*Written by Psychotherapist Jenni Huhtala
Miscarriages are far more common than you may think. It is estimated that one in three women have a miscarriage during their lifetime. Recurrent miscarriages, defined as at least three consecutive miscarriages, are rarer. 5% of couples trying to conceive experience two consecutive miscarriages and 1-2% have three or more miscarriages. After three or more miscarriages, more chronic possible causes are considered (e.g. uterine malformations, hormonal issues, immunological reasons, and chromosomal abnormalities) to get a sense of how viable it is for future pregnancies to succeed.
Grieving a miscarriage can be an emotionally and psychological intense experience. Whatever your response to your loss is completely okay, and all your feelings are valid. Just know that you are not alone in this and we are here to help. In this article, Psychotherapist Jenni Huhtala dives deep into different ways women may feel following the loss.
The psychological and emotional effects
Medicine differentiates between various types of miscarriages: spontaneous miscarriages, incomplete miscarriages, blighted ovum, chemical pregnancy, stillbirth, ectopic pregnancies, and terminations for foetal anomalies. In this post, I will focus on the psychological and emotional impact of recurrent miscarriages.
Pregnancy loss is traumatising
Miscarrying can cause various painful feelings, such as sadness, anger, fear, guilt, and shame. These negative feelings and experiences grow stronger with each subsequent miscarriage. Miscarriage, whether a singular or recurrent experience, can be traumatising. For example, traumas can be caused by a long time trying for a pregnancy or lengthy infertility treatments, uncontrollable pain or heavy bleeding during miscarriage, feeling lonely, complications, slow recovery, and unfortunately sometimes insensitive treatment or inconsiderate comments from healthcare workers.
Women who have had a miscarriage often feel that they have lost a child. They do not believe they have lost “an unviable foetus” or “just a pregnancy”, they feel the loss of an entire life. This naturally causes sadness which should be respected. Unfortunately, many feel their emotions are not taken seriously and even well-intended suggestions to “just try again” can be hurtful when the sadness has not yet been processed and they do not feel ready to even contemplate trying to become pregnant again. If left untreated, this sadness can turn into depression.
Fear, shame, and guilt
People who have experienced recurring miscarriages often blame themselves. What am I doing wrong? What is wrong with me, why does the embryo not stick? Are my eggs or my uterus somehow faulty? Seeing a doctor and undergoing tests can be a huge relief after multiple miscarriages if an explanation and therefore a possible solution is found. Sometimes tests do not show a clear reason, but they can at least help to rule out some possibilities. Unfortunately, in some cases miscarriages do seem to be down to just “bad luck”; approximately 50% of recurrent miscarriages have no known cause.
Recurrent miscarriages can cause feelings of shame for some. This can lead to your whole body or femininity seeming to feel somehow wrong or faulty. The difficulty of having a successful pregnancy can start to define your sense of self-worth, and some feel like they are “unfit to be a mother” when their body fails to carry a baby to term.
Fear of permanent childlessness (either primary or secondary) is often present in recurrent miscarriages. After one miscarriage it is easier to reflect on how common this is, since studies have shown 10-25% of pregnancies ending in miscarriage. But when miscarriages continue to happen, the fear creeps in stronger; what if I will never succeed, what if my wishes never come true?
Being a part of a small, unlucky minority gives rise to feelings of anger and frustration. Why am I the one who is statistically so incredibly unlucky? The frustration is targeted towards the uncontrollable situation, where the options to affect the outcome are very limited. Other people’s pregnancies, even those of loved ones, can cause that anger and bitterness to re-emerge, often accompanied by confusion and guilt for feeling that way.
There is no wrong or right way to feel about it
Recurrent miscarriages can cause other kinds of feelings, such as relief. After having been afraid of a miscarriage during multiple pregnancies, when it happens it can actually feel like a relief to stop being afraid, despite the sadness. Fear itself is highly stressful and exhausting. Feeling relief may seem wrong and trigger guilt: “I shouldn’t be feeling relieved when I have been wishing for a successful pregnancy more than anything else”.
Early miscarriage vs long pregnancy loss
Miscarriages can also be experienced very differently. Very early miscarriages might just feel like a delayed period, perhaps after a cautious joy for a pregnancy that has only lasted a few days. Thoughts about the pregnancy and the baby grow week by week and month by month, which in turn makes a miscarriage all the more difficult the longer the pregnancy has gone on. A later miscarriage can also be harder to recover from both emotionally and physically. One of my clients, who has had several miscarriages, said that miscarrying after a long pregnancy felt like losing a child, whereas in miscarrying a shorter pregnancy she had only lost “the chance of a child”.
Defence mechanism against future uncertainties
Women who have endured recurring miscarriages often develop defence mechanisms to help them survive the fear and the uncertainty that comes with all future pregnancies. They might not book an appointment at the maternity clinic at the earliest possible time or even check when the possible due date would be. They might not think about the development of the embryo and the foetus to not make it seem too much “like a human”. They are likely to attempt to avoid growing too attached to the pregnancy or the baby for the fear of loss.
Alternatively, some people act in the opposite way, having frequent ultrasounds or even checking the baby’s heartbeat several times a day using an at-home Doppler monitor. Sometimes the defence mechanisms can verge on the superstitious, for example “let’s not tell anyone about the pregnancy before the next ultrasound because otherwise I’ll miscarry” or “if I buy something for the baby, they will die in the womb”.
It is fairly common that the fear of a miscarriage starts to ease when the pregnancy continues beyond the point at which the last miscarriage occurred, and when the ultrasounds seem promising. The faith in the pregnancy’s success then grows a little bit at a time.
However, this may not always happen; the losses may have happened too many times or at too late a stage, or complications from the pregnancy may cause the fear of loss to continue all the way to the end. In this case it is best to work on these fears and the development of the mother and baby bond with a maternity psychologist, or a psychiatrist specialised in childlessness and/or early bonding. Some hospitals have a specialised outpatient clinic for patients especially fearful of miscarriage, which can help to address concerns they might have in the later stages of the pregnancy. More frequent ultrasounds have also been shown to ease fears.
Citations from clients have been added with their permission.
*Jenni Huhtala is Lola&Lykke’s psychotherapist, infertility and miscarriage and expert. Jenni provides support with the mental stress caused by ongoing attemps at pregnancy, infertility treatments and adoption process. Her area of expertise also includes helping relationships deal with the emotional impacts associated with infertility.
If you need a place to talk about pregnancy loss or more advice, Lola&Lykke Experts are here for you. We offer mothers a private platform where you can share your thoughts and ask questions related to motherhood and maternal health – all science-backed and free-of-charge.