October is Pregnancy and Infant Loss Awareness Month, a natural time to pause and acknowledge that the reproductive journey is too often marked by loss and grief. If this is a tender subject for you, be aware this article may be especially difficult to read.

The statistical reality

Miscarriage is, sadly, relatively common. Statistics show that women under 35 years of age have about a 15% chance of miscarrying, and the risk increases with age: a 20-35% chance for women between 35 and 45 years old, and up to a 50% chance for women over 45 years old.

Women who struggle with infertility may have a higher risk of miscarriage due to age factors, or an underlying health issue. The process of managing fertility issues may also mean becoming aware of pregnancy earlier, and therefore knowing when a  miscarriage has occurred, especially in the first six weeks when the risk is highest.

While miscarriage is common, for many women, its frequency does little to lessen the feeling of loss. The subject of miscarriage has been somewhat taboo until recent years, with more high-profile women sharing their stories. Chrissy Teigan invited her social media followers into her grief in real-time, posting not only her story of pregnancy loss, but alongside raw and intimate photos. Her story on Medium and the reaction its received is further evidence that many women are desperate to share their pain and for others to recognize it. 

While both posts have received overwhelming praise, some of the reactions are a reminder that many are still very uncomfortable with the topic - and either have not or would not grieve in a public way or would rather women endure their loss in silence. There is no one way to do something as difficult as grieving the loss of a pregnancy.

Timing and stigma

Conventional wisdom is that women and couples should not share the news of a pregnancy until the second trimester when the pregnancy feels safer. Indeed, by the twelfth week of pregnancy the risk of miscarriage has dropped significantly, to around 5%. Women struggling with fertility issues and managing even more complex emotions and uncertainty may be even more reluctant to share their news early.

While this approach takes away the need to share the disappointment of a miscarriage, it can also complicate the grieving process. Many women find miscarriage a lonely time, absent the support of friends and family who may not know the loss that’s being experienced. If partners grieve differently, there can be nowhere else to turn.

Even if family and friends are aware of the loss, there is often reluctance on their part to bring up the topic for fear of further upsetting a woman. They might not be sure what to say or do, might not know how much privacy is desired, or might not understand how the loss of pregnancy even in early stages can feel devastating.

Beyond the first trimester

The further along in pregnancy, the more secure everyone begins to feel. For women who have struggled to get pregnant, reaching this milestone can feel especially like a relief. Announcements are often made. Names are maybe discussed. Planning for the home and other celebrations begin. 

The loss of a pregnancy in the second trimester or beyond is less common and therefore little about the process is widely understood or even discussed. Depending on the stage of pregnancy, some women go through a labor and delivery process, knowing they will not be returning home with a baby - a reality that Teigan, who was halfway through her pregnancy, has brought front and center.

There is no established roadmap for grieving this kind of loss, and it can be very difficult for all involved to know how to best support a family who themselves may not know how to move forward. There is often a great deal of physical healing that must take place, on top of the emotional pain.

How can women and couples navigate loss at any stage, and what can family and friends do to support them?

For women and couples

First, be aware that everyone is different. It’s easy to think of grief as a linear process, one that is moved through in an orderly fashion, step by step. Grief is actually messy, non-linear, and doing what makes sense for you should be your priority.

In the first trimester, especially those early weeks, some move through the loss of a pregnancy more easily than others because of how common miscarriage can be. There is no obligation to feel more than you are feeling, or to compare your process to another. Do what feels right for you and your partner.

For other women or couples who feel the loss more deeply, don’t judge yourself for these feelings or try to rush yourself through your grief. For some, the loss is not just the actual pregnancy, but a compound feeling that pregnancy might not be in the cards after all. It might help to research ways different cultures commemorate a loss through ceremonies or specific objects that offer a sense of closure, lasting reminders and eventually comfort. Or talk about the way both of you can find meaning and peace, creating something that is original to you and your emotional state.

If you are at a higher risk for miscarriage and suspect you’ll want support in the event of a loss, consider sharing the pregnancy news with a few trusted friends or family members early on, so your support network is ready to go, and not catching up after the fact. If you’re comfortable you might want to talk about your fears around miscarriage in advance, too. This will help those around you be in tune with your emotions earlier on.

And of course, for those who prefer to grieve in private, friends and family may be the opposite of what you need and want during this time. Or you might find that certain people, especially those with kids, are difficult to be around. Simply acknowledging that you’re going through a tough time and need some space will let them know to respect your boundaries and have some patience, even if they don’t know the specific reason. 

Finally, if your loss feels beyond your capacity to deal with it, consider joining a support network or seek counseling with a therapist to help you navigate your grief.

Supporting others through grief

If you aren’t sure of what to say, you’re not alone. Many well-meaning people struggle with how to best comfort a friend or family member. There’s no need to overthink this though - “I’m sorry for your loss, and I’m keeping you in my thoughts” is an easy way to let someone know you are thinking of them and acknowledge their pain. It’s also acceptable to admit that you don’t know what to say, but reinforce that you love them. Whatever you do, don’t remain silent unless you know that is what’s desired.

Try to avoid platitudes such as “all things happens for a reason” or overly optimistic reassurances like “you’ll get pregnant again.” And you may feel that your own story of miscarriage and then a successful pregnancy will offer tangible hope, but it probably won’t land that way right now. These tactics can unintentionally make your loved one feel that their pain should feel less than it does.

If your friend or family member does not wish to grieve in private, sometimes practical help or a small gift can let them know they can count on you. Remember that miscarriage can be physically draining or painful, in additional to the emotional struggle. Some ways you can show up for loved ones:

• Drop off or send a favorite meal to save them the trouble of cooking
• If there are kids in the family, offer to take them for an afternoon
• Volunteer to help clean the house or do laundry
• Send luxurious bath products to ease tired bodies
• Gift a beautiful box to store any special reminders of the pregnancy
• Spend time just listening and supporting, without offering advice

When the time is right, you also may want to let them know that if they will be honoring their loss in some way and welcome loved ones to participate that you would want to share that moment with them.

If you know the due date, be sure to set a reminder for yourself so you can check in during the weeks leading up to what would have been a joyful time. The three, six, nine and twelve-months marks after the loss are also good times to let your loved one know they are on your mind and available if they need to talk.

Above all, make sure you give friends and family the option to not respond. This time can feel overwhelming and as Teigan noted it was a relief when people gave her permission to not feel the pressure to write back immediately.

Moving forward

Each woman and couple are different. Some are eager to try for another pregnancy as soon as they can, and others remain uncertain about next steps. Some willingly share their plans with others, while some wish to remain guarded. 

Open communication with your partner is key during this time period so you can both appreciate one another’s wishes and concerns. Seeking therapy may help you figure out your next steps, together, if the topic becomes challenging.

This is also an opportune time to let friends and family members know if you’d like the topic of trying for another pregnancy to remain closed and how you might want to handle sharing news in the future. Establishing barriers is a proactive way to help you manage emotions in the future.

And of course, consult with your physician or fertility specialist if you have ongoing concerns about any physical conditions that may present future risks. And speak to a mental health professional if your grief becomes too much to handle on your own.