One account of loss; living through miscarriage

Introduction

In this essay I will explore the grieving process through my own experience of a miscarriage. The act of reflecting enables a person to explore their behaviour before, during or after a particular situation (Amulya, 2002). While I have now spent much time reflecting on an experience from my past, my students will need to explore how they may react to an experience of loss and grief related to their pregnancy and childbirth. Using Schön’s (1983) Model of Reflective Practice, which is an active process of learning through one’s experiences, I will analyze how my miscarriage will affect my future teaching, and discuss the importance of covering loss and grief in childbirth classes.

Validating All Kinds of Loss

Loss (noun): 1. a losing or being lost 2. a person, thing or quantity that is lost 3. the harm, trouble, sadness etc. caused by losing someone or something

Grief (noun): 1. deep sorrow 2. a cause of sorrow 3. to fail

(The New Lexicon Webster’s Dictionary of the English Language, 1990:422,586)

Looking at the meaning of these words in a dictionary demonstrated how easy it can be to overlook many of the losses and causes of grief that can be experienced by expectant parents. When we think of loss in the context of childbirth, we immediately think of the death of a baby. It is a common mistake to believe that grief is only real when it arises after the death of a person (Stearns, 1987). Grief is the normal emotional reaction to loss (Montgomery and Morris, 1993); to any kind of loss.  Loss is part of life; everyone will experience grief at one point or another in their lifetime.

Loss can present it self in many different ways. Disappointments and the loss of dreams are also forms of loss. Unexpected and adverse birth outcomes, such as the loss of control, unplanned use of medication, assisted deliveries, and caesarean birth, among others, are very common nowadays and can be sources of disappointment to some parents. Other situations, such as prematurity, neonatal death, stillbirth, disability, and birth defects, are more easily recognized as losses that affect parents. Nevertheless, all of these circumstances involve loss and need to be acknowledged and respected.

 The Need to Grieve

It took me a long time to write this essay. I do not know exactly why, but I suspect it is because I didn’t want to relive an experience that had caused me much pain.
While writing this essay, I realized that, even though the miscarriage happened ten years ago, it still hurts to talk and think about. I began to question whether or not I had grieved enough for my loss, or if grief is something that never really goes away. According to Arnold and Gemma (1994), grieving lasts a lifetime, and is a process of learning to manage and get through life with the knowledge that a part of oneself, or an experience, is gone and can never be replaced.

Many psychologists agree that the grieving process is invaluable for people to be able to move on with their lives in a healthy way. Grief enables the bereaved to heal and integrate the loss into their life (Cowles, 1996). The childbirth educator needs to acknowledge the range of childbearing losses that may be experienced by her clients and raise awareness of the importance of grieving and support (Nolan, 1998)

Grief is still a taboo subject for most people (Ward, 1993) and many may not understand the various kinds of loss. Bowlby (1975) developed a theory of attachment which emphasised biological rather than physiological attachment. He put forward the idea that grief was a reaction to separation. If this were true, it would invalidate the need to grieve for the loss of an expectation or dream. Because of this widespread belief, some people worry that their loss is too insignificant to mourn, and thus do not allow themselves to grieve. Deits (2004) contradicts this older theory by arguing that all losses are worthy of grief. If it hurts and causes emotional pain to an individual, it is a loss, and thus needs to be grieved.

Grieving in the case of a miscarriage (or the loss of a dream or expectation) can be especially difficult. Because people believe that since there is nothing to remember, or there is no separation there must be less to grief for (Sheiderman, 1989). Grief following a miscarriage is particularly susceptible to being disenfranchised, as only the mother may have known the baby, felt it move, or seen it through ultrasound (Freda, Devine and Semelsberge, 2003).

The literature has now shown us that miscarriage is a life-changing event, leading to feelings of emptiness, dread, guilt and grief. Parents are often left with the sadness of what might have been. The loss of a pregnancy causes profound grief, yet society has longed minimized or ignored this grief (Capitulo, 2005).  It also involves major secondary losses such disruption of a significant milestone, loss of self esteem and the loss of your baby’s future. (Ilse & Hammer Burns1995).

Luby (1977) says;

“When your parent dies, you have lost your past. When your child dies you have lost your future.”

The Stages of the Grieving Processes

Now that I have acknowledged the need to grieve, I will examine the process.

Elisabeth Kubler-Ross (2005) is known for her model of the stages of grief. She describes them as a series of stages of emotions. She states that most people who experience loss go through stages of:

1. Denial, which is usually accompanied by shock and numbness;
2. Anger;
3. Bargaining, which can involve guilt;
4. Depression; and
5. Acceptance, which involves adapting and readjusting.

