“First comes love, then comes marriage…” Perhaps you remember the sound of a child’s voice reciting this playground song. For one patient of mine, “Natalie,” the memory of this poem was bittersweet. Somewhat wistfully, she said to me, “I recall hearing this for the first time when I was about five years old and playing on the playground. My friend Drew and I were swinging next to each other on the swing set, and a little girl named Ellie was reciting this poem and giggling with our friend Lucy. Those were such carefree days.”

“As I grew into adulthood, I remember that very moment I first desired to have the sound of a child’s laughter in my own home. At times, I became almost obsessed, wondering about what kind of parent I would be. I often imagined how much I would love that child. If only those deep longings to have a child were powerful enough to make my dreams become a reality”.

The Deep Emotional Pain that comes from a Miscarriage

Miscarriages in early pregnancy are an all-to- common and sad occurrence. Scientific research suggests that about ten to twenty-five percent of women miscarry prior to twenty weeks. Researchers have discovered that the most common cause of miscarriage is a chromosomal abnormality in the DNA of the fetus, caused by a damaged egg or sperm cell. There are additional factors that could lead to miscarriage like maternal health conditions, unhealthy lifestyle (poor eating habits, drinking alcohol, smoking, etc.), and advanced maternal age.

Regardless of cause, a miscarriage not only takes a toll on a woman’s body, it may also bring about deep emotional anguish.

Natalie was a thirty year old woman psychotherapist and had been married for four years when she first came in to see me. She and her husband Daniel had just begun to live through the emotional after-effects of Natalie’s miscarriage. In our first session, she said to me, “I remember the very first moment I told Daniel that we were pregnant. I had been feeling weird recently and had already taken a pregnancy test, but it was difficult to read correctly, as it was one of those crummy paper strip ones. I went out and bought one of those Clearblue tests, you know, the digital ones that are more advanced, and Daniel wanted me to administer it as soon as possible. As we were anxiously awaiting the results, Daniel was really nervous and went outside to smoke a cigar. He had always told me that he would quit smoking the day I became pregnant. I waited for him to come back inside and, in the meantime, the results came back. When he walked through the front door, I asked him if he was ready to quit and he became teary eyed. It was our dream come true!”

Natalie began looking for an obstetrician and asked her female friends for recommendations. She found a doctor that she was comfortable with and scheduled the first appointment for the seven-week milestone. “I remember how excited and anxious Daniel and I were as we walked into that appointment. It was the first time we would see our “little bug.” The ultrasound tech warned us that we may only see something that looked like a peanut, but shared that we should be able to hear the heartbeat. As she ran the wand over my tummy, there was nothing but silence. Our anxiety went through the ceiling. We wondered aloud, ‘What’s wrong?” She told us that the ultrasound result was more consistent with what we should be seeing at five weeks, not seven, and went to get the doctor.” Natalie paused for a moment to collect herself, and then continued, “The doctor wanted to do a blood test right away to check HCG levels, and then do a second blood draw forty-eight hours later. She told us that if the HCG levels had doubled in that time, then I had just tracked my progress incorrectly. This was our hope. We felt somewhat desperate, and really scared.” I nodded to her and said, “Natalie, the waiting must have felt interminable, what happened next?”

“Daniel and I had already planned a trip back to the Midwest to see his family. We had planned to break the news of our pregnancy to his family in person. Now we had to delay our departure to wait for the HCG results to come back. We did not want to have to share the exciting news and then immediately explain that there was a chance of losing the baby.” Natalie then exclaimed, “Waiting for that phone call was anxiety inducing and exhausting! I was at work, and as a therapist, I have to be emotionally attuned to my clients and I was struggling to stay focused. I kept checking my phone at break and called the doctor’s office twice. Finally, at about 3:00 P.M., the call came in from the doctor. My heart was racing and immediately I knew it was bad news because when I picked up the phone and said hello she immediately uttered a deep sigh. My heart sank before she even uttered the words. We had lost our baby. I began to cry as she started explaining our options of where to go from here. I could barely listen as she advised that I could try to let the miscarriage occur naturally, I could take a medication to induce an abortion, or I could go through a D&C which is a surgical procedure to remove the ‘contents’ My heart was broken, shattered. What would I say to Daniel? I felt devastated”. Remembering how I had felt when my wife has miscarried after 5 ½ years of trying to get pregnant, I said to her, “Natalie, I am so sorry that this happened to you. It’s a terrible loss. One that typically ushers in deep feelings of grief and emptiness that are important for us to talk through. Please tell me more.”

