Pregnancy loss and complicated grief

The loss of a pregnancy can be an extremely traumatic and painful experience.

Within a couple, where each person can usually turn to their partner for support, grief is complicated as each parent is simultaneously struck with loss. Individuals may grieve differently and these different grieving styles can lead to misunderstandings or tension, or sometimes create emotional distance within couples. 

The good news is, relationships can restabilise, and may even become stronger through sharing the experience: but this requires each individual’s grieving style to be recognised and accepted by their partner.  

While the grieving process is unique to each, we can expect people to exhibit a predictable range of responses.  These reactions don’t occur in a linear sequence: grief is more of a complicated web of emotions. It is healthy to experience these emotions fully and allow yourself the time to grieve.

To help understand how your partner might be experiencing their grief, here are some common differences in grieving style between mothers and fathers (in a heterosexual two parent family).   

MOTHERS 

• Tend to form a bond with the baby earlier in pregnancy
• Tend to have a stronger physical bond with their baby
• May report higher distress in the early stages of a loss
• May grieve for a loss of herself as the baby was a part of her body
• Tend to have emotionally expressive grieving styles 
• Tend to vocalise their feelings or express sadness through crying
• May blame themselves, medical professionals or often their partner
• May misinterpret their partner’s grieving style as not caring

FATHERS

• Tend to bond with the baby later in pregnancy when the relationship feels more tangible as the baby grows
• Do not tend to express a need to discuss the loss
• Often internalise or intellectualise grief
• May focus their energies into work
• May present as irritable
• Tend to experience more intense grief in a late stage pregnancy loss
• May feel powerless in knowing how to help their partner
• May feel it is important to be stoic and strong
• May feel ignored and unacknowledged as a legitimately grieving parent by health professionals, friends or family

Heterosexuality informs much of the scientific research on pregnancy loss and grief, and this may not be completely relevant to LGBTIQ parents, as it may not capture the additional complexities of their experience. Research into the experience of pregnancy loss and grief for the LGBTIQ community is limited, but we do know that there are factors which serve to amplify grief. Here are some of the extra factors facing two-mother and transgender parents.    

Lesbian parents 

• The carrying mother typically grieves the loss more openly, while the non-carrying mother tends to grieve in private (often wanting to be strong for her partner). 
• Lesbian pregnancies are highly planned (through insemination or IVF with a sperm donor) resulting in enormous emotional and material investment into the pregnancy.
• The non-carrying mother may experience distress due to health professional’s insensitivity, or overt discrimination, experienced through eg unfriendliness, lack of eye contact or being asked to leave during examination and treatment.   

Trans parents

• Many trans-people experience pregnancy as being “at odds” with their gender identity, which can be emotionally distressing, particularly as it involves discontinuation of hormone therapy. The pregnancy can feel like a loss of control over the body they have felt comfortable in and they may fear the return of their pre-transition state.  Despite the emotional and physical challenges, becoming pregnant is often the most socially or financially viable way to become a parent  despite the emotional challenge of the experience. 
• To lose that pregnancy through miscarriage or stillbirth compounds all of the losses that had already been endured, just to get pregnant.
• Medical assessments and interventions for pregnancy and loss may be particularly traumatising for a trans person as they are required to tolerate the prolonged exposure of their genitals. 

COMPLICATED GRIEF

Grief is a natural process that we experience after loss. In some cases however, grief can become complicated and the experience is more severe, intrusive and long lasting than usually expected. Complicated grief may look like a delayed or prolonged emotional responses. Pregnancy loss more frequently leads to complicated grief than other losses.  

 Warning signs for complicated grief:

• Avoiding the grieving process (not acknowledging the pain or feelings, refusing to talk about or see reminders of the baby)
• Refusal to plan and/or attend funeral
• Deliberately distracting from grief by keeping busy with other tasks
• Engaging in negative coping mechanisms (abusing alcohol or drugs)
• Increased physical complaints or illness 
• Intense mood swings or isolation that do not resolve 
• Neglecting self-care and responsibilities at home, school or work

RISK FACTORS INCLUDE

• Gestational age (further along, towards end of pregnancy or neonatal death)
• Type of loss (physically traumatic, planned pregnancy)
• Age of parents (young mums)
• Social support (perceived and actual)
• History (of trauma, loss, infertility, psychiatric illness or relationship difficulties) 

It is important to remember that there is no right way to grieve, and there is no set duration that grief should last. While there are no rules, the most acute grief usually declines significantly within six months, and grief is usually less intrusive 1-2 years after the loss. While loss may stop interfering with us on a daily basis, the feeling or awareness of a loss may never disappear completely.

Whatever your circumstances, and however you have experienced your loss, it is really important to reach out if you feel like you (or someone you love) need help.

I want to thank my fabulous Psychology student Anke Bezuidenhout for pulling this piece together – great work Anke!