By Dr. Carolyn DeMarco

Approximately one in five women suffer a miscarriage after becoming pregnant. To family, friends, physicians, and even to the woman herself, miscarriage may seem like a minor event of no real significance.

But following a miscarriage, the mother or father, or both, may be surprised by the intensity of their reaction to their loss, and feel an urgent need for sympathy and understanding from others. At the same time, they may find an uncomfortable silence among family and friends when it comes to discussing the death of a baby so early in pregnancy.

Even though the pregnancy is short-lived, research has shown that a woman still goes through a grieving process similar in every way to women whose babies died much later in pregnancy or in the neonatal period. The only difference is that the grieving process among women who have miscarried does not usually last as long.

Among women who have miscarried, there may be a considerable difference in the length of the grieving process depending on how long the pregnancy lasted (an early miscarriage occurs in the first 12 weeks; a late one from 13 to 20 weeks) and the degree of attachment which the mother and father have formed to the baby.

Stages of the Grieving Process
During the grieving process, a woman may experience classical stages of shock and denial, anger, depression and, finally, acceptance. But they don’t necessarily occur in that order. All the stages may co-exist at once, or feelings may rapidly fluctuate from hour to hour and day to day. Acute pangs of grief can also be brought on by the sight of a baby.

Immediately following the miscarriage, a woman may feel a sense of shock and unreality. Later on, she may be flooded with feelings of anger and sadness. She may feel angry at herself, her partner, her doctor, her religion and even the baby itself.

Another common feeling following miscarriage is guilt or self-blame. “If only I hadn’t lifted that heavy box...” “If only I hadn’t taken that painkiller...” “If only I hadn’t made love that night I started to spot...”

The sadness women feel following a pregnancy loss ranges from mild depression and irritability to full-blown depression with weeping spells, preoccupation with the loss, insomnia, loss of appetite and loss of meaning of life. In the case of full-blown depression, getting help from your doctor is always a good idea.

Many women experience physical symptoms of grief following miscarriage, which can be incorrectly diagnosed and treated by their physicians. Physical symptoms include headaches, backaches, digestive upsets, fatigue and a whole host of other ailments, all beginning around the time of the miscarriage.

A miscarriage is the death of a potential child, a symbol of hope and new beginnings. After a miscarriage, parents may feel a profound sense of failure and loss of confidence and self-esteem. Preoccupation with the events of the miscarriage may continue for many months after the event.

Suppressing natural and valid feelings is the worst thing a woman can do to herself. Absolutely necessary to her recovery is the expression of her emotions as fully as she is able, and the full acknowledgement of what her loss means to her. Only after this work is done can she begin to integrate the loss into her life and create new hope for herself.

Guidelines for Grieving
In her book, Transformation Through Birth (Bergin and Garvey, 1984), Claudia Panuthos gives some guidelines for grieving. She stresses that above all, “cast your pride to the wind and allow others to know who you really are and what is truly happening.”

She also feels it is important to make yourself a supportable person, to find the appropriate support system and then to make your needs clearly known. Furthermore, she feels it is important to find the answers to all the questions you might have surrounding your miscarriage.

Finally, she emphasizes honoring and respecting your body and feeling the right to remember your baby in any way that seems right to you, including naming the baby.

For friends and loved ones of the woman who has miscarried, the most helpful stance is to validate her feelings, whatever they may be. Comments like, “Keep your chin up,” “That’s life,” or “It’s nature’s way of getting rid of defective fetuses,” are not helpful. The woman has just experienced the loss of her child, however young that child might have been. And that particular child and time can never be replaced.

Similarly, the well-meaning, “you can try again,” is also offensive.

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