Pregnancy and Infant Loss

October is Pregnancy and Infant Loss Awareness Month. While this is a difficult topic for many, it’s importance to acknowledge those who have lived it.

This article was written by Dr. Kelsey Asplin and Dr. Shayna Keller.

In our society, there exists a prevailing expectation surrounding pregnancies—an anticipation steeped in joy, excitement, and the promise of new beginnings. Often depicted as a harmonious and straightforward journey, societal narratives tend to focus on the celebratory aspects of pregnancy, from the announcement of the news to the baby shower festivities. The cultural script emphasizes the glow of expectant mothers, the tender moments of nursery preparation, and the joyous culmination with a healthy newborn. However, beneath this curated narrative lies the complexity of individual experiences. In the delicate tapestry of life, the journey toward parenthood can be fraught with challenges, and for some, pregnancy loss becomes an unexpected and heart-wrenching part of that narrative. As we embark on this exploration of a deeply sensitive topic, it is essential to approach it with the empathy and understanding it deserves. Pregnancy loss, defined as the experience of losing a pregnancy, carries with it a unique set of emotional, physical, and psychological complexities. In this space, we aim to foster a community of support, dispel misconceptions, and offer insights that can empower individuals and couples facing the profound impact of pregnancy loss. Written by two women who have experienced their own loss, this discussion centers on compassion and a belief that knowledge (and acknowledgement) is power. Together, we navigate the often challenging path toward healing and hope.

Connecting with Pregnancy Loss

Cultural excitement often dictates the conversation surrounding pregnancy. Everyone asks you questions like, “How are you feeling?” expecting to hear the usual reports of urinary frequency, nausea, constipation, back pain, breast tenderness, and feeling more emotional. But what if you don’t experience any of those symptoms? What if you don’t feel much different than usual? What if you continue to spot after finding out your pregnant? And what about when that spotting becomes something more. The first few weeks after finding out your pregnant can be anxiety inducing for any expectant mother. Adjusting to the knowledge that a little human is growing inside of you and will be joining your world before you know it comes hard and fast. But you also want to know so many answers to questions you never knew you had, like how your lifestyle should change, what symptoms are normal, and if the pregnancy is going to make it to the 2^nd trimester. For some, the excitement of the positive pregnancy test can be overshadowed by the unknown. Unless there has been a history of pregnancy loss, most pregnancy care begins at 8 weeks, when the first ultrasound is typically performed. And until that time, mothers mostly have to wait and watch and hope that nothing goes wrong.

In that time, some women start to feel a connection to the being growing inside of them. Some may feel as though they are never alone and worry that they never will be again. Some may relish in talking to this little bundle of cells that they hope will be a part of the rest of their lives. In pregnancy loss, the connection that was so quickly made, can just as suddenly disappear. When pregnancy loss occurs, you may experience physical symptoms, like a downward tugging sensation, cramping, increased spotting or bleeding with the passage of clots and membranous tissue. But you also may feel like a part of your emotional and spiritual self is falling away and this can leave some feeling a sense of loss, hollowness, depression, and dissociation.

It’s imperative to allow yourself time to process the grief and to recognize that “time” may look different for each person. Remember, grief is not linear and can progress in any order and for any length of time through the five stages grieving: denial, anger, bargaining, depression and acceptance.²And the experience of never feeling alone, like this little creature is with you. But then the feeling, that connection, sudden disappears into a downward tugging sensation. Much like the feeling of the period about to begin. Then the cramping and then the blood. The passing of larger clots in between the cramps and then the grayish white membrane that passes, often referred to as tissue.

