How do you deal with the loss of someone who never really lived? For parents to be, a sudden miscarriage and the loss of a foetus can be devastating. While our culture makes room for grief, it is still in a limited fashion and so it can also be a lonely time. How couples experience this grief is intensely personal and can cover the spectrum from acceptance to guilt says Dr. Piyanjali de Zoysa, Senior Lecturer in Clinical Psychology, University of Colombo. This week we speak about the emotional toll miscarriage can take on a couple.
That one has miscarried often comes as a complete shock - whether it’s a quiet announcement in the doctor’s office or whether severe cramping and bleeding necessitate a trip to the emergency room. “The physical aspect itself, taken on its own, can be traumatic, with a woman having to cope with the bleeding and pain,” says Dr. de Zoysa, adding “as it can happen any time of the day, including late at night, or when you’re alone and then the resultant fear of not knowing what to do.”
Even if a woman has only been pregnant for a few weeks, “the news can have quite an impact,” she says, explaining that would-be parents typically struggle with a sense of disappointment and loss. Though the foetus may have not even developed very much, most parents will have already begun to imagine its place in their lives. These expectations lie at the root of their disappointment – they have just lost the future they hoped to build as a family.
The intensity of this emotion has a great deal to do with the circumstances under which the child was conceived - in particular, some women may feel unhappy about their pregnancy or be unprepared to support a child. “There are extreme cases where pregnancy is the result of abuse, rape, or in which the mother is in an extremely stressful intimate relationship,” says Dr. de Zoysa, explaining that in any case “connecting with the foetus doesn’t happen for every woman at a precise time.”
As the partner actually carrying the child, the experience of pregnancy is more immediate for a woman and she may have already taken note of the effects of her pregnancy hormones on her body. A woman further along will have also felt her child’s first movements within her. Though bonding will only begin in earnest when the child is born, at this stage most mothers still feel a strong connection to their unborn infant.
Most of us have little conception of the depth of mourning that many women go through, or even a clear idea of how long the grieving process can take. Some women are told they should be well over it in within weeks. “The theory about time limited grief is debatable and outmoded,” says Dr. de Zoysa. The most quoted model of the grieving process has a person experiencing five clear stages of grief: first is denial or disbelief, the second is anger where the person looks to blame external causes for their pain. The third is said to be bargaining, an attempt to negotiate a way through the grief, the fourth is depression and the fifth is acceptance.
“What we’ve seen in research and in working with people is that people might not go through all those phases or they might have a delayed reaction or they might not have it altogether,” says Dr. De Zoysa, “now, there’s a more fluid understanding of grief.”
As the weeks go by, some women who have miscarried will find themselves struggling with a constant awareness of where their pregnancy would be right now if things had progressed normally. Being round other pregnant women or mothers can be a painful reminder of one’s loss. Different women will find their own ways to cope with their feelings. Some may choose to intellectualise their loss – looking at the foetus as a clump of cells that never had a chance to become a child. For others embracing the idea of having actually lost their child will allow them to mourn. “There’s no one rule that is applicable to everyone, says Dr. de Zoysa.
Clinical depression is a very real possibility. Some individuals will struggle with intense feelings of depression. If this lasts more than two weeks and is characterised by symptoms such as an inability to function as before, a low mood, and a difficulty to find happiness with things that were pleasing in the past, then one should seek professional help, she advises. Dramatic and sustained changes in sleeping and eating patterns, and an inability to concentrate are also good indicators that psychological intervention might be required. “At times, depression may also be characterised by some talk of taking their lives,” she elaborates.
In the middle of this, fathers are often left out. “Especially in traditional societies we don’t give much emphasis to the father, I have met men who are particularly disturbed when they have lost a child,” she says explaining that once again these are tied up with expectations of happiness and family.
Unfortunately, a couple might find it difficult to support each other in this. Some women may believe their partner doesn’t feel the loss as keenly, but Dr. de Zoysa is emphatic when she says “men also grieve.”
For those around, it might be tempting to speculate on what caused the miscarriage. It’s a good idea to refrain from doing so in the immediate aftermath, says Dr. de Zoysa, pointing out that however well intentioned, it is rarely constructive at this point.
The fact is, for many women, grief over a miscarriage is complicated by feelings of guilt. If your intention is to prevent a recurrence of the miscarriage, the best thing to do is to keep your advice factual – to say you have heard that doing a particular thing can trigger a miscarriage and that the couple should verify this with their gynaecologist. This is best done at a point when it is relevant – such as when the woman is considering getting pregnant again.
Some women in particular might latch onto such explanations, whether they are true or not, says Dr. de Zoysa explaining that such cases arise out of an individual’s need to regain some control over a very painful situation. While this might not be entirely healthy, for the couple, understanding what went wrong, and allowing themselves the space to grieve can be healing. “It also helps to know it isn’t only you, but that other women throughout the generations have gone through the same thing,” says Dr. de Zoysa, adding that some women find comfort in reading about it and talking to those with similar experiences.
What triggers miscarriages
Miscarriages can occur for many different reasons, though a majority of cases are linked to genetic issues, says Dr. Nalinda Rodrigo, Consultant Obstetrician. Chromosomal and uterine abnormalities, Polycystic Ovarian Syndrome, viral and bacterial infections have also been known to trigger miscarriage. “75% of the time it is beyond a woman’s control,” says Dr. Rodrigo, “it is usually the body’s way of getting rid of an abnormal conception.” In the case of still births, most happen without any notice – though there can be warning signs. High maternal blood pressure, bleeding and babies that have stopped moving in the womb are causes for concern and should be brought to the attention of your obstetrician.
In local hospitals, it is usually the policy to ask the patient if they would like to see the foetus or not. “If they wish to, they can,” says Dr. Rodrigo, explaining that in many cases mothers refuse, while fathers ask to be shown the remains. In the aftermath, Dr. Rodrigo says he will always explain what went wrong, but is reluctant to prescribe anti-depressants.
The most effective solution, he believes, is most often to encourage the couple to try for another child. Depending on how long the pregnancy lasted, it might be possible for a couple to begin trying at once. “You can’t replace what they have lost but you can give something equivalent,” he says. |
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