The Emotional Impact of Miscarriage
Printer-friendly versionSharon Kader, RN, BA, MA (C)OACCPP, OPQ
Summer 2008
“For some life lasts a short while, but the memories it holds last forever.”
- Laura Swenson
Miscarriage is a cruel twist of fate. The reality of death before birth is an affront to our beliefs and expectations regarding the cycle of life. Miscarriage is all too often misunderstood by those who have not experienced it personally: family, friends and society in general. People tend to minimize the personal significance and emotional relevance of miscarriage, limiting it to the woman or couple going through it. However, this is very understandable given the personal nature of miscarriage and the quest for a child in general. Planning, conceiving and having a child all mean different things to people. Not everyone possesses immediate firsthand knowledge of miscarriage in particular and pregnancy loss in general. Given their lack of personal connection to this situation and the fact that they are probably dealing with multiple stressors in their own lives, people who have not had the experience of miscarriage may not be motivated to empathize with women and couples who have miscarried. Although the stresses inherent in modern life can be perceived as positive and negative, people tend to focus on getting through their day. It is not customary to ‘step into someone else’s shoes and walk a long mile with them,’ unless your situation is their situation. With the modernization of medicine and the advent of Assisted Reproductive Technologies, people may think, ‘well, you can always try again, such is life,’ without expressing very much feeling or intuition.
Although miscarriage is a physical and emotional experience that women and couples go through, it is often referred to as ‘an ordeal’ or ‘a nightmare.’ I have been counselling couples for over ten years who experience infertility or who undergo a wide gamut of fertility treatments in their quest for a child of their own. The medical interventions can be painful, anxiety-provoking, and difficult to withstand, as they require an inordinate degree of patience and fortitude. Couples who experience infertility or pregnancy loss after fertility treatments are continually confronted by feelings of anguish, torment, despair, self-blame, guilt, shame, depression and anger over their unrealized dream. The experience is often an emotional roller-coaster ride that starts with despair, turns to hope mingled with fear at each intervention, and then back to despair with each pregnancy loss or normal menstruation. The stamina and perseverance of both partners in withstanding this difficult emotional state while they continue their efforts at fertility intervention is a testimonial to their bravery, courage and love of family.
Pregnancy loss is an experience for some couples and individuals who undergo IVF treatments. Preliminary results reported from a total of 23 out of 25 IVF centres across Canada (2006) consisting of a combined total of 7506 IVF treatment cycles (including ICSI) validate the theory that a woman’s age does indeed influence pregnancy rate. The overall pregnancy rate was 32% per cycle commenced. The pregnancy rate for women under 35 years of age was 39%, for women between 35-39 years of age the pregnancy rate was 32% and for women 40 years and above the pregnancy rate was 17% (The Canadian Fertility and Andrology Society, Press Release, 2007).
Miscarriage can wear different hats and can result from different avenues. Miscarriage or unintended pregnancy loss, otherwise referred to in the medical community as ‘spontaneous abortion,’ can arise from conception in the usual way or it can occur with Assisted Reproductive Technologies (ART). Miscarriage usually refers to pregnancy loss within the first twenty weeks of gestation. The miscarriage rate for IVF (including ICSI) is approximately 16% per clinical intrauterine pregnancy. This closely resembles the overall miscarriage rate for natural conceptions (The Canadian Fertility and Andrology Society, Press Release, 2007). The majority of early pregnancy losses occur within the first twelve weeks of pregnancy. It is difficult to have an accurate reporting of early pregnancy loss given that a miscarriage can occur as early as the first six to eight weeks of pregnancy, often before the mother herself discovers that she was indeed pregnant. Sometimes the effects of a miscarriage are not physically apparent to the mother or discovered by medical technology until a few weeks after its occurrence. Therefore, the rate of early pregnancy loss is typically under-reported.
Pregnancy loss can occur from miscarriage, ectopic pregnancy, failed in-vitro fertilization, fetal reduction in multiple pregnancies, pregnancy loss of multiple foetuses in a multiple pregnancy, stillbirths and abortion. For the purposes of this article, we will explore the emotional repercussions of miscarriage and pregnancy loss in general given that the profound grief and deep sense of loss that is experienced is strikingly similar no matter where in gestation this occurs.
The cruel reality is that Mother Nature is far from perfect. The tragic element here is that as we are raised by our parents and influenced by society, this point is not really impressed upon us. As we grow, we form our fundamental beliefs and assumptions about life and how it generally works, and the tendency is to leave this crucial piece of information by the wayside. As a society, we do not focus on death and loss, partly as a way of dealing with the uncertainty and lack of control we ultimately have over our lives, and partly for survival purposes. If we have the choice, we tend to avoid purposefully inflicting emotional pain on ourselves and others. We are aware at an intellectual level that these facts exist, but we do not really believe that pregnancy loss can happen to us until it actually does. Our parents’ desires to keep us safe from the hurtful realities of life are well-intended; they fear that if we knew such harsh realities we would not attempt the frightening yet incredible journey of pregnancy, labour and delivery, and parenthood.
The emotional impact of miscarriage takes many forms. When a woman experiences a miscarriage or pregnancy loss, she also experiences a reproductive crisis. She may be a single parent or in a partnership; in either case, the experience is one of unspeakable loss. Pregnancy loss is typically surrounded by a heavy shroud of silence. People become very uncomfortable when they see someone they love and care for in turmoil and emotional pain. People do not know what to say or how to comfort their loved one who has experienced a miscarriage. This situation produces tremendous feelings of powerlessness over our own reproduction and among caring family and friends who are aware of this loss. We feel great sadness for a life unlived. Feelings of shame and embarrassment are common, and may in fact prevent us from telling our friends and relatives. In this situation the sense of isolation we experience is self-imposed. People who care cannot reach out to us, for they are not aware of our profound loss.