Recognizing the Different Types of Pregnancy Loss

Pregnancy loss can manifest in various forms, each with its own set of medical implications and emotional impact. The different types of pregnancy loss include:

1. Miscarriage:
   • Spontaneous Miscarriage: The most common type of pregnancy loss, occurring before the 20th week of pregnancy. It often results from genetic abnormalities or other factors affecting fetal development.
   • Missed Miscarriage: The embryo or fetus has stopped developing, but the body has not recognized the loss, leading to a lack of symptoms. Diagnosis is typically confirmed through ultrasound.
2. Ectopic Pregnancy:
   • The fertilized egg implants outside the uterus, commonly in the fallopian tubes. This type of pregnancy is not viable and poses serious health risks to the mother, necessitating prompt medical intervention.
3. Molar Pregnancy:
   • A rare condition where abnormal tissue grows in the uterus instead of a viable embryo. It can result in the development of a mass of tissue (hydatidiform mole), and proper management is crucial to prevent complications.
4. Stillbirth:
   • Defined as the loss of a pregnancy after the 20th week. It could be due to a variety of factors, including complications with the placenta, fetal abnormalities, or maternal health issues.
5. Recurrent Pregnancy Loss:
   • The experience of multiple consecutive pregnancy losses, typically defined as three or more. It necessitates thorough medical investigation to identify underlying causes and appropriate interventions.
6. Threatened Miscarriage:
   • Occurs when there is vaginal bleeding, but the cervix remains closed, and the pregnancy may still progress successfully. Not all threatened miscarriages end in pregnancy loss, but medical evaluation is crucial.

Understanding the different types of pregnancy loss is vital for providing appropriate support and medical care. But for those affected, our needs extend far beyond what’s typically provided in a conventional clinical setting. While pregnancy loss takes a large physical toll on the body, the emotional and psychological impact is often isolating and difficult to express to those around us.  It’s essential to approach individuals and couples facing pregnancy loss with empathy, acknowledging the unique challenges associated with each type of loss.

Pregnancy Loss Occurrence and Management

One in four pregnancies end in miscarriage, infant loss and stillbirth however only about 10 percent of these are clinically recognized pregnancies.⁴ Most pregnancy losses will occur within the first 8 weeks.¹It is often characterized by a diminishing of pregnancy symptoms, and the occurrence of cramping and menstrual spotting or bleeding, sometimes with clots. Before 8 weeks, it is difficult to see any difference between blood clots and cellular tissue from the developing fetus. After 8 weeks of pregnancy, there may be differentiated tissue associated with the fetus and the placenta. The most common reason for early term pregnancy loss is chromosomal abnormalities.⁴ What this means is the cells that are forming the early stages of the fetus realize that there is a problem in their genetic sequence, which would ultimately make life unviable. As part of their coding, they “auto-terminate” themselves and end the developing pregnancy before complications can arise. Knowing that most of these losses are not compatible with life is helpful, but this does not diminish the grief that may be associated with the loss of the connection that may have been formed in that time.

Ectopic pregnancies occur in only 1 in 50 pregnancies, but they always result in pregnancy loss. When caught early, ectopic pregnancies are most commonly treated by administering the drug methotrexate (a chemotherapeutic and immunosuppressive agent). The drug stops cells from growing, which ends the pregnancy. Over the next 4-6 weeks, the body breaks down and absorbs the remaining cells. For many, taking a chemotherapy drug to terminate a pregnancy that may have otherwise grown into a healthy baby if it had implanted just a few inches away, doesn’t feel like an appealing option. However, when it comes to ectopic pregnancies, none of the options feel like good ones. The alternative to taking the medication is to have the fallopian tube surgically removed, which also ends the pregnancy and leaves the mother with one less organ in her body. If the ectopic pregnancy is allowed to progress, which often happens if women do not have early pregnancy care and are unaware that the pregnancy is ectopic, the cells of the developing fetus will soon outgrow the available space in the fallopian tube and will rupture through it; this leads to internal bleeding and can be extremely dangerous, and sometime fatal, to the mother if they do not get emergency care quickly. This can leave women and their families feeling extremely dis-empowered in a world of not-so-great choices that all result in losing their pregnancy.

Later term pregnancy losses, which occur after 14 weeks, will often require a dilation and curettage (D&C), which is a procedure that starts by dilating the cervix, allowing the medical provider to insert small tools to “scrape and scoop” the inside of the uterus to remove any remaining fetal, placental, and endometrial tissues. This procedure is done to ensure that no tissue from the pregnancy is retained, to ultimately prevent infection.¹

Trying to Conceive after a Pregnancy Loss

The World Health Organization recommends waiting 6 months after a loss before trying to conceive (TTC) again. However, recent data doesn’t support this recommendation. Schliep et al (2016) suggests that the recommendation to wait six months should be revisited for couples that have experienced spontaneous early pregnancy loss.

