Miscarriage and pregnancy loss

Pregnancy loss can happen at any stage. Early losses, such as miscarriage, are common, yet many people feel alone because these losses are often not talked about openly. Later losses, such as stillbirth, and the death of a baby shortly after birth bring their own particular pain, including decisions about birth, saying goodbye and memorials.

Perinatal loss affects everyone involved: the person who was pregnant, their partner, and often siblings, grandparents and close friends. Partners may grieve differently or feel overlooked. LGBTQ+ parents, surrogates and those who have experienced loss through IVF may face additional challenges in having their grief recognized.

There is no "right" amount of grief based on how far along the pregnancy was. For some, an early loss is devastating; for others, the emotional response may be milder. Every reaction is valid.

Grief after pregnancy loss can involve many emotions:

• Deep sadness, emptiness or longing
• Shock and disbelief
• Guilt or self-blame, wondering if you did something wrong
• Anger at your body, others or the unfairness of the loss
• Jealousy or pain around pregnant people or babies
• Anxiety about future pregnancies
• Feeling isolated or misunderstood

Grief can also affect the body, with fatigue, sleep problems and changes in appetite. Hormonal changes after pregnancy can intensify emotions.

Feelings often come in waves and may resurface at due dates, anniversaries or during later pregnancies. Most pregnancy losses are not caused by anything the person did, and medical professionals can help answer questions about why it happened when answers are available.

Grief is not a disorder, and most people gradually find a way to carry their loss. For some, however, pregnancy loss can lead to depression, anxiety or post-traumatic stress. This is more likely when the loss was sudden or frightening, involved medical emergencies, followed fertility treatment or repeated losses, or when there is little support.

Signs that it may be helpful to seek professional support include:

• Persistent low mood, hopelessness or loss of interest
• Intense anxiety or panic, especially about health or future pregnancies
• Flashbacks, nightmares or avoiding reminders
• Difficulty functioning at home or work
• Thoughts that life is not worth living

If you have thoughts of suicide or harming yourself, seek help immediately: call or text 988 in the US, or Samaritans on 116 123 in the UK and Ireland. In an emergency, call 911 or your local emergency number.

Therapy offers a safe space to talk about the baby and the loss, express feelings that may be hard to share with others and make sense of what happened. Grief counseling can support people through the natural grieving process.

When symptoms of depression, anxiety or trauma develop, evidence-based therapies can help. Cognitive behavioral therapy can address guilt, anxious thoughts and avoidance. Trauma-focused approaches, including EMDR, can help when the loss was traumatic. Couples therapy can help partners understand each other's grief and stay connected. A psychiatrist may be involved if medication for depression or anxiety is considered.

Some people find meaning in remembrance, such as naming the baby, keeping mementos or marking anniversaries, and therapists can support these choices.

Psychologists, clinical psychologists, therapists and licensed clinical social workers with experience in perinatal mental health or grief can offer support. Your obstetrician, midwife or primary care doctor can also help connect you with services and answer medical questions.

In a first session, you can share as much or as little as you want about the loss. A good therapist will go at your pace and respect your beliefs and the way you understand your loss. Peer support groups for pregnancy and infant loss can also reduce isolation.

Ways to care for yourself after a pregnancy loss include:

• Allow yourself to grieve without a timetable.
• Tell trusted people what you need, whether that is talking, practical help or space.
• Rest and look after your physical recovery.
• Consider marking the loss in a way that feels right for you.
• Limit exposure to triggers like social media announcements if needed.
• Be patient with your partner, who may grieve differently.