End the silence: The emotional effects of infertility, miscarriage and stillbirth and the support available.

At IMI, we recognise that Mother’s Day can have very different meanings to each person. For some, Mother’s Day is a day for celebration, but for women struggling with infertility or pregnancy loss, it can be a day tinged with immense pain, loss and grief.

Despite how common infertility, miscarriage and stillbirth are, the physical, mental and emotional turmoil women experience is rarely spoken of. Contrary to common belief, becoming and staying pregnant when you plan to isn’t always as simple as having sex at the right time and maintaining a healthy lifestyle. When things don’t go as hoped or expected, it can come as a shock and leave women questioning themselves, their bodies, and their abilities as women and future mothers. Because of all of this, feelings surrounding infertility and pregnancy loss are complicated. Here, we share the breadth of emotions women can experience during these difficult circumstances and the support available.

Infertility

Around 1 in 6 couples in Hong Kong experience infertility for a variety of reasons. When a woman first struggles to get pregnant naturally, she may be surprised and seek to understand what is going on and why. As the struggles continue despite her best efforts, she may experience varying levels of depression. This might be among one of the first times that she feels she is not in control of her life. If she is infertile, she may feel her body has failed her, and all of this combined can impact her sense of self-worth. In addition to these natural feelings, she will experience a plunge in hormones, which can leave her feeling sadder and/or more depressed than she might have otherwise.

Another common feeling surrounding infertility is anger, which can be misdirected at a partner, other family members or friends. This can be particularly challenging as it can further isolate her and prevent her from gaining social support to move through this tough time.

Miscarriage

Miscarriages occur in 10-20% of known pregnancies, and in 50% or more before a woman knows she is pregnant. Oftentimes, when a woman has a miscarriage, she faces anxiety and confusion. She may also experience grief and depression. In fact, research shows that 1 in 5 women who go through a miscarriage experience symptoms of anxiety and/or depression, which can last from 1-3 years.

Dealing with miscarriage can be a lonely experience. Many families do not share their pregnancy news before the 12-week mark, but with 80% of miscarriages happening within that time, they may feel uncomfortable sharing that they have had a miscarriage. This can prevent them from getting support to manage their grief through such a loss.

If the couple does not yet have children, they may not only be mourning the loss of their baby but also their hope of becoming parents. Particularly in the case of recurring miscarriages, they may wonder if they will ever have the family they dreamed of.

Stillbirth

After 20 weeks, a pregnancy loss is considered an intrauterine loss, or in laymen’s terms, a stillbirth. The initial reaction to a stillbirth is often shock and confusion. As with other forms of loss, the parents-to-be may yearn for their baby to be alive, feel inconsolable sadness, loneliness, guilt, anger and hopelessness. They may also mourn their future as parents and as a family. The couple may isolate themselves from friends and family who are moving on and having kids, which can leave them feeling lonelier. They may feel left behind in life as if they are stagnating while the world moves forward.

While some partners may seek solace in each other and cope with their loss together, others may be consumed by their own grief and be unable to support one another. Supporting one another can bring the couple closer together. But when one or both partners feel unable to do so, this can drive the couple apart and cause problems in their relationship.

In general, men and women grieve differently but, because the woman was the one carrying the baby, her feelings of guilt and responsibility may be more intense. Often, we see mothers experiencing anxiety, restlessness, irritability and somatic (physical) distress. It’s not uncommon for some women to self-isolate.

At the same time, some men may feel the need to be ‘strong’ for their partner, which can prevent them in sharing grief together and supporting one another. They may also struggle with their partner’s expression of grief as it can be a reminder of what they are experiencing but feel they cannot express. Some men may be more comfortable expressing their feelings in anger, or to focus their attention elsewhere, which might be misinterpreted by their partner as lack of grief.

Even if they want to, cultural expectations can hold men back from sharing their feelings. Often, family and friends may be focused on the woman; it may not occur to them to ask how the man is doing or feeling. This can cause some men to feel more distress than their partners because they are not receiving any of the social support that she (hopefully) is.

For women and men, a stillbirth can be confusing in that it challenges our beliefs about the natural order of things. Children aren’t supposed to die before their parents. The grieving couple often feels helpless and are left wondering how this can be reality. In addition, sudden death can be more traumatic than a death that happens over time and is expected, which makes resolving the loss more difficult. The couple may even be surprised at how intensely they feel grief as it is not a subject often discussed. On top of all of this, varying reactions and beliefs about stillbirth can add to the challenge in managing grief. Some do not know what to say to a couple who has experienced such a loss and avoid it altogether, which precludes providing the needed support. Not having experienced anything similar, others may think such a loss isn’t as significant as it is because the couple didn’t “know” the baby.

Supporting couples through infertility, miscarriage and stillbirth

Infertility, miscarriage and stillbirth are complicated experiences that can lead to intense grief, leaving some questioning their abilities, and challenging the belief that the world is an orderly place that makes sense.

Even though everyone’s experience with grief is different, gaining the support needed can significantly reduce the intensity and length of time a person feels grief.

During this time, some turn to family and friends for support, which can significantly help grieving women and men. If, however, a couple’s usual support network does not know how to provide the comfort needed during this immensely difficult time, bereaved parents can feel worse and more isolated. Some may feel angry when family and friends suggest how they should act or feel after the loss or dismiss it as insignificant. This can also lead to intensified or complicated grief.

Organised support groups can be a big help as they offer a community of people with similar experiences that can aid in normalizing feelings and a realization that grief is a typical reaction.

Skilled therapists can also provide considerable relief by providing a confidential, safe space to express thoughts and feelings that may be uncomfortable to share with family and friends. Voicing these feelings is often the first step in the healing process. Cognitive Behavioral Therapy can be used to treat symptoms arising from miscarriage and perinatal loss. Cognitive “restructuring” can help clients identify and reframe thoughts that aren’t useful such as the belief that they have done something to cause the loss or that they may never become parents.

In instances where the loss was particularly traumatic or when grief is not resolved, Complicated Grief Therapy is useful. A trained therapist can help people move forward in the grieving process so that it becomes integrated in a healthy way, which enables the person to function as a productive member of society once again.

About Ilisa Howard

Ilissa Howard is trained in Cognitive Behavioral Therapy as well as Complicated Grief Therapy. She draws from these interventions as well as other evidenced based therapies to help those in mourning navigate their complex feelings and reduce symptoms of depression, anxiety and other challenges as a result of a loss. Ilissa believes that you will always hold the loss in your heart, but that you can also move forward and enjoy life again.

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