The pain of miscarriage and fertility

The discovery of a pregnancy is one of the most exhilarating events we will ever encounter. The idea of sharing a new life is so psychologically rich: It promises the fulfillment of personal dreams and offers a chance to repair childhood pains. Pregnancy embodies hope.

As thrilling as pregnancy can be, when a pregnancy ends in miscarriage it can be one of the most excruciatingly painful experiences of life. And, unfortunately, it is an experience that people rarely mourn publicly, further enhancing the torment.

I never realized how common miscarriage is until I experienced my own. In the days and weeks that followed our loss, we received cards, phone calls, and flowers from friends and acquaintances, sharing their own stories of miscarriage. I had never known that many of these well-wishers had suffered a miscarriage. Why is miscarriage an issue we rarely discuss?

Culturally, there seems to be a shamed silence about miscarriage, as if one should hide this "failure." As a society we are not particularly good at embracing and tolerating the emotional pain of others. As our world has become increasingly fast-paced, we seem to expect our grief and the grief of others to be quick. Also, truly acknowledging how pained a loved one is causes us pain and can bring back memories of our own hurts and losses. Perhaps we turn away from the pain of miscarriage to avoid confronting one of life's cruelest twists: A life ended too soon.

Miscarriage is fairly common. In the United States each year approximately 6.5 million pregnancies occur, and 890,000 of these end in miscarriage. It is hypothesized that the rate of miscarriage will continue to increase as many people delay childbearing until later in life. In over 50 percent of miscarriages there is no known origin.

Because miscarriage typically occurs in the first 12 weeks of pregnancy, there can be a misconception that the loss is not that great. Let me assure you, this could not be further from the truth.

Women are designed so that within days of conception we begin preparing both physically and psychologically for our child. Psychologically, the baby becomes a person in our mind and we begin an intense relationship with this child to be. Physically, our reproductive hormones increase greatly, the uterus develops a thick lining to support the growing fetus, and the breasts enlarge to prepare for nursing. So, when a woman miscarries she is left in a state of emotional and physical readiness for a baby that will never be.

The pain of this loss can bring a profound sense of failure and guilt. Some women imagine they are being punished for past misdeeds. A feeling of inadequacy as a woman can emerge. Some women believe they have done something to cause the miscarriage. Many feel they have let their partner down. And, there is always concern about not ever being able to bear children.

Anger at the world, anger at those who are pregnant, or anger at "bad parents" who so easily get pregnant, is common. Feelings of general nervousness, sleeplessness, persistent fears, excessive tiredness, headaches, nightmares, and feeling empty and sad are common. Many women feel damaged, and their self-esteem plummets. Without a supportive partner and social network, and without acknowledging their grief, many women fall into a more long-term depressive episode.

In my personal and professional experience I have found that it is healthier to acknowledge, mourn and integrate the loss into our life experience, to let it become part of who we are. If possible, although painful, it is best to view and hold the fetus and to say your good-byes. A funeral, planting a tree as a living memorial, or performing any type of ceremony that feels meaningful, is very important. There are many support groups nationwide for those suffering from miscarriage and infertility. If you think you need it, seek therapy.

Strain between partners can be seen after a miscarriage when men and woman react differently to the loss. Emotionally, men's attachments to the developing baby intensify as the pregnancy progresses so they may not experience the loss the same. And, men live in a world where their pain can be interpreted as a weakness, and they are often expected to "get back to work." So, typically, they do. Yet, when a man and woman grieve differently, in addition to their sadness, they can begin to feel isolated and misunderstood, leading to relational hardships. It is crucial to be patient with each other and to keep communicating.

If someone you care about miscarries, be understanding with their grief. Many of us may have impulses to gloss over their pain with comments like, "It wasn't meant to be," or "You can have other children." While this may be true, it gives them the message that they should not be upset or grieving. Rather, send cards and flowers, drop off baked meals, just listen and be there.

Sadly, in some cases parents will not ever be able to bear biological children. This, of course, brings on an even more intense grieving process where the parents have to give up fantasies of children that look like them or are like them genetically. Some go through the painful process of deciding not to become parents at all.

Most parents will go on to have other children. For those unable to bear biological children there are various options. And, as they say, as one door closes another opens, so please stay tuned for upcoming articles on the joys of adoption!

Lisa Keating, Ph.D., is a Carson City clinical psychologist.Write to her at editor@nevadaappeal.com.