Miscarriage from a psychotherapist's perspective

Experiencing pregnancy loss has got to be one of the most confusing, sad, messy and complicated life experiences that I’ve been through. For me, it came totally out of the blue and it is still something I am struggling to process.

My name is Zoë Aston, I am 34 years old and work as a psychotherapist, mental health consultant and author. I have a private practice in London where I see 1:1 therapy clients, I give psycho-educational talks, and, in 2021, I wrote and released a book called ‘Your Mental Health Workout’ – you can see this here. I also run a mental health support Instagram account @yourmentalhealthworkout, which would be a great place to go if you want a little bit more support after reading this blog. 

My own experience of miscarriage

During 2021 I was pregnant twice, and miscarried twice. The first ended in a missed miscarriage and I had a procedure to remove the fetus from my body at 10 weeks. There was a recovery period after this, but we conceived fairly easily a few months later. Sadly, the second pregnancy ended in a natural miscarriage at home one evening. The first miscarriage was a complete shock. Although I knew people who had had miscarriages and even lost babies much later in their pregnancy, I just hadn’t considered how likely it was to happen to me. The second loss was absolutely heart-wrenching as I came to the realisation that the tentative timeline I had set out for myself was lost.

I found myself in an internal world of darkness, loss, pain, shame, rage, deep sorrow and grief. Even with everything I know as a therapist and mental health professional, I still felt a little surprised at how utterly lost and powerless I felt.  

What I’d like to say at this point is that this internal experience hasn’t gone away for me… and I still have some really painful days centred around my losses. So, I can’t tell you if or when you’ll heal from what you’ve been through – but what I can offer is a bit of hope that in reading this you feel less alone, less misunderstood, and more able to cope with what’s happening inside of your emotional landscape post pregnancy loss.

Like many people, I felt very well looked after medically and physically through both of my losses, but I just don’t think you can understand the depth of pain that pregnancy or baby loss brings unless you’ve been there. Now, I am not a fertility specialist – in fact, the truth is, until this phase of my life I have thought very little about fertility – but I do have the personal experience, psychology education, a desire to share and to help others that I hope will reach those who need it.

Firstly, let's talk feelings.

Usually when we lose something, we go through what is known as the 5 stages of grief.  These are denial, anger, bargaining, depression and acceptance – and not necessarily in that order. Most people ebb and flow around the 5 stages until they get to a place of acceptance. The first stage is said to be denial.

Denial is a sophisticated and important psychological function that literally does not allow you to know more than you can cope with. It is the mind’s way of allowing us to process information at a speed that we can cope with and prevents us from feeling overwhelmed. However, when there’s an unsuccessful pregnancy coming out of your body and you are having to make very difficult decisions about it, the opportunity to process what’s happening at a speed that works for you is lost.

For me, instead of denial kicking in, shock took over. Because my denial system didn’t have a chance to do its thing and protect me from the incoming pain and heartbreak, shock prevented me from being in touch with the emotional reality of my situation. I tried to carry on as normal, which may have been a mistake on my part because, the reality was, that my pain was visceral and I felt like my heart was being torn out of my chest and as if my whole world was falling apart. Whilst I knew cognitively that the world wasn’t ending and that I was going to have to carry on with life, my heart was breaking, and I couldn’t get my head around how on earth someone makes it back from that place. It was a very sad and lonely place to be.

It’s important to acknowledge that in any situation where you experience psychological shock and/or denial and disconnection from your physical or emotional reality, the underlying feelings will stay in your body and eventually surface. Feelings are just energy in the body, they have their own lifespan and they need to be allowed to flow. The longer you push those feelings away the more likely they are to cause further issues, like anxiety and depression.

Almost 7 months after my first loss, I am still processing these feelings. Some days are particularly sad and painful and I feel that swell of tears in my chest. Other days I am absolutely fine. That is the nature of grief, it comes and goes without any necessary or obvious trigger, which can sometimes be inconvenient. No one wants to be bursting into tears in the middle of the supermarket or on public transport – but it happens. If you can ride the waves of emotion and let that energy flow, rather than repressing them, judging them or putting a timeline on your healing you’ll notice more moments of hope than you might expect.

My advice is to give yourself permission to feel, whatever the feeling is. It will probably feel more raw and vulnerable to start with – and that’s partly because all the maternal instincts and love you were getting ready to give are re-directing themselves.

Feeling the feelings (whether they match the ones mentioned here or include others) is how your mind and your heart can start to heal and allow you to re-navigate that lost love back towards yourself. 

