When a woman has a miscarriage, one of two things tend to happen. If she hasn’t told anyone that she was pregnant, she often decides to tell no one about her loss. If she tells no one, she suffers in isolation, and wonders if her sadness and overwhelming loneliness are normal. If she has told family and/or friends that she was expecting, she then has to share her sad news, or ask her partner to. And when people hear about a pregnancy loss, they often don’t know what to say or do. Our society doesn’t handle pregnancy loss very well. Some people consider miscarriage a normal part of trying to build a family, and dismiss the psychological consequences. Others make insensitive comments, which only make one feel worse.
The psychological toll
It is true that pregnancy loss is common, impacting an average of 15-25 percent of pregnancies, depending on the woman’s age. So in fact, most people know someone who has had a loss. But what most people don’t know is the psychological toll that miscarriage can bring. Women who have had a loss can take months or even years before they begin to feel like themselves again. Symptoms of depression and anxiety are common, especially in the first six months. Women report that they think about the lost pregnancy for years after, even after experiencing healthy pregnancies. I had a miscarriage in-between my two healthy pregnancies so it was 18 years ago. And I still think about it.
The most commonly used “antidote” for a pregnancy loss is to try to get pregnant again. Hopefully, most women will indeed get pregnant easily. But that is when the negative feelings tend to arise. It can feel very scary to be pregnant when one has had a loss. I see women all the time who are pregnant after a miscarriage and they all report anxiety about their pregnancy, with the main focus that a loss will happen again.
The good news is that the vast majority of women who are pregnant after a loss will indeed deliver a healthy baby. Repeat miscarriages aren’t common at all. So knowing that might help. But how to deal with the normal anxiety of pregnancy after a loss?
Share your concerns with your health care team. Remind them of your loss and your subsequent normal anxiety. Feel free to ask for extra blood tests early in the pregnancy to monitor the pregnancy hormone, since for the first couple of weeks it should double approximately every three days. Later on, ask for ultrasound scans, since that it the best way to monitor the progress of the pregnancy after six or seven weeks.
Remind yourself that every pregnancy is different, and the fact that your last pregnancy ended in a miscarriage does not mean this one will.
Monitor your health habits, since there are some which can increase the risk of a pregnancy loss. Eliminate alcohol, avoid all exposure to nicotine, and try to taper down your consumption of caffeine. If you are taking any medications, even over the counter one, let your health care team know. There are some medications, including prescription ones, which may increase the risk of loss. Ask about your exercise regimen. Most women are told to continue whatever they were doing before pregnancy, but make sure it’s ok.
Don’t expect yourself to feel cheerful and happy to be pregnant. If you are, awesome. But if you are nervous, remind yourself that being pregnant again can be a scary experience. Most of my patients get very anxious simply going to the bathroom, and are hyper vigilant to every bodily sensation. Feelings of crampiness are normal, and can even simply be intestinal gas, but it can cause anxiety. Remember that the blood work and ultrasounds are far more meaningful than your symptoms.
Most women report that their anxiety decreases significantly once they get past the date of their loss. So if her loss was at 8 weeks, after 8 weeks she begins to feel far better.
Practice relaxation and stress management skills. There are many lovely relaxation apps, many of which are free.
Finally, don’t pressure yourself to feel carefree during this pregnancy. Any feelings you are having are likely to be normal and they should begin to subside as your pregnancy progresses. If you want extra support, ask your health care team for a recommendation to a therapist who can support you and provide you with some coping skills to make this pregnancy as calm as possible.