Coping with the Emotional Challenges of Miscarriage

By Norman Brier
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Miscarriage--defined as an unintended ending of a pregnancy before the twentieth week of gestation--is a relatively frequent event that often produces a strong sense of bewilderment and marked feelings of distress. A woman who miscarries experiences several losses: the special attention and care she had been anticipating or receiving as a pregnant woman; the feeling of being one, a unity, with the developing fetus; the feeling of bodily adequacy related to the ability to bringing a pregnancy to term; and, especially, the times that were to be spent with the expected child.

Most people have a great deal of difficulty coping with a miscarriage. The experience is often sudden and unexpected, so that there is little time to prepare. Often it is also highly ambiguous; unlike the loss of a friend, parent, or partner, there is no person to bury or actual memories of shared time to treasure and grieve. Instead, only an imagined future can be mourned, and usually without any clear rituals to help the person structure and express her grief.

The frequent lack of adequate emotional support is likely to add to a woman's distress as well. Many of the people who might have been supportive during prior times of stress may be unaware of the pregnancy and miscarriage. Those who are aware often fail to recognize the extent of a woman's distress, or make comments that seem to minimize the experience, such as, "You'll have another," or "It wasn't meant to be."

In the support groups I conduct for women who have experienced a miscarriage, the following are some of the questions asked most frequently.

How common is miscarriage, and what causes it?

Currently, 15 to 20 percent of known pregnancies end in miscarriage. The percentage is likely to be even higher in the future, for at least two reasons. First, pregnancies are being detected earlier and, as a consequence, couples are becoming aware of unviable pregnancies that they might not have known about in the past. Second, women are postponing childbearing to a later age, when miscarriages are more frequent. The rate of miscarriage roughly doubles from age 20 to 30, and then doubles again from the early to late 30s. More than 80 percent of miscarriages occur during the first trimester, with 75 percent of these occurring before the eighth week.

A miscarriage is caused most frequently by problems in the fetus, usually chromosomal abnormalities, and by problems in the maternal environment. The latter includes uterine and placental problems, progesterone deficiency, and less commonly, infections and systemic disease. Exercising, having sex, or lifting heavy objects do not cause a miscarriage. A fall or a blow is also unlikely to cause a miscarriage unless it was life threatening. No reliable evidence exists to show that emotional distress causes a miscarriage.

Why do I feel such an intense sense of loss when I never even saw my baby?

Most women form an emotional attachment with their developing baby very early on. By about the tenth week of pregnancy, it is usual to have a distinct and definable mental image of the baby and detailed daydreams of his or her arrival. Procedures such as sonograms and amniocentesis greatly facilitate the formation of these mental images, and the pictures produced by these procedures tend to be the images most frequently imagined after the loss has occurred.

Is what I am feeling normal?

Immediately following the loss, most women experience a great deal of emotional distress. It is usual to feel a profound sense of grief, guilt, and anxiety, and a depressed mood. It is also usual to have sleep and appetite problems, little energy, concentration difficulties, and strong feelings of discouragement.