It’s a heartbreaking statistic—about 1 in 5 pregnancies end in miscarriage. Just because pregnancy loss is common, however, doesn’t mean it’s easy to process.
“Perinatal loss can feel like psychological jujitsu to work through,” says Julia Riddle, MD, a UNC Health psychiatrist with a focus in reproductive mental health.
Dr. Riddle and UNC Health OB-GYN Henny Liwan, MD, explain what you need to know about getting pregnant after loss and how to move forward with grief.
Honor Your Grief
Grief is a normal part of the process of pregnancy loss, but it’s important to recognize it and take time and space to heal.
“Grief is the ooey-gooey stuff—in many ways, it’s actually love in a different form,” Dr. Riddle says. “We don’t have as much control over grief as we’d like. It is a process that will look different for everyone.”
Dr. Riddle uses an analogy of a ball in a box to describe the grief process. Imagine you are in a small box with a ball. The ball is the loss, grief, anger, sadness and vivid memories of the experience. In these tight quarters, every time the ball hits you, it causes a grief attack where intense waves of emotion wash over you. Because the box is small, you’ll get hit often. As time passes, however, the box grows bigger, and the ball hits you less often.
“The goal is that grief never goes away,” Dr. Riddle says. “You just learn to carry the story and the importance of that experience going forward.”
Many things can trigger a grief attack. A smell, remembering a craving or going to the doctor could bring it all back when you aren’t expecting it.
“When you experience a grief attack, you have to breathe through it and embrace the emotions,” Dr. Riddle says. “That’s how you honor your grief. The box will get bigger on its own, but while you wait, you have to feel the feelings.”
Other ways to honor your grief include:
- Going to therapy
- Spending time with loved ones
- Leaning on faith or a religious community
- Joining a grief support group
- Taking time away from social media
- Journaling
If you notice signs that your grief is looking more like anxiety, depression or another mental illness—or that your grief is severe or you can’t return to work or take care of your needs—contact your doctor for help.
“Pregnancy loss can be a traumatic event, and people who experience it can go on to have psychiatric illness, especially if they have had it before or lost their baby at a later gestational age. The goal is to treat those symptoms so people can process grief,” Dr. Riddle says.
If you ever have thoughts of self-harm, call or text 988 for the Suicide & Crisis Lifeline.
If You Try to Conceive Again, Know This
As you process grief, it can feel daunting and scary to try to conceive again. To help combat anxiety or fear, Dr. Riddle recommends meeting with a therapist or psychiatrist prior to pregnancy so that you have a trusted relationship for processing emotions as they come up.
“When I ask patients to share their experience, I try to listen to where the catch is, where the stickiness is. I try to understand it so I can help them through it,” she says.
Also, remember that a new pregnancy will be a different experience.
“You’re not replacing anything,” Dr. Riddle says. “It’s OK to acknowledge that it’s both hard to be pregnant and OK to be excited. We have to give people permission to feel all those emotions.”
Medically, having a miscarriage does put you at a higher risk of having another miscarriage, but the majority of families will go on to have successful pregnancies, Dr. Liwan says. Having a miscarriage doesn’t necessarily make your next pregnancy high-risk, but you will probably be asked to come in for more appointments than usual in the first trimester to make sure the pregnancy is progressing well.
If you experience multiple miscarriages and haven’t had a work-up done, ask your doctor if you need one. This could include a complete physical exam (including a pelvic exam), blood tests, genetic tests and imaging tests to see whether there is a uterine issue.
“About half the time, there is a cause that we can treat,” Dr. Liwan says.
Even if the cause is unknown, you have a good chance of a successful future pregnancy. According to the American College of Obstetricians and Gynecologists, about 65 in 100 women with unexplained recurrent pregnancy loss (two or more miscarriages) have a successful next pregnancy.
Prepare for the Emotions Future Pregnancies Could Bring
To emotionally prepare for future pregnancies, Dr. Riddle shares the following tips:
- Make a pre-conception appointment to ask your obstetrician or midwife what you should expect if you try to conceive again. If you haven’t visited with this person before, explain that you previously experienced a loss.
- Bring someone to your appointments to support you in case you experience a grief attack. If someone can’t go with you, try to take notes during the appointment so you have the information for later, when you can better process it.
- Establish a support system. Make note of who gives you the most support, such as family members, friends or people in your community. Keep them in the loop and reach for help if you need it.
- Note the milestones. For some families, certain dates, such as the date when the baby would have been due or the gestational age (weeks of pregnancy) when the loss occurred, might bring up a lot of feelings. Speak to people in your support system or your providers about those feelings if they come up. Sometimes just voicing them helps.
- Practice grounding techniques such as box breathing (a breathing technique to help reduce stress) if you start to feel overwhelmed.
Most important, know that you are not alone and that you will find a way through the grief.
“People who have experienced pregnancy loss have an amazing human resilience and capacity to grow a blossom out of a stone,” Dr. Riddle says. “If you’ve lost a pregnancy, I want you to know that the initial phase is not forever. You will learn to carry what has happened and find a beautiful way to honor it in your life.”
If you want to see a mental health provider or an OB-GYN, UNC Health can help. Need a doctor? Find one near you.