Miscarriage is common prior to 12 weeks of pregnancy, often so early that it occurs before a woman even knows she is pregnant. If she is under the age of 40, such an early miscarriage is usually followed by a normal pregnancy. On the other hand, a late miscarriage, which occurs between week 14 and 24, is not as common. Only 2-5% of pregnancies end in miscarriages after 20 weeks, and when it does happen, there are many unique and complex emotional challenges.
Most personal losses are followed by a funeral, a chance to acknowledge the hurt, to openly grieve, to receive sympathy and support, and to digest the new reality. But a late-term miscarriage is mostly grieved privately, without a funeral.
As one patient put it, “When you have this loss without the communal support and recognition you get during a funeral, it's very hard to bounce back quickly and you're forced to put on a fake face and make-believe everything is okay, even though you and your partner are thinking about it every day.”
So, in addition to the devastation that follows any miscarriage at any point in a pregnancy, late pregnancy loss usually also means more self-blame and less social support.
Here’s what you may experience after having a late miscarriage—and some strategies for coping.
Late-term miscarriage usually means there was some abnormal fetal development due to genetic or structural problems, a physical problem with the pregnancy, or a chronic medical condition like hypertension, thyroid conditions, immune disorders, diabetes, or pre-eclampsia. In contrast, factors such as working hard, exercising, having sex, stress, and taking birth control pills before getting pregnant are not associated with causing pregnancy loss. And if emotional factors are involved, they are usually just triggers for a pre-existing condition1. If pregnancies were as vulnerable to stress as many patients believe, the human species would no longer exist.
So why do I hear so many patients blaming themselves?
“I think I lost the baby because I wanted it too much.”
“I think I’m being punished for working too hard.”
“I think I lost the baby because I took the pregnancy for granted.”
Self-blame may often be an attempt to increase our sense of control when we’re grieving from an unexpected loss. If we tell ourselves that we are responsible for our trouble, we can make ourselves believe that we have the power to fix it: “If I made myself miscarry by being stressed, I can undo it next time by relaxing.” Relaxing is a great idea, but not a miscarriage cure-all.
So How Do We Stop Self-Blame?
- Try to catch yourself doing it and replace the thought and behavior. Try to catch yourself every time you say or think, “could have,” “would have,” or “should have.” Instead, substitute a neutral, non-judgmental mantra like: “It was so unexpected,” or “It is what it is.” The problem with re-doing the past is that when you come back to the present, you have to start accepting the miscarriage all over again. This can cause you to feel re-traumatized, delay your recovery, and inhibit you from moving forward. So, stay in the here and now, and go through the difficult miscarriage experience once.
- Remember that there are no neat stages. Do not expect yourself or your partner to go through a neat series of stages of emotional recovery. You may feel more than one feeling at the same time: Sadness might be mixed with acceptance or gratitude for previous successful pregnancies. We all manage loss in our own ways and at our own pace.
Less Social Support and How to Find it
Unlike an early miscarriage, a late-term miscarriage usually means the pregnancy was apparent to everyone because you were “showing” or because you had already shared the news. This can create a few challenges. Here are a few encounters you may have and how to handle them.
People asking questions before you’re ready: Friends, family and co-workers who are part of your daily life will be aware that you no longer seem to be pregnant. They may ask you questions or offer sympathy before you are ready to handle it.
- How to respond: Don’t let fear of offending be more important than protecting yourself. Try something like: “It’s too early for me to talk about it, but thank you for caring.”
People assuming you already had the baby: Those who have not seen you in a while may assume you have given birth and ask you about the baby.
- How to respond: Again, take charge of the conversation. Try something like: “Unfortunately, I miscarried,” or “Sadly, the pregnancy was not successful.” You do not owe anyone more explanation than that.
People saying nothing at all: Because late-term miscarriage is less common than early miscarriage, family and friends often have no information about it and no experience dealing with it. They are often uncomfortable and do not know what to say, so they may sometimes say nothing at all. Or they assume you want to be private and they do not want to upset you.
- How to respond: If you want to signal to them that you do not want your miscarriage treated like a secret, try: “You may have heard that I had a late-term miscarriage. Thank you for waiting until I am ready to share the information.” Or can say, “I want to make sure that you had heard about the miscarriage because your support is so important to me/us.”
You may find that you don’t want to talk about your experience at all, and that is fine if you are processing the loss and gradually re-engaging in daily life. However, if that is not happening, or if you know you want to talk about your experience, you may benefit from joining a support group, speaking to someone who has been through the same experience or seeking help from a trained counselor.
If You Know Someone Who Has Experienced a Loss
Perhaps you are reading this because someone close to you had a late-term miscarriage. Here are four things my patients want you to know:
1. Say: “I’m sorry for your loss.” It gives them acknowledgment without intrusion.
2. Ask: “Is there anything I can do?” It offers them a personal connection.
3. Suggest: “I’ll check back with you every few days." It gives them a safety net.
4. Offer: “A hug?” It gives them permission to be vulnerable and feel protected.
Here’s what you should not say: “You can always try again," "You can have other pregnancies,” or “At least you already have a child.”
When in doubt, you do not have to say anything. Just be there and let them know you care. And not just for a day. The pregnancy lasted months, and the healing will take even longer. And you can help throughout the process.
If you had the loss, choose what you need during this difficult time and take one day at a time. There is no right or wrong answer on how to grieve or how to move forward. Find the support where you need it and know that you are not alone in this journey. For those helping a loved one cope through a miscarriage, be there—even if it might seem like you are not needed. We can all help each other through the storm to the sunshine.
1. Early Pregnancy Loss, American College of Obstetricians and Gynecologist, number 200, Practice Bulletin Number 150, May 2015)