Miscarriage and Post Traumatic Stress
Last week, early pregnancy loss and the possibility of post-traumatic stress made headlines here in the UK (Roxby 2020; Wighton 2020). New research investigating levels of post-traumatic stress, depression, and anxiety in women in the nine months following miscarriage and ectopic pregnancy was conducted by Imperial College London and KU Leuven in Belgium (Farren et al. 2019).
The results suggest that “women experience high levels of post-traumatic stress, anxiety and depression after early pregnancy loss.” My guess is that this comes as no surprise to anyone who has experienced any form of pregnancy loss.
Pregnancies that end before 12 weeks gestation are wrapped in layers of loneliness. The women I see in my practice are grieving the loss of their unborn baby and the hopes and dreams bestowed upon the child of their future. But, being before the societally normative time of sharing the news, the loss of this pregnancy is shrouded in alone-ness. ‘No one knew I was pregnant, so I didn’t tell anyone when the pregnancy ended.’
Women often use the incredibly high statistic of 1 in 6 pregnancies end in miscarriage to discredit their feelings (Tommy’s 2020). ‘This happens to so many women, I should be able to get over this quicker/easier.’ Thoughts such as this increase the silencing effect, and promote the narrative that they shouldn’t be feeling so intensely. However, research recognises that “profound guilt, anger at their bodies and fear of future childbearing” plagues women after early pregnancy loss (Mander 2006, p.42). It is therefore baffling to me, that miscarriage is often regarded as ‘less upsetting’ due to gestation (Kohner and Henley 2001, p.51).
I have sat with women where this loneliness is further intensified because they were miscarrying in public, but no one knew: bleeding heavily on a packed London tube; sitting silently at their desk at work; at a family meal; about to celebrate an anniversary and not wanting to spoil it; in the theatre… this crushing loneliness is silencing, and to survive the force of the physical pain and the emotional loss, a numbing or distorting process sometimes takes over to survive the trauma (Joseph 2015).
When we experience something that doesn’t make sense to us, we often churn it over and over in an attempt to try and make sense of it. Maybe you have experienced this? Those moments whilst driving, just before going to sleep or sitting on the sofa where you catch yourself relentlessly going over an earlier event. Usually we can make sense of what has occurred, either by ourselves, or in conversation with a friend. But, if what has happened was secret to ourselves or others, or denied to our senses, then what? Our body knows what happened, but our mind, our feelings and thoughts are playing catch up. For me, it makes complete sense that in this kind of situation, a woman would find herself experiencing intrusive thoughts, feeling anxious and on edge and possibly even flashbacks (Samuel 2017, p.173). This is the process of trying to make sense of an event that often cannot be made sense of. The relentless thoughts are an attempt to figure it out, but it is like being on quick sand – the foundations, the narrative has disappeared (Joseph 2005).
Talking and writing can be incredibly helpful. Seeing your written thoughts on paper may give them a permanent resting place.
Healthcare professionals witness women going through miscarriages and ectopic pregnancies on a daily basis, and I wonder if some have forgotten the significance of the event for the woman and her family. It is not run-of-the-mill, and women need consistent recounting of what is, and has occurred to her physically and emotionally. This communication can hugely reduce the whirring of post traumatic thoughts. Talking to a professional therapist can also help in organising these thoughts, and having someone bare witness as you restructure a narrative around an event can help reduce their intrusive power (Joseph 2015).
Farren, J., Jalmbrant, M., Falconieri, N., Mitchell-Jones, N., Bobdiwala, S., Al-Memar, M., Tapp, S., Van Calster, B., Wynants, L., Timmerman, D., Bourne, T. (2019) ‘Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study’, American Journal of Obstetrics and Gynecology.
Joseph, S. (2005) ‘Understanding Post-Traumatic Stress from the Person-Centred Perspective’, in Joseph, S. and Worsley, eds., Person-Centred Psychopathology. A Positive Psychology of Mental Health, PCCS Books: Monmouth, 190–201.
Joseph, S. (2015) ‘A person-centred perspective on working with people who have experienced trauma and helping them move forward to posttraumatic growth’, Person-Centered & Experiential Psychotherapies, 14(3), 178–190.
Kohner, N., Henley, A. (2001) When a Baby Dies: The Experience of Late Miscarriage, Stillbirth, and Neonatal Death, Rev. ed. ed, Routledge: London ; New York.
Mander, R. (2006) Loss and Bereavement in Childbearing, 2nd ed, Routledge: London.
Roxby, P. (2020) Miscarriage Can Lead to ‘Long-Term Post-Traumatic Stress’ [online], BBC News, available: https://www.bbc.co.uk/news/health-51093999 [accessed 16 Jan 2020].
Samuel, J. (2017) Grief Works., Penguin Life: St Ives.
Tommy’s [online] (2020) Miscarriage - information and support, available: https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage-information-and-support [accessed 19 Jan 2020].
Wighton, K. (2020) Miscarriage and Ectopic Pregnancy May Trigger Long-Term Post-Traumatic Stress [online], Imperial College London, available: https://www.imperial.ac.uk/news/194715/miscarriage-ectopic-pregnancy-trigger-long-term-post-traumatic/ [accessed 16 Jan 2020].