Your mental health during miscarriage
This blog post is written by obstetrician/gynecologist Dr. Madeline Kaye, MD and psychiatrist Dr. Amanda Goldstein, MD from ThreeMDs, a blog that provides easily digestible, evidence-based, and integrative medical information for women.
Early pregnancy loss (EPL) or miscarriage can be a devastating time in a woman’s life. It can feel overwhelming and isolating, but if you are experiencing or have experienced a miscarriage, you are not alone! About 1 in 5 pregnancies end in a miscarriage and nearly HALF of all women will experience at least one pregnancy loss. Women are finally starting to share their personal stories, but we still have a long way to go in supporting women through this process.
Why does pregnancy loss occur?
I always make it a point to tell women going through EPL that it is highly unlikely that anything they did or did not do caused this outcome. While excessive drug/alcohol use or poorly controlled medical problems like diabetes can increase the risk of miscarriage, the overwhelming majority of miscarriages are caused by genetic abnormalities of the developing fetus. That glass of wine you had before you knew you were pregnant was NOT a contributing factor. The older we get, the more genetic abnormalities our eggs have. Our bodies can detect an abnormal pregnancy and ultimately stop it from continuing. This is why miscarriage rates increase as we age. Before age 30, the risk of miscarriage prior to 12 weeks is approximately 8%; by age 35 it is 16%; by age 40 it is 33%; and by age 40 it is nearly 60%.
Age is the biggest risk factor for having a miscarriage, but there are other factors as well. If you have had one miscarriage, then your chance of having another is increased, but not by a significant amount. The odds are still very much in your favor of having a healthy subsequent pregnancy. Once you have had two consecutive miscarriages, your risk doubles; after three consecutive miscarriages, your risk quadruples. If you have had 2-3 consecutive early pregnancy losses, it is considered recurrent pregnancy loss. At this point, your doctor should start looking into other rare causes of miscarriages.
How do you cope with pregnancy loss?
The journey following a miscarriage combines the mourning of losing a family member with the physical, hormonal, and emotional changes of pregnancy. This process should not be minimized and can equally affect both partners. The intensity of emotions experienced and the amount of time needed to pass in order to feel like yourself again is unique to each individual. The emotional fluctuations of bereavement may be even more extreme following a miscarriage due to feelings of elation immediately preceding the loss, a sudden change in hormone concentrations, or physical and figurative emptiness.
There is no right way to grieve. For some people, it may feel like a roller coaster of emotions including sorrow, numbness, guilt, and anger. You may be distracted at work or when socializing by intrusive thoughts about the loss. Some symptoms of bereavement overlap with depression, like insomnia, poor appetite, and weight loss. It is difficult even for professionals to distinguish early bereavement from depression, so we use time as a guide. If you are unable to maintain baseline functioning (hygiene, chores, work) after six months, or you continue to struggle with intense emotions after one year, then please see a psychiatrist, who can help identify sources for extra support (and this does not always mean from medication). Be kind to yourself and take as much time as you need.
Love from Team OBGynechiatry,
Dr. K and Dr. G
