grief feelings in general

Grief is a normal, healthy and appropriate response to a miscarriage but that may not seem so to all people we come in contact with.

Although over 70% of women perceive that a baby is lost when a miscarriage happens, society in general does not necessarily believe that, often regarding it as an insignificant event, so miscarriage is seldom acknowledged or discussed and often treated as a taboo subject. We have noticed midwives' websites in New Zealand seldom have a heading for 'Miscarriage' amongst their others so the inference can be that pregnancies only end in healthy, full term babies. This only adds to the shock and misery when things do go wrong - whatever it may be. No miscarriage should be taken lightly, by our-selves or the community. It is a sad commentary on any society and its ignorance that when we miscarry, instead of receiving sympathy and support, we can be made to feel that losing our baby is somehow our own fault. Recurrent miscarriers even more so.

People do have difficulty understanding what may have never been seen, heard, smelled or touched even existed and can refuse to acknowledge the possibility that it was a baby. There seems to be no universal agreement for when a soul enters a body either mainly because widely held fundamental beliefs vary and consequently for when a foetus becomes a baby. Unfortunately the key to recognising a little life lost is dependent on an acceptable community definition. A stillbirth (in NZ that means that the baby is born after 20 weeks gestation) is far easier to acknowledge as a baby with a soul, even though a miscarriage may have happened only one day earlier and there is a discernable body. That there are a no legal requirements for miscarriage like a birth or death certificate, and no obituary notice, no memorial service, no funeral formalities and often little left to bury anyway, especially if the miscarriage was early in the pregnancy or passed in the toilet. This all tends to signify that a baby never existed however a miscarriage is often life-changing.

Even though up to 70% of miscarriages are due to chromosomal abnormalities and no-one’s fault, this is not generally known, so with no apparent meaningful explanations about the cause of a miscarriage, conscious or subconscious thoughts can result in a cultural ambivalence and the sometimes judgemental attitude of ‘women can control the outcome of their pregnancy by abiding by the rules e.g. non smoking, non drinking, choosing correct foods etc.’ Unfortunately, when that happens and we buy into this attitude ourselves, aside from it adding to our already guilty feelings and re-enforcing them, it makes it easy for others to continue with that point of view.

Meaningful and descriptive words such as a ‘premature stillbirth’ or ‘early stillbirth’ would be more useful too than the word ‘miscarriage’, which is associated with the legal, ‘miscarriage of justice’ phrase. This can link fault in people’s minds with the tendency to blame the mother again. There is little automatic assumption that the father could be part of the problem but research shows that men often are. (see Causes)

Nor is it always accepted that for most women and their partners, the loss will be followed by a period of grieving, even though it is more meaningful in the woman’s case, although may not cut in for several weeks. A late miscarriage can intensify their grief as they have had longer to attach themselves more closely to their baby and often feel safe and more confident once past the 12 week date. The baby will be bigger and may have begun to ‘show’ so people can guess at a pregnancy even if they haven’t been told. Usually the baby's tiny, fast beating heart has been seen and heard at a scan and the mother may even have felt the new life moving, confirming that everything is going smoothly. Statistics are also on their side - so their loss is even more poignant. But they may also find more understanding and empathy from everyone which can be helpful toward a healthy recovery. Ultimately however, comparing grief related timeframes is not useful as everyone experiences their own unique depth of grief.

When grieving is not acknowledged or validated by the community and not legitimised by medical professionals, the subsequent feelings can remain unresolved, becoming disenfranchised grief and cause serious relationship and mental health problems. For the woman, depression is not uncommon and there is also a tendency for them to think the emotions they are experiencing are somehow wrong and also trivialize it themselves. They may also expect (or be expected to) not to feel too bad when they have other children. But each child is different and loved for their own sake. The grief is for this lost baby and the difference it would have made in everyone’s lives. It can be so stressful that many women in fact wonder if they are going mad.

