Mental Health and Miscarriage: Supporting Yourself and Others through Pregnancy Loss
Let’s be real, the conversation of miscarriage is not an easy one.
Anyone who has gone through a fertility journey knows the ups, downs and complicated emotions that journey can bring all too well. And of course, that moment where you get a positive pregnancy test, can quite literally, change everything.
Anyone then who has lost those pregnancies understands all too well the other emotions that follow. The grief, the heartbreak, the loss of more than just the pregnancy, but of the plans, the expectations, the hopes that were made for the future.
And everyone processes that differently. For some, talking about the experience is just too painful. For others, sharing their story is an important part of their healing. Many others fall somewhere between the two, or aren’t quite sure how to process it all.
The reality is that with up to 1 in 4 women experiencing miscarriage at some point in their lives, it’s likely that you or someone else you know have experienced pregnancy loss. Yet, even with these harrowing statistics, mental health support especially after pregnancy loss remains largely under supported and under-discussed. While it’s not an easy one, having the conversation about pregnancy loss is important and one we need to have.
So let’s talk about miscarriage and shed some light on this conversation that often feels taboo. Let’s discuss the mental health challenges that may arise after pregnancy loss, and talk about what it looks like to support yourself and others navigating this type of loss.
The Realities of Pregnancy Loss
It’s important to realize that the term “Pregnancy Loss” encompasses miscarriage, abortion and fetal loss and represents one of the most common adverse pregnancy outcomes. It is estimated that around 15-25% of clinical pregnancies in Canada end in miscarriage, occurring before 20 weeks gestation with a spontaneous death of an embryo or fetus.
“Early pregnancy loss” is considered to occur before 10 weeks of pregnancy, while “Late abortion”, “Late miscarriage” or “Fetal miscarriage” occurs between 10-22 weeks gestation. “Fetal loss” or “Stillbirth” is used following a loss greater than 22 weeks gestation. “Recurrent miscarriage” is often used after 2 or more consecutive miscarriages, or in cases when 2-3 or more miscarriages occur, nonconsecutively. It’s important to use these terms appropriately as we can, as this can help to show acknowledgement in the type of loss someone has experienced, and further help to understand the mental health implications that come from their unique loss.But more importantly, it is best to ask the person how they would refer to their experience of loss and use terms such as “baby”, “your child” or the name of the baby to further help acknowledge their loss if preferred. While there have been documented differences in some of the mental health challenges that occur for these different types of pregnancy losses, it’s important to realize that everyone’s experience is different, important and not more or less significant than any other loss.
Mental Health Challenges Following Pregnancy Loss
So of course, we can recognize and understand that the emotional aftermath following a pregnancy loss can be significant and overwhelming. However, it’s important to understand what types of experiences and emotions may come up for someone you know experiencing this type of loss, and to recognize that these emotions are not abnormal to those experiencing it themselves. So let’s talk about what some of these mental health implications to pregnancy loss can look like:
Grief
Miscarriage is a unique form of loss in which you are grieving someone you never met, yet for some time, were closer to you than anyone else. Grieving is a natural response to this loss and may come with feelings of sadness, anger, or even guilt. It’s okay to experience the ebbs and flows that come with grieving a pregnancy loss, and to realize that grief is not at all linear. In the initial weeks after a loss, it’s often also hard to distinguish symptoms of grief from depression, so seeking further support to help process these emotions can be helpful.
Anxiety and Depression
It has been suggested in some studies that the prevalence of depression in the 1-2 months following a miscarriage can be as high as 22-36% with rates of anxiety tending to be higher than those of depression at 12 weeks after a miscarriage. While rates of anxiety and depression tend to gradually decrease over time following a pregnancy loss, it has been suggested that mental health recovery can take 2-4 years or more. It is important to realize that both the pregnant person and the partner can experience significant mental health challenges following a pregnancy loss with some studies estimating that over 70% of affected women and 66% of their male partners experience anxiety, and 51% of affected women and 19% of their male partners experience depression following recurrent miscarriage.
In supporting someone through a pregnancy loss, or experiencing one yourself, it’s helpful to know that anxiety and depression are common experiences shared by those encountering this type of loss, and to seek additional mental health support as needed during this time.
Other Mental Health Challenges
Many individuals experiencing pregnancy loss experience a sense of stigma to the conversation which shows up in social and medical settings alike. This sense of taboo over the conversation can lead to prolonged feelings of isolation and the sense of this loss being insignificant. Additionally, experiences of PTSD, substance use and suicide are important mental health challenges that can follow pregnancy loss, so further support is needed to open up the conversations about mental health following pregnancy loss for this reason.
As always, it’s important to not look at these possible mental health struggles and compare one experience to what is “expected” or to anyone else’s process. Everyone’s experience is unique, and what’s most important is that the person going through the loss receives the support they need to process the experience.
How to Support Those Experiencing Pregnancy Loss
Supporting someone through a miscarriage can be challenging but incredibly important. Some of the most protective factors documented in reducing mental health challenges following pregnancy loss include support from partners, families, communities, employers, and professional services. If you know someone experiencing a pregnancy loss, here are some ways you can help:
Listen
Sometimes, the best support you can offer is simply to listen, letting them share their feelings without trying to fix or minimize their experience.
