Miscarriage: The Invisible Traumatic Loss

Miscarriage: The Invisible Traumatic Loss

By Kristin Miller, LCSW

While there are aspects of the grief process that are universal, it is important to recognize elements that are specific to miscarriage.

I can still picture the scene in my head. A small casket in the distance. A sea of children, each holding tightly to a yellow balloon, making sure not to let go before the adults gave the signal. Songs were sung, tears were shed, memories were shared, and a life was honored. That life belonged to my friend Andrew who, like me, was seven years old.

Though I didn’t know it then, this was the beginning of my passion for working with people who have experienced loss. While obtaining my MSW at Columbia University, I was drawn to electives about terminal illness, grief, and loss. In my 22 years as a therapist, I have had the privilege of doing grief work with countless clients. These clients have experienced the loss of children, adolescents, and adults due to a variety of causes including car accidents, homicide, suicide, cancer, HIV/AIDS, drowning, drug overdoses, heart attacks, and IPV. In recognition of October being National Pregnancy and Infant Loss Awareness Month, I would like to take the opportunity to shine a light on a specific loss that is often overlooked: miscarriage.

A miscarriage is a traumatic loss, yet it is also a loss that is often invisible. This leads to “disenfranchised grief,” a term coined by Dr. Kenneth Doka, which he defines as “a loss that is not or cannot be openly acknowledged, socially sanctioned, or publicly mourned.” Disenfranchised grief is a natural emotional reaction following a loss that is not openly accepted by society. When grief is disenfranchised, others don't recognize the relationship that existed, the loss that was experienced, or the feelings of the person who experienced the loss. Familial, cultural, and societal norms impact how people grieve and also determine acceptable and unacceptable circumstances in which to grieve.

Experiencing a miscarriage often involves shock and confusion. Not being able to openly grieve can be isolating and can lead to suffering in silence; moreover, it can prolong and complicate the grief process. The psychological consequences of miscarriage may have little or no outward physical manifestations which means they can easily go unrecognized by professionals, family, colleagues, and friends. Significantly, research shows that anxiety, depression, PTSD symptoms, and suicide are strongly associated with miscarriage.

While there are aspects of the grief process that are universal, it is important to recognize elements that are specific to miscarriage. Many people experience miscarriage before their pregnancy is visible to others, so others may not know about the pregnancy loss. Even if others know, there is often a lack of support. There is no wake or funeral, which means grieving parents miss out on the rituals where grieving people traditionally obtain support. Once acouple finds out they are pregnant, the relationship with their child starts. Many couples immediately name their child and talk to their child. And they certainly start to dream dreams about the life they will have with their child.

Furthermore, there are hormonal changes that occur during pregnancy that can affect brain chemistry and make the parent more susceptible to depression and anxiety. The person who was pregnant can feel betrayed by their body, lose trust in their body, and have extreme anxiety regarding trying to get pregnant again. They may feel defective, worthless, and like a failure due to the societal expectation that women will produce children. Miscarriage often impacts the relationship between partners, as well as their relationships with family and friends. In addition, partners may grieve the loss differently. There are also numerous trauma triggers, including seeing other pregnant people, babies, playgrounds, doctor’s offices, commercials for baby products, as well as attending children’s birthday parties. Guilt and shame often accompany experiencing these triggers.

If you have the privilege of working with clients who are grieving the loss of their baby due to a miscarriage, here are some helpful tips to keep in mind.

1. Provide psychoeducation regarding the grief process. While each person’s grief process is unique, providing clients with information regarding common grief reactions can be very helpful. Having knowledge can help miscarriage loss survivors feel more prepared in a process that is often invisible, disorienting, and overwhelming. This also includes providing websites and information about support groups due to the isolating nature of this type of loss. I have seen countless clients benefit from connecting with other parents with this shared traumatic experience.

2. Create a safe space for the parent(s) to acknowledge, feel, and process all of their emotions. As discussed earlier, disenfranchised grief can complicate the grief process. Because miscarriage loss survivors can feel unseen and their grief is often minimized, they may minimize their own feelings. It is important to let clients know that all of their feelings are okay. I often tell my clients that feelings are teachers and when we learn to sit with and get curious about them, we can learn things about ourselves. We cannot heal what we don’t feel, so getting in touch with feelings is an essential part of the healing process.

3. Don’t rush the process. I often find myself reminding clients, “Your process is your process.” In a society where there is so much comparison, miscarriage loss survivors often feel like they should be further along in their process and can be hard on themselves when they continue to experience intense emotions months or even years after the loss. Grief is a day by day, moment by moment process. Part of being effective at this work means being able to sit with clients who are sobbing and expressing intense emotion and helping them learn to honor their process.

4. Encourage assertiveness and boundary setting. People often don’t know what to say to a grieving parent after a miscarriage loss. As a result, they may give advice or say things that they think are helpful, but are actually insensitive. My clients share stories of friends and family members saying things like, “It’s been ___ months; you really need to move on,” “You need to get out more,” “Your baby is in a better place,” “At least you weren’t that far along,” and “You can try again.” Teaching clients to use “I-statements” to express how they feel and to ask for what they need is essential. This includes concrete things like help with doing tasks like cooking, cleaning, or driving them to an appointment. It also includes helping them say no to things they don’t want to or don’t feel up to doing, as well as creating boundaries about what they do and don’t feel comfortable discussing.

5. Be intentional about self-awareness, self-reflection, and self-care. This work is extremely rewarding and can also be challenging. Part of being effective in grief therapy involves bearing witness to excruciating pain and strong affect. It’s important to notice what thoughts, feelings, and bodily sensations happen during the sessions. If you have experienced your own losses, this work can trigger intense emotions. Taking care of yourself is essential to being able to provide the best care for your clients.

As social workers, we are committed to ensuring that each client feels seen, heard, understood, and valued. This is especially important when serving clients whose trauma is invisible. I am grateful for the privilege of joining grieving clients on their healing journeys. I have witnessed deep pain and despair, as well as hope, resilience, and transformation. It is truly a gift to do this work.

References:

Quenby, S. et al. (2021). Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. The Lancet. 397(2), 1658-1667.

https://www.verywellhealth.com/disenfranchised-grief-5214998

https://www.partnershipmch.org/copingwithloss/

About the Author:

Kristin Miller, MSW, LCSW, a therapist, clinical supervisor, and co-owner of Mosaic Counseling & Consulting, is extremely passionate about providing creative and culturally competent therapeutic services. She provides premier training and consulting to mental health and social service professionals, as well as educators. Ms. Miller is a volunteer trainer with the American Foundation for Suicide Prevention and board member of the Anti-Racist Mental Health Alliance of NJ. As a professor at Seton Hall University, she teaches courses on trauma and ethics and enjoys nurturing and mentoring future social workers. Ms. Miller’s areas of expertise include trauma, grief and loss, racism and racial trauma, depression, suicide prevention, and faith-based counseling. Learn more at https://mosaiccounselingnj.com