Emotional support for repeated miscarriages

According to the WHO, infertility is considered a chronic illness, since it causes emotional reactions that are the same as those seen in patients with other serious chronic pathologies.

Infertility is considered to be a stressful event that causes an “emotional imbalance” and affects a high percentage of patients.

The reactions and emotional states evolve and change throughout the treatment cycles.

In successive treatments, anxiety levels tend to progressively diminish due to a possible desensitization to the increased stress from not achieving pregnancy despite all the invested effort, energy and finances.

There are especially difficult moments with failed cycles and repeated miscarriages.

Repeated spontaneous miscarriages occur when a woman has lost 3 or more pregnancies before week 20 of gestation, meaning when the foetus is still not able to survive outside of the womb.

Hope is renewed over and over again, followed by loss after loss, which renews the feelings of pain, suffering, anger, fear and guiltiness.

The grief from losing a foetus depends on the level of attachment that was developed, which normally occurs around the 12th week, when the parents are able to see it and listen to it through an ultrasound screen.

The sadness associated with miscarriage is unique, since it is not based on experiences or memories, but rather prenatal affective bonds based on desires and fantasies.

Characteristic feelings on women who just suffered a miscarriage

• The woman that spontaneously miscarries is often reluctant to mention her miscarriage.
• She rarely sees what she has lost.
• Since it happens so quickly, the woman cannot prepare for the situation.
• There is no explanation for the feelings of guiltiness.
• She has feelings of helplessness when she starts to bleed and can’t do anything about it.

Pregnancy lost Psychological consequences

• Immediate: feelings of emptiness, unease and loss of appetite, sexual desire and sleep.
• Secondary: post-traumatic stress, overexcitement, intrusion and constriction.
• Overexcitement: startled overreactions, anxiety attacks, irritability, anger and difficulty concentrating and sleeping.
• Intrusion: reliving the traumatic event at unwanted and unexpected times. Intrusive recurring thoughts about the miscarriage, nightmares, and intense reactions of grief or depression on the anniversary date of the miscarriage.
• Constriction: numbing of emotional resources, avoiding stimuli associated with the trauma. Inability to recall the miscarriage and efforts to avoid activities that may arouse memories of the miscarriage. Disinterest in previously enjoyed activities.
• Sexual Dysfunction: between 30-50% of women who have miscarried state they experience sexual dysfunction that begins immediately after their miscarriages.

Emotional stages

1.  State of shock: this may last hours or even weeks. They unconsciously cannot accept the loss.

2.  Search phase: acute episodes of pain, distress, faintness, which gradually decrease. They try to find an explanation of what happened.

3.  Disorganisation phase: Daily activities are resumed with sadness, lack of self-esteem and indifference. This stage may last from 6 to 12 months.

4.  Reorganisation phase: accepting the loss of the foetus. She may appear melancholy when remembering it. Family and social relationships re-stabilize.

Getting over the grief requires a psychological process of acceptance and redefinition of the loss.

The importance of reducing stress before starting treatment has been identified.

Techniques to reduce stress after a spontaneous miscarriage

Relaxation: learn how to relax and think positively, learn breathing techniques, and replace recurring negative thoughts with more positive ones and pleasant relaxing images.

Clarify values to reduce anxiety when a person doesn’t know what to do about a situation or wonders if they made the right choice. For example, choosing when to end treatment; the most appropriate option.

Learning how to express emotions, assertive behaviour and use a sense of humour are essential for infertile people to acquire control of the situation and their lives.

Useful advice for difficult times

• Limit conversation time within the couple when it only focuses on children and pregnancy.
• Relax before going to the Assisted Reproduction clinic and during treatment, egg retrieval and transfer by visualising previously associated pleasant images.
• While waiting to take the pregnancy test, pursue distracting recreational activities.
• On the day of the test, prepare a response for either result.
• After repeating unsuccessful treatments, assess other alternatives.
• In times of doubt, uncertainty, and disorientation: set goals and prioritise them.

The couple should implement resources that will help reduce the emotional impact: perception and externalization of anxiety, depression and pessimism, optimism, perceived control, support from friends and family and the couple’s sexuality.

Therefore, having solid personal resources is essential to overcoming the mourning from the recurring miscarriages, since it may end up harming the relationship and creating confusion from the fact that many recurrent abortions have no known medical cause.

Psychological therapy helps couples overcome successive losses.

Reducing stress will allow the couple to maintain or achieve a state of emotional balance that helps them confront their problems.

In general, a great desire for pregnancy appears after abortion. The birth of a new baby provokes memories of the previous loss, even though it represents a positive experience that concludes the previous trauma.

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Natalia Romera, Psychologist of Instituto Bernabeu and specialist in reproductive problems.