Although miscarriage is a reasonably common event – one in four women will experience it – coping psychologically with a miscarriage can be far from easy. Having a pregnancy confirmed is often a time of exquisite joy, especially if a couple has been trying to conceive. Emotions, dreams, planning and excitement all start building from the moment a pregnancy test is found to be positive. But just as quickly, this can all turn to disappointment when a miscarriage occurs.
Depending on the stage of gestation, how a miscarriage is managed may vary. If it occurred very early on and has been diagnosed as “complete”, then dilatation and curettage (D & C) may not be necessary. However, this is usually attended after a woman has a miscarriage, as it helps to clear all of the products of conception and reduce the risk of infection and prolonged bleeding.
One of the issues with miscarriage is that it is often seen as a medical issue rather than an emotional one. In the first trimester of pregnancy, the baby is still referred to as “the embryo” or “foetus”, rather than “the baby”. Though for expectant parents, it has already become a baby and not simply a group of tissues with the potential to become one. In the rush to deal with the medical management of bleeding, ultrasounds and confirmation of miscarriage, it can be easy to overlook the emotional side. Grief when a pregnancy is lost is not proportional to the weeks of gestation. You have a right to grieve for your own unique baby in your own unique way. Avoid feeling you need to justify this to anyone, even yourself. Grief has a biological basis and is deeply influenced by our life experiences and expectations, hopes and fears.
Recognising the feelings of loss and grief which parents may be experiencing is somehow easier when a baby has been stillborn or lost within the 2nd or 3rd trimesters of pregnancy. But even though the pregnancy may not have progressed for as long, the intensity of sadness may be just as real. We are all unique and comparing ourselves with others is generally not useful.
It may sound like an old cliché, but time really does heal. When in the midst of sadness, it can be difficult to feel there will be better days ahead but this is almost always the case. Talking to friends and family about the baby and how you feel will help. But it’s important to do this when you feel ready and not because you have a sense of having to. It is normal to feel a state of shock and just “needing to get through” what has to be done in the early days after miscarrying. Bleeding and pain during pregnancy can be very frightening and come as a complete surprise, to focus on what is important and prioritise your health is vital.
Give yourself permission to grieve. How you do this will be very individual; perhaps you have never felt grief or lost someone close to you before. There is no prescription for how and when grieving needs to happen. Some days you may feel fine and on others feel overwhelmed with sadness. Go easy on yourself. Trying to force yourself into just “getting over it” is likely to create feelings of unresolved loss later on. Be kind to yourself and don’t overlook the basics. Eat and sleep well, look after your hygiene and grooming. Making the effort to get out of bed and shower, change into clean clothing and eat a meal may seem like an insurmountable hurdle, but it will make you feel better.
Grief is a normal process and includes a shifting of emotions such as denial, anger, bargaining, depression, and acceptance. Grief felt after the loss of a baby from miscarriage or other event is not necessarily depression and while there may be some overlap, it should not be treated as such. If you feel angry one day and dissociated from your loss the next, this is normal.
You may want to isolate yourself for a short while, just to feel centred again. When a miscarriage occurs, you’ll find that lots of people are involved in decisions around your life. Doctors, ultrasound technicians, hospital staff and even pathology services attain importance for a short, sharp period of time. After miscarriage, there can be a sense of being very alone and no longer the focus of anyone’s attention. Aim to see this as a quiet oasis of time just for you.
You may like to create some sort of memorial for your baby. For some parents this is in the form of planting a tree, perhaps one which blooms at the time of year the miscarriage occurred or when your baby would have been due. A special piece of jewellery, keepsake, a book of poetry can all help to create tangible links which help to maintain a connection with the baby. Some parents choose to keep very private links with the baby they have lost and not feel the need to share this with others. For some, trying to move on and not maintain an external connection is more personal and simply right, no explanations are required.
Joining a support group can be extremely useful. This can either be on-line or in face to face groups or via telephone support. The benefits of shared experience can really help to not feel so alone. In the midst of sadness it is very common to feel as if no-one has ever experienced the same emotions. But a few well chosen words, talking honestly and perhaps sharing some helpful hints to get through each day can be infinitely soothing.
Don’t overlook the support of other women, particularly those of an older generation. Our current understanding of the importance of talking about grief and not bottling it up has not always been the practice. In years gone by, when a woman had a miscarriage or her baby died, they were told to “just get over it”. Great comfort can be gained from those who are genuinely empathetic.
Have some time off work; you don’t even need to explain why. Trying to resume normal life and leisure activities too soon after miscarriage can be destructive. Even if you feel you are fine and on top of things, a few days off just to recover physically is beneficial. A doctor’s certificate can cover human resource management requirements and help give validity to your absence.
Consider going away for while. Breaking old routines of behaviour and literally having a change of scenery can help to break the cycle of despair. Go somewhere beautiful, reconnect with your partner, do something you’ve always wanted to do. Aim to make this a time of gain in some way, rather than it being solely about loss.
Write in a journal and externalize what you are feeling. The purpose of this is not so it can be read by anyone but yourself; in fact, you may even find it too challenging to look back on. But over time, it can be really useful to see how far it is possible to come from feeling so sad.
Keep busy. There is a certain amount of truth in the benefits of keeping busy and not being idle. Give yourself some time to grieve and put other things on hold. There will come a time when the rest of your life will start to pile up and need your attention to gain control over again. Exercise, sport, a pastime which requires a lot of focus can all be useful. If you find your concentration is flagging, try to build up gradually to a comfortable level. Recovering from a miscarriage is similar to other major life events.
Make a point of saying goodbye to your baby. This could be in the form of a service, a gathering with your family or just a few moments of quiet reflection with your partner or even alone. No matter what stage of gestation the miscarriage occurred, your baby will have reflected and symbolized a great deal. Acknowledging this and allowing yourself to move forward will be very healing.
For more information and support, see your General Practitioner, midwife or health care professional. You can also visit http://cope.org.au or http://www.sands.org.au, or call the SANDS helpline on 1300 072 637.