How to Cope After Miscarriage or Stillbirth

If you're reading this following a baby loss, I want to say how sad I am that you've experienced this, and I hope that some of my words will be validating.

Baby loss can be experienced in many ways, but how do we define it in our culture and in our experiences? What does it mean to all people who have hoped and longed for a child who is not born into the world, nor bringing a family into fruition? 

I've worked with many people who've hoped (and I dare say prayed in one way or another), and this can include the loss of hope when an embryo developed via IVF doesn't settle in the womb. But I'll talk about that another day. For now, I'll focus on miscarriage and stillbirth, and will come back to IVF and the termination of pregnancies another time. 

So many hopes are dashed when what we long for isn't realised. Bringing a child into the world is perceived as normal, natural and perhaps expected of us. But that isn't the case for everyone.

Miscarriage

There is an arbitrary and binary biological distinction between miscarriage and stillbirth.

Miscarriage of pregnancy is defined as: when a growing embryo or foetus doesn't survive past 23 weeks’ gestation. 23 weeks is a long time, when you can learn of a pregnancy at 7-9 days after conception. 152 days is a long time to hope, feel excited, look to the future, plan and imagine what life would be like with a baby in your arms.

Sharing the news with family and friends, wondering how you'll manage the childcare when you go back to work after parental leave. It's a lot to think about, and the loss of a potential baby via miscarriage is often painful. Breaking the news to family and friends – who have also been hopeful and excited about a potential new arrival into the family and community – can be devastating.

Approximately 1 in 5 pregnancies are lost to miscarriage. All that hope and planning, lost in a moment. The vision of a future collapses.

Mylene Klass – pop star, activist and ambassador at Tommy’s – has been a great visionary in pushing forward the awareness in society of the impact that miscarriage grief has on the person carrying the foetus, and their wider familial and social network. Her voice from lived experience is powerful and welcome. She's campaigned to have bereavement leave for miscarriages, which will come into law in 2027. The amount of paid bereavement leave for a miscarriage will be three days. I'm not sure it'll be sufficient, but it’s a start. Following a miscarriage, you can apply for a baby loss certificate, which seems to be a step toward legitimising the feelings of loss and pain. You can find out more here. 

EastEnders is often an example of well-informed social commentary that tackles important issues. There have been several relevant storylines over the years. Below are two such examples of how the pain and disappointment of baby loss are reflected in people’s own experiences as well as across their family and social network. You might find these YouTube clips validating for you:

• Whitney and Lee’s miscarriage
• Whitney and Lauren talk about Whitney’s miscarriage

Stillbirth

Stillbirth is defined as the death of a baby before or during birth at or after a pregnancy is lost at or after 24 weeks of gestation. Stillbirth can occur for a variety of reasons, such as birth defects, maternal health complications such as diabetes or infections, and umbilical cord problems, to name but a few. Despite significant medical advances, 60% of the causes of stillbirths are unexplained.  

There are risk factors that may increase the likelihood of a stillbirth, such as obesity, smoking and maternal age (under 21 or over 35 years old). The rates of stillbirth in the UK are 3.9 in 1000, as opposed to rates in Norway, for example, which are much lower at 1 in 1000 births. That's quite a big health inequality across Europe. Additionally, there are cultural and ethnic deprivation and differences in the rates of stillbirth, which are higher than the overall average of stillbirths. Year on year, the rates of stillbirth in the UK are reducing, and there are government targets for ongoing reductions.

It's important to register any stillbirth within 42 days of the death in England and Wales, 21 days in Scotland and one year in Northern Ireland. After a stillbirth, bereaved parents are entitled to Parental Bereavement leave of two weeks, with the possibility of additional maternity /paternity leave. It may also be possible to have compassionate leave and sick pay, if your employer supports this. You may well need some time to rest and recuperate after a stillbirth. It can be truly devastating.

You can find out more about leave from work following a stillbirth here. 

The clip below from EastEnders depicts the physical and psychological pain, alongside the depiction of not being fully able to engage with the dead baby, as a protective avoidance of loss: 

• Shabnam and Kush’s Stillbirth

Heartbeat, Scan and Movement

A foetal heartbeat starts to develop at five weeks of gestation and is monitored by a midwife regularly. Hearing the heartbeat is often a moving experience. This sign of life delivers a reality – often more powerful than the initial pregnancy test – potentially bringing excitement and joy. Perhaps also an attachment to the growing foetus is formed.

After hearing the heartbeat, there are at least two scans offered by the NHS. The first is at 11-14 weeks and determines the estimated date of delivery of the growing foetus. This gives a more accurate due date than the first day of your last menstrual cycle. You can also choose to have a screening test for Down syndrome.

