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

TOP TAKE-AWAY: PSYCHOTHERAPY: A TREATMENT FOR WOMEN AND THEIR PARTNERS WHO HAVE EXPERIENCED REPRODUCTIVE TRAUMA

Women who have experienced reproductive trauma struggle with having to go on with everyday life after their tremendous loss. They may find it extremely difficult to deal with their loss. They may also struggle with how their partner grieves and copes differently from them, which can cause problems in their relationship. Although pregnancy loss may be very difficult to get through, there is hope. One treatment that can help women and their partners to cope with their loss and strengthen their relationship is psychotherapy. Psychotherapy helps individuals change their behaviors and overcome problems that they face daily.

Every woman has her own unique reproductive story. I am sure at some point in your childhood, you played house pretending to be a mother, tucked your favorite stuffed animal into bed, or had your own baby doll that you took care of like it was your child. Most women have fantasized about their future as mothers; being able to nurture a happy and healthy baby. If a reproductive loss occurs, it can be extremely overwhelming and painful, causing women to realize how their reproductive stories have been in place for most of their lives.

TOP TAKE-AWAY: MANAGING FEELINGS AND EMOTIONS IN PREGNANCIES FOLLOWING LOSS

It is widely assumed that when a woman who has experienced a miscarriage becomes pregnant again, everything will be fine, but that is not always the case. Women must be able to resolve the trauma associated with their prior miscarriage(s) in order to fully engage in their new pregnancy. This article discussed five common strategies women who have experienced pregnancy loss often use to manage their emotions in subsequent pregnancies.

TOP TAKE-AWAY: GUIDELINES FOR DEALING WITH PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT

Many women who have experienced pregnancy loss often state that nurses, doctors and other medical professionals appear insensitive or uninformed when it comes to discussing their pregnancy loss. It has been established in the research that how women are treated by medical professionals can significantly impact their grieving process. Therefore, it is important that women and their families experiencing pregnancy loss are receiving proper support, care and information from their medical team.

TOP TAKE-AWAY: BREAKING THE SILENCE IN THE WORKPLACE

For those of you who have experienced pregnancy loss, you are quite familiar with the silence that surrounds it. This is especially true in the workplace. Approximately 47% of women in the workplace have experienced a miscarriage and have grieved in silence because of the perception that society is not open to hearing womens’ stories of loss. This results in silence becoming a default response and women keeping their pregnancy a secret in the workplace in fear of being judged by their co-workers. Often times, when women share their experience of miscarriage at work, their co-workers do not know how to handle or respond to the situation - further enforcing the belief that women should not share their feelings of loss and grief.

TOP TAKE-AWAY: SOCIAL SUPPORT AS A PATHWAY TO HEALTHY COPING

After parents experience a miscarriage, they often struggle to cope. Many parents use passive coping, which can be maladaptive in the long term because it consists of self-blame, wishful thinking, and ignoring the situation.

Active coping is a more adaptive form of coping, because it involves problem solving, changing the situation, or changing something about the self in order to deal with the situation. However, active coping can be uncomfortable and even make parents feel worse in the moment. In order to actively cope, a person has to directly confront the situation, and that can make you feel sad, angry, or anxious in the moment. So, while it may be beneficial in the long-term, it can be very hard to do in the short-term.

TOP-TAKE AWAY: AVOIDANCE AFTER RECURRENT MISCARRIAGE IS NORMAL, YOU’RE NOT ALONE

Recurrent miscarriages, where women experience multiple miscarriages, affect around 1% of women. While all miscarriages have a psychological impact, recurrent miscarriages may come with an additional layer of psychological distress. The frequency of miscarriage makes it more personal to women - they may feel like it’s their fault and that they will never have a successful pregnancy.

TOP-TAKEAWAY: HOW OTHERS CAN BE HELPFUL TO THOSE WHO HAVE EXPERIENCED PREGNANCY LOSS

After pregnancy loss, many women experience grief and distress, but they also experience silence. Some women report feeling hurt that their family and friends do not acknowledge their loss or seem to be avoiding them. Social support can be helpful in preventing depression following pregnancy loss - but it is important that those who are trying to be supportive are doing it in a helpful way.

