Processing the complex emotional experience of grief takes time.  According to the Swiss psychologist Elisabeth Kubler-Ross’s conceptualization of grief, a person processes a loss in a series of five stages (1969).  Although originally theorized her stage model to be processed in a linear fashion, Kubler-Ross amended the stage model into a more non-linear, vacillating series of stages that people will go through.  Every person grieves in a different way.  There is no “right” way to grieve.  A person may mourn in a non-linear manner, may not complete one stage before moving on to another, or may experience all of the stages and then return to previous stages.  In McCann and Wagner’s summary of the five stages, they review the emotional, non-linear Kubler-Ross stage model of grief and discuss the complexity.

 

• Denial: “This can’t be happening” A sense of shock or disbelief.  Emotional numbness or blunting may be experienced.  This can be particularly difficult if the pregnancy had surpassed the first trimester.  Working through this acute phase of distress involves accepting the reality of the loss.

• Anger:  “Why me?”  Anger is an emotional experience that humans are used to managing.  We receive messages from our society that anger is dangerous and needs to be avoided at all costs.  What few people realize is that pain is usually underlying anger.  With respect to grief, anger represents the intensity of our pain and our love.  It is a natural emotion that should be felt in order to allow it to dissipate.  I like to use the visualization that anger can be viewed as a wave in that it crests, peaks, and eventually falls.  If we continue to avoid or distract ourselves away from anger for fear of it overtaking and overwhelming us, we will never be able to move past the deep hurt and pain that is leading us there.

• Bargaining: “If only …” or “What if…” Subsequent to a sudden loss like in a miscarriage, bargaining can be seen as a truce of some sort.  We want our loved (and pregnancy) to return and bargaining is used to find fault within ourselves that it was something we did or did not do.  Bargaining keeps us in the past and is a barrier to moving forward.  

• Depression:  Depression is a normal part of grieving a loss.  It allows us to determine our emotional experience in the present and acknowledge that the loved one is not physically going to be with us.  Understandably, we feel a great sense of loss, sadness, and frustration. 

• Acceptance:  Most people never feel “ok” or “back to normal” after a loss.  Acceptance does not diminish the importance of the loss, but rather recognizes your new reality as your enduring reality.  We may never like this reality, but we must accept it as there is no other option.  Although one cannot replace someone we have lost, we can begin to build a life where we invest in ourselves and others and begin to live again.  The multifaceted understanding of grief can only be processed if we give ourselves its appropriate time, care, and attention.

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1. Take care of yourself: ​​Give yourself time and permission to grieve. Remember to relax and eat well-balanced meals.  Examples of caring for yourself include taking a warm bath, wearing comfortable clothing, watching a favorite movie or television program, and enjoying a favorite meal. 

2. Share your story: Allowing yourself to process your grief and loss with a trusted family member or friend can be extremely helpful. For those who feel uncomfortable or do not feel they have that kind of support, there are many ways to connect via the Internet and social media platforms like Facebook, Twitter, Instagram and website chatrooms like The Bump.

3. Ask for what you need: Often when we are struggling we feel as though others should know how to comfort us or “what to do.”  People are often hesitant of saying or doing the wrong thing in one’s effort to help another person who has experienced a loss.  Being able to articulate your needs with your support system and advocate for yourself is critical to getting your needs met.

4. Honor your loss: A religious service or memorial can be helpful for you and your partner (and others) to express the grief and sense of loss you feel.  It allows us to observe our loss, honor one’s experience, and conveys the baby’s life in our reality.  Some examples of honoring the loss include lighting a candle, conducting a memorial service, growing a plant, prayer, or creating a memory box.

5. Reach out for help: If you feel as though you need assistance in processing the emotional and/or physical impact of the miscarriage and loss, connecting with a medical professional or mental health professional who specialize in women’s health can be beneficial. 

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Books

Douglas, A., & Sussman, J.R. (2000). Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant     Loss. Taylor Trade Publishing: Lanham, Maryland.

McLaughlin, S. (2005). Surviving Miscarriage-You Are Not Alone. iUniverse, Inc.: Bloomington, Indiana.

Shahine, L., Elenbaas, L., & Douglas, J. (2007). Not Broken: An approachable guide to miscarriage and recurrent       pregnancy loss.

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Social Media

• @ihadamiscarriage

  • Psychologist Dr. Jessica Zucker, Ph.D. specializing in women’s reproductive and maternal mental health

• @griefunfolding

  • Support network of women who share stories of pregnancy and infant loss

• @findyourttctribe

  • Giving a voice to all things infertility, pregnancy, and motherhood

• @4thtribodies

  • Body positive photodoc + storytelling series for Parents and Postpartum

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References

Dimmer, J. (2014). Miscarriage: A Guide to Care. Retrieved on 2/1/19 from         https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2F          healthAndWellness%2Fpregnancy%2Fpregnancy%2Fmiscarriage.html

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Geller, P. A., Psaros, C., & Kornfield, S. L. (2010). Satisfaction with pregnancy loss aftercare: Are women getting what they want? Archives of Women's Mental Health, 13(2), 111-124.doi:10.1007/s00737-010-0147-5

 

Kohns, L.K. (2016). Perinatal Loss and Grief: Supporting Families [PowerPoint slides]. Retrieved from http://hmhbbroward.org/wp-content/uploads/2016/03/Dr-Cohns-Perinatal-Loss-and-Grief.pdf

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Kübler-Ross, E. (1969). On Death and Dying, Routledge, ISBN 0-415-04015-9.

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Kubler-Ross, E., & Kessler, D. The Five Stages of Grief.  Retrieved on 2/7/19 from             https://www.mccombwagner.com/download/29506/TheFiveStagesofG.pdf

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Nikčević, A. (2003). Development and evaluation of a miscarriage follow-up clinic. Journal of Reproductive &   Infant Psychology, 21(3), 207. doi:10.1080/0264683031000154999.

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About the author: Dr. Kristen Hurrell, Ph.D. is a clinical psychologist who specializes in individual therapy.  She has chosen to specialize in areas that include (but are not limited to) prenatal and postpartum mental health, depression, anxiety, eating disorders, relationship difficulties, family conflict, parenting issues, loss and grief, self-esteem, and adjustment.  She is currently accepting patients for her private practice in Bloomfield Hills, Michigan.  For any additional questions or concerns, please contact her at drkristen@kristenghersihurrell.com.

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