Pregnancy and infant loss: breaking the silence to better support

Lightning doesn’t strike twice. We’ve all heard the saying before, taken to mean an extreme event won’t occur a second time after it’s been endured once. 

But the saying is a myth. In some cases, lightning does strike twice. And again. The Empire State Building is actually struck about 25 times every year1

Until this month, I didn’t think twice about whether or not lightning struck twice. 

My family is in the process of moving from Cleveland to Tampa and my husband and I spent the last two months house hunting. Before we started our home search, in what was the surprise of our lives, we found out we were pregnant. We have a 5-year-old, a 3-year-old, and after over a year of trying for a third child, we lost a baby this past Christmas after an ultrasound had confirmed a strong heartbeat. 

With the knowledge we were now expecting for a fourth time, we cautiously navigated the home-finding process. Do we look for a home with space for our family to grow into? A room for a nursery? An area for a basinet in our future bedroom? We wanted to be hopeful and plan for the best, but were reluctant after enduring the loss of a baby just nine months earlier.

I also hesitated to share the news of our latest pregnancy. As the days and weeks passed, we grew more confident in the idea we would get to bring this baby home and I started to let a few in on the secret. They met our news with excitement and well-intentioned sentiments: 

This is a different pregnancy, a different baby, and it will have a different outcome.”

Many women have healthy and successful pregnancies after a loss.

Lightning doesn’t strike twice.

Except for us, lightning did strike twice. The first time it struck sudden and violent, the second time it struck slow and silent. The day finally arrived for my husband and I to go in for an ultrasound of our fourth baby. The baby looked perfect but did not have a heartbeat. 

We had another miscarriage. 

A Future Dashed

When you have a miscarriage, you don’t just lose a pregnancy, you lose a baby. You lose a future you expected and planned for. A framework you had built up—dates earmarked, plans made, a specific house bought.

When you are suddenly looking at a future with one less person, the scaffolding is dismantled. A room planned for a nursery will not hold a crib or changing table. Plans are cancelled. Dates loom on the calendar—once filled with anticipation and excitement are now filled with dread and heartbreak. 

Losing these babies has been unexpected and disorienting. Their losses have upset our sense of balance, knocked us off our feet, and changed the course of our future. Our hearts and home expanded in anticipation of their arrival and now hold voids in their absence. The losses of these babies have been lightning strikes to our lives.

The first time you lose a baby, you don’t know how you will get through the shock and pain. The second time you lose a baby, the shock and pain are the same. It’s still just as devastating. But you’ve lived through it once. You know your heart will keep beating even though your baby’s heart stopped. You know life will go on even though your baby’s life will not. 

I no longer carry these babies inside of me and I will not get to carry them in my arms. Instead, I carry the grief of a stolen present and future. And I am not the only one who carries this. Approximately 1 In 4 pregnancies end in miscarriage2. 1 in 100 women will experience repeated miscarriages3. 1 in 160 women will live through the tragedy of stillbirth4. Chances are, you know someone who has lost a baby or have lost one yourself. And I am so sorry for your loss. 

More Than a Medical Event

Despite pregnancy and infant loss affecting so many, it remains largely undiscussed. According to a poll of 6,000 women conducted by the miscarriage-research nonprofit, Tommy’s, two-thirds of women who have miscarried say the feel like they can’t even talk to their best friend about it5. Women and their partners feel like they have to endure the physical and emotional tolls of losing a baby in silence, further compounding the grief, emotional, and physical distress they are experiencing.  

Rayna Markin, Ph.D is a licensed psychologist and leading researcher on the psychological experience of pregnancy and perinatal loss who partially attributes the pressure to not talk about the loss of a baby to the modern world view of seeing a pregnancy loss as not a psychological, emotional, or mental process, but as a medical event. 

Losing a pregnancy—losing a baby—has profound and far-reaching impacts on parents6, which Dr. Markin summarizes in her introduction for a special section of the journal Psychotherapy (Psychotherapy, Vol. 54, No. 4, 2017)7.