If you aren’t quite sure what to say in response to someone’s loss, just being present and willing to listen is often best. If what you are about to say to them sounds cliche in your mind, it will definitely sound much worse to the person receiving it. Phrases like “don’t worry, you will get pregnant again”, “At least you have some children” or “Everything happens for a reason” can come with good intention, but can be incredibly hurtful for someone experiencing a loss and grappling with the uncertainty of future pregnancies. Something as simple as “I don’t have the words to say, but I’m really sorry for your loss” or crying with the person if it feels sincere to do so, can often go a long way.
Acknowledge Their Loss
Recognize that their loss is significant, and use terminology to describe their loss based on their preferences. They may prefer for you to know and understand the technical terms related to their loss, or using terms like “baby” or the name of their child instead.
If it feels sincere for you to do so, ask if there’s anything they would like to do to honor this child’s life and their loss. An offer to host a memorial, ceremony or funeral can sometimes help the person know that their loss is significant to you, while being respectful of the decisions they make in how they would like to grieve this loss.
Offer Practical Help
Some of the most helpful support for someone experiencing a pregnancy loss can be to offer to assist with daily tasks, whether it’s cooking a meal, running errands, or helping with childcare. At times especially during the initial weeks following loss, it can be difficult for someone to ask for help, or they may not even know what they need, but dropping off a meal or sending a gift card to get a meal can go a long way.
What to Do If You’re Experiencing Pregnancy Loss
If you are navigating the pain of a miscarriage, first of all, I am deeply sorry for your loss and hope that you know that you are not alone in this. While everyone’s process and experience after a pregnancy loss looks different, here are some helpful steps to consider as support through your on healing journey:
Take Time to Grieve
Honor your feelings and give yourself permission to grieve realizing that grief doesn’t have a timeline and can come in waves. Check in with yourself and see whether taking time off work will be helpful in your grieving process, or whether work is a helpful motivation to move forward – everyone is different in this. But if taking time off is helpful for you, spend that quality time with your partner and give yourself both permission to cry, get angry, process and grieve however you need to.
Build a Good Support Network
Surround yourself with compassionate friends and family, and seek out support groups where you can share your experience with others who understand. For some, sharing their story with others who have experienced the same thing can be incredibly healing, as I have heard it said “welcome to the sisterhood that none of us chose to be in, but are bonded together through it”. There are times when the grieving process can feel incredibly isolating, but seek people who will be willing to check up on you and help you to feel less alone through it.
Create a Team of Practitioners
Engage in a care team that may include a Naturopathic doctor, Counselor, and Doula in addition to your Primary care provider. It is suggested that around 90% of women desire specific follow up care from their physicians, but only around 30% of them receive this attention. Having a multi-faceted approach and multiple practitioners you trust can help you address the aspects of physical and emotional healing that you need to support you through this loss.
Share Your Story
If you feel comfortable, sharing your experience can help you process your feelings and might provide comfort to others going through similar situations. You may not feel right away that you are capable of sharing your story given how raw the emotions are, and that’s okay. Be kind with yourself in the process, and if it feels right to share, then do so.
Create a Memorial
Given that a pregnancy loss can often feel like a more “invisible” loss than others, consider creating a small memorial to honor your loss. This could be planting a tree, having a funeral or memorial, creating a scrapbook, or getting a piece of jewelry with the birth flower/stone. This can be a practical way for you to honor the loss of this little life in a more tangible way.
Address Physical Symptoms
While mental recovery is significant following a pregnancy loss, there are still significant physical changes that your body experiences as well including symptoms of fatigue, bleeding, acne, and hormonal changes that you may want extra support for. Naturopathic treatments, such as herbal remedies, targeted supplementation and nutrition support, may be able to support your recovery on an individualized basis, so speak with a Naturopathic doctor to see how they may be able to support you in your recovery.
Seek Professional Guidance
It is normal to have a myriad of questions following a pregnancy loss, especially regarding the potential outcomes of future pregnancies. While 50-60% of miscarriages are estimated to be due to chromosomal abnormalities, other risk factors may influence these rates including uterine lining and structural abnormalities, hormonal concerns, infections and microbiota influences, sperm or egg DNA damage, underlying blood conditions, environmental factors and more. While there are often times when there isn’t a clear answer to why a pregnancy loss occurred, working with a fertility-focused practitioner can help answer some potential questions and provide some clarity on possible treatment options to support future pregnancies when the time comes.
In Conclusion
Miscarriage can often be hard to talk about, but the more that we foster open conversations about pregnancy loss, we can break the silence, support one another, and decrease the stigma of such an important experience. If you or someone you know is navigating this journey, remember: you are not alone, and there are resources and support available to guide you through this loss.
Dr. Heather Elford, Naturopathic Doctor, Doula – Booking Link
References
- Van Tuyl R. (2024). Improving access, understanding, and dignity during miscarriage recovery in British Columbia, Canada: A patient-oriented research study. Women’s health (London, England), 20, 17455057231224180. https://doi.org/10.1177/17455057231224180
- Cuenca D. (2023). Pregnancy loss: Consequences for mental health. Frontiers in global women’s health, 3, 1032212. https://doi.org/10.3389/fgwh.2022.1032212
- Nynas, J., Narang, P., Kolikonda, M. K., & Lippmann, S. (2015). Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers. The primary care companion for CNS disorders, 17(1), 10.4088/PCC.14r01721. https://doi.org/10.4088/PCC.14r01721
- Mergl, R., Quaatz, S. M., Lemke, V., & Allgaier, A. K. (2023). Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths–A systematic review. Journal of psychiatric research.
