Pregnancy Loss

Background

I have explored the impact of pregnancy loss for heterosexual women, in an interview study with Catherine Collins and Clemence Due, and for men, in a systematic review with heterosexual Clemence Due and Stephanie Chiarolli. In addition, I have explored the impacts of pregnancy loss for gay men undertaking surrogacy in India, with Clemence Due and Jennifer Power. I have recently contributed to a new Australian Psychological Society information sheet on LGBT people and pregnancy loss, available here.

A full list of my research publications on the topic of pregnancy loss can be found further down the page, and are drawn on in the applications of research findings sections below.

Applications of research findings for practitioners

The interview study with heterosexual women focused on how pregnancy loss affects a woman’s relationships with her partner, family and friends. This study found that many of the women who had experienced pregnancy loss experienced emotional isolation and a substantial strain on their relationship with their partner due to the loss which, for some participants, continued for decades after the loss. In contrast, a small number of women experienced the loss as increasing the depth of their relationship with their partner. These findings suggest that practitioners working with women and heterosexual couples who have experienced pregnancy loss should be aware that that this loss is likely to have an emotional impact, and that this can be either isolating or bonding for couples. In addition, these findings highlight the need to practitioners to suggest ongoing support may be needed for women who have experienced pregnancy loss.

The findings also suggest that pregnancy loss impacted on relationships with wider family and friends. This particularly included the difficulties participants had engaging with others who were pregnant or had recently given birth. In some cases, this meant that it was difficult for the participants to turn to people who would have otherwise been emotional supports for them. In addition, the ongoing impact of pregnancy loss was not taken into account by other people. These findings suggest that practitioners need to offer women guidance and support following pregnancy loss, which may include working with women in dealing with engaging with others who are pregnant or have recently given birth. In some cases it may also be useful to provide support for families as well, who are having difficulty understanding the impact of the loss for the woman who experienced pregnancy loss.

The study also found that participants felt that pregnancy loss could permanently change them personally, due to ongoing grief and/or jealousy of others, or positively in terms of it changing their approach to life and other people. Again, this highlights for practitioners the diversity of experiences and long-term impacts pregnancy loss can have on women.

The study further found that participants experienced both negative and positive interactions with healthcare professionals. In particular, negative experiences related to confusing and inappropriate language and communication, the hospital environment, lack of emotional care, and lack of follow-up care. Positive experiences related to emotionally-engaged and present individual staff and the healthcare system as a whole. These findings highlight the importance of training for healthcare professionals  to support women who experience pregnancy loss.

The systematic review identified 29 articles that included empirical data on heterosexual men’s experiences of pregnancy loss. The review found that men tended to feel that their role was as a ‘supporter’ to their female partner and that men felt that their loss was overlooked compared to their partners. This suggests that it would be useful for practitioners to both pay specific attention to the men’s own experiences of loss, and discuss with men how they can best support their partners. Practitioners working with both members of heterosexual couples need to be particularly careful not to focus solely on women’s experiences of loss.

The review also found that men were more likely to engage in compensatory behaviours (such as increased alcohol intake) following pregnancy loss as compared to women. This has clear implications in terms of health and wellbeing for men, as well as implications in terms of the impact of these compensatory behaviours on their partners, families, and friends. These findings suggest in particular that it is useful to work to unpack men’s feelings of loss as they may feel it’s not culturally acceptable for them to express this, and to find other outlets to deal with their loss.

The interviews with gay men who had undertaken surrogacy in India highlighted that potential pregnancy loss was not something that had been discussed with them by the clinics. Findings also indicated that responses from clinics tended to focus on encouraging people to try for another baby, rather than dealing with their grief at the loss. These findings suggest that practitioners can play an important role in discussing the possible outcomes of pregnancies via surrogacy arrangements, as negative outcomes such as pregnancy loss tend to be glossed over by clinics and other sources of information. The findings also suggest that practitioners could provide much needed support if pregnancy loss is experienced. It is important for practitioners to keep in mind that gay men who have undertaken surrogacy overseas have likely invested a considerable amount of time, finances, and emotions in pursuing this process. Pregnancy loss for gay men may be compounded due to the difficulties of conceiving the child in the first place, a lack of social support from others, and potential discrimination and lack of knowledge from practitioners.

Bringing these studies together highlights the importance of practitioners being aware of the diversity of experiences and backgrounds of people experiencing pregnancy loss. This includes diversity in terms of conception (e.g. reproductive heterosex, surrogacy) and family form (e.g. heterosexual couples, gay couples).