The second scan at around 20 weeks pregnant detects 11 physical conditions that the growing foetus may have, as well as its position. A scan can enhance the potential attachment with the foetus. Seeing an image of it is powerful and can make the pregnancy more feel more real, with attachment, hopes and dreams for the future potentially growing alongside the baby.  

The first feelings of movement in pregnancy happen at about 16-20 weeks of gestation. These enhance the reality of something growing and being inside you, if you're the pregnant party. If you're the partner of someone who's pregnant, you'll soon feel the baby move from outside the womb. These feelings internally or externally may give you a further sense of a bond. The investment in the future develops, and preparation for the baby may start; buying a cot, clothes, decorating the nursery, and so on.

These preparations also move towards a future with a baby. Unfortunately, for some, this future is not realised. The foetus/baby does not survive, potentially leaving devastation in its wake. 

Response to Baby Loss

The experience of baby loss is, of course, different for everyone – physically, emotionally and psychologically. It’s a spectrum. Unfortunately, some people can offer quite invalidating comments, no matter how well-meaning. Others can make minimising comments, or a sharing of experience that doesn’t resonate for all. These well-intentioned comments can often be based on personal experiences that are projected onto you. This can be helpful, but often it’s not. Each experience is unique – you are unique – so of course, your response to baby loss is unique.

For the person carrying the foetus/baby, there may have been pain, and a significant amount of blood and foetal tissue that needs to leave your womb – a sharp reminder of the loss. People can go on to experience flashbacks and nightmares, they may avoid friends who are pregnant or have young children, and have difficulty sleeping and eating, to name a few.

If there's a partner involved, they may be experiencing some similar experiences as well as being at a loss to know how to best support the person who was carrying the foetus/baby, while managing the loss for themselves.  

Men's Experience of Baby Loss

My doctoral thesis ‘On not being a father’ included a literature review relating to men’s experience (apologies for the lack of gender diversity; my thesis is 16 years old and we've recognised gender expression to be broader than the binary notion of man and woman now).

The literature review found that men experienced powerful emotions and responses in the immediate aftermath of the miscarriage, such as anger, loss, sadness and disappointment, and a feeling of having their guts ripped out. However, there were also responses such as, “It’s not like losing a real baby, is it? If it was a real baby I'd be upset.” The literature also demonstrated that some men could feel embarrassed for feeling upset about a miscarriage.

There were, of course, opposing positions about the hope that can be generated for men when their partner imagined them in a range of parental activities, such as picking the child up from school. At the time of my thesis and the literature available at that time (and to be honest, there isn’t much more now), there was often a sense of traditional gender roles. It was found that men (and potentially partners of all genders) supported their partner at the expense of their own emotional wellbeing. This was a theme across the literature, for example: “Thinking about our lost baby… you know I had to hold myself up for her and say everything is all right.”

Several years on, I can’t help but think that the stereotypical gender role during the aftermath of a miscarriage is potentially invalidating for all involved – the person who was carrying the foetus and the partner(s) involved. My hope is that we can all learn what we need from each other, rather than there being a binary emotional vs. pragmatic approach. However, I do still see this play out in the people I work with. All approaches and experiences of the loss of a foetus/baby are valid.

Mental Health After Baby Loss

Mental health may be affected after baby loss, but it isn't necessarily the case. It may be helpful to follow the guidance below, ‘Five ways to manage grief after baby loss’, and the free Psychological First Aid guide you'll receive if you sign up to my monthly newsletter.  

Common Mental Health Problems Following Baby Loss

Adjustment Disorder

Adjustment disorder relates to experiencing a stressful life event that has led to marked distress, with feelings of hopelessness. Additionally, anxiety, sadness, agitation, low mood, poor sleep, rumination, worry and poor self-care. This presentation is on the trauma continuum. Stillbirth and miscarriage are, of course, potentially stressful experiences.

Generalised Anxiety Disorder (GAD)

This may be a pertinent presentation in baby loss, especially if there have been multiple losses. GAD is characterised by an intolerance of uncertainty and worry. From a behavioural perspective, there's an attempt to seek out certainty and to ward off all of the potential concerns that can be envisaged. There's often tension across the shoulders and neck.

Prolonged Grief Disorder

This can be diagnosed 6-12 months after the loss. It's characterised by both trauma and separation distress. As such, there are some features of PTSD alongside the grief of separation. Often, there's a belief that it would be a betrayal to the lost baby if we were to live our lives without the loved one and to move towards reclaiming life. There's no need to forget the loss, but instead we can live a life that acknowledges the loss but doesn’t inhibit our occupational health, wellbeing and wider life. People who have experienced prolonged grief disorder are at significant risk of physical health problems as well as psychological problems.