Natalie talked over her options with Daniel and she chose the medication method. While she wanted the process to occur as naturally as possible, she also wanted to ensure that she could be at home when she began passing the tissue. The doctor prepared Natalie and Daniel as best she could for what was to come. Natalie shared with me, “Nothing could have prepared me for how bad it felt. The pain was incapacitating. My husband kept asking me, ‘What can I do?’ yet there was nothing that either one of us could do other than waiting it out. I felt helpless, a feeling I am not used to. I was literally paralyzed by the pain. I couldn’t move. All I could do was sit and cry. This torture lasted for about twelve hours and then all of that physical and emotional pain began to lift slowly. I felt kind of numb. It was like waking up from a nightmare only it had actually happened.” I looked at her with kindness, and recalling the sadness once experienced by my wife and me under similar circumstances, I commented, “The physical pain can be excruciating, made all the more difficult to bear by all of the emotions that may have overwhelmed you. What do you remember feeling at that point?”

The Aftermath

She went on, “Guilt is what hit me at first. I started questioning what I did wrong, or what I could have done better. Daniel kept telling me that it was nothing I had done but I couldn’t get rid of the feeling that somehow it was my fault. I also felt guilty because there were other people in my life who had carried to twelve weeks, or had to deliver a stillborn baby, and here I was falling apart over a miscarriage at five weeks”. Natalie tried to explain this feeling to her friends and family members and they all reassured her that although she miscarried early, it did not make her feelings about the loss any less valid, or any less painful. And I added, “Natalie, regardless of the stage of pregnancy, not uncommonly a pregnant woman is already filled with many feelings and fantasies about their unborn child. These can be quite vivid. And the strength of these fantasies and feelings, not the stage of pregnancy, will determine the magnitude of grief that one might feel.”

At about two weeks post-miscarriage, her sad and angry feelings became more-and- more pronounced. Natalie recalled having a day where she was very irritable and was unsure of why. “I was driving home from picking up dinner and Daniel was giving me one word answers and was really pissing me off. I ended up hanging up on him and burst into tears. I tried to operate from a therapist’s mindset and began to search for the trigger. I realized that this was the first day that I had the time to let it all sink in. It hit me like a massive avalanche of feelings all at once.

“Prior to this moment Daniel and I had gone through two hectic weeks with company coming in and out. And as I arrived home that evening it was the first time the two of us had the opportunity to sit together and explore what had happened, and our raw emotions began to pour out.” Natalie described what it was like for her in that moment. “I almost don’t remember getting home. I was so upset and when I walked through the door I looked for Daniel. I explained to him that I was really hurting and that I was not okay. Our dogs were panicked and so I sat down on the kitchen floor and began to hold and comfort them and Daniel sat with me. That unsettling feeling of not being able to move set in once again, yet this time it was different. This time it had to do with overwhelming emotions, not the physical pain. I just wanted to curl up in a ball and fall asleep and start over, but I knew it would not be that simple. Daniel just held me and I cried and he cried too, and that’s where we sat for about thirty minutes. We just allowed our emotions to pour out of each other. We shared our fantasies with each other about what our child would have been like, and just sobbed. We just felt so grief-stricken. I still feel that way. It really scares me.” She began sobbing in our session and I said to her, “Natalie, at times such grief may feel completely overwhelming, as if it will take over your life and consume you. Some of those in grief may worry that once they start crying, they will never stop. I assure you that what you and Daniel are experiencing is a natural part of the process of grieving your loss, and the fact that you can be there for each other is a sign of the strength of the loving bond between you. I am confident that you have the emotional strength to get through this, and can be a kind of companion to help see you and Daniel through it.”

