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Coping with Miscarriage, Pregnancy Loss and Infertility

When starting a family our hope is for this to be a joyous time our life; however, this does not always reflect everyone’s experience around conception and pregnancy. About 10% of women in the United States have difficulty getting pregnant or staying pregnant. Unfortunately many women/families can be very private with these struggles but this can also be very isolating. The truth is that our reproductive story is strongly ingrained in our sense of self, when something goes awry, whether through infertility, premature birth, a pregnancy loss or, as it often happens, a combination of these events, it is a trauma that negatively impacts all aspects of a person’s life. Even moreso if we feel alone in this experience, watching those around us conceiving and having children.

A reproductive loss can cause deep heartache and despair in expectant parents regardless whether the loss occurs early during the pregnancy (known as miscarriage), later in the pregnancy (referred to as stilbirth) or in the short period after a baby is born. In many instances, this same set of emotions can happen when couples learn that their fertility treatments were unsuccessful.

Following infertility or a loss, you may experience emotions unlike those you have experienced before. You may no longer trust your body, your health or the belief that pregnancy and starting a family will be a given. You may feel helpless or out of control. These emotions can be intense and scary. Even when you gradually resume your usual activities and get back to your routine, you may be left with a sense that something in your has forever changed and wonder if you will ever feel like yourself again.

Types of Reproductive Loss

Miscarriage

About 15-25% of recognized pregnancies end up in miscarriage. No one can prevent a miscarriage from happening so when a woman experiences a miscarriage she may feel anxious and out-of-control.

Often miscarriages feel like invisible losses to the rest of the world. Perhaps you were waiting to share the news, so friends and family didn’t even know you were pregnant when you experienced your miscarriage. This makes your grief feel silent and increases feelings of isolation and loneliness. While you are certainly mourning the loss of a baby that will never be, it may be difficult for others to comprehend your grief because your baby was never born. Remember that grief is a natural process, which everyone experiences differently.

Stillbirth
Still births or neonatal losses occur when a woman delivers a nonviable baby after the 20th week of pregnancy. This impacts over 25,000 families each year. For many parents, a stillbirth loss is unexpected and shocking, which can complicate grief symptoms as well as healing.

Infertility
Infertility is a condition that prevents conception of a baby. The diagnosis of infertility is usually given to couples who have been trying to conceive for at least one year without success. This impacts approximately 10-15% of couples in the United States. Dealing with infertility may cause a woman to feel disconnected from her body and her reproductive health. She may feel like she is failing herself and her partner. She may be worried about how fertility issues will impact her relationship and their future dreams of having a family.

Women who have miscarried or had unsuccessful attempts at in vitro fertilization (IVF), may be hesitant to try again as it is costly, time-consuming and emotionally draining. Fertility problems impact everyone differently and you may not be sure where you can turn for support. Therapy can help you cope with fertility challenges in a healthier way.

Normalizing Emotional Experiences

Regardless of the specific circumstances surrounding your loss, grief is a normal and expected reaction to a loss, including a pregnancy or reproductive loss. The first several weeks following a loss are the worst and most intense. It does get better slowly and overtime as you begin to accept your new normal. There is no right or wrong way to feel during this time. Remember that everyone grieves and heals differently, even among partners.

For women who were carrying the pregnancy or trying to conceive, the emotional experiences are often compounded by the physical changes in your body. If you were taking fertility medications, many of your hormone levels are probably out-of-whack. If you experience a first trimester miscarriage, your hormones will likely be shifting back to how they were before the pregnancy. The further along you were in your pregnancy, the more likely that your body was preparing for a new baby and all the necessary changes that go with it. You may experience physical symptoms from the hormonal changes and from the emotional distress.
These physical symptoms include:

  • Fatigue
  • Disrupted sleep
  • Difficulty concentrating
  • Loss of appetite
  • Frequent crying

In addition to physical symptoms, there is emotional distress known as grief. Grief is what happens when someone we love dies. Of course you loved your baby even before knowing him or her. So it is understandable that you feel the way that you do. There is no “right” way to grieve. So try to be accepting of any and all feelings.

After a reproductive loss, it may seem like the whole world is pregnant. You may have friends or family members who are pregnant. These constant triggers may be painful and re-open memories of your own loss. Eventually, you will begin to integrate the loss into your life and make meaning from a devastating situation. Here is some emotional distress that parents experience immediately following a loss and after several weeks.

Immediate grief symptoms include

  • Feeling numb
  • Disbelief
  • Profound sadness
  • Guilt
  • Anxiety
  • Anger
  • Isolation
  • Concern about the future

After the first several weeks

  • Intense emotional distress (such as depression, anxiety and anger)
  • Grief
  • Avoidance of painful reminders
  • Fixation on the loss
  • Fear about the future

Grieving Styles: Men and Women Grieve Differently

Usually, women are expressive about their loss and more likely to seek support from others. Men, on the other hand, tend to be more action-oriented and engage in problem-solving. Your partner may seem like he is skipping over his grief and instead, focused on making arrangements. This may feel like your partner is not being sensitive to your needs. Remember that this loss happened to both of you. It is okay to talk to the other one about it. Communication is very important during this time as it lets both partners know that their grief is normal and inevitable.