Doctors, psychologist, psychiatrists and social workers who work with the bereaved disagree as to the order in which these stages happen. Some experts believe there are only three or four stages, and there is disagreement with regard to the importance of experiencing and completing each stage.
Although the experience of grief, while universal and dynamic, is individual (Reed, 2003), I will try to compare my own experience to Kubler-Ross’ model of grief.

When my first born was seven months old I started to yearn for another baby. We started trying right away since we wanted our children to be close in age. I conceived on our first try and I was delighted that things were going according to our plans. Much to my surprise, not long after confirming the pregnancy, I started to bleed.
I had an ultrasound when I was taken to the hospital, which showed a very slow fetal heart beat. Although the nurse warned me that there was only a very slight chance of not miscarrying, I clung to the idea that everything was going to be alright. At this point I was in the denial stage. The possibility of loosing my baby was too much for me to bear and I couldn’t accept that there was a real chance of miscarrying. When cramps followed the bleeding and the heartbeat got even slower, I was in a state of disbelief. This couldn’t be happening to me.  Why me?
Although I still hadn’t officially miscarried, I was experiencing what Schoenberg et. al. (1974) call anticipatory grief. Anticipatory grief is when the grieving process begins before the event takes place, but there are indications of its inevitability.
After the miscarriage was over and I had undergone a D&C, I got into a state of shock and felt numb. I felt like I wasn’t present. My body was there, but my mind had gone with my baby. Shock anesthetised the pain for a while, but when I returned home, the first roll of consciousness that I wasn’t pregnant anymore struck like a tidal wave, with accompanying tears of pain and sadness. My tummy wouldn’t grow anymore, and my baby had been scraped from inside me.

Wylie (1991) states that confronting reality is necessary before you can begin to accept it. In cases of death, the body must be seen. A stillborn baby can be rocked, a child can be held, an accident victim is identified. Only then do the facts become real, and the grieving person can move on to the next stage.
In the case of an early miscarriage, there are no memories to hold on to, there is no baby to rock, there is no one concrete to say goodbye to, to help make the experience real. There is only the loss of a dream, of something that was once meant to be. How do you deal with what might have been? How do you deal with the loss of a dream and move on? Do you experience the same grieving process as in cases of death?
Shear and Shair (2005) believe this is so, but because intangible losses are often not acknowledged, it can be harder for the bereaved to grieve thoroughly. This can lead to a complicated grief. Complicated grief is when the bereaved individual experiences impaired or prolonged acute grief (Shear and Shair, 2005).
The only concrete thing I had was the home pregnancy test I had done. I entered the anger stage when I saw it upon returning home from the hospital.  The anger can be internal or it can be accompanied by verbal and/or physical aggression (Boss, 1999). I still remember smashing the pregnancy test into bits.
Immediately after the miscarriage we started trying to get pregnant again. I thought that I could replace the emptiness I felt from the miscarriage by getting pregnant again. Two months later I was pregnant and to my surprise, it did not replace the baby I had lost.  Although the birth of another child may diminish feelings of loss, it does not take them away (Friedman, 1996). I continued to think about the baby I had lost and what it might have been. At the time, I though I had found a way to avoid grieving, but now I realize that I had simply delayed it. Coping with pregnancy after a miscarriage was too much for me to handle. Loss of self-esteem can result from a woman’s inability to rely on her body. The fear of it happening again usually accompanies the woman during her entire pregnancy (Friedman, 1996).  As it turned out, this was a very difficult pregnancy, with emotional and physical challenges. I then entered the depression stage. When the pregnancy ended with the birth of my daughter, the depression persisted. It just changed its name to postnatal depression.
The acceptance stage lasted the longest for me. It was a very gradual process, and it is difficult to pinpoint when it began and ended or if it is still an on-going process. It involved learning to live with the fact that I will never get to know this baby in real life but have gotten to know in my heart.

From this analysis I can assume that my immediate grieving process was mostly compatible with Kubler-Ross’ model with the exception that I skipped the bargaining/guilt stage. I can also identify with Luby (1977), that some stages are experienced more then once. I have to say that writing this essay has allowed me to revisit some of the stages and thus grieve more successfully.

