The first time it happened I was young, unassuming, naïve and outright inexperienced in anything maternal. I had been married for a year and we were now ready to have our first bundle of joy. Preparations had started in earnest by way of stopping contraception, investing in baby and parenting magazines, shopping for names as well as sharing our expectations of whether the first one would be a boy, girl or better still twins.
It all happened at the same time; the discovery of life and the end of it. It started by an excruciating pain that would disappear as fast as it came from my left side. I endured it for a week before visiting the doctor. After examination I was told that I was pregnant but for some reason there was no baby in the uterus so they needed to do a laparoscopy to check and clear against an ectopic pregnancy. The procedure was done, we did not only loose our baby, my chances of giving birth were also instantly halved because I had also lost my left tube which they could not save. Fast forward four years later I had suffered four other miscarriages before giving birth to our first miracle in 1999. We had our second miracle in 2003 after which I had 2 more miscarriages before giving up on the maternal duty of bearing children.
My story is not unique as research shows that one in every four to five pregnancies end up in miscarriage. My heart goes out to those who have to deal with such loss. I care about the mental wellbeing of those who lose their children before they are born. World Health Organization (WHO) acknowledges studies done indicating that after a miscarriage, up to half of the women experience anxiety symptoms while 15% experience depressive symptoms. Such symptoms during and after a miscarriage can be conceptualized as a pattern of grief and/or as a traumatic event. The symptoms, as was in my case may be compounded by the fact that hospital staff may not be sensitized to provide support for the emotional distress associated with miscarriage. What is the grieving process like, what societal norms act as risk or protective factors, is there help for the grieving parent of the unborn child?
The complexity of grieving death before holding the life
Grief is as unique as our individuality as well as our loss. While I will draw from my experiences in a quest to help others, I do so with the full knowledge that grief is never uniform and no one can be a master of grief.
Grief is by nature complex, however its more complicated when we cry over someone we never held, someone who may not have had a name. Sometimes we do not even know whether it was a she or a he yet that someone had become part of us in a way that only you as a parent can fathom. Many times, miscarriages happen before one has informed family and friends of the existence of a pregnancy making it difficult to share with them the loss when it happens. Some cultural norms may also come in the way where the belief is that a pregnancy is not necessarily communicated but you allow it to get to a point where it is “seen” in the fullness of time. Even in those circumstances where it has been communicated or now known, most of us do not know how to communicate with someone when all of a sudden, we realise the pregnancy is no more yet there is no baby. When a miscarriage happens there is no funeral, no ceremony, no gathering of family to give you social support. Many a times its just you alone or you with your spouse navigating on your own through the maze while trying to make sense of everything. It also gets complicated when its coupled by physical pain, like in my first case where I had undergone a major surgery to remove the tube.
Blind Spots
Due to the above-mentioned complex nature of grieving an unborn child there are blind spots that one needs to be aware of in their journey. First it is helpful to face the reality of your loss. You need to accept that you are grieving, and your loss is as real as someone who has lost a child or anyone dear. It does not become a real loss because everyone knows about it or because we conduct a funeral. What makes it a loss is the fact that you have lost something precious. Giving yourself permission to grieve is the first step. Miscarriage will affect you; just like any huge loss, it will not leave you the same person you were before. Now, you will have different and maybe more fears, different and more unanswered questions, a different kind of sadness. Some people may expect and tell you to snap out of it but it’s not that simple.
Secondly its easy to isolate yourself and suffer alone unnecessarily. There is need to appreciate that others are also experiencing your loss, for example your spouse and grandparents. By grieving together, you get a chance to share your grief. This will also help you understand that when the people close to you ask questions which only you may have answers to, they are not necessarily blaming you or despising you, but they are also seeking closure. I definitely am not asking you to take care of them during your lowest moment but knowing that they also are hurting helps you to understand what’s going on around you.
How to move on
For one to be able to move on, it helps to live and process your grief. Elisabeth Kubler Ross introduced the concept of stages in grief. You may or may not go through all the stages, neither are they necessarily linear, but appreciating that these points exist and allowing yourself to process them will be of great help. At any stage if you feel overwhelmed seek professional help, from counsellors, psychologists or any available community help programs that may be available in your community.