It doesn’t help either when women come across medical professionals, whose focus is only on the physical aspects of miscarriage, perhaps dismissing it as a minor mishap, without acknowledging the possible emotional repercussions to their patients. That attitude is disconcerting and more is also expected from medical professionals in today’s world of saving so many more lives. The medical terminology used around women’s physical experience, alienates women further from what is, in none medical terms, their body’s natural response to a baby that was never going to survive. It can feel bewildering for women to hear their baby referred to as ‘product’ or ‘tissue’ and especially referring to their miscarriage as an ‘abortion’. To women there is a huge difference between them and women who choose not to carry their baby to term, for whatever reason, and associate that with the common term ‘abortion’ that is used in that context. A miscarriage is definitely not a choice. The use of these medical words seems insensitive and lacking in compassion and because miscarriage is not usually life threatening either, the woman’s whole experience can be minimised. The medicalisation of miscarriage can oversimplify the complexity of the resulting grief. This general lack of acceptance and understanding of what women perceive as their lost baby, adds to and intensifies the stress levels and mourning and isolation of miscarriage grief they then have to deal with.

Unfortunately, people can simply not know that by acknowledging what the parents are feeling, they can help their healing by even saying as little as ‘I am sorry for your loss’ and perhaps offering a hug if it is appropriate. (See ‘Seven Helpful things to say and do’ etc.) If support for women was openly sanctioned by medical professionals, particularly emphasizing that the most common reason for miscarriage was from genetic abnormalities (a term most would understand and an acceptance of the normalcy and numbers of miscarriages) and not the woman’s fault, people could more easily understand what was happening and perhaps even encourage parents to talk about their experience as they would with any loss. This would make a huge difference and help the parents’ acceptance of their grief without them feeling that their miscarriage was being minimised and invalidated. There is seldom a burial plot and headstone for such fragile remains however, any inappropriate comment - especially from a medical professional - can be engraved on the parents’ minds forever from the rawness of their grief and quoted even 50 years later.

Thank you to those of you who do their best to understand. It is difficult, but know that your effort will be appreciated and make a difference at this significant time in people’s lives and you will always be remembered. Meantime, it is not the grieving parents but the general public, including people close to the mother-to-have-been, who decide by default whether miscarriage grief is appropriate, how long it should last and when it may be socially shown. Given the statistics of 1 in 4 women miscarrying that is a lot of people in the community being adversely affected when the prevailing attitude is as above.

Personal

If this is your first miscarriage, which you may have only heard referred to peripherally, you could be bewildered by the devastation and intensity of your feelings and be in a state of disbelief, thinking to yourself ‘Babies aren’t supposed to die’. The loss of a baby undermines our most fundamental human need to reproduce so the grief you are feeling is serious; Everyone is unique and express their grief differently. It affects us in so many ways we don’t even realise (see ‘Grief issues special to miscarriage’). The pain of grief is caused by losing someone we have begun to love. Bonding with your baby will have already started and the stronger the bond, the deeper the pain. Studies show that the mother usually begins bonding with the baby from very early pregnancy, although many of us weren't even aware of it, so the depth of this grief can be shocking. It is generally experienced sequentially in three stages; the psychological shock and intellectual stage – in the head; the longest is the emotional and suffering stage – in the heart; the physical reconciliation and recovery stage – in the gut; and overall we are usually spiritually affected.

Grief is not self-indulgence. It is a necessary, normal and healthy process to experience. Suppressed grief is unhealthy. Your feelings at any time may fluctuate and include one or more of the following: shock, loss of concentration, confusion, denial, anger, guilt, jealousy, shame, numbness, a sense of betrayal, forgetfulness, loneliness, lostness, isolation, emptiness, depression, frustration and unreality. Staying in the present can be elusive, nothing but your grief seeming particularly important, the only thing having any meaning being your baby's death. Time can slip by unnoticed or drag. Dates and things associated with your loss like certain tunes or scents or scenes seem to be set in your memory forever and especially things said to you around this time. You may feel sadness in your body physically as well, like being unable to sleep even though exhausted, and feel tense or achy, and maybe feel cold and become unexplainably shaky along with general misery. This can all be scary and disorienting. It may also seem strange to still feel lonely even when you are well supported, however it is not unusual. It is all part of normal grief and will pass. (Some women may not feel any of this at all or at least a milder version and it also could happen weeks after the actual miscarriage.)