Post Traumatic Stress Disorder (PTSD) / Complex PTSD

Rates of PTSD symptoms and diagnosis range from 18-39% for women and up to 16% for fathers. Left untreated, the duration of the symptoms can persist for 5-18 years. PTSD cannot be diagnosed until a month after the trauma event. If you're experiencing flashbacks, nightmares or other re-experiencing symptoms, you're likely to be experiencing signs and symptoms of PTSD. Other features of PTSD include avoidance, fear, anxiety, hypervigilance, changes in mood state, withdrawal and rumination. If you've experienced multiple losses, you're likely to be more at risk, which may lead to personality change.

In Remembrance and Memorial

It may be important to mark the loss, and in fact, I'd encourage it. This may feel impossible if the loss was early in pregnancy. However, there are ways this can be done regardless of the stage of pregnancy, for example:

• Name the lost baby.
• Create a compassionate image of you and your lost baby somewhere safe and calm.
• Write a letter or poem.
• Choose a piece of music you enjoy and hold the lost baby in mind when you listen, or even dance to it. 
• Plant a tree, e.g. using this Memorial Tree Hamper
• Have an object that represents the lost baby.
• Choose an important day – the loss day or what would've been the due date, for example – and acknowledge the loss by lighting a candle or raising a glass.
• Create a memorial service.

It could be anything; what’s important is that it means something to you.

Watch this clip for an example of a memorial for a miscarriage in EastEnders.

If you've experienced a late miscarriage or stillbirth, you'll have the opportunity to hold your baby, take photographs, and take hand and footprints from clay. You'll be able to have a funeral for the baby and some clergy may offer a ceremony free of charge.

I'd like to close with the deepest of sympathy for your loss, and I hope you find peace sooner rather than later.

Five Ways to Manage Grief After Baby Loss

1. Stay connected, be in community 

You may feel you want to withdraw, retreat into yourself. But this will bring feelings of loneliness. If you have a partner, talk together about the loss. You'll have different experiences and perspectives, all of which will be valid to you as individuals. Acknowledge, support and accept each other’s experience and emotional response to the miscarriage or stillbirth.

2. Be kind and compassionate

Blame, guilt and shame have no place here. You, your partner(s), family and social network will all have entirely different responses, feelings and beliefs about the loss. That’s ok. However, it can feel very painful if you're not aligned with the ones you love. Seeking out people who have a lived experience of miscarriage can be very helpful, supportive and validating.

3. Ask for leave 

If you've experienced a miscarriage, ask your employer for sick or annual leave. If you've experienced a stillbirth, you can take paid maternity or paternity leave as well as bereavement leave, sick leave or annual leave. Take as much advantage of this as possible.

4. Spend time with the baby/foetus

If you've experienced a stillbirth or late miscarriage, spend time with the baby/foetus. Hold the baby, name it, take photographs, footprints and handprints. The loss is real; mark it. As painful as this may be, the evidence is that doing this is protective for your mental health and wellbeing in comparison to people who decline this. For an earlier miscarriage, it may not be possible to do this. However, you can engage with your baby in your mind’s eye and talk with them, grieve for them.

5. Look after your fundamental needs

Eat well, move your body, drink water. Sleep if you can, but try not to stay in bed all day; otherwise, your brain will soon associate bed with thinking about the loss, and it'll be even more difficult to get to sleep. If you need to get up in the night, create a cosy space with soft lighting and make a cup of herbal tea or hot chocolate. Try not to be on a screen as TV and scrolling on Instagram, etc. is very stimulating for the brain. Listen to calming music or a podcast. BBC Sounds has several options.

Get help if you need to from specialist organisations and charities, for example:  

• Aching Arms 
• Glow in the Woods
• The Lilly Mae Foundation
• Petals: The Baby Loss Counselling Charity
• Stillbirth and Neonatal Death Charity
• The Miscarriage Association
• Tommy’s: The pregnancy and baby charity

There are also several podcasts you may find helpful, for example:

• Baby Loss, Grief & Love

Bibliotherapy

Gravensten, I.K. (2013), Women’s experience in relation to stillbirth and risk factors for long-term Post-traumatic stress symptoms: a retrospective study, BMJ. 

Rynkins, K. et al. (2022), Comparing Post Traumatic Growth in mothers after stillbirth early miscarriage. PL0S ONE, https://pmc.ncbi.nlm.nih.gov/articles/PMC9359608/pdf/pone.0271314.pdf

Taylor, C. (2010), On not being a father. Unpublished manuscript, held in the British Library.

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