, so pregnancy loss may similarly affect a variety of genders.
Losing Multiple Pregnancies
Trish, a 34-year old Black woman, based in San Jacinto, CA, shares her two experiences of pregnancy loss. “I was 17, going on 18 when I experienced my first pregnancy loss. I was a senior in high school and a live-in nanny. I was used to caring for children but was in no way ready for my first child. I found out I was pregnant and was in complete shock,” she says. At that time, Trish reflects that the stress of having ended the relationship with the baby’s father and the reality of still being in high school ultimately caused a miscarriage. “Although relieved, I felt shame in the fact that my body failed at supporting life,” she says. With her second pregnancy, Trish says, “My mind spiraled with the second loss. I couldn’t figure out why my body refused to carry a child. I ate healthily, was active, took my medication, and relaxed often. Yet, I still couldn’t keep a baby within my womb.” A 2016 study in the Journal of Women’s Health found that bereaved participants showed high levels of mental health distress nine months following a perinatal loss with limited rates of treatment. Trish shares how she went on anti-depressants to help with her mental state following that second pregnancy loss. “I eventually tried and succeed in having a child but not without complications and more stress than anyone should have to endure,” she says. While she currently has a 13-year old and recently decided to try for another child, Trish wishes more people understood the high likelihood of pregnancy loss. “Sometimes our bodies don’t carry babies to term for a reason, and sometimes it’s just not our time,” she says. Trish notes, “My stress levels are already heightened because of previous loss. I’m glad I had a strong support system while I was grieving my pregnancy loss because so many don’t have the support they need and it ends badly. Don’t be afraid to reach out to your healthcare provider.”
Grieving Such Loss
Psychotherapist, Haley Neidich, LCSW, PMH-C, says, “Pregnancy and infant loss is a reverberating trauma that is felt throughout the entire family. From the moment one finds out they are pregnant the idea of the child becomes fully realized in their heart and mind.” Neidich explains, “Not only is the loss itself traumatic, but the experiences with medical providers and the medical aspects of the loss can compound the trauma. This is especially true for people of color who more frequently experience trauma and discrimination at the hands of medical providers.” People who lose a pregnancy or infant may often present with symptoms of depression, anxiety, insomnia, and Post-Traumatic Stress Disorder (PTSD), so Neidich says, “They need to be given the time and space by loved ones to grieve this loss just like any other death in the family would be grieved.“Since the pandemic has increased isolation for many pregnant people and their families, Neidich notes, “Grief and loss is a community familial process, and not being able to hold and feel the comfort of those in their lives is deeply painful at a time where they need it the most.” In terms of the pandemic, Neidich explains how it may create a deeper sense of loneliness that can compound mental health issues for those who lose an infant or pregnancy. “Anyone who has experienced pregnancy or infant loss would benefit from talking to a psychotherapist who specializes in working with the perinatal population,” she says. Neidich highlights, “Postpartum Support International has a pregnancy and infant loss support group, a warm line for support and to receive guidance for accessing ongoing care. They also have a specialized coordinator to make sure that people are connected with the right services.“Grief is not a linear process, so Neidich encourages individuals to be gentle with themselves during the time it takes to heal. “Many families benefit from a service or ritual to commemorate the loss, like planting a tree in the yard or having a special piece of jewelry made to honor the loss,” she says. Neidich notes, “I want the public to understand how common pregnancy loss is: 1 in 4 pregnancies end in loss. It is important to understand when someone has lost a pregnancy or infant that being present for them and allowing them the space to truly grieve is essential.” While some may try to gloss over pregnancy loss or try to make it better with platitudes about trying again or what is in God’s plan, Neidich shares how these are the things that people cry about in her office. “What people need during this time is for someone to acknowledge their pain and sit with them in it and that’s very uncomfortable for people to do,” she says.