Applications of research findings for people who have experienced pregnancy loss

The interview study with heterosexual women who had experienced pregnancy loss found that many women experienced a substantial strain on their relationship with their partner due to the loss. For some participants, this strain continued for decades. However, some of the participants reported that the loss increased the depth of the relationship with their partner. These findings suggest that people who experience pregnancy loss may find counselling useful to discuss their emotions and the impact of the loss on them and their partners. It may be particularly useful for couples to undertake this counselling together, whilst allowing for both partners to discuss their experiences. Other forms of support, such as community support groups and networks (in person and/or online) may also be useful.

The participants also discussed having difficulties engaging with friends, family, and colleagues who were pregnant or had recently given birth. These findings suggest that if support people are unavailable to women who have experienced pregnancy loss, talking with a mental health professional or engaging with a support group may be useful for guidance and support.

The study also found that participants experienced both negative and positive interactions with healthcare professionals. In particular, negative experiences related to confusing and inappropriate language and communication, the hospital environment, lack of emotional care, and lack of follow-up care. Positive experiences related to emotionally-engaged and present individual staff and the healthcare system as a whole. These findings highlight the need for women who have experienced pregnancy loss to be prepared for mixed reactions from healthcare professionals, and to seek out further support if needed.

In terms of the review of research with heterosexual men, men often felt their role was as a ‘supporter’ to their partner and that their own grief was overlooked. This suggests that the experiences of both members of couples need to be paid attention to, including within the couple themselves, but also making it clear to family and friends that both partners have been impacted on by the loss.

The review also found that men were more likely to engage in compensatory behaviours (such as increased alcohol intake) following pregnancy loss than women. Whilst it can be difficult culturally for men to talk about their feelings, it is important for them to do so with someone they feel comfortable, otherwise their health and wellbeing is likely to be negatively impacted.

The research with gay men who had undertaken surrogacy in India highlighted that potential pregnancy loss is unlikely to be discussed with them by the clinics in which they undertake surrogacy. These findings suggest that people considering surrogacy should reflect on all of the possible outcomes, and what their responses and actions may be if pregnancy loss should occur.

Overall, the findings from the studies show that participants experienced pregnancy loss differently, highlighting that it is important for people who have experienced this form of loss not think that their feelings need to conform to one type of experience.

Resources for practitioners

Australian

Australian Psychological Society – Perinatal grief: A poignant form of bereavement (by Margaret McSpedden)

Red Nose – Support for professionals

Sands (Miscarriage, stillbirth and newborn death support) – Professionals

International

American Psychological Association – Miscarriage and loss (by Elizabeth Leis-Newman)

Miscarriage Association (UK) – For professionals

Miscarriage Support Auckland (NZ) – Helpful suggestions for health professionals

National Institute for Health and Care Excellence. (2012). Ectopic pregnancy and miscarriage: diagnosis and initial management.

Resources for people who have experienced pregnancy loss

Australian
Pregnancy loss – government sources

AccessAustralia – Australia’s National Infertility Network – Pregnancy loss

AccessAustralia – Australia’s National Infertility Network – Recurrent miscarriage

Health Direct – Miscarriage

Health Direct – Pregnancy loss

Pregnancy, birth & baby – Miscarriage

Pregnancy, birth & baby – Pregnancy loss

Government of Western Australia – Department of Health – Pregnancy loss

NT Government – Pregnancy and loss

Women’s and Children’s Health Network – Pregnancy – Miscarriage

Victoria State Government – health.vic – Miscarriage

Pregnancy loss – additional sources

Australian Psychological Society – Information Sheet: LGBT pregnancy loss

Bears of Hope (Pregnancy & infant loss support)

Beyond Blue – Get support – Phone 1300 22 4636

Raising Children Network – Pregnancy: miscarriage & stillbirth

Red Nose – Early pregnancy loss support library

Red Nose – Support – Phone 1300 308 307 (24 hours a day)

Sands (Miscarriage, stillbirth and newborn death support)

Forums

Bubhub – Pregnancy loss support

Essential Baby – Miscarriage and pregnancy loss

International

Miscarriage Association (UK)

Miscarriage Support Auckland (NZ)

Books/sources with personal stories

Healthtalk Australia – Experiences of miscarriage

Miscarriage Association – Your stories

Picture books

Blanford, C. (2012). Something happened: A book for children and parents who have experienced pregnancy loss. Something Happened Handbook.

Cohn, J., & Owens, G. (1994). Molly’s rosebush. Concept Books.

Falk, C., & Roman, K. (2015). A rainbow baby story: The rainbow after the storm. CreateSpace.

Schwiebert, P., & Bills, T. (2003). We were gonna have a baby, but we had an angel instead. Grief Watch.

Schwiebert, P., & Bills, T. (2007). Someone came before you. Grief Watch.

My research publications

Due, C., Obst, K., Riggs, D. W., & Collins, C. (Online First 2017). Australian heterosexual women’s experiences of healthcare provision following a pregnancy loss. Women and Birth.

