Grief after miscarriage

They had planned to tell Ammu on her birthday. Sohel had already ordered the cake, with a little pair of shoes in icing, and Shampa had practised the sentence in the mirror. At ten weeks, in a clinic in Rampura on a Tuesday afternoon, the screen was still.

Sohel cancels the cake by phone and goes back to the office two days later, where he cries once, in the stairwell, and tells no one. Shampa folds and unfolds the tiny kantha a friend gave her too early. A colleague means well: “At least it was early, na?” Shampa nods, and that night says to Sohel, “We hadn’t even told Ammu yet.” On Friday, his oldest friend turns up with fuchka and an awful story about his own wedding, and for the first time in a week, Shampa laughs.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding grief after miscarriage

Miscarriage is the loss of a pregnancy before the baby could survive. Because it often happens before anyone has been told, the grief can be private and unrecognised, and people may hear “you can try again” before anyone has said “I’m sorry”. Grief after miscarriage is a normal response to a real loss. For some, it goes further, into persistent anxiety, depression, or post-traumatic stress, with intrusive memories of the scan or the bleeding, avoidance of hospitals or pregnant friends, and feeling constantly on edge. Partners grieve too, often differently and more quietly.

How common it is

A Lancet review estimated that 15.3% of recognised pregnancies end in miscarriage, about 23 million a year worldwide, and that 10.8% of women have had one miscarriage. In a study of women at three London hospitals, 29% met the screening criteria for post-traumatic stress one month after early pregnancy loss and 18% after nine months; moderate or severe anxiety fell from 24% to 17%, and moderate or severe depression was 11% at one month and 6% at nine. In a related analysis of couples from the same London hospitals, 7% of male partners met the criteria for post-traumatic stress at one month, far fewer than the women but not none.

Signs worth noticing

• Grief that is not easing at all after several weeks
• Flashbacks or nightmares about the loss or the hospital
• Avoiding pregnant friends, baby shops or the clinic
• Constant worry about future pregnancies
• Feeling numb, guilty, or unable to talk to each other

How care helps

The Lancet review recommends that screening and treatment for the mental health effects of miscarriage be available, because they are common. A psychiatrist listens to the story of the loss, checks for depression, anxiety and post-traumatic stress, and treats them in their own right, with psychological therapy and, where needed, medication. Sessions together can help a couple who grieve at different speeds. Questions about why it happened, and about trying again, are best answered with the obstetrician.

What getting better can look like

Shampa and Sohel might find it in telling Ammu after all, and being held by her. It might be a small marker of the baby they wanted, and a birthday cake next year that they can eat without crying.

Common questions about grief after miscarriage

Is it normal to grieve after a miscarriage?

Yes. Miscarriage is a real loss, even very early, and grief is a normal response. In one London study, many women had symptoms of post-traumatic stress or anxiety a month later, and some still did nine months on. If grief is overwhelming or not easing, help is available.

Do men grieve after a miscarriage?

Yes, though often less visibly. In a London study of couples, some male partners had clinically important post-traumatic stress, anxiety or depression after early pregnancy loss, at lower rates than women. Partners may hide grief to support the other, which can leave both alone.

When to see a psychiatrist

If grief, fear or numbness is still heavy after several weeks, or is affecting sleep, work or your marriage, please ask for help. If either of you has thoughts of suicide, call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Quenby et al., The Lancet, 2021 (PMID 33915094)
• Farren et al., American Journal of Obstetrics and Gynecology, 2020 (PMID 31953115)
• Farren et al., Ultrasound in Obstetrics and Gynecology, 2021 (PMID 33032364)