Coping with miscarriage: grieving, healing, and seeking support

RTL Today spoke to Salvatore Emmanuel Loria, director of the psychology service at Robert Schuman Hospital, as well as Daniela Pavan and Lucie Reiland, who are psychologists at Kirchberg Hospital, about dealing with miscarriage and how best to support yourself through the process of healing.
 
Miscarriage is defined as pregnancy loss before 24 weeks of pregnancy. After the 24th week of amenorrhea, it is considered a stillbirth.
 
Any woman who has suffered a miscarriage(s) knows it can be a devastating experience, an unfathomable loss, where you can be left devoid of hope and purpose.  
 
As an expat, often far from immediate family support, the isolation and grief can be all the more pronounced. Seeking support can help process the trauma and allow healing to begin.  
 
“The subject of miscarriage is often surrounded by stigma. Although it is relatively common (10 to 20% of pregnancies end in miscarriage), families can sometimes feel illegitimate in their grief. The loss of a baby can trigger a wide array of emotions, ranging from shock, guilt, sadness, shame, anger, loneliness to disbelief, which are often dealt with in silence,” explains Salvatore Loria.

“Your world stops while the external world keeps going and expects that you do too. Many steps follow a miscarriage and can cause an emotional rollercoaster, such as saying goodbye and leaving the hospital, going back home to a prepared nursery, going back to work…"

“After a miscarriage, people often search for meaning, both in the loss and in their lives. Sometimes, the way people see the world and their purpose in it is completely changed by this event which may seem 'senseless'."

“What is particularly difficult is the loss of an imagined future. Their identity as a parent, which was built on these expectations, can also be disrupted. Building meaning, making sense of the event and constructing new ways to navigate the world without the child they had expected can help reduce their suffering."

One of the ways one can do this is by giving an identity to the baby and maintaining a bond, he says.

"Some people give the baby a name, wish to take pictures or to keep memories such as clothes or footprints. This can help with their own identity as parents too - the parents they will always be - and bring legitimacy to their grief.”

Healing is not linear

One of the most important ways to support the grieving process is by having social support, Lucie Reiland explains.

“Trustworthy friends, family and/ or thematic groups provide a sense of belonging and bring emotional comfort as you deal with your loss. A trusting relationship and open communication with your medical and psychosocial team is also very important. In fact, medical information about the miscarriage can help alleviate some of the arising guilt."

“Depending on your needs, mental health professionals can accompany and help you build skills to deal with particular emotions and situations. Adaptive coping strategies such as positive self-talk, meditation, physical activity, creative activities, daily routines, realistic goals, and spiritual or cultural practices have also been shown to help as long as they align with your specific beliefs and needs."
 
“It is important to remember that healing is not linear, and that you should give yourself the time and compassion to deal with each day at a time. You may have difficult days after many good ones but that does not mean that your progress is gone,” she emphasises.

Explaining the loss 

For women who have other children at the time of their loss, announcing the loss of a baby can be a particularly difficult task.

“It is a natural reaction to want to avoid this conversation, to protect them and perhaps to protect yourself. However, silence does not take the pain away and can often times be isolating, for adults but also for little ones."

“Children know when something is off and it is important for them to be able to make sense of what happened. You should start the conversation with a simple, concrete statement, using the name of the baby if they had one as well as the word 'death'."

It is better to avoid using euphemisms such as 'went to sleep' as children might become scared of going to sleep themselves, Ms Reiland advises.

“Telling them that the baby 'got sick' should also be treated with caution as fears may arise that other people, such as you or them, will also become ill. You should explain that it is different than when mommy and daddy get sick and go to the doctor to get better. The same goes for 'went away' or 'left'. Let the children guide the conversation with their questions and try answering with age-appropriate words, without overwhelming them with information that they do not want or need,” she points out.

“Make sure that the child receives the same explanations from all adults. Depending on their age, children may also think that the pregnancy loss was somehow caused by them (for example if they formerly expressed that they do not want a sibling): it is important to let them know early on that their feelings and actions had nothing to do with what happened.”

Leave from work 

In terms of leave from work after a miscarriage, it is suggested this be discussed with your doctor, nurses, and social team. They will explore the situation together based on individual circumstances and medical, psychosocial, and professional needs.

“Legally, in Luxembourg, there is the right to maternity leave after 24 weeks of amenorrhea (22 weeks of pregnancy), if the pregnancy was declared (CNS, Initiativ Liewensufank, Ministère de la Santé)."

“Before the 24th week of amenorrhea, it is considered a miscarriage, with the possibility of a sick leave from your doctor. The employee is entitled to a five-day extraordinary leave regarding the death of a minor child”, Daniela Pavan affirms.

Each grief is different 

It is essential to remember that each grief is different, even for one person at different moments of their life. Mr Loria and Ms Pavan offer the following detailed advice on how to help the healing process:

• Allow yourself to discover who you are and what you really want or need as a unique person. The right way is the way that helps you to feel better!
  
  
• Increase your ability to accept help. Reach out to trustworthy loved ones and to your medical and/ or psychosocial team. Social and professional support are essential as you start processing the event and the grief that follows. Support groups can also be helpful.
  
  
• If needed, seek external support for administrative procedures which can be painful and overwhelming following the loss.
  
  
• Reduce the tendency to minimise the situation. You may have the instinct to avoid your feelings and to engage in various activities prematurely. It is important to practice self-compassion and acknowledge your feelings and difficulties by verbalising them or expressing them in a way that is meaningful to you, in private or with the support of your network.
  
  
• Avoid blame, be kind to yourself. Sometimes we tend to look for someone to hold responsible for events that seem senseless. However, this may reinforce feelings of guilt and anger. Educating yourself by seeking information from your medical team may be helpful to make sense of what happened.
  
  
• Take your time: the right moment is your moment! It is important to not rush the healing and to respect the temporality of your grief. But if it becomes a source of worry, it’s best to consult your psychotherapist. Consulting a psychotherapist doesn’t mean that one is not dealing with it correctly. There isn’t a need to wait until it gets “bad enough”. It is important as well to wait until you feel ready to speak to someone.
  
  
• Communicate openly with your partner. It is important to express your feelings and thoughts together in order to build a way of supporting each other as a team. What is not verbally said could still be expressed by the body, by behaviours. Even if there is a fear of putting even more emotional weight on the other, it can be easier to bear it together, as it helps to deal with your common grief. 

• Remember that each person grieves differently. Find your own ways and focus on your personal resources: which ones may have helped you to deal with difficulties in the past?
  
  
• It may be hard for people to know what to do or what to say. Do not hesitate to tell them what would help and what wouldn’t at different moments. Allow yourself to make mistakes and to find the best way to get better; you deserve to feel better.
  
  
• Respect your limits. You do not owe explanations to anyone. Sometimes, talking may not be helpful depending on your interlocutor. 

Support networks in Luxembourg

• Omega 90 (adults and children)
• Initiativ Liewensufank/Eidel Aerm 
• Association Spama
• Weesen Elteren (Croix Rouge) 
• Stärekanner ASBL 

Books that may help explain baby loss to children

• The Invisible String - Patrice Karst  
• The Ducklings of our Hearts - Kara Mangum
• My Sibling Still - Megan Lacourrege
• We Were Gonna Have a Baby but We Had an Angel Instead - Pat Schwiebert
• Something Happened - Cathy Blanford
• Someone Came Before You - Pat Schwiebert