Due, C., Chiarolli, S., & Riggs, D. W. (2017). The impact of pregnancy loss on men’s health and wellbeing: A systematic review. BMC Pregnancy and Childbirth, 17, 380.

Collins, C., Riggs, D.W. & Due, C. (2014). The impact of pregnancy loss on women’s adult relationships. Grief Matters: The Australian Journal of Grief and Bereavement, 17(2), 44-50.

Riggs, D. W., Due, C., & Power, J. (2015). Gay men’s experiences of surrogacy clinics in India. Journal of Family Planning and Reproductive Health Care, 41(1), 48-53.

Other research publications (selected)

Australian

Conway, K., & Russell, G. (2000). Couples’ grief and experience of support in the aftermath of miscarriage. Psychology and Psychotherapy, 73(4), 531-545.

Harvey, J., Creedy, D., & Moyle, W. (2001). Women’s experience of early miscarriage: A phenomenological study. Australian Journal of Advanced Nursing, 19(1), 8-14.

Lee, C. (2012). “She was a person, she was here”: The experience of late pregnancy loss in Australia. Journal of Reproductive & Infant Psychology, 30(1), 62-76.

Lee, C., & Rowlands, I. J. (2015). When mixed methods produce mixed results: Integrating disparate findings about miscarriage and women’s wellbeing. British Journal of Health Psychology, 20(1), 36-44.

Rowlands, I. J., & Lee, C. (2010). “The silence was deafening”: Social and health service support after miscarriage. Journal of Reproductive & Infant Psychology, 28(3), 274-286.

St John, A., Cooke, M., & Goopy, S. (2006). Shrouds of silence: Three women’s stories of prenatal loss. Australian Journal of Advanced Nursing, 23(3), 8-12.

International

Black, B. P., & Fields, W. S. (2014). Contexts of reproductive loss in lesbian couples. MCN: The American journal of maternal child nursing, 39(3), 157-162.

Brier, N. (2008). Grief following miscarriage: A comprehensive review of the literature. Journal of Women’s Health, 17(3), 451-464.

Craven, C. (2016). Infertility and reproductive loss. In A. E. Goldberg (Ed.), The Sage encyclopedia of LGBTQ studies (pp. 584-587). Thousand Oaks: Sage.

Craven, C., & Peel, E. (2014). Stories of grief and hope: Queer experiences of reproductive loss. In M. F. Gibson (Ed.), Queering maternity and motherhood: Narrative and theoretical perspectives on queer conception, birth and parenting (pp. 97-110). Toronto: Demeter Press.

Craven, C., & Peel, E. (2017). Queering reproductive loss: Exploring grief and memorialization. In E. R. M. Lind & A. Deveau (Eds.), Interrogating pregnancy loss: Feminist writings on abortion, miscarriage, and stillbirth (pp. 225-245). Bradford, Ontario: Demeter Press.

Cumming, G., Klein, S., Bolsover, D., Lee, A., Alexander, D., Maclean, M., & Jurgens, J. (2007). The emotional burden of miscarriage for women and their partners: Trajectories of anxiety and depression over 13 months. BJOG: An International Journal of Obstetrics & Gynaecology, 114(9), 1138-1145.

Gold, K. J., Sen, A., & Hayward, R. A. (2010). Marriage and cohabitation outcomes after pregnancy loss. Pediatrics, 125(5), e1202-e1207.

Peel, E. (2010). Pregnancy loss in lesbian and bisexual women: An online survey of experiences. Human Reproduction, 25(3), 721-727.

Peel, E., & Cain, R. (2012). “Silent” miscarriage and deafening heteronormativity: A British experiential and critical feminist account. In S. Earle, C. Komaromy & L. L. Layne (Eds.), Understanding reproductive loss: Perspectives on life, death and fertility (pp. 79-92). Farnham: Ashgate.

Prior, M., Bagness, C., Brewin, J., Coomarasamy, A., Easthope, L., Hepworth-Jones, B., . . . Metcalf, L. (2017). Priorities for research in miscarriage: A priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology. BMJ Open, 7(8), e016571.

Shreffler, K. M., Hill, P. W., & Cacciatore, J. (2012). Exploring the increased odds of divorce following miscarriage or stillbirth. Journal of Divorce & Remarriage, 53(2), 91-107.

Wojnar, D. (2007). Miscarriage experiences of lesbian couples. Journal of Midwifery & Women’s Health, 52(5), 479-485.

Wojnar, D., & Swanson, K. M. (2006). Why shouldn’t lesbian women who miscarry receive special consideration?: A viewpoint. Journal of GLBT Family Studies, 2(1), 1-12.