Improving Miscarriage Care Means Confronting the Loss: Senior Therapist and Director of Tribeca Maternity Rachael Benjamin in Very Well Family

Miscarriage Has A Real Emotional And Relational Cost That Shouldn’t Be Taken On Without Confronting Loss: Women And Birthing People Need Cohesive Care

In my work as Director of Tribeca Maternity, I witness firsthand the emotional and relational toll (in addition to physical and monetary tolls) that miscarriages take on women and birthing people, as well as their partners and families. I also see quite glaringly the gaps in the care offered after a miscarriage, which can leave women and birthing people alone to take care of these emotional and relational costs themselves. Drawing on these observations, I was recently asked to respond to a new comprehensive study that makes recommendations on how to improve miscarriage care in Very Well Family. 

In the article, writer LaKeisha Fleming breaks down the study by The Lancet, which asserts a need for providers to create an organized care management plan for miscarriage survivors. The various ways a miscarriage can happen, from a D&C (dilation and curettage) in a hospital to taking medication at home to a miscarriage that passes organically, can often make women and birthing people wonder if they need more help than they’re receiving (or any help at all). As I explain in Very Well Family, “You have a miscarriage and you do it on your own and then you’re left to wonder do I need help or not…From the women I’ve talked to, they’re suffering alone.” By alone, I mean we need to be able, as care providers building relationships with patients, to sit with pain and grief rather than move past it or ask the person to move past it.  

The study advises that this cohesive care should include follow-ups and paying close attention to multiple miscarriages (the article reveals the risk of miscarriage increases by 10% with each subsequent miscarriage). The study also recommends OB-GYNs provide mental health screenings after miscarriages, as well as have a list of maternal mental health referrals available. This, as I noted in the article, “would be fantastic for women after a miscarriage because at least it would be saying you’re allowed to feel these things.”

Because this article and the study examined within it raise important questions about what miscarriage care should look like, I want to continue the discussion here about how providers can allow women and birthing people to feel and grieve pregnancy loss, as well as the pain that this loss brings up, in the time that they need rather than quickly moving past it:

A Miscarriage Is A Complex Loss, No Matter How You Felt About The Pregnancy

The Lancet’s study cites a surprising statistic that there are 44 pregnancy losses per minute worldwide. Because miscarriages are losses that happen every day, this experience should be normalized. Yet the experience shouldn’t be treated as so normal that the emotional loss is overlooked. Miscarriages are a loss and a shock for the person who experienced the miscarriage and often their family.

A miscarriage is a complex loss whether the pregnancy was something you wanted, something you wanted to want, something you weren’t sure you wanted but were curious about, or something you didn’t want but still have feelings about. I want to emphasize that even if the pregnancy wasn’t wanted, a miscarriage can still be felt as a loss. You may be sad about not wanting the baby, as well as sad over the miscarriage itself. A loss can also still be a relief, as well as a sad thing or an upheaval of sorts. It’s the loss that something lived–a hope, a dream, a baby, a family–and then suddenly was gone.

A miscarriage is also a bit of an existential crisis–a loss of control and of the body. As the article notes, sometimes a miscarriage can be prevented, but a lot of times, it’s a product of unknowns without reason. This can feel both scary and sad.

After A Miscarriage, Women And Birthing People Need To Feel This Loss For As Long As It Takes

Because the loss of a miscarriage is so complicated, women and birthing people, as well as their families, need the opportunity to confront the loss and feel the sadness, the grief, or the hurt for as long as they need to. By feeling the sadness, grief, or hurt, I mean let yourself really go there by crying and hanging with the feeling. Allow yourself to feel low without covering it up, glossing over it, or pretending it away.

Giving yourself the ability to feel whatever feelings come up allows you to name what the experience was and is rather than quickly moving along to okay, what’s next, or skipping steps so the complexity of the loss is under-recognized and under-felt. For instance, ask yourself: What are you sad about? The loss of the baby? The disappointment with your body? With your partner? With your practitioner? What are all the facets of this that make you sad? When we sit with the loss and feel it, we can discover what the loss means to us and then, tend to it rather than hiding or simply just living with it. This is key in order to process what happened.

Doctors And Other Providers Can Sometimes Move Past The Loss Of A Miscarriage Too Quickly 

Ideally, after a miscarriage, a doctor, therapist, or other provider should help women and birthing people name the loss, let the processing happen, and provide the opportunity to let these feelings be felt and seen by others in the time needed. However, perhaps because miscarriages are so frequent, doctors and other providers can sometimes push past a woman or birthing person’s grief and emotional pain. It’s all too easy to breeze past what a medical process like miscarriage leaves a person feeling–a loss of control, of their body, of life, of their hope, or of what their family hoped for, as well as possible ambivalence about wanting to try again.  

In some ways, this is understandable. Many providers and the medical system in general are overwhelmed. Grief, loss, sadness, and the range of emotions felt after a miscarriage are a lot for an OB, a nurse, or a midwife to hang with when they may have other responsibilities and patients to get to. The medical system too may see miscarriages as all too common and are therefore desensitized to it. It also may be as simple as providers just wanting to help patients feel better as quickly as possible, but pushing too quickly past loss and sadness doesn’t help.

Providers, Including Some Therapists, May Also Just Not Know How To Emotionally Hang With This Kind Of Complicated Loss

Beyond being overwhelmed, doctors, midwives, and therapists may just not know how to hold space for a loss like a miscarriage in the way that is needed. Doctors and other providers may know how to deal with situations medically, but emotionality may be less known. And dealing with a miscarriage is a complex blending of biology, emotionality, and grief. Miscarriages may also bring things up for providers that they may not have the emotional capacity to know how to hang with such as the depth of sadness, loss, and shock.

This holds true for some therapists as well. Some therapists can be trained in symptoms and diagnosis rather than how to give a patient time and space to feel the complicated range of feelings after a miscarriage. It can be easy to rely on a set of diagnostic criteria rather than relating to a patient and letting them grieve or be as sad as they need to be in order to feel the loss, link it to other losses in the past or present, and figure out what’s next.

How Can Practitioners And The Community Advocate For Slowing Down Post-Miscarriage?

The Very Well Family article encourages practitioners to refer patients to a mental health provider with whom they have built a relationship and trust. I think this is a great start to allowing women and birthing people the time they need to process this loss. Being able to refer a patient post-miscarriage to a good therapist can help the patient explore and lean into their sadness and grief, as well as know that they’re not alone.

A good therapist is uniquely positioned to hold space for the pain of life and knows how to slow patients down in order to help them to go back to something they felt or they’re skipping feeling because it just hurts too much. We can help patients see that they can be with the hurt–they can survive it and make space for feeling that hurt, as well as any pain that came before the miscarriage. It’s important for women and birthing people to be in a space like a therapy office where you can go to feel the pain, be with it, and tend to it rather than hide or pretty it up because that’s what cultural pressure says you’re “supposed to do.” 

Beyond doctors and other practitioners having a Rolodex of good therapists, communities should continue to advocate that doctors and other providers slow the process down after a miscarriage rather than try to move past it as quickly as possible. In some ways, the Very Well Family article itself opens the door to this advocacy by asserting: “Please, providers, slow down.” A community of advocates (such as advocacy groups like Tommy's, a British miscarriage and pregnancy loss support group, or the National Association to Advance Black Birth), therapists, and even patients who have experienced miscarriage can help push providers to note they are missing something–the human experience of loss, sadness, or the upheaval of the loss on their relationships and families.

–Rachael Benjamin