Guilt is a common part of any grief, but in miscarriage it usually plays a much greater role. We want to reassure you that a miscarriage from a non-viable pregnancy i.e. chromosomal abnormalities that creates a fetus which is incompatible with life, causing the death of your baby, does not result from ordinary exercises like bending, stretching, walking, swimming, having sex or anything you inadvertently did or didn't do in normal daily activities. These 70% of miscarriages are inevitable and nothing could have been done to save the pregnancy. Some people feel their loss was a punishment from God, but this was an act of nature.

It is misdirected and counter productive to take on board guilt and blame yourself and it can delay a healthy recovery. Continuing to self blame leads you to also not seeing yourself as a potential mother. We all tend to want to blame some-one, especially when we don’t have answers. (See our list of ‘why miscarriages happen’ for other possible causes.) Unhealed miscarriage grief can also eventually lead you to allowing it to define you, perhaps leading to missing out on other things in life.

Evading and avoiding our feelings by taking drugs, sedatives or alcohol are tactics we can use to prevent ourselves from feeling pain. While initially they seem to deaden it, they really just slow down the grieving process so that it drags on unnecessarily and/or suppresses it. However, if your health professional really feels that drugs are necessary, use them strictly in accordance with their instructions.

Unexpressed grief always has consequences, often in unrecognised ways. For instance, relationships tend to suffer and can lead to breakdown. (See University of Michigan Health System research April 2010 ‘Couples are more likely to break up after the loss of a pregnancy and unmarried couples are at even higher risk'.) According to new published today.’ http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1535. As in all child loss, whole futures are affected which is really difficult to accept, unlike most deaths that are about the past. We have also come to the conclusion (as we have found other counsellors and organizations have too) that baby loss is at least part of post-natal depression after a subsequent pregnancy.

We may be surrounded by people who live in a culture of ‘grief denial’ but it is normal to grieve following a loss and grief is referred to as ‘the healing feeling’. You do not need anyone’s permission to grieve. Everybody reacts differently and we encourage you to accept your feelings whatever they are. They vary greatly for each of us.

Allow yourself to laugh sometimes when appropriate, as it is part of the healing process too, making the pain more bearable. It is helpful to join an online group, or a local group if there is one, or friends who have experienced miscarriage, for a sense of belonging and support to overcome the worst of the feelings of isolation. From our experience supporting women, a mentally healthy person should feel more like themselves by three to six months, albeit changed and perhaps with a deeper appreciation for life.

However you may wish to consider counselling if it is taking longer, or if at any stage you experience particular difficulties or feel obsessed by your loss, especially if you have had recurrent miscarriages or other losses to compound your grief. If your feelings seem beyond anything we have covered, PTSD (Post Traumatic Stress Disorder) is also a possibility. To clear your mind from that worry, identify your symptoms by trying; http://helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm Consult your doctor for further advice.

Grief can make some women feel driven with an excess of energy; and they offer to do charitable acts or become involved in situations to help them regain their sense of self-worth. This sometimes drains them and it can be a way of avoiding their pain. This has been referred to as the ‘missionary zeal of the newly bereaved’ which those who have experienced it will recognize.

The following is a synopsis from research being done at Tufts University by Dr. Diana Bianchi (6 paragraphs down on her site) that resonates with many of us who have lost babies and it confirms why we often feel our loss so strongly – ‘With each pregnancy, a woman is given fully functioning white blood cells from her child. Regardless of the outcome of the pregnancy, live or still, full term or miscarried, the mother is left with cells filled with the DNA of the child in her body. Cells that are fully working, in the brain even, that show up first on the site of infection or injury.’

Even when we are functioning on a reasonable level again and we think we have dealt with our grief feelings as they are no longer disrupting our lives and we allow ourselves to tentatively feel joy again, they can recur, especially around dates and other personal anniversaries. The healing scar is still fresh and the ‘what if’s’ are always there to be imagined.

Although grief healing means refocusing and finding acceptable ways to live with your loss, it does not mean forgetting or making your memories insignificant. Nor does it mean you will like it but a healthy recovery from grief makes it necessary. The baby bond formed can last forever, although the sorrow does dissipate over time and the memory becomes a part of your life. It diminishes in intensity when less sadness is experienced and there is more acceptance of our loss or losses. Most of us never forget our lost babies and don’t just ‘get over’ our longing and sadness; we will probably always feel that tiny, precious, secret place in our heart that aches. We can come to cherish that in a healthy way and recover and refocus again for a new normality.

A poem often quoted;