Heal Together By

  • Understanding that grief is normal, natural and personal
  • Being sensitive to each other’s needs and feelings
  • Keeping communication open and sharing thoughts and feelings
  • Accepting and being respectful of different coping style

How can I help myself grieve?

As a grieving mother, your sense of loss may be more acute than your partner’s and you may need more time to mourn the loss. Expressing your emotions in an open and supportive environment will help you to understand the unimaginable. Eventually, you will be able to accept your feelings of grief and integrate this loss. Here are some things that you can do to help yourself get through this difficult time:

  • Talk to supportive people about how you feel
  • Join a support group to meet other parents who understand what you are going through; this may help you feel less isolated
  • Be honest about what you need; your friends and family want to help, but may not know how
  • If you were far along in your pregnancy and people knew that you were expecting, select one person from each group to tell what happened if you don’t feel like you can talk about it. Remember, you can still shape the message and control how much is shared with others
  • Check-in with your partner often and communicate openly
  • If you don’t feel ready to participate in family events or special occasions, give yourself permission to sit out. Your friends and family will understand
  • Integrate the loss into your life, make something for your baby, such as an album or plant a tree in your baby’s memory, anything that helps you to recognize and make meaning of your loss
  • Be easy, kind and accepting of yourself as you heal

When do I need professional help?

Of course, it is natural and expected for you to grieve. But grieving can feel uncomfortable. If you are feeling stuck in your sadness, grief, anger or guilt due to a reproductive loss, therapy can help. Ask yourself these questions:

  • Have you stayed in bed all day, every day, for several weeks?
  • Are your emotional experiences interfering with your ability to work, take care of yourself or your other children, or engage in basic self-care?
  • Are you having frequent and intrusive flashbacks or nightmares about the loss?
  • Do you have any intent to act on suicidal thoughts or do you plan to harm yourself?
  • Are you engaging in any other self-destructive acts?

How can therapy help me?

Therapy provides the space to help you get through your sadness and other intense feelings. As a therapist, I will guide you through this time in a way that feels safe, healing and honors the loss of your loved one. Benefits of therapy include:

  • Helping you to heal faster by easing the pain of your loss
  • Regaining control of your emotions
  • Preparing for triggers that may elicit feelings of sadness about your loss
  • Encouraging communication with your partner to support each other during this difficult time
  • Ensuring that your relationship survives by understanding and overcoming gender differences in grieving
  • Feeling like yourself again
  • Promoting hope and confidence to experience another pregnancy one day, should you desire

How can family and friends show support?

The loss of a child, regardless of the child’s age, is one of the deepest pains we can experience. Often parents, who are experiencing the loss, want to turn to the baby’s grandparents, other family members and friends, but can’t identify the kind of support that they need. Family and friends often feel helpless when someone close to them experiences a reproductive loss (miscarriage, stillbirth, infertility). As family and friends, here is what you can do:

  • Be in the space to listen. A person who has experienced a loss may want to share their story over and over as a way for them to remember their baby. Show that you care by listening attentively and engaging in good body language. Know when to be silent, sometimes a grieving person just wants someone to listen to them.
  • Be prepared to talk about the baby. Don’t be afraid to say the baby’s name (if a name was given) or talk about the loss to help the grieving person heal.
  • Be aware that grief has physical reactions, as well as emotional reactions. Physical reactions include poor appetite, disturbed sleep, restlessness, low energy, crying and other pain. Emotional reactions may include: anxiety, persistent fear, panic, nightmares, despair, loneliness and isolation. Encourage your friend or family member to reach out when they are experiencing these feelings.
  • Be present. Because we do not have control over a pregnancy loss, women who experience this can feel anxious, fearful or panicky. Try not to leave a grieving mother alone. This will reduce her feelings of anxiety and loneliness.
  • Understand grief. It is important to realize that grief is an individual process that is not bound by an exact time frame. You may think that the individual should be “over it” by now, but the person who experiences a loss will never be over it. Instead they find ways to live with the memories and pain associated with the loss. Sometimes grief can turn into depression, which would warrant professional help. The difference between grief and depression is hope. If you feel hopelessness, your grief may have turned into depression and you may need therapy.
  • Reassure the grieving person that their feelings are natural and necessary for healing. Remember that specific dates and anniversaries may trigger an emotional response. Be sensitive during these times and encourage the grieving person to talk about their loss.
  • Take care of yourself too. A reproductive loss can impact the entire family. This may have been a grandchild or niece or nephew that you lost. This is your loss too. Give yourself the opportunity to mourn and to heal.