“The experience of my stillbirth was a hole in my heart, such a disappointment, the feeling that I was so close to meeting my baby,” wept Deborah, who lost her son in the 35th week of pregnancy. “I asked, 'Why did this happen? Why to me? What is the lesson I can learn from this?'”
Deborah shared her mourning, depression, and response to the triggers that she experienced in the aftermath of her loss. Five months after the stillbirth of her son, Deborah (not her real name) continues to reel from her loss.
As Dr. Danny Horesh of Bar-Ilan University, an expert on trauma and the emotional implications of pregnancy loss, explained, “Stillbirth and pregnancy loss occur on a daily basis, but because it has to do with pregnancy, the loss goes under the radar. Stillbirth is highly traumatic, and we should not neglect it in any way. Just like how we look at soldiers coming back from war, or someone who has gone through sexual abuse.”
While existing pregnancy loss literature has focused on the sadness and grief surrounding miscarriage and stillbirth, researchers like Horesh believe more attention needs to be paid to the trauma of the experience.
The loss of a pregnancy can be a deeply distressing event for the parents and other family members, whether as a miscarriage (prior to Week 20 of gestation) or as a perinatal loss (any time after Week 20 until one week post-birth). In the United States, there are approximately 24,000 stillbirths each year, the cause of which may be from maternal health issues, placental complications, hemorrhage, pre-eclampsia, or other still unknown causes.
In her 30-plus years as a midwife at Israel’s Hadassah University Hospital in Jerusalem, Malka Nukrian has cared for many patients who have experienced pregnancy loss. Noting the struggle patients faced, in 2006, Nukrian started a support group for women who had experienced pregnancy loss.
She noticed a trend in the women who attended the meetings—participants shared their experiences of depression, loss, impact on their marriages, but also how the loss was traumatic. The women had spent months excitedly anticipating the arrival of their babies, only to return home, as Nukrian explained, “with empty hands, but full of the pain of the loss. The woman feels confused after the birth. She has experienced a birth, but has no baby to bring home.”
Wanting to understand better those who had lost a child during pregnancy, Nukrian was delighted when Horesh, who was interested in researching that same cohort, contacted her. Together Horesh, Nukrian, and Yael Bialik gathered a sample of 97 women at Hadassah Hospital who experienced pregnancy loss after their second trimester. Of this sample, the vast majority of women had experienced a stillbirth, with the average loss being occurring around Week 28 of pregnancy.
Horesh was astounded by his findings. “Over 40 percent of women in our sample had full-blown post-traumatic stress disorder (PTSD), which is very, very high. Almost 30 percent of the women met the criteria for major depressive disorder (MDD). These numbers highlight the magnitude of distress,” Horesh said. There was also a high co-morbidity between post-traumatic stress and depression.
Further analysis of findings showed that women who were further along in their pregnancies, as well as expectant mothers with a shorter amount of time since the pregnancy loss, faced a higher risk of suffering from PTSD and MDD. Findings also showed that younger age and lower religious observance were associated with more severe PTSD, but not MDD.
Horesh and Nukrian urge mental health and medical professionals to pay closer attention to women in the aftermath of late pregnancy loss. As part of that, they seek to develop improved specific, personalized screenings and interventions for patients—both immediately in the delivery room, as well as in the weeks and months following the stillbirth. As Nukrian said, “The loss of the baby is a significant loss. It is important to give recognition and space to the loss, mourning, and pain. Mourning takes time.”
Referencing his research in this area, Horesh encourages professionals to acknowledge that women after late pregnancy loss are often highly vulnerable. “We believe this vulnerability should be identified in the maternal ward at the hospital. Talk to these women and screen them for depression and PTSD,” he says.
Given the pain and shock of losing a baby, professionals would do well by their patients to see the experience through the lens of trauma. As part of that, they might begin offering support quickly in the face of the mother’s shattered expectations of birth and parenthood, and not wait until symptoms are more pronounced.
Horesh, D., Nukrian, M., & Bialik, Y. (2018). To lose an unborn child: Post-traumatic stress disorder and major depressive disorder following pregnancy loss among Israeli women. General Hospital Psychiatry, 53, pp. 95-100. https://doi.org/10.1016/j.genhosppsych.2018.02.003