Mixed emotions: Women may find themselves dealing with grief and joy simultaneously when a successful pregnancy follows a miscarriage. (Image by Corbis).
A blood clot no bigger than a pea permanently changed my life. I was six, maybe seven, weeks pregnant, and by all accounts, the perfect candidate for an uncomplicated pregnancy. I was 24 years old, an avid exerciser at a healthy weight. No woman in my family had ever lost a baby.
But when I saw that speck of blood — a bright red alarm against the white of my toilet paper — I knew I was losing our first child.
I’d always assumed a miscarriage happened in one agonizing day. But it turned out to be a much more grueling process — nearly two weeks of bleeding, cramping, and crying, made worse by people’s attempts to ease my unique heartache with universal platitudes.
“You know, this just means the pregnancy wasn’t viable.”
“Don’t worry, this isn’t the end of the line for you — a lot of women miscarry.”
“It just wasn’t meant to be.”
I had to have blood work done weekly to track the decline of my pregnancy hormones. And each time I was handed the piece of paper with my results, I was confronted with the callous medical term for miscarriage — spontaneous abortion — screaming at me in bold, black type. I wanted to protest— this wasn’t my choice; this isn’t an end result I decided upon.
The truth is, the pregnancy had been unplanned—it happened just a few months after my husband and got married. But it was a happy, welcome surprise. After the miscarriage, however, I slowly began shutting myself off to the idea of having children. My fear that a future pregnancy would end in another loss was too intense, especially after my obstetrician spotted a uterine septum, a wedge of tissue that partly divides my uterus, during a follow-up ultrasound.
“You should have surgery before you try to get pregnant again,” my doctor cautioned me. Even though the uterine defect wasn’t necessarily the cause of my loss, it seemed increasingly clear, at least to me, that my miscarriage wasn’t due to a problem with the fetus, but one with my body — a body that might insist on betraying me.
But then, almost a year later to the day, I got pregnant again. I had been married for more than a year, I’d started a lower-stress job, and the raw pain of my loss had settled to a dull ache. All the pieces were in place, the timing was right. Yet my excitement was matched, if not exceeded, by my anxiety. Every day felt like a blessing, but every trip to the bathroom (and when you’re pregnant, there are a lot of them) felt like a threat.
When my pregnancy symptoms randomly waned — my breasts weren’t as sore, I didn’t feel crippled by nausea — I couldn’t be thankful for the respite from the normal discomforts of the first trimester. I could only be terrified. I often woke up in the morning with a sudden, irrational belief that I was no longer pregnant, a fear no amount of soothing words could calm.
Doctor’s appointments became my lifeline — a chance to hear my child’s heartbeat, and know that I had one more day with her, at least. I stopped exercising out of a fear that I might somehow jostle the baby, even though my doctors reassured me that physical activity was perfectly safe. At nearly seven months pregnant, just writing this piece feels like tempting fate.
As a health writer, I know my experience isn’t unique. Research has consistently shown that women with a history of miscarriage experience greater anxiety during pregnancy than those with no previous losses. And that’s even true of women, like me, who miscarried very early in their pregnancy — an experience often written off as “common” or “less painful” than a later-term loss. “It doesn’t matter when in the pregnancy the loss occurred,” Dr. Michael R. Berman, author of Parenthood Lost: Healing the Pain After Miscarriage, Stillbirth, and Infant Death, told Yahoo Health. “Miscarriage puts the patient in a very anxious mood for the next pregnancy.”
Often, that anxiety trumps the joy typically associated with those two pink lines. “You now know that something can go horribly wrong,” said Emma Robertson Blackmore, an assistant professor of psychiatry at the University of Florida, Jacksonville.
In a 2014 Dutch study, women described their first pregnancy as “living on a cloud” — they fantasized about life with their little one, mulled over names, and obsessively search every aspect of pregnancy on the Internet. But their post-miscarriage pregnancies were different. They performed multiple pregnancy tests out of an insistent need for proof that they were still, in fact, pregnant. Exercise was abandoned. They hesitated to bond with their unborn child.
In fact, these anxious mothers-to-be may try to squelch all emotions and even forgo any behaviors associated with their previous pregnancy. “A lot of women decide that they have to do it differently the next time around, so they hold back,” said Joanne Paley Galst, a psychologist who specializes in pregnancy loss. This is what psychologists call “emotional cushioning,” a way for the woman to protect herself from pain, often by refusing to prepare for her child’s arrival. “It’s not because they don’t care,” Galst said. “It’s because they value this pregnancy so much.”
