Miscarriage can be devastating in ways that are difficult to explain to people who haven't experienced it. It doesn’t necessarily matter how long you knew about the pregnancy or how many people you told, the loss can still feel enormous.
Part of what makes miscarriage grief so complicated is that you aren't only grieving what has already happened. You're often grieving a future that was invisible but had already started to feel real. Maybe you'd calculated your due date and imagined what season the baby would be born in. Maybe you'd pictured your older child becoming a sibling, thought about maternity leave or started mentally rearranging bedrooms.
Then suddenly, all of that is gone, while most of the world around you continues on, often none the wiser.
Why does miscarriage hurt so much?
People sometimes assume that the earlier a pregnancy ends, the less significant the loss should feel. But attachment doesn't work according to gestational age. A positive pregnancy test can change the way you imagine your life almost immediately, particularly when the pregnancy was deeply wanted or took a long time to achieve. This is why when someone miscarries at six, eight or ten weeks, they are sometimes surprised by the intensity of their grief. You're losing a pregnancy at whatever stage it/they were in, but you’re also losing the particular version of your family and future that had begun taking shape in your mind.
For people who have been trying to conceive for a long time, there is another layer to the loss. The pregnancy may have felt like the end of an exhausting period of waiting, tracking, testing or fertility treatment. Losing it can mean being abruptly returned to a place you were so relieved to finally escape.
Miscarriage grief doesn't always feel like sadness
Grief after pregnancy loss can look very different from what people expect grief to look like. You might cry constantly for several days and then feel strangely normal. You might feel numb, angry, irritable or jealous. You might be completely fine around one pregnant friend and find yourself devastated by another person's pregnancy announcement for reasons you can't quite explain.
A lot of people also become preoccupied with figuring out what happened. You may replay the days before the miscarriage and wonder whether you exercised too hard, had a drink before you knew you were pregnant, waited too long to call your doctor or somehow missed an important sign. Even when you understand intellectually that you didn't cause the miscarriage (you didn’t), your brain may continue looking for something you could have done differently. Uncertainty is hard for our brains, and finding something to blame can temporarily feel easier than accepting that something terrible happened that you couldn't control.
Grief also doesn't move neatly forward. You may feel much better for several weeks and then be blindsided by your original due date. Your first period afterward might be unexpectedly painful. You may struggle when someone who was pregnant at the same time as you starts showing, has a baby shower or gives birth. Feeling okay for a while doesn't mean the loss didn't matter, and having a difficult day months later doesn't mean you've gone backward.
Sometimes you're grieving while the miscarriage is still happening
One particularly difficult aspect of pregnancy loss is that grief can unfold alongside an ongoing medical experience. You may find out during an ultrasound that there is no heartbeat and then immediately be asked to make decisions about what happens next. You might wait for your body to miscarry on it’s own, take medication or have a procedure. You may still have pregnancy symptoms while knowing that the pregnancy is no longer viable.
For some people, there is also a period of uncertainty before the loss is confirmed. Maybe the pregnancy is measuring behind, the heartbeat isn't what your provider expected or your hCG isn't rising normally, but no one can tell you for certain what is happening yet. Being told to come back in a week can feel unbearably long when you are simultaneously hoping for the pregnancy and beginning to grieve it.
The physical experience can also be upsetting in ways people aren't always prepared for. Bleeding, cramping and seeing pregnancy tissue can be frightening or traumatic. At the same time, you may be expected to communicate with doctors, arrange childcare, miss work and make medical decisions while you're trying to process what is happening.
Why miscarriage can feel so lonely
Pregnancy loss is sometimes described as disenfranchised grief, meaning a significant loss that isn't always fully recognized or supported by the surrounding culture. There may be no funeral, ritual or obvious marker that something important has happened. Depending on how early the miscarriage occurred, many people in your life may not even have known you were pregnant.
This creates a strange disconnect. Something enormous has happened to you, but the outside world may have almost no visible indication that anything has changed. You might be answering emails, picking up your kids from school or sitting through a work meeting while privately thinking about the fact that you were supposed to be pregnant.
Even your partner may experience the loss very differently. One person may want to talk about the pregnancy constantly while the other becomes quiet or focuses on practical things. One may want to try again immediately while the other can't imagine going through another pregnancy yet. Different grieving styles don't necessarily mean that one person cared more, but they can make an already lonely experience feel even lonelier.
