Laura* tried to swallow the knot of panic in her throat as the sonographer paused again to reposition the ultrasound device. She laid there helplessly as they prodded her swollen abdomen, straining their ears for the sound of a heartbeat. As her pregnancy approached 10 weeks, her hopes and dreams for the unborn child hinged upon this biorhythm. The seconds ticked by like hours. The silence was deafening. Those life-affirming beats were never heard, and the doctors confirmed her worst fear: the pregnancy was over.
Despite the fact that one out of four pregnancies end in miscarriage, the pain suffered by this loss felt no less shocking and profound. Laura was in the 80% majority whose miscarriage had no known cause.
As a licensed clinical psychotherapist, Laura came to see me two weeks after her D&C procedure, which removed the remnants of the pregnancy. In our first session, she shared that she had been feeling overwhelmingly sad and confused by the untimely end of her pregnancy. She said that without warning or provocation, dark emotional clouds would settle into her mind and she would feel flooded by despair, anxiety and failure. In an effort to pull herself out of her sadness, she decided to go back to work. Her colleagues could not understand her pain and while they tried to be helpful, their encouragement to “just get pregnant again” ignited a searing ache in her heart. She silently questioned “what must be wrong with me that I could feel so distraught about losing a baby that I never met.”
While this anguish was new to Laura, her experience is familiar to thousands of women across the country. We live in a death-denying society, which means there is often no comfortable way to speak about loss. Even when we reflect on the deceased, we speak about the life they lived, which further complicates the question of how do you grieve when the deceased was never born? This can cause the resulting bereavement to feel socially-unsanctioned. This rejection can trigger feelings of shame and despair. In contrast to our society’s norms, the best way to move through the loss is to address these events and emotions.
It is necessary to grieve a miscarriage because it is a healthy response to death. Mourning is how our conscious mind works through the pain. The psychotherapy treatment helped Laura create a space to confront the unrealized fantasies of what could have been, and examine her internalized identity as a maternal figure. We normalized that even though she did not look pregnant, her body underwent a trauma and was still hosting a deluge of hormones. She developed the language to speak about her loss, and understood that intrusive thoughts and rapidly changing emotions are normal parts of the bereavement process.
As Laura’s grief oscillated between acute, raw sadness and a more restorative orientation, she became more successful at integrating this event into her life. She gave herself permission to tenderly reflect on her past pregnancy and relinquish some of the misattributed self-blame surrounding her loss. Intellectually she knew the miscarriage was not her fault, but through our work, she was able to emotionally embrace this acceptance. Instead of trying to return to her pre-pregnancy emotional life, she worked towards finding and tolerating a new normal.
The therapy was often difficult, and many times we sat in silence as tears rolled down Laura’s face. Through the ashes of her pain blossomed a strength and resilience that she never imagined. Had she tried to ignore her pain and she would have increased her risk in developing a perinatal anxiety or mood disorder in an upcoming pregnancy. This response to unresolved grief can stay with a person like a ghost, always being present and indefinitely impacting the family functioning (including future children).
In the months that Laura and I worked together, the focus of her treatment has shifted. Now that she can better tolerate her authentic feelings around her miscarriage, she is thinking about trying to get pregnant again. As she looks to the future with a healthy dose of nerves and excitement, she can also lovingly reflect on the past.
*Name has been changed
Lindsay Liben, LCSW, is an advisor to FertileGirl and has a New York based private therapy practice, focusing on women’s issues including infertility, depression, anxiety, and life transitions. She believes that by helping her patients get in touch with their most authentic selves, they can make choices that set them up for personal success.