Recovering From Miscarriage: More Than Physical
Andrea Sager had it all planned out. Her 6-month-old child and the baby she was newly pregnant with would play on the same sports teams at school and giggle in their bunk bed at home. Perhaps best of all, she and her husband would only have to take the duo, who'd be about 14 months apart, to Disney World once. "What luck!" thought the 27-year-old lawyer, who lived in Cincinnati at the time.
But when she went for a doctor's appointment at what should have been 12 weeks pregnant, the clinicians couldn't find a heartbeat. An ultrasound revealed that she'd lost the pregnancy a few weeks before. "I yelled out, 'Nooo!' and started crying," Sager remembers. "That was definitely a hard day."
The next day was hard, too. Sager underwent a D and C, or a medical procedure to remove the tissue, and remembers "freaking out" when being wheeled back to the operating room because she didn't understand why this happened to her. "People try to tell you it wasn't your fault ... but it was my body that did it," she says. "Even if it's nothing I did physically, it's still my body."
The next few days were difficult as well, but they were made easier by her parents and best friend, who flew in to help out with her son while she recovered in bed and her husband went to work.
A few weeks later, everything was normal -- medically. But physically and emotionally, Sager was far from recovered. She gained 30 pounds and, like her husband, became depressed. She tried to bury herself in work, as was her nature, but that tactic didn't work anymore. Seven months into her new job at a law firm, she quit, sold her house and the side business she owned with her husband and moved the family to Houston, where she is from. The miscarriage, she says, "was the hardest thing my husband and I have ever been through."
[See: Being Childless Is Painful for Many Women: Here Are 9 Coping Strategies.]
From a medical perspective, miscarriage is common and managed routinely. Many women are physically capable of returning to work the day after a procedure like the one Sager had -- the most invasive of the management options most women are given. Unlike, say, a broken wrist set with a cast, onlookers and even loved ones may never know the pregnancy or its loss occurred.
But from a mental and emotional perspective, the impact a miscarriage can have on a woman's life -- and the recovery it requires -- can far exceed whatever's captured in the medical records. In Sager's case, for instance, the experience affected her mental and physical health, altered her career path and even triggered her to pick up her family and move across the country. While some women are relatively unfazed by the experience and can move on swiftly without psychological repercussions, others grieve deeply for a long time -- even if their pregnancy loss occurred before they'd experienced any signs of pregnancy or gone to their first doctor's visit.
"Once you see a positive pregnancy test, if it's a desired pregnancy, you're immediately off to the races -- you start to have a fantasy about pregnancy and motherhood," says Dr. Caitlin Fiss, an OB-GYN in private practice in New York City. Losing that, compounded by the drop in hormones that occurs after a miscarriage, can feel unbearable.
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
And yet, recovery from miscarriage often only focuses on the physical: nothing in the vagina for one to two weeks to prevent infection and call your doctor if you have heavy bleeding, fever, chills or severe pain are standard discharge instructions. And while following them is indeed important, "sometimes women get the message that you should just cycle through this and get back to business," says Dr. Joyce Gottesfeld, an OB-GYN at Kaiser Permanente in Denver. Indeed, in one study of Australian women who'd had miscarriages, researchers identified "lack of emotional care" and "lack of follow-up care" as two common themes across their experiences.
That was true for Heidi McBain, a marriage and family therapist in Texas, who experienced a miscarriage at home one day before her second trimester. She was sent home from the hospital and follow-up appointments only with information like how long she should wait before trying to get pregnant again. (It's technically possible to get pregnant again right away, Fiss says, but women usually aren't advised to have intercourse for a couple weeks and may want to wait until they start ovulating again in order to track their cycles.) McBain didn't receive referrals to local therapists specializing in grief and loss. "As a mental health counselor, I was shocked," she says.
Addressing both aspects of the loss is important because physical and psychological recovery are intertwined, Gottesfeld points out. "Can you physically get up and go back to work the next day? Maybe you can; however, I do think that's going to hinder your psychological recovery," she says. Plus, physical recovery isn't even necessarily desirable for women, given what it represents. For McBain, for instance, losing the baby weight would signal healing, but it also signaled a loss. "I felt like when the weight came off, the last physical connection to this baby would be lost too," she says.
The good news is that the medical community is increasingly recognizing the emotional pain many women and families experience after pregnancy loss, believes Gottesfeld, who has been practicing for 25 years. When she had a miscarriage early in her career, she underwent a D and C to manage it one afternoon and was scolded for taking off work the next day. Today, she says, "we are more honoring of the woman's experience, and I think that's important because ... if people don't allow proper psychological resolution time, it's going to come out some other way." Research even suggests that not effectively working through the grief of a pregnancy loss can damage a parent's relationship with future children.
[See: How to Find the Best Mental Health Professional for You.]
For McBain, seeking a counselor on her own was critical for processing the grief before trying to get pregnant again. She encourages other women to do the same. "Life will be different and hard," she says, "but it will get better." As for Sager, who is now six months pregnant, the move down south was the fresh start she and her husband needed to recover from the blow of pregnancy loss. "We've been great ever since."
