Losing a baby, at any stage of pregnancy, is an absolutely devastating experience. This loss is often negated or discounted, both by medical services and also by society. Yet this is complex grief as there is so much hope, fantasy and expectation interwoven within the grief and utter disbelief when it happens. Psychotherapy offers women and couples an opportunity to honour the depths of this loss and to form a narrative encompassing all the complexities and fears this loss can hold.
Research shows us that about 25% of pregnancies end in miscarriage and that the first 12 weeks are the most susceptible time, with miscarriage in the second trimester at around 1-2 in every 100. Age would appear to be a factor too. After the age of 30, the chance of miscarrying rises rapidly, reaching 53% at 45 years of age.
What is often negated are the different types of loss, with miscarriage being only one of them. Stillbirth and neonatal loss are less well known and rarely talked about, almost as if there is a taboo about naming them. These losses often bring uncertainty. ‘Do I mention the baby, do I stay silent?’, for example. Many women feel silenced by society, as if they are not allowed to speak or grieve about their loss.
The Office for National Statistics says that stillbirth in the UK is at about 1 in 256 births. This type of loss often has no obvious cause, compounding the sense of grief and loss for women. Neonatal loss (loss in the first 28 days) is slightly lower, at 1 in 357 births. Around 60% of stillbirths are unexplained, compounding the devastation felt. Statistics for TFMR are hard to come by at present.
There are also terminations for medical reasons (TFMR) and molar pregnancies, both of which are almost completely unheard of and certainly rarely talked about. This type of pregnancy is due to the fertilisation of an abnormal egg which then implants into the womb. The placental cells grow too quickly and overtake the cells of the embryo, resulting in a fluid-filled mass of cells, or rarely a cancerous mole. A diagnosis of foetal abnormality may put parents into an almost impossible decision of whether to terminate their pregnancy – often at a later stage – or to carry to full term, knowing that the baby may not survive birth, or may die very soon after. This is such a complex and devastating situation for parents. Most people have never heard of a molar pregnancy, so finding information is often difficult, as well as gaining any sort of help.
I see women and couples who are struggling with this grief. When they come in for psychotherapy after the loss of a baby, they want to be able to speak and be truly heard. The first session may feel wrought with pain and complexity and it is important to allow space and time, however long this may be, for the story to be told. For some women, it can take months for the depths of despair to come to the fore within the psychotherapeutic relationship and this may be due to the depth of guilt and shame, and the belief that it is somehow her fault. It is important to honour that many women will have been in relationship with their fetus even prior to conception, particularly if the pregnancy was long-awaited and due to IVF or Artificial Reproductive Techniques (ART). Losing this yearned for baby is truly complex grief, often with the added complication of the medical response to the loss. There will often be the yearning to know why, which is compounded by the response that the loss is ‘unexplained’ or that there is no medical reason, giving no closure. This can lead women into a sense of “if only I had….”, or a continuous yearning to ask why, which may feel like stuckness, both in psychotherapy and in their intimate and familial relationships. It also may feel like a kind of madness to the woman, which can be frightening for her and for those around her. It is important to listen, to hear her fears, to offer the safety and security so she can bring this ‘madness’ in whatever shape or form it comes.
Each woman and couple will grieve in their own way for their baby, there is no set pattern to this. Some women grieve for many years, and this can put strain on relationships. It is so important to allow time and to have no cap or limit on this. It is also important to allow the parents to grieve at their own pace. This can be difficult, as one partner may come to terms with their grief at a much faster pace than the other. They might have difficulty understanding why their partner continues to mourn this loss. This can cause friction within the couple and relationship break-downs, so talking about this early on within psychotherapy can be helpful.
Often a woman will still have a very strong maternal instinct for some time after their loss, and this can be frightening. Talking this through and normalising this for her is important. This might be a strong urge to hold their deceased baby, or having somatic pain in their arms, the ache of wanting to cuddle them. Some women isolate themselves, unable to connect with the world around them, suffused often with intense feelings of guilt, anger and also jealousy towards those who are either pregnant or who have a healthy newborn. Again, these intense emotions can bring real fear, and a sense that she must isolate herself to go through these emotions on her own.
The most important factor when giving psychotherapy to a woman, or couple, with such a loss is compassion, pacing and allowing them to speak. It takes time to come to terms with such a loss. This cannot be hurried. There is no protocol that will take the pain away. Staying in the moment and metaphorically walking beside them in the grief with absolutely no agenda can allow the space and time to heal.
Psychotherapy can offer a safe space to explore your feelings, YOU CAN LOOK FOR AN ACCREDITED THERAPIST ON THE UKCP WEBSITE
You can also find support by contacting:
In an emergency, call: 999
NHS (England), call: 111
NHS Direct (Wales), call: 0845 46 47
Miscarriage Association, call: 01924 200 799
The Samaritans 24 hour helpline, call: 116 123