Why do people say such unhelpful things after miscarriage?
Most people really are trying to help. The problem is that grief makes people uncomfortable, particularly when there isn't anything they can do to fix it. They want to make you feel better, so they reach for reassurance.
This is how you end up hearing things like, "At least you know you can get pregnant," "Everything happens for a reason," "It was probably for the best," "You can try again," or "At least it happened early." Someone may tell you how common miscarriage is or immediately launch into a story about someone they know who had several miscarriages and eventually had a healthy baby.
These comments are usually intended to offer hope, but they can land as minimizing. Knowing miscarriage is common doesn't necessarily make your miscarriage less painful. A future pregnancy doesn't replace this pregnancy. And learning that there was probably a chromosomal problem may answer a medical question without resolving the emotional one.
Usually there isn't a sentence that can make miscarriage okay. What tends to help more is having someone recognize what actually happened: you wanted this pregnancy, you had already begun imagining this baby, and losing it hurts.
Miscarriage can change the way you experience pregnancy
One of the more lasting effects of pregnancy loss is that it can change your relationship with pregnancy itself. Before miscarriage, a positive pregnancy test may have meant, We're having a baby. After miscarriage, it may feel more like, Maybe we're having a baby.
If you become pregnant again, you may desperately want to feel excited and instead find yourself checking the toilet paper every time you use the bathroom, analyzing whether your breasts are still sore or worrying when your nausea disappears for an afternoon. You may count the days until your next ultrasound or feel temporarily reassured after an appointment only to become anxious again the next morning.
Some people avoid buying anything for the baby or telling other people about the pregnancy because allowing themselves to become attached feels dangerous. Others become very focused on milestones: getting past the week of the previous miscarriage, seeing a heartbeat, reaching the second trimester, getting through the anatomy scan. Pregnancy after loss can contain genuine excitement and genuine fear at the same time.
Grief and anxiety can start to become intertwined
After miscarriage, it makes sense that your brain would become interested in preventing another one. Unfortunately, there may be very little you can actually do to guarantee that, which creates an especially difficult combination of high stakes and low control.
You might find yourself repeatedly Googling miscarriage statistics, monitoring symptoms, asking your partner for reassurance or struggling during the days between appointments. If you're trying to conceive again, ovulation and pregnancy testing can start to take over an enormous amount of mental space. Every period can feel like another loss, even though you know it isn't the same thing.
This is one reason miscarriage doesn't always fit neatly into the category of grief. Pregnancy loss can involve grief, anxiety, trauma, anger, guilt and a changed sense of safety in your own body. Sometimes people seek therapy because they are grieving the miscarriage itself, and sometimes they seek therapy months later because they realize they haven't felt like themselves since it happened.
You shouldn't have to convince your therapist that this was a real loss
Therapy can be helpful after miscarriage, but reproductive grief is an area where specialization matters. It can be exhausting to spend therapy explaining why an early pregnancy felt like a baby to you, why someone else's pregnancy announcement was so upsetting or why becoming pregnant again hasn't erased the loss that came before it.
Working with a therapist who specializes in reproductive mental health means you don't have to start there. At Seattle Reproductive Psychotherapy, our therapists already understand the particular emotional landscape of miscarriage, infertility, trying to conceive after loss and pregnancy after miscarriage. You don't have to convince us that your loss was significant enough to grieve or explain why something that happened months ago is still affecting you.
That leaves more room to actually talk about what happened, what it meant to you and what you need now.
There is no right way to grieve a miscarriage
Some people name the baby and some don't. Some keep ultrasound pictures and pregnancy tests, while others need to put everything away. Some want to talk about what happened repeatedly and others barely want to talk about it at all. You might want another pregnancy immediately or need months before you're ready to consider trying again. You may even desperately want to be pregnant while simultaneously feeling terrified of becoming pregnant.
None of these responses tells us how much you loved or wanted your pregnancy. There isn't a correct way to grieve a miscarriage, and there isn't a particular point at which you should be "over it."
For most people, grief does change with time. The goal isn't necessarily to forget what happened or to stop caring about the pregnancy you lost. It's for the loss to become something you can carry without it taking up quite so much of your emotional world.
And sometimes that begins simply with having a place where you don't have to minimize it, explain it or make it easier for anyone else to hear.
