I’d like to welcome Hannah Mirmiran, today’s guest blogger. Hannah Mirmiran is a therapist who found What’s Your Grief a few months ago and has since become a great supporter (Thanks Hannah!). Because of her personal and professional link to grief work as it relates to pregnancy loss, we asked if she might be willing to write a post about the topic.
Hannah is a licensed clinical social worker who practices as a psychotherapist at Omaha Integrative Care in Omaha, Nebraska. She works with individuals, couples and groups and specializes in grief and loss with a focus in pregnancy loss, infertility, illness and cancer. She is a certified group psychotherapist through the American Group Psychotherapy Association and is a member of the American Society for Reproductive Medicine.
This post is about the rarely-discussed yet commonly-experienced occurrence of pregnancy loss. Because there’s so much to cover, it will be a two-parter.
Let’s start with some definitions. Pregnancy loss is a broad term that refers to the unexpected loss of an unborn baby. Generally, losses that occur in the first 20 weeks of pregnancy are labeled as miscarriages and those that occur after 20 weeks are called stillbirths.
As a psychotherapist, a good chunk of my practice is devoted to working with people who are grieving and have experienced the scary, difficult, and often-invisible hardships of illness, infertility, high-risk pregnancy, pregnancy loss, and infant death.
I am also personally connected to this issue, having experienced pregnancy loss twice. I am a mom who had two miscarriages between the births of my living children.
I believe I was eager to become a mother and have my own children starting at about age three. I have always loved babies. The day I turned 11 (the minimum age allowed), I registered for the Responsible Babysitter’s Training course and infant CPR, so I could begin babysitting. Subsequently, much of my free time in junior high school, high school, and college was spent watching others’ children. I loved babies and couldn’t wait for the day when I would have my own children.
It never really occurred to me that the journey to motherhood might not be easy. I guess I thought that giving birth to living children was a birthright for any woman of childbearing age. I grew up with the traditional, albeit naive, view that I could go off to college, get married, buy a house, get a dog, and then have two or three children, preferably in that order.
Growing up I don’t think I knew of anyone who had experienced miscarriage or pregnancy loss. Certainly, no one discussed pregnancy loss and whether it had happened.
It wasn’t really until I was in my twenties that I realized that starting a family was not easy for everyone and that there might be potential complications and roadblocks along the way. Around that time, in my personal life, some of my friends began to talk about their experiences with infertility and loss. One friend in particular opened up to me quite a bit about her own miscarriage. Professionally, I also met with clients who had struggled to get pregnant and had experienced miscarriages. Infertility and pregnancy loss began to appear in many realms of my life.
I saw that the grief experienced by someone who lost a pregnancy was not unlike the grief of someone who has lost a close friend or family member. These losses were deeply felt and devastating. I’ll never forget one client in particular who opened up about an ectopic pregnancy that had occurred fifteen years earlier. With tears in her eyes she spoke of a pain and loss that was still very much with her, despite the fact it had occurred many years ago.
It was clear that giving birth to living children was not an easy process for everyone. This seemed very unfair to me. Growing up, I truly thought that if you worked hard enough you could achieve anything. It seemed unfair that there were people who wanted babies but could not have them, no matter how hard they tried or how desperately they wanted to have children.
Even after I discovered that parenthood is not an easy road for everyone, I still never really imagined my own path to building a family could be so challenging. Initially, it started rather easily for me. My husband and I decided we were ready to start a family and after trying for a relatively brief period, I became pregnant. The pregnancy progressed fairly normally until 25 weeks, when I experienced preterm labor. At that point I was put on strict bed rest for the next 10 weeks. The pregnancy was difficult, but it ended well when my son was born full-term. Today, he’s a healthy four and-a-half year-old.
When we decided it was time to expand our family, my husband and I simply assumed it would be just as easy the second time. Unfortunately, it wasn’t. It took longer to get pregnant and that was frustrating. However, after some time trying we were thrilled to learn that I was pregnant again and things started to look up.
After that positive pregnancy test, I remember marking my calendar with the pregnancy milestones, the expected due date, and the upcoming doctor’s appointments. I signed up for on-line pregnancy groups, registered for weekly e-mail pregnancy updates, and unpacked my cute maternity clothes from my first pregnancy ready to settle in for another adventure. I was concerned that this pregnancy might also be difficult, so I remember spending a lot of time talking to the doctor about how we could be proactive to prevent early labor and another pregnancy on bed rest.
Everything was going well, so we shared the news of our pregnancy with family. We looked forward to adding a second child to our home. Then, one Sunday evening in August, I started experiencing cramps and feeling ill. My husband and I went to the Emergency Department, where we learned I was in the process of having a miscarriage.
I remember the days and weeks that followed the miscarriage as feeling like I’d been hit by a truck. I was in a state of shock. I cried and experienced waves of denial, sadness, anger and guilt. It was very difficult for me to be around our son. Even though he gave me great comfort, I felt as though I had to hold it together in front of him. I also felt I had let him down in my efforts to provide him with a sibling.
I felt so lonely after my miscarriage. No one talks about miscarriage, and I was reluctant to talk about what happened with my friends because most of them were pregnant or had new babies.
I was also angry. It never really occurred to me that miscarriage could ever happen to me. Growing up I was aware that sometimes pregnancy is difficult, and I remember knowing about the possibilities of birth defects and genetic issues. But I don’t remember hearing much about miscarriage, stillbirth, or infant death. I never thought there was a chance it could happen to me. I didn’t feel as though I had the information and education that miscarriage is fairly common and pregnancy loss is possible. As a result, I felt unprepared when it happened to me. Even though it might have scared me to hear it, I wish my doctor had told me beforehand that loss could occur. I might have been bettered prepared to face it.