Men also suffer their experience of pregnancy loss in silence. Society is not very forgiving of a man openly grieving. Society tends to dictate that men need to be strong and give strength to their partners. Men also feel a need to protect and save their female partners from their profound grief, and therefore tend to repress and deny their own experience of loss. Interestingly, what is often most disturbing for a man is not the pregnancy loss itself but rather the profound grief reaction that his wife or partner is going through. Witnessing this intense grief can often be overwhelming and threatening for a man. Couple counselling is often helpful under these circumstances.
Modern society also tends to exert pressure on couples who have experienced pregnancy loss to ‘stop suffering and move on,’ as if the natural grieving process has a dangerous allure to it and should be avoided with the same intensity as an anaphylactic allergy. Unfortunately, grief that has not been expressed can translate into feelings of deep sadness, and lead to excess weight gain and psychosomatic complaints such as body aches, pain and headaches. We tend to push our grief to the periphery of our existence, but its impact is felt in our daily interactions. Our grief often makes its presence known in a disguised form, such as a more cynical outlook on life, a quick rise to anger over seemingly minor stressors and difficulty empathizing with other people’s losses.
The natural grieving process will be difficult to carry out if a minimization of the event has occurred. Unprocessed grief can resurface even years after a traumatic event. A common trigger for this long-buried grief can be a loss or an experience that has a fundamental similarity to the circumstances of the original loss. This is why some adults who have been functioning well prior to a major traumatic event will have a tremendously hard time recovering from this stressor, while others will not have the same difficulties under similar circumstances.
When a woman discovers that she is pregnant she typically experiences a wide gamut of emotions ranging from intense anxiety to great exhilaration. Each pregnancy holds a special significance and unique meaning for each woman. This meaning is formed by the nature of the relationship with her partner, whether the pregnancy was planned or not, her age, work commitments and financial security. Just as important are her fundamental attitudes towards pregnancy, motherhood and her own earliest experiences of being mothered.
The news of a pregnancy, whether its occurrence stems from a long battle with infertility or happens quite early on, brings with it the promise of personal fulfillment and the potential for self-growth. It is not uncommon for a newly pregnant couple to articulate a desire to “not make the same mistakes my parents made.” A pregnancy can also arouse fears of abandonment. These fears may be predicated on a repetition of an unpleasant past.
When we are pregnant, it is very natural to fantasize about the baby we are carrying, even if we are pregnant for just a few days. These fantasies express some of our deepest hopes and fears regarding the lives of our future family. New losses tend to trigger long-buried and possibly forgotten feelings regarding earlier losses. This heightened state of emotional awareness can often overwhelm our sense of control over our lives. It is in this state that it is all too easy to scrutinize and blame ourselves for the outcome of the pregnancy loss, or blame our caregivers and medical team. ‘Maybe someone could have done something different or better. Maybe I should have tried a new hospital, doctor or city.’ It is very tempting to attribute blame. After all, we are intelligent beings and it is human nature to try to make sense out of our experiences.
After a miscarriage, an optimistic world-view can slowly change to a more cynical perception that the world is a haphazard place and a sense that what is given will be ultimately taken away. This point of view may trigger long-hidden fears of impotence and abandonment. Unfortunately, these perceptions are self-limiting and can become obstacles to the grieving process. This can add additional stress to a situation already overloaded with intense feelings. Emotional difficulties may arise because some of these realizations, although they seem like new and compelling lessons about the world or ourselves, may not be entirely accurate or valid. The tragedy here is that we behave in accordance with our new perspective. Difficulties may arise in our intimate and work relationships. Our faltering sense of general well-being exemplifies the traumatic fall-out from pregnancy loss.
Although the emotional underpinnings of pregnancy loss and loss in general entail a fairly complex process, coming to terms with one’s situation offers hope for a fulfilling and meaningful future. This new hope can begin with your own self-directed process or it can take place within the safe context of counselling. The counsellor and client gently tread the unchartered territory of the special meaning and significance that the pregnancy held and its relevance to your dreams and personal development. Giving yourself permission to experience the feelings related to a dream not realized and a love not seen to fruition can be the first step in looking forward towards the future.
Rituals can have profound emotional significance as one copes with the aftermath of miscarriage. In the case of a stillborn or pregnancy loss later in gestation, seeing and holding the foetus or baby and saying your goodbyes can indeed help one cope with this situation. A burial with loving family and friends accompanying the grieving parents can lend a sense of closure to a tragic experience. In the case of an early pregnancy loss, there is no baby to say goodbye to and possibly hold. The loss seems more unreal. In this case, people may have a harder time assimilating the experience. Constructing something tangible which represents the baby in a meaningful way to you may often be helpful. A plaque with a special engraving, perhaps the baby’s due date or framed ultrasound pictures are examples of mementos which serve to remember your baby and express caring for your lost child.
Planting a living thing such as a tree or bush helps to acknowledge the fragility and mortality of life as well as our hopes for a new life. Acknowledging your caring for your lost child is a way of expressing a profound and fundamental theme in human nature. There are no bounds to the perseverance and vitality of the human spirit.
“The purpose of life is a life of purpose.”
- Robert Byrne
About the author
Sharon Kader provides counselling services in Ottawa related to coping with Infertility, PMS, Menopause, Midlife Crises, Life Transitions, Work-Life Balance, Cancer Recovery and Trauma, at The Midlife, PMS and Infertility Centre. Dr. B. Norman Barwin, M.D., C.M., Medical Director.