“I am sorry, but there is no heartbeat…. There is no more baby.”

To hear such words brings total devastation, disbelief and disrupted dreams to millions of families whose pregnancies end in the loss of a son or daughter in miscarriage.  A small percentage of mothers (probably about 25% according to one study) do not seem to grieve or need as much support; they may be able to accept the miscarriage a bit easier and don’t seem too upset at the time.  However, the vast majority of mothers (and fathers) do.  The meaning of a pregnancy and the depth of loss are impacted by the fact that they saw the miscarriage not just as a medical event.  Rather, they saw this as a life – their baby with a future in their family – not to be replaced by another baby and not to be minimized because the baby was little or the pregnancy short.

Why does miscarriage matter to so many people?  

The investment into a pregnancy, even an unexpected one, can run deep for most parents-to-be: from taking prenatal vitamins, to eating well, attending appointments with a doctor or midwife over months of pregnancy, to readying the nursery, buying a new house or a more baby-friendly car, to reading and talking with others to learn about pregnancy, labor, birth, and babies, and to sharing their excited hopes and dreams between themselves and each other.

These hopes and dreams often begin in childhood when playing house with baby dolls and even parenting little sisters and brothers, building bonds of love and preparation for future parenthood. Attachment and bonding continues to grow as teens babysit and young adults watch others parent and make plans for how they will parent one day. Sometimes baby names are discovered and held (or written in diaries) for when they are needed.  Selection of marriage partners may partially depend family planning compatibility, often a key topic of conversation for dating, engaged and newly married couples. Do we both want kids? How many? How will we parent?  Where would we live?  How many can we afford?

“Unbeknown to me at the time, my husband David was assessing my potential as a mother long before he asked me to marry him.  He admitted years later that he looked at my grandmother and mother as role models and then looked at me asking himself, ‘Will she be a good mother to my children someday?”  

And when the pregnancy is confirmed with home pregnancy kits and blood tests at the clinic, the journey officially begins. Commonly, fear is mixed with excitement about the addition of a little person to the family. Ultrasounds and a changing body may cement the reality – a baby is on the way.

Confusion increases with minimization of the loss

To parents who view this as the loss of a baby – a daughter or a son, the dissonance and lack of support does not allow them to grieve in a healthy manner.  Medical providers and their close community often undervalue and misunderstand the significance of the miscarriage.

Medical Caregivers

When receiving news that mom is having a miscarriage, parents can view it as cold, cruel, heartbreaking news. No plans are made for the pregnancy to end so abruptly.  Who dreams of that?  The loss of present and future and the loss of a life (not just a medical event) can be devastating to many moms and definitely many dads/partners.  Sadly, the pain and anguish can be compounded by the way the ER or clinic/office staff treat parents.  If there is simple acceptance, a cold response, and/or messages to move on and forget or to imply ‘try again’, the bereaved parents can feel even more upset and confused.

Additionally, the normal hormonal changes, including when milk comes in, can also be extremely emotionally upsetting.

If medical care providers demean the loss with words or through their actions, parents can feel totally disrespected. They may think thoughts like ‘do they have the right to be filled with emotions and regrets about having their baby die?’  They may wonder why they are upset and try to squash such feelings in hopes they will go away.  Rarely does this happen.  When providers affirm the meaning of the miscarriage, offer compassion, resources and information, and most importantly, acknowledge parents’ feelings of pain and loss, most parents are grateful for such good care.

While many medical professionals speak of miscarriage in clinical terms such as: fetus, products of conception, abortion, habitual aborter, embryo, pregnancy…. This is not how most mothers and partners describe their pregnancy. These medical words can be very hurtful and demean the significance and value of this little life that’s been lost.  At least two doctors have been working to change the insurance codes and language used (so as not to cause more pain for parents.  It would be helpful if providers ask parents about the meaning of their pregnancy and this loss.  By listening, they can determine if this is the loss of a baby accompanied by all of the emotions that follow.  From that point forward speaking words that affirm ‘baby, son, daughter, child’ is more in line with the family’s beliefs and affirms their right to miss their baby and allows them to grieve this death while finding ways to honor their little one.

Family and Friends

An added burden on grieving families can come from relatives and friends who undervalue the significance of the loss and misunderstand how the parents feel and what they need. Through their silence or by suggesting parents move on quickly or try again, they insinuate this life matters little.

Too often the common response to a miscarriage is to view it as a ‘small loss’, more of a medical event like the flu or minor surgery.  Common responses may be advice to ‘Let it go and don’t dwell on it,’ ‘Be thankful you can get pregnant,’ ‘At least you have another child to keep you busy,’ ‘Get pregnant again soon, then you’ll have your baby in arms.’  For so many reasons these messages can cause even more pain.

For most parents, the love is already there and the loss creates a huge void in the family for now and potentially for the rest of their lives.  One mom I counseled who had a miscarriage asked, “Did they think I was going to have a puppy or a monkey or a ‘just a pregnancy’?  I was growing a baby, which meant I needed to take care of my body with vitamins and healthy eating, exercise and so much more.  Why would they suddenly act like it is not a child and that after only a few weeks, I should now be ready to move on?  I feel like I am going crazy.”

There is a natural need for many parents/families to dwell and grieve for some amount of time for their loved baby.  This is the normal process that follows death and other significant losses. Otherwise, what is the message?  That the baby meant so little that the parents were ‘over it’ and pregnant again in a few months.

What to say that might help grieving parents after miscarriage

“I am sad this has happened to your beloved baby and you.”   “How unfair this is – you don’t deserve this.” “My sister had a miscarriage and she felt the loss deeply.  I wonder if you might want to connect up with her.”  “I want to help you but may not know how.  Please forgive anything I say that doesn’t help and guide me, if you will, to offer what you do need or want.”  “Even though you have other children, you will feel this loss and need to mourn as a way to heal.  I’ll be here beside you for as long as you want.”  “Is it okay if I call your little one by name (if you named the baby)?” 

Whether parents will have another baby is debatable – there are no guarantees. But even having another baby is not the complete answer to the loss of a previous baby.  The new baby is a different child and not simply a replacement.  Other children in the home may be viewed as blessings, but they don’t supplant the baby who would have or could have been a lifelong member of the family.

Understanding why miscarriage matters can help families who are grieving to realize they have good reasons for being emotionally upset and why grieving for this baby (and remembering the dreams, the hopes and the experience) can help them work towards healing.  When the community understands this, they can be more intentionally helpful and supportive in the short and longer term.  As well, medical providers who seek to determine the meaning of the loss for families and offer appropriate, supportive care are appreciated for their kind care.