No-one knows for sure how many pregnancies end in miscarriage, but we do know that it’s the most common adverse outcome of any pregnancy – and that at least one in four pregnancies end this way. But despite this commonality, few of us know how to respond well to a friend or family member who has been through such an experience. As a therapist working in the field of pregnancy loss, I hear about the hurt of inadequate responses time and again: miscarriage tends to provoke a silence, or a hushed awkwardness, or comments that often miss the mark. Any of these will only make a potential anguish harder to bear.
There are many reasons why miscarriage confuses us, making it difficult to know what to say. The vast majority will happen in the first twelve weeks of a pregnancy, when the baby-to-be is medically described as an ‘embryo’ (or, at around 8 weeks, it becomes a ‘fetus’). But a grieved-for miscarriage involves so much more than an embryo no longer developing. It may well mean the death of a potential child who was yearned-for, and – in my experience – perhaps loved. It can also involve the death of a previously held innocence about pregnancy, and a breach of a previously held trust in life going ‘to plan’.
- Start with ‘I’m so sorry’.
Whatever a woman may feel about her pregnancy, it’s fair to say that most miscarriages are distressing events. So even if she may not feel devastated by her pregnancy ending early – maybe she had yet to call a baby to mind – she may well have suffered great pain and significant blood loss. She may even have had to take medicine to ‘complete’ the pregnancy, or endured surgery to her womb (that may even have had to be repeated). But starting with this simple statement will help open up a conversation, in which you can learn more about what went on.
- Ask about the pregnancy
If a woman wants to talk about her miscarriage, she’ll need to tell the whole story, and this often begins when her future baby was called to her mind – with the decision to start ‘trying’. If you ask in general terms about this, you can then learn more about how she related to her pregnancy. If she uses the word ‘baby’, then realise that this was a baby that lived powerfully in her mind, as well as womb, maybe for months before conception – or, many years. She may have been through gruelling fertility treatment to conceive it. She may well have imagined holding it, dressing it, pushing it in a particular stroller. She may even have named her baby. You can find some or all of this out.
- This is not your fault
So many women feel guilty after a miscarriage – partly because women are primed to take responsibility for other peoples’ welfare from a very early age, but also because we don’t know nearly enough about why miscarriages happen, and we need to make sense of things in the face of a scientific void. Reassure her that she did nothing wrong, nor does anyone judge her.
- Give permission to grieve
Because miscarriage is so misunderstood, women often feel they can’t claim a ‘grief’, and even if they do, they can feel ‘wrong’ for grieving ‘too long’. Acknowledge her grief and reassure her that, as with any other grief, there should be no limit on this process. In doing this, you are also endorsing the real relationship with a baby that came to an end. Watch out for signs of other anguish too: miscarriage can also cause anxiety and depression, or even trauma.
- Ask about the baby (if appropriate)
Late miscarriages are rare, and they will usually happen in a hospital. This may well mean that the expectant parent(s) met their baby. If so, ask about this meeting. They may have taken photos of their baby, or washed and dressed it. They may have had the agonising decision about what to do with their baby’s body, along with decisions about a funeral ritual too. We don’t tend to know about these acts, as they get tucked away in private. All of this may also apply to an earlier miscarriage too.
- Remember the partner
Bear in mind that a bereaved mother-to-be may well have a partner dealing with his or her emotional responses too. Both male and female partners are often forgotten about after miscarriage, but it is possible that a loss can hit them just as hard – and maybe even more. Just because they have had to step up to support the expectant mother, this won’t necessarily mean that they are ‘ok’ and coping well – whatever it looks like from the outside. Plus it may mean they were witness to their partner in great distress while feeling powerless to help.
- Avoid saying stock comments
As a general rule, don’t say anything beginning with the words ‘at least’ – such as ‘at least’: ‘it was early on’ or ‘it was nature’s way’ or ‘you can get pregnant’ or ‘you have another child’.
Don’t assume anything either, such as: ‘I know exactly how you feel’ or ‘You must be devastated’ or ‘You’ll be fine once you are pregnant again’.
And don’t say anything that could possibly convey a hint of blame, such as: ‘Do you think you should take it easy now?’ or ‘Will you start eating meat again?’
And if you say nothing at all, consider that actions can sometimes speak louder than words – send a gift, or a card or give a warm hug. One of the kindest condolences that came my way after pregnancy loss was the delivery of a plant, with a note ‘Something to remember your baby by’.