An article by Schliep et al (2016) found that there is no physiological reason to wait up to six months before TTC again. This article looks at the question pertaining to early term losses without any specific medical rational, the pregnancy losses that are ‘spontaneous.’ The authors found that couples that conceive in the first three months after a loss were more likely to get pregnant again than couples who waited longer. The article also found that there was no higher risk of developing “any pregnancy complications, including pregnancy loss, preterm birth, preeclampsia, and gestational diabetes.”

Those who experience ectopic pregnancy, especially if it was their first time being pregnant, are thought to have a higher risk of recurrent ectopic pregnancies. It is generally recommended that they schedule a hysterosalpingogram after their menstrual cycle returns, typically 2-6 weeks later. This procedure involves injecting saline or radioactive dye up through the cervix and into the uterus and fallopian tube(s) to assess if the fallopian tubes are “patent” or open and able to transmit an egg to the uterus. When they do get pregnant again, it is recommended these women receive early pre-natal care and imaging to monitor the progress of the pregnancy and intervene early if it turns out to be ectopic again.

Every human’s grieving process is unique, and the type of pregnancy loss, especially late term and ectopic losses, may have a considerable impact on the emotional well-being of the woman or couple affected. It’s important to consider your readiness to try again. While some may feel ready immediately, others may find the trauma of their experience prevents them from wanting to try to get pregnant for some time, if ever. It is important to be mindful of your needs as an individual and as a couple, and it may be helpful to connect with a mental health counselor or therapist for additional support.

Supporting Those Who Experience Pregnancy Loss

Supporting a Couple after a Pregnancy Loss

• Be mindful of the statements you make saying things like I am sorry for your loss or I am here for you both are thoughtful things to say.
• Make and bring over some nourishing soup or stew, during periods of grief the digestive system needs foods that are easy to digest.
• Ask if you can help with anything – like picking up older children from school, grocery shopping, washing a sink of dishes or doing a load of laundry
• It’s quite common that those who are grieving don’t know what they need or feel bad asking for it. To the extent that you know the person who experienced the loss, extending support without asking may be appreciated. Have their favorite food delivered to their doorstep, send flowers to their work, or ask if you can show up to watch a movie or sit with them in quiet solidarity.

Supporting yourself after a pregnancy loss

• Take time away from responsibilities like work and school
• Consider asking for support from loved ones
• Eat warm, flavorful foods that are easy to digest.
• Herbal teas such as those with tulsi/holy basil, rose, hawthorn and chamomile can be wonderful to hold the heart and reduce symptoms after the pregnancy loss
• Prioritize sleep and rest
• Ask for help
• Have grace for yourself and listen to what your body tells you it needs.

If you or someone you know has experienced pregnancy loss and are looking to take a more natural approach to healing and prenatal care, naturopathic medicine is supremely positioned to be your ally. With practitioners who specialize in healing, preconception support, as well as pre- and post-natal care, naturopathic medicine can support your body through the journey you’re on. Connect with one of us today.

References

1. Overview of Pregnancy Loss (no date) Stanford Medicine Children’s Health – Lucile Packard Children’s Hospital Stanford. Available at: https://www.stanfordchildrens.org/en/topic/default?id=overview-of-pregnancy-loss-90-P02466 (Accessed: 18 October 2023).

2. Understanding the five stages of grief (2023) Cruse Bereavement Support. Available at: https://www.cruse.org.uk/understanding-grief/effects-of-grief/five-stages-of-grief/ (Accessed: 18 October 2023).

3. Schliep, K.C. et al. (2016) ‘Trying to conceive after an early pregnancy loss’, Obstetrics & Gynecology, 127(2), pp. 204–212. doi:10.1097/aog.0000000000001159.

4. Dugas, C. and Slane, V. (2022) ‘Miscarriage’, StatPearls [Online].

December 20, 2023