For some women, the nail biting subsides once they’re past the point in their pregnancy when the miscarriage happened the first time. For others, the entire nine months is fraught, which can be as isolating an experience as the miscarriage itself, since the excitement of friends or family members just feels off-putting, said Galst. “[The responses] range from being hyper-vigilant, maybe having more doctor visits,” said Robertson Blackmore, “to almost shutting down and detaching.”
And while these coping mechanisms may be helpful in the moment, women who resist bonding with their baby — or even just refuse to feel the excitement of anticipation — may experience regret or guilt once they’re holding a healthy newborn in their arms. That’s why psychologists like Galst and Robertson Blackmore encourage anxious expectant moms to try these strategies to help them relax during their nine months:
Give yourself permission to grieve
As counterintuitive as this might sound — how will feeling sad help me enjoy my pregnancy? — Galst encourages women to acknowledge that they may still be suffering the loss of their first child when they become pregnant with their second. In fact, it takes most women about five to six months to stop feeling “so raw” after a miscarriage — and during that time, women can easily conceive again. “I give them permission to have feelings, because they’re still grieving when they go through a subsequent pregnancy,” she said.
The good news: Becoming pregnant again can actually help you heal after a miscarriage. “We used to recommend that people wait [to become pregnant again] until their grieving is complete,” said Galst. “First, I don’t think you’re ever done grieving. But also, the experience of being able to be pregnant again — and deliver a healthy baby — is extraordinarily healing.”
Keep a journal
Yes, you’re probably already keeping a pregnancy journal for your little one to look back on — but there’s another, more personal journal you should consider keeping: Write about your worries, your fears, or your regrets about the previous baby — anything that’s invading your brain as you try to enjoy your pregnancy, suggested Robertson Blackmore. “Sometimes, it’s very difficult to talk to family or friends or even your partner about your concerns, because they may not be supportive or it may just increase their anxiety and worry,” she said. A journal is a cathartic, private way to express yourself.
Read up on recovery
Browsing the Internet probably isn’t a good idea — you’ll likely land on pages about pregnancy that will just freak you out. But Galst does recommend reading books about pregnancy after a loss, such as Celebrating Pregnancy Again by Franchesca Cox or Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Lossby Ann Douglas and Dr. John Sussman.
Stay in the present
Even if you fear another loss is inevitable, you can’t predict the future, which means worrying about it only creates undue mental tension. But you can focus on the present — and right now, you have a healthy baby growing inside you. “Just try to remind yourself, ‘So far so good,’” said Galst. “You’ve seen your doctor, you’re taking your prenatal vitamins, you’re doing what you can. So you have no reason to think there is a problem. Today, you’re pregnant and it’s okay.”
Take time for yourself
Focusing on your pregnancy every second of every day for nine months will only exacerbate your anxiety — and we all know stress isn’t healthy, no matter your condition. So find an activity that helps you unwind, whether it’s prenatal yoga, crafting, or reading for half an hour, and commit to doing it daily, said Robertson Blackmore.
Let yourself shop for the baby
It’s okay to hold off on shopping until you’ve passed the “scary” point — the time in your pregnancy when you miscarried before. But eventually, consider allotting half an hour a day to shop online for your little one, or even just daydream about what your new baby will look like, said Galst. “Women often need encouragement to start to plan — to give themselves permission to experience hope for the pregnancy,” she said. Often, at the 20-week mark, women with a history of loss are comfortable enough to do so.
Engage your health care provider
If you’ve switched doctors since your last pregnancy, make sure your current one knows about your history of miscarriage, said Robertson Blackmore. That way, your M.D. will be more sensitive to your needs — and more tolerant if you regularly call the office with concerns.
Some docs may even allow you to schedule extra appointments, if that’s what gives you peace of mind. “One of the responsibilities of our profession is to help the patients that aren’t as optimistic. That may require having them come in [more] often to hear a heartbeat,” said Berman. “Or having them call whenever they need to call — and not saying, ‘Oh, it’s you again.’ If a woman knows she has a partner in her provider, that can make for a more enjoyable pregnancy.”
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