Shock & Denial
When a great loss happens, it is sometimes met with shock and denial. Episodes of denial are normally associated with the need to be in isolation. You don’t even want to communicate the loss to anyone because deep down you are hoping it’s not true. I remember one time when my husband insisted on a second and even third scan before accepting that I was indeed miscarrying. It must have been hard form him to just take it, that I had miscarried again. Denial and shock help as a buffer to allow the brain to take in the loss bit by bit, in portions that it can process. I had to allow my husband to get the closure he needed by getting a second and third opinion on the matter.
Frustration or Anger
Anger is often associated with grief because grief signifies an unreachable therefore blocked goal. In our quest to resolve what has happened we seek solace in needing explanations leading us to seek for someone to blame. The anger may be directed at self, God, the doctors, family or friends as we try to process how things could have been different: ONLY IF!! The presence or absence of regrets does not take away the fact that this kind of loss is permanent and that nothing much can be done now to reverse it. Allow yourself to feel your anger and where necessary to forgive. It is also easy to be angered by how people will be responding to your loss, however it is important to accept that very rarely do people intentionally hurt us. During this time help may be offered, kindly accept where you need help and politely turn down when you do not want the kind of help offered. For example, to help you recuperate friends and family may offer to take siblings, so that you find time to rest. Preferences differ, some will want to be closest to their children in which case you may politely deny or if you think it will help accept this kind of help.
Depression
When our goals become unreachable depression is inevitable. Permanent loss of life means never getting that life back. Even if you were to get pregnant again, it will be another pregnancy and it can never compensate for the one you lost. Depression sets in, in moments of helplessness when one feels they are losing control on their outcomes. The fact that in most cases very few people, if anyone at all is acknowledging your pain due to maybe ignorance, either of your situation, or of how to reach out, a grieving parent is often left isolated. Anhedonia (inability to feel pleasure) may be prevalent in grief which may represent as both a cause and outcome of your depressive episodes. Finding someone to express you true feelings to will help.
Acceptance & Integration
At this stage you will be starting to accept what happened and finding ways to pull yourself up so that you can move on. Important to note is the fact that you may be at this place on Monday and find yourself back at depression or anger on Friday. Take each day as it comes and always self-care and get support when you need to. It is at this stage that you may start trying to conceive again, a process which may be complicated by the fears and build up of anxiety over the possibility of suffering another miscarriage. Finding the needed support is an ongoing key through all these stages.
How communities can help
As alluded to before, people grieve differently and the greatest gift you can offer a grieving person is respecting their wishes unless they are self-harming. Some will want to be alone some may not, just don’t insist on anything they are not comfortable with. Stop judging, one well-meaning friend told me that if only I could have faith in God, the miscarriages would stop. I looked at them wondering what type of “faithometer” they were using, because as far as I was concerned, I had faith in God. Communities need to be sensitive to hurting people in general. Let’s interrogate some of our cultural practices and see if they are still relevant and useful to our mental wellbeing, discard the not so useful ones and encourage the helpful ones.
Another way of helping is by encouraging those sinking, to seek help from neutral places. Do not insist on the helper but gentle nudging will do the trick. Instead of saying let’s go to a psychologist, you can say would you want to talk to someone professional? At times it will mean bringing the professional to where they are. Another best way is for communities to make use of the cultural indigenous systems such as reaching out to the elderly and religious leaders, to process our grief. Above all let us normalize getting therapy when facing difficulties that we are failing to process by ourselves.
If you or someone you know is struggling with the mental and emotional challenges of miscarriage, it may be helpful to seek support from a therapist. A therapist can provide a safe and supportive space to process feelings of grief, sadness, guilt, or any other emotions that may arise. They can also offer coping strategies, validation, and guidance as you navigate the journey of healing.
Fatima
Consultant & Wellness Coach at Psycmates
Compiled using information from the following sources
Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss: Simon and Schuster.
Mehta, M., & Pattanayak, R. Follow-up for improving psychological well-being for women after a miscarriage: RHL Commentary (last revised: 1 January 2013) The WHO Reproductive Health Library. Geneva: World Health Organization.
Cohain, J. S., Buxbaum, R. E., & Mankuta, D. (2017). Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more. BMC pregnancy and childbirth, 17(1), 437.