It has now been about a month since the miscarriage, and both Natalie and Daniel still experience ups and downs. Natalie has been honest with herself and Daniel in admitting that she feels she is dealing with some depression. “There are days when I don’t want to get out of bed and days where I don’t really have much of an appetite. Sometimes little things will cause me unnecessary stress or irritability and I have to remind myself to take a few deep breaths and refocus my attention. The bad days are becoming less though, and it has helped to talk with my mom and others who have lived through a miscarriage. Each day I heal a little bit more and I know that things will be okay, I just have to give it some time”.

Natalie and Daniel experienced a cycle of grief and loss. As the two of them continued to reach out for help and share their story, they discovered how many of their loved ones had gone through similar experiences. Unfortunately, miscarriages are not discussed as openly as other traumatic experiences in life, and so many people are unaware of how often this emotionally devastating event occurs. Women not infrequently ask themselves self-blaming questions like, “Is it that cup of coffee I had?” or “Was it those glasses of wine I drank before I knew I was pregnant?” Because there is such misunderstanding and even stigma around this topic, many people shy away from talking about it. By not reaching out to others for emotional support, they may continue to feel alone and not realize how many other families are struggling with the aftermath of this kind of loss.

A rainbow baby is a baby that is born to a woman following her miscarriage. He or she is called a rainbow baby because it is “the beauty after the storm.” Before you consider conceiving a rainbow baby, it is important to make sure that you are emotionally and physically ready. That’s the best way to ensure that a rainbow baby gives many families hope and joy once again.

Natalie recently went to see her doctor for her three-week check-up post-miscarriage. She reported that the doctor was pleased with the physical healing but repeatedly reinforced the need for Daniel and Natalie to take additional time to emotionally heal before trying to get pregnant again. She reported, “The doctor told us that there is nothing worse than her handing us a newborn baby sometime in the future, while we are still grieving. She also brought up a very good point, that if we were to get pregnant again so soon, I would be terrified about another miscarriage, and that my fear may cause stress to the new baby as it grows inside of me.”

Begin to Untangle Your Heart

If you or someone you care about has suffered a miscarriage, although the desire may be there to quickly recreate the high that accompanies a pregnancy, make sure that you and your partner feel a strong emotional readiness to move forward. Here are some ways you can help yourself or a loved one cope with and work through this difficult emotional experience.

Step 1: In the aftermath of a miscarriage, be sure that you don’t isolate yourself from those who care about you. You can benefit from their emotional support, and not feel all alone with powerfully painful feelings. Feelings of guilt and shame are not uncommon, and having others listen and understand what you are living through can lighten your burden.

Step 2: Make sure to go to all of the follow up appointments with your doctor to ensure that you are not suffering from complications and are healing properly.

Step 3: Keep in mind that you have sustained a major loss, no matter how far along you were in the pregnancy. For any pregnant woman, the baby they are carrying “comes alive” in their heart long before the day she gives birth. Allow yourself the time and space you need to grieve.

Step 4: As the emotions well up inside of you, let them surface. Do not try to suppress them. Reach out to your loved ones and consider seeking help from a professional, particularly if you begin to have difficulty with day-to-day functioning, or have persisting overwhelming emotions. They can help support you through the depression, sadness, anger and other emotions you may feel; and facilitate your grieving.

Step 5: Give yourself time to heal. Do not try to force the grieving process, believing that you need to get better as soon as possible to try get pregnant again. Each person grieves in their own time and in their own way. Be mindful and respectful of your personal method of mourning, and let it run its course.

Step 6: Be hopeful and optimistic that a successful pregnancy and a rainbow baby are in your future. By taking these steps, and being patient with yourself, I am confident that you will untangle your heart following a miscarriage.

A Tip to Untangle Your Heart

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