The Unexpected Loss

When excited mom-to-be Lily Allen had a miscarriage at six months last November, friends and fans rallied around as the devastated 25-year-old singer and her boyfriend of 18 months – decorator Sam Cooper – grieved. Yet, two years earlier, her miscarriage four months into an unplanned pregnancy drew a different response. Back then, Lily was single, having broken up with the father (Chemical Brother Ed Simons), and when she told the UK’s Daily Mirror that she was ‘in a very dark place after the whole thing happened’ and that it was ‘the toughest thing I’ve had to go through in my life’, some were surprised. General thinking is that having a miscarriage in circumstances such as these somehow makes it easier to handle – especially if it happens early in the pregnancy, when miscarriages are common. (It’s estimated that one in four known pregnancies ends in miscarriage – most in the first three months; many more are lost before women even realise they’re pregnant.) But miscarriage is a complicated kind of loss and can affect you whatever the circumstances and however early it occurs. According to Rochelle Friedman and Bonnie Gradstein, authors of Surviving Pregnancy Loss (Little Brown & Co), the psychological and physiological processes of pregnancy kick in soon after conception. Levels of reproductive hormones in your system soar, the lining of your uterus thickens to support the fetus, your breasts enlarge to prepare for feeding, and your emotions shift gear. An attachment and sense of ‘oneness’ with the fetus can form even when the pregnancy is unplanned, say Friedman and Gradstein. Unless you are set against having a baby (perhaps contemplating abortion or placing the child for adoption), you can be left feeling empty and incomplete when a miscarriage interrupts the pregnancy, grieving over what is lost now and for what may have been. ‘Coping with miscarriage may be one of the most difficult processes a woman ever has to face,’ says Illeana Cocotos, a Johannesburg psychologist and bereavement counsellor. ‘It can bring feelings of fear, sadness, depression and guilt, which are the normal emotions associated with grief. And with an unplanned pregnancy, many women may have resolved early feelings around not wanting the baby by the time the miscarriage occurs.

They may then experience the normal emotions associated with grief, as well as feeling that because they didn’t want the baby initially they somehow caused the miscarriage, or that it’s a punishment.’ Yet levels of grief can differ widely. ‘All loss follows the stages of denial, shock, bargaining, anger and depression, before acceptance begins and you can move on,’ says another Johannesburg psychologist, Dr Colinda Linde, author of Get The Balance Right (Metz Press). But the degree to which you experience these emotions will vary depending on certain factors, she says: was it a good-news pregnancy, the miscarriage of which was devastating, or was it experienced as a less significant loss? Was it an early miscarriage or one due to a severe genetic defect? Did it put stress on your relationship with your partner, or did it allow you to bond through shared grieving? Linde sees many young women in the early stages of commitment or their career who are either ambivalent about pregnancy or actively do not want children at that moment. ‘When they fall pregnant unexpectedly or because of pressure from their partners, a miscarriage can be an opportunity to assess where they are and what they want from their relationship and career at that stage,’ she says. ‘Of course there is grieving, as it is still a loss, but it is easier and they are able to move on faster.’ If you don’t want the baby at the time of the miscarriage, you may even experience a sense of relief when it happens, says Cocotos. ‘In this instance, a woman may rationalise that the miscarriage was for the best, and not experience it as a loss. She may recover easier and will not necessarily go through the grieving process; she can then experience guilt for not grieving, and see herself as an awful person for not feeling sad. Then again, some women still mourn after a miscarriage, even if they didn’t want the baby.’ The response to a miscarriage is so individual that most women would benefit from some type of counselling when it happens.

HOW BEST TO COPE

‘Counselling can help grieving mothers identify their feelings and reduce the risk of having emotional problems months or even years later,’ says Cocotos. (See ‘Time to get help!’)

1. Acknowledge your loss.
One of the best ways is to share it with others, but this can be hard if the miscarriage happens before you’ve told family or friends about the pregnancy, or if the pregnancy is unplanned. Having a small ceremony can help – lighting a candle, planting a tree, and if the pregnancy is far along, naming the unborn child, holding it or having a burial ceremony. Also talk through your loss with your doctor when you’re over the initial shock, to understand the reason for the miscarriage. ‘In most cases it’s caused by a chromosomal defect in the fetus,’ says Cocotos. ‘This knowledge may help you realise that you could have done nothing to prevent the miscarriage and didn’t contribute to it happening.’ Type-A personalities – women who are driven perfectionists – can find it particularly difficult to accept the loss and look on miscarriage as a failure, she adds. ‘They’re used to being able to achieve what they want by hard work and persistence, so it’s difficult for them to accept their body “letting them down” like this.’ If you’re one of those women, get professional help

2. Feel your grief.
You know the stages – identify and work through them as they arrive, in whatever order they arrive. Cry, scream, punch a pillow if it helps, says Linde. ‘The point is to feel the emotion enough to be able to acknowledge and process what has happened in order to move on. Dwelling on or getting bogged down in “if-onlys” is not beneficial, and will block healthy recovery.’ Express your feelings creatively – keep a journal, paint or make music – and, when you’re up to it physically, dancing, gymming and running release feel-good hormones. Don’t be tempted to suppress or escape feelings with alcohol or drugs, or by trying to get pregnant again straight away. Don’t listen to well-meaning people who urge you to ‘get over it’. Find a support group – ask your doctor, or join one of the many communities online.

3. Invest in your relationship.
Your partner is probably experiencing emotions similar to yours and you need to work through the grieving process together,’ says Cocotos. ‘Naturally, initial feelings about an unplanned pregnancy will impact on feelings about the miscarriage.’ Men and women often deal with grief differently. Friedman and Gradstein report a study showing that women are more likely to see miscarriage as the loss of a person, while men see it as a sad event but not a death. Not all fathers will interpret it this way, but in general men talk about their feelings less, and may feel they must take care of their partners by staying strong. Women can interpret this as not caring. ‘It’s important to communicate your feelings and try to stay connected during this difficult period,’ says Cocotos. ‘If the two of you struggle to deal with your grief and your relationship is at risk, get help.’

4. Adjust to your changed situation.
Give yourself time to change the perception that you’ve lost a part of yourself, says Linde. You need to take back your old identity. Accept that you will have changed, and even grown, through your grief. Take leave from work and try a change of scene or a new hobby. If you hope to have a baby in future, remind yourself that most women who have miscarriages go on to have healthy pregnancies.

HELPING A FRIEND WHO MISCARRIED

• Don’t underestimate the impact of miscarriage, which can be hard to grasp unless you have had one.
• Be there for her: you don’t have to say anything, just hold her and listen patiently. (She may need to tell her story repeatedly.)
• Don’t be afraid to talk about the baby or her loss.
• Encourage her to express her pain and anger.
• Don’t minimise her loss by saying things such as ‘you were only three months along’.
• Don’t offer platitudes (‘it’s for the best’, ‘you’re young, you can have another’) to explain it away.
• Don’t offer your own stories of loss except very briefly to show you care.
• Don’t say you know how she’s feeling unless you too have had a miscarriage.
• Don’t try to hurry her healing, but if the grieving persists or tips towards depression (see ‘Time to get help!’), suggest going with her to get help.

Remember that the anniversary of the loss may reawaken her emotions – call or send a card, or take her a small remembrance.