When you are ready, you might like to check out the mindfulness ‘workout’ in my book, as well as the ‘How to feel your feelings’ and ‘What to do with feelings’.

The epitome of powerlessness.

Pregnancy loss changed significant parts of me, both inside and out. My body changed, my perspective changed, my hopes and dreams changed, the timeline I had set out for myself changed, my experience of grief and loss changed, and my understanding of powerlessness changed too. That sense of powerlessness, which I’m sure many will relate to, is that feeling we get when we realise we are not, or do not feel, in control of what’s happening. Interestingly, it is often our struggle to admit powerlessness that causes things like panic attacks, rage episodes, and what we sometimes call ‘breakdowns’.

There are many, many things in life we are powerless over. And let’s face it, most of us – me included – like to feel in control of ourselves. In control of our bodies, minds and emotions.

Losing a baby can leave you with a sense of emptiness and powerlessness over your own body and mind, and that, for the majority, is devastating.  

The thing about feeling powerless, as awful as it can be, is that when we allow ourselves to admit we are powerless and not in control of what’s happening, we energetically take some of that power back. We give ourselves permission to start to let go of being in control and take responsibility for looking after ourselves, whatever happens next. This means working on a deep level of trust within your relationship with you. 

When I got my head around this, I noticed that I stopped wanting to punish and shame myself. I found a mantra that really helped me: ‘I trust my body; it is doing everything it is designed to do’. This mantra may or may not work for you, so try and find one that fits and repeat it to yourself as many times a day as you need. If you want more help with this, check out the ‘Appreciation Workout’ in my book (linked below).

If you're the partner, friend or family member of somebody who has lost a pregnancy, please remember that it's not your job to make it better – you are also powerless. Instead of putting pressure on yourself to fix it, try the following:

• Actively listen and be with the other person.
• Seek to understand what it’s like through asking questions.
• Show empathy through expressing understanding of their feelings.
• Express your own feelings too (this one will help them feel less alone).
• Avoid giving advice, unless it is requested.

The matter of stigma.

Whilst there is so much more support and insight I’d like to offer about the emotional effects of pregnancy loss, I simply cannot cover it all here. Those of you who have been there will relate to the feeling of not quite being able to explain the magnitude of what is happening inside you. Even in the closest of relationships, when you have someone you love by your side and going through the loss with you, being in the body that once carried a baby that did not make it is possibly one of the most lonely experiences I've encountered. Loneliness tends to get worse when we lose connection with ourselves, so I’d strongly recommend taking actions to keep your connections to yourself. Mindfulness is a really helpful tool, as is any kind of emotional wellbeing programme. What I actually want to touch on in relation to loneliness is how the stigma, taboo and shame associated with miscarriage intensify this feeling.

Why are we silenced and left to deal with it alone? Why was it that only when I started talking to people about it that I found out just how many others had been through something similar? I understand that the pregnancy experience itself happens inside of you, so it is a very private, individual and unique thing. But just over half the population might fall pregnant at some time in their lives, which could end in a number of potential outcomes – so why do we shy away from talking about those outcomes?

As touched on above, usually the reason we shy away from difficult conversations is because we feel we must be able to fix them. If we can’t fix them somehow, we feel we’ve done something wrong. We feel we are not good enough and experience a sense of shame. This goes for the person who lost the pregnancy and the people around them too.

Shame is where stigma and taboo are born. Shame keeps us silent; shame + silence = stigma. 

1 in 4 people experience pregnancy or baby loss (a figure which is probably much higher in reality), and I was grateful that I knew a couple of people I could talk to who had shared their experience previously. It really did make all the difference. That sense that they had been where I was and I didn’t have to even try to explain my feelings was invaluable; any shame I felt died when I was able to connect with others. If we don’t talk about it, we perpetuate the sense of shame which is made up of those feelings of not being enough, of feeling worthless, like a failure. It is shame that causes the majority of long-term emotional suffering. Each time we talk about our losses, we challenge that sense of failure, and we create a window of opportunity to indulge in the antidote to shame – compassion.

As I’ve said, I still have some really low days around my losses – so I continue to do my best to take my own suggestions by giving myself permission to feel, heal, focus on helpful self-talk, and remaining vocal about the issue so that shame and loneliness do not creep up on me.

My losses will always be a painful part of my story as well as a part that needs to be loved and tended to, just like the babies that didn’t make it. 

For more help and support, you can follow me on Instagram or visit my website, www.zoeaston.com.

If you're interested, you can also pick up a copy of my book here.