TOP TAKE-AWAY: MOURNING INVOLUNTARY CHILDLESSNESS

The Invisible Loss

Involuntary pregnancy loss and childlessness is often an invisible type of loss, as many women believe their loss is socially unacceptable to discuss and cannot be openly acknowledged (Sives, 2016).  Admitting such a loss causes social discomfort, not only for the woman who has experienced it, but for the people she may be sharing her loss with as well.    

Women who experience involuntary pregnancy loss often profess strong feelings of isolation.  Finding the right words to accurately explain their situation and feelings can present some challenges.  Women have reported that when they vent to their partner or family members, they are either misunderstood, not fully “heard,” and/or the conversation is filled with awkward silences and well-intentioned, but unhelpful comments (Sives, 2016). 

TOP TAKE-AWAY: MEN GRIEVE MISCARRIAGE TOO

Men’s grief following miscarriage is often thought to be less intense and last for a shorter period of time compared to women. However, that’s not true for all men - some men have experienced similar or higher levels of grief compared to their partner. Some men report feeling as if they lost their identity as a father; one moment they were looking forward to fatherhood, then the next it was snatched away. Some men also report being concerned about future pregnancies and feeling of anxiety and fear about their future and having children.

TOP TAKE-AWAY: YOU ARE NOT A MONSTER: PREGNANCY DETACHMENT RESULTING FROM MISCARRIAGE

In preparing a manuscript for publication, we have been rereading the many pregnancy loss stories women have shared with us through our 2017 online survey.  

One woman’s description of her experience with pregnancy after loss provoked us to share her thoughts as a means of reinforcing the fact that there is no right or wrong way to respond to pregnancy loss. The woman was brave enough to share how her emotional detachment to a subsequent pregnancy made her feel like a horrible person.  

“Pregnancy as I knew it to be, happy, joyful, exciting, no longer existed for me though, which made me feel like a horrible person.  How could I not be excited about having another baby? My doctor kept reassuring me that it was my mind’s defense mechanism to protect my heart from being broken again.  After nine months of feeling that awful way, as soon as they placed my 2nd daughter in my arms, all of those emotions that I was suppressing came flooding out.  I finally breathed and let my guard down.”

TOP TAKEAWAYS: ATTACHMENT AND GRIEF

Attachment

The first trimester is monumental in a pregnancy. This is where the mother starts bonding with the baby, futures are being imagined, and announcements are being made. When a mother first finds out she’s pregnant, she starts developing an attachment to the baby and a new bond is made. The mother may experience the attachment more intensely, compared to the father, as the baby grows inside of her (that is, the mother is the gestational parent). Because of this strong attachment, the mother may feel the grief more strongly than the father. “Perhaps the mother's attachment to her child is the strongest bond in humans. This relationship has two unique characteristics. First, before birth, the infant gestates within the mother's body, and second, after birth, she ensures his survival while he is utterly dependent on her” (Goldbach et al., 1991). 

TOP TAKE-AWAYS: HOW RELIGION HELPS COPING WITH PREGNANCY LOSS

Experiencing pregnancy loss is heartbreaking. Women who go through this heartache sometimes do not know how to cope with this loss. This can put women at risk for developing mental issues such as:  depression, posttraumatic stress disorder, and anxiety.  Suffering from heartbreak and a series of mental health issues puts women in an extremely vulnerable state. With that being said, it is imperative for women to look for different outlets that may help them cope with their loss.  For some, Religion can be one of those outlets.  

Religion as a Support Group
Religion is a way women can cope with pregnancy loss. Attending church services and meeting individuals who care about your well-being serves as a great coping method. Some may call this a “social network” where you can rely on people for help (Petts, 2018). Women who experience pregnancy loss often search for therapists or support groups to help alleviate some of their pain. When participating in religious groups, there is not always a need to go searching for these outlets. Religious groups are very much similar to support groups. Both groups tend to offer encouragement, comfort, and advice to individuals who are in need. In addition, what makes this even better is that religious participation is free of cost.