In the weeks that followed, I started seeing a grief counselor who was very helpful in creating a safe space for me to grieve, to ease my feelings of guilt, and to give me information about pregnancy loss. She let me know that what I was feeling was normal and expected. I went back to work and started to get a sense of a “new normal”.
My husband and I decided to try again when we felt ready. Fortunately, we became pregnant again soon. Unfortunately, that pregnancy also ended in miscarriage.
After the second miscarriage, I was devastated. Suddenly, an aberration of one miscarriage turned into a pattern and I was scared. I was also very angry. How could this happen twice? Why did it keep happening? How was it possible that I gave birth to a living child and then had repeated miscarriages? Doctors are reluctant to do genetic testing or many interventions until a third miscarriage, but luckily, our physician was very supportive and pursued testing after the second miscarriage. Ultimately, we never received any definite answers, and there was never any precise cause determined for either miscarriage.
Following the second miscarriage, I felt a tremendous amount of guilt and embarrassment that it must be my fault, especially since it happened twice. I immersed myself in literature and information trying to learn everything I could about recurrent miscarriage. I was horrified by the terms used by the medical community to refer to pregnancy loss. It disturbed me that miscarriages are often clinically labeled as “spontaneous abortions”. There are several other medical terms that are also cold including “blighted ovum”, “ectopic pregnancy”, “non-viable fetus”, “missed abortion”, and “chemical pregnancy”. Even in the non-medical world, miscarriage is often euphemized as “we lost the baby”. Really?!? After going through a miscarriage, becoming pregnant again, and then doing everything I could humanly do to bring a living baby into this world, “I lost the baby”? This phrase made me feel like it was my fault. As if I misplaced my child at the mall.
Miscarriage is actually quite common. Some statistics show that up to one in four pregnancies ends in miscarriage. With the earlier methods of detecting pregnancy now available, we can confirm pregnancy days before a missed period. Doctors theorize that a woman now knows she’s had a miscarriage whereas before, she may have actually had a miscarriage, but wouldn’t have known because there was no early testing method and an early miscarriage may have been mistaken for a “late, heavy period”.
It’s now been a few years since my miscarriages, and in those years, I’ve done a lot of my own grief work and counseled many women and couples who have experienced pregnancy and infant loss. I’ve also facilitated a group for women who have become pregnant after loss. In my own experience, and in the experiences of those with whom I’ve worked, it’s been helpful to know about some of the shared experiences, to know you’re not alone and what you are feeling is normal. Here are some of the commonly expressed experiences of people who have lost pregnancies:
• Pregnancy loss is overwhelming and can feel devastating. The intense feelings of sadness and anger are surprising to many people who lose a pregnancy, but they are very real. Research has shown that the grief and emotional experiences of loss are similar for women who lose pregnancy at virtually any stage and that the length of the pregnancy doesn’t necessarily correlate with the depth of the grief experienced. Studies have also shown that the grief after a miscarriage is similar to the feelings we go through when a close family member or friend dies.
• Loneliness is very common. When a friend or family member dies, everyone around us acknowledges our grief. There are rituals and customs surrounding death. When you have a miscarriage, many people around you don’t know you’ve suffered a loss and they may not have even known you were pregnant. There isn’t typically time allowed off from work. Friends and family members often don’t know what to say and the person who has experienced the loss does not feel understood or validated. Walk into a Hallmark store and you’re hard-pressed to find the miscarriage acknowledgement section.
• Guilt is also common. The guilt I felt after miscarriage was unexpected and painful. After both of my own losses I went through a process of scanning my memory for everything I’d eaten, everywhere I’d been, and everything I’d done during each pregnancy and wondered what I had done to “cause” my miscarriages. Guilt is a feeling I’ve seen shared by nearly every mom who has lost a pregnancy. As well as guilt, “why” questions are also commonplace. Why did God allow this? Why did this happen? Why did the pregnancy end when I was so desperate for another baby? These questions are common and can be discouraging because there often isn’t a clear answer.
• Facebook can suck. I’ll admit it. I spend many an hour on Facebook and obsess over status updates and “like” quippy cards with the best of them. But after a pregnancy loss, suddenly your Facebook wall seems plastered with others’ ultrasound pictures, photos of cheery, hopeful baby showers and healthy newborns, happy family pictures, and other reminders that everyone else has what you want. Inevitably, you can begin to feel like an outsider to the whole process.
• Partners suffer as well. No one especially ever talks about how partners experience loss. Partners of women who’ve miscarried often feel the loss in different ways and can experience a wide range of emotions and different feelings, including resentment that they were not connected to the baby in ways that the mother was and frustration that there isn’t a way to fix the situation. Partners may feel helpless and may not feel like there is space to talk about their feelings.
• Fear and anxiety are likely. This is especially true if you become pregnant after a pregnancy loss. Miscarriage is unexpected, and it can leave you feeling like you are walking on eggshells through a minefield. I would characterize pregnancy loss as a traumatic event. Any time we experience trauma, nightmares, flashbacks, and anxiety can follow. A pregnancy following a loss can be an anxiety-ridden and terrifying experience.
• It’s important to grieve. While society may not recognize miscarriage as a significant loss, it is very real and significant to those affected. If you experience a miscarriage, it is important to give yourself the space to grieve the loss of the pregnancy and the death of your baby. It’s also important to talk about it.
So, how can you appropriately grieve a pregnancy loss? What are some tools to help cope with a miscarriage? What can you do or say if a loved one is experiencing a pregnancy loss? How can you find support after a loss? What should you do about Facebook?
Stay tuned for part two where I answer these questions and discuss other suggestions for grieving a pregnancy loss. If you don’t want to miss the post, be sure to subscribe to ‘What’s Your Grief’ to stay up to date by e-mail.