Losing a pregnancy hurts on many levels. It can be physically uncomfortable to downright painful, but the emotional aspects of a miscarriage are far more profound, multifaceted, and often require more time for resolution. Whether a woman is newly pregnant or farther along at the time of miscarriage is irrelevant - loss is loss. And with any loss, comes grief.
Once the OB provides a due date, we naturally construct a mental image of what life with a baby will look like, and thoughts about a new family flood our minds. Then when the pregnancy ends prematurely, a woman is left to grieve the actual loss along with this theoretical future family that will never be. It’s a double whammy.
Grief after miscarriage is similar to any other form of loss, and it conforms to the well known Kubler-Ross Grief steps, with a few alterations. Women often progress forwards and then take steps back before moving forward again and eventually feeling relatively comfortable with the past and the new normal. It can be difficult to process feelings about miscarriage because partners often experience grief at different speeds and may express their feelings in different ways.
Furthermore, it can be hard to talk about a loss with friends and family, many of whom will likely be unsure what to say and, with good intentions at heart, will end up saying something that feels disingenuous or preachy that inadvertently can be irritating or even hurtful to a woman who recently miscarried.
As a result, women often report feeling highly isolated and alone in their grief, which is unfortunate and unnecessary considering that one of two women have miscarried. Finding other women who have similarly suffered a miscarriage and can be there for you to empathize and provide a shoulder to cry on is incredibly helpful. Grief-based support groups in person and online often function to provide a safe place for women to open up about their feelings and begin to process and heal. If you or someone you know have recently gone through a miscarriage, it’s important to understand the chain of reactions that may follow.
So to mark Pregnancy and Infant Loss Awareness Month and shed light onto this particularly difficult time in someone’s life, here are the 5 stages of grief after a miscarriage.
1. Shock and denial. Being told there is no heartbeat on ultrasound or that miscarriage is inevitable often feels like a punch in the gut, followed by a sense of disbelief. How is it possible? Just a moment ago this pregnancy was real, and now my world is crashing down. All I had to do was pee and instead there’s blood everywhere. Why? This can’t be right.
Feeling as though one’s head is spinning or that you’re in a cloud is normal, as is the desire to confirm the doctor’s finding once or twice or more times because of disbelief. Many women continue to experience transient nausea until hormone levels drop, making it hard to believe the pregnancy has ended. If a pregnancy is far enough along, women may misattribute gas or cramping to phantom kicks, which also reinforce this sense of denial.
2. Anger. Why my pregnancy? Why my baby? Some women externalize anger: ‘I did everything right, I took my prenatal vitamins and I ate well. This isn’t fair...’ Others may be angry at themselves, wishing they had done things differently, despite being told and knowing on some level that miscarriage is not her fault. Women may be irritable and angry with their partners for not understanding their experience or for not having the same degree of reaction or response as they are. They may also be angry at her friends who have had babies despite realizing this is not logical.
Even the most rational woman may be very easily angered and hostile at those around her, seemingly without cause because she is angry at the situation. Miscarriage is not fair, it doesn’t make sense, and it is a good reason to be angry -- so when a woman is pissed, it’s ok. Don’t try to stifle the anger, just understand that it’s because a wanted pregnancy is gone and not really directed at the people who are trying to be supportive and loving and are grieving also.
3. Bargaining stage. ‘If I eat only organic foods, remove all chemicals from my makeup and skin care products, and keep all toxins out of my house, then my next pregnancy will be ok, right?’ This period is notable for looking for ways to right the wrong, to find a reason and to remedy it. The notion that a miscarriage can occur without cause or that one cannot prevent it is highly upsetting, and this stage is focused on fixing things. This is a time where women search for answers and try to make it all better. In fact, it’s not uncommon to try to conceive right away during this time while all is seemingly perfect, and then to be incredibly frustrated if things don’t go as planned.
4. Depression. This time is characterized by awareness of the magnitude of the loss and that nothing can change the past or can inherently ensure the future. Women frequently isolate themselves, even from those who want to help, and feel as if they are the only ones who have ever experienced such grief. They often have low energy and little motivation during that time.
The severity of the depression depends on a woman’s experience and likely on if she is otherwise prone to depression and other psychiatric illnesses. If this stage is severe enough to negatively impact daily life for more than several days or if there’s any thought of self-harm, please reach out for help from a trained mental professional. Ask your OBGYN for a referral or go to postpartum.net to connect with a local coordinator who can help you find a perinatal and reproductive psychiatry trained clinician in your area.
5. Acceptance. The magnitude of the grief begins to lessen over time. Eventually, days will pass without thinking of the miscarriage, which can cause guilt. This sometimes throws a woman back to a lower step such as anger or depression. But, that’s ok - the idea is to move forwards along the process at your own pace. Eventually, this loss will be a part of your story without defining your life or being the focus of your thoughts, day in and day out. The memory never goes away, but the sharp pain fades with time.
Dr. Carly Snyder is a reproductive and perinatal psychiatrist with a unique approach that combines integrative medicine-based treatments. She maintains a private practice in Manhattan and specializes in women’s mental health. Dr. Snyder is a frequent lecturer on the subject of Women's Mental Health and Wellness and has received extensive medical training from New York University, Beth Israel Medical Center, and Payne Whitney Women’s Program at New York Presbyterian Hospital – Weill Cornell Medical Center. She is also an executive board member for Postpartum Support International. Her weekly radio show, "MD for Moms," can be heard Wednesdays at 1pm ET on the BBM Global Network and TuneIn radio, or anytime on BBMglobalnetwork.com/MD-for-moms. Dr. Snyder’s HuffPost parenting blog shares the MD for Moms moniker. Dr. Carly resides in NYC and the North Fork with her husband and three awesome children. In her free time you can find Dr. Carly training for a marathon, skiing or gardening.