TOP TAKE-AWAYS: THE BENEFITS OF MISCARRIAGE BLOGS

Why do women blog about miscarriage?

Loneliness, anxiety, and depression are common emotions felt by women who have experienced pregnancy loss. And many times women are forced to deal with these feelings  alone, separated from others who can relate. Support for these women can be limited because of the lack of sensitivity and acknowledgment, lack of follow up care, lack of medical information, unwanted advice from others, and the false presumption that recovery happens quickly (Pang et al., 2018). 

With this lack of support, women tend to turn to internet sources in search of solace and information about pregnancy loss. Research suggests that gaining information and emotional support can potentially reduce the risk of depression, anxiety, and other complications that women face (Pang et al., 2018). Online blogs give women an outlet to share their stories and find the emotional support they need to cope with their loss. 

TOP TAKE-AWAYS: WHAT ARE EUPHEMISMS AND HOW DO THEY CONTRIBUTE TO THE CULTURE OF SILENCE?

A euphemism is a mild or indirect word or expression substituted for one considered to be too harsh or blunt when referring to something unpleasant or embarrassing.

Examples: 
“Down there” = Vagina
“Lady Parts” / “Backside” = Vagina/Buttocks 
“That time of the month” or “Aunt Flo”= Menstrual Cycle
“Change of life” or “The change” = Menopause
“Miss” = Miscarriage 

Euphemisms have become heavily imbedded in our culture. They are often overlooked because of how normalized they have become. They are so common that we are oblivious to their use in everyday language. 

TOP TAKE-AWAYS: CONCRETE RECOMMENDATIONS FOR BREAKING THE SILENCE

Why is it that miscarriages are rarely ever talked about? It seems as though we only hear about them when it happens to someone close to us. Even then, the individuals who experience this tragedy often feel silenced. 

In this article, Layne (1997) shared her personal story of miscarriage. Just like any woman trying to conceive, Layne and her husband rejoiced as they discovered that they would soon become parents. After her thirteenth week of pregnancy, Layne began to have complications. She started cramping, spotting and soon began to bleed profusely. She called her birthing center and they directed her to contact the emergency room. Layne was not happy when she found out that no one from the birthing center would accompany her after promising that they would be by her side if anything were to go wrong. She claims that she “wrongly assumed their principle of care.” Despite their lack of support, her husband rushed her to the ER where she found out that she would be going home without her baby.

TOP TAKE-AWAYS: RISK OF MISCARRIAGE AFTER AMNIOCENTESIS: FACTS AND PERCEPTIONS

Amniocentesis, the sampling of amniotic fluid using a hollow needle inserted into the uterus, is the most common invasive procedure used to diagnose genetic conditions prenatally (Eddleman et al., 2006).

When faced with the decision of whether to undergo amniocentesis, most women experience some anxiety around making that decision.  This is likely because there is well-documented risk of miscarriage associated with the procedure.

What the exact rate of risk is varies a bit among investigators and organizations.  The CDC released a statement that the risk of miscarriage is between .25 and .5%, or  1 in 200.  In 2006, the First and Second Trimester Evaluation of Risk (FASTER) trial calculated the risk of miscarriage after amniocentesis to be 1/1600 or 0.006% higher than for those who did not undergo amniocentesis (Eddleman et al., 2006).  In 2007, the American College of Obstetricians and Gynecologists (ACOG) published the rate of miscarriage associated with amniocentesis as 1/300-1/500.  In all, these risks are very low.  

TOP TAKE-AWAYS: THE FATHERS' PERSPECTIVE

Serrano and Lima (2006) surveyed 30 couples to gain a better understanding of the impact of recurrent consecutive miscarriages on their relationship.  

• 90% of the couples were married and were in a relationship for an average of 6.66 years;  
• The average age of mothers was 31.73; the average age of fathers was 33.63;
• 76.7% of the couples reported 3 miscarriages, 20% reported 4; 1 couple reported 6 miscarriages;
• The couples in this study did not have living children and their most recent miscarriage occurred anywhere from three months to over one year prior to completing the survey.

Both partners answered questions about their grief, distress, relationship quality and sexuality following their most recent miscarriage.