The joys of pregnancy in the first trimester are often muted by the fears of pregnancy loss. The newly pregnant woman may choose to not tell many people she is pregnant because of the statistics of the relatively common occurrence of early pregnancy loss. Yet once the earliest stages of pregnancy have ended, the mom-to-be usually relaxes, comforted by the statistics that much less is likely to go wrong from that point on. She begins to tell everyone she knows and of course, eventually, the signs become unmistakable.
Unfortunately, late pregnancy loss can occur and when it does, it can wreak emotional havoc on the woman and her family and friends. Because her signs of pregnancy were almost surely noticeable, gone is the option for her to disclose or not disclose what has happened to her. Emotionally, she had experienced such a high, a feeling of nearly making it, that the letdown can be almost unbearable. Add to that the physical discomforts and emotional confusion associated with having to give birth to a fetus that is not alive and it is clear why this period may represent one of the most difficult times in a woman's life.
One Woman's Experience
Susan Trepal, age 38, of Ohio, experienced a miscarriage at 17 weeks. Susan reports that the most unexpected part of her miscarriage was being told that she would actually have to give birth to the silent baby. She was familiar with miscarriage and just assumed she would undergo a dilatation and curettage (D and C) to end the process of the miscarriage. Instead, she was shocked when she was told that not only would she have to deliver, but she might need to be induced as well. "To go through all that pain and then there is nothing there," Susan recalls as one of the most difficult parts of her hospital experience.
Susan, like many of the mothers I have worked with who have experienced miscarriage, puts an emphasis on trying to remain hopeful despite how difficult that is at times. "I try to turn around my experience to be a help for other people." Susan points to a very strong spiritual foundation helping her through the tough times.
Friends and Family
Friends and family are often left wondering how they should handle a late stage miscarriage. Susan says, "I was very moved by and grateful for the cards and phone calls from many concerned people, some of whom barely knew me. It was nice to know that they were there for me." If in doubt, sending a card or flowers is a thoughtful gesture that will usually be appreciated. What was not helpful? "People who would discount my whole experience and say 'Well, you can just have another one'." A woman who has miscarried first needs to grieve for her current loss, and it helps to have that acknowledged by friends and family.
The Grieving Process
The grieving process for a late pregnancy loss is as individual as the women who experience the loss. Some women prefer to view the fetus after delivery, while this is too difficult for others. Some women will want to know the gender of the child, name the child and keep track of the child's birthday. Others prefer not to. Some women do not want to see the baby nursery they started preparing and ask someone to put everything away for them while others prefer to go through all the items they lovingly chose one by one. Decisions must be made about funerals or memorial services for the fetus, and some women choose not to do either. Even when it comes to support, some women who have undergone a late pregnancy loss may find them comforting, but for some of the women I have worked with listening to the experiences of other women who may be suffering even years after the loss is just too unpleasant. I encourage the women that I see to listen to their inner needs and be respectful of their individual style of grieving. No woman who has endured such a loss should judge herself or her emotions.
One of the hardest aspects of the grieving process is the guilt many women feel about their miscarriage. Was it something they did or did not do; was it the missed prenatal vitamin or overtime at work? Was it stress or worry, the argument that was had with a co-worker? Were there signs that were missed? Every mom asks these questions, even knowing intellectually that none of these chance happenings were likely to have played a role in the miscarriage. But the questions remain and often go unanswered.
Women who experience late pregnancy loss must deal with physical as well as emotional issues. Later pregnancy loss is complicated by the physical and hormonal changes that a woman undergoes after giving birth. The postpartum woman who is not able to bring her baby home still experiences breast engorgement, vaginal soreness and heavy discharge. These signs and symptoms are a constant reminder of the miscarriage.
Late pregnancy loss can place a strain on a relationship. The mom-to-be was not the only one looking forward to the beginning of a new life, so a father may have his own strong emotions to deal with as he is being supportive and comforting to his partner. This high emotional state can cause eruptions of anger of partners either towards each other or towards healthcare providers or others. Both spouses may wonder if anything that one or the other did caused the horrible tragedy. In the case of a poor relationship, there can be serious accusations and a tearing apart of the couple; this situation calls for professional consultation. Most healthy relationships though will be able to weather this challenge, and many couples report that it brings them even closer.
Tips on Dealing with the Loss
Here are some tips on dealing with a late pregnancy loss:
- Allow yourself plenty of time to grieve and allow your grieving to take whatever form is most natural and comfortable for you.
- Stay connected to your spouse. Let him know how you are feeling and how he can best support you. You may need to let him know the miscarriage is not his fault.
- Seek outside help. Often, talking to an objective outsider can be helpful even if it is only for a few visits. Your obstetrician should be able to recommend someone for you.
Susan says she often reminds herself that she will be OK. She is comforted by a quote from her mother who underwent a similar loss many years ago: "It is something you will never forget, but it gets better every day." Comforting words indeed.