Psychotherapy as a Catalyst for Finding Peace After Pregnancy Loss

by Jennifer Batza, LCSW, Psychotherapist at Wildflower Center for Emotional Health              


Why would anyone talk to an utter stranger
about her miscarriage, much less pay for that conversation?

How can focusing on the pain of a pregnancy loss
help to ease that pain without prolonging the grief?

Does healing from perinatal loss grief mean
forgetting or dishonoring the baby?

Why do even those women who enjoy healthy partnerships
and highly supportive family and friend networks still find therapy
to be a useful tool after a loss?

 

PREGNANCY LOSS AS THE UNSUPPORTED GRIEF

A miscarriage at any gestational age leaves a profound impact on nearly all women and couples, and yet people grieving pregnancy loss do not typically receive effective support. Family members, friends, coworkers and society at large tend to discount or mismanage support for pregnancy loss. While social traditions abound for sharing enthusiasm about pregnancy or for consoling people when death occurs at other life stages, people grieving a miscarriage often hear platitudes or crickets. This painful gap in solidarity happens when bystanders can’t relate to the emotional experience of pregnancy or when their own experience with miscarriage looms so large that it impairs their perception or ability to focus on the miscarriage grief of others.  

Lack of data, not empathy   Frequently, an early miscarriage occurs before aspiring parents disclose the pregnancy to their social network.  No grief support is offered because both the pregnancy and the loss are secrets shared exclusively with their inner circle.  

Generational differences   When early pregnancy loss happens, commonly only older family members – the baby’s would-be grandparents – have been told about the pregnancy. Often their style of supporting the grieving couple is focused on convincing the couple to discount the impact of the pregnancy due to its brevity, to focus on other things or to focus on the positive, and to try for conception again.  This “out of sight, out of mind” and “if at first you don’t succeed, try again” mentality, though well-meaning and loving, can prolong the grieving process for parents after a miscarriage by urging them to deny or rush past their grief instead of processing and releasing it. Even grieving parents who have access to an older support figure who experienced a miscarriage may feel unsupported.  People who lived through a miscarriage to conceive and who have aged out of childbearing years may offer ineffective support because their recall of the miscarriage recovery process is too remote to accurately reflect the intensity of the emotions involved.  Years of parenting children into adulthood may obscure the memories of miscarriage and the difficulty of questioning fertility.  

Too close for comfort  Siblings and friends who were close to the mother or the couple before the loss may suddenly seem unavailable when it comes to talking about this type of mourning.  Very often, a mother or couple’s peers are also attempting to conceive, pregnant, or parenting babies.  Discussions of miscarriage with friends or family who share this stage of reproductive life may feel inappropriate or off-limits.  Such conversations can feel too potentially upsetting or negative for pregnant women, while exposure to the viable pregnancy of another mother can be jarringly evocative of the lost pregnancy for the grieving parents.  

Avoiding old scars  Lastly, some people are unable to provide support for pregnancy loss because they have their own complicated reproductive histories. Friends or family who never received support for their own pregnancy losses or who lived in a time when miscarriage or even infant death were even more frequent than today tend to impose stoicism on others. People who have terminated pregnancies or chosen adoption may find that those losses impede connection to others around involuntary pregnancy loss.  

Because so many of the key figures in a mother or couple’s lives are not always equipped or available to provide helpful support after a pregnancy loss, even those with abundant social lives find psychotherapy after pregnancy loss beneficial. Contact with a therapist who has significant professional experience with perinatal loss benefits women and couples because the clinical conversation treats three components of this loss that don't generally receive impartial attention from one's existing social connections.  

ASPECTS OF LOSS A PSYCHOTHERAPIST CAN ADDRESS

First, pregnancy loss disrupts a significant role transition. A person whose pregnancy does not produce a living, healthy baby may feel stuck in a limbo between the pre-pregnancy identity and the parent identity which had already begun to take shape during the pregnancy. Pregnant women and couples are interrupted in the process of changing into mothers and fathers. Often parents do not realize the extent of this disrupted transformation until they describe their emotional experience out loud with a careful listener. The act of articulating these thoughts brings parents a sense of clarity and unburdening. A professional can help parents of lost pregnancies to claim and understand this socially unrecognized identity and navigate life in the wake of this transition. 
 
Second, processing the grief of perinatal loss is most efficient without filters.  A professional helps the parent grieving a pregnancy loss to articulate and unburden herself or himself of every aspect of the loss experience, even those thoughts and feelings that feel shameful and dark. After experiencing a pregnancy loss, parents often report that encounters with other pregnant women or babies become triggers for grief. In addition to tearfulness and distress, grief expresses itself as anger, resentment, envy, and judgment. Support from even the closest family members and friends requires the griever to self-censor in order to conform to social graces and filters, particularly with peers who are pregnant or closely connected to a pregnancy or baby. By using a professional as a sounding board and a support, a grieving parent can identify, articulate, and examine those reactions to grief that are socially unpalatable.  Most grieving parents find great relief in speaking some of the unspeakable thoughts around pregnancy loss and ultimately leave these thought patterns by bringing them into the light in conversations with a caring professional.     

A third reason for seeking professional support after pregnancy loss is the griever’s cycle of needing accompaniment coupled with the urge to self-blame and isolate. When a pregnancy does not result in a living, healthy baby, the parent suffers a very physical, primal loss in addition to an intellectual, rational loss. The aching arms, feeling of physical emptiness, and the urge to physically act in some way to recover the baby are all symptoms of this primal response to the loss of the next generation. While parents experience a host of rational and social responses, one component of loss that goes unaddressed but is deeply felt by grieving parents is this preverbal, "Mother Bear" grief.  Miscarriage can lead a mother to question whether she is somehow at fault and whether she will be excluded from the cohort of mothers who surround her in real life or social media.  Without consciously realizing it, a woman may begin to doubt her worthiness and fear rejection from normal society due to not having a baby.  It is this facet of grief that can lead typically rational people to doubt reassuring explanations from the medical team, that fuels superstition or self-doubt around the cause of the loss, and generates urges to isolate from others. This irrational and powerful side of grief is experienced physically and often feels as compelling and true as a gut instinct. The most effective response to such grief is accompaniment, the physical presence of a person who is dedicated to giving the loss survivor attention and preventing her isolation. Eye contact, attuned listening, and the act of committing time to attend to this grief is key to processing and dispelling the grief.  

MAKING GRIEF MORE MANAGEABLE THROUGH ENRICHMENT, NOT ERASURE

Couples or mothers may fear that focusing on their grief will deepen or prolong their distressed state. Others avoid treatment because they fear therapy will make them forget or dishonor the loved baby that was expected from their pregnancy. Psychotherapy for pregnancy loss accelerates parental healing without worsening or dispelling the grief.  Women or couples who work with a therapist dedicated to this phenomenon will find that taking the time to sort through their thoughts and emotions with a trained listener will help them understand how grief influences them and how they can respond to their reactions in ways that allow them to function in the present even as the past loss impacts them.   

By working with a therapist, loss survivors give the grief the attention and interaction needed to process this often misunderstood emotion. After a shocking experience of loss of control and extreme disappointment, entering therapy restores control to loss survivors and allows them to integrate the experience of pregnancy loss into the rest of their life stories.  With therapy, aspiring parents can parlay this loss into an additional, enriched layer of identity and transform an isolating, overwhelming grief into growth, connection, and even hope.