Relationships

Every family that is grieving face new and unexpected problems. Conflicts in the family setting are common. The ability to deal with grief as a couple is often a function of the prior emotional strength of the relationship. In poorly adjusted families, where relationships were already precarious, situations that add additional emotional strain can result in the end of the family unit (Scheiderman, 1989). On the contrary, working through loss together can result in positive growth of the relationship (Deits, 2004).
Another point to consider is that grief is different for different people. Frequently, each partner’s experiences are not synchronized. This may be a source of interpersonal stress. There is no absolute, predictable, systematic progression or pattern for a person’s response to a loss. Grief is distinctive for each individual. Although parents may be mourning the same loss, it affects them uniquely, and they each have to go through their own grieving experience.
When my husband and I lost our baby, our mutual support helped us through the pain of the loss. It left us with a deeper and stronger bond of love, and a greater appreciation of each other and our first-born son. This confirms my belief that we have a very solid relationship, that we can work out our differences, and are able to successfully support one another as we work towards similar goals.

Religion, Faith and Loss

One rarely experiences loss without being forced to the edge of faith. Some people will let a lifetime of belief crash right in front of them, while others draw strength from the traditions of which they are a part.
Religious faith can lead the grieving individual through the darkness and pain of loss. Religion can influence one’s fundamental view of life, it can provide the comfort and motivation required for recovery, and it can provide supportive strength (Deits, 2004).
On the other hand, it is not uncommon for the bereaved to question their faith. “How could God allow this to happen?” is often asked. The inability to find an acceptable answer to this question may lead some people to start to doubt the existence of God. It can be very difficult to rationalize how a benevolent God can allow bad things to happen (Marx, 2003).
I, myself, questioned how could God give me a child to then take it away. Wasn’t I a good enough mother to be granted another child? Why was God doing this to me? I didn’t actually question the existence of God but I was very angry at Him.
Eventually that anger dissipated as I started to cope with my loss. But many, who actually question the existence, may never again believe in God. 

Loss and the Childbirth Educator

There are a number of topics that need to be raised in prenatal classes but are difficult to talk about. For me personally, issues that are most likely to upset expectant parents are the most difficult ones for me to discuss, such as stillbirth, premature birth, birth defects, and Sudden Infant Death Syndrome.
This difficulty lies with the childbirth educator herself, and with the group members. Childbirth educators often feel guilty about raising issues that may upset, and perhaps frighten, expectant parents. It is important that the class instructor to have thoroughly debriefed their own experiences before attempting to provide learning opportunities for clients on these challenging topics (Nolan, 1998).
Some childbirth educators will avoid some or all of the topics altogether. Others may say that they are willing to cover anything, provided that it is brought up by someone in the class. Yet others will ensure that certain subjects are always included (Priest and Schott 1999).
I find myself belonging to the second group. My trouble is not with talking about difficult subjects, but rather to the parent’s reaction to these topics. I prefer to find opportunities in class to raise parent’s awareness to potential outcomes. I understand the importance of covering difficult topics such as loss and grief; however, it is very difficult for me to broach such subjects in a group of happy expectant parents. Seeing their excitement suddenly become distress makes me feel guilty. Nolan (1998) states that when parents react adversely to a topic, it is important for the childbirth educator to accept these reactions as natural, and to acknowledge how difficult the topic is. I know it is my job to realistically paint the picture of what childbirth could be like. Although it is important for me to raise awareness of the reality that their expectations may not to be met, Nolan (1998) also states that any discussion about different outcomes, no matter how brief, may be enough for a particular group.

Although I believe that the childbirth educator can be a good source of support for parents experiencing a loss related to their childbearing experience, I also believe that we need to be aware of our limitations as supporters in this role. I see the childbirth educator’s primary job as to prepare expectant couples to different possible outcomes.
The childbirth educator can listen, empathise and give information, but unless they also possess special qualifications in counselling and bereavement, students should be referred to professionals more qualified to give support. Educators need to be aware of their boundaries. Peer support can be quiet useful and can foster a support network for expectant parents during classes and should be encouraged. The childbirth educator also needs to be aware of community support available in her area.

Conclusion

Now that I have had the perspective of time, and have accepted the fact that I lost a baby, I am able to draw on my personal experience to empathize with others. The fact that I had a miscarriage is now part of who I am. Through reflection and the writing of this essay, I have been able to fully integrate the experience into my sense of self and turn into a learning experience (Schön, 1983). This will undoubtedly help me as a childbirth educator. I feel that I will be able, in my future teaching, to approach the subject of loss with considerably more confidence and knowledge, and will be able to foster a trusting environment for expectant parents to feel comfortable to discuss their fears.

 Daniela Vasconcellos (2006)

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My experiences of giving birth

My experiences of becoming a parent

One account of loss; living through miscarriage

My views on Informed choice

The needs of fathers