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How you may feel when you’re no longer expecting

©MFMER

People react to death in many kinds of ways. Your upbringing, culture and personal experiences with illness and death influence how you respond to loss. People experiencing miscarriage can land anywhere on the wide spectrum of grief, and their feelings can change moment to moment. At the same time, your body is still recovering. How you feel emotionally and how you feel physically may feel one and the same — lousy — or you might feel a disconnect between the two.

You can go back and forth between feeling at peace and like you are moving on … and then feeling down and tired and not being sure why. As a doctor, I want to tell you that however you experience grief is OK. Having a mixed bag of feelings during this time is completely normal. There is no one way to get through the grief of a miscarriage. My patients have felt all of these things — and so have I with both of my losses.

In the first days and weeks after miscarriage, you may feel:

  • Sadness and pain
  • Disbelief and numbness
  • Anger and outrage
  • Helplessness and guilt
  • Isolation and loneliness
  • A yearning for the baby
  • A need to talk about the baby or the miscarriage
  • A need to not talk about the baby or the miscarriage
  • An urge to cry all the time
  • Concern for your partner or your other children
  • Fear of future losses or of not being able to get pregnant again

People experiencing pregnancy loss report feeling all those emotions. Research has shown that miscarriage typically causes significant distress — much more than many doctors or the public realize. In fact, the feelings of distress, trauma and grief can be just as deep and challenging as they are after losing a loved one. You may feel anxious and uncertain about a range of physical and emotional issues.

Grief after loss

After your loss, you may experience months of highly intense emotions. Some people may experience all these feelings, others just a few. Sometimes you proceed through these emotions one at a time, and sometimes you jump around, feeling one emotion one day and another the next. And on exhausting days, you may flip back and forth before bedtime.

Sadness, shock and anger

Sadness is the biggest emotion that people think of after a loss. You may feel numb at first and be in total shock when you get your diagnosis. You may feel angry at the unfairness of the loss, especially if you felt like you did “everything right.” You might be angry at your doctor or midwife, who you think might have been able to stop the miscarriage from happening if he or she had just done something. Anger may come out at your partner or your children because it can be less painful to feel anger than to feel sadness. You may even be angry at yourself, blaming yourself for not being able to stop the loss.

Guilt

Guilt is an expression of underlying self-blame. Guilt has been found to be the strongest — I would say the most insidious — aspect of grief after pregnancy loss and needs time to resolve.

Bargaining


Bargaining is common with any kind of grief. You may find yourself making bargains or promises to God, to fate or to the universe to get the baby back or make sure that your next pregnancy is healthy.

Anxiety


Anxiety symptoms may be even more common than depression symptoms after miscarriage. Almost half the people experiencing pregnancy loss will show symptoms of anxiety, which centers on pregnancy-related issues. It’s normal to worry about developing physical problems after a dilation and curettage (D&C), like continued bleeding or vaginal discharge. It’s normal to worry about possible underlying medical illness that contributed to the loss. Many people fear whether they’ll ever be able to have a baby and are anxious about the prospect of another miscarriage. They spend enormous amounts of mental energy agonizing over the trauma and trying to determine why it happened. From here, some spiral into guilt, blame and shame. And the less support you have to lean on, the more likely it is that you’ll feel anxious. One loss can create fear of other losses.

Grief is a process

The bottom line with grief is that it’s a process, and a tiring toggling between emotions is to be expected. Your ability to cope with your feelings will be strong on some days, and not so good on others.

Grieving for a long time is less of a concern than is the intensity of your grief. I tell my patients to think not so much about the calendar as about how their grief affects their lives. If your grief impacts your work, your relationships and the rest of your life, you could benefit from some help, even if it hasn’t been “that long.” Without help, grief can turn into adjustment disorder, where you feel symptoms similar to depression and it takes you up to six months to feel like yourself again.

If your feelings interfere with your ability to live your life the way you want to for more than two weeks after your miscarriage, it’s a good idea to talk to your doctor. Even if you’re not sure if you need help, the two of you can discuss it.

The intensity of these feelings will eventually wane. Most people begin to accept the loss and can settle back into life as they know it. This doesn’t mean, though, that the loss isn’t always a part of you. Some of my patients describe it as a piece of their heart or a part of their soul that always bears the wound of the miscarriage. It may not seem like it now, but that part does get smaller with time.

Acceptance can take longer than you would expect. It can take up to six months or a year after the loss, and some experts think even up to two years after the loss, before you feel like you’ve regained your balance.

Bottom line: There’s no set amount of time that is “normal” to grieve a loss of any kind, including a pregnancy loss.

You will heal, even if it doesn’t feel like it today. And you may decide to try to get pregnant again. Some people feel that when they think about another pregnancy, it somehow betrays the memory of the one they lost. But being ready to move on to the next stage of your life, whatever that is for you, isn’t a sign that you’ve forgotten the other pregnancy. Feeling strong again and looking toward the future and what it might hold doesn’t mean you’ve erased what’s happened to you in the past.

If you want it to be, this pregnancy will always be a part of you. You don’t need to keep grieving a miscarriage to respect the baby you lost. You can be happy with a new pregnancy and still terribly miss the pregnancy that wasn’t meant to be at the same time. The happiness of the new does not replace or kick out the old. You can hold both in your heart at the same time.

An excerpt from Your Guide to Miscarriage and Pregnancy Loss

Kate White, M.D., OB-GYN

Dr. White, author of Your Guide to Miscarriage & Pregnancy Loss, is an associate professor of obstetrics and gynecology at the Boston University School of Medicine and the vice chair of academics in the OB-GYN department at Boston Medical Center. She is a fellow of the American College of Obstetricians and Gynecologists, a fellow of the Society of Family Planning, and a member of the American Public Health Association. As a board-certified OB-GYN, mother and pregnancy loss survivor, Dr. Kate has been caring for women for more than 20 years, helping them navigate every stage leading up to menopause, including periods, childbirth and pregnancy loss. She also conducts research in contraception, has been continuously grant funded for 15 years, and frequently lectures regionally and nationally on topics related to women’s reproductive health. Dr. Kate lives outside of Boston with her husband and their three children.

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