Can You Have Postpartum Depression After Miscarriage?

Chaunie Marie Brusie, RN, BSN

Having a miscarriage is physically and emotionally difficult under any circumstance. Indeed, "in a national survey that we completed, one in five women reported that the emotional loss following a miscarriage was similar to that of losing an older child," explains Dr. Zev Williams, M.D., director of the Program for Early and Recurrent Pregnancy Loss (PEARL) at Montefiore Medical Center/Albert Einstein College of Medicine in New York. Some women even develop postpartum depression after miscarriage.

Though time and comfort are often the best healers, it helps sometimes to understand the mourning process that can accompany a miscarriage, and to know what you can do to start coping with pregnancy loss. Here's how to begin.

Emotional Aspects of Miscarriage

Many women form an attachment to their baby early in the pregnancy, particularly if they've been trying to conceive for some time. So after a miscarriage, they're likely to go through a period of mourning and possibly experience the same stages of grief that can accompany the death of a loved one. The stages are:

  1. Denial: A refusal to believe what has happened

  2. Anger: Blaming yourself or others for the loss

  3. Bargaining: Striking a deal with yourself or God to have things return to the way they were

  4. Depression: Feeling listless, tired, despondent, guilty, punished, and/or as if there's no pleasure or joy in life

  5. Acceptance: Realizing that life has to go on, and regaining your energy and goals for the future

Can You Have Postpartum Depression After a Miscarriage?

During the mourning period, emotions may be thrown into turmoil. If a woman has been trying hard to conceive, she may mourn the child she has lost as well as the fact that she's no longer pregnant. If she's suffered more than one miscarriage, she may be saddened by the fact that she's unable to carry a pregnancy to term.

Some women may develop a form of postpartum depression after miscarriage. Symptoms include intense sadness, emptiness, anger, irritability, fatigue, guilt, worthlessness, and jealousy of those who are pregnant. The woman may also be preoccupied with her loss or unable to take pleasure in life—even in things she previously found enjoyable. Postpartum depression is especially possible if these symptoms last for more than a few weeks.

If you're having trouble dealing with these emotions, speak with your doctor, who can refer you to a counselor if necessary. Severe cases of postpartum depression may need treatment with antidepressant medications, talk therapy, or behavioral methods like cognitive behavioral therapy.

How Men React To Miscarriages

Men and women often experience a miscarriage differently. Men tend to have less of an emotional attachment to the pregnancy in the early months, so they may feel less pained and grief-stricken by the miscarriage. Sometimes this can cause a misunderstanding and conflict in a marriage, since each partner tends to expect the other to react to the miscarriage in a similar way.

The important thing to remember is that mourning is a process that takes time. While some people are able to put aside their feelings and move on, others find that they need weeks or even months to be able to fully function again. Eventually, though, the pain of a miscarriage will subside and the world will indeed look brighter. But until then, it's important to honor your feelings and to take the time you need to grieve.

9 Ways to Cope with Miscarriage

Grief and mourning can last anywhere from less than a month to a year or more, depending on the circumstances of the miscarriage. Initially, the feelings are intense and all-encompassing. But over time, they begin to ease up, giving way to periods of relative calm, well-being, and, eventually, acceptance.

Though there's nothing you can do to "rush" the mourning process, there are simple ways you can take care of yourself as you heal.

Ask for help in breaking the news. If you're feeling too fragile to talk about your miscarriage or to deal with other people's reactions, ask a friend, relative, or coworker to tell others so you don't have to discuss it.

Don't take hurtful comments to heart. Many people don't realize how profound a loss miscarriage is and may say things like "Don't worry, you can always try again." More often than not, though, people don't mean to be insensitive—they're just unaware of how you're feeling and can't fully comprehend your pain.

Help others understand. If you feel up to it, educate the important people in your life about pregnancy loss. Suggest, for instance, that they read a book on the subject, such as A Silent Sorrow—Pregnancy Loss: Guidance and Support for You and Your Family by Ingrid Kohn, Perry-Lynn Moffitt, and Isabelle A. Wilkins (Routledge).

Don't apologize for your pain. During your healing process, friends and relatives may pressure you to "move on," "get over things," or "return to life as usual." But don't feel as though you need to comply until you're ready. Your pain is a normal response to the profound loss you've suffered, and you needn't blame yourself or apologize to anyone for how you feel.

Seek support. After a miscarriage, it may help to talk with someone who's been through the same experience, or to join a support group that meets regularly. SHARE, a national organization for couples who've experienced miscarriage, may be able to put you in touch with a support group in your area.

Ask for household help. As you recover from a miscarriage, ask friends and relatives to help with household chores, like laundry, errands, or cooking. You'll need time to physically and emotionally heal, and it can help to lighten some of your day-to-day responsibilities.

Be mindful of your feelings. Immediately after a miscarriage, you may find it hard to be around friends and relatives who are pregnant or have babies. If it feels too painful to see them, give yourself permission not to visit. Tell them that you still hold them dear, but that this is a difficult time for you and it's just too hard to see them now. Also, think about how you feel before accepting any invitations to a baby shower, baptism, or first birthday party.

Think about anniversaries and holidays. Anniversaries, such as the date the pregnancy was lost or the due date, may also be painful, and you may feel sadder than usual at these times. If you need to, take the day off, attend a religious service, or mark the date in some special way. Holidays may be difficult after a miscarriage too. If you're grieving, think about quietly observing the holiday at home or attending festivities only briefly.

Consider the future. If you and your partner have been through more than one miscarriage, you might begin thinking about how much loss you can bear. At some point, you'll need to discuss whether you want to continue trying or consider adopting a baby, or if you can feel comfortable living your life without children.

Sources: RESOLVE: The National Infertility Association; The Couple's Guide to Fertility by Gary S. Berger, MD, Marc Goldstein, MD, and Mark Fuerst (Broadway); SHARE