TOP TAKE-AWAY: Acknowledging Men’s Response to Pregnancy Loss

The impact on fathers is often overlooked in pregnancy loss. Men’s grief may be missed or ignored by healthcare workers, counselors, family members, and even their spouse. The experience can be as intensely upsetting for men as it is for women. Both partners may experience feelings such as shock, grief, anger, and frustration. This can be compounded by men not outwardly expressing their grief, which can lead others to not fully understand the true feelings men have about their experiences. In turn, this may lead to more emotional turmoil later on. 

There are a variety of reasons why men may not feel comfortable expressing their emotions following pregnancy loss. 

1. They may feel that in order to properly support their partner, they need to minimize their own feelings. 

2. Some might feel that they need to move on from the experience, or they may try to avoid their feelings about the experience by working more or turning to drinking or drugs.

3. Some may even engage in aggressive behaviors, funneling all their emotions of grief and loss into anger. 

There are some ways in which men who have gone through a pregnancy loss can be helped to express their feelings in a healthy way. 

1. For one thing, men should be encouraged to express and explore their emotions about the pregnancy loss as soon as possible, along with women. 

2. If women are offered counseling by healthcare workers, men should be encouraged to join and participate. If they do not feel comfortable participating, it may still be beneficial to recommend one-on-one counseling or therapy for them to start the process of acknowledging their grief. 

3. Education may also be an important part of support and emotional expression. Teaching men about socialization and how depression can be masked by other emotions may help them to understand their feelings and behaviors in a more open way. Simply helping these men to recognize and understand their grief and trauma in a healthy way will help them to be more open and comfortable about expressing their emotions and healing from loss.

Rinehart, M. S. & Kiselica, M. S. (2010). Helping men with the trauma of miscarriage. Psychotherapy: Theory, Research, Practice, Training, 47(3), 288-295. https://doi-org.holyfamily.idm.oclc.org/10.1037/a0021160

TOP TAKE-AWAY: Cognitive Behavioral Therapy (CBT) Strategies for Healing After Loss

The trauma experienced after a miscarriage can be overwhelming. Some women may develop distressing thoughts about themselves and their lives, or isolate themselves, pushing away family members and friends. One form of treatment that may be helpful is cognitive behavioral therapy, or CBT. This form of psychotherapy focuses on a client’s thoughts and behaviors, which can help women heal from their loss in a more effective way. For women who have experienced pregnancy loss, there are three effective strategies used in CBT that can be beneficial: behavioral activation, cognitive restructuring, and mindfulness and acceptance. 

Behavioral activation involves engaging in meaningful and enjoyable activities that provide a sense of accomplishment. Women who have experienced pregnancy loss may sometimes isolate themselves, often for fear of having to share the news of their loss. However, by isolating themselves, women may miss the positive social support that comes from interacting with others. In CBT, behavioral activation starts small, with activities that require no planning, before moving on to more complex and value-driven activities. Some of these activities might include traveling to visit family, or volunteering for a cause they are passionate about.

Cognitive restructuring for women who have experienced pregnancy loss involves identifying the thoughts and beliefs that these women have, evaluating their accuracy and usefulness, and modifying them to be more balanced and helpful. These women often have beliefs about themselves and their lives that cause emotional distress, such as the belief that they will never be a mother, or that they are to blame for their pregnancy loss. Cognitive restructuring involves asking questions about these beliefs to help women tease through the accuracy and helpfulness of such beliefs. For example, women may be asked to examine a situation where they felt they were judged by someone for their pregnancy loss, consider the other explanations for their behaviors, and decide for themselves what beliefs are more compassionate and balanced.

Mindfulness and acceptance is also an important factor for women who have experienced pregnancy loss. Women with pregnancy loss will often try to avoid their negative emotions or painful experiences. CBT asks these women to learn to accept their emotions, no matter how painful, and show them that they can still lead a quality life even with those feelings. By focusing on being mindful in the present, these women get out of “autopilot” and can catch the subtle changes or triggers that lead to their emotions. 

All three of these strategies are useful in some way to help women who have experienced pregnancy loss to accept their situation, address their emotional distress, and begin to participate in their lives again.

Wenzel, A. (2017). Cognitive behavioral therapy for pregnancy loss. Psychotherapy, 54(4), 400-405. https://doi.org/10.1037/pst0000132

TOP TAKE-AWAY: The Importance of Validation from Healthcare Professionals: Three Strategies for Engagement

Every woman has a unique reproductive journey, successful or otherwise.  When a pregnancy loss occurs, it is important for women to have their feelings validated by those around them, including their healthcare providers.  In many cases, healthcare professionals get it right -- they validate a woman’s experience and are sensitive to the wide range of emotions that can be triggered by a loss.  However, in some cases, healthcare professionals fail to recognize that not all women experience pregnancy loss in the same way.  Women's experiences with loss and grief are complex and not solely related to how long they were pregnant.  Because of this, it may be possible for a healthcare professional to underestimate the significant emotional trauma a woman may experience with an early loss.  Healthcare professionals serve as authority figures whose reactions can affect how women may view their own loss. Thus, it is important that they validate the full range of emotions that women may experience.  

A few ways to ensure women have their feelings validated include:

1. Treating her experience with sensitivity - This is a difficult situation for any woman and it is important to approach her with consideration and sensitivity.
   
   

2. Focusing on her perspective and feelings - However a woman views her pregnancy loss, she needs to feel as though her response is valid and justified and she has every right to feel how she does. The healthcare provider may not share the same view of the situation as the woman, but they must work to keep the focus on the woman’s individual perspective.
   
   

3. Allowing her to lead the conversation - It is essential to allow the patient to lead the conversation. This may feel counterintuitive, because healthcare providers have a lot of expert knowledge that they may want to share. However, it may be helpful to let the woman focus on what aspect of her experience she wants more information about, let her express how she feels, and let her be the one to ask the questions she wants answered. This allows the healthcare provider to tailor the information disseminated to what she needs and/or wants to hear.

When healthcare professionals take the time to take these steps, it can allow women to feel heard, understood, and strengthened.  As a result, this allows women who experienced pregnancy loss to tell their stories instead of feeling shame and guilt. Each woman has her own reproductive story, and as a result each woman deserves her story to be validated in order to feel comfortable enough to share it with others.

Corbet-Owen, C., & Kruger, L.-M. (2001). The health system and emotional care: Validating the many meanings of spontaneous pregnancy loss. Families, Systems, & Health, 19(4), 411–427. https://doi-org.holyfamily.idm.oclc.org/10.1037/h0089469