Infertility After Miscarriages
Mary Beyer, a 31-year old white woman, based in Indiana, says, “I have had three miscarriages that I know of because most people with uteruses will have at least one in their lifetime that is undetected.” Beyer describes her first as a few months into dating her now-husband when she was 22, which she estimates was between 6-8 weeks along in the pregnancy, but she did not know she was pregnant until the miscarriage. “That was very difficult, dealing with the new knowledge that I was pregnant but also losing it at the same time,” she says. Navigating medical care was also traumatic. Beyer explains, “I was alone throughout most of it. I went to the ER a few days later where I was verbally abused, left in a room by myself for hours without my partner being allowed back, and when I specified I wanted a female physician they sent an older man in who was very rough and uncaring with the physical exam.” After this, Beyer wondered if there may be issues, and told her husband then that if he was not willing to do whatever it took for her to be able to conceive, then it would be best to discontinue their relationship. “He had a more optimistic outlook and said we should not freak out or worry until we knew for sure if there were going to be problems,” she says. Beyer notes, “With the second miscarriage, we were together for a few years and had started trying. I estimate about 8-10 weeks. We had suspected I might be pregnant and were planning to see a doctor the next week. At this point, we discussed fertility treatments and decided to undergo testing.” Since her husband had two children from his previous relationship, Beyer suspected the “unexplained infertility” diagnosis before it came. “We started fertility treatments in the fall of 2016, but when my specialists said our best bet was IUI or IVF, we stopped,” she says. Unfortunately, they could not afford tens of thousands of dollars upfront multiple times. “Still unwilling to give up, we kept doing what we were before—trucking cycles, timed intercourse, specialty diets, etc.,” Beyer says. Her last miscarriage was in June of 2019. Beyer further explains, “I knew I was pregnant from about six weeks onward. We told family and close friends. We were so excited. I went in for an ultrasound appointment in my tenth week and they couldn’t find the heartbeat.” Beyer had tried to see her obstetrician, but they would not see her until 12 weeks despite being high-risk, however, she began bleeding and cramping heavily before that. “This one was the most devastating as we had been planning and trying and preparing and knew I was pregnant,” she says. Prior to miscarriages, Beyer had suffered from anxiety and depression, and both conditions worsened with subsequent losses. “Between my second and third miscarriage, I began taking Zoloft and doing fertility treatments after being diagnosed with unexplained infertility,” she says. Beyer explains, “The struggle that I had with conceiving and carrying to term and the knowledge that I might not be able to do so when I have always wanted to be a mother, definitely heavily affected me.” Even though she acknowledges that it was not logical, Beyer struggled with seeing others become pregnant easily even after poor parenting. “It felt massively unfair that someone who wanted something so badly could not have it and other people will take advantage of it,” she says. Beyer wishes that pregnancy losses and infertility struggles were less taboo to discuss, and that more resources were readily available to people, as she reflects on feeling alone and scared during her first miscarriage. “I didn’t know what was happening or how to alleviate it,” she says. Since she struggled to cope after, Beyer wants people to know they are not alone and there is no need for shame. “One in four people will experience pregnancy loss and one in eight struggle with infertility,” she says. Beyer further reiterates, “They are both a lot more common than you think, and I’ve realized so many people I know have also struggled with one or the other, since I started being open about it.”
No Right Way to Feel
Neuropsychologist and faculty member at Columbia University, Sanam Hafeez, PsyD, says, “Miscarriages can cause grief, depression, and anxiety, and these effects can last anywhere from one to three years.” Hafeez notes that those who have experienced such loss can develop depression, anxiety, PTSD, etc., and blame themselves for what happened, or fixate on what they would have done differently to prevent the loss. With respect to the pandemic, Hafeez highlights the impact on challenges of pregnancy and infant loss as many support groups moved online. “When a support group moves online, individuals in the group may feel it is harder to form an attachment to the group when the session is virtual,” she says. Hafeez explains that therapy also moved online, but some people prefer the in-person interaction to effectively communicate with a therapist. “The pandemic also forced us to isolate ourselves, and for some people, this meant spending weeks or months alone,” she says. Since individuals tend to feel alone after pregnancy and infant loss, Hafeez highlights how being physically alone can only exacerbate these feelings. “The trauma of the pandemic we endured also compounded feelings of guilt, isolation, loneliness, anxiety, depression, etc.,” she says. Hafeez encourages individuals to seek professional help if they have symptoms of PTSD, anxiety, or depression. “Speaking to a therapist can help lower physical and emotional stress, help you process your individual experience, and provide strategies to help you cope,” she says. Additionally, Hafeez notes that joining a support group may help to connect with others who have experienced pregnancy and infant loss. “Empowering yourself with knowledge about your loss may help you feel more in control of your situation if you understand what happened,” she says. “Losing a baby through stillbirth or miscarriage is a taboo subject around the world linked to shame and stigma. Many individuals do not receive the appropriate care when their baby dies. When you lose a baby, most people experience a wide range of different emotions,” says Hafeez. While individuals may go through sadness, confusion, anger, guilt, depression, loss of appetite, difficulty concentrating, etc., Hafeez cautions that there is no right way to feel after pregnancy and infant loss. “Receive support when you feel overwhelmed or out of control,” she says. “A therapist can help guide you through the grieving process. Remember to take time to heal and grieve. There is no set time for the healing process, and it is something that cannot be rushed.” It is understandable to feel shame, as Hafeez notes that some wonder if they were to blame. “It can be difficult to accept that you were powerless in preventing the loss, however, the reality is, there is likely nothing anyone could have done to stop the situation from occurring,” she says.