“Numerous studies have documented the devastating effects of pregnancy loss on parents, particularly on the mother, including chronic and severe grief that may extend for years, beyond the birth of a healthy baby, and does not follow the typical linear decline found with other types of grief, as well as symptoms of depression, anxiety, and trauma,” writes Dr. Markin. “Furthermore, after a pregnancy loss, women tend to report feelings of guilt, self-blame, a yearning for the lost baby, low self-esteem, and an increase in suicidal thoughts and obsessive–compulsive symptoms. Women have lost faith in their bodies, in the world as a fair and predictable place, and in others as a source of support and comfort.”

When society views miscarriage strictly through the lens of a biological process, it dismisses a parent’s deep grief and denies support for the myriad of potential health implications associated with pregnancy loss. Classifying a miscarriage solely as a medical event fails to see the mother as someone whose life has been irrevocably changed, further stigmatizes pregnancy loss, and silences the grieving. In these oversights, we are failing to support bereaved parents. 

A Call for Support

October is Pregnancy and Infant Loss Awareness Month, initiated in 1988 to cast light on the women, their partners, and the families who have lost babies and shared futures. 

Despite Pregnancy and Infant Loss Awareness Month first being recognized more than 20 years ago, drastic discrepancies still exist between patient needs following a miscarriage and current clinical practices. Women are responsible for seeking medical attention and coordinating care after the loss of a pregnancy while handling fluctuating hormones, grief, trauma, and the feeling that they can’t talk about their loss. Systems need to be created so women do not have to shoulder this burden in its entirety. 

The timing of care following the loss of a pregnancy has been shown to influence the degree of adverse physical and emotional health effects women experience8. With the knowledge that miscarriage is a significant source of psychiatric morbidity, mental health screening should be standard following the loss of a pregnancy. 

Counseling programs after a pregnancy loss are shown to reduce depression, anxiety, and stress in women with recurrent miscarriage9. Following a miscarriage, patients should be provided with resources to connect with licensed professionals who can offer appropriate treatment. 

Employers should allot paid leave for women and their partners who are experiencing the loss of a baby, which often requires a trip to the hospital, general anesthesia, and surgery. 

Finally, society should not shy away from parents who are navigating pregnancy or infant loss. We need to learn to sit with the broken-hearted, even if its uncomfortable. 

To change current practices and create better systems of support—both medically and socially—we must continue to raise awareness. 

How do we raise awareness of pregnancy and infant loss? By talking about it. We cannot create networks of support in silence. We cannot create healing environments in isolation. Which is why I am sharing my story of repeated miscarriages.

While my losses have left me empty in more ways than one, they have also made me who I am today: more compassionate and discerning. I find myself looking around rooms and counting heads. I wonder which women and their partners have endured the same losses my husband and I have. I know if a couple misses a holiday dinner, they may be recovering from a miscarriage. I know if a woman sends an email saying she won’t be calling in to a meeting due to unexpected surgery, she may be preparing for a D&C. I know a man who suddenly cancels work travel may be taking his wife to the hospital for surgery and grieving the loss of a baby. 

As we pack the belongings of our home in Ohio, I wish some of our future neighbors in Florida may know that the family moving during a global pandemic, also just lost their second baby in less than one year. 

Sharing stories of pregnancy and infant loss can be difficult, but it is necessary if we want to shape a society that supports grieving parents. Lifting up the voices of parents who have endured pregnancy and infant loss during the month of October is one place to start. 

Pregnancy and Infant Loss Awareness Month is punctuated by Wave of Light, a global event where everyone is invited to light a candle on October 15 at 7 p.m. to acknowledge all the babies who are not carried in the arms, but in the hearts of their parents. Please join me in lighting a candle to recognize the babies we have lost and all the others who are loved and missed. 

Sources:

1. https://www.noaa.gov/stories/5-striking-facts-versus-myths-about-lightning-you-should-know

2. https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby/unacceptable-stigma-and-shame 

3. https://www.acog.org/womens-health/faqs/repeated-miscarriages

4. https://www.cdc.gov/ncbddd/stillbirth/facts.html

5. https://www.parents.com/pregnancy/complications/miscarriage/why-its-important-to-talk-about-miscarriage/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468887/

7. https://psycnet.apa.org/fulltext/2017-55835-005.html

8https://pubmed.ncbi.nlm.nih.gov/32550017/

9. https://pubmed.ncbi.nlm.nih.gov/33688267/

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