Ask an RE: How do I heal after a miscarriage?
ASK AN RE: HOW DO I HEAL AFTER A MISCARRIAGE?
Dr. Lora Shahine shares advice on healing after a pregnancy loss and why we need to stop stigmatizing miscarriages.
While miscarriages are more common than you may realize — as many as one in four pregnancies end in loss — the physical, emotional, and mental impact of miscarriage is unique for every woman. In the months directly following a pregnancy loss, studies have shown that a large number of women fit the diagnostic criteria of post-traumatic stress disorder (PTSD), and many suffer from anxiety and depression.
The approach to healing after this traumatic experience is multifaceted, and attention should be paid not only to your physical wellbeing, but also your mental and emotional health.
To get a better understanding of the process of healing after a miscarriage, we spoke with Dr. Lora Shahine of Pacific NW Fertility, who drew on her clinical expertise in recurrent pregnancy loss and miscarriage for her latest book Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss.
For this edition of Ask a Reproductive Endocrinologist, Dr. Shahine shares her insight into the importance of taking time for self-care, having open conversations, and creating solid support systems after a pregnancy loss.
Celmatix: What advice do you give to your patients during the first few weeks following a miscarriage?
Dr. Shahine: My advice is to work with your doctor to make sure you are recovering physically, but also to take care of yourself emotionally. Following up after miscarriage depends on each situation, but many clinics will repeat an ultrasound or follow bHCG blood levels to make sure your body is recovering. It can be emotionally challenging to go back to the clinic for more tests, but follow your provider’s recommendations to take care of your physical health.
Not all medical providers pay attention to the emotional healing needed after miscarriage, so this is where patients have to be advocates for themselves. Recognize that grief is often present after a miscarriage and be kind to yourself if you have mixed, intense emotions. Find healthy ways to heal emotionally that are right for you — take time off, practice mindfulness, consider counseling, surround yourself with people that support you, be a little selfish, and put yourself first to take the time you need to heal.
Celmatix: What are your recommendations for in-person or online communities and support groups?
Dr. Shahine: Resolve.org has a great list of patient support groups lead by professionals and peers that can be searched by zip code. Some hospitals, especially women’s and children’s hospitals, host support groups for miscarriage and child loss. Churches and community centers are also good places to start your search. Before attending a support group, be sure to email or call the leaders to make sure the format is a good fit for your emotional needs and situation.
If you’re looking for online support, there’s an Instagram account all about sharing the experience of miscarriage called @IHadaMiscarriage. The account, started by Los Angeles-based psychologist Dr. Jessica Zucker who had her own second trimester miscarriage, has had an overwhelmingly positive response from women around the world who are comforted by her message. In an interview with People, Dr. Zucker emphasizes “the more people share their stories, the more we continue to dispel the stigma and shame and feelings of guilt or even self-blame that can arise.”
Celmatix: What conversations do you recommend women have with their partners or closest loved ones after experiencing a miscarriage? And what about the people who they’d would rather not discuss their experiences with?
Dr. Shahine: Most of my patients are surprised by the outpouring of empathy and support when they share their loss with others. Many discover that their close friends and relatives have had miscarriages but never shared their stories “because it never came up.”
One of the toughest conversations patients tell me about is with managers or work colleagues, but most of the time they report a positive experience with sharing. Not everyone will be sensitive or know what to say when they hear the news of someone’s miscarriage, and sometimes my patients report awkward and uncomfortable experiences when people want to know more details than they’re ready to share. In those situations, remind yourself that you’re the one who gets to decide if or when you’re ready to share certain aspects of your experience with others. In those awkward moments, feel empowered to tell detail seekers, “Thank you for your concern, but I’m not ready to talk about it right now.”
Celmatix: What misconceptions do you find women have around miscarriage?
1. Women feel like it’s their fault. Women come to me feeling broken. They blame themselves, their body, their stress, and more for the loss. Even when we discuss that the most common cause of first trimester miscarriage is a chromosomal or genetic imbalance in the embryo — women still feel guilty about miscarriage. This guilt stems from a lack of control. It can be comforting in a way to seek blame on something they did to cause the loss, because then they can change that behavior in a subsequent pregnancy and avoid feeling this grief again. I try to shift their thinking from blame and guilt to knowledge and hope in the next time they conceive. Without a single test or intervention — most women will have a successful next pregnancy because it’s a whole new opportunity.
2. Women feel like miscarriage is rare. Approximately 25% of clinically recognized pregnancies (pregnancy seen in an ultrasound) end in miscarriage. And if you include biochemical pregnancies like positive home pregnancy tests followed by a late period, the incidence of miscarriage is much higher. Part of my goal is to talk more about miscarriage and help people feel less isolated.
Celmatix: How can doctors be better advocates for women who experience a pregnancy loss?
Dr. Shahine: Unfortunately, doctors can unwillingly and unknowingly contribute to the isolation and silent suffering around miscarriage because most tell their patients not to share the news about their pregnancy until after the first trimester. As a miscarriage and fertility specialist, this is how I was trained to counsel patients, and I said it for years. When patients are thrilled with a reassuring first trimester ultrasound (that shows an appropriate size of pregnancy and a fetal heartbeat), we’re taught to share in the joy but ensure ‘cautious optimism’ and warn patients that miscarriage can still happen.
Just in case of what? Just in case the pregnancy stops developing and you have to go back and tell all of those people you joyfully announced your news to that actually, you had a miscarriage. The doctor’s advice to wait to announce a pregnancy is given with good intentions and supposedly with the patient’s best interest in mind. However, after years of caring for women with recurrent miscarriage, I think that as doctors, we’re making things worse. When patients need support the most, they are suffering alone. This pattern contributes to the stigma around miscarriage, and we can change that.
Now when patients ask, “When can I announce the pregnancy?” I say, “When you’re ready,” and, “Consider sharing it with close friends and family first.” I care for many patients with recurrent miscarriages, and everyone is different. A new pregnancy for couples with recurrent pregnancy loss is a new opportunity to suffer — the joy of a positive pregnancy test is numbed by their past pain.
I recommend seeking support and focusing on self-care during the process.
Celmatix: How have you seen attitudes and conversations shift about miscarriages, and how do you hope they will continue to evolve?
Dr. Shahine: We are talking about miscarriage more now than ever before. Beyoncé sang about miscarriage on her Lemonade album, Mark Zuckerberg and Pamela Chan shared their story of recurrent miscarriage before having their family.
Miscarriage does not discriminate — you can be rich and famous and still struggle to have your family. Opening the conversation will increase understanding, decrease stigma, and help women feel less guilty and isolated!
Many women are hesitant to share their miscarriages with family and friends because they aren’t sure what people will say. And people can, unwillingly and unknowingly, say unhelpful things like, “It’s meant to be,” “It’s God’s plan,” “Be patient,” “Just relax.” However, my patients who do share that more times than not, they find comfort in the outpouring of support and willingness of others to share their own experiences.
After initiating the conversation, many patients discover that their own mothers, sisters, friends, and colleagues had miscarriages and had never shared their experiences because it never came up or they didn’t know what to say.
Sharing allows couples to feel less isolated, less ashamed about miscarriage. Sharing is not for everyone, but it can be a positive step towards decreasing the stigma and increasing awareness.
Miscarriage is common, and it’s emotionally painful. Let’s stop hiding from it. The more we can share and support each other the fewer people will suffer in silence and the stigma around miscarriage can end.
Dr. Lora Shahine is a Reproductive Endocrinologist at Pacific NW Fertility and author of two books: Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss and Planting the Seeds of Pregnancy: An Integrative Approach to Fertility Care.