Article by Dr. Shradha Shejekar, Consultant – Psychiatrist, Aster RV Hospital, JP Nagar, Bengaluru
Miscarriage is an issue that many parents may face during their journey to parenthood and can be a stressful event for the hopeful parents. According to the American College of Obstetricians and Gynaecology, about 26% of all pregnancies end in miscarriage, out of which around 80% occur in the first trimester. Almost 1 in every 4 pregnancies ends up in miscarriage and the trauma and emotional baggage associated with it is immense, especially for a woman, who deals with the physical repercussions as well. In such situations a woman may find it difficult to cope or not know how to manage herself. Every human being reacts to stressful events differently and miscarriage can definitely be challenging.
Post suffering a miscarriage, a mother may go through a variety of emotions, starting from grief, pain, sadness to guilt or self-blame. A cardinal take-home message must be that it is okay to feel sad, it is okay to feel the pain and it is okay to cry or express your pain. Human beings of our current era tend to suppress or avoid dealing with difficult emotions as we have all undergone some amount of psychological conditioning to believe that hiding or suppressing emotions is a sign of strength. Instead, allow yourself time to overcome the feelings attached to a traumatic event. Do not beat yourself up or blame yourself due to the miscarriage. It is often common for mothers to feel like they were somehow responsible for the loss of the child however that is not necessarily the case and medical science can always help guide you back onto your path to motherhood.
In some situations, when you or your family is unable to cope with the grief of losing your baby, it may be pertinent to seek expert help. Any grief when persistent and which worsens beyond 3-6 months (depending on the intensity of the situation) needs to be evaluated, as there is a chance that there might be underlying depression/ anxiety or another mental health issue that is manifesting in other forms like repeatedly thinking about the loss, inconsolable crying/ agitation even a few months after the loss, hallucinations, lack of motivation, insomnia, irritability, feelings of helplessness/hopelessness and worthlessness.
If persistent grief is left unaddressed, it can lead to adverse consequences. While some might eventually overcome it depending on their mental health, will power and support from family and friends, others who silently suffer might have to deal with the physical effects of stress. It is a misconception that stress acts just like any other emotion wherein it passes without any physical consequences, however it must be reiterated that when the body is consistently in a state of stress for a long time, it can start to affect almost every organ in the body. Excessive and long term stress can give rise to other dreaded health conditions like BP issues, diabetes, weight issues, sleep disturbances, memory deficits and disturbances in the menstrual cycle. Most importantly, stress can affect your ability to conceive again. The release of stress hormones like cortisol can even affect the reproductive organs in the body. When a woman experiences extended periods of stress, they will notice that they have irregular, missed or heavy periods during their menstruation cycles. This can also make it difficult to properly track the ovulation window during which the couple can plan pregnancy. Stress can lead to disinterest in sexual activity which can further delay chances of conception. The health of the ovum (egg) also declines when one is stressed for a long time which can lead to further delay in conception. Additionally, stress can give rise to diabetes, hypertension, thyroid disorders, obesity which can further complicate conception and pregnancy.
One of the most common challenges that a woman may face in such a situation is to compare themselves with other parents and they may beat themselves up for not being able to experience a smooth pregnancy. Avoid doing so – do not compare yourself with other parents, know that each couple’s journey to parenthood is different, everyone has their own share of difficulties and roadblocks may appear in different forms in each individual’s life. Reinforce positive thought patterns in your mind – whenever you observe yourself going into a downward spiral, replace these with more positive, forward-looking and productive thoughts. For e.g., miscarriage is not the end of your pregnancy journey – would you abandon a goal that is dear to your heart due to some unexpected crises or would you look for alternatives to achieve that goal? It is more likely that you would choose the latter. Consider this event in the same light and seek help and support to cope. The early morning time after one just wakes up is a sensitive period, try to do an activity that calms, refreshes you and gives you a positive mind-set to see the day through. For example, you could read a motivational story for about 5-10 minutes, do breathing exercises, take a stroll in a garden, etc. If you start to feel emotionally exhausted and overwhelmed, seek help from a psychiatrist.
Post suffering a potentially traumatic experience like miscarriage, there may often be the lingering fear of trying to conceive again. One way to approach this is – your body may have naturally identified that the pregnancy would not be viable in the long run hence during the very early stages, it has naturally resulted in a miscarriage. Appreciate your body and its inherent capacity to have such wonderful mechanisms in place. However, you must always consult a professional for expert advice, particularly if you have experienced repeated miscarriages. Medical science has evolved so much that there is a solution to most of these issues and even if not then there is always the option of surrogacy or adoption. After all, a parent is not just someone who gives birth but a parent is one who raises a child against all odds and provides the little one a happy, healthy and creative environment.
Once you are ready to start trying again, speak to an obstetrician to help plan your pregnancy, understand your health conditions and chart out a plan to successfully conceive. Communication during this period is also incredibly important, ensure that you and your partner have an open flow of communication, let your partner know about your physical and emotional state and preparedness to try to conceive again. Involve your partner in your meetings with the doctors, in diet changes and exercises so that you feel connected with each other throughout the journey. Ensure that you are following a healthy diet, avoid alcohol and substance use and take folic acid supplements after consulting with your doctor. If you are on some medications prior to conception, discuss the safety of its continuation with your doctor. Ensure good sleep hygiene. Avoid discussing the miscarriage experience (both yours and others) as it is unique and has its own reasons and could lead to further stress. Take up hobbies that interest you and uplift your mood. Last but not the least, enjoy the process of pregnancy as a natural event, do not force yourself and keep deadlines to achieve it, this will make the process tiring. Instead, allow yourself to relax – be alert about your body and the various changes it is experiencing.